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Lithium withdrawal


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#1 seven

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Posted 20 October 2006 - 06:40 PM

Pdocs contend that lithium has no withdrawal symptoms and blame symptoms that may emerge (as a result of a too rapid discontinuation) on your bipolar mania. They will only call it "lithium discontinuation syndrome" since they believe there is no such thing as lithium withdrawal.

For one thing, I think the psych community overlooks the rebound effect of simply taking away a drug with depressant properties. Even a normal person discontinuing rapidly would, I contend, be at risk for symptoms (dysphoric, hypomanic, anxiety, agitation, or otherwise). And another, lithium may well have unique withdrawal symptoms of its own that have been written off as mania.

Nowhere in the literature do I see any acknowledgement of this. The knee-jerk explanation given is always the bipolar, as if they were trying to give you evidence of your bipolar and teach a morality lesson about compliance. The patronizing never ends.

I do think this is a disservice and provides only misconceptions about lithium as a "test" for bipolar.

So, anyway, this is what i've been thinking lately. I just wish there were some solid addressing of the true withdrawal aspects of lithium--and not just finger-pointing to a possibly red herring (the bipolar).

7

Edited by seven, 20 October 2006 - 06:48 PM.



#2 AirMarshall

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Posted 20 October 2006 - 07:11 PM

Pdocs contend that lithium has no withdrawal symptoms and blame symptoms that may emerge (as a result of a too rapid discontinuation) on your bipolar mania.

For one thing, I think the psych community overlooks the rebound effect of simply taking away a drug with depressant properties. Even a normal person discontinuing rapidly would, I contend, be at risk for symptoms (dysphoric, hypomanic, anxiety, agitation, or otherwise). And another, lithium may well have unique withdrawal symptoms of its own that have been written off as mania.

Nowhere in the literature do I see any acknowledgement of this. The knee-jerk explanation given is always the bipolar, as if they were trying to give you evidence of your bipolar and teach a morality lesson about compliance. The patronizing never ends.

Kay Jamison & Fred Goodwin in their definitive text Manic Depressive Illness, 1990, pp679 - 681 specifically discuss rebound mania/ relapse following lithium discontinuation, and the common clinical believe that discontinuation nearly always results in relapse. They cite five studies going back to 1968 supporting this concept. Lithium mania rebound is well known in the psychiatric community.



I do think this is a disservice and provides only misconceptions about lithium as a "test" for bipolar.

No responsible physician diagnoses illnesses based on response to drugs. Now on the otherhand, a practitioner will take reassurance that he has correctly diagnosed and prescribed a patient, when the patient's condition improves appropriately to standard treatment protocols. The two are not the same.

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#3 seven

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Posted 20 October 2006 - 08:32 PM

Air Marshall,

Rebound mania risk is a given. But I am suggesting these symptoms are not exclusive of genuine lithium withdrawal symptomology as well. It's only logical that the sudden discontinuation of a depressant is going to produce rebound symptoms. And the nature of those symptoms is going to be influenced by the drug in question.

Normal subjects experience the same lithium mood side effects that bipolar people do. Mental dulling, depressant symptoms, etc. All of this according to studies Kay Jamison cites in touched by fire. What makes you think they would be spared rebound agitation?

Rebound stimulation may or may not provoke mania in a bipolar person. But that's not what I'm talking about. I'm talking about that rebound collection of symptoms that may occur as withdrawal, defined as withdrawal, the sudden discontinuation of a drug and adverse symptoms that ensue.

No one admits this exists.

Everyone INCLUDING ME admits rebound mania exists. But that is NOT what I'm addressing here.

I hope you get what I'm trying to say. Thanks for your response.
7

#4 AirMarshall

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Posted 20 October 2006 - 09:45 PM

I think that you are arguing for a difference without distinction. Rebound symptoms are rebound symptoms.

And, I'm going argue that what you are discussing is not "withdrawal" symptoms, but merely the reappearance of the underlying illness.

Since withdrawal is generally defined as:

Withdrawal refers to the characteristic signs and symptoms that appear when a drug that causes an addiction [or dependence]is regularly used for a long time and then suddenly discontinued or decreased in dosage.


Lithium does not cause addiction nor physical dependence, therefore does not cause withdrawal.


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#5 seven

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Posted 20 October 2006 - 11:25 PM

A.M.

What I'm saying is a normal non-mi person who suddenly discontinues lithium WILL be at risk for adverse symptoms and those symptoms would not be rebound mania. It would be the brain rebounding back like a rubber-band after a depressant has been taken away.

Withdrawal from anti-depressants, anticonvulsants and antipsychotics are acknowledged. Their withdrawal profiles are well described. And they are not addictive substances. However, withdrawal from Lithium is NOT acknowledged.

So why is everyone in denial about the fact that suddenly discontinuing Lithium can produce "mania" type symptoms whether you are bipolar or not?

Pdocs will almost always say those discontinuation symptoms are "rebound mania." But what if they're not? What if that's just a natural and expected chemical process, your brain bouncing back, adjusting to the absence of lithium, making its own way back to a stable state?

