Since lithium is known to deplete calcium in bones, should bipolar patients on lithium should take calcium supplements?
MANJI: Lithium depletion of calcium in bones is not a very common occurrence. Medication-wise, calcium supplementation is not a big issue. A small percentage of bipolar patients develop hyperparathyroidism on lithium. In these cases, a more careful investigation is warranted. The hyperparathyroidism should first be corrected; calcium supplementation may then be necessary. Mood disorders themselves can cause lowering of calcium in bones in older patients, which puts them at risk for osteoporosis because of elevations in cortisol and the activation of the sympathetic nervous system. (Phil Gold at the NIMH has done a lot of good research in this area.) Today we think once you lose that bone, it is cumulative over your lifetime. So almost certainly, unless there is a medical reason not to be taking calcium, you are not doing yourself harm by ensuring adequate calcium levels by diet and exercise. Diet and exercise are the best means, and for most people, they are adequate. If not, then calc
