There are several options for printing:

• Click "Print this page" on the left to print the whole section
• Download a handy PILL (Patient Information Leaflet), a two-page summary of the main questions and answers from here. This can then be printed.

You can also get the NPSA (the UK's National Patient Safety Agency) booklets, information and an alert card from 2009 here:

• Lithium record booklet
• Lithium patient information book (English)
• Lithium patient information book (Welsh; Therapi Lithiwm - Gwybodaeth bwysig ar gyfer cleifion)
• Lithium alert card

There are many other Patient Information Leaflets (PILs) across the world for patients and carers. There are also official information leaflets (often called a Data Sheet, Package Insert, or Summary of Product Characteristics). They are not on our site, so we can't take any responsibility for them but you can click here for links to other sites and leaflets

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Lithium is licensed and officially approved to help treat the symptoms of:

• Bipolar mood disorder
• Bipolar depression
• Bipolar mania or hypomania

Lithium is also occasionally used to help treat many other conditions e.g. aggression, and cluster headaches. Lithium is probably best at stopping bipolar high moods coming back, but can also be effective for stopping the low moods as well.

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The usual dose of lithium in adults for bipolar will depend on your blood levels.

The starting dose is usually around 400mg a day. The usual dose will then be changed depending on your blood levels. It will tend to be lower in older people and in people with kidney problems.

It is not usually recommended in children under 12 but this is more because it has not been studied rather than because of any concerns about safety.

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This may depend on what you are taking it for. The answer for bipolar mood disorder will probably be the same as for mania and depression but click on the links for the main options (self-help and help from others), the main medicines, and a handy chart comparing the main medicines:

• Bipolar mood disorder - main options, main medicines and handy chart
• Bipolar depression - main options, main medicines and handy chart
• Bipolar mania - main options, main medicines and handy chart

There are other treatments for the conditions above. The main ones are included in the section on each of the conditions above.

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It is not known exactly how lithium works. There are many theories, but it probably evens-out or stabilises the speed at which the brain passes messages around. It may thus stabilise brain cells and nerves, and their 'secondary messengers' [which are chemicals in the brain cells that pass messages from the brain cell wall to the inside of the cell). Lithium itself is similar to the sodium in salt. Lithium also increases the volume of the grey matter in your brain within a few weeks of starting. People taking lithium have a bigger amygdala (the area of the brain that processes emotions) and it reduces your chance of getting Alzheimer's Disease.

Lithium also reduces anger, aggression and impulsivity, and this may be the reason it reduces thoughts of suicide (Muller-Oerlinghausen 2011). In fact in all 99 districts in the whole of Austria, the higher the levels of lithium in the drinking water the lower the levels of suicide (Kapusta 2011).

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Take your dose as directed on the medicine label. You should take it at a regular time each day. Lithium should be taken once a day and this is best at bedtime. On the day of your regular blood test, be careful to delay your dose until after your blood has been taken or your level may come back very high.

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Tablets
Tablets should be swallowed with at least half a glass of water whilst you are sitting or standing so that they reach the stomach and do not stick in your throat.

The slow-release or extended release tablets (e.g. 'Liskonum', 'Camcolit 400', and 'Priadel') should be swallowed whole and not chewed. These tablets are made so that they release lithium over a longer period of time. This can help to reduce side-effects or reduce the number of times a day you need to take this medicine. If you cannot swallow them whole they can be broken. Do not crush, chew or dissolve them as this will cause the drug to be released too quickly and you may get more side effects.

Liquids (lithium citrate only)
Your pharmacist should give you a medicine spoon or oral syringe. Use it carefully to make sure that you measure the correct amount. Ask your pharmacist for a medicine spoon if you do not have one.

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This may depend on what you are taking it for. Click the link below for the answer for that condition:

• Bipolar mood disorder
• Bipolar mania or hypomania
• Bipolar depression

Generally lithium may take several weeks to start to work. For people who suffer from manic depression it may take many months before the depressive part of this illness improves.

