Highlights
- From phones to meds, lithium's uses extend beyond batteries.
- Lithium has long been regarded as the "gold standard" for the maintenance treatment of bipolar disorders (BD), supported by extensive evidence.
We have all heard about the uses of lithium in our daily lives. Gobally, the lithium industry is significant and rapidly growing – driven by the demand for batteries.
Due to their high energy density, long cycle life, and relatively low self-discharge rate, lithium-based batteries have become the most popular types of rechargeable batteries.
Fires triggered by lithium batteries hog headlines.
It’s no wonder everyone’s familiar with this thing: it powers our phones, watches, hand-held devices, portable power tools, cars, and medical diagnostic gear.
Question: Is lithium toxic?
Answer: It depends on the quantity.
Lithium as medicine
Since the 1970s, lithium has been used as a drug, too. It is a prescription medication and requires close monitoring by a doctor. At the right quantities, lithium is used as a mood stabiliser in medications.
It is currently used to treat bipolar disorder – a condition characterised by extreme mood swings between mania (elevated mood) and depression.
Additional uses (limited):
In rare cases, lithium may be prescribed for other conditions like cluster headaches or schizoaffective disorder, but its primary use is for bipolar disorder.
Lithium use in medications:
Lithium has long been regarded as the "gold standard" for the maintenance treatment of bipolar disorders (BD), supported by extensive evidence. Research, however, indicates a steady decline in lithium prescriptions over the past two decades.
A survey developed by the International Society for Bipolar Disorders (ISBD) Task Force on the “Role of Lithium in Bipolar Disorders” was distributed via various academic and professional international channels.
Conditions treated with lithium include:
- Bipolar disorder: Lithium is a mainstay treatment for bipolar disorder, helping to regulate mood swings and prevent manic or depressive episodes.
- Schizophrenia (in some cases): In some cases, lithium may be prescribed as an adjunct medication alongside other medications for schizophrenia to help manage mood swings and aggression.
California-based researchers led by Krutika Chokhawala (Western University), who published their work in StatPearl, stated that in addition to acute manic and mixed episodes and maintenance treatment in patients aged 7 or older, lithium is also prescribed off-label for treating major depressive disorder as an “adjunct therapy”.
It is used for managing bipolar disorder without a history of mania, addressing vascular headaches, and alleviating neutropenia.
In 1974, the US FDA approved lithium for treating bipolar I disorder in 1974.
What it does:
Lithium is a medication used to treat bipolar disorder, but its exact mechanism of action is still being studied. It's thought to affect how nerve and muscle cells transport sodium and influence brain chemicals like serotonin.
How it's taken: Lithium comes in pill, capsule, and liquid forms. It's typically taken orally, one to three times a day.
How long it takes to work: It can take 1 to 3 weeks for lithium to show its effects.
Dosage: The dose of lithium varies depending on the individual and their condition. It's important to have regular blood tests to monitor lithium levels and adjust the dosage as needed.
Drug interactions: Lithium can interact with other medications, so it's important to tell your doctor about all the medications you're taking.
Contraindications: Lithium is not recommended for people with allergies to lithium or severe kidney disease.
Warnings: Lithium toxicity can occur even at therapeutic doses. Regular monitoring of blood levels is crucial. Be cautious about dehydration and electrolyte imbalance while taking lithium.
In the survey, comprising 886 responses (of which 606 completed the entire questionnaire while 206 completed it partially), respondents from 43 different countries across all continents showed that lithium was the most preferred treatment option for the maintenance of bipolar disorder (BD) patients (59 per cent).
Clinicians were less likely to prefer lithium as a first option in BD maintenance phase when practising in developing economy countries, the researchers found.
Therapeutic window of lithium
While lithium is used as a drug for nearly 50 years, it has a narrow therapeutic window – meaning the difference between a safe and toxic dose is relatively small. That's why close monitoring is crucial when taking lithium medication.
Potential adverse effects
There are concerns about potential adverse effects and its status as an older drug. That’s why regular blood tests are needed to ensure safe and effective levels in the patient’s body.
Drug-drug interactions
It can interact with other medications, so it's crucial to disclose all medications you take (prescription and over-the-counter) to your doctor. Lithium can cause side effects.
How lithium can be toxic
In a June 2023 article published in StatPearls, titled “Lithium Toxicity”, researchers Shireen A. Hedya, Akshay Avula and Henry D. Swoboda cited different grades of severity of lithium intoxication.
While lithium toxicity signs are obvious and can be identified and managed easily; ignoring it can be fatal, they warned.
“Indeed, in some cases, lithium toxicity can lead to coma, brain damage, or even death. Moreover, lithium can induce serotonin syndrome, a potentially fatal and life-threatening condition. Intoxication degree is of utmost importance for understanding lithium toxicity diagnosis and management.”
The severity of lithium toxicity generally fall into one of three grades:
- Mild symptoms: nausea, vomiting, lethargy, tremor, and fatigue (Serum lithium concentration between 1.5-2.5 mEq/L).
- Moderate intoxication: confusion, agitation, delirium, tachycardia, and hypertonia (serum lithium concentration between 2.5-3.5 mEq/L).
- Severe intoxication: Coma, seizures, hyperthermia, and hypotension (serum lithium concentration (more than 3.5 mEq/L).
Considerations for different patients:
Pregnant women: Lithium can increase the risk of birth defects, so it's generally not recommended during pregnancy.
Breastfeeding women: Lithium can pass into breast milk, so it's generally not recommended for breastfeeding mothers.
Children: Lithium's safety and effectiveness haven't been established for children under 7.
Older adults: There are special considerations for using lithium with other medications in older adults.
People with kidney problems: Lithium can worsen kidney problems, so it may not be suitable for people with severe kidney disease.
Side effects: Lithium can cause a variety of side effects, including:
- Tremors
- Thirst
- Increased urination
- Diarrhoea
- Nausea
- Fatigue
- Confusion
- Memory problems
Top 5 battery chemistries
From phones to meds, lithium's uses extend beyond batteries. Here are the top 5 alternatives to lithium-ion batteries:
Sodium-ion batteries:
These are seen as a promising alternative to lithium-ion due to their abundant and inexpensive sodium resource. They offer similar performance to lithium-ion in some applications, but generally have lower energy density.
At least 14 million metric tonnes can be found on US, according to the US Geological Survey.
Due to permitting issues, less than 1 per cent of global lithium is currently mined in the US.
Lithium-sulfur batteries:
These boast the potential for much higher energy density than lithium-ion, translating to longer battery life. However, challenges include managing the formation of lithium polysulfides during discharge, which can reduce battery life.
Redox flow batteries:
These aren't your typical rechargeable battery. They store energy in liquid solutions and offer large-scale energy storage for applications like grids. They boast long lifespans and safety, but have a lower energy density than lithium-ion.
Magnesium batteries:
Magnesium offers several advantages: it's abundant, safe, and has a high theoretical energy density. However, researchers are still working on overcoming challenges related to electrolytes and electrode materials to make them commercially viable.
Solid-state batteries:
These are a potential future technology that could offer significant improvements in safety, lifespan, and charging speed. They replace the flammable liquid electrolyte in lithium-ion batteries with a solid electrolyte, reducing fire risk. However, solid-state batteries are still under development and not yet widely available.
Disclaimer: This article is for informational purposes only and should not be considered professional medical advice. It is best to consult your doctor
