logo
episode-header-image
Mar 2023
35m 20s

PsychEd episode 52: How to Use Lithium

PSYCHED
About this episode

Welcome to PsychEd — the psychiatry podcast for medical learners, by medical learners. This episode is an introduction to the use and monitoring of lithium in bipolar disorder. Join Tingting Yan (CC4) and Dr. Alex Raben (staff psychiatrist at CAMH and lecturer at the University of Toronto) for a lively case-based discussion.

Learning Objectives

The learning objectives for this episode are as follows:

 

By the end of this episode, the listener will be able to…

  1. Describe the indications and process for starting lithium

  2. Monitor and interpret serum lithium levels

  3. List short and long-term adverse effects of lithium



Produced by: Tingting Yan CC4, Dr. Alex Raben (staff psychiatrist)

 

Hosts: Tingting Yan, Alex Raben

 

Audio editing by: Alex Raben

 

Show notes by: Alex Raben

 

Contents:

  • Learning objectives: 00:44

  • Lithium background and brief history: 2:48

  • Women’s health and lithium: 5:28

  • Underutilization of lithium: 8:02

  • Baseline blood work for lithium: 11:32

  • Choosing a lithium starting dose: 14:32

  • Lithium serum levels: 16:17

  • Lithium titration: 20:46

  • Lithium toxicity: 23:48

  • Lithium side effects: 26:52

  • Summary: 32:11

 

References

  1. Baastrup PC, Poulsen JC, Schou M, Thomsen K, Amdisen A. Prophylactic lithium: double blind discontinuation in manic-depressive and recurrent-depressive disorders. Lancet. 1970;2(7668):326-330. doi:10.1016/s0140-6736(70)92870-9

  2. Bauer LA. Chapter 17. Lithium. In: Bauer LA. eds. Applied Clinical Pharmacokinetics, 2e. McGraw Hill; 2008. Accessed March 16, 2023. https://accesspharmacy.mhmedical.com/content.aspx?bookid=510§ionid=40843106

  3. Chokhawala K, Lee S, Saadabadi A. Lithium. StatPearls.

  4. Davis J, Desmond M, Berk M. Lithium and nephrotoxicity: a literature review of approaches to clinical management and risk stratification. BMC nephrology. 2018 Dec;19:1-7.

  5. Draaisma D. Lithium: the gripping history of a psychiatric success story. Nature. 2019 Aug 1;572(7769):584-6.

  6. Hedya SA, Avula A, Swoboda HD. Lithium toxicity.

  7. Malhi GS, Bell E, Outhred T, Berk M. Lithium therapy and its interactions. Australian Prescriber. 2020 Jun;43(3):91.

  8. Malhi GS, Gessler D, Outhred T. The use of lithium for the treatment of bipolar disorder: Recommendations from clinical practice guidelines. J Affect Disord. 2017;217:266-280. doi:10.1016/j.jad.2017.03.052

  9. McKnight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR. Lithium toxicity profile: a systematic review and meta-analysis. Lancet. 2012;379(9817):721-728. doi:10.1016/S0140-6736(11)61516-X

  10. Patorno E, Huybrechts KF, Bateman BT, Cohen JM, Desai RJ, Mogun H, Cohen LS, Hernandez-Diaz S. Lithium use in pregnancy and the risk of cardiac malformations. New England Journal of Medicine. 2017 Jun 8;376(23):2245-54.

  11. Tondo L, Alda M, Bauer M, Bergink V, Grof P, Hajek T, Lewitka U, Licht RW, Manchia M, Müller-Oerlinghausen B, Nielsen RE. Clinical use of lithium salts: guide for users and prescribers. International journal of bipolar disorders. 2019 Dec;7(1):1-0.

  12. Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar disorders. 2018 Mar;20(2):97-170.

 

CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.