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This will depend on what you are taking lithium for. It may also depend on how unwell you have been or how severe the symptoms have been, as people respond differently. Click on the link below for the answer for that condition:

• Bipolar mood disorder
• Bipolar depression
• Bipolar mania or hypomania

Generlly, people usually need to take lithium for quite some time after it has been started. As well as treating the illness, lithium also helps to prevent the symptoms returning. Once you have started lithium, you may need to take lithium for a long time, probably for at least two or three years and quite possibly much longer. For it to continue keeping you well, lithium must be taken each and every day. Stopping and starting it will very probably be harmful to you e.g. it will increase your chances of becoming ill again, more side effects. But it should reduce your chances of getting Alzheimer's Disease though.

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Lithium is not addictive as such but a some people do get some short-term effects if lithium is stopped suddenly but this is because the brain doesn't take kindly to lithium being taken away suddenly. It prefers to get used to the idea first. For a drug to be addictive or produce dependence, then it must have a number of characteristics:

• should produce craving for the drug when the last dose "wears off"

• there should be a "reward" (e.g. a good feeling) from taking the drug

• should produce tolerance ie you need more drug to get the same effect

• should produce withdrawal symptoms specific to that drug.

These characteristics come from the World Health Organisation. Lithium has none of these and so is not addictive. Any discontinuation effects are probably more of an "adjustment" reaction from sudden removal of a drug rather than "withdrawal".

Click here to read a bit more about this, where you can find our thoughts on this knotty problem.

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Start again as soon as you remember unless it is almost time for your next dose, then go on as before. Do not try to catch up by taking two or more doses at once as you may get more side-effects. You should tell your doctor about this next time you meet. If you miss several doses start again when you remember and tell your doctor. You may need a new blood test to check that there is enough, but not too much, lithium in your blood. Missing the occasional dose (e.g. no more than once a week) isn't usually a big problem but try not to miss any more than that. See also the question on stopping lithium.

If you have problems remembering your doses (as very many people do) ask you pharmacist, doctor or nurse about this. There are some special packs, boxes and devices that can be used to help you remember. You can try leaving the pack somewhere you will see it each morning e.g. in the bathroom, kitchen, by your bed, in a car etc.

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Absolutely not! (but see below) It is very unwise and risky to stop taking lithium suddenly, even if you feel better. Recent studies have shown that if you are taking lithium for bipolar disorder and stop it suddenly (i.e. over less than 14 days) you have a 1 in 2 (50%) chance of becoming ill again within six months and a 9 in 10 (90%) chance of becoming ill again within 3 years. If you need to stop lithium, it should be gradually over at least four weeks, preferably longer i.e. 3-6 months The dose should be decreased gradually during this time to minimise possible problems.

There are no set rules for coming off lithium, but we would suggest something along these lines to try to reduce the risk of anything unwanted happening e.g. getting ill again:

You can choose which one to follow with your doctor or nurse. Just remember you've got a lot to lose if you stop lithium too quickly and become ill again.

Obviously if you have for some reasons got a very high or toxic level you may need to stop taking lithium suddenly. However, stopping it completely is very unwise. If you have a very high level, you need to take advice given to you, but you will probably need to miss a few days doses, then restart at a lower dose.

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The table below will show you some of the main side effects you might get from lithium.

Do not be worried by this list of side effects. Some people get no side effects at all and others may get some effects that are not listed in this table. Side effects tend to be worse with higher doses. Starting with a lower dose sometimes helps. If you think you might have a side effect to your medicine, you should discuss this with your doctor, nurse of pharmacist. You should also see the manufacturer's information leaflet.

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Lithium may make you feel drowsy or sleepy at first. You should not drive (see below) or operate machinery until you know how it affects you. You also should be careful as this may affect your reflexes or reaction times.

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It is not uncommon for people to put on some weight when taking lithium. Weight gain occurs mostly in the first 1-2 years of being on lithium, mostly in people who are already a bit overweight and may be more common in women than men, This weight gain may be partly because a common side-effect of lithium is feeling thirsty, and drinking large amounts of high calorie drinks can cause people to put on weight. If this happens, try drinks which are low in calories e.g. low calorie squash or water, and cut down on sugar and milk in your tea and coffee. It is impossible to know what the effect on your weight may be because each person will be different. It is important that you do not ignore feelings of thirst as this can lead to lithium poisoning.

