Bipolar Husband Stops Lithium
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My husband was diagnosed as bipolar about five years ago. He was manic 90% of the time and depressed 10%. He has been on lithium for the past five years, but recently decided to stop taking it. Attempts to reason with him have been unsucessful. Given the drastic consequences of his last manic episode (just prior to diagnosis), I am wondering what to expect now. Specifically, how long will it take for all the residual lithium to leave his body? Will he be likely to spiral upward from feeling good to mildly euphoric to busy/chatty to full-blown mania, OR will he go from recently medicated to full-blown mania in a very brief time? I'm hoping we make it through the holidays before disaster strikes.

Dear Sue --
Here are some thoughts.  What would happen if you called the doctor or team who's prescribing his lithium and said "here's what he's done and I'm really worried" -- ?  Often the response will be basically no response; but some doctors might respond by inviting your husband in for a visit, and maybe helping you set up some sort of monitoring system, to alert the doctor if symptoms start to appear.

Unfortunately, as you are probably painfully aware, there is often little anyone can do if someone stops their medication and is becoming ill again -- until they are potentially dangerous to themselves or others.  Make sure you've hooked up with the National Alliance for the Mentally Ill chapter in your area; some chapters are great, some are ok, but their mission is to help you and when that can't really amount to much, to allow you to at least help others based on your experience. 

I presume you've taken protective measures like limiting, as much as you're able, his access to large sums of money (including ATM cards)?  In a worst case, if you have joint accounts, you can take out what you might need and freeze everything else.  If he used to have symptoms most or all of the time (per your 90% up, 10% down), then I would presume his symptoms might return very soon; whereas if the episodes were infrequent (like yearly, say) then it could be about that long until you see something amiss.  However, there is one study and a lot of supportive opinion to suggest that the risk of relapse is much higher and more rapid if a person stops lithium all at once (over less than two weeks), as opposed to a gradual taper (over 1 month or more): this is a very often cited study (abstract here). 

From the sound of it he probably wouldn't listen if you told him, "hey, if you're going to stop, at least taper -- it'll reduce your relapse risk a lot" -- but you could try, or at least print the abstract and hand it to him.  Many people in his position have already begun to relapse when they decide this; and any alcohol use (including e.g. holiday cheer) can accelerate the process.  Tough situation you're in, and all too common; sorry not to have happier holiday news.

Dr. Phelps

Published December, 2000

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