Lithium Overdose Symptoms and Treatment

Using Psychiatric Medications Safely

Lithium is a psychiatric medication that is used to treat bipolar disorder and schizoaffective disorder. Drugs like lithium act as mood stabilizers, helping individuals with these mental health disorders obtain a better quality of life. Those who are prescribed lithium will have regular blood tests to monitor the levels of the drug in the system. This helps keep a tab on potential toxicity.

Lithium is not an addictive drug, like other prescription pills such as opioids or benzodiazepines. Lithium is not a typical drug of abuse, so overdose is typically a result of someone’s intention to inflict harm on themselves. Other instances where lithium overdose may occur is when the drug is used with drugs or alcohol, as it can have a potentially fatal interaction with those substances.

Lithium overdose is considered a serious medical emergence that requires immediate intervention. Following the recovery from the overdose, the individual will possibly be referred to a residential mental health treatment program where an intensive approach to the contributing factors can be beneficial.

About Lithium

Lithium is a psychotropic drug that is used to treat mental illnesses, such as bipolar disorder, schizophrenia, and occasionally depression and ADHD. Lithium is also known as lithium carbonate and lithium citrate, and sold under the brand names Lithobid, Lithane, Carbolith, and Eskalith, and has been in use since the 1870s. Lithium is made from stone materials and other chemical agents that can slow the activity of nerves and muscles. Researchers have not yet determined why lithium is effect as a mood stabilizer, but the medication has proven to be very effective in this regard. Lithium is sometimes prescribed alongside other medications, such as antipsychotic drugs.

While effective in managing mood disorders, lithium does carry some health risks so is not appropriate for patients with heart conditions, kidney disease, or thyroid disease. The serum level of lithium must be continually monitored to reduce the risk of toxicity.

The effects of lithium include:

• Relief from depressive episodes
• Relief from manic episodes
• More stable moods and emotions
• Prevents seizures

Common side effects experienced on lithium include:

• Itchiness
• Thinning of hair
• Muscle weakness
•  Weight gain
• Frequent urination
• Acne
• Impaired memory
• Mild nausea
• Poor concentration
• Loss of appetite

How Someone Overdoses on Lithium

When an individual ends up with too much lithium in the blood it can lead to lithium toxicity, also known as lithium overdose. There are three levels of lithium toxicity to define the overdose, these are:

• Acute, as when someone who has never used the drug takes too high a dosing
• Chronic, as when excessive levels of lithium in the bloodstream build up as a result of daily use of the drug
• Acute on chronic, as when someone who is prescribed lithium suddenly takes an excessive dosing, either accidentally or intentionally

When an individual ingests too much lithium, the concentration of the drug in the system is then graded as mild, moderate, or severe. A blood level of more than 3.5mEq/L is considered severe and can result in dangerous health risks, including death.

In some cases, typically in teenage patients, an intentional overdose may occur. Since the drug does not produce a high, when an intentional overdose occurs it is likely to be an attempt at self-harm or suicide.

Symptoms of Lithium Overdose

An excessive level of lithium in the bloodstream can result in the following symptoms:

• Confusion
• Fatigue
• Slurred speech
• Drowsiness
• Nausea or vomiting
• Muscle weakness
• Blurred vision
• Ringing in the ears
• Diarrhea
• Blackouts
• Poor muscle coordination
• Ataxia
• Tremors
• Twitching
• Dizziness
• Insomnia
• Loss of appetite
• Cardiac arrhythmia
• Coma

For those who recover from a lithium overdose there may be long-term health complications experienced, referred to by the acronym SILENT (syndrome of irreversible lithium-effected neurotoxicity). Symptoms of SILENT include reduced cognitive functioning, memory loss, and sub-cortical dementia.

Lithium Overdose Treatment

When a lithium overdose is suspected, the medical team will order the following lab tests:

• Serum lithium concentration
• Glucose
• Metabolic panel to assess kidney function
• Urine test (testing for pregnancy)
• Serum acetaminophen and salicylate concentration levels

Emergency interventions for a lithium overdose will be determined by the severity of the toxicity. If it is chronic toxicity-related, meaning due to a build up of toxins in the blood, treatment may involve simply reducing or stopping the lithium dosing until serum levels are normal. For acute or acute on chronic overdoses, more aggressive treatment is required. This may include:

• Intravenous fluids
• Activated charcoal administration
• Gastric lavage, or stomach washing
• Whole bowel irrigation
• Kidney dialysis
• Drugs to control seizures and nausea

In addition to the increased serum levels of lithium involved in lithium toxicity, another source may be due to drug interactions. Some medications lead to dehydration, such as diuretics, NSAIDs like Advil and Aleve, and ACE inhibitors.

