Specifics of lithium carbonate in psychiatric emergencies
DOI:
https://doi.org/10.33448/rsd-v15i2.50692Keywords:
Psychiatric emergencies, Lithium carbonate, Mood disorders, Lithium intoxication, Public Health.Abstract
Introduction: Lithium carbonate plays an essential function in the management of mood disorders, standing out for its robust mood-stabilizing efficacy and its well-established protective effect against suicide. Nevertheless its application in emergency situations necessitates prudence owing to its low therapeutic index, very gradual initiation of action, coupled with the necessity for ongoing clinical and laboratory surveillance. Objective: To critically analyze the use of lithium carbonate in psychiatric emergencies, focusing on clinical indications, associated risks, management of intoxication, and implications for the organization of health services. Method: This is a narrative literature review based on a non-systematic search of the PubMed/MEDLINE, Scopus, and SciELO databases, complemented by international clinical guidelines, consensus statements from scientific societies, and classical psychiatric texts. Original studies, narrative and systematic reviews, clinical trials, observational studies, and normative documents relevant to the use of lithium in urgent and emergency contexts were included. Results: Lithium has well-established efficacy in acute mania, relapse prevention, and reduction of suicide risk. In emergency settings, its prescription should be limited to situations involving adequate clinical assessment, demonstrated capacity for adherence, absence of a recent history of intoxication or medication-related suicide attempts, and assurance of outpatient follow-up with appropriate laboratory monitoring. Lithium intoxication is potentially severe, requiring early recognition and prompt, appropriate clinical management. Conclusion: Despite its substantial benefits, the use of lithium carbonate in psychiatric emergencies must be judicious, individualized, and integrated into a comprehensive care plan that ensures continuity of treatment, with the goal of maximizing therapeutic benefits while minimizing preventable risks.
References
Baldaçara, L., Grudtner, R. R., da S. Leite, V., Porto, D. M., Robis, K. P., Fidalgo, T. M., Rocha, G. A., Diaz, A. P., Meleiro, A., Correa, H., Tung, T. C., Malloy-Diniz, L., Quevedo, J., & da Silva, A. G. (2021). Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 2. Screening, intervention, and prevention. Brazilian Journal of Psychiatry, 43(5), 538-549. https://doi.org/10.1590/1516-4446-2020-1108
Baldaçara, L., Grudtner, R. R., Leite, V. S., Porto, D. M., Robis, K. P., Fidalgo, T. M., Rocha, G. A., Díaz, A. P., Meleiro, A., Correa, H., Tung, T. C., Malloy-Diniz, L. F., & da Silva, A. G. (2021). Brazilian guidelines for the management of suicide behavior. Part 2. Screening, intervention, and prevention. Braz J Psychiatry, Forthcoming 2020.
Baldaçara, L., Ismael, F., Leite, V., Pereira, L. A., Dos Santos, R. M., Gomes Junior, V. P., Calfat, E. L. B., Diaz, A. P., Perico, C. A. M., Porto, D. M., Zacharias, C. E., Cordeiro, Q., da Silva, A. G., & Tung, T. C. (2019). Brazilian guidelines for the management of psychomotor agitation. Part 1. Non-pharmacological approach. Braz J Psychiatry, 41(2), 153-167. https://doi.org/10.1590/1516-4446-2018-0163
Baldacara, L., Pettersen, A. G., Leite, V. D. S., Ismael, F., Motta, C. P., Freitas, R. A., Fasanella, N. A., Pereira, L. A., Barros, M. E. L., Barbosa, L., Teles, A. L. S., Palhano, R., Guimaraes, H. P., Braga, M. A., Castaldelli-Maia, J. M., Bicca, C., Gligliotti, A., Marques, A., & da Silva, A. G. (2022). Brazilian Psychiatric Association Consensus for the Management of Acute Intoxication. General management and specific interventions for drugs of abuse. Trends Psychiatry Psychother. https://doi.org/10.47626/2237-6089-2022-0571
Baldaçara, L. R., Rocha, G. A., Pinto, F. I., Gomes, I. E. V. e. M., Ribeiro, C. C., Calfat, E. L. d. B., Rosa, C. E., Leite, V. d. S., Barros, M. E. L., Motta, L. S., Agne, N. A., Ribeiro, P. G., Teles, A. L. S., Amaral, L. R. O. G. d., Ribeiro, J. d. A. M., Neves, M. d. C. L. d., Ribeiro, H. L., Silva, I., Lentz, V. J., & da Silva, A. G. (2022). Brazilian Psychiatric Association consensus for the management of psychiatric emergencies in pregnancy and postpartum period. Debates em Psiquiatria, 12, 1-44. https://doi.org/10.25118/2763-9037.2022.v12.389
Barroilhet, S. A., & Ghaemi, S. N. (2020). When and how to use lithium. Acta Psychiatr Scand, 142(3), 161-172. https://doi.org/10.1111/acps.13202
Cipriani, A., Hawton, K., Stockton, S., & Geddes, J. R. (2013). Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. BMJ, 346, f3646. https://doi.org/10.1136/bmj.f3646
Fernandes, J. M. B., Vieira, L. T., & Castelhano, M. V. C. (2023). Revisão narrativa enquanto metodologia científica significativa: Reflexões técnico-formativas. REDES – Revista Educacional da Sucesso, 3, 1-7.
