Lithium: What It Treats, How It May Work, Side Effects, and Safe Use

A plain-language guide for people taking lithium, people considering it, and the families who help them.

Lithium is a prescription mood stabilizer used to treat mania and help prevent future episodes of bipolar disorder. It can also help some people with depression that has not improved enough, when added to an antidepressant. Safe use requires blood tests, attention to side effects, and a plan for illness and medication interactions. The right choice depends on the condition being treated, past response, other health needs, and your preferences.1,2

This guide is for people considering lithium, people already taking it, and family members who want to help. It explains what the evidence supports, where questions remain, and what to ask your care team. It does not provide a personal dose or a plan to change treatment on your own.

Key takeaways

• Lithium is FDA-approved to treat manic and mixed episodes of bipolar I disorder and to help prevent new episodes. It is sometimes added to an antidepressant when depression has not improved enough.
• The amount of lithium that helps is close to the amount that harms, so lithium levels need regular blood tests, even when you feel well. Kidney, thyroid, and calcium checks watch for longer-term effects.
• Warning signs of too much lithium include an abnormal heartbeat, new vomiting or diarrhea, a worse tremor, unsteady walking, slurred speech, blurred vision, ringing in the ears, and confusion. If you notice them, stop taking lithium and get help right away.
• Some medicines can change lithium levels, including ibuprofen, naproxen, some blood pressure medicines and water pills, SGLT2 diabetes medicines, and GLP-1 medicines such as semaglutide. Do not take over-the-counter anti-inflammatory pain relievers (NSAIDs), such as ibuprofen or naproxen, unless your prescriber says it is OK. Check with your prescriber or pharmacist before starting or stopping any of the others.
• If you become pregnant, do not stop lithium abruptly on your own. Contact your prescriber promptly, because untreated illness carries risks too.
• The evidence that lithium lowers suicide risk is mixed. Lithium does not replace a safety plan or crisis care.

Need urgent help? Call 911 if someone has a seizure or uncontrollable shaking of the whole body, faints or collapses, is extremely weak, has trouble breathing, cannot be woken up, or is severely confused. Call Poison Control at 1-800-222-1222 right away after an extra dose or an overdose, or if a child or anyone else swallows lithium, even if they feel fine. If an overdose may have been on purpose, call 911. For suicidal thoughts or a mental health crisis, call or text 988 or chat at 988lifeline.org. If you think lithium may be building up in your body, stop taking it and call your prescriber or Poison Control now, or go to the nearest emergency room. Do not restart until a clinician says it is safe. Lithium toxicity can happen even when your last blood level was in the usual range. See the warning signs of lithium toxicity.1,3,4,5,6

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What is lithium?

Lithium is a prescription mood stabilizer with an important role in bipolar disorder. It can treat mania and help prevent future mood episodes. Clinicians also use it for some conditions that are not on its U.S. Food and Drug Administration (FDA) label. This is called off-label use. Its value depends on the treatment goal, the person’s response, and whether safe monitoring is practical. Taking lithium does not, by itself, establish a diagnosis.2,5,7

Lithium is a chemical element. Prescription products use lithium carbonate or lithium citrate to deliver the active lithium ion. These are medicines with controlled formulations, individualized doses, and blood-level monitoring.1,5

Lithium belongs to its own treatment category. Valproate and lamotrigine are anticonvulsants, which are seizure medicines that are also used to stabilize mood. Lithium is not an anticonvulsant. It is also different from an antidepressant, an antipsychotic, or a short-term sedative. These medicines can have overlapping uses, which explains why someone may receive lithium alongside another treatment. The combination should have a clear purpose, such as controlling an acute manic episode or treating depression that persists.2,7,8

John Cade published his early report on lithium and manic illness in 1949.9 Modern use rests on later clinical research, not on age or tradition alone.7,8 Lithium is still used because it can both treat mania and help prevent new episodes.5,10 A useful treatment plan aims for safe sleep, steady judgment, meaningful relationships, and the ability to take part in daily life.

The goal is not to erase someone’s personality. Still, feeling emotionally flat or mentally slowed deserves attention. Depression, poor sleep, other medicines, thyroid problems, and lithium itself may contribute.5 Tell the clinician what changed and when. If slowing comes on suddenly, or comes with unsteadiness, confusion, slurred speech, or unusual sleepiness, treat it as possible lithium toxicity and follow the urgent steps.5 In a study of 262 people with bipolar disorder, those taking lithium scored about the same on memory and thinking-speed tests as those who were not. The authors concluded that lithium, used as prescribed, did not seem to meaningfully harm thinking skills. That study tested thinking skills, not emotional flatness.11 Being less impulsive is not the same as losing all pleasure or motivation, and those experiences should not be dismissed.

What does lithium treat?

In the United States, lithium is approved to treat manic and mixed episodes of bipolar I disorder and to help prevent new episodes. Clinicians also use it off-label for some other conditions, such as depression that has not improved enough with an antidepressant.2,5 “Off-label” means a use is outside a specific product’s FDA labeling. It does not automatically mean the treatment is inappropriate. The important questions are how good the evidence is and why that use fits this person.

The FDA column below uses the current U.S. label for immediate-release lithium carbonate tablets and capsules. That label covers lithium used alone for bipolar I disorder in people age 7 and older, both for treating manic or mixed episodes and for ongoing (maintenance) treatment. Do not transfer this age boundary to every lithium product. Product-specific details appear under What forms of lithium are there?5

The table below summarizes each use, its U.S. label status, the evidence, and its main limits.

Lithium is not an automatic choice for ordinary mood changes, grief, stress, anxiety, ADHD, or a personality disorder diagnosis. A prescription should follow an assessment with a specific, measurable target.

How does lithium work?

Lithium’s complete therapeutic mechanism is not established. It affects several systems inside and between cells. The evidence does not support explaining bipolar disorder as a lithium deficiency or saying that lithium simply corrects a chemical imbalance. Laboratory findings help researchers understand possibilities; they do not prove why a particular person improves.5,23,24,25,26,27,28,29

An analogy is a network of traffic signals. Lithium may influence how strongly signals travel, how cells respond, and how activity changes over time. It is not one switch that turns a single brain chemical up or down. The analogy describes coordination, not a literal wiring repair.