This is very important especially if you do lots of exercise or go on holiday to a hot country where you may be sweating heavily too.

If you do start to put on weight or have problems with your weight, your doctor can arrange for you to see a dietitian for advice. Any weight you put on can be controlled while you are still taking this medication, with expert advice about diet. In some people weight gain can be a serious problem. If it causes you distress make sure your doctor knows about this. A change in your dose may be necessary in extreme cases.

Sometimes lithium can cause weight gain by causing fluid retention (known as oedema or edema) which can cause swelling of e.g. the ankles or face. This can sometimes be treated without having to stop lithium e.g. by taking a diuretic (often called "water tablets" e.g. frusemide). However, this can be tricky and has to be done carefully as some diuretic or water tablets can cause lithium levels to rise.

Weight gain can be part of the so-called ”metabolic syndrome”. You might want to read a bit more about this.

Click here for a few tips on how to help you feel less hungry and lose weight.

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Drugs can affect desire (libido), arousal (erection) and orgasmic ability. Lithium has not been reported to have a major effect on any of these three stages, other than stabilising mood. However, if this does seem to happen, you should discuss this with your doctor, as a change in dose may help minimise any problem.

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It is important that you do not drink too much or too little fluid. If you drink too little, this can lead to lithium poisoning. Here is some advice:

• The best rule to obey is not to ignore feelings of thirst. Mind you, drinking lots of high calorie drinks can cause you to put on weight (see weight gain as separate question).
• Drinks containing lots of caffeine e.g. coffee, tea, colas etc. can cause you to lose fluid. This can lead to an increased lithium effect (because it gets more concentrated), so having some decaffeinated drinks is a good idea.
• Do not have a low salt diet. Lithium is very similar to sodium salts in the body. If you have a low sodium diet, the body tends to try to keep lithium as an alternative. This can lead to a build up in lithium in the body and so lithium poisoning.
• Do not to make any major changes to your diet unless you have talked to your doctor, nurse or pharmacist first. You may need some extra blood tests.

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Whether or not it is safe to drink alcohol with any medicine will depend on:

• How much you have to drink e.g. the amount and over how long
• What you then try to do (e.g. sleep or drive)
• If you have any other conditions e.g. epilepsy, asthma or a chest infection (as alcohol can make it harder to breathe)
• If you are taking any other medicines

Alcohol reaches all parts of the brain and can affect many things e.g. thinking, reactions and breathing. Alcohol can also boost the effect of GABA (the brain's main calming chemical messenger).

There is not a complete ban on drinking alcohol if you are taking lithium, but try not take more than about one or two drinks a day as this may affect the level of lithium in your blood. It may also cause you to feel more drowsy. If this happens, you must take extra care if you need to drive or operate machinery as it can affect your reaction times. You should seek advice on this.  

It is not safe to drive after drinking alcohol, with or without lithium. Some countries allow driving after a small amount of alcohol but others have a zero tolerance. The UK has the highest limit in Europe, France lower, Scandanavia even lower and zero in some Eastern European countries. It is not possible to say what blood level you might have from a drink so it is safest not to drink if you know you may have to drive. It is taken as a very serious offence in most countries. You should see National Guidelines, laws and regulations in the country in which you are driving.

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Lithium can quite easily become toxic if your blood levels get too high. This can happen if lithium is taken with any medicine that stops the kidney removing lithium from the body.

Lithium has quite a few interactions with other medicines:

• The effects of lithium can sometimes be increased by ACE inhibitors for high blood pressure (e.g. captopril, enalapril, lisinopril, ramipril) and some "water tablets" or diuretics (e.g. bendroflumethiazide or co-amilozide, although furosemide is probably OK).
• Lithium levels can be increased by NSAIDs (used for arthritis or pain, e.g. higher doses of aspirin, ibuprofen, naproxen, diclofenac, ketoprofen, mefenamic acid) or COX-2 inhibitors (used for pain or arthritis e.g. celecoxib, etoricoxib). Low doses of aspirin e.g. 75mg a day are unlikely to have any effect on your lithium levels.
• The effect of lithium can be decreased by theophylline or aminophylline.
• Make sure your doctor, pharmacist or nurse knows about your lithium. Paracetamol is safe in normal doses with lithium

This does not necessarily mean that this will happen in everyone or that some of these medicines can not be used together. It is just that you may need to follow your doctor's instructions very carefully. There are many other possible drug interactions (e.g. you can try an external on-line drug interactions checker, although this is nothing to do with our site).

