Physicians should feel confident prescribing lithium for patients with bipolar disorder, according to an Oxford University study in which the potential side effects of the drug were evaluated.
Bipolar disorder is fairly common and can occur at any age. It is estimated that one person in 100 has the disorder.
Lithium is considered the most effective long-term treatment for bipolar disorder, but it is now prescribed less due to concerns about the drug’s side effects, such as kidney function problems.
Individuals with bipolar disorder experience mood swings from one extreme to another; periods of depression and mania may last several weeks or longer. These phases of feeling high and low are often so intense that they interfere with everyday life. Lithium calms both depression and mania and reduces the risk of suicide.
Driven by the notion that many bipolar patients could benefit from lithium but are missing out because of these worries, the research team led by Professor John Geddes decided to investigate deeper regarding lithium’s side effects.
The researchers reviewed nearly 400 articles concerning the possible negative effects of lithium and made several recommendations designed to guide lithium treatment in the future.
Geddes and colleagues came to the conclusion that there is definitely an increased risk of abnormalities in the thyroid and parathyroid glands. These occur in about 25 percent of patients on lithium therapy compared with 3 percent and 0.1 percent in the general population, respectively.
Lithium use also promotes weight gain, and can slightly reduce the ability of the kidneys to concentrate urine.
However, the study reveals that evidence linking birth defects with lithium treatment in pregnancy is still inconclusive, and there is very little proof linking lithium with hair loss or skin problems.
The team suggests that doctors discuss the risk of side effects with the patient before starting lithium treatment. Incorporating calcium levels to blood tests would be beneficial based on the high risk of hyperparathyroidism.
The researchers also believe that the uncertainty regarding birth defects should be explained to women of childbearing age, rather than simply not recommending lithium during pregnancy.
Geddes and his team believe that more research is needed on the association between lithium and the kidney.
The results are published in the Lancet medical journal.
Source: Oxford University