Deeper reading: five proposed pathways

• Messages inside cells. Inositol helps cells relay incoming signals. Lithium affects enzymes involved in recycling it. Experiments in lab-grown nerve cells and in a simple amoeba support an effect on this messaging system, but its exact contribution to mood improvement remains uncertain.23
• GSK-3. This enzyme helps regulate many cellular activities. Lithium can inhibit it, directly and through other pathways. Strong laboratory evidence identifies it as a target; that does not make it the single proven explanation for treatment response.24,26
• Glutamate and dopamine. These signaling chemicals help regulate activity, motivation, and other functions. Animal and cell studies show that lithium can change glutamate handling and signaling downstream of dopamine receptors. Describing it as simply lowering dopamine or raising serotonin would miss this complexity.25,26
• Biological timing. Sleep and daily rhythms are closely tied to mood. One study of 193 people with bipolar disorder, and of skin cells grown from 59 of them, linked circadian features with lithium response. These associations are promising, but do not establish a routine test that predicts success.27
• Cell resilience and plasticity. Rodent-cell experiments show effects on growth-related signals such as BDNF and on responses to cellular stress.28 A small study of neurons grown from the skin cells of six people with bipolar disorder found that lithium calmed overactive neurons only in cells from people whose illness had responded to lithium. These findings do not prove that treatment repairs brain damage or prevents dementia.28,29

How well does lithium work for mania, prevention, and depression?

During mania, a person may sleep very little without feeling tired, speak rapidly, take unusual risks, or become extremely irritable. Some episodes also include depressive symptoms, called mixed features. Lithium’s purpose is to reduce the episode. It is not an instant rescue medicine. Response is assessed over days and weeks, and urgent or severe symptoms may require hospital care or additional medicines.7

Maintenance means continuing treatment after the episode improves to reduce the chance of another one. It does not mean that someone is currently ill. Prevention is judged over months and years, using the person’s previous pattern as part of the discussion.

The BALANCE trial gives one concrete example. The trial followed 330 people age 16 or older with bipolar I disorder for up to two years. New treatment for an emerging mood episode was needed by 59% of those assigned lithium, 69% of those assigned valproate, and 54% of those assigned both. Lithium did better than valproate; the result was statistically significant, but only just. Combination treatment was not clearly better than lithium alone. Participants first had to tolerate both medicines, and treatment was not blinded. These results cannot predict an individual’s outcome.12

For an existing bipolar depressive episode, the picture is less clear. In the eight-week EMBOLDEN I trial, lithium did not significantly outperform placebo on the main depression rating scale, while quetiapine did.13 Even so, CANMAT/ISBD, a guideline group from Canada and other countries, lists lithium as a first-line option for bipolar I depression. It looks at evidence from every phase of the illness. In contrast, the 2023 U.S. VA/DoD guideline does not suggest lithium alone for a current episode of bipolar depression. It puts quetiapine first and lists lithium only as one part of a combination with lamotrigine. These recommendations answer somewhat different questions and weigh the evidence differently.7,8

For major depression without bipolar disorder, lithium is generally considered as an addition when an antidepressant has not helped enough. NICE, a U.K. guideline organization, includes this specialist option.2 A 2025 U.K. trial studied 212 adults whose depression had not improved enough with earlier treatment. Over one year, those assigned to add quetiapine had fewer depression symptoms overall than those assigned to add lithium. It was an open-label comparison, not proof that lithium never helps.14

A July 2026 analysis adds caution. Its standard analysis favored adding lithium. But the benefit was no longer clear after the authors adjusted for small studies and for possible publication bias, the chance that studies with weak results were never published. Most lithium studies were older and did not use today’s usual definition of treatment-resistant depression. Lithium remains an option worth discussing, with realistic expectations rather than a promise of success.15

How do you know lithium is helping?

For acute symptoms, the clinician reviews improvement over the first several weeks alongside tolerability and blood levels. For depression augmentation, agree on a review point and what would count as meaningful improvement. For prevention, the benefit is judged over months and years. Feeling well is part of the intended result. It does not by itself show that medication is unnecessary. Trials assess these different goals over different periods.12,13,14

Choose a few treatment goals before starting. Examples include sleeping on a steady schedule, having fewer racing thoughts, going back to work, or preventing the kind of episodes that have led to a hospital stay in the past. A symptom diary can make changes easier to discuss. A better score on a mood scale, full remission, fewer future episodes, and better daily functioning are related but different outcomes.

Research links better lithium response with certain illness patterns: episodes in which mania is followed by depression and then a period of wellness, no rapid cycling, and no psychotic symptoms. A family history of bipolar disorder, a shorter illness before starting lithium, and a later age of onset were also linked to better response. These are group-level clues with important study limitations, not rules that guarantee success or exclude someone from treatment.30

If lithium is not helping enough, the team should check the target diagnosis, actual dose-taking, blood-sample timing, interactions, side effects, sleep, and substance use before deciding what to change.8 Difficulty taking a medicine or getting laboratory tests is a treatment problem to solve together. It is not a personal failure.

Does lithium lower suicide risk?

Lithium has important evidence suggesting a protective effect, but the research is not uniform. Suicide deaths, attempts, self-harm, suicidal thoughts, and hospital admissions to prevent suicide are different outcomes. A finding about one should not be presented as a finding about all of them.

An influential 2013 review found fewer suicide deaths with lithium than placebo in randomized trials. The often-quoted result came from 4 of the review’s 48 trials. Events were rare, and the same review did not find a clear reduction in deliberate self-harm. It would be misleading to turn that result into one promised percentage for every patient.31,32

Later findings were less certain. A 2022 review of randomized trials found suicide rates of about 0.2% with lithium and 0.4% with placebo or usual care. That difference was not statistically clear. These were pooled results from different populations and follow-up periods, not a personal annual risk estimate.32

A U.S. trial reported in 2022 enrolled 519 veterans with depression or bipolar disorder who had a recent suicide-related event. Compared with adding a placebo, adding lithium to usual care did not reduce a combined outcome of repeat suicide-related events. The trial was stopped early because it was unlikely to show a benefit. The combined outcome included suicide attempts, interrupted attempts, hospital stays to prevent suicide, and suicide deaths. Adherence and achieved lithium levels were limitations; the result should neither be ignored nor stretched into proof that every possible protective effect is absent.33

A 2025 review of trials found estimates favoring lithium for suicide deaths and attempts, but neither result was statistically conclusive. Rare events and differences among trials limited certainty.34

