What Is Lithium Prescribed For? Uses, Benefits, and What to Know
Author:
Blossom Editorial
Lithium is a mood-stabilizing medication most often prescribed to treat and prevent the manic and depressive episodes of bipolar disorder. It has been used in psychiatry for decades and remains one of the most well-studied medications for mood disorders.
Despite its long history, lithium can be misunderstood or overlooked. Understanding what lithium is prescribed for, how it works, and why it requires regular monitoring can help you feel more informed if it's part of your treatment plan.
Key Takeaways
Lithium is mainly prescribed for bipolar disorder: It is FDA-approved to treat manic and mixed episodes and for maintenance treatment of bipolar I disorder in adults and children aged 7 and older.
It has several off-label uses: Providers may also prescribe lithium alongside an antidepressant for treatment-resistant depression, and research has examined whether lithium may reduce suicide risk in people with mood disorders.
Monitoring is part of treatment: Because the difference between an effective dose and a potentially harmful one is small, people taking lithium may need regular blood tests to check lithium levels, kidney function, and thyroid function.
What Is Lithium?
Lithium is a naturally occurring element that is used as a medication in the form of lithium salts, such as lithium carbonate and lithium citrate. It comes as capsules, tablets, extended-release tablets, and an oral solution.
Lithium belongs to a group of medications called mood stabilizers. These medications can help reduce extreme shifts in mood, energy, and activity levels. Clinical reviews describe lithium as a first-line treatment for bipolar disorder, even though newer mood stabilizers, including certain anticonvulsant medications, are also available.
How Does Lithium Work?
Researchers don't fully understand how lithium stabilizes mood, but they have identified several possible ways it may affect the brain. Understanding these mechanisms can help explain why lithium is used to prevent and treat mood episodes.
Effects on Brain Signaling
Lithium appears to influence several chemical signaling pathways inside nerve cells, including systems involved in mood, motivation, and behavior. These effects may help reduce some of the overactivity associated with mania while also supporting mood stability over time.
Protective Effects on Nerve Cells
Some research suggests lithium may have neuroprotective effects, meaning it could help protect brain cells from stress and damage. Scientists are still studying how these effects may contribute to its benefits in people with mood disorders.
FDA-Approved Uses of Lithium
Lithium's FDA-approved uses focus on bipolar I disorder. Bipolar I involves at least one manic episode, which can involve unusually elevated or irritable mood, increased energy, reduced need for sleep, and sometimes risky behavior. Lithium is approved for two main purposes within this condition.
Treating Acute Manic and Mixed Episodes
Lithium is approved to treat active manic episodes and mixed episodes, which involve symptoms of mania and depression at the same time. It can help reduce symptoms like racing thoughts, pressured speech, grandiosity, and impulsive behavior. Because lithium can take time to reach its full effect during mania, providers may combine it with other medications at first.
Maintenance Treatment for Bipolar I Disorder
Lithium is also approved for long-term maintenance treatment. In this role, it is taken daily even when a person feels well, with the goal of preventing future manic and depressive episodes or making them less severe.
A meta-analysis of five randomized controlled trials with 770 participants found that lithium lowered the overall risk of relapse compared with placebo, with the clearest effect on preventing manic episodes. Mood stabilizers like lithium can help prevent mood episodes or reduce their intensity.
Both approvals apply to adults and to children and teens aged 7 and older. The approval for pediatric patients was supported by clinical trial data in young people with bipolar I disorder. When lithium is used for bipolar disorder, providers usually start with a lower dose and raise it gradually based on blood levels and how symptoms respond.
Off-Label Uses of Lithium
Providers sometimes prescribe lithium off-label, which means using it for a purpose the FDA hasn't specifically approved. Off-label prescribing is common and legal when it's supported by clinical evidence and a provider's judgment.
Treatment-Resistant Depression
When an antidepressant alone doesn't adequately relieve depression, a provider may add lithium to enhance its effects. This approach is called lithium augmentation.
A systematic review and meta-analysis found that adding lithium to both older and newer antidepressants improved response compared with placebo. However, the estimated benefits varied widely across studies.
Lithium augmentation is one of several options for treatment-resistant depression, along with switching antidepressants or adding a different type of medication.
Bipolar II Disorder and Bipolar Depression
Lithium is not formally approved for bipolar II disorder, which involves hypomania (a milder form of mania), and depressive episodes. However, providers may prescribe it off-label to help stabilize mood in people with bipolar II disorder or to treat depressive episodes associated with it.
