For those who know me, or have been kind enough to read some of my other ramblings, you’ll know that I manage my bipolar disorder through medication as well as self-care techniques. But one, in particular, has had a huge impact upon my life… Lithium Carbonate.
As it so happens, today is my Lithium monitoring day so I thought I’d write a little bit about my life on Lithium…
DISCLAIMER [This blog post does not intend to be advocating the use of any medications without the approval of mental health professionals. It is a subjective snippet of my experience on this mood stabiliser. I am not suggesting it is the right choice for everyone. Always consult a mental health professional for guidance on your own medication.] DISCLAIMER
I was diagnosed as having type 1 bipolar affective disorder in 2015 whilst studying my undergraduate degree at the University of Southampton, but I’ve had issues regulating my moods all my life. The diagnosis itself didn’t shock me. I always knew I felt a little ‘different’ to my friends. It wasn’t so much me and who I was, but the way I thought, the way I felt and how I coped which didn’t seem quite right. The biggest shock to me was how I’d have to manage it, the lifestyle changes that come with it, how long I’ll have to spend finding a way to get it under control, and how long these little pills will be in my life for.
You can lose so much of your life to this disorder, with and without active episodes. According to the NHS, if a person is not treated, a bipolar-related manic episode can last between three and six months.
Episodes of depression tend to last longer, between six and twelve months. With effective treatment, episodes will usually improve within about three months.
WHAT IS LITHIUM CARBONATE I HEAR YOU ASK?
Some of you may have heard of these helpful little pills, as it is a popular method for managing bipolar episodes, but like most, it comes with its own list of pros and cons.
I remember growing up hearing only bad things about it, so when my psychiatrist told me I had to try it I was terrified. In the midst of a full-blown manic episode, I spent forty-five minutes sitting in the doctors’ room whilst two psychiatrists explained to me all of the things that can go wrong. I mean I get it, they have to tell me so that I’m informed, but I was so overwhelmed I questioned whether I was doing the right thing.
HOW DOES IT WORK?
Lithium Carbonate has been developed to help reduce the frequency and severity of manic episodes in bipolar disorder. It can also help relieve depressive episodes and reduce suicide risk. Not only this, it can be effective in preventing future episodes as well. As a result, it is often prescribed for a long period of time, even between active episodes, as maintenance therapy.
No one really knows how it works, but what is known is that it acts upon an individual’s central nervous system (the brain and the spinal cord). Whilst doctors do not know how Lithium is effective in stabilising mood – it is thought it helps to strengthen nerve cell connections in the regions of the brain associated with thinking, mood regulation and behaviour.
It usually, like most medications, takes several weeks for Lithium to start working. It works best if the amount of Lithium in the blood is kept at a constant level; for me, all I need to know is that this number is between 0.4 and 1. It is really important that this level is not too low nor too high. As a result, people taking Lithium are asked to submit periodic blood tests throughout their treatment, beginning weekly through to three-monthly submissions, 12 hours after the last dose. When they check the Lithium levels, they will often check your kidneys and thyroid function too.
One of the biggest things for successful Lithium therapy is to drink lots of water. Even the amount of salt there is in your diet can affect how much Lithium is in your body. It might sound mundane and self-explanatory… but you have to drink A LOT of water. I am now part fish. I can’t leave the house without a bottle of water anymore, I can’t go to bed without one either. I go through several of these a day…
WHAT ARE THE SIDE EFFECTS?
Whilst being on Lithium Carbonate has been life-changing for my progress in addressing my moods for the first time in my life, it hasn’t always been easy. Side effects have knocked me on my arse more than once.
Some of the side effects I have personally experienced include…
- Increased thirst… all the bloody time, especially after taking my tablets at night…
- Increased urination… weirdly enough from all that drinking… The general advice is not to drink too much alcohol when this happens.
- Vomiting, nausea, and an upset stomach… a lot. If it persists, it can help to speak to your pharmacist.
- Weight gain… don’t believe me, ask my stretch marks. Whilst it’s not been as much as the other meds I have taken, it’s definitely been there.
- Poor concentration, impaired memory, drowsiness, feeling dazed… what were we talking about again?
- Metallic taste, like you’ve had something metal or bitter in your mouth, it should wear off after a few weeks.
- Acne… like a bloody teenager all over again…
- Hand tremors, it feels like a fine shaking of hands, it’s not dangerous but it can be irritating. I struggle to paint my nails and to write sometimes because of it. If it gets worse or spreads to your legs or jaw, stop taking it and see your doctor!
*this list is not exhaustive, nor is it certain anyone will experience them, they are representative of some of the side effects I have experienced, and the most common.*
IS IT SAFE TO TAKE WITH OTHER MEDICATIONS?
