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Lithium for Depression

Nursing Knowledge

Lithium for Depression

Lithium, a mood stabilizer, has been a cornerstone in the treatment of bipolar disorder and some forms of depression for decades. In clinical nursing practice, lithium requires close monitoring due to its narrow therapeutic window and severe potential adverse effects of toxic doses. Keep reading for nursing considerations around lithium treatment and the most important patient education points.

Last updated: December 17, 2024

What is lithium?

Lithium is the third element on the periodic table and the oldest mood-stabilizing drug. It is used to treat bipolar disorder, schizophrenia, and borderline personality disorder.

Lithium methods of administration

Lithium is taken orally in pill, capsule, or liquid form. Dosing is titrated based on desired effect and serum level monitoring. It usually takes 5–7 days from initiation of therapy to note benefit and up to 3 weeks to achieve peak effect.

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NCLEX Review: Mood Stabilizers (Lithium)

Case Study: Male Patient on Lithium

How does lithium help with depression?

While the exact mechanism of action is unknown, lithium modifies sodium transport in nerve and muscle cells, is thought to alter the metabolism of neurotransmitters (specifically catecholamines and serotonin), and may alter intracellular signaling.

Lithium: nursing considerations and interventions

Lithium has a narrow therapeutic window and can cause significant adverse effects. Careful monitoring is required.

Before initiating lithium therapy

Check baseline kidney function
Check baseline thyroid function
Baseline ECG (clients > 50 years old)

During lithium therapy

Check serum lithium level every 2–3 days upon initiation and every 3–6 months once stable
Repeat kidney and thyroid function testing 1–2 times per year

Common early side effects of lithium

Gl distress (nausea, bloating, diarrhea)
Fatigue
Muscle weakness
Headache
Confusion
Memory impairment
Polyuria and thirst

Client education points about lithium

Help clients know what to expect in terms of side effects. Early symptoms often resolve with time. Report if severe/persistent.
Teach clients to maintain normal dietary sodium intake.*
Teach clients to increase their fluid intake. Lithium blocks the effects of ADH, causing increased urine output (can lead to hypovolemia).
Diarrhea can lead to sodium loss, putting clients at risk of lithium toxicity. Clients should be alert to signs of toxicity and notify their provider of diarrheal illness.
Educate clients to consult their provider before taking drugs that affect lithium levels, including:
- Diuretics
- NSAIDs
- Antihistamines
- ACE inhibitors
- Metronidazole

*Lithium is a positively-charged ion and is processed like sodium by the kidneys. Low serum Na⁺ causes the kidneys to retain Li⁺ along with sodium. Li⁺ retention can lead to toxicity.

Lithium toxicity

Lithium levels

Normal: 0.6–1.2 mEq/L
Toxicity: > 1.5 mEq/L
Risk of death: > 2.5 mEq/L

Lithium toxicity symptoms

Mild toxicity: nausea, vomiting, lethargy, tremor, fatigue
Moderate toxicity: confusion, agitation, delirium, tachycardia, hypertonia
Severe toxicity: coma, seizures, hyperthermia, hypotension, death

https://youtu.be/1JCUJsbRr8E?si=DIfdiezurOMJEmWQ

Alternatives to lithium for depression

Depression treatments

ECT and Psychotherapy for Depression

Review of non-medication treatment options for depression

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Depression: Nursing Diagnosis & Symptoms

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Overview of Lithium, the first mood stabilizer, including administration, monitoring, therapeutic range, toxicity, and client education topics

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