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Bipolar disorder affects about 1 in 40 American adults, and about 1% of teenagers live with it. Despite how common it is, there is still no cure, although several treatments, including medication, can help to manage the condition.
While many think bipolar disorder has two sides, recent advancement in research suggests it's actually more of a mood spectrum, with depression at one end, and mania at the end. Lithium is one medication that has proven to be very effective in treating mania in bipolar disorder. For many, it is a go-to drug for treatment-resistant BD.
Lithium is widely used to reduce the frequency and severity of manic episodes in bipolar disorder. It may also reduce the risk of dementia in BD patients as well as scale down suicidal ideation.
But how and why is a monovalent cation so effective in a mental health issue like this?
Lithium works as a mood stabilizer. However, the mechanism of action of lithium in bipolar disorder is not yet fully understood.
Lithium is believed to work in bipolar disorder by modulating the levels of certain neurotransmitters in the brain, including serotonin and norepinephrine, and by altering intracellular signaling pathways.
One theory is that lithium may help stabilize mood by decreasing neurons' sensitivity to certain neurotransmitters associated with mania, such as dopamine. Consequently, the patient will be less excited, agitated, and hyperactive. It may also increase the level of serotonin to quell depression. This goes with the chemical imbalance theory that a lack of serotonin may cause depression.
Additionally, lithium may help protect the brain by preventing neurodegeneration that's associated with bipolar disorder.
Furthermore, studies show that the prefrontal cortex of patients on lithium may not shrink as much as that of someone else who has suffered mania throughout life. Given that shrinking of the brain is associated with a higher risk of dementia, this is likely why lithium is effective in reducing the risk of dementia as you get older.
In general, lithium is thought to be effective in treating bipolar disorder because of its ability to regulate neurotransmitters (dopamine and serotonin) and signaling pathways, as well as its neuroprotective effects.
Lithium is the gold standard for treating mania in bipolar disorder and is a major treatment option for preventing the recurrence of manic and depressive episodes. It also remains one of the most widely used medications for treating bipolar disorder.
Can we say lithium is the best treatment for bipolar? Well, not exactly, as what works for patient A might not be the best for patient B. It all boils down to several factors.
But to a large extent and given the myriad of evidence and studies, lithium has proven to be a miracle in the study of mental health and bipolar disorder in particular.
Most people use lithium for years without any issues. However, some people experience adverse effects with the drug, such as blurred vision, kidney problems, and thyroid issues after prolonged use. But one may drastically reduce the risks of lithium's side effects by using the med in very little amounts, considered subtherapeutic doses (anything below 0.6 mmol/L that still does the job).
If you're on lithium medication, you also want to be checking your blood lithium level regularly to prevent living with high lithium amounts in your blood, which can be a precursor to the adverse side effects.
