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    Can You Just STOP Taking Lithium?
    illneverbackdown posted:
    I saw my new psychiatrist yesterday who evaluated me and compared his observations to notes from 2 other doctors that went back a period of 8 years. His final conclusion, and what i felt was true all along, was that i was not bipolar. I told the doc that when i was in a behavioral hospital in April for panic attacks, they told me i was bipolar and put me on the lithium, and reduced my klonopin. He told me that Lithium would not help with panic, anxiety, and overall feeling of fear that i have been experiencing, and cold turkey, he told me to stop the lithium. He said that if i am not bipolar, that i would not have any kind of withdrawls or side-effects from going off it. I'm on 600mg's, a day which is the second highest dose you can be on, and had been for over a month. Yesterday was the first day not taking it. This morning is my 3rd missed dose. I don't feel anything YET, if i even will, but he also increased my klonopin back to the 1mg/3x's daily, which was the amount i was on before i went in the hospital.
    Because i am type 1 diabetic and my numbers are out of controll. They are in the 3-4 hundreds. (i'm going for tests and seeing my diabetes doctor) the psychiarist said he wants to wait until i get everything under control before he will consider putting me on any additional meds because dealing with the diabetes is VERY important. In the meantime, i still have the anxiety, fear, and panic even with the increased klonopin. Can You Just STOP Taking Lithium? The fear of the unknown about what might happen has me on edge! Thanks.
    hope7951 responded:
    Lithium is a naturally occuring metal that everyone always has in their body to some degree. You might want to gradually reduce your dose. It takes 5 days to get out of your system and less time to get below therapuetic levels. You can just stop cold turkey with no withdrawl.
    You become what you think about...
    Joseph F Goldberg, MD responded:
    Dear illneverbackdown,

    There is no withdrawal from stopping lithium. In people with clear bipolar disorder, abruptly stopping increases the chances for a faster relapse than gradually stopping (tapering over a few weeks) but that's different from the question of immediate "withdrawal" type effects of stopping. It is true that lithium has no known or proven value for panic or anxiety.

    - Dr. G.
    whayden replied to Joseph F Goldberg, MD's response:
    hey Dr. G,

    first of all thank you so much for creating this site, and offering all the knowledge and wisdom you have about this to people that really need it. there are so many sites that say all kinds of BS and the problem with that is..when someone with a serious problem tries some advice thats not true and it doesent work, they suffer from it. but you know what youre talking about, and that putsme at ease. so thank you sir.

    I was wondering if you could help me with something..i have been taking lithium for like a yr..i first got put on it because i had just gotten clean from being a heavy heavy marijuana smoker, and pretty heavy drinker..and pretty much as soon as i got clean i went into a deep state of depression and badly wanted to kill myself but was too scared to do it. i couldnt take it anymore so i said either im gona off myself today or get help so i got prescribed lithium and felt instantly better as soon as i took helped me alot but now im at the point where i feel that it dulls me too mch, and makes me dopey, tired, lazy and un motivated. i dont feel depressred anymore cause my life is going real well now and i dont want to die atleast not yet cause im leaving for tour next month. (i play music)..but i moslty really wana get off it now cause its starting to make me feel physically sick...i feel like there is some kind of tide or tsunami erputing in my body whenever i takeit.. it scares out of me..i cant tell if im gona be okay or if im gona doc said to ween off of it and decrease by 300 mgs..thengo down 600 mgs.. then take just 600 a day and then 5 day normal dose is 1500 mgs a day. (im 6'3'' 240)..anyway..i reallydont want to have to keep taking them because of how nauseus i become when i take i was thinking maybe i cud just quit altogether..would i get physically sick if i quit?? would i still be okay emotionally if i feel fine now? i dont take it in the day time now and i feel fine all day..what do you think? cause if there is even a chance il bne okay if i quit xold turkey i wana do it..cause dude..this is scaring me so much...when i take the was never like this until now..i think too much of it has built up inmy systemm..
    Joseph F Goldberg, MD replied to whayden's response:
    Dear Whayden,

    Thank you for the kin words about this website.

    I would be curious what blood level 1500 mg/day of lithium produces for you...if the level has been on the high side (say, close to 1.0 or more) then your nausea may be a sign of lithium toxicity. Typically doctors check lithium and kidney tests about every 6 months in people taking lithium.

