Medications

Other Factors that Affect Lithium Levels. In addition to drugs, other factors may affect lithium levels:

• Seasonal change -- lithium levels may be higher in summer.
• Menstrual cycle -- lithium levels may drop during the premenstrual phase.
• Weight loss
• Changes in salt intake
• Dehydration
• Diarrhea

Patients should be sure to contact their doctor if they have any suspicious symptoms or illnesses.

Noncompliance. Noncompliance is common. One study of lithium users found that patients took their medication only 34% of the time. Another reported that nearly a third of patients eventually went off the drug.

Side effects are certainly one reason for noncompliance. Some patients regret the loss of their manic episodes and the exhilaration and creativity that sometimes accompany them. In one small study of artists with bipolar disorder, however, only 25% felt their work had declined, while another 25% found no change in their creative output, and 50% believed that lithium had improved their output.

Despite side effects and other concerns, this important drug saves lives. Doctors are confident that lithium, which has been in use for more than 50 years, can be taken safely, even for life, by most patients.

Valproate and Other Antiseizure Drugs

Antiseizure drugs, also called anti-epileptics or anticonvulsants, affect the neurotransmitter gamma aminobutyric acid (GABA), which helps prevent nerve cells from over-firing. These drugs may be an alternative for patients (especially substance abusers) who do not tolerate or respond to lithium. They also may be used in combination with lithium, atypical antipsychotics, or other drugs.

Standard Antiseizure Drugs.

• Valproate (Depakote), also called valproic acid or divalproex, is now a first option for many bipolar disorder patients. Valproate also helps migraine headaches, a common problem among patients.
• Lamotrigine (Lamictal) is approved for maintenance treatment of adults with bipolar I disorder. It also appears to be better for treating bipolar depression than other mood stabilizers.
• Carbamazepine (Epitol, Tegretol) is a standard alternative antiseizure drug used for mood stabilizing. In 2004, the FDA approved an extended release form of carbamazepine (Equetro). Oxcarbazepine (Trileptal) is another drug that is similar to carbamazepine.