Can you explain how lithium is used to treat bipolar disorder? Are there any potential risks associated with taking this medication?

Lithium is what we in psychiatry call a ‘dirty’ drug.

This has nothing to do with its efficacy or side effects, but rather means that it works by hitting many different pathways in the brain. (A ‘clean’ drug works by hitting one particular pathway. In other words, easier to explain.)

Lithium for bipolar works first by reducing the transmission of excitatory messengers, notably dopamine and glutamate. It also increases the amount of inhibitory messengers such as GABA. In other words, it calms the brain.

Alas, not as simply as all that. Lithium also effects what we call ‘second messenger’ systems, the primary method of communication from nerve cell to nerve cell. In other words it tends to stabilize cell membranes and reduce ‘cascade’ events, such as mania.

Lithium also reduces oxidative stress in the brain by promoting the presence of protective proteins. In this way it is somewhat neuroprotective against cognitive decline.

This all sounds well and good, but unfortunately lithium’s actions are not confined to the brain.

Lithium most notoriously acts on the kidneys, thyroid, and gut. The most common side effects are GI distress and dehydration. Longer term, lithium can cause kidney failure and hypothyroidism. It can also cause weight gain, and lead to tremor.

Most people, on reasonable doses of lithium, with regular supervision and labwork, tolerate the medication pretty well. But certainly regular visits with a psychiatrist are necessary. And these should be in-person to better assess any burgeoning side effects.

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