How to Discontinue Lithium

[Guest Guest_Ammity_*]

im sick of lithium and i'd wait to ask my dr on advice on how to get off but 1, i dont value her advice and 2, i dont know when i next see her. i take 3 pills, all 300 each equaling 900 total... i assume all i have to do is take away one pill for about 2 weeks then another pill for a week or so and then wala no more acne, leg problems, inability to take advil problems. merry christmas to myself since i've had the most horrific cystic acne i've ever seen for over a year. and it stops today.

[crazynotstupid]

If you really want to go off it--yeah, that's generally a safe way.

More to the point--if you don't value your doc's advice and don't even know when you see her--find a new doc.

[ShadowCat]

im sick of lithium and i'd wait to ask my dr on advice on how to get off but 1, i dont value her advice and 2, i dont know when i next see her. i take 3 pills, all 300 each equaling 900 total... i assume all i have to do is take away one pill for about 2 weeks then another pill for a week or so and then wala no more acne, leg problems, inability to take advil problems. merry christmas to myself since i've had the most horrific cystic acne i've ever seen for over a year. and it stops today.

I'd really really recommend coming off it as slowly as possible, at least take more than 2 weeks... maybe 3-4 would be ideal if you can handle the physical side effects. Just speaking from experience, its a bad idea to come off fast.

[Silver]

no more acne, leg problems, inability to take advil problems. merry christmas to myself since i've had the most horrific cystic acne i've ever seen for over a year. and it stops today.

1. CNS is right. Time to talk to your doc about how you feel about your care, get a second opinion, or transfer care. You've stuck with her for over a year, apparently for a reason.

2. The slower you can go off, the better your odds are. Rebound episodes are nasty, in my experience (personal and observed) - twisty rabid affective weasels that can bite you in the eyeballs. Dropping SL by about 0.1-0.2 per week isn't a bad rule of thumb. I'm afraid the only citation I have to back that up (to hand, anyway) is lecture notes from a conference. The 150 mg caps are useful for this. Of course, SL monitoring and 150 mg caps both require medical involvement.

3. If it's not the right drug for your brain, then so be it. If it's significantly helping your brain, enough so that you now feel you have the luxury of discontinuing it, then compare that with the discontinuation reasons. I'd be dead in a ditch without it, and a recent d/c for medical reasons has been... chaotic, so I have pretty strong evidence for my part that I need it. Cystic acne, tremor, hypothyroidism, and all. But you may well have been taking it for a year without any perceived benefit for some reason, so maybe it's just not working for you.

Edited December 26, 2007 by Silver

[borzage]

I agree with CNS about finding a new p-doc - although there's nothing wrong with calling her for advice on coming off Lithium.

I hated Lithium. I took it in high school and had the cystic acne (although I didn't know what was causing it at the time), weight gain and paralyzing apathy. If it doesn't agree with you, then don't take it!

It is a good idea to be under the care of a pdoc when you come off these meds, so you'll have someone to help you if you run into trouble. It's also a good idea to explore other meds to find something that works better for you.

I came off mine cold turkey, and nothing bad happened (although I'm not suggesting you do the same). I felt so much better off Lithium!

[isis]

i was at 500mg and really sick. reduced it to 250mg for about 5 days, then went off it altogether.

i was so sick from taking it that i dont think i would have noticed any withdrawal effects.

[Guest Guest_Ammity_*]

of course there's a reason i've been with her for a year. I get charity care, so i'm stuck with her because the other Nurse Practioner isnt taking any patients. And NO, they will not give me a real live intelligent Psychiatrist.

The reason I've been taking it for over a year is because I finally felt stable when we added Geodon to it. The depression lifted wtihin a few days of taking Geodon. So either Geodon did the trick, or the combination did the trick. It'd be a foul reality if indeed I do need Lithium. Because at age 25, cystic acne isn't helping me any. The antibiotics used to treat the acne aren't helping the acne, and they're also making me unable to use birth control (reduces efficacy). The no NSAIDS stuff doesn't feel nice when I have arthritis in the winter. And last but not least, the RLS type EPS or whatever it is in my legs is a pain in my... legs.

i take way too many pills because of Lithium. If i get off it, i can take away doxycycline, nystatin, and benzotropine. and then maybe my boyfriends wont give me a huge lecture the first time they see my pill container!

[Silver]

Might still be worth calling her office and letting her know what your plans are. If she (or her office) gets called in a crisis, that way she's up to speed.