Studies of people in everyday care, including a large one from Sweden, link lithium treatment with fewer suicide-related events. That study counted suicide attempts and suicide deaths together. It compared the same people during times on and off each medicine, and it found fewer events during lithium treatment but not during valproate treatment. Comparing people with themselves removes some differences between people, but other things that change over time can still affect the results, so this kind of study cannot prove cause and effect.35

A 2026 study used U.S. veterans’ health records and was designed to imitate a clinical trial. It looked at adding lithium to other treatment for depression or bipolar disorder. Over 10 years, it did not find a clear drop in suicide deaths or other suicidal behavior. Like other record-based studies, it may be affected by differences between groups, and it could not check whether people took lithium as prescribed, their dose, or their blood levels.36

Studies comparing lithium with valproate have had mixed results. A September 2026 study and review found no clear overall difference between the two medicines. Smaller analyses within that paper pointed in different directions and need confirmation. Different comparators and outcome definitions help explain why studies can seem to disagree.37

The practical conclusion is that possible suicide-related benefit can inform a broader treatment decision. Lithium cannot eliminate risk and does not replace urgent assessment, psychotherapy, a safety plan, or crisis care. Discuss safe storage of medicines, and ask whether smaller supplies would help when overdose risk is a concern.6,38

If safety is at risk: In the United States, call or text the 988 Suicide & Crisis Lifeline at 988, or chat at 988lifeline.org, for suicidal thoughts or a mental health crisis. Call 911 or go to an emergency department for immediate danger or a life-threatening emergency. If someone may have taken extra lithium on purpose, call 911 and do not leave them alone, even if they seem fine. Do not wait for lithium to start working.4,6

Is lithium orotate the same as prescription lithium?

No. Lithium supplements, such as lithium orotate or lithium aspartate, are not an interchangeable replacement for prescription lithium.39,40 A small number printed on a supplement bottle may refer to elemental lithium, while prescription capsule and tablet strengths describe a lithium salt.1,40 Do not substitute products or try to convert the dose yourself. Once absorbed, lithium from a supplement is expected to act like the lithium in your prescription, so it may add to the lithium in your body. Do not take a lithium supplement with prescription lithium unless your prescriber tells you to.41 Trace lithium in drinking water has been linked with health outcomes in population studies, but those studies do not establish a useful or safe treatment dose.40,42

Can lithium prevent dementia?

Research into dementia and aging is continuing. A 2025 study linked lithium changes in human brain samples with Alzheimer’s disease and tested lithium interventions in mice. The mice got tiny amounts of lithium in their drinking water. This kept their blood lithium near natural levels, far below the levels used in prescription treatment. That work offers hypotheses to test, not evidence that taking lithium orotate prevents dementia in people. Laboratory neuroprotection and proven clinical benefit are different claims.42

In a small 2026 randomized trial, 80 adults aged 60 or older with mild cognitive impairment (mild memory or thinking problems) took low-dose prescription lithium or a placebo for two years. Lithium did not clearly slow decline on the study’s main memory tests, brain scans, or blood marker. Larger trials are needed.43

How does lithium compare with other bipolar medicines?

The right comparison depends on whether treatment targets mania now, depression now, or future episodes. This table covers selected adult uses, not every treatment option. Some of these medicines are also approved for certain uses in children or teens, with different age limits. FDA approval belongs to a particular product and indication. An off-label use may still be appropriate.7,44,45,46,47,48,49 For a fuller comparison, see Mood Stabilizers Demystified.

The table below compares lithium’s main alternatives by role and by limits.

Three of these medicines carry FDA boxed warnings. Lamotrigine’s warning is about serious rash. Divalproex’s is about liver failure, pancreatitis, and harm to an unborn baby, including birth defects and lower IQ. Carbamazepine’s is about serious skin reactions and serious blood-cell problems.44,45,46 The antipsychotics in this table carry a boxed warning with two parts. First, older adults with dementia-related psychosis have a higher risk of death when treated with antipsychotics, and these medicines are not approved for that use. Second, antidepressants raised the risk of suicidal thoughts and actions in children, teens, and young adults in short-term studies. Anyone taking one of these medicines should be watched closely for worsening mood or suicidal thoughts, especially in the first few months and after any dose change.47,48,49 For suicidal thoughts or a mental health crisis, call or text 988. For immediate danger, call 911.6 Pregnancy planning requires an individual review for every option.44,45,46,47,48,49 Medication works within a broader plan that can include psychotherapy, steady sleep routines, substance-use care, and family education.10

What are the warning signs of lithium toxicity?

Lithium carries an FDA boxed warning about toxicity. Treatment needs a clear safety plan: when to take it, when to have blood work, who reviews the results, and whom to call during illness. A dose that suited you last month may need review after dehydration, a kidney problem, or a medication change.1,50

Warning signs of too much lithium include:

• an abnormal heartbeat (slow, fast, or irregular)
• vomiting or diarrhea that is new or getting worse
• drowsiness or weak muscles
• clumsiness or unsteady walking
• a tremor that is worse or coarser than usual, or muscle twitching
• blurred vision or ringing in the ears
• slurred speech or confusion

When lithium builds up slowly, there may be no vomiting or diarrhea at all.1,4,5,50,51,52

If you think lithium may be building up, stop taking lithium and get help right away. Call your prescriber or Poison Control at 1-800-222-1222 (free, 24 hours a day), or go to the nearest emergency room. Do not wait for the next scheduled blood test. Symptoms can occur even when a recent level was in the usual range. Do not restart until a clinician says it is safe. For fainting, light-headedness, a new abnormal heartbeat, or shortness of breath, get emergency care right away.1,4,5,50,51,53

Call 911 if the person has a seizure or uncontrollable shaking of the whole body, faints or collapses, is extremely weak, has trouble breathing, cannot be woken up, or is severely confused. Do not let an impaired person drive. For an accidental extra dose, a possible overdose, or if a child or anyone else may have swallowed lithium, call Poison Control at 1-800-222-1222 right away, even if the person feels well. If it may have been on purpose, call 911 and do not leave the person alone. Have the container available. Do not make the person vomit or try home remedies unless Poison Control or a clinician tells you to.3,4,6,52,54

This emergency advice differs from a planned decision to stop treatment. When there is no suspected toxicity, discuss changes with the prescriber and plan them together.

What forms of lithium are there?

