Is Lithium as Effective 2nd Time
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Q:  Is Lithium as Effective 2nd Time 

I have been to two psychiatrists and now on my third, who wants me to get off of Lithium.  I have only been on it for a year am Bipolar II.  The doctors only concerns have been because of my weight gain, which I am working on, and have already lost 20 of the 40 pounds I have gained.

 My question is, I have heard that once you get off of Lithium and then try and get back on it, it will never be as effective the second time around.  I am terrified at this prospect since Lithium is the only med that has ever helped me.

Thank you,

Dear Gillian -- 
The statistic you have heard sounds  a lot better the other way around: it is true that some people who have been on lithium then go off do not respond the same way again when they go back on.  However, just how many people are we talking about here?  That's not clear; what is clear is that not everybody can count on it working again.  So, in a way you and your doctor are both right: you are right to worry it might not be the same, but she/he is right to worry about weight gain (although I wouldn't be worrying if the trend was downward, until it was upward again...).  I warn people we can't count on something working again in just the same way; but I don't let that hold me back if the medication's doing something bad, as well as something good.  If you had already had Depakote, carb- or oxcarbazepine, lamotrigine, Zyprexa and thyroid (see my website for more on those); then worrying about changing away from lithium might be warranted.  

Dr. Phelps  

Published October, 2001


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