Reader Question: Julie, what is the best lithium level?

All people with bipolar disoder know the medication called lithium.  Did you know that lithium is measured in the blood to make sure the dose is not too high? In the question below, Dyane asks how she can know what level works the best. I wrote a long answer- so be ready to become a lithium expert!

Hey Julie,

I have been taking lithium for the past 4 years. I think it’s a great drug, and I have accepted the fact that I need to take it for the rest of my life as long as it doesn’t poop out on me or destroy my organs. I wondered if you take it or have taken it, and if so, how low a dosage did you take? My other question is do you know ***how low*** do people ever go with lithium – of course everyone is different, everyone has different blood levels of it, etc., so that’s a difficult question to answer well, but I figured I’d throw it your way. I currently take 900 mg of lithium a night, with no adverse side effects (thank God) and my blood level is at the low end of the therapeutic range. .7 I think. THANKS for anything you can share with me! Take care, Dyane

Hi Dyane,

Your question has many levels- the kind of question I like!

First of all, drug efficacy as well as side effects are completely dependent on our physiology.  It’s about the brain and the liver as this is basically the train station for most drugs.  My coauthor Dr. John Preston has a theory that those who experience severe side effects tend to keep a med in the liver for a longer period- which means the meds stay in the body longer. Interesting theory.

Lithium, unlike most bipolar disorder medications is processed through the kidneys. Kidneys are sensitive creatures which is why people taking lithium absolutely must have blood tests to measure their lithium level.  I talk to a lot of people who take lithium and the main reason they go off of lithium even though it’s working is for kidney safety.  This is usually after taking the drug for many years.  You don’t have to be scared to take lithium- you just have to be careful.

I started lithium last year and it has profoundly changed my life. Though it’s basically an anti mania drug, it’s also used for serious depression.  I added Zoloft to the lithium and kept on my Lamictal. I also take Ritalin and use Ativan when I can’t sleep.

My lithium side effects were off the chart for months- weight gain, fogginess, apathy ( a very serious side effect), memory loss and sleepiness-  intense sleepiness. But I waited it out. Maybe I just gave my liver and kidneys enough time to process all of pills. I am depression free for the first time in ten years.  Interestingly,  my lithium levels have stayed the same even though my side effects have lessened considerably.

I’m glad the lithium is also working for you and you don’t have side effects. Awesome!

This means that my brain/body reacted differently to the lithium than yours. I wish I were more like you.

Regarding lithium levels: the goal is 1.0, but this is just a benchmark.  It’s mostly to make sure people don’t go in to lithium toxicity. All med dosages are based off average milligrams, but it’s common to go way under and way beyond the dosage with meds such as Lamictal.  For example, my mom takes 125 mg for her depression and I take 700mg.  Lithium dosage is more compact. Most people I know who take lithium are between 900-1200 mg. But this is not really the important statistic- it’s all about the lithium level in the blood.

The reason I’m writing an encyclopedia here is to point out that successful lithium use is a combination of a dosage that works with the minimum of side effects and a level as close to 1.0 as possible.  Your .7 level is very close to 1.0 and is not low at all. When my friend Sharon went to the hospital in a manic episode, her lithium level was at .3  That was too low for her and the mania broke through. But, this isn’t to say that a low level will not work for someone else. If it works, it works.  We just have to keep it from going too high. It’s so important to remember that when blood levels are too high it can lead to lithium toxicity which can ruin the kidneys.

I was in and out of an extremely severe depression for almost five years. Lithium with added Zoloft saved my life. To be honest, I would give up a kidney for this, but I prefer to stay healthy! This is why I get my lithium level checked regularly. I’m glad it works for you.  Lithium works well with other drugs, so if any of you reading this are desperate for relief, lithium may be the answer.

You are now an expert on lithium!  Julie