... days, staggering, falling, stronger tremors, leg weakness, light-headedness, nauseous, other issues. I quit it immediately. Time passing helps. Docs are baffled. One referred to similar events happening to folks taking lithium for a long long time. Anybody have a similar experience?
I took lithium for almost 30 years. In late May I experienced what seemed to me toxicity: over a few
Question posted by Carter West on 12 July 2021
Last updated on 12 July 2021
Answers
mmmousemaid
12 July 2021
"Docs are baffled"... ahem; long term lithium treatment at even recommended dosages can lead to toxicity due to reduced renal clearance and other variables such as thyroid disturbance, dehydration, diarrhea, etc. Lithium affects every cell in the body and cannot be expected to clear entirely over many years of taking it. Frequent blood tests for toxicity is the small price doctors have to pay for this truly miraculous drug. Even blood tests showing a safety level do not reflect the true danger of toxicity as the blood tests do not reflect the gradual residual accumulation in the brain. Doctors prescribing lithium can avoid bafflement by reading up on the effects of lithium in many good books and articles. It is well known as a "narrow therapeutic index" drug.
Cessation of lithium upon toxicity can reverse most damage, and started again after a few months. Some effects may take a long time to reverse. Wishing you a good recovery, and perhaps asking your dr. to refer you to a lithium specialist. I was comatose from a renal impairment toxicity for a few days, and the dose being at 1.6 but the ER drs. reduced it by half (1200mg to 600mg). It was an insidious rise to toxicity which could have been prevented had the dose been gradually reduced over 40 years. I am grateful to the ER drs. and the lab technician who alerted my GP.
Carter West
12 July 2021
CW – Extreme thanks for your reply, which went beyond my hopes and saved me a bunch of research. You respect lithium as a powerful, highly effective medication, as do I, but have kept your eyes open to its potential harms. Toxicity for me involved a sudden spike, with stronger tremors and unsteadiness walking (I fell, staggered, once even had to crawl). Nausea and light-headedness followed when I stopped taking it, which I did immediately on my own, before seeking medical help. All those persist, but mostly all are abating.
My main takeaways from what you wrote: (1) the pervasiveness of lithium and presumably its effects all through the body, which sounds consistent with the aftereffects I suffered;; (2) its "gradual residual accumulation in the brain," which apparently even regular testing won't catch, perhaps because such accumulation is a source of toxicity distinct from lack of renal clearance, which is all that blood tests will measure; and (3) much damage can be reversed once lithium use is discontinued, though that can take a long time to clear – that's my experience so far. Psychopharm and I are in the process of replacing it with Depakote and Seroquel – so far, so good.
Questions still: I finally get to see a nephrologist 7/22. Would he qualify as a “lithium specialist” or should I my GP refer me to one specifically? (I live near Boston MA USA and I'm sure we can find one.) You're saying that lithium can be restarted if desired (not likely after this trauma, correct? (Not likely after this trauma, unless bipolar II forces my hand). I'm concluding that when dosing, psy'pharms have to account, not only for the sheer level of toxicity (my creatinine remained in normal range, below or at 1.3, up until the toxic spike when it hit 1.6) but also for how quickly toxicity rises – i.e., the faster the rise, the brighter the red flag. Violent tremors had sent me to the ER in January; a red flag should have been raised then. Lastly, could you name a couple of good articles that address these and other issues? If you're concerned that I'm asking you to play doctor, don't be. I've been around the block a few times. Though I'm impressed with what you've shared, I'm not taking as holy writ! I'll definitely consult with the docs. Thanks in advance ...
... though "in advance" isn't a whole lot, especially after what you've given me here. I’ll add my gratitude for the lab technician and the ER docs to yours. My regrets if I've taxed your patience. Thanks for your well-wishes for my recovery; they are returned many times over. I'll do my best to pay all this forward.
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Further information
- Lithium uses and safety info
- Lithium prescribing info & package insert (for Health Professionals)
- Side effects of Lithium (detailed)
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