Prescription products supply the active lithium ion through a salt. Carbonate is used in solid forms; citrate is used in the oral solution. The product name, strength, and release type all matter. FDA records now list these prescription forms: capsules, immediate-release tablets, extended-release (slow-release) tablets, and a generic lithium citrate liquid. A database listing does not guarantee that a particular pharmacy has stock.55,56,57,58

Eskalith and Eskalith CR are older brand names that are no longer marketed in the United States. Generic carbonate products remain available.52 Many immediate-release product labels, including the FDA reference label, cover bipolar I mania, mixed episodes, and maintenance from age 7. So does the current U.S. oral solution label. The Lithobid label and generic extended-release labels say safety and effectiveness below age 12 have not been established and do not recommend use at those ages. One product’s age boundary does not automatically apply to another.1,51,53,60

Milligrams on a carbonate capsule describe the salt’s mass. “Elemental lithium” describes the lithium portion itself. Liquid labels may use milliequivalents, abbreviated mEq. A blood result measures concentration in blood. These numbers are different measurements, not interchangeable dose instructions. Ask the pharmacist to check any conversion.1,51 Do not substitute lithium orotate supplements for a prescription.40

Take the prescribed product on its prescribed schedule. Taking it with food may help nausea.1 Ask for a missed-dose plan suited to your schedule; never double a dose to catch up. If you are unsure whether you already took a dose, call the pharmacist rather than guessing. Arrange refills before you run out. Review a change in release type, schedule, or product with the pharmacist and prescriber; repeat levels may be needed.50,52,59

Why do you need lithium blood tests if you feel well?

After absorption, lithium is not broken down by the liver. The kidneys remove it in urine. Changes in kidney function, water, or sodium balance can alter how much stays in the body. Lithium has a narrow therapeutic window: the amount that helps can be close to the amount that causes harm. This is why symptoms and blood tests both matter.1

A lithium result commonly appears as mmol/L or mEq/L. Because each lithium ion carries a single charge, these have the same numerical value.1 The printed laboratory range is a reference, not your personal target. A level suitable for short-term mania may be higher than the level chosen for long-term prevention or for an older adult.61,62 NP Fady’s guide to lithium levels, lab timing, and Inland Empire heat explains how to read a result with your team.

When should the blood be drawn?

Many teams use a blood sample about 12 hours after the last dose. This standardized timing helps compare results. With twice-daily dosing it is usually before the morning dose. With once-nightly dosing, a morning sample about 12 hours after the evening dose is not the lowest point before the next dose. Even so, an expert task force recommends this timing and uses the same target ranges as for twice-daily dosing. Morning-only or unusual schedules need specific instructions. The Lithobid and generic extended-release labels describe an 8-to-12-hour interval; immediate-release and oral solution labels specify 12 hours. Follow your team’s instructions and report exactly when you took the last dose. Do not rearrange the schedule yourself.1,53,60,61

After a dose change, lithium often needs about five to six days to reach a new stable pattern in someone with normal kidney function. It can take longer with reduced clearance. An early safety test and a later steady-state test answer different questions. The U.S. immediate-release label calls for an initial level after three days; U.K. NICE guidance uses one week, then weekly until stable. Your clinician chooses the plan.1,38,61

What lithium level is the target?

There is no single normal lithium level for everyone. Your prescriber sets a target for your situation. The examples below come from U.S. labeling and expert groups; they are not self-adjustment instructions.

The extended-release Lithobid label uses older wording and lists different ranges. If you take an extended-release product, ask which target your team is using.53 A 2026 review of 14 observational studies supports lower, age-adjusted targets and individualized monitoring for older adults. No included study looked separately at the oldest adults, and the review does not set one best level for every older adult.63

Which tests do you need on lithium, and how often?

Most people taking lithium need regular lithium levels plus kidney, thyroid, and calcium tests. How often depends on how long you have taken lithium and on your risk factors. Some schedules in the table come from U.K. guidance (NICE and the NHS). They are labeled as U.K. guidance because they are not U.S. label requirements. Local plans may differ.2,38,50 U.S. labels differ by product. The Lithobid label advises level checks twice a week during acute treatment and at least every two months during stable maintenance. Ask which schedule applies to you.53

The table below lists each test, what it checks, and common timing.

Testing is also needed after important interactions, illness, or concerning symptoms. Pregnancy, older age, changing kidney function, and inconsistent intake may require more frequent checks. Urine tests, detailed kidney studies, or parathyroid testing are selected for a clinical question, not routinely ordered in full for everyone. Know who will contact you with results and what to do if you hear nothing.50

Who needs extra caution?

The U.S. immediate-release lithium labels say to avoid lithium in severe kidney impairment (creatinine clearance, a measure of kidney filtering, below 30 mL/min). The extended-release Lithobid label also warns that poor kidney function raises the risk of toxicity. Milder kidney impairment calls for a more cautious plan, with slower dose changes and more frequent blood tests.1,5,53 Existing thyroid disease may be managed alongside lithium. Significant heart disease needs special review.5,53

The U.S. labels for lithium capsules, tablets, and oral solution say lithium should be avoided in known or suspected Brugada syndrome, an inherited heart-rhythm condition. Before starting, tell the team about unexplained fainting, a family history of Brugada syndrome, or a relative who died suddenly and unexpectedly before age 45. In these cases, the labels advise a review by a heart specialist. Also tell the team about any breathing problems. After starting, get emergency care right away for fainting, light-headedness, a new abnormal heartbeat, or shortness of breath. Some conditions, such as an allergy to an ingredient in the product, mean it should not be used at all. Other conditions call for caution or a specialist’s advice.1,5,51,52,53

What are the side effects of lithium?

Mild nausea or a fine tremor can appear early. Some effects settle; others need a treatment change. New symptoms after months of stability deserve attention. Fatigue, slower thinking, weight change, acne, or sexual problems should be discussed without assuming lithium is the only cause. Depression, thyroid illness, other medicines, and sleep problems can contribute.11,52,64,65

The table uses four levels of urgency. Routine: mention it at your next visit or call during office hours. Same day: call your prescriber’s office today. Urgent: get medical advice now from your prescriber or their after-hours line; if you cannot reach them quickly, go to an emergency department. For a possible overdose or too much lithium, you can also call Poison Control at 1-800-222-1222. Emergency: call 911 or go to the nearest emergency department.

Can lithium affect the kidneys?