About Bipolar Disorder

Bipolar disorder, formerly referred to as manic-depressive illness, is a unique mental health condition that causes abrupt shifts in mood. According to the National Institute of Mental Health (NIMH), bipolar disorder afflicts about 2.6% of the adult population in the U.S.  Among those diagnosed, 82% are classified as severe. These extreme mood variances cause a great deal of instability in the life of the individual, and often results in depleted energy and activity levels. Although the manic phases are part of the disorder, the majority of those with bipolar tend to suffer mostly the low mood, or depressive episodes.

Manic phase symptoms include:

• Euphoria and elation
• Fast talking
• Increased activity level
• Racing thoughts and difficulty staying focused
• Rapid speech
• Insufficient sleep
• Aggressive behavior
• Irritability or agitation
• Impulsive behaviors
• Engaging in risky behaviors, such as substance abuse or sexual promiscuity
• Psychosis (hallucinations or delusions)

Depressive phase symptoms include:

• Persistent sadness
• Feelings of hopelessness and despair
• Intense fatigue
• Anxiety
• Sleep disturbances
• Excessive worry
• Loss of interest in activities once enjoyed
• Chronic or vague pain with no known medical cause
• Trouble concentrating
• Irritability
• Suicidal ideation

There are different types of bipolar disorder that are differentiated by the level of the intensity of symptoms, as well as the types of symptoms. These include:

• Bipolar I disorder
• Bipolar II disorder
• Cyclothymic disorder
• Unspecified bipolar disorder

Science has yet to identify exactly what causes bipolar disorder. However, certain factors are recognized as potentially causal, including genetics, brain chemistry imbalance, extreme protracted stress, personality traits, and substance use disorders.

Comprehensive Treatment for Bipolar Disorder

When someone seeks psychiatric help for the symptoms of bipolar disorder, the first steps will include both a physical exam and a psychological evaluation using various assessment tools as well as the verbal interview. Because there are variations of bipolar disorder, the doctor will pay close attention to the unique features conveyed through these assessments in order to arrive at an accurate diagnosis.

The primary methods of treating bipolar disorder are with the use of prescription medications and targeted psychotherapy. Psychiatrists can prescribe medications for a the mental health disorder causing the mood swings. Medications include lithium, and may also include other drugs, such as antidepressants or anti-psychotics. Medication is paired with psychotherapy, where the patient discusses pertinent life events or past traumas that might be contributing to the bipolar disorder.

If outpatient services are not adequately helping the individual’s daily functioning, a more intensive level of care may be beneficial. Residential mental health programs can be very helpful in providing a more intensive treatment approach while the patient resides in the safe, supportive treatment environment. Residential mental health programs offer the following treatment elements:

Psychotropic medications.  A thorough evaluation of the patient’s present medications and dosing will be conducted. The doctor will determine if the medication should be adjusted or changed to better serve the individual’s specific diagnostic needs. If the patient is already on lithium, the serum levels will be tested for toxicity.

Psychotherapy. There are several evidence-based psychotherapies available to help a patient struggling with bipolar disorder. The primary goal of psychotherapy is to help the patient better manage stress and triggers. This can be accomplished through

• Cognitive behavioral therapy. (CBT) teaches patients re taught ways to reshape their self-defeating thought patterns that can trigger symptoms, and to replace the disordered thought-behavior patterns with healthier beliefs and more positive behaviors. When these new thought/behavior patterns are practiced they can be important coping tools.
• Psychoeducation. These sessions help the patient understand the disorder, the importance of adhering to medication, how to detect an emerging episode, and stress management techniques.
• Interpersonal and social rhythm. Teaches mood and activity tracking to better establish healthy daily routines, improves sleep quality by regularizing circadian rhythms, and identifies any particular interpersonal issue or problem area that is contributory.
• Family therapy. Helps the family better understand the loved one’s bipolar disorder, teaches problem-solving skills and more effective communication skills.

Holistic activities. The residential program may include involvement in a variety of holistic activities that can assist with managing stress levels and emotion regulation. These might include yoga, deep-breathing exercises, mindfulness meditation, art therapy, acupuncture, or massage therapy.

Mood disorders like bipolar disorder are able to be managed through a consistent commitment to continuing psychotherapy, practicing new thought and behavior patterns, holistic methods, and adherence to medications.

The Treatment Specialist Offers Online Guidance About Mood Disorders

The Treatment Specialist is an online resource that provides useful information about mental health and substance use disorders. Our experienced specialists are available to offer free guidance for individuals who are seeking help for a mood disorder such as bipolar disorder. To learn more about lithium and treatment for mood disorders, please reach out to The Treatment Specialist today at (866) 644-7911.