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Cigarette smoke contains over 3000 different chemicals. Some of these chemicals can make some of the enzymes in the liver work faster (called "enzyme induction" of e.g. CYP1A2 or P4501A2). Enzymes break down unwated chemicals in the body. This means that any medicine those enzymes break down will be broken down quicker. So, you'll end up with less of that medicine if you smoke. And also you will have more of it in the body if you stop smoking. However, lithium does not seem to be affected so there seem to be no extra problems if smoking with lithium.

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By including this section, we're not saying it's right to take illicit or illegal drugs, because it isn't. We're just trying to answer the questions as best we can under the circumstances. With illicit drugs, the full answer is usually that we don't really know. So, we can only go on a few studies, a few reports and what we know about the drugs themselves.

Cannabis (illegal in most countries):

Smoking cannabis increases the amount of dopamine in the pleasure centres of the brain, which is where the reward or buzz comes from. However, psychosis also comes from having too much dopamine in another area of the brain. You have to remember that cannabis can increase dopamine in all areas of the brain and so can make psychosis worse. Please be careful, everything in moderation and if dope makes you worse, keep off the grass. It really won't help you in the long-term. Don't forget that if you're a toker, you're also a smoker, so see the question above. However, lithium does not usually seem to be affected so there seem to be no extra problems if smoking cannabis with lithium. You might feel a little more drowsy and you should have your lithium levels checked regularly.

Cocaine (illegal in most countries)

Cocaine is of course highly addictive and has many adverse or side effects on the body and brain. It can make most mental health symptoms worse in the long-term. However, there are no reports of extra problems with lithium and cocaine, although this doesn't mean it's safe.

Ecstasy (illegal in most countries)

Ecstasy has many effects on the brain, the main ones producing the high seem to be by boosting serotonin, noradrenaline and dopamine in the brain. While it can cause a high, the effect wears off fairly quickly. It seems that the toxic effects on the brain are cumulative i.e. the more tablets you have over your lifetime, the more chance you have of having damage to the brain e.g. long-term depression and poor memory. However, there are no reports of extra problems with ecstasy and lithium, but again this doesn't mean it's safe.

Opiates

The opiates include many chemicals, some of which are used in medical care (e.g. codeine for diarrhoea and stopping coughs, diamorphine and morphine for pain). However, there are no extra problems reported from taking opiates (e.g. heroin, methadone, codeine) with lithium, although you might feel more drowsy.

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You should have no problems with "The Pill" and lithium.

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In the UK, Levonelle one step® is available and is usually known as 'the morning after pill'. It is taken to reduce the chances of becoming pregnant after unprotected sex or failure of a contraceptive method. In fact "Emergency Contraception" is the better term because it can be taken up to 72 hours (3 days) afterwards. It can be bought over-the-counter without a prescription from pharmacies. EllaOne® tablets (which may work up to 5 days afterwards) and a coil (Intra-uterine device) can also be used but must be prescribed by a Doctor.

If you are taking lithium, the usual dose should work if you follow the instructions carefully.

N.B. We accept that for religious, cultural or ethical reasons some people do not approve of, or agree with, the use of the "Morning After" pill. However, we have answered the question because it is one of the most often asked of NHS Direct in UK, and they suggested we include it.

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Several female functions such as menstrual cycle (e.g. your periods) are controlled by a hormone called prolactin. Prolactin in the body rises during and after pregnancy and this triggers the body to make breast milk. The amount of prolactin in the body is kept in control by one part of the brain uses dopamine as its chemical messenger. Luckily lithium doesn't seem to have any effect on dopamine in this part of the brain and so should not have any effect on your periods. If your periods are irregular or late, or you start leaking milk, then you should see your doctor about this to find the cause.