Fountoulakis, K. N., Tohen, M., & Zarate, C. A., Jr. (2022). Lithium treatment of Bipolar disorder in adults: A systematic review of randomized trials and meta-analyses. Eur Neuropsychopharmacol, 54, 100-115. https://doi.org/10.1016/j.euroneuro.2021.10.003
Garriga, M., Pacchiarotti, I., Kasper, S., Zeller, S. L., Allen, M. H., Vazquez, G., Baldacara, L., San, L., McAllister-Williams, R. H., Fountoulakis, K. N., Courtet, P., Naber, D., Chan, E. W., Fagiolini, A., Moller, H. J., Grunze, H., Llorca, P. M., Jaffe, R. L., Yatham, L. N., . . . Vieta, E. (2016). Assessment and management of agitation in psychiatry: Expert consensus. World J Biol Psychiatry, 17(2), 86-128. https://doi.org/10.3109/15622975.2015.1132007
Gitlin, M. (2016). Lithium side effects and toxicity: prevalence and management strategies. International Journal of Bipolar Disorders, 4(1). https://doi.org/10.1186/s40345-016-0068-y
Goodwin, G. M., Haddad, P. M., Ferrier, I. N., Aronson, J. K., Barnes, T. R. H., Cipriani, A., Coghill, D. R., Fazel, S., Geddes, J. R., Grunze, H., Holmes, E. A., Howes, O., Hudson, S., Hunt, N., Jones, I., Macmillan, I. C., McAllister-Williams, H., Miklowitz, D. R., Morriss, R., . . . Young, A. H. (2016). Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology, 30(6), 495-553. https://doi.org/10.1177/0269881116636545
Grunze, H., Vieta, E., Goodwin, G. M., Bowden, C., Licht, R. W., Möller, H.-J., & Kasper, S. (2010). The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2010 on the treatment of acute bipolar depression. THE WORLD JOURNAL OF BIOLOGICAL PSYCHIATRY, 11(2), 81-109. https://doi.org/10.3109/15622970903555881
Lam, R. W., Kennedy, S. H., Adams, C., Bahji, A., Beaulieu, S., Bhat, V., Blier, P., Blumberger, D. M., Brietzke, E., Chakrabarty, T., Do, A., Frey, B. N., Giacobbe, P., Gratzer, D., Grigoriadis, S., Habert, J., Ishrat Husain, M., Ismail, Z., McGirr, A., . . . Milev, R. V. (2024). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023 : Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes. The Canadian Journal of Psychiatry, 69(9), 641-687. https://doi.org/10.1177/07067437241245384
Leite, V. d. S., Baldaçara, L., Canedo Filho, D. d. P., Grudtner, R. R., Freitas, R. A. d., Ribeiro, F. V., Akowanou, G. E. R. H., & Amaral, L. R. O. G. d. (2026). Effectiveness of interventions in the prevention of mood disorders: an overview of systematic reviews with meta-analysis. Debates em Psiquiatria, 16, 1-47. https://doi.org/10.25118/2763-9037.2026.v16.1542
Malhi, G. S., Bell, E., Bassett, D., Boyce, P., Bryant, R., Hazell, P., Hopwood, M., Lyndon, B., Mulder, R., Porter, R., Singh, A. B., & Murray, G. (2021). The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry, 55(1), 7-117. https://doi.org/10.1177/0004867420979353
Malhi, G. S., Bell, E., Singh, A. B., Bassett, D., Berk, M., Boyce, P., Bryant, R., Gitlin, M., Hamilton, A., Hazell, P., Hopwood, M., Lyndon, B., McIntyre, R. S., Morris, G., Mulder, R., Porter, R., Yatham, L. N., Young, A., & Murray, G. (2020). The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: Major depression summary. Bipolar Disorders, 22(8), 788-804. https://doi.org/10.1111/bdi.13035
Malhi, G. S., Das, P., Outhred, T., Irwin, L., Morris, G., Hamilton, A., Lynch, K., & Mannie, Z. (2018). Understanding suicide: Focusing on its mechanisms through a lithium lens. J Affect Disord, 241, 338-347. https://doi.org/10.1016/j.jad.2018.08.036
Malhi, G. S., Gessler, D., & Outhred, T. (2017). The use of lithium for the treatment of bipolar disorder: Recommendations from clinical practice guidelines. Journal of Affective Disorders, 217, 266-280. https://doi.org/10.1016/j.jad.2017.03.052
McKnight, R. F., Adida, M., Budge, K., Stockton, S., Goodwin, G. M., & Geddes, J. R. (2012). Lithium toxicity profile: a systematic review and meta-analysis. The Lancet, 379(9817), 721-728. https://doi.org/10.1016/s0140-6736(11)61516-x
