Lithium Use for Bipolars
Lithium carbonate was the first medication proven to stabilise mood in bipolar disorder. (Cade-1959). It also was shown to prevent manic and depressive episodes returning. Lithium does a better job of preventing manic episodes and controlling manic symptons than it does preventing depressive episodes, but it can still be an effectiive antidepressent when used alone.(Keck & McElroy-1996, Prien-1984, Zornberg & Pope-1993) Lithium has the most research support in psychiatric mood stabilizer medications.
The lithium slow release version (Quilonum-SR) maintains a more even therapeutic level in the bloodstream over a 24 hr period. There is a greater time lapse window (3 – 13hrs) for taking blood samples for accurate testing, although the 12 hr interval is still advisad.
SINGLE DOSE ADJUSTMENT OF RESULTS
When interpreting blood level concentrations for a patient taking a daily single dose, 12-hour concentrations are 10% to 25% higher after a single night time dose, so correspondingly higher blood levels than those seen with twice-daily dosing should be aimed for. This is important for patients who are at the lower end of the therapeutic range.
The therapeutic range which should be aimed for is 0.5 to 1.2 mmol/L. Manic tendency patients should aim for a level higher in the range, depressive tendency patients should aim for a level lower in the range.
Because lithium can be a threat to the long term health of the kidneys, maintaining a good level of hydration is important. In simple terms, if water intake increases, more flushing will take place in your system and less residual chemical will be retained in the kidneys. Any health advisor will recommend at least 2 litres of water a day for anyone (fruit etc. counts too).
INTERVAL BEFORE SAMPLING
It is important that blood samples be taken as close to the 12 hr interval (from last dose) as possible. A 1 hr margin (each way) is acceptable but not advisable.
If the lithium blood level concentrations fall below the therapeutic range, lithium will not work.