Mood Stabilizer — Lithium

Psychiatric

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Examples

lithium carbonatelithium citrate

Prefix / Suffix: Lithium

Physiology

Bipolar disorder involves dysregulation of mood and neurotransmission. Lithium stabilizes mood through multiple cellular mechanisms.

Mechanism of Action

Mechanism not fully understood; alters sodium transport, modulates neurotransmitter release, and inhibits second messenger systems.

Indications

Bipolar disorder — acute mania and maintenance
Reduces suicide risk in bipolar disorder

Side Effects / Adverse Effects

Fine tremor, GI upset, polyuria, polydipsia (common, mild)
Toxicity (>1.5 mEq/L): coarse tremor, confusion, ataxia, seizures, arrhythmias
Hypothyroidism (long-term)
Nephrogenic diabetes insipidus
Weight gain

Contraindications

Severe renal impairment
Severe cardiovascular disease
Pregnancy (Ebstein's anomaly)
Significant dehydration or sodium depletion

Nursing Considerations

Narrow therapeutic range: 0.6–1.2 mEq/L — monitor levels regularly
Maintain consistent sodium and fluid intake (low sodium increases lithium levels → toxicity)
Avoid NSAIDs, ACE inhibitors, thiazide diuretics (increase lithium levels)
Monitor renal and thyroid function (TSH) at baseline and periodically
Teach early signs of toxicity: nausea, tremor, confusion — hold drug and notify provider
Takes 1–2 weeks for therapeutic effect; benzodiazepines/antipsychotics may be used acutely

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