Murphy, N., Redahan, L., & Lally, J. (2022). Management of lithium intoxication. BJPsych Advances, 29(2), 82-91. https://doi.org/10.1192/bja.2022.7
Nabi, Z., Stansfeld, J., Plöderl, M., Wood, L., & Moncrieff, J. (2022). Effects of lithium on suicide and suicidal behaviour: a systematic review and meta-analysis of randomised trials. Epidemiol Psychiatr Sci, 31, e65. https://doi.org/10.1017/s204579602200049x
Pereira, A. S., Shitsuka, D. M., Parreira, F. J., & Shitsuka, R. (2018). Metodologia da pesquisa científica. Editora da UFSM. https://repositorio.ufsm.br/bitstream/handle/1/15824/Lic_Computacao_Metodologia-Pesquisa-Cientifica.pdf?sequence=1
Perico, C. A., Santos, R. M. D., Baldacara, L. R., Simaro, C. S., Junqueira, R. C., Pedro, M. O. P., & Castaldelli-Maia, J. M. (2022). Psychiatric emergency units in Brazil: a cross-sectional study. Rev Assoc Med Bras (1992), 68(5), 622-626. https://doi.org/10.1590/1806-9282.20211267
Risemberg, R. I. C., Wakin, M., & Shitsuka, R. (2026). A importância da metodologia científica no desenvolvimento de artigos científicos. E-Acadêmica, 7(1). https://doi.org/10.52076/eacad-v7i1.675
Rybakowski, J. (2020). Lithium treatment - the state of the art for 2020. Psychiatr Pol, 54(6), 1047-1066. https://doi.org/10.12740/pp/128340 (Leczenie litem – stan wiedzy na rok 2020.)
Sakrajda, K., & Rybakowski, J. K. (2025). The Mechanisms of Lithium Action: The Old and New Findings. Pharmaceuticals, 18(4). https://doi.org/10.3390/ph18040467
Sher, L. E. O. (2008). Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, Second Edition. American Journal of Psychiatry, 165(4), 541-542. https://doi.org/10.1176/appi.ajp.2007.07121846
Shorter, E. (2009). The history of lithium therapy. Bipolar Disorders, 11(s2), 4-9. https://doi.org/10.1111/j.1399-5618.2009.00706.x
Strawbridge, R., Boules, C., Morriss, R., & Young, A. H. (2025). Lithium: Old Drug, New tricks? Current Psychiatry Reports, 27(12), 679-686. https://doi.org/10.1007/s11920-025-01646-0
Tondo, L., & Baldessarini, R. J. (2024). Prevention of suicidal behavior with lithium treatment in patients with recurrent mood disorders. Int J Bipolar Disord, 12(1), 6. https://doi.org/10.1186/s40345-024-00326-x
U.S. DEpartment of Veterans Affairs. (2023). Management of Bipolar Disorder (BD). https://www.healthquality.va.gov/guidelines/MH/bd/
Venkateswaramurthy, N., & Priyadarsini, R. (2023). A Review of Repercussions of Lithium Amalgamated with Antipsychotics for the Remedy of Bipolar Disorder. Journal of Drug Delivery and Therapeutics, 13(5), 106-109. https://doi.org/10.22270/jddt.v13i5.6064
Volkmann, C., Bschor, T., & Köhler, S. (2020). Lithium Treatment Over the Lifespan in Bipolar Disorders. Front Psychiatry, 11, 377. https://doi.org/10.3389/fpsyt.2020.00377
Wortzel, H. S., Simonetti, J. A., Oslin, D. W., Hermes, E., & Matarazzo, B. B. (2023). Lithium Use for Suicide Prevention, Revisited. J Psychiatr Pract, 29(1), 51-57. https://doi.org/10.1097/pra.0000000000000680
Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., Sharma, V., Goldstein, B. I., Rej, S., Beaulieu, S., Alda, M., MacQueen, G., Milev, R. V., Ravindran, A., O'Donovan, C., McIntosh, D., Lam, R. W., Vazquez, G., Kapczinski, F., . . . Berk, M. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipo lar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord, 20(2), 97-170. https://doi.org/10.1111/bdi.12609
Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., Sharma, V., Goldstein, B. I., Rej, S., Beaulieu, S., Alda, M., MacQueen, G., Milev, R. V., Ravindran, A., O'Donovan, C., McIntosh, D., Lam, R. W., Vazquez, G., Kapczinski, F., . . . Berk, M. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20(2), 97-170. https://doi.org/10.1111/bdi.12609
Zisook, S., Domingues, I., & Compton, J. (2023). Pharmacologic Approaches to Suicide Prevention. Focus (Am Psychiatr Publ), 21(2), 137-144. https://doi.org/10.1176/appi.focus.20220076
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