Edited by seven, 22 October 2006 - 11:20 AM.


#6 Guest_jeff_*

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Posted 04 July 2008 - 04:43 PM

I was on lithium for 2 1/2 years and when I was tapered off of it and finally got off of it I experienced significant withdrawal from the medication, including being emotional.... I had no energy on lithium and sleeping alot and when I got off it I had alot of energy and it was difficult to sleep. I could tell I felt differently then I ever felt in my life.. and it took a long time for my brain to recoperate, but eventually it did.. and now I've been off all psychiatric medication including lithium for almost 2 years and trying my best to get my career back. if anyone wants to discuss, feel free to email me at jdatto@aol.com

thanks.

A.M.

What I'm saying is a normal non-mi person who suddenly discontinues lithium WILL be at risk for adverse symptoms and those symptoms would not be rebound mania. It would be the brain rebounding back like a rubber-band after a depressant has been taken away.

Withdrawal from anti-depressants, anticonvulsants and antipsychotics are acknowledged. Their withdrawal profiles are well described. And they are not addictive substances. However, withdrawal from Lithium is NOT acknowledged.

So why is everyone in denial about the fact that suddenly discontinuing Lithium can produce "mania" type symptoms whether you are bipolar or not?

Pdocs will almost always say those discontinuation symptoms are "rebound mania." But what if they're not? What if that's just a natural and expected chemical process, your brain bouncing back, adjusting to the absence of lithium, making its own way back to a stable state?



#7 Guest_Guest_Peter_*_*

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Posted 05 October 2008 - 04:26 PM

Lithium IS an addicting drug. Every drug that works via neuroreceptors or transmitters or transmitter inhibitors will cause the brain to adujst to this new chemical evinorment as it tries to balance everything out. A well supported brain will be able to handle everything life throws at it; it is those brains which have been under too much stress or too little of the right nutrition or both that cannot balance everything as well. Too much transmitting = racing thoughts. You take some lithium to slow things down and it does but your brain is working hard to compensate and it takes time for it to adjust (at least 4 weeks). If you take the lithium away, even just some of it, without titrating slowly then you have just thrown a curve-ball to your brain. It has been trying to speed up your thinking back to a normal pace. If you don't give it time to readjust to the new levels you will likely have manic experience. Whenever the brain adjusts to a drug, this is called addiction; of course, some drugs are worse than others. ALL MEDICATIONS THAT PRODUCE AN EFFECT ARE ADDICTING; even the ones that aren't directly affecting the brain. Blood pressure meds, for example, act the same way: they produce a Blood Pressure lowering effect and if you stop them too quick, after having been on them for a few weeks, your BP goes up sharply beyond where you started before taking the meds! It will settle down eventually, but as always go slowly and employ those others means of dealing with the root cause rather than the symptoms.

Also, the British Journal of Psychiatry has numerous articles detailing studies which do show a legitimate lithium withdrawal separate from BiPolar (or other disease). You have to pay for access but it was worth it, I copied maybe a dozen of them to keep on file (I have a family member withdrawing from lithium).
Hope this helps.

#8 Velvet Elvis

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Posted 05 October 2008 - 04:35 PM

You seem to have a different definition of addiction than the rest of the world.

Oh never mind. I'm not even going to bother

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#9 Silver

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Posted 05 October 2008 - 04:43 PM

Yet again.
Dependence: physiologic phenomenon.
Tolerance: physiologic phenomenon.
Addiction: behavioral phenomenon.

And also, yet again, the ASAM definitions (bolding is mine, however)
I. Addiction
Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and
environmental factors influencing its development and manifestations. It is characterized
by behaviors that include one or more of the following: impaired control over drug use,
compulsive use, continued use despite harm, and craving.
II. Physical Dependence
Physical dependence is a state of adaptation that is manifested by a drug class specific
withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction,
decreasing blood level of the drug, and/or administration of an antagonist.
III. Tolerance
Tolerance is a state of adaptation in which exposure to a drug induces changes that result in
a diminution of one or more of the drugís effects over time.
Bipolar I, other stuff

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#10 december_brigette

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Posted 05 October 2008 - 05:56 PM

hi,

thankfully lithium is so cheap that if it is "addicting" its not gonna make me homeless.

90 - 300mg pills for 50 cents!!! thank you medicare.

db

dx: bipolar 1, anxiety, and a little ptsd

current meds:
cymbalta 90mgs
depakote 1500 mg
prazosin 1 mg
seroquel 50 mg

topamax 50mg
xanax 2.50 mg

other meds ive tried: abilify, ambien, effexor xr, lamictal, lexapro, lithium, lunesta, paxil, provigil, tegretol, trazodone, wellbutrin, zoloft.
 
"I mixed Benadryl and Tegretol one time. Spent three days guessing weight at the Iowa State Fair. Got crabs, and a tattoo, of a crab," Andy on "weeds."