As I explained in my previous post, I am taking a combination of tablets to address my mental illnesses. However, every medication produces an interaction, either with the parts it should or with other medications you might be taking. This is why it is important to let all health professionals know that you are on Lithium therapy, as some will increase the levels in your body or increase the risk of side effects. Even simple tablets like anti-inflammatories (Ibuprofen) can increase the level of Lithium!
Always, always check before starting anything new. It’s you that has to live with it.
HOW SHOULD I TAKE LITHIUM CARBONATE?
“No low-salt or sodium diets. No crash diets. Eat a balanced diet. Don’t drink too much alcohol as it can change the level of Lithium. Don’t stop too suddenly. Don’t use recreational drugs as it can affect the Lithium level. Stay out of direct sunlight. Don’t become dehydrated. …” are all pieces of advice given to me by healthcare professionals.
Whilst Lithium is not addictive, it is said you shouldn’t stop taking it suddenly. Well, you shouldn’t stop taking any medications unless instructed by a healthcare professional.
Give Lithium Carbonate a chance to work for you, most people have to be on it for years but that doesn’t mean it’s a bad thing. I remember once someone I knew said she was scared to ‘depend on medication’, we all ‘depend’ on it because it has a job and a purpose to help us – the stigma about mental health medication has to end, it doesn’t happen towards physical medications.
Sometimes the side effects of Lithium can be relieved by altering the level of dosage. But never attempt to do this on your own!
Do not change the brand of Lithium without consultation.
Wherever possible, try to take your dose at the same time each day, with a glass of water. I take my 800mg at a single dose at bedtime, since doing this I have never forgotten to take it.
Do not crush or chew the tablets.
If a dose is missed, take it as soon as possible, as long as it is only up to three hours after the usual time. DO NOT double the dose the next day.
Always tell your doctor and pharmacist the trade name of your lithium; as this should be the same unless under exceptional circumstances.
Lithium has to be stopped at least two weeks before scheduled surgeries owing to the interaction between it and the anaesthesia. But only under the advice of your doctor.
HOW DO I MANAGE LIFE ON LITHIUM?
When you are prescribed Lithium (for UK patients) for the first time you’ll (should) be provided with an NHS purple Lithium treatment pack. It looks like this and will include…
- An information booklet. This is good to look over once in a while as it tells you how to use the pack, what lithium is used for, and signs to look for if it gets too high.
2. A Lithium alert card. This should be carried with you always- I tend to keep it in my phone case, so I’ll always remember. It is to be shown to all healthcare professionals, even the dentists so they can best inform your care and in case of accident/ emergency.
3. A record book for your blood test results. This can be helpful if like me you’ve transferred from different NHS trusts and want to have control in your own treatment. At the beginning of my treatment, I did not always record the blood test results or the doctors did not disclose the level to me to record, this is something I always try to remember now.
MY THOUGHTS ON LITHIUM:
I think it is sometimes easy to forget the bigger picture of the damage which can be caused by these medications. Having weekly or monthly blood monitoring can seem like a lot of effort; especially for those who don’t like needles or hospitals. But again, it is important to recognise that this medication requires an active approach to staying healthy and stable in recovery.
I like having a sense of control in my treatment, the fact that this medication requires constant care means I generally have greater access to MH professionals in comparison to other medications I have tried before. I’ve gotten used to never leaving the house without a water bottle. I’m still working on trying not to get dehydrated, especially in the summer.
Things I never would have ever considered, are now really important and I can feel the difference in the way I think and feel if I don’t treat them properly. But overall, it is safe for people who are appropriately monitored and take care, medication cannot do all the work for you, you have to help out too.
Lithium Carbonate has, unfortunately, been linked to birth defects and should be used with caution in pregnant women, especially the first three months. Therefore, being only 23 and with hopes of one day of having a family means I will have to change my entire medication regime to accommodate this. This change scares me more than staying on Lithium for the rest of my life.
Whilst it sounds scary, it has helped me more than I can ever explain. I managed to graduate university with a 2:1, something which before due to manic episodes and hospitals seemed impossible. I hadn’t slept in nine days, stood on the roof at uni thinking I could fly, now my feet are firmly on the ground, looking to the future.
Whilst I used to think it was so unfair that I had to fill my body full of pills that other people didn’t, it’s not about fairness. It’s about how I get my life back, and sometimes I feel like this is how I do that. I do not lack anything others have, I have learned more self-control and discipline than I ever thought I would or could have.
Lithium has given me my life back, and it would not have been the same without it.
If you have any questions about your medication, you can talk to your doctor, someone at your local pharmacy, or call NHS 111 in the UK.