Lithium can affect the kidneys in two main ways. It can make urine less concentrated, so the body loses more water. It can also be associated with reduced filtering function over time. Other, less common kidney problems can also occur. Frequent urination does not, by itself, prove progressive kidney damage. Call your prescriber the same day about new swelling of your hands, feet, or ankles.5,52,64

When the kidneys do not respond properly to the hormone that helps save water, the condition is called nephrogenic diabetes insipidus.66,67 Some specialists now call it arginine vasopressin resistance (AVP-R).68,69 It differs from diabetes mellitus, the condition involving high blood sugar. Report heavy urination and persistent thirst. Do not restrict water to manage the problem yourself. Do not cut back on salt or start a water pill or an anti-inflammatory pain reliever for it on your own; some treatments used for this condition can raise lithium levels. A clinician may reassess lithium and consider treatment, sometimes with kidney-specialist help.5,66,67

Long-term kidney findings are mixed. A Swedish study of 10,946 people starting lithium or valproate found similar risks of worsening kidney disease overall during follow-up. Higher lithium levels were associated with acute kidney injury.70 A Danish study of 6,659 people with bipolar disorder found more kidney abnormalities among lithium users. But severe kidney problems were rare. Lithium users also had more blood tests, and more testing can find more abnormal results.71 These are observational studies, and patient selection, monitoring, duration, and other illnesses affect the results. They do not show that lithium always damages kidneys or that it carries no kidney risk.70,71 A 2025 Hong Kong study linked lithium with a mildly higher risk of moderate chronic kidney disease. The risk was higher with higher lithium levels or more episodes of high levels. The study did not link lithium with more severe kidney disease or kidney failure. A 2026 Dutch study found that most long-term users lost kidney filtering faster than the average for adults in general, more so with longer use and higher levels.72,73

If filtering function declines, the team considers its pace, past toxicity, other causes, and lithium’s benefit. A 2025 Swedish study found that, on average, decline slowed after lithium was stopped. A 2026 Dutch study, in which fewer people stopped lithium, did not find a clear change in how fast filtering declined. Neither study can predict what will happen for one person.73,74 Continued lithium, closer monitoring, or a planned switch may each be reasonable in different circumstances.74

How can lithium affect the thyroid and calcium?

Lithium can slow the thyroid. Less often, an overactive thyroid can occur. Thyroid problems can affect energy, weight, thinking, and mood. An underactive thyroid can often be treated while lithium continues.5,71 Lithium can also raise calcium through effects on the parathyroid glands, which help control calcium. Persistent elevations need evaluation. They may not go away after lithium is stopped, and some people need specialist treatment, sometimes surgery.5,53,71

The prescriber may address side effects by checking the level and interacting medicines, changing the formulation or timing, or treating a specific problem. These are supervised options, not instructions to adjust treatment yourself.

Rarely, serious neurologic problems persist after lithium toxicity. Published reports describe problems such as lasting balance or coordination difficulties, but the true frequency is unknown. This is another reason to act promptly when warning symptoms develop.5,75

Which medicines interact with lithium?

A medication can change lithium clearance, change fluid balance, or add a separate nerve-related risk. Some combinations are useful with monitoring. The safe response is a medication review, not abruptly stopping every drug in the table. The table shows common examples, not every interaction.

In June 2026, the European Medicines Agency’s drug safety committee began reviewing a possible link between GLP-1 medicines and higher lithium levels. It asked companies that sell lithium in Europe for more information by August 26, 2026.86 As of September 30, 2026, no conclusion or label change had been announced, and the U.S. lithium labels checked for this guide did not list this combination.1,5,51,53 The review does not mean that everyone taking both medicines will develop toxicity.86

Bring one list that includes prescriptions, pain relievers, cold medicines, supplements, and recreational substances. Tell dental, surgical, urgent-care, and emergency teams that you take lithium before they prescribe medicines or give instructions about fasting. Lithium can make some medicines that relax muscles during general anesthesia last longer.1,52 For a planned procedure or a course of electroconvulsive therapy (ECT), ask for written instructions about lithium and fasting. Before ECT, your team may pause or stop lithium because it can make memory and thinking side effects worse. Do not stop lithium on your own.87

What causes lithium toxicity, and how is it treated?

Acute toxicity happens when someone who does not normally take lithium swallows a large amount at one time. Chronic toxicity is buildup during ongoing treatment, such as after dehydration or reduced kidney clearance. Acute-on-chronic toxicity means an extra ingestion in someone already taking lithium. You do not need to identify the type before seeking help. For a possible overdose, an extra dose, or suspected toxicity, call Poison Control at 1-800-222-1222 or get urgent medical advice right away, even if the person feels well. Do not take more lithium until a clinician says it is safe. If an overdose may have been on purpose, call 911. Call 911 if the person has a seizure or uncontrollable shaking of the whole body, faints or collapses, is extremely weak, has trouble breathing, cannot be woken up, or is severely confused. Symptoms can be delayed after an ingestion, so feeling well at first is not proof of safety.3,4,6,51,53,88

Hospital care may include repeated blood tests, fluids chosen for the person’s condition, and dialysis in severe cases. Dialysis removes lithium from the blood. These decisions depend on symptoms, kidney function, levels over time, and the kind of exposure.4,88

The daily-life steps and the sick-day plan below help reduce avoidable risk. They do not replace urgent assessment when toxicity is possible.

Living with lithium: heat, fluids, salt, caffeine, and alcohol

Lithium care works best when the plan fits your life. That includes meals, exercise, pregnancy plans, transportation to blood tests, and the people you want involved. Ask for a plan you can understand and follow. Trouble taking a medicine is a problem to solve together, not a personal failure.

Drink enough fluids every day, and keep your usual salt intake steady. Do not suddenly start a low-salt diet, take extra salt, or force large amounts of water to change your lithium level unless your team tells you to. A person with heart failure, kidney disease, or a fluid restriction needs a plan that respects those conditions. Discuss fasting, major diet changes, and exercise in hot weather before starting them. Tell your prescriber before a big increase or decrease in hard exercise, because your lithium level may need a check.1,5,50,89

Heat, saunas, heavy sweating, fever, vomiting, and diarrhea can dehydrate you and raise your lithium level. Try not to get overheated or dehydrated, especially during exercise and in hot weather. Ask your team ahead of time what kind and how much fluid to drink on hot days. If you have been sweating more than usual or have had diarrhea, you may need more fluid and salt, so call your prescriber right away, before your next lithium dose. Drinking too much liquid can also be unsafe.5,51,89 NP Fady’s guide to lithium levels, lab timing, and Inland Empire heat covers hot days and local cooling resources in more detail.

