Treatment of lithium-induced side-effects: contemporary review

SUMMARY Although unique in its effectiveness, lithium shares with other psychotropic medications the potential to induce multiple side-effects that significantly influence tolerability, acceptability and patient adherence. We review the available evidence to provide a contemporary update for clinicians in treating lithium-induced side-effects. Most adverse effects of lithium are either transient or not severe enough to require discontinuation. Distressing side-effects can reduce gradually or become tolerable with a ‘watchful waiting’ approach or, if not tolerated, dose reduction. Side-effects leading to discontinuation may allow for later rechallenge. Side-effects such as stage 5 chronic kidney disease and the syndrome of irreversible lithium-effectuated neurotoxicity (SILENT) merit discontinuation. There is a paucity of studies examining management of lithium side-effects, with most treatments for them based on small samples or case series/reports. Treatments will usually mirror recommended interventions from other treatment settings.