    If you ever had a manic or hypomanic episode, then stopping lithium and taking nothing instead would increase the chances for having another mania or hypomania at some point in the future. If however you never had a distinct mania or hypomania, but instead were prescribed lithium for other reasons, then it would be harder to know what to predict your mood would be like off of it. If I had a patient who was going to stop lithium, I would want to continue to monitor them on a regular basis so that if signs of relapse were occurring, we would be able to catch it and do something before things became worse. When lithium is stopped, the usual recommendation is to taper it off over about 2-4 weeks in order to minimize the change of a relapse in bipolar disorder.

    Dr. G.
    Paulnjesse replied to Joseph F Goldberg, MD's response:
    Dr G I have been reading up on stopping lithium but one thing that has me un sure is my daughter is on 300 mg in the morning and 450 mg at night bith are extended release how do we help hervstop with them being er meds
    Joseph F Goldberg, MD replied to Paulnjesse's response:
    Dear Paul,

    Your daughter's doctor would be in the best position to advise on whether or not it is wise to lower or stop her lithium, and what the consequences of stopping it would be (eg, relapse). Generally speaking, when lithium is being stopped for some appropriate reason, doctors usually taper it over at least 2 weeks (eg, reducing by 150-300 mg/week) -- but important to have her doctor advise on the wisdom of stopping rather that taking it upon herself to do that.

    Dr. G.
    ddnos replied to Joseph F Goldberg, MD's response:
    So Dr. G., I have heard you and others say that one does not experience withdrawals going off lithium, then I would think about the one time about 8 or 9 years ago when for some crazy reason, I let myself run out of lithium (didn't order refill on time) and so I pretty much stopped taking it abruptly. Within a day, I couldn't sit still, I was "speed talking", racing thoughts, trembling, etc., all of which got worse with each day. I think i was only out of lithium for a few days. I always thought I was experiencing withdrawals from stopping the med abruptly, but I think what you are saying is that no, that wasn't withdrawal, but relapse, yes?

    Thank you
    Forgiveness is letting go of the hope that the past could have been any different --Unknown
    Joseph F Goldberg, MD replied to ddnos's response:

    Unusual experience you describe. Lithium lasts in your system for at least 5 days so missing a day wouldn't appreciably change the pharmacokinetics (blood level, bioavailability). Arguably a few days might start to usher in signs of relapse, though here too it would be unusual for mood symptoms to resurface so rapidly after stopping lithium. As a salt, it is not protein bound and there is no physiological tolerance that develops to lithium, so there is no pharmacologic withdrawal per se.

    Dr. G.
    ddnos replied to Joseph F Goldberg, MD's response:
    Well leave it to me to have unusual reaction! Seems that my body is good at doing that! I could be a little off re the actual number of days off lithium, but I do know that the reaction described was definiately within at least a few days of discontinuation and didn't stop until I got back on my normal dose of lithium. Weird!

    You see? That's why I'm so afraid to do anything one way or the other re meds. Who else gets as sick as I do simply weaning off Nardil half a pill at a time and with so many different physical symptoms? I've only seen one other person, and he wasn't even as bad as me. I did my last 1/2 pill reduction of nardil way back in Aug 2, and I'm STILL experiencing physical symptoms, though not as bad as the first 5 weeks! This is totally crazy! ANd now to find out that my experience with lithium was "abnormal" doesn't even surprise me much. Crazy!

    Thanks for your input!
    Forgiveness is letting go of the hope that the past could have been any different --Unknown
    chevyman1996 replied to Joseph F Goldberg, MD's response:
    Hello Dr.G! I must ask, I've been off of mine due to toxicity and increase in anxiety. I had some therapy along the way but in my current situation I don't have any source of transportation, so I couldn't get the proper therapy. I had to stop mine abruptly because my blood levels were dangerously high. When I stopped it made me a little woozy at first. Then it seemed as if each day that went by I got better and better with that. Before this I only seemed to have a little touch of bi polar depression which was easier for me to handle than being on medication, which I know is most people's story and I understand them completely. My main question is when will these relapse symptoms disappear and I return to the way I was? I could actually get out and about and socialize before I started Lithium.
    Joseph F Goldberg, MD replied to chevyman1996's response:
    Dear chevyman, If by "relapse symptoms" you mean the illness symptoms of bipolar disorder, they are lifelong and typically don't go away without medicine. If instead you mean, lingering side effects from lithium, they usually resolve within a few weeks of stopping it, if not sooner. Dr G

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