I was about 21 when I was initially prescribed lithium. My first experience with a psychiatrist had not been a good one. I had not been listened to, and had felt patronised and judged for some of the life choices I’d made. Eventually, after several distressing visits, I got to see a second psychiatrist who was much nicer. He listened quietly to a description of my symptoms and suggested that I might have bipolar disorder, and that I should begin taking lithium.
Before I could start lithium, he explained, I would need to undergo a range of physical health checks at the local general hospital. I spent a miserable, lonely day moving from department to department; I didn’t feel I could ask anyone to take a whole day off to keep me company. I had an ECG conducted by a pimply young man about my age; I couldn’t say which of us was more embarrassed as he stuck electrodes on and around my bare breasts. Next up was a chest X-ray, followed by a further wait to get bloods drawn to test thyroid and kidney function.
The tests frightened me. Did I want really want to take something that could have such an impact on my physical health? Lithium seemed very heavy-duty, especially for someone as young as I was. And then there were the dire warnings about lithium in pregnancy (it can cause birth defects, especially to the developing baby’s heart), when I was already planning to start a family after graduation. I never went back to that psychiatrist, never took the lithium, and didn’t pay the bipolar diagnosis much attention (HINT – MISTAKE).
I’m not the only person who regards lithium with fear and awe. As http://www.psycheducation.org/, a useful resource on bipolar treatment, puts it:
many people worry that lithium is one of psychiatry’s “Big Guns”, something we use for patients with really severe mental illnesses. They think, “Hey, I’m not that sick”, and conclude that lithium is not right for them.
That quote describes perfectly how I have always felt about lithium. Anything requiring weekly (at least initially) blood tests to ensure you are not being actively poisoned by it feels huge and risky.
Lithium didn’t always have to overcome an image problem. In the nineteenth century it was applied to a range of medical disorders, including renal problems, gout and rheumatism. A number of the bottled mineral waters still on the market today (including Vichy and Perrier) at one time used their relatively high lithium content as a selling point. I had no idea until I started researching this article that, just as Coca-Cola was initially marketed with an extra kick from cocaine, 7-up initially contained lithium citrate. This was the active ingredient that the company boasted, “dispels hangovers” and “takes the ‘ouch’ out of grouch.”
Today lithium is prescribed to treat bipolar disorder and major depression in both its citrate (as a liquid) and carbonate (as a tablet) forms. A quick Google search reveals that there are many people happy to testify that lithium changed their life for the better. There is good statistical evidence that it reduces the incidence of suicide in people who take it, and following an initial study in Japan it has even been suggested it could be added to drinking water as a public health suicide prevention measure. There are also some studies suggesting that lithium neuroprotective; in other words, it actually improves the health and growth of brain cells and may event prevent the development of dementia in later life.
The snag with lithium is that it operates within a narrow window. Too little in the bloodstream, and the patient sees little beneficial effect. Too much, and toxicity results, potentially causing kidney damage, thyroid problems, seizures and even coma. People starting lithium need to sign up for a programme of regular blood tests to check the blood serum level and their renal and thyroid functions. Lithium can also have dangerous interactions with other drugs, so every single time somebody on lithium is prescribed a medicine or buys one over the counter, they need to make the doctor, dentist or pharmacist. Everyone prescribed lithium in the UK should be given a “lithium pack”, produced by the NHS National Patient Safety Agency, which contains a record book for the dosage prescribed and results of blood tests, and a Lithium Alert Card to make clinicians aware in an emergency that the person takes lithium.
I’m due to start taking lithium next week. I have my weekly phlebotomist’s appointments booked at my GP surgery. I’m starting in a week when I don’t have too many responsibilities, in case the potential side-effects of early treatment (which can, apparently, include drowsiness – and I’ll be taking the lithium alongside my amazing sedative antipsychotics! – and upset stomach) are an issue. 16 years after I was first prescribed it, lithium still feels like something big.