Discontinuing/Quitting Lithium — How do You Wean Off Lithium?Abrupt lithium withdrawal in contrast to gradual tapering can cause pronounced episodes of returning mania 5 as well as bipolar relapses. Gradual withdrawal observed in clinical studies demonstrated fewer instances of returning symptoms, 4x fewer suicides compared to continuing the medication, and where symptoms did return, patients had less severe versions of their returning symptoms overall.6,17,22 Show
No published clinical studies were found relating to withdrawal from natural lithium or lithium orotate. At times, a prescribing physician may choose to slowly convert their patient from the prescription form of lithium (lithium carbonate) to lithium orotate as a way to bridge off the drug. This technique involves gradually taking away the medication version and slowly introducing lithium orotate. This is a pragmatic route for many, but it should be discussed with your integrative medical doctor before attempting. There are reasonable theories regarding the role of trace minerals in respect to mental health. Deficiencies can play a prominent role in preparing for and executing Lithium withdrawal. At the Alternative to Meds Center, pre-taper lab testing is done to establish whether such deficiencies exist and then programs a person for corrective supplementation and diet to resolve these. In general, improving nutrition is beneficial for anyone recovering from medication discontinuation. It may be possible that a trace mineral deficient person (which is common due to over-farming techniques in agriculture) may respond positively to lithium. An unsubstantiated hypothesis may be that lithium could play a certain role in these deficiencies and possibly covering the function of other similar minerals. It could be argued that trace mineral supplementation could offer support and that the use of trace mineral supplementation during withdrawal may be of benefit. As this is a bit of a tenuous assertion, please discuss this with an appropriate doctor who has both knowledge of medications as well as supplemental methods before considering this protocol. A case study published in the 2019 Journal of Advanced Mind-Body Medicine concluded that lifestyle interventions, as well as nutritional interventions, were important components of recovery and remission of symptoms in a medication withdrawal clinically supervised setting.19 The protocols that are used in Lithium withdrawal at Alternative to Meds can be reviewed on our services overview page. Lithium is an alkali metal, the lightest metal found in the earth.Lab synthesized compounds are produced called lithium salts. Lithium salts such as Lithobid are prescribed for the treatment of mania, bipolar disorders, depression, and PTSD. Natural lithium supplements are available OTC. Prescribed as a mood stabilizer, Lithobid, Lithate, and other brand names, are synthesized forms of lithium that have been studied since FDA approval for their efficacy in treating certain disorders, as well as to explore the potential for unwanted side effects.1,2,13 Less information is available for clinical trials concerning the non-prescription form of lithium called lithium orotate. Lithium orotate is not available over-the-counter in all countries, due to concerns by regulators over hypothetical rather than observed toxicity dangers should the supplement be taken in extraordinarily large doses. One such occurrence was found in an article published in the Journal of Medical Toxicology, where a woman took 18 tablets (instead of one) of an over-the-counter lithium orotate supplement who became nauseous and experienced light hand tremors, both of which disappeared after 3 hours.20 Below is medical information concerning these and other topics related to lithium and may be helpful to those considering starting or stopping a prescription of this type of drug. What Lithium Medication Is Used ForLithium had been extensively used for the control of mania since the late 1870s but became an increasingly abandoned practice in psychiatry as new antipsychotic drugs were developed and approved by the FDA and around the world starting in the 1950s for the treatment of mania.3,4,21 Long-term studies on Lithium used in the treatment of mood disorders such as bipolar illness show a disappointing level of efficacy,23 so much so that some researchers consider the marketing of Lithium an overreach by pharmaceutical companies whose sole criteria is the profitability of such products.24 Lithium salts or compounds are used as psychiatric medication (mood stabilizers) and are prescribed for these conditions:
Lithium Alternative Names and SlangLithium refers to the metal, or mineral, however, the word lithium has become synonymous (although not entirely accurate) with all the various compounds and salts that have been produced in pharmaceutical labs across the world. The natural form of the element is simply called lithium and is not patentable because it is a natural element found in mineral deposits in the earth. It is important to understand the nature and molecular structure of any drug or supplement that one takes. Various forms of compounds and salts will contain lithium, synthesized using various types of binding agents, such as:
There have been many other compounds/mixtures produced over the last century and a half. Some of these were found to be toxic, as in the table salt version, and unsuitable for use in food products, as in the 7-UP soda pop of the 1950s. Some have survived and exist in pharmaceutical products used today. Brand names include numerous examples such as Theralite, Efalith, Lito, Prolix, and hundreds of additional trade names. Lithium Side EffectsA study out of Norway published in the BMC Journal of Psychiatry showed that a majority of the participants discontinued the prescription drug lithium carbonate to avoid the side effects of the drug. Diarrhea, tremors, diabetes insipidus, and weight gain were the 5 most common reasons for discontinuation according to the authors of the study.9 According to the FDA label 2 for lithium carbonate, signs of lithium toxicity include a similar list, including diarrhea, vomiting, tremors, ataxia (clumsiness, loss of coordination), drowsiness, and muscular weakness. Other common reasons for discontinuing the medication due to side effects, according to a study published in the International Journal of Bipolar Disorders11 include weight gain, cognitive impairment, impaired kidney function, hyperthyroidism, and hypothyroidism. Because of the vast number of potential side effects, we have categorized a sampling of them for clarity. These side effects along with many others are listed on the FDA drug label. Lithium carbonate side effects include:Gastrointestinal & Renal:
Musculoskeletal
Cognitive
Dermatological
Ocular/Aural
Other Conditions & Disorders
What information concerning lithium carbonate should you communicate to the client?Warnings: It is very important to have the right amount of lithium in your body. Too much lithium may lead to unwanted effects such as nausea, diarrhea, shaking of the hands, dizziness, twitching, seizures, trouble speaking, confusion, or increase in the amount of urine.
Which instruction is most important to a patient on lithium therapy?Take lithium exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Swallow the extended-release tablet whole; do not split, chew, or crush it. Your doctor may increase or decrease the dose of your medication during your treatment.
What should be monitored in a patient taking lithium carbonate?Also observe/inform patient to be aware of signs of toxicity: blurred vision, GI disturbances, muscle weakness, drowsiness, etc. These usually occur at levels >1.5mmol/litre, but can occur at lower levels. Monitor older adults more closely, as they are at greater risk of developing toxicity. Use lower doses.
What should you monitor when giving lithium?Key Points. Baseline testing for lithium includes electrolytes, creatinine, GFR, BUN, thyroid function tests, EKG, CBC, and weight. Tests should be monitored every 4 to 6 months and more often in elderly patients and those with cardiovascular disease.
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What information concerning lithium carbonate should you communicate to the patient?
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