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Tapering lithium

Tapering lithium

Postby TheEscapologist » Oct 19, 2011 6:23 pm

I am going off lithium now. I Reduced with one pill in june (from 5 to 4, 42 mg's). Although I'm very concerned about the so called terapeutic window and the actual possibility of tapering lithium slowly, without it loosing all it's effect when you go below this window. Is there anyone who can tell me how it works, and if it does not work, what else you can do to prevent a withdrawal relapse into mania?

Here's a quote from Breggin's Medication Madness which made me a bit confounded:

"It is not known whether tapering helps to prevent withdrawal mania, but stopping any mood-stabilizer slowly is a good idea. Although there's not much data on drugs other than lithium, be on the safe side and assume that stopping any mood stabilizer may increase the risk of emotional instability".
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Re: Tapering lithium

Postby yellowrose » Oct 19, 2011 6:26 pm

Hi Escapaologist I tapered Lithium in 2007 but had a severe psychotic relapse (worse than any episode I had had to that point).

I was on 800mg and reduced by 100mg to 700mg and within 3 weeks I was psychotic.

I have been stuck on lithium since then (3.5 years)

I really dont know how to get off my drugs without having a psychotic relapse.
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Letter of advise I received from a psychiatrist

Postby yellowrose » Oct 20, 2011 4:30 pm

Hi Escapologist and everyone else. I wrote to a psychiatrist asking for advice and this is the letter I received in reply. I have removed the name of the psychiatrist to protect her identity. I hope she won't mind me posting an anonymised version here as I think it could help other people...

Dear Liam,
thank you for writing. I sympathise with your situation very much- it must
be a terrible dilemna for you, caught between a rock and a hard place.

What i would suggest is a very gradual reduction of medication, aiming
initially to get onto lower doses rather than stop completely. if you can
get onto lower doses and remain stable, then maybe you can have another go
at withdrawing. Lithium withdrawal is particularly likely to precipitate
mania, as you found out.

I would discuss this with a friendly psychiatrist/GP or other
professional. maybe you could go back to the psychiatrist you withdrew
with before, if they are willing to help again. Decide which drug is
causing the most adverse effects, and start with that one. You could aim
to get onto 1mg BD of risperidone, and 400mg of lithium to start with, but
reducing only one at a time, and then see if you remain stable on those
doses.

If unfortunately you do have another relapse, and I hope you don't, I
would state clearly that you want your lithium stopped, not to be
re-started, because this seems to have the highest risk of
withdrawal-induced relapse. You could write an advanced statement to this
effect. I would also recommend a supply of benzodiazepines for occasional
use if you start feeling high or getting reduced sleep.

I hope that is helpful, and very best of luck.

Yours
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Re: Tapering lithium

Postby BingoGirl » Oct 20, 2011 4:54 pm

I tapered off lithium, took me a year! After being on it for a year. I did it very slowly and had periods when the dose stayed constant. I did have some pretty sever mood swings but not full blown mania again. I had support from friends but no support from a doctor. When I told my psychiatrist I wanted to come off it, he disagreed initially, then made a plan to come off it in 6 weeks! That would have been too fast for me. It is totally your choice, there is not much research done on the matter.

I made the most informed decision I could, it hasn't been a linear path,i have thought at various times that it was a bad idea, I have been rehospitalised a few times. It took a while to work out that drinking was also a contributing factor to my mood swings, i needed to stop that before finding out that I'm actually okay drug free. If I couldn't have done it without medication I would have been happy to take the lowest dose I could. It is a trade off with any medication I think.
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Re: Tapering lithium

Postby BingoGirl » Oct 20, 2011 4:55 pm

advanced statement is a really good idea, worth it just in case.
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Re: Tapering lithium

Postby yellowrose » Oct 20, 2011 4:57 pm

Thanks Bingo Girl,

I know what you mean about the doctors. With me they were very reluctant but then planned to do it over 8 weeks!!

