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Using lithium in bipolar disorder

Vol. 2, No. 11 / November 2003

“Tips for Using Lithium in Bipolar Disorder” by West B. Magnon, MD, (Pearls, Current Psychiatry, September 2003) had some “do not try this at home” aspects to it.

For example, when Dr. Magnon said “Lithium, 900 mg/d, works fine,” I believe he was referring to 900 mg/d of lithium carbonate, because 900 mg of lithium is equivalent to 4,791 mg of lithium carbonate, a generally toxic dose. Also, to suggest that one dosage fits all flies in the face of decades of research.

More important, to say that “Gauging lithium blood levels is a waste of time, assuming you have checked for kidney disease” is a dangerous statement. Numerous examples exist of lithium toxicity induced by drug interactions or dehydration in patients without kidney disease.

James W. Jefferson, MD
Distinguished senior scientist, Madison Institute of Medicine
Clinical professor of psychiatry,
University of Wisconsin Medical School

Dr. Magnon responds

Dr. Jefferson’s comments reflect the standard thinking about use of lithium carbonate.

My points are:

  • I have not seen these so-called extensive studies about lithium toxicity
  • When given in reasonable, effective dosages, the patient responds without toxic effects.

Lithium does have some unpleasant side effects, such as tremor, and weight gain is common in some patients, especially women. Continuous lab testing is just not necessary, however.

West B. Magnon, MD Bradenton, FL

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