psychiatrictimes.com/view/l..., lithium’s renal risks-easily avoided with standard monitoring as long as one is prepared to move on to another agent if creatinine levels are rising-are even lower with low-dose lithium. The side effects that make people want to stop treatment (tremor, frequent urination, nocturia) are also much less frequent.
In general, the only significant problems with low-dose lithium are tolerability and thyroid issues. About 1 person in 10 to 15 gets dull, flat, and “blah” (the “lithium made me a zombie” effect, overrepresented in online testimonials). I explain to my patients in advance that if this happens, we’ll give up on it. This adverse effect does not diminish with time and generally persists even if the dose is reduced. Then there’s weight gain: is it dose-related? To my knowledge, this has not been established. I nurture some hope this is so.
That leaves the thyroid issue. Thyroid-stimulating hormone (TSH) levels must be monitored even with low-dose lithium. In women, induction of hypothyroidism is extremely common-and almost predictable in women with a family history of thyroid problems. The latter may be an uncovering of an autoimmune disorder. If your patient has a high-normal TSH value before lithium (eg, 2.5 mIU/L or above, and certainly above 3 mIU/L), she is at even higher risk for lithium-induced hypothyroidism.
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