For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

 

Up next
Aug 1
PsychEd Episode 68: South Asian Mental Health with Dr. Farooq Naeem
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.This episode covers South Asian mental health with Dr. Farooq Naeem, a senior scientist with the Institute for Mental Health Policy Research and a psychiatrist at the Centre for Addiction and Men ... Show More
52m 42s
Jul 25
PsychEd Shorts 3: Approach to Psychotic Symptoms
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.This short episode is about an approach to patients with psychotic symptoms.Hosts: Ravi Bhindi (CC3), Dr. Angad Singh (PGY2)Audio editing: Dr. Angad Singh (PGY2)Show notes: Dr. Angad Singh (PGY2) ... Show More
21m 13s
Jul 1
PsychEd Episode 67: Catatonia with Dr. Patricia Rosebush
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.This episode covers catatonia with Dr. Patricia Rosebush. Dr. Rosebush is a Professor in the Department of Psychiatry & Behavioural Neurosciences at McMaster University. She is the distinguished ... Show More
1h 1m
Recommended Episodes
Jul 2022
The Science & Treatment of Bipolar Disorder
In this episode, I explain the biology, symptoms, causes and types of bipolar disorder (sometimes called bipolar depression). I discuss neuroplasticity and how the brain normally regulates mood, energy, and perceptions; then, I contrast that with the biology of bipolar disorder, ... Show More
2h 16m
Jul 2022
#221: Caring for Patients with Bipolar Disorder
Bipolar disorder is a mental health condition characterized by alternating episodes of emotional highs and lows. The occurrence of these extreme mood swings is variable. Some individuals experience them multiple times per year while others have rare occurrences. Though a lifelong ... Show More
30m 15s
Apr 2024
The Bipolar Clock: Stabilize Mood By Resetting Your Body Clock | Dr. Holly Swartz | EP 40 🌓
Award-winning researcher ⁠Dr. Holly Swartz⁠ breaks down the "bipolar clock", and proposes a fresh approach to take charge of your bipolar symptoms by timing your light exposure, temperature, body position, eating, and social contact. Dr. Swartz also discusses the science behind s ... Show More
38m 58s
Apr 2023
Ketamine: How Special is Special K?
For years, ketamine has been thought of mostly as a horse tranquilizer — or a street drug that puts you in a scary-sounding K-hole. But now, we’re hearing reports that it could be almost a miracle medicine, treating stubborn depression and other mental illnesses. So how good is i ... Show More
32m 16s
Aug 2023
Bipolar II Disorder: Misdiagnosis, Stigma & Telling My Story | Sara Schley | EP 36 🦋
Author Sara Schley recounts her story of living with bipolar II disorder - from her first episode of depression in college, to publishing her memoir after keeping it a secret for over 40 years. Sara also breaks down why people with bipolar II disorder are commonly misdiagnosed, h ... Show More
42 m
Mar 2024
Ozempic: Is It Scarier Than We Thought?
We looked at this class of weight loss drugs a year ago, and they've only gotten more popular — and more controversial. We’re hearing that these kinds of drugs can be tough on your stomach, and that the weight loss comes with worrisome loss of muscle. We’ve also heard claims that ... Show More
40m 18s
Dec 2022
Creativity & Bipolar Disorder | Dr. Sheri Johnson | EP. 26 🎨
Professor Dr. Sheri Johnson (University of California Berkeley) and mental health educator Victoria Maxwell discuss the relationship between creativity and bipolar disorder, how to maintain creativity outside of mood episodes, and answer questions from the TalkBD audience. Hosted ... Show More
59m 43s
Aug 2021
Reboot #167 LIVE! CBC Abnormalities
Enjoy this Curbsiders classic and stay tuned this Wednesday, August 25, 2021 for a brand new CBC Abnormalities Triple Distilled episode. Take a deep dive into common CBC abnormalities. We recorded LIVE at joint grand rounds between Walter Reed NMMC and Uniformed Services Universi ... Show More
52m 33s
Jun 2024
Bipolar in the Bay: Garbageman, Wrestling Coach & Advocate | Robert Villanueva | EP 41 🌉
This is the powerful bipolar disorder story of "ordinary guy" Robert Villanueva. Robert "Coach V" Villanueva grew up in East Bay of San Francisco amidst undiagnosed bipolar disorder. Seeking a better life away from a dysfunctional home, Robert left home at 15 and became a wrestli ... Show More
30m 45s