Psycho-Babble Medication Thread 836653

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Lithium resistance?

Posted by linkadge on June 26, 2008, at 20:18:28

This page suggests that:

"Fifty-five percent of patients develop a resistance to lithium after three years, and only an estimated one-third of those on lithium remain episode-free for two years."

I've heard this from other places too. So, lithium poops out?

http://www.mcmanweb.com/mood-stabilizers.html

Linkadge

 

Re: Lithium resistance? linkadge

Posted by Phillipa on June 27, 2008, at 0:59:19

In reply to Lithium resistance?, posted by linkadge on June 26, 2008, at 20:18:28

I know my now deceased ex-father-in-law was on it for many years periodically twice a year stopped to lose weight but it always worked when he went back on it after suffering mania and then depression. Phillipa

 

Re: Lithium resistance?

Posted by Looney Tunes on June 27, 2008, at 1:53:22

In reply to Lithium resistance?, posted by linkadge on June 26, 2008, at 20:18:28

This is true of alot of medications.

But one problem with Lithium is that when you stop taking it and then go back on it, it is not as effective and there is a greater chance that it will not work. This is well documented.

I have been on Lithium for 15 years and have not had any problems. I do take other meds along with it, so maybe they mask the Lithium resistance, but I never thought of it that way.

 

Re: Lithium resistance?

Posted by SLS on June 27, 2008, at 7:00:06

In reply to Re: Lithium resistance?, posted by Looney Tunes on June 27, 2008, at 1:53:22

> This is true of alot of medications.
>
> But one problem with Lithium is that when you stop taking it and then go back on it, it is not as effective and there is a greater chance that it will not work. This is well documented.


The term used in the past for this phenomenon has been "Lithium-induced lithium refractoriness". There have been a few retrospective studies and anecdotal accounts of this happening. As is often the case in psychiatry, there is debate whether or not this occurs at all. I don't think this lithium refractoriness has been proven such that it would be taken into consideration by those practicing evidence-based medicine.

One tragic anecdote that I know of involves woman who was maintained effectively on lithium for eight years. Her doctor thought that this was enough time to produce a continued remission after discontinuing the lithium. Within a month of discontinuation, she relapsed, never to respond to lithium again. She has been chronically depressed for 18 years and cannot function inside or outside the house.


- Scott

 

Re: Lithium resistance? SLS

Posted by linkadge on June 27, 2008, at 18:21:46

In reply to Re: Lithium resistance?, posted by SLS on June 27, 2008, at 7:00:06

My mother did well on lithium for the first two years. She is still on a theraputic level, but it does not control her bipolar disorder well at all any more.

After reading that (I don't know its validity), it go me wondering.

Linkadge

 

Re: Lithium resistance?

Posted by SLS on June 28, 2008, at 11:32:01

In reply to Re: Lithium resistance? SLS, posted by linkadge on June 27, 2008, at 18:21:46

> My mother did well on lithium for the first two years. She is still on a theraputic level, but it does not control her bipolar disorder well at all any more.
>
> After reading that (I don't know its validity), it go me wondering.

There had been some controversy when the following article was published. The interest in this purported phenomenon no longer exists, and remains largely unexplored.


- Scott


************************************************

Am J Psychiatry. 1992 Dec;149(12):1727-9.Click here to read Links

Comment in:
Am J Psychiatry. 1993 Nov;150(11):1756.
Am J Psychiatry. 1994 Oct;151(10):1522.

Lithium-discontinuation-induced refractoriness: preliminary observations.
Post RM, Leverich GS, Altshuler L, Mikalauskas K.

Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892.

The authors used a systematic life-chart methodology to observe four patients with bipolar disorder in whom long periods (6-15 years) of effective lithium prophylaxis were followed by relapses on lithium discontinuation. Once the drug was reinstituted, it was no longer effective. The incidence, predictors, and mechanisms underlying this phenomenon all require further systematic study. The current preliminary observations suggest an additional reason for caution when lithium discontinuation in the well-maintained patient is considered.

PMID: 1443252 [PubMed - indexed for MEDLINE


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