 

"Psychiatry is just this year's candy pink stove." from the tv show Madmen.


#11 Guest_peter_*

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Posted 14 October 2009 - 04:32 AM

Lithium IS an addicting drug. Every drug that works via neuroreceptors or transmitters or transmitter inhibitors will cause the brain to adujst to this new chemical evinorment as it tries to balance everything out. A well supported brain will be able to handle everything life throws at it; it is those brains which have been under too much stress or too little of the right nutrition or both that cannot balance everything as well. Too much transmitting = racing thoughts. You take some lithium to slow things down and it does but your brain is working hard to compensate and it takes time for it to adjust (at least 4 weeks). If you take the lithium away, even just some of it, without titrating slowly then you have just thrown a curve-ball to your brain. It has been trying to speed up your thinking back to a normal pace. If you don't give it time to readjust to the new levels you will likely have manic experience. Whenever the brain adjusts to a drug, this is called addiction; of course, some drugs are worse than others. ALL MEDICATIONS THAT PRODUCE AN EFFECT ARE ADDICTING; even the ones that aren't directly affecting the brain. Blood pressure meds, for example, act the same way: they produce a Blood Pressure lowering effect and if you stop them too quick, after having been on them for a few weeks, your BP goes up sharply beyond where you started before taking the meds! It will settle down eventually, but as always go slowly and employ those others means of dealing with the root cause rather than the symptoms.

Also, the British Journal of Psychiatry has numerous articles detailing studies which do show a legitimate lithium withdrawal separate from BiPolar (or other disease). You have to pay for access but it was worth it, I copied maybe a dozen of them to keep on file (I have a family member withdrawing from lithium).
Hope this helps.

my fiancee was eratic after lithium was removed suddenly after 12 years usage & <50,000mg over dose. please provide me with info "british journal manic like"

#12 hexgeist

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Posted 14 September 2010 - 07:24 AM

Lithium IS an addicting drug. Every drug that works via neuroreceptors or transmitters or transmitter inhibitors will cause the brain to adujst to this new chemical evinorment as it tries to balance everything out. A well supported brain will be able to handle everything life throws at it; it is those brains which have been under too much stress or too little of the right nutrition or both that cannot balance everything as well. Too much transmitting = racing thoughts. You take some lithium to slow things down and it does but your brain is working hard to compensate and it takes time for it to adjust (at least 4 weeks). If you take the lithium away, even just some of it, without titrating slowly then you have just thrown a curve-ball to your brain. It has been trying to speed up your thinking back to a normal pace. If you don't give it time to readjust to the new levels you will likely have manic experience. Whenever the brain adjusts to a drug, this is called addiction; of course, some drugs are worse than others. ALL MEDICATIONS THAT PRODUCE AN EFFECT ARE ADDICTING; even the ones that aren't directly affecting the brain. Blood pressure meds, for example, act the same way: they produce a Blood Pressure lowering effect and if you stop them too quick, after having been on them for a few weeks, your BP goes up sharply beyond where you started before taking the meds! It will settle down eventually, but as always go slowly and employ those others means of dealing with the root cause rather than the symptoms.

Also, the British Journal of Psychiatry has numerous articles detailing studies which do show a legitimate lithium withdrawal separate from BiPolar (or other disease). You have to pay for access but it was worth it, I copied maybe a dozen of them to keep on file (I have a family member withdrawing from lithium).
Hope this helps.



Hi Guest_Peter_,
I am currently tapering off lithium. Would you mind emailing me please an of those articles from the British Journal of Psychiatry please if you still have them? I'd really appreciate it.
Hexgeist

#13 Guest_Weirdness_*

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Posted 11 October 2010 - 06:57 PM

Prozac, Zoloft, Lithium, Depakote and Effexor XR all do the same thing to me -- I get fat, lazy, nervous, angry, and i have horrible LSD flashbacks. Meds don't work for me. i'm beyond help

#14 Moil

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Posted 12 October 2010 - 01:48 AM

The use of these terms is really grating on me at the moment so here is some official definitions:

Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.


Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.


So this means that while it is not uncommon for someone to be both physically dependent and addicted to something like heroin, it is really unlikely for someone to be more than physically dependent on most psych meds.  An active desire to not take the meds just doesn't really fit addiction.

Sorry for nitpicking, but that bugged the hell out of me...and on an unrelated note, I finally figured out how to make a quote box. 

Edit: "w", "e" whats the difference, well besides one making a whole hell of a lot more sense than the other.

Edited by Moil, 12 October 2010 - 01:56 AM.

Dx:  Major Depressive Disorder...though I think the lithium may be hiding something other than the fact that it owes me money

Rx-AM:  3 X 20mg fluoxetine; 3 X 300mg Lithium Carbonate; Water

Rx-PM:  3 X 300mg Lithium Carbonate; Water

Tx:  Elevated volume

Meds That Remain Only in Memory:  Citalopram made my toilet and I too familiar;  Sertraline is what they gave me in school > 10 years ago 

  






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