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It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur spontaneously in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed its main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups:
A = Studies show no risk, so harm to the unborn child appears only a remote possibility
B = Animal and human studies indicate a lack of risk but are not fully conclusive
C = Animal studies indicate a risk but there is no safety data in humans
D = a definite risk exists but the benefit of the drug may outweigh the risk in some people
X = the risk outweighs any possible benefit

Lithium is classified as "D". There is much controversy about lithium in pregnancy. Reports from Scandinavia in the 1960s suggested that there was a problem, but recent studies have shown that the risk of problems is only slightly higher than in women not taking lithium.

The major risk with lithium in pregnancy is something called Ebstein's anomaly, a rare heart defect in the child. The chance of this happening without lithium is about 1 in 20,000 children, and this rises to about 1 in 1000 with lithium. So, it might be 20 times more likely with lithium, but still very rare. So rare that, when speaking to Mr Martin Cameron BMSc (Hons) MD MRCOG DRCOG (Consultant in Obstetrics and Gynaecology at Norfolk and Norwich University Hospital) in October 2010, I found that he had only ever seen one case in his entire life, and that was in a woman not taking lithium. This heart problem can be detected so you should seek personal advice from your GP, who will arrange for specialist screening to be carried out.

You might think that the best thing to do would be stop lithium as soon as you know you're pregnant. This is not a good idea because:

• the risk of relapsing if you stop lithium suddenly is very high, and may be as high as 1 in 2 women (50%)

• by the time you realise you are pregnant, the potential effect on the heart would already have happened so it's too late to stop.

Regular blood monitoring will be important as you get closer to your due date as lithium levels may rise towards the end of pregnancy. You should have a blood test every 4 weeks until you are 8months pregnant, then weekly until you give birth. You should seek specialist advice.

One piece of good news is that one study was able to show that lithium did not appear to have any effect on physical or mental development over the first 5-10 years of the child's life if the mum took lithium throughout pregnancy.

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Almost every medicine passes into breast-milk. The main questions are how much and if this is likely to have an effect on your baby. But also remember that being ill (e.g. depressed, manic, psychotic) may have more harmful and lasting effects on you and your child (such as bonding and behaviour e.g. Field, 2010) than a small amount of an effective medicine. If you have been taking a medicine while you are pregnant, you should usually be able to carry on as the amount in breast-milk is much less than the baby would have got while you were pregnant. It is usually thought to be fairly safe if the baby gets less than 10% of the mum's dose. But there may be times when although a medicine gets into breast milk the benefit may be worth the risk, so you should seek personal advice on this.

If you stop any medicine suddenly, some people can get discontinuation or withdrawal symptoms (see question above). If you have been taking a medicine during pregnancy, the same can sometimes happen to the baby when born. If the drug gets into breast milk, this can reduce the effect of suddenly not having the medicine (as well as coping with being in the big wide world too).

If you want to breast-feed there are some things you can do to reduce any risk:

• Nearly all medicines can be taken once a day. So, taking your daily dose just before the baby's longest sleep (often this will be at night) will reduce the amount the baby gets from the milk.
• Any side effects in the baby will be higher if the mum is taking a higher dose. So, try to take the lowest dose possible to still get an effect.
• Try not to take any medicines you don't really need. This includes any medicines you might buy over-the-counter
• Make sure your nurse, health visitor or doctor checks your baby for any side effects e.g. being extra sleepy, having colic, feeding problems, being floppy or poor weight gain. If there are any problems you might need to switch medicines or drop your dose a bit
• Hind milk (the second half of the feed) is likely to contain slightly more of any medicine than the first half
• Avoid new medicines if possible as there is less information about them and breast-feeding.

You must be extra careful of any medicines if your baby was pre-mature, or has kidney, liver, heart or brain problems.

