Lithium Treatment for Bipolar Disorder

Lithium is one of the oldest and most effective treatments in psychiatry — and one of the most misunderstood. Used well and monitored properly, it prevents mood episodes, reduces the risk of suicide, and helps many people with bipolar disorder stay well for years. This is an area Dr. Anindo Mitra (MBBS, MD Psychiatry, JIPMER) knows in depth: his MD research examined the clinical predictors of lithium response in 189 patients with bipolar I disorder, published in the Indian Journal of Psychiatry (2025). Care is available in-person in Gurugram and online across India.

Who this is for

This page is for people with bipolar disorder who are considering lithium, are already taking it, or want to understand it before deciding. It is written to help you make an informed choice through honest, balanced information — the benefits and the responsibilities.

Why lithium is valued

Among all treatments for bipolar disorder, lithium has some of the strongest evidence for:

  • Preventing relapse — reducing both manic and depressive episodes over the long term.
  • Reducing suicide risk — a benefit that is fairly unique to lithium among mood stabilisers.
  • Long-term stability — many people do exceptionally well on it for years.

For the right person, lithium is often the single most effective option, which is why it remains a first-line treatment worldwide despite newer alternatives.

What taking lithium involves

Lithium works within a specific range in the blood: enough to be effective, not so much as to cause problems. That is why treatment involves a clear, manageable monitoring routine:

  • Blood levels. Periodic blood tests check that your lithium level is in the right therapeutic range — especially after any dose change, and then at regular intervals once stable.
  • Kidney function. Because lithium is cleared by the kidneys, kidney function is checked before starting and monitored over time.
  • Thyroid function. Lithium can affect the thyroid, so thyroid tests are done periodically; if the thyroid is affected, it is usually easily managed and is not a reason to stop.
  • General health checks. Including calcium and, as appropriate, other parameters.

This monitoring is routine, not alarming — it is exactly what makes long-term lithium safe.

Staying safe on lithium

A few practical points keep lithium safe, and they are explained clearly at the start:

  • Hydration and salt. Dehydration (from illness, heat, vomiting, diarrhoea, or reduced fluid intake) can raise lithium levels. Staying well hydrated and keeping salt intake steady matters.
  • Other medications. Certain drugs — including some common painkillers (NSAIDs) and blood-pressure medications — can raise lithium levels, so always mention lithium to any doctor or pharmacist.
  • Recognising toxicity. Warning signs of a level that is too high include coarse tremor, vomiting, diarrhoea, drowsiness, confusion, or unsteadiness. If these occur, seek medical advice promptly and have your level checked.

Lithium in pregnancy and breastfeeding

Lithium requires special, individualised planning around pregnancy. It carries some risk, but for many women the risk of a bipolar relapse in pregnancy or postpartum is also serious, so decisions are made carefully by weighing both — ideally as preconception planning rather than in a hurry. Monitoring is adjusted during pregnancy and around delivery. If you are pregnant, breastfeeding, or planning a pregnancy, this is discussed thoroughly; see Perinatal Psychiatry. Do not stop or change lithium on your own if you discover you are pregnant — contact your psychiatrist urgently to plan safely.

Shared decision-making

Whether to take lithium is your decision, made together with clear information. Dr. Mitra will explain what the evidence says for your situation, what monitoring involves, and the alternatives (see Mood Stabilizers in Bipolar Disorder), so the choice genuinely fits your life and preferences. Lithium is never stopped abruptly; if reducing or stopping is appropriate, it is done gradually and planned in advance.

In-person in Gurugram and online across India

Available in-person at Athena Behavioural Health, Sector 47, Gurugram, and online across India via Zoom or Google Meet, in English, Hindi, Bengali, and Tamil. Blood-test monitoring is arranged locally wherever you are.

Safety and urgent help

If you have signs of lithium toxicity (marked tremor, vomiting, confusion, unsteadiness), stop taking the next dose and seek medical help urgently. For thoughts of self-harm or a crisis, contact emergency services, your nearest hospital, or Tele-MANAS on 14416. This page is educational and does not replace an individual consultation.

Book a consultation

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Frequently asked questions

Is lithium safe? Yes, for most people, when monitored properly. Regular blood tests keep the level in the safe, effective range and check kidney and thyroid function. Lithium's strong benefits — including reducing suicide risk — are a major reason it remains widely used.

How often will I need blood tests? More frequently when starting or after a dose change, then at regular intervals (often every few months) once you are stable, along with periodic kidney and thyroid checks. Your exact schedule is explained to you.

Does lithium damage the kidneys? Lithium is cleared by the kidneys and can affect kidney function over long-term use in some people, which is precisely why kidney function is monitored — so any change is detected early and managed. For many, long-term lithium is well tolerated.

Can I take painkillers with lithium? Some common painkillers (NSAIDs like ibuprofen) can raise lithium levels. Always tell your doctor or pharmacist you take lithium before starting any new medication, and ask which pain relief is safe.

Can I take lithium during pregnancy? It requires careful, individualised planning, ideally before conception, weighing the medication risk against the risk of relapse. It is not automatically stopped — decisions are made with you. Never change it yourself on discovering a pregnancy; contact your psychiatrist urgently.

What are the signs that my lithium level is too high? Coarse tremor, vomiting, diarrhoea, drowsiness, confusion, or unsteadiness. If these occur, seek medical advice promptly and get your level checked — often the cause is dehydration or a drug interaction.