30 year old with Bipolar II Disorder…wants to start lithium but asks — can I still “party” sometimes while on lithium…wants to know the threshold for drinking while on lithium. I know the books say no more than 1-2 servings of alcohol … wondering what the hive’s experience has been. What’s the limit on alcohol while taking lithium? Hold dose that day (or day after) to decrease risk?
Here is what I will recommend but let’s hear others’ recommendations as well.
I will motivate the patient to not drink with lithium as the risk is high. If the patient is still drinking: aim for low alcohol (no specific amount is listed in literature) and maintain their hydration. If the patient has a history of alcohol use disorder or other addiction behaviors: I will not recommend even a low amount as the risk of them drinking more is high.
Here is the summary of lithium & alcohol interaction:
Acute alcohol does not affect lithium absorption, elimination, distribution, or clearance, but alcohol can increase serum lithium concentrations when taken with alcohol. (1)
Another concern is increased alcohol use induced diuresis by antagonizing ADH, which can indirectly place a patient at risk of high lithium levels.
I agree no amount of alcohol is good with lithium.
It is important for this patient (without alcohol use disorder) to be able to drink 5 or so drinks on an occasion with his friends on the weekend on a monthly basis or so. Would you suggest avoiding lithium if this is his plan…just not wanting to throw it out so easily as it is gold standard? Or is there anything we can do to mitigate a risk there?
Educate patient to limit to 1-2 drinks and maintain the hydration status. Educate them that no specific guidelines exist for the lowest safe alcohol dose with lithium, educate about signs of lithium toxicity and document this in your notes.
Which symptom(s) are you treating with lithium for this patient?
The other options you can consider for bipolar 2 disorder depression management are:
These are first and second line recommendations per recent CANMAT guidelines for bipolar 2 disorder.