Daily Archives: November 28, 2012

The L(ithium) Word

If bipolar disorder didn’t have enough of a stigma for those of us attached to it to have to deal with, the disorder’s leading medication for treatment, Lithium, seems to have an additional stigma all its own.

Why is this particular drug feared so intensely? And is any of that fear even warranted? I know that even for me, starting down the medication route again left me terribly nervous about the prospect of taking lithium, and I didn’t even particularly know why.

Today I’d like to take a stab at demystifying some of the stigma that surrounds bipolar drug number one; Lithium. I’m going to address five of the most common terrors I’ve heard associated with the drug, and though I’m not trying to convince anyone that lithium is a good idea, I’d like it if people stopped treating lithium like a leper. Stigma around lithium directly effects the stigma around mental health in general.

Fear #5: Lithium has too many side effects. 

Like any other psychological drug, side effects vary (not only from drug to drug, but from patient to patient as well). Side effects experienced by one person may not be experienced at all by the next person, but the idea that these side effects may occur can be very dissuading against taking any one particular drug.

Lithium has been around the longest, the most people have tried it, and anyone who has spent time in a support group or networked with someone who is interested in sharing about their personal experiences with medications they’ve taken practically everyone has an opinion about having taken lithium (or not). Negative opinions of lithium given to someone about to try some new medications for themselves will probably give them negative feelings about lithium’s potential side effects (which may not even be relevant to them) without ever even trying it for themselves.

Personally, I did not have any wild side effects from taking lithium, and all of the side effects I had have since dissipated. That doesn’t mean if you try it you wont have any, or that you will have some. Every person is different, so trying to base your own treatment off the treatment of others is (usually -that might be different if they are a blood relative) ineffective.

Lithium’s side effects are on par with most of the other psychiatric drugs out there; they exist. But side effects generally exist with any psychiatric drug. The only thing that will determine the side effects you develop is your own physiology, so there is no way to know how you will react without trying (or getting genetic testing) for yourself.

Fear #4: Lithium is only for people who are really bad off.

Lithium seems to have this stigma that only people who are really the worst off need to be taking it. At the same time, though, many people will only consider lithium as a last resort, so naturally by the time they need that resort, things will have gotten worse.

I think this fear comes from a fear of mental illness itself, and because lithium is a drug that is used specifically for psychological purposes, taking it means accepting you’ve got a psychological need to be met. In that way, it can be easy for people to say, “lithium is only for people with bipolar disorder, and I don’t really have that, I’m not that bad off, so I shouldn’t have to take it.”

Let’s think about it. Yes, lithium is used to treat bipolar disorder, but it isn’t even used to treat many of the most severe symptoms. It acts as a mood stabilizer, like lamictal or depakote. It doesn’t touch psychosis (which is what I would suggest if someone asked me what someone who is “bad off” might experience) -that is left to the world of antipsychotics (which I personally believe are much more potent and need to be monitored just as carefully, if not moreso than lithium).

Lithium is often a first choice for people who have just been diagnosed because it is not a treatment specifically for those who are in immediate need of assistance through medication. In fact, lithium takes longer than some other drugs to build up in your system, so it isn’t as effective to put someone on it who needs immediate medication and is “bad off”.

Fear #3: Lithium produces drooling zombie-like creatures that can’t think.

This really goes back to fear #5 about side effects, but I wanted to add this one specifically because it is a pretty specific concern that I feel is mostly unwarranted.

All psychiatric medications effect the brain, that is how they work. But, as I mentioned about side effects, each person is effected differently. I think this particular fear comes from the portrayal of things like psychiatric hospitals or facilities on tv or in movies. It can be easy to lump an image (of people shuffling around or drooling) with the word lithium because, again, it is one of the oldest psychiatric treatments. When people think old psychiatric treatments, it is easy to think old mental facility and barbaric psychiatric practices. 

Again, side effects for drugs vary from person to person, but what lithium isn’t is a tranquilizer, so “zombification” (in the purest sense of the word) should not occur.

Fear #2: Lithium doesn’t work. 

The short answer here is “how do you know until you’ve tried it?” After all, lithium wouldn’t be one of the oldest treatments for bipolar disorder if it didn’t show any signs of working, if that was the case they would have gotten rid of it ages ago.

For myself, though, I can see where this connection might be made, here in the Pacific Northwest Kurt Cobain is something of a household name. I don’t claim to know what went on for that musician, but the fact that he wrote a song called Lithium and also commit suicide could leave people connecting dots that maybe shouldn’t be connected.

Again, I know I’m repeating myself here but lithium works differently for different people. It might not be effective for some, but it might be really helpful for others. For as many people I’ve heard tell me they didn’t like lithium or that it didn’t work for them, I’ve had similar amounts of people tell me lithium has pretty much saved their lives.

Fear #1: Lithium is much more dangerous than other drugs. 

I think this particular fear is fueled by the fact that taking lithium requires having your blood drawn regularly for careful monitoring. You see, lithium is considered thereaputic when in a specific amount in your body, but anything more than that can be damaging through lithium toxicity.

Kidney damage can occur for some people who take lithium, and it is much more likely to occur if toxic levels of lithium are taken.

This is much less of a problem than it sounds, because the system doctors use today to introduce lithium to a patient and start increasing the dosage is combined with a series of blood draws to closely monitor the amount of lithium entering the bloodstream.

Personally, since practically every drug in the world functions best within a certain range, I wish this was a practice more widely used with other medications (because it makes me feel safer and less likely to accidentally overdose).

You may not remember, but I experienced lithium toxicity  a while back, and it was something I knew (going into it) that toxicity might occur because my doctor and I were pushing the limits of how much lithium I could take to see if it would activate the drug (make it start to work). The toxicity itself was more like being drunk than anything else, it was obvious enough to catch it without things escalating further, and everything was fine. I was shocked, though, that I had gone months being afraid of this “toxicity” and then when it finally happened, it felt little more than a nuisance.

Again, everyone is different. And for some, lithium has an effect on the thyroid so additional medication needs to be taken to compensate. Kidney damage can occur over long periods of time. I don’t think that these effects are much scarier than any other possible effect of the psychiatric medications I’ve taken, and the fact that lithium has been around a lot longer actually makes me feel better. Doctors know how lithium effects the body, they know what effects could happen several years down the line -and that is something that they don’t know about many of the other newer medications on the market today.

In conclusion…

First, I just want to re-iterate that lithium has really gotten a bad wrap. I know I was guilty of having a prejudice about lithium just as much as anyone else before I started taking it, and I was mortified to try it because of everything I’ve just talked about, those unknowns scared the bejeezus out of me. What was funny was that I should have given it a chance much sooner, because it is the medication that has produced the least amount of side effects for me.

I would try to keep an open mind, because ranking medications in terms of what you will or wont try (without any solid reasoning) could seriously hinder your chances at finding a medication that works.

And finally, I wanted to say that it is important to consider how we portray the medications we are taking to others. Labeling a drug like lithium as something that is “only for people who are bad off” puts stigma in our community that seeps out to build on the stigma outside of the mental health community as well. I just want to urge you to consider how you portray the medications you’ve tried or are taking, because it is one thing to give your decided opinion about a drug, but it is another to herald one as, “a miracle drug!” or “the worst experience I’ve had in my life, don’t ever try it!”. Our words about these drugs effect whether or not others seek help, and feel comfortable with the choices they are making. 

And those are two things I want to be sure that I am promoting.