Before travel, arrange refills and ask how to handle time-zone changes and laboratory appointments.90 Keep a current medication list available.52

Can you drink coffee on lithium?

Coffee does not require an automatic ban. However, a sudden large reduction in caffeine can raise lithium levels in some people; a large increase may lower them. Evidence includes case reports, so the size of the effect cannot be predicted. Tell your prescriber before making a major change in coffee or energy-drink use.83

Can you drink alcohol on lithium?

Alcohol can add to drowsiness and dehydration, and dehydration can raise your lithium level. Avoid it when starting lithium or after a dose increase until you know how you feel, and discuss whether drinking is appropriate for your illness and other medicines.89

Can you drive while taking lithium?

Do not drive or operate machinery when you first start lithium or after a dose change until you know how it affects you, or any time you feel sleepy, dizzy, shaky, or mentally slowed.5,89

What about supplements and recreational drugs?

Ask before adding supplements, recreational substances, or over-the-counter medicines. Recreational drugs can change lithium levels, and some, such as ecstasy, can cause dehydration. Products described as natural have not been tested well enough to show they are safe with lithium.50,89,91 Do not combine lithium with psilocybin (magic mushrooms), LSD, or similar psychedelic drugs. In one study of reports people posted online, almost half of the 62 reports about mixing lithium with these drugs described a seizure. Reports like these cannot show how often this happens, but the warning is serious. Do not stop lithium to take them. If you have already combined them, tell your prescriber. Call 911 for a seizure.92 See the interaction table for specific medicines.

How do you make a lithium sick-day plan?

Ask your team to write down whom to call during office hours and after hours, when you need same-day testing, and what to do if you cannot keep fluids down. Ask specifically about fever, repeated vomiting or diarrhea, and medicines that cause major fluid loss. Do not assume a routine test next month will catch a problem happening today.

If an illness causes repeated vomiting or diarrhea, a high fever, or heavy sweating, or you are not eating and drinking much, call your prescriber right away, and do not take your next lithium dose until you have talked with them. Ask when to restart and whether you need a blood test. If you cannot reach your prescriber or their after-hours line quickly, go to an emergency department. If you also have any other warning sign of too much lithium, such as confusion, unsteady walking, slurred speech, an abnormal heartbeat, or a much worse tremor, stop taking lithium and get help right away. Call 911 if the person has a seizure or uncontrollable shaking of the whole body, faints or collapses, is extremely weak, has trouble breathing, cannot be woken up, or is severely confused. For a possible overdose or an extra dose, call Poison Control at 1-800-222-1222 right away, even if the person feels well.1,3,4,5,51,52,59 This emergency advice is different from choosing to stop long-term treatment.

Can you take lithium during pregnancy?

Yes, some people do, with a coordinated plan. ACOG is the U.S. professional group for pregnancy doctors. It says not to stop a mood stabilizer just because of pregnancy; valproate is the exception. Both treatment and untreated illness carry risks. Severe depression, mania, or psychosis can disrupt sleep, eating, safety, relationships, and prenatal care. Treatment changes also carry risks.93

If you are planning pregnancy, arrange a visit with your psychiatric prescriber and obstetric clinician before trying to conceive. Review past episodes, what happened during previous medication changes, other treatments, and your support system. If you discover a pregnancy, contact your prescriber promptly. Do not abruptly stop lithium solely because of the positive test. The plan depends on your illness, treatment history, and pregnancy.94

What do the pregnancy numbers mean?

A large U.S. Medicaid study examined live births from 2000 through 2010. Heart malformations occurred in 2.41% of infants with first-trimester lithium exposure, compared with 1.15% without lithium exposure. That is about 24 versus 12 per 1,000 births in the observed groups. After accounting for measured differences, the relative risk was 1.65, with a 95% confidence interval of 1.02 to 2.68. Risk appeared higher at higher prescribed doses, but the study did not establish a dose with zero risk.95

These were heart defects, not the rate of all birth defects. The study relied on prescription and health records, could not remove every difference between groups, and did not include pregnancies ending before a live birth. These numbers cannot predict one baby’s outcome.95

Another study, using data from several countries, found more major birth defects overall after lithium use in the first trimester. Its estimate for heart defects alone was uncertain. Its comparison group was pregnancies affected by mood disorders without lithium. Different comparisons and definitions help explain why studies do not give identical estimates.96

Newer evidence also matters. An Australian study published in July 2026 looked at preterm births that started on their own. They occurred in 8.1% of pregnancies exposed to lithium and 2.4% of unexposed pregnancies. After adjusting for other factors, the risk was about twice as high (adjusted relative risk 2.18). The study also found associations with larger-than-expected babies and heart malformations. Only 234 pregnancies involved lithium. Studies that watch what happens, rather than assign treatment, cannot fully separate the effects of the medicine from those of the illness and other factors. These findings support careful obstetric follow-up, not stopping treatment on your own.97

How do lithium levels change during pregnancy and after birth?

Pregnancy can make the kidneys remove lithium faster. A dose that previously worked may become too low or too high. A study following 113 pregnancies found that lithium levels fell most in the middle of pregnancy, then rose again late in pregnancy and after birth. Clinicians use repeated lithium levels and kidney tests, symptoms, and the pregnancy course to guide treatment. Checks often become more frequent near delivery and during the early postpartum weeks.98

After lithium use in the first trimester, ACOG advises a detailed ultrasound in the middle of pregnancy (second trimester) that looks closely at the baby’s heart. A specialized ultrasound of the fetal heart may also be considered. Tell the team promptly about severe pregnancy vomiting, dehydration, preeclampsia, or major blood loss, because these can change lithium handling.93

Make a delivery plan before labor. The U.S. label tells prescribers to lower or stop the dose two to three days before the expected delivery date. Once the parent is medically stable after delivery, it says to restart the dose used before pregnancy, with close blood-level checks.5 U.S. and Canadian guidelines note that some experts pause lithium for a short time at the start of labor or before a planned induction or cesarean birth. The Canadian guideline says this is debated, and some specialists instead continue a stable dose with close monitoring.93,94 A small observational study found no abrupt rise in maternal levels around birth and did not support routine discontinuation in medically stable patients. About half of its 29 newborns had a health problem after birth, most of them mild and short-lived. The study had no comparison group and was too small to tell whether these problems were linked to the baby’s lithium level.99 Lithium reaches the baby before birth, so tell the baby’s clinician about it and ask how the baby will be watched after delivery. Floppiness, unusual sleepiness, or poor feeding in the baby needs prompt care. Call 911 if the baby has trouble breathing, turns blue or gray, or is hard to wake.5,93 Timing, kidney function, hydration, lithium levels, and relapse history all matter. Do not change your dose yourself. Follow the coordinated plan from psychiatry, obstetrics, anesthesia, and the newborn’s clinician.