Lithium discontinuation rebound, although not inevitable, is common enough to be worth some serious thought. The references in this article should get you started. Goodwin and Jamison's Manic Depressive Illness text (2007) has a few pages on the topic as well. It really does need to be tapered over 4 weeks or by dropping the serum level by 0.2/week, and even then, it's not always a great one to d/c.

Your boyfriends lecture you on your pill container? Wow. You are a far more tolerant woman than I ever was, or they have some serious nerve. (Of course, my problem is that if I don't have the pill container, I end up with a lot of boyfriends. New ones. Every day.)

Good luck!

[Ammity]

Ok I really want to know the dosage. i'm not new with crazymeds or pdocs.

Edited December 28, 2007 by Ammity

[lachesis]

Do not discontinue on your own without medical supervision. IF you go batshit enough to be dangerous to someone then what will you be telling a judge and where will you end up?

There was one man near where I live and he discontinued his meds and a year later backslided. He resumed his past medication on his own and went psychotic and killed somebody. That is what he got for playing doctor with himself. Is it worth it?

I went psycho on some neighbors and the police were called. If I was not seeing a pdoc I'm sure I would have been arrested. Instead got taken to the looney bin. The police supervisor was mostly concerned that I had gone of my medication which I had not. If I had and told him that I had, I'd say the police would probably not leave me alone.

This is a lesson for all. As mental health consumers we like to be in charge of ourselves but society does not think that we should be. If something goes wrong....

[Ammity]

so we say taper and stay at the dose for 2 weeks each time, unless symptoms appear, then go slower?

[Ammity]

tapering down 300mgs at a time every two weeks is working fine for me. a little more anxiety than usual but nothing incapacitating.

[Ammity]

and a bit of agitation...

[Guest Fireboy]

I, too, would like to phase out my lithium dose (14 years of use) gradually. The effects from the lithium has required me to take levoxyl for thyroid regulation. My question is this, since I am ramping down the lithium, when and how do I eliminate the levoxyl? Do I continue with it until the lithium is history and then cold turkey the levoxyl, or should it be phased out simultaneously with the lithium?

I have notified my doctor that I am purposing to do this. She, resistantly, instead of helping me schedule a safely coordinated program, proffered zyprexa for my use if I should encounter situations that I have trouble coping with. I am not averse to having zyprexa as a safety valve that I take when I need it. Something that is there for use occassionally, rather than having lithium taking its toll on my health.

I'd appreciate feedback on this. I am in week one, of my first 25% per two-week lithium reduction phase out and would appreciate feedback on this phase-out regimen.

Thanks.

[AirMarshall]

Sound like a reasonable schedule, if you pdoc has approved. From a purely chemical standpoint, lithium has a half life of about 24 hours so it takes 5 days for any change in dosage to reach a steady state.

The important reason to take an even longer taper with lithium is that lithium can cause a nasty rebound of bipolar mania (ask me x2). *hangs head* So, it's important to allow time for the body to compensate.

Scheduled thyroid reduction? None. It isn't that simple. You will need to get off the lithium and then carefully monitor your thyroid levels in the months and years following. There is no guarantee that your hypothyroidism will go away. Although lithium has a reputation for "causing" hypothyroidism, it really is an 'association" and not a proven cause.

Lithium is thought to work by affecting the calcium channel in the brain cells, and it is not understood how this could affect the thyroid. Kay Jamison (of An Unquiet Mind fame) in her text Manic Depressive Illness, says that 30% of Bipolars have thyroid abnormalities regardless of lithium use. Some researchers belive that lithium may only unmask a hyporthyroid condition and not actually cause it.

The good news is the the thyroid meds have typically have no side effects, are relatively inexpensive, and are quite effective at alleviating fatique and skin problems.

Best, a.m.

[SashaSue]

Regardless of whether lithium actually causes thyroid problems, or just correlates with them, neither way is there any guarantee you'll be able to stop the thyroid meds when you're entirely off the lithium. If you've been on it for 14 years, it must kind of be working, no? And your big problem is the thyroid stuff? Personally, I'll take the effects of lithium, or whatever else, on my health, over those of unmedicated bipolarity, any day. Have you discussed a different maintenance med with your pdoc, or are you just going to kind of wait until it becomes necessary, and figure it out then?

[James]

I know this thread is old. I have tapered off clonazepam/valium and escitalopram 5 years ago. The rule is to taper off slowly, the slower the better to minimise withdrawal symptoms. 10% reduction per week of the last dosage is recommended. If you have lots of withdrawal symptoms, then go slow at 5%. It took me more than 6 months to taper. I did not take any other drug to help me. What helped me was food - lots of green leafy vegetables and fruits, cold liver oil, pumpkin seeds and sunflower seeds, oats with full cream milk, little meat, eggs, etc, etc. No alcohol, no refined white sugar. Exercise will help a lot if you can do it. I failed during my first attempt, there were too much withdrawal symptoms and I went back up the dosage and held there. Later I tried again and I was successful.

