Tapering Lithium

[AyYiYikes]

Has anyone tapered off lithium to either a sub clinical level or completely off? I’ve read one can just stop, but often a manic episode is fairly certain. I’ve been on 750 mg for months and put up with side effects (rash, dry skin, memory issues, heat intolerance, constant thirst although I drink a LOT of water) - the depression never got better, but I’ve been ok. Not suicidal. But I have to say I wasn’t suicidal until the pdoc started me on other meds which didn’t agree with my body earlier this year. I’ve been flat (I call it that. Just sort of alive but neutral) but ok and can work. Blood levels are therapeutic. My thyroid is now affected. Dr said not bad enough to treat w/med.

Over a week ago I took it down to 600mg and left a message for pdoc, as my fatigue is awful, I’m itching like crazy, my hair is falling out, worse tinnitus and I’m getting constant headaches. Then migraines with aura/scintillating scotoma (I call them sparkly amoebas that cause a blind spot) and they’ve happened twice while driving to work, happen at work, at home - seem to  start from light (sun bouncing off a car’s chrome, headlights, computer screen).  Also GI issues. Pdoc wants me to stay on 600mg. Past couple days I cut it down even more, 300 mg/day, as the tinnitus is annoying and one ear gets an added deep hum. So today I woke up with no hum and feeling pretty good. Good, as in I noticed I didn’t feel like total crap as I have all year. Not so depressed. Enough energy and desire to get things done. Not manic. Then I thought this evening I should take at least one capsule 150mg and within an hour my ear started humming and I’m exhausted. 

Maybe this is more of a rant. Just wondering if anyone tapered down and how it went. I know YMMV.  I’m sensitive to meds so it doesn’t take much.  I don’t take lots of meds, have had bad s/e with some others, and only also take Ativan occasionally for anxiety. Not wanting to try new meds right now, just taper this down to a manageable level. And hoping that works.

 

[Rabbit37]

TBH, I've taken lithium holidays here and there, just needing more energy for a short while. I tend to be more on the depressive side of BP, so no mania, although some nice hypos. I take 600mg, I've had no problems knocking it down to 300mg for a couple of days, then stopping. I don't have s/e's worth mentioning to begin with, I've never noticed withdrawal symptoms (although omg just learned the hard way not to forget seroquel for a day - ouch).

if pdoc isn't on board, though, please be careful. You do sound *very* sensitive to meds. 

[dancesintherain]

I went off it and ended up manic, but that was probably partly due to not having an adequate replacement.  I had been experiencing side effects that hinted at lithium toxicity (though I only learned that after the fact).  I went back on it relatively quickly thereafter because of how bad my brain reacted from me going off of it.

i dont know how typical that is though.  I currently keep my level at a technically subtherapeutic level (around 0.5) and that helps a lot with side effects.  I do have other meds to make up the difference though.  You probably know this already, but the range is really guidance and it’s usually more important how you’re doing.  I hit 1.1 and was out of my mind and neurologically devastated, whereas that’s a level technically in the range and where some people function well.

[rowan77]

I went off lithium in September 2016 and within 2 weeks I was very manic. I had to go off it due to kidney damage. It was replaced by a low dose of valproate which was raised as I became manic but I remained manic for weeks as my meds were adjusted. When I hit valproate 1600mg I started to feel better and the mania began to subside. It is very important to go off it very slowly if it is possible. This did not happen in my case. I was tapered off it over 2 weeks because my pdoc was so worried about my kidneys and I had been to see a nephrologist who confirmed the damage.