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{{SummarySheet}}
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{{SubstanceBox/Lithium}}
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[[File:Lithium carbonate.svg|350px|thumbnail|right|The structure of the carbonate of lithium, lithium carbonate.]]
[[File:Lithium carbonate.svg|350px|thumbnail|right|The structure of the carbonate of lithium, lithium carbonate.]]
'''Lithium salts''', or '''lithium''' (sold as many salts of the lithium ion and under many trade names, such as Eskalith) is a widely-prescribed mood-stabilizing pharmaceutical of the lithium salt chemical class that produces mood-stabilizing, calming, and dulling effects when administered. Lithium is used clinically for bipolar disorder. Lithium has been reported to potentially trigger psychosis and severe seizures when combined with psychedelics, notably [[LSD]].
Lithium salts, or lithium (sold as many salts of the lithium ion and under many trade names, such as Eskalith, Lithobid, and Carbolith) is a widely-prescribed mood-stabilizing pharmaceutical that produces mood-stabilizing, emotional dampening, and anti-manic effects when administered. It is primarily used in the treatment of bipolar disorder and severe depression. Lithium has been reported to potentially trigger dangerous interactions when combined with psychedelics, particularly [[LSD]].
==History and culture==
History and culture
{{historyStub}}
Lithium's mood-stabilizing properties were first discovered in 1949 by John Cade, an Australian psychiatrist. It became the first medication specifically approved for the treatment of mania in 1970 by the FDA. Despite being one of the oldest psychiatric medications still in widespread use, its precise mechanism of action remains incompletely understood.
 
Chemistry
==Chemistry==
Lithium is typically administered as a salt, most commonly lithium carbonate (Li₂CO₃) or lithium citrate. The therapeutic effects come from the lithium ion (Li⁺). Unlike most psychiatric medications, lithium is an element rather than a complex organic molecule.
{{chemistry}}
The therapeutic window of lithium is narrow, requiring regular blood monitoring to maintain safe and effective levels, typically between 0.6 and 1.2 mEq/L.
Unlike sodium carbonate, which forms at least three hydrates, lithium carbonate exists only in the anhydrous form.[13] Its solubility in water is low relative to other lithium salts. The isolation of lithium from aqueous extracts of lithium ores capitalizes on this poor solubility. Its apparent solubility increases 10-fold under a mild pressure of carbon dioxide; this effect is due to the formation of the metastable bicarbonate, which is more soluble:[7]
Pharmacology
 
Lithium's mechanism of action is complex and multifaceted, including:
Li2CO3 + CO2 + H2O ⇌ 2 LiHCO3 The extraction of lithium carbonate at high pressures of CO 2 and its precipitation upon depressuring is the basis of the Quebec process.
• Inhibition of inositol monophosphatase and inositol polyphosphate 1-phosphatase
 
• Inhibition of glycogen synthase kinase-3 (GSK-3)
Lithium carbonate can also be purified by exploiting its diminished solubility in hot water. Thus, heating a saturated aqueous solution causes crystallization of Li2CO3.
• Modulation of neurotransmitter systems including serotonin and dopamine
 
• Effects on circadian rhythms
Lithium carbonate, and other carbonates of group 1, do not decarboxylate readily. Li2CO 3 decomposes at temperatures around 1300 °C.
• Neuroprotective effects through various pathways
 
Subjective effects
==Pharmacology==
The effects of lithium develop gradually over weeks. Common subjective effects include:
{{pharmacology}}
Positive
Lithium has a complex pharmacology.
• Mood stabilization
==Subjective effects==
• Reduction in manic symptoms
{{EffectStub}}
• Decreased suicidal ideation
 
• Emotional regulation
The subjective effects of lithium are primarily mood stabilisation. The onset of these effects are gradual and take place over weeks or months. Long term users who respond report “normality” and partial or full resolution of symptoms of bipolar disorder or depression. Some users report a reduced emotional range and some reduction in creativity.
Neutral
 
• Emotional dampening
Lithium has no obvious effects on a single dose within the therapeutic range. Doses above the therapeutic range do not produce positive effects. Effects include nausea, prickling sensation on the skin, headache progressing to confusion, delirium, coma and potentially death.
• Reduced emotional reactivity
 
• Mild cognitive dulling
===Experience reports===
Negative
There are currently no anecdotal reports which describe the effects of this compound within our [[experience index]]. Additional experience reports can be found here:
• Thirst
* [https://www.erowid.org/experiences/subs/exp_Pharms_Lithium.shtml Erowid Experience Vaults: Lithium]
• Frequent urination
 
• Mild tremor
==Toxicity and harm potential==
• Reduced creativity (reported by some users)
{{toxicity}}
• Weight gain
It is strongly recommended that one use [[responsible use|harm reduction practices]] when using this substance.
Toxicity and harm potential
===Lethal dosage===
Risk factors
===Tolerance and addiction potential===
• Narrow therapeutic window
===Dangerous interactions===
• Regular blood monitoring required
{{DangerousInteractions}}
• Kidney function must be monitored
{{DangerousInteractions/Intro}}
• Dehydration risk
*'''[[Psychedelics]]''' - This combination has been reported by many users to cause seizures and psychotic breaks, notably with [[LSD]]. In an unconfirmed anecdote, one death was reported to be triggered by the combination of LSD and lithium.<ref>http://www.erowid.org/chemicals/lsd/lsd_health3.shtml</ref> Note the same Erowid article has anecdotes of lithium users using psychedelics multiple times safely and even a published study done with no ill effects reported. Article Title: ''Alterations in responses to LSD in humans associated with chronic administration of tricyclic antidepressants, monoamine oxidase inhibitors or lithium''. Behav Brain Res 1996;73(1-2):pg 229-33, Bonson KR; Murphy DL Also ''Chronic administration of serotonergic antidepressants attenuates the subjective effects of LSD in humans.''Bonson KR, Buckholtz JW, Murphy DL. Neuropsychopharmacology. 1996 Jun;14(6):425-36. doi: 10.1016/0893-133X(95)00145-4. PMID: 8726753
• Thyroid function impacts
*'''[[SSRIs]]''' - Combination with Lithium has a potential to cause serotonin syndrome,  in people concurrently on serotonergic medications such as [[sertaline]] (Zoloft), and [[fluoxetine]] (Prozac). <ref>Lithium Interaction with SSRI's | https://en.wikipedia.org/wiki/Lithium_(medication)#Interactions</ref>
Lethal dosage
 
The lethal dose is approximately 5-10 grams for most lithium salts, though toxicity can occur at lower doses. Symptoms of toxicity include:
==Legal status==
• Severe tremor
{{LegalStub}}
• Confusion
 
• Seizures
==See also==
• Kidney failure
*[[Responsible use]]
• Coma
==External links==
• Death
*[[wikipedia:Lithium (medication)|Lithium (medication) (Wikipedia)]]
Dangerous interactions
 
Psychedelics - Particularly dangerous with LSD, with reports of seizures and psychotic episodes. Combination should be avoided.
==Literature==
SSRIs - May increase risk of serotonin syndrome.
==References==
NSAIDs - Can increase lithium levels to toxic range.
<references />
Diuretics - Can dangerously alter lithium levels.
 
Legal status
[[Category:Psychoactive substance]][[Category:Proofread]][[Category:Approval]]
Lithium is a prescription-only medication in most countries. It is not scheduled under international drug control conventions.
References
[Include standard references]
[[Category:Mood stabilizers]]
[[Category:Prescription drugs]]
[[Category:Psychoactive substance]]
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