Share your success so other can learn.

Wish you all luck!

Edited December 23, 2010 by James

[AnneMarie]

I know this thread is old. I have tapered off clonazepam/valium and escitalopram 5 years ago. The rule is to taper off slowly, the slower the better to minimise withdrawal symptoms. 10% reduction per week of the last dosage is recommended. If you have lots of withdrawal symptoms, then go slow at 5%. It took me more than 6 months to taper. I did not take any other drug to help me. What helped me was food - lots of green leafy vegetables and fruits, cold liver oil, pumpkin seeds and sunflower seeds, oats with full cream milk, little meat, eggs, etc, etc. No alcohol, no refined white sugar. Exercise will help a lot if you can do it. I failed during my first attempt, there were too much withdrawal symptoms and I went back up the dosage and held there. Later I tried again and I was successful.

Share your success so other can learn.

Wish you all luck!

James, the taper schedule for benzos is different than for Lithium. To my knowledge, a Lithium 300mg reduction every couple weeks is generally sufficient. At 900-1200mg, that's six to eight weeks. It also depends on you and what other drugs you are taking. I had to stop suddenly, but my other meds kept me stable. If you are stopping Lithium with no other stabilizer, then the issue really is about having no other stabilizer if you are bipolar.

[Guest Ellen]

I am taking Cymbalta now so would it be safe to taper off lithium?

[Dyane]

Even though this is an old thread, I read it with great interest and was alarmed at the super-quick, unsafe tapers folks were recommending over the years. Please read the following reply I got from a neurosurgeon who has bipolar - I hope it helps you!

Below is the advice I got from Dr. Liz Miller a couple days ago. She is the highly acclaimed author of "Mood Mapping", a renowned mental health advocate in the U.K., the subject of Stephen Fry's groundbreaking t.v. series "The Secret Life of the Manic Depressive" (on youtube now) She is also highly controversial and incredibly inspiring to me.

Dr. Miller was diagnosed with bipolar and she has been med-free and doing well for over 12 years. Her new blog is at <edited out link>.

I am seeking a support team with others who have bipolar and are tapering off lithium, if you are interested please PM me. I'd be thrilled to hear from you. I am also extremely interested in finding *success stories* about those who have successfully tapered off lithium. Thanks for reading this and take care!

Hi Dyane,

Apologies for the slow reply – have been in China, and couldn’t access the website (thanks Google )

This is an article I wrote about coming off medication some time ago

<edited out link>

As far as reducing medication – it is important to get everything else right first. Medication should be the last thing to go, when you sorted out your environment, physical health, relationships, strategies and identity and hence learnt to manage your mood. At that point – who needs pills!!!

For my part, I take care of my diet, exercise lifestyle, relationships and am doing what I love! what more could I ask? I have been off meds for the last twelve years and never been happier or healthier!

Lithium gets in the clockwork! – it seems to work at the level of cell messenger RNA.

J Baldessarini did some studies that showed if you stopped lithium suddenly – 85% had a further episode within 2-3 years, compared to 30% of a control group who reduced their dose more slowly over 6 weeks. It is interesting the long lasting effects of lithium. “Effects of the Rate of Discontinuing Lithium Mainte- nance Treatment in Bipolar Disorders” RJ Baldessarini, Journal of Clinical Psychiatry 57:441-8, 1996

Many people have successfully come off lithium. My view is that reducing lithium needs to be done very slowly. Taking it down by as little as 100mg a month depending on how sensitive you are to its effects.

Ask your psychiatrist what he would do if your kidneys failed? You are asking to do whatever that might be, before your kidneys fail – so that you don’t have to go through dialysis etc. A cardinal sign of impending kidney failure is getting up in the night to pass urine, because your kidneys are losing their ability to concentrate urine. If this is the case for you, you certainly must come off lithium.

In the meantime, concentrate on a healthy life and take your time to make changes!

<edited out link to website>

Best wishes

Dr Liz

Edited October 30, 2012 by sylvan
<edited out links>

[Wooster]

There are loads of people whose quality of life is what it is because they actively work with their health care providers to find a medication schedule that works for them.

Decisions about medication should be made in consultation with one's health care provider and NEVER because of what any random individual or group of crazies on the internet suggest.

[Lib1]

I want to stop taking Lithium.   Was at 300 mg and now down to 150.   How do I reduce dosage with

the capsules I have?