I think doing it over a year like you is fantastic and much more sensible. I must find one of the threads that tells you if you can cut Lithium into smaller doses.

I think the letter from the psychiatrist above is fantastically helpful

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Re: Tapering lithium

Postby BingoGirl » Oct 20, 2011 5:12 pm

yeah it is very revealing! wish my psychiatrist had been like that. Just sent you an email.
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Re: Tapering lithium

Postby TheEscapologist » Oct 20, 2011 5:19 pm

Sad to hear you've had the same problem yellowrose. It's so irritating that withdrawing itself would induce psychosis, it only makes you feel more stuck. Interesting letter though. The part about swithching from lithium to another medication in case of relapse cought my attention. Not that I intend to relapse, but since I have no plans on staying on medications for the rest of my life, it would at least make the next time easier (probably).

I saw that you're taking other meds also, at least Risperdone for one. Would it be possible to withdraw using Risperdone as the medication that is gradually tapered. Perhaps you would have to higher the dose first, I don't know.

BingoGirl, your story fills me with hope. So you are completely drug free now? How long was it since you withdrew?

Speaking of advance statements. Does anybody know what medication would be better than lithium if your goal is to withdraw?
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Re: Tapering lithium

Postby TheEscapologist » Oct 20, 2011 5:21 pm

Yellowrose, If you find that thread I would very much like to hear about it!
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Re: Tapering lithium

Postby yellowrose » Oct 20, 2011 5:25 pm

Hi Escapologist & Bingo Girl. Here is the thread

viewtopic.php?f=64&t=23626

Also Escapologist what you said about being put onto an alternative drug. I didn't think of that. I just thought it meant you would just refuse all drugs.

In it the person says they cut lithium and drank it with water but I want to convinced it is safe first.

peace
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Re: Tapering lithium

Postby yellowrose » Oct 21, 2011 7:13 am

anyone got any advice on how you cut lithium?
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Re: Tapering lithium

Postby BingoGirl » Oct 22, 2011 1:39 am

I've been off Lithum for 6 years. I was on it a year when I was 18 and withdrew off it which took a year. I was drug free for a year, then had a psychotic episode, took antipsychotics for a few years, and also took antidepressants at one point. I tapered off both of these over the course of about 16 months, then got addicted to Benzodiazapines and tapered off these too! now have been completely drug free for 10 months and hope to remain so for the rest of my life.

The way I did it was probably quite dodgy. Not sure if I should share it. I mean I was 18 and not exactly sensible. I bought analgesics from the chemist which came in capsules. I emptied them out and cut the lithium tablet with a pill cutter and weighed it, then stuffed it into the capsule and took that with water.

I guess it is similar to what that person did on the other thread, except they bought 'baggies' whatever they are? to put the lithium inside. It is important because of the time release seal, you don't want it to instantly hit your blood stream.

Have no idea if it was a good idea. I just know that if I would have reduced the lithium by 100mg at once, I would have just gone crazy. It was too much. If I were to do it know, I would probably have gained the advice of a pharmacist and a doctor.

Does anyone know the smallest pill size for Lithium?I thought it was 100mg.
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Re: Tapering lithium

Postby BingoGirl » Oct 22, 2011 1:43 am

I have an advanced directive which states I don't want any drugs for two weeks upon being admitted to hospital (hopefully that never happens again). It is signed by a lawyer and a private psychiatrist. Have never had to use it. They don't have to follow it. It might work, it's probably worth having it.
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Re: Tapering lithium

Postby TheEscapologist » Oct 22, 2011 7:02 am

I'm glad that you've pulled through BingoGirl, and I hope you won't need to go back to any of these meds in the future.

You say you've used 100mg pills. Do you remember how much you used to cut these? I'm wondering if perhaps it wouldn't be as necessaryfor me to do this since I'm taking smaller pills. I'm from Sweden, and here the standard size of lithium pills is merely 42mg's.

