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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by wearybuthopeful on February 15, 2005, at 23:59:55
For several reasons, including lithium-induced thyroid problems that were corrected for quite a while with Synthroid, my shrink has advised I get off lithium with intention of starting lamictal later.
We're talking bipolar depression (no mania or hypomania except for one episode of hypomania ten years ago on Prozac). My previous doctor of 10 years insisted I have unipolar depression. This guy had a different view so I decided I had little to lost by a lithium trial.
I was at a low dose of the extended release form, 675 mg. Current doc said to drop down to 450 mg. pending latest thyroid lab results (see above post) - it's been 2.5 weeks.
I phoned in my lab results two days ago (he has no fax!) and haven't heard back. He works part time, but I would have expected to hear by now.
He may be annoyed because I indicated I had reduced from 450 mg. to 225 on my own and asked him to let me know if I should go back up to 450 mg. I'm a medical writer and I know how to read research. But I didn't find much on tapering schedule - just a couple references that said 300 mg every 5-7 days. Normally I'm very "compliant!"
Can anyone give me some guidance on a reasonable tapering time frame? Did I jump the gun?
Any thoughts would be most appreciated.
(I feel a bit tired, but that could be thyroid issues - was on the lithium for about 14 months.
Thanks so much in advance.
Posted by SLS on February 16, 2005, at 6:58:08
In reply to Tapering off lithium, posted by wearybuthopeful on February 15, 2005, at 17:59:36
> For several reasons, including lithium-induced thyroid problems that were corrected for quite a while with Synthroid, my shrink has advised I get off lithium with intention of starting lamictal later.
> We're talking bipolar depressionLamictal is a great choice of medication under these circumstances. I've seen others successfully make the switch from lithium to Lamictal and remain asymptomatic for depression. However, I believe it would be MUCH smarter to taper the lithium very slowly while at the same time titrating the Lamictal. There is no danger in taking lithium and Lamictal at the same time. They are often combined on purpose.
I know one woman who recently made the switch successfully. She suffered predominantly from bipolar depression, and lithium worked like magic. She, too, was experiencing thyroid abnormalities. However, she used the gradual taper/titration strategy. It took several months to accomplish. She did not experience a single day of depression over this period of time. The problem is this: if one comes off of lithium too quickly, the rate of relapse is much greater than if a gradual taper is used. My concern is that you will not be on a prophylactic dosage of either drug for an extended period of time. Lamictal must be titrated very slowly. It might take two months for you to get to 200mg, which is the average dosage for bipolar depression.
Of course, if lithium isn't helping at all, then you can discontinue it immediately. No taper is necessary. There is no real withdrawal syndrome. Since you have been on it for 14 months, though, I would proceed as if it really is helping, and not remove it until you reach a therapeutic dosage of Lamictal.
I guess your decision depends on the urgency to discontinue Lithium. I am not familiar enough with the course of lithium-induced hypothyroidism to know what are the consequences of continuing lithium for another two months.
Good luck.
- Scott
Posted by wearybuthopeful on February 16, 2005, at 19:19:48
In reply to Re: Tapering off lithium » wearybuthopeful, posted by SLS on February 16, 2005, at 6:58:08
Thanks you so much Scott. Now I see that there was better place to post this!
For some reason my doctor doesn't want me to do both at the same time, though I'm well aware that lamictal has to be upped very slowly due to the rash risk.
Sounds like I can go off the lithium without ill effects - at least in the sense of mania which I have never suffered from. Frankly, the lithium wasn't doing much for me anyway. At least I think so! So I'm taking a little risk here being drug-free for a while. (After I'm off the lithium, tapering off the klonopin that I use for sleep).
I'm anxious to get off the lithium because I went from hypothyroid to hyperth. and had some really bizarre lab results, though they are quickly improving now that I'm lessening both the lithium and the Synthroid.
Thanks again - I really appreciate your comments.
Posted by SLS on February 17, 2005, at 8:44:57
In reply to Re: Tapering off lithium, posted by wearybuthopeful on February 16, 2005, at 19:19:48
Seeing as how the lithium wasn't helping, I think I would do exactly the same thing if I were in your position. It sounds to me like you have a good doctor.
I wish you nothing but the best.
- Scott
This is the end of the thread.
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