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Bipolar disorder Adults

Lithium blood-level monitoring

If you take lithium long-term, a blood lithium level should be checked every few months to keep the dose safe.

78% of the time this step is missed
3.7x higher risk of harm when missed
Safety first: Do not change or stop lithium yourself - abrupt changes are dangerous. Ask about monitoring.

The silent should: If you take lithium long-term, a blood lithium level should be checked every few months to keep the dose safe.

In our analysis of de-identified U.S. psychiatric records, this step was missing 78% of the time it should have happened.

Why it matters: Forward-12mo inpatient IRR: 3.68x (95% CI 2.75-4.93) for sub-therapeutic (<0.6 mmol/L) vs therapeutic (0.6-1.2 mmol/L) among the 20,020 monitored lithium users.

Not everyone is missed equally: For Native American patients this step is missed 94% of the time, versus 78% for White patients.

This page is information to help you ask questions — it is not medical advice, and you should never start, stop, or change a medication on your own. Bring these questions to your clinician.

Questions for your doctor the next time you see them

Copy a line and ask it — these are questions, never instructions to change treatment.

  • I take lithium - when was my last lithium blood level?
  • How often should my lithium level, kidneys and thyroid be checked?

The evidence

Over the following 12 months, hospital-admission rate: 3.68x (95% confidence interval 2.75-4.93) for too-low (<0.6 mmol/L) vs therapeutic (0.6-1.2 mmol/L) among the 20,020 monitored lithium users.

Guideline — read the guideline →

This page is informational and not medical advice. It describes care patterns across a population, not your situation. Bring these questions to a clinician who knows you.

Build a checklist for your own care →