New psych took me off Lithium

Not necessarily bad.
I was on 600mg of lith and 200 of lamictal.
She said that after roughly 8 years on lithium, it could lead to side effects (thyroid and kidney) as well as the amount I was on was probably not doing much anymore (I did need my meds tweaked).

She put me on 100mg bid of the lamictal instead of 200 at once. I was feeling myself crashing and getting lethargic about 6 hours after my lamictal. New dose seems to be nice.

Anything I should watch out for getting off lithium?

She also prescribed Trazadone for sleep (50mg) because I have some issues with that. I can use it prn, and I'm not a fan because it's an antidepressant and those have sexual side effects I am prone to, mainly libido.

Anyhow, thanks in advance for any advice.

Just a question- did your doctor run any kind of blood tests or panels [thyroid, kidney, serum level] re:lithium before taking you off the medication?

Because... how well lithium works for an individual is affected by the serum level of the medication in the blood- which can vary from person to person. It is not dictated necessarily by the actual dosage in milligrams. And the precise serum level which works for each individual can vary- though the typical therapeutic range is usually .6-1.1ish.

If no serum level was taken, that's one issue.

Another issue is that kidney and theyroid functions don't just magically go to hell in one night.
They are to be monitored regularly.

There are people who are on lithium for many many many years and don't have problems; they are adequately monitored and it works for them

There is a reason it is often referred to as "the gold standard" when it comes to bipolar medications.

Because it works, it's cheap, easy to manage and monitor... and despite claims to the contrary- if a person takes care of themselves there are not nearly as many bad side effects- nor do they occur as often- as the rumors would have you believe.
I also question that if you were on 600mg, but it was doing nothing... why on it for so long?

But ya know... my two cents, likely worth as much



-Josie

I wonder the same thing. I was on 900mg of lithium for about two years and my levels were only checked once. I got very very sick. I had lithium toxicity. It also took out my thyroid. I've been on thyroid meds ever since. I have that checked every 4 months.

Josie, Lithium does not always work, and serious side effects or lithium causing other health issues is not all that rare. If you consider regular blood testing for kidney function, thyroid function, and lithium serum levels easy to manage that's ok, but not everyone is going to feel that way. And not everyone is going to think those risks are worth the pro's. The side effects can be intolerable and persistant despite how well you take care of yourself. There is rumors and then there is people's real life experiences.

If someone feels the medication is no longer working why quiz them on why they stayed on it so long, why not find something else. Some medications may work for a time and then not, it's not a given that what once worked will always work. I think the op would know if it was still working well or not.

I'm part of the group that had intolerable side effects, and another member, her husband had SUDDEN kidney failure. His levels were checked like clockwork, and he still ended up in the emergency room. It was such a harrowing experience that she and her pdoc opted that she get off the Lithium too.

Also it is well documented that Lithium is not to be rxd past a certain age due to the high chances of kidney failure in "older" patients.
The red flags surrounding Lithium are nothing like "The boy who cried wolf". They are real.

Just wanted to reiterate Anika's post about rumours and real experience. Most rumours have an actual root and don't get sucked from the rumour god's thumb.

To the OP, I unfortunately have no advice re: coming off Lithium I flushed all my meds and went cold turkey so have no idea which med caused what withdrawl symptom.

I agree. Not all that rare does not necessarily mean "will happen if you take this medication". And, as another poster indicated, failure to perform appropriate blood work can be problematic. That appears to be an issue in many cases.

I ask because of curiosity and it is a factor that was brought up with in the discussion. We're it something taboo, I would think that would be specifically mentioned, as I am not a mind reader. I would also think the OP would mention that specific situation themselves. If, however, the OP does for some reason feel quizzed, and I would assume that to have a negative association over merely questioned, I would apologIze for that.

But the OP has not expressed such a thing, unless they are doing so vicariously through you, Anika- though that specific situation has not been made clear to me either.

Again, we both agree Anika.

I do find it interesting that what I wrote seems to be painted in a black and white manner, as though I apparent feel lithium has no risk for any negative side effects or reactions.

Whoever wishes to is, obviously, free to reread what I wrote.
It's still there.

Josie, I said that because she said it doesnt feel like it is working "anymore", which would mean that it was at some point. Not that they just stayed on it for 8 years and that it wasnt working for a big part of that time or most of that time, or for so long. I believe that I can ask you a question about your post, just as you can ask a question. I never said you couldn't..I asked why.

Yes it is interesting, I can see why it would be read as back and white tho by the words choosen and statements made.

Sxprt, i have come off lithium quite a few times, it was one drug I did not have too much trouble coming off of. I never had and problems with it like you see with ad's or benzos.

I also tried Trazodone for a sleep aid. It did push me to mania but many other people take it with succsess. Hopefully you won't experience libido problems with it, as prn maybe that will do the trick.

I know there has been a lot of people here who prefered lamictal over lithium, I hope it works for you.

Now now. We're all here to support each other. No need for a debacle.

sxprt...I've never been on Lithium so I have no advice to give on that. I'm taking trazadone for sleep and I love it. Many have had negative experiences with trazadone but I have had absolutely none. My sleep is uninterrupted now and it only suffers when my symptoms get out of control (i.e. mixed episode).

I wish you the best in your new treatment. Have a great day!

Hi! I can comment on the part of your question that says "anything to watch out for while getting off lithium"...

I just got off of it. I tapered for a couple days and then pitched the rest. I know it was not a wise decision, but for me, I became fed up with the weight gain. I am only 2 weeks into being off of it, but I have to say I am SO surprised at how easy it has been!

