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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Roslynn on February 29, 2012, at 12:58:26
Hi everyone, my lithium dose was adjusted downward and I'm wondering how soon my body will adjust to the new dose. I don't mean me specifically, but in general, how soon would someone's body chemistry "even out," so to speak, and adjust to a lower dose of lithium? So that you know you're going to be "OK" at the lower dose?
Saw a scary post from long ago about a lady who discontinued lithium and then 3 months later her depression returned. Why would it take 3 months?
How long does lithium last in your system after you discontinue it?Thanks for any insight.
Roslynn
Posted by SLS on February 29, 2012, at 14:25:27
In reply to Scary lithium questions PLS answer, posted by Roslynn on February 29, 2012, at 12:58:26
> Hi everyone, my lithium dose was adjusted downward
Why?
Depression or mania?
What is your current blood level?
If someone is to relapse, it can take up to 4 months after drug discontinuation for this to happen. It is possible that you wouldn't know how a dosage reduction would affect you for several weeks. It has nothing to do with lithium still being in your body. The lithium leaves the body very quickly.
There has been some debate about this, but there might be a danger of lithium not working again if you need to restart it after a period of discontinuation. However, I don't know how often this occurs. We do see this happen fairly often with the SSRIs, so this is not an untenable theory. I have a friend to whom this happened with lithium.
http://www.dr-bob.org/tips/split/Starting-and-stopping-lith.html
You are not discontinuing lithium entirely at this point, so I have a feeling that even if you did begin to deteriorate, you would recover very quickly once you increased the dosage again.
- Scott
Posted by Roslynn on February 29, 2012, at 15:29:42
In reply to Re: Scary lithium questions PLS answer » Roslynn, posted by SLS on February 29, 2012, at 14:25:27
Hi Scott,
Thank you so much for your reply.
My lithium dosage was adjusted from 600mg to 300mg at my request because I feel that my meds are interfering whenever I try to increase my anafranil (the only med that has worked for me in 4 yrs.)
I have depression...at 600mg my blood levels are usually about .7, although I don't believe the medication is helping me in the first place.
I guess my fear is that the lithium could be doing *something* to help, something that I am not aware of, and so i will start to feel worse while weaning off Li.
However, like you said I am not going off the med entirely and I could just increase the dose again.
Question: If I start to feel bad, how do I know it's due to less lithium in my system or if it's some kind of rebound effect? Weird question, i know.
Why does it take so long to know how a drug discontinuation will effect you?
Thank you,
Roslynn> > Hi everyone, my lithium dose was adjusted downward
>
> Why?
>
> Depression or mania?
>
> What is your current blood level?
>
> If someone is to relapse, it can take up to 4 months after drug discontinuation for this to happen. It is possible that you wouldn't know how a dosage reduction would affect you for several weeks. It has nothing to do with lithium still being in your body. The lithium leaves the body very quickly.
>
> There has been some debate about this, but there might be a danger of lithium not working again if you need to restart it after a period of discontinuation. However, I don't know how often this occurs. We do see this happen fairly often with the SSRIs, so this is not an untenable theory. I have a friend to whom this happened with lithium.
>
> http://www.dr-bob.org/tips/split/Starting-and-stopping-lith.html
>
> You are not discontinuing lithium entirely at this point, so I have a feeling that even if you did begin to deteriorate, you would recover very quickly once you increased the dosage again.
>
>
> - Scott
Posted by SLS on February 29, 2012, at 16:40:13
In reply to Re: Scary lithium questions PLS answer » SLS, posted by Roslynn on February 29, 2012, at 15:29:42
Hi again.
> My lithium dosage was adjusted from 600mg to 300mg at my request because I feel that my meds are interfering whenever I try to increase my anafranil (the only med that has worked for me in 4 yrs.)
You have nothing to worry about.
For depression, lithium dosages can be lower than what is necessary for bipolar disorder. 300 - 600 mg is the range for depression. I take 300 mg, and am responding well to it. 600 mg does not help me any more than 300 mg. I just get more side effects. If you begin to deteriorate, I am all but sure that you will recapture the full benefit by returning to 600 mg. Your blood level at 600 mg is higher than what I believe is necessary for depression. I would guess that a range for unipolar depression would be somewhere between 0.2 - 0.6 mEq/L. I think mine is around 0.2 mEq/L.
> I have depression...at 600mg my blood levels are usually about .7, although I don't believe the medication is helping me in the first place.
I know that if I were in your position, I would want to try reducing the lithium dosage, too.
> I guess my fear is that the lithium could be doing *something* to help, something that I am not aware of, and so i will start to feel worse while weaning off Li.This is, of course, a possibility.
> However, like you said I am not going off the med entirely and I could just increase the dose again.
You should be okay.
> Question: If I start to feel bad, how do I know it's due to less lithium in my system or if it's some kind of rebound effect? Weird question, i know.
That is a great question. There is nothing at all weird about it. The issue of lithium rebound has been written about in medical journals. Its existence has not been proven. I doubt that a dosage reduction from 600 mg to 300 mg would elicit a rebound effect. Actually, I haven't come across anyone describing a rebound phenomena for lithium discontinuation. Acute relapse - yes. The thing is, a rebound relapse would resolve on its own without restarting treatment if it were a true rebound.
> Why does it take so long to know how a drug discontinuation will effect you?I guess you could conceptualize it as an inertia effect. Physiologically, some changes (receptor reregulation for example) take weeks to occur. For some people, there is an inertia that can last for months before relapse occurs. However, most relapses occur withing the first four months after drug discontinuation. I recently tried to discontinue Abilify. I tapered gradually. It took about three weeks for me to relapse after complete discontinuation.
I am anxious to see how well you do with increasing your Anafranil dosage.
Good luck.
- Scott
Posted by Phillipa on February 29, 2012, at 18:57:20
In reply to Re: Scary lithium questions PLS answer » Roslynn, posted by SLS on February 29, 2012, at 16:40:13
Scott always thought you had bipolar with only one episode of mania? Phillipa
Posted by Roslynn on March 1, 2012, at 15:25:40
In reply to Re: Scary lithium questions PLS answer » Roslynn, posted by SLS on February 29, 2012, at 16:40:13
Dear Scott,
Thank you so much for answering my questions. I so much appreciate your knowledge and patience!!
Thanks again,
Roslynn
This is the end of the thread.
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