Lithium Treatment OSCE

What is it?
The drug you have been prescribed is called Lithium. It is a long-term mood
stabiliser. By mood stabiliser I mean it tries to prevent the sort of fluctuations
between high and low moods that you have been experiencing.

How does it work?

Unfortunately, we don’t know its exact mode of action. But it seems to affect
the way brain cells signal to each other, by stabilising excitable neurones.

How do I take them?

They come in tablet form so you will need to take them orally, usually once a
day at night. If you miss doses regularly, you will probably relapse.

Are there any side effects?

Yes. In the short term you might notice: dry mouth, mild tremor, tiredness, it
sometimes causes people to vomit, drink more than they usually would
(polydipsia) and pass urine more than they usually would (polyuria), it also has
a metallic taste. In the long term it might cause weight gain, affect your kidney
function and affect your thyroid by causing hypothyroidism.

Side effects closely relate to level of Li in the blood.

Will I need any tests?

Yes. Before the treatment is started, we will need to do a full physical
examination, an ECG to check your heart and do some baseline blood tests such
as a blood count (FBC) and check your thyroid and kidney function (TFTs
U+Es).

Until the levels of Li are stable in your blood, we will need to do blood tests
once a week. Once your levels are stabilised, we would only need to the blood
tests once every 3 months. The safe level is between 0.4 –1.0 mmol.

Is there anything else I should know?

Yes. Firstly, certain drugs can interact with Li and cause the level of Li in your
blood to increase. These include drugs for treating high blood pressure (ACEi,
diuretics), NSAIDs, antidepressants (SSRIs). Dehydration can also cause Li
levels to increase. So always remember to have plenty of fluids.

Things to look out for, that might suggest that you may have increased levels of
Li in your blood include: anxiousness, dizziness, sudden tremors, lethargy.
Very high levels of Li may cause slurred speech, ataxic gait and worsened
tremor. If this should ever happen, stop the Li immediately and see a doctor or
come into hospital, where we will be able to help you.

Second thing is (if female) contraception, Li is teratogenic, this means it is

harmful to the developing baby. So you must ensure that you are taking
adequate contraception, LARCs.

Thirdly, there are alternative drugs such as sodium valporate and

carbamazepine but Li has been shown to be better at treating the condition you
have (i.e. bipolar).

Here is a leaflet.