Also Known As
[Often referred to by brand name (see MedlinePlus Drug Information)]
Formal Name
Lithium
This article was last reviewed on
This article waslast modified on
May 28, 2018.
At a Glance
Why Get Tested?

To measure lithium levels in the blood in order to determine the therapeutic level when just starting lithium medication; to maintain the therapeutic level or to determine lithium toxicity

When To Get Tested?

When beginning treatment with lithium as the dose is adjusted to achieve therapeutic blood levels; at regular intervals to monitor lithium levels; as needed to detect sub-therapeutic levels or high (toxic) concentrations

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

None

You may be able to find your test results on your laboratory's website or patient portal. However, you are currently at Lab Tests Online. You may have been directed here by your lab's website in order to provide you with background information about the test(s) you had performed. You will need to return to your lab's website or portal, or contact your healthcare practitioner in order to obtain your test results.

Lab Tests Online is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called "normal" values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

For more information, please read the article Reference Ranges and What They Mean.

What is being tested?

Lithium is a drug used as an antipsychotic in the treatment of bipolar disorder. Occasionally, it can be used in other disorders to augment an antidepressant that does not adequately treat a depression. This test measures the amount of lithium in the blood.

Bipolar disorder is a mental condition characterized by alternating periods of depression and mania. These periods may be as short as a few days or weeks or as long as months or years. During a depressive episode, those affected may feel sad, hopeless, worthless, and lose interest in daily activities. They may be fatigued but have trouble sleeping, experience weight loss or gain, have difficulty concentrating, and have thoughts of suicide. During a manic episode, those affected may be euphoric, irritable, have high energy and grandiose ideas, use poor judgment, and participate in risky behaviors. Sometimes affected people will have mixed episodes with aspects of both mania and depression. Bipolar disorder can affect both adults and children.

Lithium is prescribed to stabilize the mood swings of a person with bipolar disorder. It is often called a "mood stabilizer" and is sometimes prescribed for people with depression who are not responding well to other medications. Less commonly, lithium may be prescribed to prevent schizoaffective disorder and cluster headaches.

Because lithium is a relatively slow-acting drug, its effect on mood may take several weeks. Dosages of the drug are adjusted until blood concentrations are within a therapeutic range—the blood level range that achieves the desired effect and treats an individual's bipolar disorder. The actual amount of drug that it will take to reach this steady state will vary from person to person and may be affected by a person's age, general state of health, and other medications that they are taking.

Lithium levels are monitored on a regular basis because blood levels must be maintained within a narrow therapeutic range. Too little and the medication will not be effective; too much and symptoms associated with lithium toxicity may develop.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed. However, timing of the sample collection may affect results. Generally, lithium blood levels are performed 12 hours after the last dose (also known as a "trough" level). Tell the person who draws your blood when you took your last dose so that the results can be interpreted correctly.

Accordion Title
Common Questions
  • How is it used?

    The lithium test is used to measure and monitor the amount of lithium in the blood so that a healthcare practitioner can determine whether the drug blood concentration is within the range that will adequately treat an individual's bipolar disorder (therapeutic range). The test may be used to measure blood levels every few days when a person first begins taking lithium to help adjust the dose and reach the desired blood level and may also be used at regular intervals or as needed to monitor blood concentrations. If a person starts taking additional medications, a healthcare practitioner may order one or more lithium tests to judge their effect, if any, on lithium levels. Lithium tests may also be ordered if toxicity is suspected.

  • When is it ordered?

    Lithium is ordered frequently when a person is starting lithium treatment. After a person has stable blood concentrations in the therapeutic range, a healthcare practitioner may order lithium tests at regular intervals to ensure that drug levels remain in this range.

    The test may be ordered when a person's condition does not appear to be responding to lithium to determine whether concentrations are too low, the medication is ineffective, and/or to determine if the person is complying with therapy (taking the lithium regularly). It may also be ordered when someone experiences a troublesome level of side effects and/or exhibits symptoms that the healthcare practitioner suspects may be due to toxicity, such as:

    • Drowsiness, lack of energy
    • Dizziness
    • Muscle weakness
    • Lack of coordination
    • Slurred speech
    • Nausea, vomiting and/or diarrhea
    • Confusion
    • Irregular tremors or shaking
    • Restlessness

    Extremely high levels can lead to stupor, seizures, renal failure, and death.

