Lithium therapeutic range for maintenance (vs initial stabilization)?

[tamagotchi]

I was just reading "Clinical psychopharmacology made ridiculously simple" and read the following passage about lithium levels.  It was pretty much what I expected, until I came to the highlighted sentence below:

 

Generally the starting dose is 600 or 900mg/day given in divided doses.  The therapeutic range and toxic range of lithium are very close to one another.  Thus it is necessary to gradually increase the dose while carefully monitoring blood levels. Most patients must reach a level between 1.0 and 1.2 mEq/L.  Not infrequently the level may need to be higher to obtain symptomatic improvement (1.2 to 1.5) [...] On occasion, patients may need and tolerate blood levels up to 2.0 mEq/L. However, there is increased risk of toxicity at such doses.  Generally, daily doses range from 1200-3000 mg.  Once mood is adequately stabilized, the dose can be lowered somewhat (0.8 mEq/L blood level for Bipolar I or 0.6 mEq/L for Bipolar II) for maintenance treatment.

 

Whenever I see people talking about the therapeutic range here, it's closer to the first set of numbers, 1.0 to 1.2.  Generally when someone posts that they are stable on a lower level like 0.6 to 0.8, it's described as an atypically low level.

 

But according to the author above, a level of 0.6 would actually be normal for maintenance of BP II?

 

This would match with my experience, for me 0.6 was plenty for controlling the highs, I never ventured even slightly into hypomania territory or above when at that blood level.  I had thought this was a low level.  Maybe I'm not as special as I thought? 

 

Disclaimer: I am not taking lithium at this time, it's been a couple of years.  I'm just interested in this question.

Edited February 19, 2014 by tamagotchi

[CeremonyNewOrder]

I honestly could never tell the difference in levels because I don't get any side effects from it. I started at 0.5 and I'm now at 0.8.

[MiaB]

My pdoc considers me stable at 750mg with an average blood level of 0.7.  I wound up in the ER several times early on in my lithium treatment (when we were still figuring out my daily dose), and it seems that 750mg is as high as I can go without needing IV fluids and prescription strength antiemetics.  I have BP 1.

[Butterflykisses]

I am on 900 mg and my blood level is 0.6. What is interesting is that when I used to be in heat all day at my old job my level got up to 1.2 on the exact same dose. That is why I typically don't mess with my lower level dose because I know it is safe, I am scared of toxicity. I have SZA-BP1

Edited February 19, 2014 by Butterflykisses

[mcjimjam]

My level is 0.6 and I haven't had any hypo or mixed episodes at all on it. 

 

I've mostly read that 0.6-1.2 mmol/l is the standard therapeutic range. Some sources say 0.4-1.2 or 0.8-1.2 etc. These are just guidelines though. There are quite a few on here who have really low levels and find it effective.

[crtclms]

I'm on 600mg, and have a blood level of .5. It seems to work for me, although I am probably about to muck around with my meds a bit. The first time I tried it, I started at 900mg, and was toxic.

 

I would like to go up to 750 to see if I can safely reach the "official" therapeutic range without getting sick.

[Luna-]

Here in SA, the recommended blood level is 0.6-1.2. At least that is what various pdoc have said.

 

I was first put on 750mg but the pdoc missed that I was also on a dieretic for hypertension. After 5 days I was hallucinating and unable to walk and admitted to hospital. My level was 1.7.

 

On a lowered dose of 500mg, my blood level was 1.0. But lithium was all SEs for me with no benefit.

[San]

I took 900mg (300mg 3x's a day) and my blood level was usually 0.7-0.8.