Overabundance of Thirst: A Potential Downside of Lithium Treatment
In the treatment of bipolar disorder, lithium is a commonly prescribed mood stabilizer. However, long-term use of this medication can lead to a condition known as nephrogenic diabetes insipidus (NDI), which affects the kidneys' ability to preserve and concentrate urine, potentially leading to dehydration.
NDI can manifest with symptoms such as excessive thirst and frequent urination. Approximately 70% of people taking lithium experience these symptoms, and the risk increases with longer duration of use, increased age, higher dosages, and using more lithium than prescribed.
To manage NDI, diuretics such as amiloride (Midamor) can be used. Amiloride is beneficial as it helps produce urine while keeping potassium levels stable. In a 2021 study, the diuretic triamterene (Dyrenium) was found to effectively manage a case of NDI for an 81-year-old woman with bipolar disorder and no history of diabetes insipidus.
Hydrochlorothiazide (Microzide) may also be recommended, but more research is needed on its effectiveness for NDI. Reducing sodium intake may also be advised to prevent excess water retention.
In the early stages, excessive urination due to lithium treatment is reversible when the dose is reduced or lithium is tapered off. However, if left untreated, severe symptoms of dehydration can occur, necessitating immediate medical attention. Signs of severe dehydration include diarrhea, disorientation, dry mouth, headache, insatiable thirst, nausea or vomiting, shaking hands (tremors), and more.
In the event of severe dehydration, medication and intravenous (IV) fluids may be required. It's important to note that NDI impacts an estimated 12% of people who have been on lithium for more than 15 years.
For those who find the most benefit in lithium treatment, a supportive dose of amiloride can be continued. Another mood stabilizer, such as lamotrigine (Lamictal), can be a potential alternative in the early stages.
Screening for NDI may include measuring electrolyte levels and checking renal and thyroid functions twice a year. It's crucial for individuals taking lithium to be aware of these potential side effects and to discuss any concerns with their healthcare provider.
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