Britney Spears made many shocking statements during a June 2021 hearing about her conservatorship — including that she was forced to take a psychiatric medication called lithium (Eskalith, Eskalith-CR, Lithobid, Lithonate, Lithotabs) after refusing to perform in Las Vegas.
The fact that the pop star described the medication as “strong” and said it made her feel “drunk,” has raised many questions about lithium among the public — including what lithium treatment is and what risks it can pose.
So, what’s the truth about lithium? Here are eight things you should know about this medication.
Fact 1: Lithium Is Most Commonly Used to Treat Bipolar Disorder
Lithium is considered a mood stabilizer — a group of medications used to treat the highs (mania) and lows (depression) of bipolar disorder. It’s approved by the U.S. Food and Drug Administration (FDA) for two important uses related to bipolar disorder.
One use is to treat mania, or the higher-energy state in bipolar disorder marked by extreme euphoria or irritability combined with racing thoughts, faster speech, lack of need for sleep, and impulsivity.
Another use is what’s called “maintenance therapy.” This means lithium helps prevent future manic and depressive episodes and helps someone keep their mood stable and avoid major mood disturbances.
In addition, lithium has been shown to reduce suicidal thoughts and behaviors. It’s sometimes also prescribed to people diagnosed with depression and schizophrenia as part of their treatment.
Myth 1: Lithium Works Instantly
Lithium does not work instantly. This treatment needs to be started slowly, and there is a specific level of this medication in the blood that needs to be reached.
If the level of lithium in your blood is too low, it may not work, and if it's too high, it can be dangerous. Even after the correct dose of lithium is reached, it can take one to three weeks for this medication to take full effect.
This is important because sometimes, especially when someone is manic, an additional, faster-working medication may be needed temporarily until the lithium treatment kicks in. After the lithium starts working, the other medication can be tapered off (slowly stopped).
Fact 2: You Need to Get Lab Tests Before Starting and While Taking Lithium
Lab tests before and while a person is taking lithium are important for several reasons. This medication can affect your kidneys and thyroid, so your doctor needs to know how well they’re functioning before starting treatment. Your doctor will also monitor you for changes in kidney and thyroid function while you're on this treatment.
Lithium can cause weight gain. In addition to checking your weight before you start treatment to monitor future weight gain, your doctor will check you for high cholesterol levels, high fat levels, and for prediabetes or diabetes. These test results allow your doctor to both assess your individual risk in starting the medication and to monitor any side effects you may experience from the medication.
Even after the right dose of lithium is found, your doctors still need to monitor the levels of lithium in your blood, because many factors can affect these levels, such as certain other medications, salt intake, and the amount of liquid you drink.
Myth 2: Lithium Is Stronger and More Dangerous Than Other Psychiatric Medications
When I counsel people on lithium, I get very different responses each time. Some people feel more comfortable with lithium than other medications because it’s a naturally occurring element, while other people have heard about experiences like Spears’s and worry that it’s too strong for them.
The truth is that all psychiatric medications can have serious side effects. No matter what psychiatric medication is being started, it’s essential that your doctor discuss how the medication can help you, its side effects, and potential alternative treatments if it doesn’t work for you. This process is called “informed consent.”
In cases like Spears’s, having a conservator affects informed consent. But even in cases like these, it’s important to remember that the person taking the medication should be included in the discussion as much as possible, no matter what.
In my experience as a psychiatrist, even if someone is psychiatrically impaired and needs help making decisions, they are still included in the decision-making process when it comes to medical interventions. Typically, if this person is willing to take one type of treatment and not another, the treatment option they prefer is selected.
Fact 3: Lithium Can Affect How Awake and Alert You Feel
One thing Spears mentioned disliking about lithium during her June 2021 hearing was that it made her feel “drunk.” While it is not typical to feel drunk while taking lithium, it can affect how alert and awake you feel. Even at the correct dose, you can feel somewhat drowsy and less mentally sharp when taking lithium.
But, if you feel noticeably drowsy and confused when taking lithium, it could be a sign that the dose is too high and you’re experiencing lithium toxicity. Additional signs of lithium toxicity include tremors, slurred speech, muscle weakness, and stomach issues like vomiting and diarrhea. If you experience any of these, seek help immediately to get your lithium levels checked.
Myth 3: We Know Exactly How Lithium Works
Lithium is complex, and experts don’t know exactly how it works in the body. What we do know is that lithium affects the movement of sodium (a mineral in the body) across nerve and muscle cells, can alter levels of neurotransmitters, or chemical messengers in the body like serotonin and dopamine, and can affect the way nerve cells receive and send messages.
I mention this myth because too often, the causes and treatments of mental illnesses are explained in very simple terms. In reality, these things are much more complex, and there are major limitations to what experts currently know about them. It’s important that people know about these limitations, because it’s only with honest information that people can make informed decisions about their health.
Fact 4: You Can Safely Take Lithium Long Term
During her June 2021 hearing, Spears mentioned that lithium should not be used for more than five months — this is not true.
The risks and benefits of a medication vary by individual and need to be constantly assessed during treatment. But there are people who do really well on lithium when it comes to symptom control and have minimal side effects (or side effects that feel worth it to them for the benefits they are experiencing from the treatment). People who do well on lithium treatment can continue to work with their doctors and safely take this medication long term.
Myth 4: If Your Bipolar Disorder Is Not Well Managed, You Should Abruptly Change Medications
One concerning part of Spears’s June 2021 hearing was her statement that her medications were abruptly changed against her wishes. Having not evaluated Spears myself, I don’t know the details of her treatment, but what she described in court is not typical — psychiatric medications should never be abruptly changed.
If you feel your symptoms are not well managed on your current medication, speak with your doctor. The best way to make changes is to do so slowly. This may include slowly changing the dose of medication, slowly stopping a medication, or slowly adding a different medication (or a combination of these) — the key word in all this is "slowly."