title: [Lithium treatment and potential long-term side effects: a systematic review of the literature].
abstract: OBJECTIVE
  Lithium is recommended by all treatment guidelines for bipolar disorder (BD) as a first-line maintenance treatment. However, the potential side effects and risks associated with long-term lithium use may at times make the implementation of these recommendations in daily practice challenging. The aim of the study is to review available literature on potential long-term side effects of lithium.
  
  
  METHODS
  A PubMed/Medline search was performed on papers dealing with long-term treatment with lithium and side effects. Articles published from January 1980 to February 2013 were selected.
  
  
  RESULTS
  Long-term lithium treatment is associated with a reduced urinary concentrating ability, with subsequent polyuria and polidypsia and nephrogenic diabetes insipidus (in 10-40% of patients). Lithium also reduces glomerular filtration rate, and increases risk of renal failure, although the absolute risk is small (0.5% of patients). Lithium treatment is associated with significant higher TSH levels, with a 6-fold greater risk of hypothyroidism in lithium-treated than in control subjects. Less known is the increase of PTH and calcium levels induced by lithium. An exacerbation of psoriasis is also frequently associated with lithium treatment.
  
  
  CONCLUSIONS
  Lithium remains a fundamental tool for the treatment of BD. Clinicians should know potential side effects (renal, endocrine and dermatological) associated with long-term treatment with lithium, for a correct management of the patient. A specialist referral is often necessary; the question is how to deal with long-term side effects more than whether or not withdrawing lithium. This decision should remain a psychiatrist's competence.
authors.forename: Umberto
authors.initials: U
authors.lastname: Albert
authors.forename: David
authors.initials: D
authors.lastname: De Cori
authors.forename: Giovanni
authors.initials: G
authors.lastname: Blengino
authors.forename: Filippo
authors.initials: F
authors.lastname: Bogetto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Maina
mesh_terms: D018692:Antimanic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D016022:Case-Control Studies; D003875:Drug Eruptions / Q000209:etiology; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D006961:Hyperparathyroidism / Q000097:blood / Q000139:chemically induced; D007037:Hypothyroidism / Q000097:blood / Q000139:chemically induced; D007674:Kidney Diseases / Q000139:chemically induced / Q000503:physiopathology; D016651:Lithium Carbonate / Q000009:adverse effects* / Q000627:therapeutic use; D015201:Meta-Analysis as Topic; D017410:Practice Guidelines as Topic; D011565:Psoriasis / Q000139:chemically induced; D016032:Randomized Controlled Trials as Topic; D013972:Thyrotropin / Q000097:blood
chemical_list: D018692:Antimanic Agents; D016651:Lithium Carbonate; D013972:Thyrotropin