How can you protect the weeks after birth?

The weeks after delivery deserve active planning. A review pooled studies of people with bipolar disorder. After birth, 66% of those who had no preventive medicine during pregnancy had a relapse, compared with 23% of those who did. Relapse meant any return of depression, mania, hypomania, or psychosis, or a psychiatric hospital stay, not psychosis alone. Only 60 women were in the medication group, compared with 385 without medication. This was not a randomized lithium-only comparison, and follow-up and treatment varied. It shows why medication decisions should include relapse risk after birth.100

If postpartum psychosis is the only time a person has had psychosis or mania, a specialist may recommend a prevention plan that starts lithium right after delivery. For people with bipolar disorder, the same review found that continuing preventive medicine during pregnancy appeared to protect against relapse after birth; that benefit is weighed against possible risks to the baby. This is different from treating ordinary postpartum sadness. Arrange protected sleep, help with feeding and other care, early appointments, and clear warning signs before the baby arrives.100

New hallucinations, false beliefs, paranoia, severe confusion, or manic behavior after childbirth may signal postpartum psychosis. Call 911 or go to an emergency department. Do not wait for a routine postpartum visit.101 Feeling little need for sleep, or being unable to sleep even when there is a chance to, can be a warning sign; call the prescriber right away. Make sure another responsible adult stays with the parent and baby while help is arranged.102 If there are thoughts of suicide or of harming the baby, call or text 988. Call 911 if anyone is in immediate danger.101

Can you breastfeed while taking lithium?

The U.S. product label does not recommend breastfeeding during lithium treatment; it calls for close infant monitoring if breastfeeding is chosen.5 NIH LactMed is more flexible. It notes that most sources do not treat lithium as a strict reason to avoid breastfeeding a healthy, full-term baby. This is especially true after 2 months of age, and when lithium is used alone rather than with other psychiatric medicines. It adds that lithium may be used by mothers of full-term babies who are willing and able to monitor their babies closely. Newborns, premature infants, and babies who are dehydrated or ill have greater difficulty clearing lithium.103 U.K. NICE guidance does not encourage breastfeeding while taking lithium, although it supports each family’s feeding choice. The U.S. Medication Guides for lithium tablets, capsules, and oral solution tell patients not to breastfeed. Because guidance differs, this choice needs a joint plan.5,51,104

The evidence is limited. In one Swedish study of 30 closely monitored breastfed infants, two had unexpectedly high lithium levels during the first month. About 1 in 4 babies had poor growth in the first month, and four mothers were advised to breastfeed less and give more formula.103,105 After the first weeks, the babies’ lithium levels settled at barely measurable amounts, and apart from poor weight gain, the authors found no harmful effects. There was no untreated comparison group, and participating families had close follow-up. Reassuring findings in this setting do not establish safety for every baby or settle long-term developmental questions.105

If breastfeeding is considered, agree on the plan with both the lithium prescriber and the pediatric clinician before discharge. The plan should address maternal lithium checks, infant feeding and weight, and whether and when to check the baby’s lithium level, kidneys, and thyroid. Published monitoring schedules differ.103 Get prompt pediatric care if the baby:

• feeds poorly or is not gaining weight
• is unusually sleepy or restless
• seems floppy or stiff, or feels cold
• has vomiting, diarrhea, or fewer wet diapers
• has a fever or another illness

Call 911 if the baby is hard to wake, turns blue or gray, or has trouble breathing.5,103,106

Canadian CANMAT guidance also supports individualized feeding decisions. It does not recommend breast milk exposure to lithium for babies born early, babies born with kidney problems, or babies with illnesses that can cause dehydration. It also advises watching the baby for changes in behavior and muscle tone. Formula feeding, donor milk where appropriate and available, or a clinician-planned combination may be considered. The plan should account for treatment, sleep, the baby’s health, and the family’s preferences. Needing a different feeding plan is not a failure.94

Lithium for children, teens, and older adults

For children and teenagers prescribed lithium, make sure the young person understands the reason for treatment in age-appropriate language. Agree on who handles refills, reminders, school-day doses, and blood tests. Sports, hot classrooms, stomach illnesses, and changing schedules belong in the care plan. Invite the young person to describe side effects directly, rather than relying only on adult observations. Age approvals depend on the exact product and indication, as explained in the section on lithium forms.

Older adults often need lower lithium targets and closer checks of kidney function, falls, thinking changes, and other prescriptions.62,63 New confusion or poor balance should not automatically be dismissed as aging. Ask whether a laboratory’s printed range matches your personal target.

For anyone, practical barriers deserve practical help:

• Ask a pharmacist about a suitable formulation if swallowing is difficult. Do not crush or switch products without checking.
• Request large-print, translated, or verbal instructions if written directions are hard to use.
• Choose reminders that fit your day and clarify who reviews test results.
• Tell the office early if cost, insurance, transportation, or laboratory hours are making care difficult. Ask for help before stretching doses or skipping tests.

What if you want to stop taking lithium?

You can ask to review treatment at any time. Feeling well may mean treatment is helping, but side effects, medical changes, pregnancy plans, or personal preferences are valid reasons for a careful discussion.

A planned stop usually means lowering the dose slowly with a clinician’s guidance, then watching for mood symptoms that come back. An older study that followed people over time found more early relapses when lithium was stopped quickly than when it was stopped slowly. In that study, about 3 in 4 people had a new mood episode within 5 years of stopping, even though all had been stable on lithium alone. It does not supply a personal taper schedule. Decide how symptoms will be monitored and what treatment, if any, will replace lithium.38,107 If you think lithium may be building up, follow the steps for suspected toxicity instead.50 That is not a planned taper.

How can family members help?

Ask what help feels useful. Support should preserve privacy and independence, not turn a relative into a medication enforcer.

