EstherGreenwood: Tapering off Lithium

[EstherGreenwood]

Hi and thanks for adding me to the forum. I am a pretty straightforward case I believe; whilst I have tried quite a few different meds in the last decade, I am actually only on 2 at the moment: Lithium and Nortriptyline.

 

CONTEXT: I am relatively well (read: functional) right now so proposed to my psychiatrist that we taper off some meds. He was hesitant but agreed we could try stepping back on the Lithium. I was taking 3 x lithium tablets initially, but we dropped to 2 last month and this month I'm down to 1 (hoping to make that none next month). I will not be making any changes to the Nortriptyline whilst adjusting the Lithium.

 

ISSUE: The first month I didn't experience any side-effects and blood tests showed that I was still in the therapeutic range. HOWEVER this month, I am experiencing lower mood, extreme fatigue and cognitive 'fuzziness' which I suspect is related to Lithium withdrawal. I haven't had any suicidal impulses or ideation, which I think was my psych's main concern. Also, I will have definitely dropped out of the therapeutic range at this stage.

 

QUESTION: So what I was wondering was: if we assume that the above symptoms are related to coming off Lithium, what is the prognosis for the symptoms resolving? Do I just wait this out? OR is this just what my life will be like forever if I don't take Lithium (ergo I should just start taking it again)?

 

[Altostrata]

Welcome, Esther.

 

That very large decrease (33%) per month of your lithium dose might be too much for your nervous system. It needs time to accommodate to drug changes.

 

See Why taper by 10% of my dosage?

 

Tips for tapering off lithium

 

If I were you, I'd stop tapering lithium for a good while, maybe several months, and let those symptoms dissipate. If you continue tapering, you are likely to make them worse.

 

There really is no such thing as "therapeutic range", that's an arbitrary number set by the drug companies. It's immaterial anyway -- if you're physiologically dependent on a drug, you still need to taper it to avoid withdrawal symptoms, which can be much worse than your original reason for getting psychiatric drugs.

 

Are you still taking Valium, Ativan, and Seroquel? Why, and how often? This can have a big effect on your symptom pattern. Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

[EstherGreenwood]

Thanks for the response, Altostrata!

 

So continuing tapering will possibly make the symptoms worse - but will they eventually pass? I'm in a safe environment at the moment (living with family and not working), and as I think I'll probably always experience stress at any point in my life (i.e. there will probably never be a "perfect time") this seems like a good time to bash ahead. But from what you say I gather you think that would be a rather reckless approach?

 

I was heartened to read in the linked feed [sorry I hadn't found this prior to posting] that fatigue is a withdrawal symptom of tapering off lithium. I wasn't sure as generally I'm quite tired and my GP tried to suggest that maybe this extra fatigue and cognitive dullness was just because I was a bit more tired than usual.. However it is definitely a distinct experience from my regular lethargy so it was reassuring to read that others had experienced it.

 

PRN-wise I currently only take Ativan (1mg tabs) and I do so sporadically; usually a half tablet if I am feeling black (anxious/depressed) and can't sleep. In the last 10 days I have had 1.5 tablets total. I will start tracking more carefully when I take it, as you suggest.

[Altostrata]

We do not recommend continuing to taper when you already have withdrawal symptoms. This could make withdrawal symptoms much, much worse, and they can take a long time, perhaps many months, to diminish.

 

It's a good thing your environment is low-stress, but that is not the only factor in withdrawal. Please do not take chances with your nervous system.

 

Please do keep daily notes of your dosage and symptoms. You have a complex drug history showing signs of long-term overprescription. If you want to get off the drug merry-go-round, you'll have to be methodical, few doctors know anything about adverse drug effects.