Going back to the necessity of tapering lithium at all: Your story seem to indicate further that this indeed is a good idea. I'm wondering though, how did you feel during withdrawal? Were you aware of this "therapeutic window" effect? And did you notice that at one point in the withdrawal the medication just stopped working immediatly, even though you still took it?

Yellowrose, I'm with you about being really sure firts about cutting.

It's so frustrating that the doctors doesn't acknowledge/know anything about, the facts about withdrawal mania. I think I shall try to formulate some kind of advanced statement about letting me be medication-free at first during a potential hospitalisation.
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Re: Tapering lithium

Postby yellowrose » Oct 22, 2011 7:39 am

Hi Escapologist, Bingo Girl and everyone else,

I have been simultaneously asking this question on a pharmacists forum aswell. To be honest their view of mental illness is so 'white bread' they just see medication as a cheap and effective treatment.

Interestingly they did make one valid point that Big Pharma doesn't really make any money out of Lithium because it is an old inexpensive drug off patent. I argued that bio-psychiatry and Big Pharma still form a kind of 'complex' that is about capitalism and social control.

I dunno I have all these Icarus style sociological critiques of psychiatry but maybe without the medication I will be barking.
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Re: Tapering lithium

Postby TheEscapologist » Oct 25, 2011 7:31 pm

Hi again!

I understand what your saying yellowrose. Sometimes I feel I want to get of the drugs only to show these people that their wrong! It's an additional motivator I guess...

Nevertheless, I will probably continue tapering already tomorrow. This will be a reduction from 4 to 3 pills, that is: 42 mg's. I'm sorry that I cannot find smaller doses, but I don't feel too sure about cutting the tabs and I do believe I have enough security in other ways.

Here's a quote that gave me hope of overcoming this "withdrawal-mania":

"However, studies examining the effects of gradual withdrawal of Lithium have demonstrated that gradual rather than acute discontinuation appears to lower the risk of relapse. In a study by Balderessini and collegues examining effect o gradual versus rapid withdrawal, individuals were just under 4 times more likely to have a relapse if they came off Lithium within 1-14 days, compared to withdrawing over 14-30 days."

And here's the link to the website: http://www.comingoff.com/index.php?opti ... &Itemid=47
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Re: Tapering lithium

Postby yellowrose » Oct 25, 2011 7:39 pm

Be careful escapologist. It might not be that easy. I withdrew over several months but stillhad a mania.
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Re: Tapering lithium

Postby TheEscapologist » Oct 30, 2011 8:59 am

Thanks yellowrose. I realise it might not be as easy as just going slow with the tapering. Although, that is not all I have planned for nor is it all I have done. I'm seeing a very good therapist who's got experience of helping people go off meds and she's helped me a lot since I started seeing her.
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Re: Tapering lithium

Postby yellowrose » Oct 30, 2011 10:32 am

Good to hear that escapologist. I am sticking on the meds for the time being.
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Re: Tapering lithium

Postby meuh » Jan 10, 2012 4:07 pm

Bringing the topic up from the dead.

I have decided, on my own, to taper off lithium. I am doing this because my psychiatrist repeatedly says that it's "not what I need." I agree. I don't want to be on it.

She would like me to replace it with Seroquel. I have thus far refused due to severe adverse reactions to every other neuroleptic drug I have taken until now.

I am currently on lamictal and lithium, so I am aiming for being solely on lamictal.

I am down from 800mg of lithium to 400mg for now. I never had a heavy dose and was barely in what is considered therapeutic range, so I believe I will stop taking the lithium altogether within the next week. I halved my dose about a month ago and have noticed no change in my mood stability for better or for worse, and the withdrawl side effects have been limited to nausea and headaches for a couple weeks.

I have not spoken with my psychiatrist about this out of fear of being hospitalized out of spite (she has already had heated discussions with me for the past few months saying that she will put me in the hospital or cease treating me if I refuse to cooperate, that is to say, take what she tells me to.)

I don't know how this is going to turn out, but I feel it is in my best interest at this time.
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