• Keep agreed appointment, blood-test, and refill reminders.
• Have an up-to-date medication list and the prescriber’s contact details.
• Agree which changes in sleep, energy, speech, spending, or mood should prompt a call.
• Know the illness plan and the warning signs of too much lithium.50
• Keep lithium and all medicines out of the reach of children. Talk about safe storage and who can help during a crisis.5,6
• Save the Poison Control number, 1-800-222-1222, in your phone. Know to call or text 988 for a mental health crisis or thoughts of self-harm, and to call 911 when a life is in danger.3,6,10
• Offer practical help with meals, transportation, childcare, and sleep.
• Listen when the person reports side effects or wants treatment reviewed.

Support helps, but no family can prevent every episode. Take care of your own health, too.10,108

Questions to bring to your prescriber

1. What symptom or future episode are we targeting, and why lithium for me?
2. What is my personal target level?
3. Exactly when should my blood be drawn after my last dose, and should I wait to take my next dose until after the test?
4. Who reviews my results, and how will I hear back?
5. What is my plan for fever, vomiting, diarrhea, or dehydration?
6. Which pain medicines, prescriptions, supplements, or diet changes should I check first?
7. What should I do if I miss a dose or take an extra dose?
8. What changes if I plan pregnancy, become pregnant, or want to breastfeed?
9. Which side effects should trigger a routine call, same-day assessment, or emergency care?
10. If I want to stop, what is our supervised plan?

Frequently asked questions

Is lithium addictive?

No. A return of mood episodes after stopping is different from addiction. Planned stopping should be gradual and clinician-guided.5,90

Does a lithium prescription prove I have bipolar disorder?

No. Lithium is also used for other reasons, including adding to an antidepressant for some people with major depression. In the United States, that use is off-label. Ask what your treatment targets.5,89

Will lithium change my personality?

The goal is stability and functioning. Feeling emotionally flat or mentally slowed deserves a treatment review, not dismissal.89

How long might I need lithium?

Often for years, especially when it is used to prevent bipolar episodes. The right length depends on your diagnosis, history, response, side effects, and preferences. Revisit the plan regularly.59,90

Can lithium toxicity happen without taking extra pills?

Yes. Illness, dehydration, kidney changes, and interactions can increase exposure during usual treatment.1,50

Can I take pain medicine or supplements with lithium?

Do not take over-the-counter anti-inflammatory pain relievers (NSAIDs), such as ibuprofen or naproxen, unless your prescriber says it is OK and plans any extra blood tests. Ask your prescriber or pharmacist before any new pain medicine or supplement.5,38,50,91

What if I miss a dose of lithium?

Follow your product-specific plan or ask your pharmacist. Never double up to catch up.5,51

What if I take an extra dose?

Call Poison Control at 1-800-222-1222 right away, even if you feel well. The call is free and confidential, 24 hours a day. Call 911 if someone has a seizure or uncontrollable shaking of the whole body, faints or collapses, is extremely weak, has trouble breathing, cannot be woken up, or is severely confused.3,4,51,52,59,109

What should I do about vomiting, diarrhea, or fever?

Call your prescriber right away, and do not take your next dose until you have talked with them. If you also have any other warning sign of too much lithium, stop taking lithium and get help right away. See the sick-day plan.1,59

Can I exercise or travel while taking lithium?

Usually, with a plan. Avoid getting overheated or dehydrated during exercise or hot weather, and ask how much fluid is right for you. Get refills before you go, and ask your prescriber how to time doses across time zones. Do not change your schedule alone.5,59,64,90

What should my family know?

With your consent, share your illness plan, warning signs, emergency contacts, and the practical support you want. Family education and caregiver support may help both you and your family. Help should respect your privacy and choices.10,108

Related reading on NP FADY

• Lithium Levels, Labs, Interactions, and Summer Heat
• Mood Stabilizers Demystified: Lithium, Lamictal, and Beyond
• Bipolar Maintenance: Staying On or Stopping Medication
• Bipolar Disorder: Planning Pregnancy and Postpartum
• Staying Well Through Pregnancy and the Postpartum Weeks
• Combining GLP-1s With Mood Stabilizers and Antipsychotics

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This article is for education and is not a substitute for diagnosis or treatment from a qualified health professional. Do not start, stop, or change medication without your prescriber’s guidance. Evidence last checked September 30, 2026.

If you or someone you know is in crisis

• Call 911 or go to your nearest emergency room for any life-threatening emergency.
• 988 Suicide & Crisis Lifeline — call or text 988, or chat at 988lifeline.org, available 24/7, free and confidential. En español: marque 988 y oprima 2, o envíe AYUDA al 988. Deaf or hard of hearing: 988 videophone (ASL) or TTY 711 then 988. Veterans: 988 and press 1, or text 838255.
• Crisis Text Line — text HOME to 741741.
• The Trevor Project (crisis support for LGBTQ+ young people) — call 1-866-488-7386, or text START to 678-678.
• National Sexual Assault Hotline (RAINN) — call 1-800-656-HOPE (4673) or text HOPE to 64673; free, confidential, 24/7. Online chat at RAINN.org/hotline.
• National Domestic Violence Hotline — call 1-800-799-SAFE (7233) or text START to 88788; 24/7, help in 200+ languages. Online chat at TheHotline.org. If your phone or computer may be monitored, calling from a safer device is an option.
• Riverside County — Inland SoCal Crisis Helpline 951-686-HELP (4357), 24/7 (Inland SoCal United Way / 211+, in partnership with RUHS-BH); Community Access, Referral, Evaluation and Support (CARES) Line 800-499-3008, 24/7.
• San Bernardino County — Access Unit (Behavioral Health Helpline) 888-743-1478, 24/7; Mobile Crisis/CCRT 800-398-0018 (24/7, all ages) or text 909-420-0560. Arrowhead Regional Medical Center (ARMC) has a dedicated walk-in adolescent psychiatric ER (ages 13–17).
• Children under 13 — call 911 for immediate danger, contact your county's mobile crisis team (they respond to all ages), or go to the nearest pediatric emergency room.
• California Peer-Run Warm Line (non-crisis — someone to talk to) — call or text 1-855-600-WARM (9276); daytime and evening hours, not a 24/7 line.
• NP Fady (non-emergency) — for routine scheduling or questions, call (909) 707-6261. This line is not monitored for emergencies.