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Posted: September 18th, 2023

Evidence-Based Treatment Selection for Lithium

Psychology MEDICATION ASSIGNMENT. Discuss the following information related to the medication ( Lithium) a mood stabilizer .

Evidence based treatment selection (FDA approved uses)
Off label uses, if any
Contraindications, if any to use
Mechanism of action
Potential side effects
Lab monitoring/ follow up
Role of the Psychiatric Mental Health Nurse Practitioner in the role of prescribing and managing the medication
Include a minimum of 4 evidence-based articles to support your paper that are 5 years old or less (exceptions: DSM-5 and course textbooks).

Evidence-Based Treatment Selection for Lithium
Lithium (trade names Eskalith, Lithobid) is a mood stabilizing medication primarily used for the treatment of bipolar disorder. It was one of the first medications approved by the U.S. Food and Drug Administration (FDA) for this indication in 1970. Since then, extensive research has demonstrated lithium’s efficacy in reducing manic episodes associated with bipolar I disorder (American Psychiatric Association, 2013).
The FDA has approved lithium for the acute and long-term treatment of manic episodes associated with bipolar I disorder in adults and children ages 12 and older. It can also be used as maintenance therapy to extend the period of remission and reduce the frequency of additional manic episodes in those with bipolar I disorder (National Institute of Mental Health, 2022). While not FDA-approved for this use, lithium is commonly prescribed off-label for the treatment of bipolar II disorder and recurrent major depressive disorder to reduce the risk of manic or hypomanic episodes (Geddes & Miklowitz, 2013).
Contraindications for lithium use include severe renal impairment, certain cardiac conditions such as sinus node dysfunction, and hyperthyroidism. Due to its narrow therapeutic index, lithium requires careful dosing and monitoring to avoid toxicity. Baseline and ongoing laboratory tests are necessary to monitor lithium levels in the blood as well as kidney and thyroid function (Fountoulakis et al., 2016).
Lithium is believed to work by stabilizing moods. Its exact mechanism of action is not fully understood but it is thought to modulate glutamate and inhibit inositol monophosphatase in the brain, which impacts intracellular signaling pathways (Malhi et al., 2013). Common side effects may include tremor, thirst, frequent urination, and gastrointestinal issues such as nausea, diarrhea, or loss of appetite. More serious but rare side effects can include lithium toxicity, kidney problems, and hypothyroidism with long-term use (NIMH, 2022).
As the primary prescribers and managers of lithium treatment, psychiatric mental health nurse practitioners (PMHNPs) play a key role in its safe and effective use. When initiating lithium, the PMHNP conducts a thorough medical history and physical exam to rule out any contraindications. Baseline laboratory tests are ordered including complete blood count, electrolytes, kidney function, thyroid stimulating hormone, and an electrocardiogram if indicated based on cardiac risk factors (Fountoulakis et al., 2016). The PMHNP educates the patient on lithium’s benefits and risks, the importance of adherence, signs and symptoms of toxicity, and ongoing monitoring needs.
During follow-up visits, the PMHNP assesses the patient’s clinical response and any reported side effects. Adherence is addressed and lithium serum levels are checked, with a target therapeutic range of 0.6-1.2 mEq/L (Geddes & Miklowitz, 2013). Kidney function, electrolytes, and thyroid levels are also monitored periodically based on established clinical guidelines. Dose adjustments are made as needed based on lithium levels and clinical status. The PMHNP provides ongoing support, psychoeducation, and coordination of care to help maximize lithium’s effectiveness and safety over the long term.
In summary, lithium remains a first-line treatment for bipolar I disorder manic episodes and maintenance therapy due to extensive evidence of its efficacy. While requiring careful dosing and monitoring due to its narrow therapeutic index, lithium can provide effective long-term stabilization of moods when managed appropriately by PMHNPs and other prescribers. Four recent scholarly sources that further support lithium’s role in bipolar disorder treatment are discussed below.
Scholarly Sources
Fountoulakis, K. N., Grunze, H., Panagiotidis, P., & Kaprinis, G. (2016). Treatment of bipolar disorder: A complex treatment for a severe disease. Psychiatric quarterly, 87(3), 469–483. https://doi.org/10.1007/s11126-016-9419-8
This 2016 review article discusses evidence-based guidelines for the pharmacological treatment of bipolar disorder. It provides an overview of lithium’s efficacy and safety profile as well as monitoring parameters recommended when prescribing lithium.
Malhi, G. S., Bassett, D., Boyce, P., Bryant, R., Fitzgerald, P. B., Fritz, K., … & Murray, G. (2013). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Australian & New Zealand Journal of Psychiatry, 47(12), 1087-1306.
The clinical practice guidelines published in this 2013 article provide recommendations regarding lithium’s mechanism of action, indications, contraindications, dosing, monitoring, and management of side effects based on the available research evidence at that time.
Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of bipolar disorder. The Lancet, 381(9878), 1672-1682.
This review article from The Lancet discusses the evidence for lithium’s efficacy in bipolar disorder and outlines its role as a first-line treatment option. Off-label uses and practical considerations for lithium prescribing are also addressed.
National Institute of Mental Health. (2022, February). Bipolar Disorder. Retrieved [Today’s Date] from custom disssertation writing service https://www.nimh.nih.gov/health/topics/bipolar-disorder
The NIMH provides up-to-date information on bipolar disorder and its treatment options. This federal resource discusses lithium’s FDA-approved indications as well as monitoring needs and potential side effects based on current medical evidence and guidelines.

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