Lithium Adverse Events Management: Academy’s Lecture Series
A patient in his mid 30s was brought to the hospital by police for increased aggression towards his family members. On evaluation he reported a decline in his sleep over the previous four days. He was speaking rapidly, with a lot to talk about a huge investment that he had made online. He admitted to having high energy and a racing mind. It was immediately evident that he was highly distractible, with increased aggressive and hypersexual gestures.
He was diagnosed with bipolar disorder 8 years ago but had poor response to trials of divalproex, carbamazepine, aripiprazole and risperidone. I expected him to have had a trial of Lithium at some point, but to my surprise none of his previous psychiatrists have considered that option at all.
Why do we shun highly effective drugs like Lithium for bipolar disorder and Clozapine for schizophrenia?
Lithium’s therapeutic neglect is rather a sad story. It is the gold standard treatment for bipolar disorder and some argue that it is the only drug with an effect that fits the term Mood Stabilizer (1). But it continues to be underutilized by physicians due to our concerns over its side effect profile.
Interestingly, physicians are deterred by lithium’s side effects more than patients who are on it! (2)
At Psychiatry Education Forum Academy, we believe that it is critical to periodically remind oneself of how to tackle the common as well as serious side effects of lithium. For example, fine tremor is one of the most common side effects of lithium, seen in approximately one quarter of patients. On the other hand, severe tremors that are often coarse may be a sign of lithium toxicity.
When it comes to side effects, we have seen among our colleagues, knowing what to look for and how to tackle each side effect, imparts a great deal of confidence that enables effective use of Lithium.
References:
- Post RM. The new news about lithium: an underutilized treatment in the United States. Neuropsychopharmacology. 2018 Apr;43(5):1174-9.
- Gitlin M. Lithium side effects and toxicity: prevalence and management strategies. International journal of bipolar disorders. 2016 Dec;4(1):1-0.
Psychiatry Education Forum Academy is excited to announce the release of our next updated 4-days lecture series on Understanding Lithium’s Adverse Events Management: Here we will discuss the clinical details of how to Recognize, Manage, Monitor, and Prevent these adverse events from lithium.
TABLE OF CONTENT
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