We used to think that quite a lot of lithium gets into breast milk and so it is contraindicated (not allowed). However, recent studies have shown that perhaps it is not as much as we thought in some people (Viguera, 2007). However, lithium in the baby's blood can cause the baby to become sleepy and floppy. But if you stopped lithium and became ill again this could easily be more harmful to you and your baby. It should be possible to breast feed while taking lithium if you and the baby are monitored carefully, the amount in your baby is tested using the usual blood tests and the baby feeds and drinks enough. You should seek personal expert advice on this. 

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You may feel drowsy and/or confused at first when taking lithium. Until this wears off, or you know how lithium affects you, do not drive or operate any type of machinery. You should be careful as this may affect your reaction times or reflexes.

If you are taking any medicines, the rules about driving will depend on the country you’re driving in. Click on the links below for advice:

• Medicines and driving in the UK (England, Scotland, Northern Ireland and Wales)

• Medicines and driving in the Republic of Ireland

General advice on driving safely

If you want to drive, you should take sensible steps to reduce any risk. These could include:

• Avoid driving when you are tired or ill
• Do not drive after having any alcohol as this can make any drowsiness worse (a third of all fatal road traffic incidents involve alcohol-dependent drivers)
• Avoid driving at night, dusk or in bad weather
• Avoid motorways, dual carriageways and the rush hour
• Give yourself plenty of time. Don’t rush
• Be extra careful if you have not slept well the previous night

As some medicines can affect your driving, be extra careful:

• If starting a new medicine
• After a change in dose (especially an increase)
• If you are on a high dose or seem very sensitive to side effects
• If you are taking any medicines for other symptoms e.g. antihistamines for hay fever or allergies
• If your medicine causes you blurred vision, drowsiness, poor co-ordination, poor attention

If you are driving less than 2000 miles a year, once you consider insurance, tax, MoT, repairs, maintenance, parking and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

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The aim of treatment with lithium is for the amount of lithium in your blood to be enough to help your symptoms, but not to get high enough to give you side effects. Everybody is different and so your lithium dose needs to be exact for you. It will depend on many things e.g. your age, weight, height, any other medicines you might be taking, and how good your kidneys are. To get your dose right, a blood sample needs to be taken and checked. This will need to be done about every week or so at the start of treatment but later on only about every three months or so. When you are stable, make sure that you have a blood test at least every three months. You may need to have extra tests if you have a change in dose, get any increase in side effects (see above), if you get diarrhoea (the 'runs'), if you have to take any medicines that might interact with the lithium or if the weather is very hot. All these things can increase or decrease your lithium level and give you side effects, or no effect.

The UK NPSA (National Patient Safety Agency) issued an alert in 2009 saying:

• there should be good systems to make sure blood test results are sent to your prescriber
• when starting lithium people should have written information and a book to keep a record of lithium and other results (see above)
• doctors and pharmacists should make sure blood tests have been done and that they know of any interactions with other medicines that might affect lithium

The level of lithium in your blood needed to give you the right balance between positive effects and side effects will be an individual thing. In general, the accepted wisdom is that:

• Below 0.4mmol/L is usually thought not to work for most people, although some people still seem to do well on very low doses
• 0.4-0.6mmol/L - may have lower side effects but is probably slightly less effective than the higher levels
• 0.6-0.8mmol/L - the usual effective range, although side effects will increase with increased levels
• 0.8-1.2mmol/L - usually only needed for people for whom mania or hypomania is more of a problem
• 1.2 and above - generally thought to be the toxic or dangerous levels. These are higher levels than needed in most people, with more risk of worse side effects.

Please note that these are general comments for advice only, and your needs may be different. Please talk about this with your doctor or other carer if you have any questions.

If you normally have a dose in the morning and a blood test within about four hours, you should delay this morning dose until after your blood test. If you don't, the level will appear to be higher than it is.

Every six months or so, the blood test can also be used to check on your thyroid and kidneys. Lithium can cause the thyroid gland to make less thyroid and this can slow you down. This is easy to sort out by taking a thyroid (levothyroxine) tablet every day.

You should have some extra blood tests on your lithium levels if you have a change in dose, have a physical illness, start to go high or low, after any major changes in sodium or fluid intake or if you have any signs of having too high a dose of lithium.

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