Three Important Questions re. Lithium
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Q:  Three Important Questions re. Lithium

Is it true that it is better to take lithium by itself than also with an antidepressant? (For better effects?). Does lithium literally rot your teeth from the inside out, or cause other dental problems? Should I only take my lithium when I feel myself going in a "low"? Thank you for your time--please help! 

Dear Jessica --

Well now, you raise three important questions.

First, is lithium better alone than with an antidepressant? This question sounds simple enough, but it leads to an incredibly complex story. Let's see if I can give you the bottom line and let you pursue more information if you wish.

A) in the opinion of most mood experts, the mainstay of medication treatment of bipolar disorder is the group of medications called "mood stabilizers". Lithium as one of the prime examples in this class of medications.

B) in general, most mood experts believe that antidepressants have the potential to make bipolar disorder worse, and should be avoided if not clearly necessary, instead relying on mood stabilizers to prevent depression from returning.

Therefore, in general, without looking at your particular circumstances, the starting assumption amongst many mood experts would be that lithium alone will work as well as or better than any lithium/antidepressant combination. There are several research studies which support this conclusion, including a recent major study in the New England Journal of Medicine.  You can find a more general discussion of the role of antidepressants in the treatment of bipolar disorder, from my personal point of view, but gathering together much of the research on this, on my webpage entitled "
Antidepressant Controversies".

However, for you personally, it may be very important to combine lithium with an antidepressant. That would be a conclusion that is up to you and your psychiatrist. Please do not interpret my answer as a comment upon whether an antidepressant is right for you. I am simply answering your question in general terms. Do not stop your antidepressant (or your lithium!) And without discussing these ideas further with your provider.

As for the second issue, lithium and dental problems: I had to go look that one up. I have never heard of any such concerns. Interestingly, using a Google search for "lithium dental", I found an article from the 1970s, a two paragraph letter to the editor, in which a physician describes a concern about lithium worsening the risk for cavities in one's teeth ("dental caries"). This citation was about fifth on the list of links, following two articles which were studying rats trying to determine if lithium might actually enhance the effects of fluoride on preventing dental caries (it did not).

Repeating that search using
Pub Med, for a more research oriented approach, yielded a few articles written by dentists, commenting on oral hygiene in patients with bipolar disorder. From these, I think it is fairly clear that the concern amongst dentists is not about a direct effect of lithium on the health of one's teeth. Rather, if there is any effect of lithium on dental health at all, it is probably through having a dry mouth much of the time. That is not good for teeth, which are protected by elements in saliva.

From what I can see, you can completely eliminate the risk of any effect of lithium on your teeth by simply drinking plenty of water (obviously one would not want to use sugared soft drinks for this purpose!).

Finally, for your third question: this one is easy. The whole idea of taking lithium, for most people (perhaps not in your circumstance, although I would doubt this), is to prevent future episodes of mood problems. Therefore the whole idea is to take it when you are well, in order to stay well. At least this is how we generally use it in most people.

Thank you for your interesting questions. Good luck with your discussions with your doctor about all this.

Dr. Phelps

Published July, 2007


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