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Does lithium become less effective as a person gets older?


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I've been taking lithium religiously since I was 18 years old (1200 mg/day). I'm 51 years old now. I don't have thyroid or kidney problems. I'm Bipolar II. I've never been hospitalized. I graduated from college with a BS in chemistry and have maintained a fairly sucessfull career. Throughout my life I would always have issues with depression where I would always ask a psychiatrist for help. I don't seem to have issues wirh hypomania. I've tried mood stabilizers, anti-depressants, anti- psychotics which never seemed to help "lift my mood". I'm taking only lithium now for the past 3 years (still 1200 mg/day).

Lately, I've been feeling depressed lacking in self confidence and lately my thinking hasn't been clear and I seem to be indecisive. I feel these symptoms are being noticed by others at work now. I think these symptoms are due to the hypomanic or depressive phases of the bipolar and it seems unlikely that they would be from lithium side effects.

I'm curious to know if Lithium carbonate looses it's effectiveness over time? Over the 33 years that I've been taking it, my lithium level has been regularly at 0.6 meq/liter. If I increase it, do you think these negative issues will improve?

Thanks

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I wonder if as you get older, you may need a higher level. Now I know NOTHING about this so I'm sorry, but my mom is about your age, and she's gotten more depressed. Menopause and all, post menopause, pre menopause...seriously I don't mean to offend. But my mom discusses depression a lot with me and she was okay till she was about 48. I wonder if it's just because your hormones are different. Kind of like how preteens are so messed up because their hormones are changing. If not those things, I doubt it loses its effectiveness...I mean, some people are on Lithium like 50 years! For me, Lithium worked great about 2 weeks...lol. Then stopped working. My level was only 0.5, and no one thought to change it, so I quit it...

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As far as I know, Lithium does not loose efficacy over time or as we age. I've heard that stopping and restarting can have an effect but I've stopped and restarted without change in effectiveness. So, not so sure about that one. Anyway, your serum level isn't very high. I'd try more Li before something else.

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I have not seen anything in the literature or in Jamison & Goodwin that indicates lithium loses effectiveness with age or length of use.

Lithium was approved in the US in 1970, and the Extended Release form in 1978/79, you represent one of the true leaders in long term use (and I think you would agree, overall success!).

Do keep in mind that it is possible to have break through episodes of hypomania/depression, that require either med adjustment or supplementation. These don't represent a failure of your long term medication. Typically prompt and adequate action can stabilize you and then probably return you to your lower level baseline medication. I think you have been fortunate not to have experienced so many ups and downs over the years.

Get on the phone and get in to see your pdoc and regular physician. Despite your clean history, a physical with Full Metabolic Panel, Complete Blood Count and Lithium level is warranted as the starting point (all common blood tests). It's always smart to start with the firm physical checks before adjusting the psych meds.

Best regards and welcome aboard. a.m.

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