I fully expected a fight and withdrawls etc. but I did not experience that at all. The extent of what happened was this:

1) after day 2 or 3 without meds my head just felt a little odd. not bad, just odd/foggyish.
2) constipation which has not fully resolved yet (sorry if thats gross but i thought you should know : )
3)I was mildy hypomanic about 3-5 days w/out meds. it lasted a few days and i was kind scared S***less that it would grow into something more intense but i practiced my breathing, stretching, meditation, and relaxation and made it through without any further escalation
4) I gained a little weight the first few days off and now the scale has tipped back the other way (pounds are slowly falling off. I am thankfully down 4 lbs from 2 weeks ago).
5) my energy levels seemed to wax and wane more. I would basically tire out in the mid-afternoon and I am coming out of that now.

Overall, it has been so easy compared to the SSRI paxil-hell-withdrawl I once experienced.

I sure hope you have an easy go of it!

Lithium can do bad things to people after long term use. Look at Jeremy Brett. He was having health problems from being on Lithium for Type I Bipolar.

Kidney and thyroid were not monitored regularly - in fact my doc never brought that up. This doc is sending me for those tests.
My lith level has been tested, but not reg. Another reason for switching docs. This is the same doctor that fairly recently didn't tell me that zyprexa would possibly put weight on me -- so fast in fact that my GP recommended stopping because the blood glucose was a major risk at that point. Yeah, it would have been nice to know the side effects first, before I liked it's effects.

So far so good. I feel more up it seems overall. I am a bit more manicy and I do crash a little in the evening, and I feel myself come down a bit about 5 hours after my lamictal dose but not too bad, I can just tell. Weight is consistent, although I didn't gain with lithium.

We'll see if it effects my mood. Hopefully for the better since I am prone to having a "bit" of a temper
This is a weird time for me, trying to get a house, major career transition, and saving up for an engagement ring - it's an awful lot right now, and I know I'm a bit off because of all this at times.

Good to know about traz. I go manic, not too much depression (just situational sometimes). I will keep an eye on that, I hope to try it tonight in case I can't wake up well, it's ok on a weekend.

Thanks for the advice everyone.
I hope to go in for the blood test soon. I just have to get up earlier than the seniors to beat them waiting in line for bloodwork at the hospital.

Been on lithium for 10 years (low dose last 7 yrs). Also lamictal 10 yrs. Neither done anything for me. Dr told me that therapeutic and toxic level for lithium are very close to one another so it's hard to dial in a dose which gives you relief. I hit therapeutic dose once (1800 mg) and felt very relaxed, focused, no irritability, etc. then immediately had problems with my muscles working. Recently tegretol helped stabilize my moods/concentration but had to stop due to side effects. Had side effects with depakote, too.

Never heard of tegretol. Depakote, I had side effects too.

I took the trazadone Saturday night, and told my gf that I needed 7+ hours to sleep. When she woke me I only had gotten just over 5. I don't remember the first hour or so of waking up/being awake. Just tid bits - means I was super groggy and I couldn't function. I would not drive a car, for instance. I also had a sinus migraine because of the weather change here, so there were two factors.
I went to sleep for two more hours and felt good (other than the headache still, but I could function)

The one thing that Lith should have been controlling was my temper. I have a short fuse sometimes and anger issues, and that has been pretty consistent since I was a teenager (I can just control it better using adult logic, sometimes )
That will be the next to work on with psych, getting my anger under control.

Going off slowly on any drug is advisable. That's my 2 cents!

I switched from Lithium to Tegretol (over a period of days) last year and had an manic episode. My pdoc said that something like 90% off people who switch or taper off quickly have an episode due to some boomerang effect. Go very very slowly and monitor closely.

Lithium is my miracle drug. They expected to have me on a cocktail of about 6 things, but 1 dose of 600mg lithium 1ce a day is apparently the magic number for me. (that being said I've been getting really depressed lately, I still say it's amazing for me). However, it's definitely not for everyone. I see myself as a bit of a special case because despite the toxicity and bad side effects, I haven't shown any hint of negative reproductions. I took a very long time getting on it, but I've missed doses before that would send people into a 2 week downward spiral. I also accidentally on purpose took myself off lithium cold turkey. DONT DO THAT! ITS BAD! but it didn't have any effect on me and my mood didn't start shifting again for another month or two after that. I was off it for about three months.

Anyway, the moral of the story is that it reacts massively different for everyone, and that the only real thing you can do for lithium is get your levels checked all the time. I do mine every 2-3 months.

Also, Josie's right about how the mg dose your on doesn't really matter, it's the levels. 600 is a really low dose for most people, but I was completely different on 750, where as some people are on 1000+ and don't have an effect or much of one. it's all about the lithium levels in your blood.

My husband is the one who went into sudden kidney failure due to lithium toxicity despite blood monitoring having been done actually quite soon before the whole nightmare began. A friend of mine took lithium for decades and ended up with severe hydrocephalus in her early 70's that the neurologists partially attributed to the long-term lithium use.

Between personally witnessing both incidents, I made the personal decision that I would no longer take lithium, even though it worked well for me. My pdoc understands my point of view even though he doesn't completely agree with it. He is working with me on finding an alternative; currently trying lamictal again and that seems to be going well thus far.

I had no problems coming off of lithium. Pdoc said oddly enough that where patients often see a change/problems in at about the one month mark with their mood.

Lamictal as a maintenance drug is predominately effective against depression, and lithium is predominately effective against mania. Combined, they're the gold standard maintenance combination for bipolar. Without lithium, you're at higher risk for hypo/mania, depending on who you are.