Reducing Suicide Risk in Mood Disorders
One potential benefit of lithium that researchers have studied is its effect on suicide risk. A systematic review and meta-analysis of 48 randomized controlled trials involving more than 6,600 participants found that lithium was associated with fewer suicides and deaths from any cause compared with placebo in people with mood disorders.
However, the evidence isn't completely consistent. A 2022 randomized trial in veterans with depression or bipolar disorder was stopped early after finding no overall difference between lithium and placebo when added to usual care. Researchers continue to study whether some groups may benefit more than others, and lithium is not a substitute for crisis support or comprehensive care.
Other Off-Label Uses
Less commonly, lithium has been used for a few other purposes. These include:
Vascular headaches: Lithium has been used to help prevent certain types of recurring headaches.
Neutropenia: Lithium can raise white blood cell counts and has been used in some cases of low neutrophil levels.
Schizoaffective disorder: Schizoaffective disorder is a mental health condition with symptoms of both schizophrenia and mood disorders. Mood stabilizers may be added to other treatments to help with mood symptoms in this condition.
Why Lithium Requires Regular Monitoring
Lithium has a narrow therapeutic range. This means the amount needed to be effective is relatively close to the amount that can cause toxicity. Regular blood tests help providers find a dose that works while staying within a safe range.
Before and during treatment, providers typically check:
Lithium blood levels: Measured several days after starting or changing a dose, then periodically once stable
Kidney function: Lithium is cleared by the kidneys, and long-term use can affect kidney function
Thyroid function: Lithium can cause an underactive thyroid in some people
Electrolytes and hydration: Dehydration or low sodium can raise lithium levels
Heart health: An electrocardiogram may be recommended for people with certain risk factors
Some medications can increase lithium levels, including NSAIDs like ibuprofen, certain blood pressure medications, and diuretics. Always tell your provider about every medication and supplement you take. Signs of lithium toxicity can include worsening tremor, confusion, vomiting, diarrhea, unsteady walking, and muscle weakness, and they require urgent medical attention.
Who Should Use Caution With Lithium?
Many people take lithium with manageable side effects, especially when levels are carefully monitored regularly. Some side effects of lithium may ease over time or improve with dose and timing adjustments.
Lithium may not be recommended for everyone. Providers use extra caution in people with kidney disease, heart conditions, dehydration, or thyroid problems. If you are pregnant, planning a pregnancy, or breastfeeding, talk with your provider about the risks and benefits, since lithium can pass to a developing baby and into breast milk.
When to Talk to a Provider About Lithium
Lithium can be an effective part of treatment, but it works best as part of a carefully managed treatment plan. Consider speaking with a psychiatric provider if:
You're experiencing mood swings, periods of unusually high energy, or episodes of depression
Your current bipolar or depression treatment isn't adequately controlling your symptoms
You're taking lithium and notice new or worsening side effects
You're thinking about stopping lithium, since stopping suddenly may raise the risk of relapse
You're starting a new medication that may interact with lithium
If you or someone you know is thinking about suicide, call or text 988 to reach the Suicide and Crisis Lifeline, or go to the nearest emergency room.
How Blossom Health Can Help
If you're wondering whether lithium or another mood stabilizer could help, Blossom Health can connect you with board-certified, licensed psychiatric providers for virtual care. Every Blossom provider can evaluate your symptoms, make a diagnosis, and prescribe medication when appropriate.
Your first appointment is usually an hour-long video session where your provider reviews your symptoms, medical history, current medications, and goals. From there, you can work together on a treatment plan with ongoing follow-up, and your provider can explain what lab monitoring lithium would involve. Blossom works with many insurance plans, so you can check your coverage when you sign up. Get started with Blossom Health.
Medical Disclaimer
This article is for educational purposes only and does not constitute medical advice. The information provided should not replace consultation with a qualified healthcare provider. Individual responses to medications can vary significantly, and what applies to one person may not be the same for another.
Always consult with your doctor or pharmacist before making any decisions about medication changes, discontinuation, or interactions with other substances. If you’re experiencing concerning symptoms or side effects, please seek professional help from a healthcare provider.
In case of a medical emergency, contact your local emergency services immediately or call 911. For mental health emergencies, contact the National Suicide Prevention Lifeline at 988.
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