Lithium
Lithobid
Mood StabilizerGeneric availableTDM data
The mechanism of action of lithium as a mood stabilizing agent is unknown.
Compare Lithium →FDA-Approved Indications
- Bipolar I — acute manic and mixed episodes (7+ years; monotherapy)
- Bipolar I — maintenance treatment (7+ years; monotherapy)
Common Off-Label Uses
- Cluster headache prophylaxis
- Augmentation of antidepressants in MDD
- Aggression/self-harm
- Schizoaffective disorder
- Neutropenia (clozapine-induced)
What Sets This Drug Apart
- Only mood stabilizer with unique anti-suicidal evidence: Cipriani 2013 NMA OR 0.13 for suicide, OR 0.38 for all-cause mortality — distinct from mood-stabilizing effect
- Narrow therapeutic index (0.6-1.2 mEq/L maintenance); toxicity closely related to serum levels and can occur near therapeutic range with dehydration, NSAIDs, or ACE inhibitors
- No hepatic CYP metabolism — entirely renally eliminated; no drug interactions via CYP pathway, but many drugs affect renal lithium clearance
- More effective for euphoric/classic mania and manic-pole prevention than for bipolar depression; mixed states and rapid cycling respond less well
- Approximately one-third of lithium-treated patients are excellent responders with near-complete episode prevention on monotherapy
- Requires the most comprehensive monitoring of any mood stabilizer: serum levels, renal function, thyroid (TSH), calcium/PTH, ECG, weight
- Hypothyroidism (clinical or subclinical) is a well-established risk requiring baseline and ongoing TSH monitoring every 6-12 months
Boxed Warning
LITHIUM TOXICITY