Lithium

Lithium-Is an alkali metal- available as Li carbonate or Li citrate Mode of action not fully known Modifies the production and turnover of certain neurotransmitters , particularly serotonin May also block dopamine receptors Primarily excreted by kidneys

Usage-Acute mania or hypomania episodes Prophylaxis of bipolar ( manic-depressive disorder ) Unipolar affective disorder Recurrent depressive disorders where treatment with other antidepressants has been unsuccessful and / or as an adjunct with other antidepressants Mood stabilizer Control of aggressive behaviour, mutilating behaviour or intentional self harm often in the context of personality disorder

Long term side effects-Nephrogenic diabetes insipidus Hypothyroidism ( risk greatest in 1st 2 yrs of treatment ) Hyperthyroidism ( rare ) Hyperparathyroidism Cardiotoxicity Decreased renal function ( a small benign fall in eGFR seen in in 20 % of people ) Oedema Weight gain Hyperglycaemia Tardive dyskinesia ( and other movement disorders )

Why bother-Narrow therapeutic index Recommended range is 0.4 to 1.0 mmol/L Level 0.6-0.8 if being prescribed 1st time 0.8 to 1.0 → who have relapsed previously while taking Li or who still have sub-threshold symptoms with functional impairment while on treatment with Li

Toxicity-Toxicity happens at approx level of > 1.5 mmol / L and above...