Lithium and other mood stabilisers

Explains how lithium and other mood stabilising drugs work, how they might help you, whether to take them if you’re pregnant or breastfeeding, and what alternative treatments are available.

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lithium

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Key facts about lithium

Lithium is a mineral that occurs naturally in the environment. It can be prescribed in these forms, to be used as a mood stabiliser:

lithium carbonate (Camcolit, Liskonum, Priadel) in tablet form.
lithium citrate (Li-liquid, Priadel) in liquid form.

When you are first prescribed lithium, you should be given a purple lithium treatment pack. This pack should include:

a lithium information booklet
a lithium alert card. You should always carry this card with you and show it to any health professional before they treat you for any condition (including your dentist)
a lithium record book. This is to help you and your doctor keep track of your blood test results and other details of your health.

You can find more detailed information about this drug in the official Patient Information Leaflet (PIL), including what it's for, how to take it, possible side effects and important safety information. This leaflet should come with your medication (usually inside the box). You can also access it online as a PDF via these links:

If a drug can come in different forms (such as tablets or liquid), there may be a separate PIL for each one. You should look at the PIL for the particular form and dose you've been prescribed. Many PILs are available online on the MHRA Products website.

If you have any questions about your medication you can:

talk to your doctor, or the healthcare professional who prescribes your medication
speak to someone at your pharmacy
contact NHS 111 if you live in England
contact NHS 111 or NHS Direct (0845 46 47) if you live in Wales.

Taking lithium safely

When you are prescribed lithium, the healthcare professional who prescribes it should explain how to take it safely. This includes letting you know its benefits, risks and side effects. They should also explain what the signs are if you take too much.

This information explains some things that you can do to make sure that the level of lithium in your blood remains steady, within a certain range. If your lithium level drops too low, then the treatment probably won't work for you. If it rises too high it can become very dangerous, and could potentially be fatal.

The information below explains how to:

manage your dose
manage your fluid and salt levels
have regular blood tests

It's also important that you:

know the possible side effects and signs of lithium overdose, and know what to do if you experience any serious side effects. It may help to let your family, friends or carer know the signs of taking too much lithium, if you are comfortable doing this
understand if any other drugs may interact with lithium, including over-the-counter drugs such as ibuprofen. If you have questions about this, speak to your doctor or pharmacist
keep your lithium information booklet and record book somewhere safe, and always carry your lithium alert card with you
understand the risks with taking lithium if you are pregnant or breastfeeding
understand the risks of stopping taking lithium too suddenly.

Manage your dose

The dose of lithium that you are prescribed will be personal to you, depending on several factors. These include:

whether you are prescribed lithium citrate or lithium carbonate
whether you have just started your treatment, or if you have been taking lithium for some time
whether you are taking any other medication
your age and general physical health.

If you have questions about your dose, speak to your doctor or the healthcare professional who prescribes you lithium. This includes questions about what to do if you miss a dose.

Manage your fluid and salt levels

The amount of salt and water in your body can affect your lithium level, so you'll need to manage your salt and liquid levels carefully.

These are some ways to keep your fluid levels steady:

Water – try to drink about the same amount of water every day. If you feel thirsty, have some water to avoid becoming dehydrated. The important thing is not to drink too much or too little compared to how much you would usually have.
Caffeine – avoid sudden changes in how much you drink coffee, tea, cola or other caffeinated drinks. Caffeine makes you lose water, which can affect your lithium level.
Other medication and alcohol – you should check with your doctor or pharmacist before you take any other medication or drink alcohol. This is because they may interact with the lithium in your body and and affect your lithium level.

These are some ways to keep your salt level steady:

Eating – don’t make sudden changes in the amount of salt you normally eat, and avoid fasting. You should speak to your doctor if you plan to start a new diet, especially if it is a low-salt diet.
Sweating – try not to get into situations where you are likely to sweat heavily. For example, avoid saunas and sudden bursts of heavy exercise, and take it easy in hot weather.
Sickness – you should tell your doctor if you have a high temperature, you are vomiting or you have diarrhoea. They might ask you to stop taking lithium temporarily, until you're better.
Exercising – it's good to exercise regularly, provided that you're getting enough fluids and salt. But you should try to avoid taking your lithium dose just before doing vigorous exercise.

Have regular blood tests

Regular blood tests are important because they monitor the amount of lithium in your blood. This helps to make sure your dose is low enough to be safe, but also high enough that the treatment works.

You might hear this test called:

a lithium level test
a serum lithium level test
a plasma lithium level test.

You should wait 12 hours after a dose before having a blood test, otherwise the reading might not be accurate. If you aren’t sure whether this is possible, for example if you take lithium twice a day, speak to your doctor about managing your doses.

How often you should have a blood test depends upon where you are in your treatment:

If you’re in the early stages of treatment or your dosage is being adjusted, you should have a blood test once a week.
If your lithium levels have recently steadied after starting to take lithium or having your dosage adjusted, you should have a blood test once a month.
If you've been taking a steady dose of lithium for a while and are confident with how to manage your lithium level safely, you should have a blood test once every six months.

Your doctor may also ask for a blood level check if there are signs that your bipolar disorder is returning. This is to check if your lithium level is too low. Or they may ask for a blood level check if you start experiencing more unpleasant side effects. This is to check if your lithium level is too high.

What else might I want to know?

About psychiatric medication. For what you should know before taking any psychiatric drug, receiving the right medication for you, and your right to refuse medication, see our pages on psychiatric medication.
About mood stabilisers. For what they are, how they can help, what to know before taking them and alternatives you could try, see our pages on mood stabilisers.
About side effects. For what to do if you experience a side effect, see our page on coping with side effects.
About coming off medication. For information on making your decision, planning withdrawal and withdrawal symptoms, see our pages on coming off psychiatric drugs.
About accessing treatment. For information on this, see our pages on seeking help for a mental health problem.
About interactions with recreational drugs and alcohol. For information on this, see our page on recreational drugs and medication.

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If you have personal experience of taking this drug and would be interested in producing a blog or vlog about it to appear alongside our information, see our pages on telling your story.