Current thinking favors the notion that episodes actually cause changes in the brain that prepare the way for later episodes and progressive intensity of illness. Mania and depression, it should be remembered, are disruptive events. Jobs are lost, marriages severely tried, social relations undermined. Some 10 percent of patients eventually successfully commit suicide. There is a small risk of some degree of kidney impairment.
Hypothyroidism can occur.
Since the therapeutic level of lithium is not far blow its toxic level, blood has to be drawn for lithium levels frequently, especially early in treatment. And of people stopping lithium, half of them have relapsed by six months. Abrupt cessation seems to carry more risk of relapse. Not all patients are helped by lithium. In those shown to be nonresponsive or poorly responsive, other drugs are used, often in combination with lithium.