Tuesday, 6 May 2008

Lithium

Since being appointed as a Consultant, I think there's only one patient I've ever initiated lithium with.

But I've inherited many, so today reviewed a lady (as I am wont to do, every 3 months). All was well, it always is, but she still likes to come to see me. She's always beaming. For a lady who's on lithium as augmentation for the treatment of depression, rather than lithium treating mood swings or bipolar disorder, this is pleasing to see. Much goodness. She's no mood problems, no change in activities, no side effects, no new physical health symptoms or problems, no changes in other medication, all is well.

Lithium levels are perfect, renal and thyroid function are normal, calcium's fine.

I think the only useful thing I did with her today was comment on the splendid weather and glorious sunshine. "It's getting hot, you're on lithium, remember to drink plenty of fluids!"

Some days, my work really isn't too, too taxing.

5 comments:

Am Ang Zhang said...

Well, may be I am old fashioned ( I have retired), but for when I was still practicing, Lithium is still the drug of choice. In my book The Cockroach Catcher I describe how one patient was switched with disastrous results and another survived a serious encephalitis whilst on Lithium. It will take a while before Old Age Psychiatrists take over my ex-patients.

The Cockroach Catcher

Seratonin said...

I'm interested in this because has been mentioned to me by my Shrink as a possibility for my treatment.

Useless CPN said...

I have a few people I work with on Lithium. They all seem to do well on it. My Grandmother has also taken it for about 40 yrs (she has BPAD) and never had any real problems.

I have linked to you from my new blog btw.

The Shrink said...

Seratonin, I've no problem with lithium use. It's a simple salt, so is pure (unlike say chlorpromazine, which is effectively over 100 tablets mixed in to one pill). For long term use, it's therefore a better choice than many other options.

It works. That's the bottom line. If I was struggling and needed augmentation or stabalisation with medication, I'd be happy with lithium. It works well more of the time than other options. Olanzapine reps try and claim theirs works as well, but I'm not so convinced.

The only reason I favour other drugs first line is 'cause I mostly prescribe for older adults. Lithium isn't broken down by our bodies, we just pee it out. If your kidneys aren't working as well, it's harder to get rid of it, so it builds up. In older folk, kidney function worsens over time so I'm never totally sure that it's as safe as I'd wish. Not because lithium is unsafe, but because their kidney function is changing and I don't know how much or how fast. in the older adults, modest dehydration (not drinking enough in the Summer, having vomitting ot diarrhoea) can increase the concentration of lithium.

It needs blood tests every 3 months for lithium levels, but you also need tests for kidney, thyroid and parathyroid function too. That means older adults, becoming more infirm, have to have tests every 12 weeks forever. What happens if they can't get to have it? It's unsafe to guess, so do we do what's unsafe or do we stop their lithium?

Basically, in older adults, use of lithium isn't straightforward.

It's not that I've a problem with lithium, it's simply that it's not as convenient or straightforward for older adults to use as safely or conveniently.

Useless CPN, I've also seen scores of folk do well on lithium. I guess it's my own prejudice rather than lithium being a bad drug :-)

Seratonin said...

Thanks Shrink for your reply.I can understand the reasoning being not prescribing for older age patients.Especially with the dehydration - have witnessed a fair few on my ward refusing anything other than tea, bless em.