    Blood samples for lithium levels are generally drawn 12 hours after the last dose. Since dosage timing varies and some formulations are time-released, collection specifics may vary.

  • What does the test result mean?

    The therapeutic range for lithium has been established at 0.6 - 1.2 mmol/L. Within this range, most people will respond to the drug without symptoms of toxicity.

    Response and side effects will be individual. For some people with bipolar disorder, their condition will not be adequately treated at the low end of the therapeutic range. Others may experience excessive side effects at the upper end of the therapeutic range. Patients should work closely with their healthcare practitioners to find the dosage and concentration that works best for them.

    In general, when lithium results are in the therapeutic range and both the patient and their healthcare practitioner are satisfied that the person's bipolar disorder is being appropriately managed, then the dosage of lithium is adequate, particularly if the person is not experiencing significant side effects.

    If the blood level is below the therapeutic range, it is likely that the affected person is not receiving adequate medication. If levels are above the therapeutic range and if there are significant side effects present at the current dose, then it is likely that the dose is too high. In these cases, a healthcare practitioner may adjust the lithium dose. However, patients should not decrease or stop taking their medication without consulting with their healthcare practitioner as it can worsen their bipolar symptoms. Dosage determinations and adjustments must be evaluated on a case-by-case basis.

  • Is there anything else I should know?

    Lithium is eliminated from the body primarily by the kidneys. Long-term use of lithium carries a risk of decreased kidney function.

    People with kidney disease may have increased lithium levels because of decreased elimination. Healthcare practitioners will monitor kidney function over time with tests such as BUN and creatinine.

    Patients who take lithium may develop hypothyroidism. Healthcare practitioners will often regularly monitor a person's thyroid function with a TSH test.

    A variety of prescribed drugs, over-the-counter medications, and supplements can increase, decrease, or interfere with the concentrations of lithium in the blood. For more information, see MedlinePlus Drug Information: Lithium.

    Lithium levels and side effects can increase with the loss of salt and water from the body, such as may occur with a salt-free diet, excessive sweating, or with an illness that causes vomiting and diarrhea. To keep blood levels of lithium stable, the National Institutes of Health recommends drinking 8 to 10 glasses of water or other liquids each day, keeping salt and caffeine intake the same as before starting the drug, and avoiding alcohol.

  • How long will I need to be on lithium?
    Lithium is usually taken every day for a person's lifetime. Bipolar disorder can be managed but not cured.
  • Who orders lithium tests?

    They may be monitored by your primary healthcare practitioner but may also be ordered and monitored by a mental health professional.

  • Can I test my lithium level at home?

    No, the test requires specialized equipment. Blood samples are collected from a vein in the arm and tested in a laboratory.

View Sources

Sources Used in Current Review

2017 review performed by Kenneth Ihenetu, PhD, DABCC, FACB, Lab. Director, UNITEC Labs Inc.

Pauwels, S., Vermeersch, P., Desmet, K., Vanstapel, F. (2014). Practice-Oriented Quality Specification for Therapeutic Drug Monitoring. Clin. Chem. 60 (3):559-560.

Rej, S., segal, M., Low, N., Musci, I., Holcroft, C., Schulman, K., Looper, K. (2014). The McGill Geriatric ithium-Induced Diabetes Insipidus Clinical Study (McGLIDICS). Can. J. Psychiatry. 59 (6):327-334.

National Institute of Mental Health (2015). Bipolar Disorder. Available online at https://www.nimh.nih.gov./health/publications/bipolar/index.shtml. Accessed on 3/20/2017.

Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER, Bruns DE, eds. St Louis: Elsevier Saunders.

Sources Used in Previous Reviews

Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition]. Pp 1121.

Spearing, M. Updated (2006 February 17,Updated). Bipolar Disorder. NIMH [On-line information]. Available online at http://www.nimh.nih.gov/publicat/bipolar.cfm#bp6.

