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6 results

  • Treatment of lithium-induced side-effects: contemporary review

  • Wilhelm Nieuwoudt, Ciara Maher, Brian O’Donoghue, John Lally
  • Journal:
    BJPsych Advances , FirstView
    Published online by Cambridge University Press:
    23 March 2026, pp. 1-17
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  • Although unique in its effectiveness, lithium shares with other psychotropic medications the potential to induce multiple side-effects that significantly influence tolerability, acceptability and patient adherence. We review the available evidence to provide a contemporary update for clinicians in treating lithium-induced side-effects. Most adverse effects of lithium are either transient or not severe enough to require discontinuation. Distressing side-effects can reduce gradually or become tolerable with a ‘watchful waiting’ approach or, if not tolerated, dose reduction. Side-effects leading to discontinuation may allow for later rechallenge. Side-effects such as stage 5 chronic kidney disease and the syndrome of irreversible lithium-effectuated neurotoxicity (SILENT) merit discontinuation. There is a paucity of studies examining management of lithium side-effects, with most treatments for them based on small samples or case series/reports. Treatments will usually mirror recommended interventions from other treatment settings.

  • 8 - A Lifelong Struggle through Depression and Madness

  • Edited by George Kirov, Cardiff University
  • Book:
    Waves of Hope
    Published online:
    26 May 2025
    Print publication:
    12 June 2025, pp 129-145

  • Summary

    Liz remembers experiencing episodes of depression since an early age but completed her university degree and worked as a medical doctor for many years. The story starts with the description of a psychotic episode that she experienced for the duration of one summer. Diaries kept from that time were used for the story, giving the episode detail, helped by a poem also written at the time. The depression gradually got worse over the years, despite trying more than twenty different antidepressants and mood stabilisers, regular exercises and prolonged courses of psychotherapy, causing an early retirement and eventually hospital admissions. Finally, ECT was recommended, and it worked despite the very long and resistant type of depression. The improvement was incomplete, though; it required maintenance treatment and caused marked memory problems, which are also described in detail.

  • Management of lithium intoxication

  • Niamh Murphy, Lynn Redahan, John Lally
  • Journal:
    BJPsych Advances / Volume 29 / Issue 2 / March 2023
    Published online by Cambridge University Press:
    28 February 2022, pp. 82-91
    Print publication:
    March 2023
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  • Lithium is a gold standard maintenance treatment in bipolar affective disorder. It has a narrow therapeutic range, and at higher serum lithium levels there is a risk of adverse effects and toxicity. There are three patterns of lithium intoxication: acute, acute-on-chronic and chronic. We describe risk factors for lithium intoxication, mechanisms of toxicity and clinical symptoms seen in lithium intoxication. We describe both the acute and chronic effects of lithium toxicity. Lithium intoxication may be life-threatening and associated with longer-term sequelae. The management of lithium intoxication involves determining the type of intoxication. We discuss treatment strategies aimed at reducing absorption and increasing elimination of lithium. We discuss clinical indications for extracorporeal methods such as dialysis, which are used to limit the time and degree of exposure of the central nervous system to toxic lithium concentrations. Haemodialysis is the most rapid method of eliminating lithium from the body, but careful monitoring is required. Preventive strategies to mitigate the risk for lithium intoxication are discussed.

  • Psychiatric hospital utilisation following lithium discontinuation in patients with bipolar I or II disorder: A mirror-image study based on the lisie retrospective cohort

  • L. Öhlund, M. Ott, M. Bergqvist, S. Oja, R. Lundqvist, M. Sandlund, E. Salander Renberg, U. Werneke
  • Journal:
    European Psychiatry / Volume 64 / Issue S1 / April 2021
    Published online by Cambridge University Press:
    13 August 2021, p. S79
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  • Introduction

    Evidence for lithium as a maintenance treatment for bipolar disorder type II remains limited since most treatment-prevention studies focus on bipolar disorder type I or do not distinguish between types of bipolar disorder.

    Objectives

    To compare the impact of lithium discontinuation on hospital utilisation in patients with bipolar disorder type I or schizoaffective disorder and patients with bipolar disorder type II or other bipolar disorder.

    Methods

    Mirror-image study, examining hospital utilisation within two years before and after lithium discontinuation as part of LiSIE, a retrospective cohort study into effects and side-effects of lithium for the maintenance treatment of bipolar disorder as compared to other mood stabilisers.

    Results

    For the whole sample, the number of admissions increased from 86 to 185 admissions after lithium discontinuation, with the mean number of admissions/patient/review period doubling from 0.44 to 0.95 (p < 0.001). The number of bed days increased from 2218 to 4240, with the mean number of bed days/patient/review period doubling from 11 to 22 (p = 0.025). This increase in admissions and bed days was exclusively attributable to patients with bipolar disorder type I or schizoaffective disorder.

    Conclusions

    Our findings suggest that due to a higher relapse risk in patients with bipolar disorder type I or schizoaffective disorder there is a need to apply a higher threshold for discontinuing lithium than for patients with bipolar disorder type II or other bipolar disorder.

    Disclosure

    Michael Ott has been a scientific advisory board member of Astra Zeneca Sweden, Ursula Werneke has received funding for educational activities on behalf of Norrbotten Region (Masterclass Psychiatry Programme 2014–2018 and EAPM 2016, Luleå, Sweden): Astra

  • Clinical course and need for hospital admission after lithium discontinuation in patients with bipolar disorder type I or II: mirror-image study based on the LiSIE retrospective cohort

  • Louise Öhlund, Michael Ott, Malin Bergqvist, Sofia Oja, Robert Lundqvist, Mikael Sandlund, Ellinor Salander Renberg, Ursula Werneke
  • Journal:
    BJPsych Open / Volume 5 / Issue 6 / November 2019
    Published online by Cambridge University Press:
    22 November 2019, e101
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  • Background

    Currently, the evidence for lithium as a maintenance treatment for bipolar disorder type II (BD-II) remains limited. Guidelines commonly extrapolate recommendations for BD-II from available evidence for bipolar disorder type I (BD-I). Comparing the impact of lithium discontinuation is one way of assessing effectiveness in both groups.

    Aims

    To compare the impact of lithium discontinuation on hospital admissions and self-harm in patients with BD-I or schizoaffective disorder (SZD) and patients with BD-II or other bipolar disorder.

    Method

    Mirror-image study, examining hospital admissions within 2 years before and after lithium discontinuation in both patient groups. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of bipolar disorder as compared with other mood stabilisers.

    Results

    For the whole sample, the mean number of admissions/patient/review period doubled from 0.44 to 0.95 (P<0.001) after lithium discontinuation. The mean number of bed days/patient/review period doubled from 11 to 22 (P = 0.025). This increase in admissions and bed days was exclusively attributable to patients with BD-I/SZD. Not having consulted with a doctor prior to lithium discontinuation or no treatment with an alternative mood stabiliser at the time of lithium discontinuation led to more admissions.

    Conclusions

    The higher relapse risk in patients with BD-I/SZD suggests a higher threshold for discontinuing lithium than for patients with BD-II/other bipolar disorder. In patients with BD-II/other bipolar disorder, however, judged on the impact of discontinuation alone, lithium did not appear to prevent more severe depressive episodes requiring hospital admission.