Because of possible complications, lithium may either not be recommended or may be given with caution when a person has existing thyroid, kidney, or heart disorders, epilepsy or brain damage.
Women of childbearing age should be aware that lithium increases the risk of congenital malformations in babies born to women taking lithium. Special caution should be taken during the first three months of pregnancy.
Lithium, when combined with certain other medications, can have unwanted effects. Some diuretics (substances that remove water from the body) increase the level of lithium and can cause toxicity. Other diuretics, like coffee and tea, can lower the level of lithium.
Signs of lithium toxicity may include nausea, vomiting, drowsiness, mental dullness, slurred speech, confusion, dizziness, muscle twitching, irregular heartbeat and blurred vision. A serious lithium overdose can be life-threatening. Someone who is taking lithium should tell all the doctors, including dentists, he sees about all other medications he is taking.
With regular monitoring, lithium is a safe and effective drug that enables many people who otherwise would suffer from incapacitating mood swings to lead normal lives.
Not all patients with symptoms of mania benefit from lithium. Some have been found to respond to another type of medication, the anticonvulsant medications that are usually used to treat epilepsy.
Carbamazepine (Tegretol) is the anticonvulsant that has been most widely used. Bipolar patients who cycle rapidly — that is, they change from mania to depression and back again over the course of hours or days, rather than months — seem to respond particularly well to carbamazepine.