Goldberg, J. and Citrome, L. (2005 February). Latest therapies for bipolar disorder, Looking beyond lithium. Postgraduate Medicine online v 117 (2) [On-line journal]. Available online at http://www.postgradmed.com/issues/2005/02_05/goldberg.htm.

Geddes, J. et. al. (2004 February). Long-Term Lithium Therapy for Bipolar Disorder: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Psychiatry 161:217-222 [On-line journal]. Available online at http://ajp.psychiatryonline.org/cgi/content/full/161/2/217.

Newport, D. J. et. al. (2005 November). Lithium Placental Passage and Obstetrical Outcome: Implications for Clinical Management During Late Pregnancy. American Journal of Psychiatry 162:2162-2170 [on-line abstract]. Available online at http://ajp.psychiatryonline.org/cgi/content/abstract/162/11/2162.

Schapiro, N. (2005). Bipolar Disorders in Children and Adolescents. Medscape from J Pediatr Health Care. 2005; 19 (3): 131-141 [On-line information]. Available online at http://www.medscape.com/viewarticle/504584_1.

Menon, L. (2005 August, Updated). Lithium. National Alliance for the Mentally Ill [On-line information]. Available online through http://www.nami.org.

Walling, A. (2005 January 1). Evidence-Based Guidelines for Bipolar Disorder Therapy. American Family Physician [On-line journal]. Available online at http://www.aafp.org/afp/20050101/tips/19.html.

Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER and Bruns DE, eds. 4th ed. St. Louis, Missouri: Elsevier Saunders; 2006, Pp 1271-1272.

Harrison's Principles of Internal Medicine. 16th ed. Kasper D, Braunwald E, Fauci A, Hauser S, Longo D, Jameson JL, eds. McGraw-Hill, 2005 Pg 2557.

(Updated March 24, 2009) Lee D, Gupta M. Toxicity, Lithium from Medscape. Available online at http://emedicine.medscape.com/article/815523-overview. Accessed September 2009.

(January 15, 2009) MedlinePlus Medical Encyclopedia. Bipolar Disorder. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000926.htm. Accessed September 2009.

(January 4, 2009) Mayo Clinic. Bipolar Disorder. Available online at http://www.mayoclinic.com/health/bipolar-disorder/DS00356. Accessed September 2009.

National Alliance on Mental Illness. Medications, Lithium. Available online through http://www.nami.org. Accessed September 2009.

(Jan 14, 2009) Lloyd A. Netdoctor: Lithium. Available online at http://www.netdoctor.co.uk/diseases/depression/lithium_000290.htm. Accessed September 2009.

C. Wijeratne and B. Draper. Reformulation of current recommendations for target serum lithium concentration according to clinical indication, age and physical comorbidity. Aust N Z J Psychiatry. 2011 Dec; 45(12):1026-32. Available online at http://www.ncbi.nlm.nih.gov/pubmed/21961481. Accessed July 17, 2013.

Serum lithium measurement. MUSC Health: Medical University of South Carolina. Available online at http://www.muschealth.com/lab/content.aspx?id=150195. Accessed July 17, 2013.

Lithium. Egton Medical Information Systems Limited. Available online at http://www.patient.co.uk/doctor/lithium. Last reviewed 02/05/2013. Accessed July 17, 2013.

Label and Approval History. Food and Drug Administration. PDF available for download at http://www.accessdata.fda.gov/drugsatfda_docs/label/2004/16860slr074,18152slr020_eskalith_lbl.pdf. Issued 2004. Accessed July 17, 2013.

Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER and Bruns DE, eds. 4th ed. St. Louis, Missouri: Elsevier Saunders; 2006 Pp 608-609.

Ask a Laboratory Scientist

 

Your questions will be answered by a laboratory scientist as part of a voluntary service provided by one of our partners, the American Society for Clinical Laboratory Science (ASCLS). Click on the Contact a Scientist button below to be re-directed to the ASCLS site to complete a request form. If your question relates to this web site and not to a specific lab test, please submit it via our Contact Us page instead. Thank you.

Contact a Scientist