Lithium Toxicity & Permanent Brain Changes
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Q:  Lithium Toxicity & Permanent Brain Changes

I had lithium Toxicity approx. 2 yrs ago and have not been the same since. I have severe short term memory loss with bouts of zone out times that I cannot remember doing things I also will start typing odd things on the computer while at work until I snap out of it. Objects not really there out of corner of my eye. Cannot seem to get my head to coordinate for a time...Is this still related to the toxicity..sounds similar to an article i read on "chemo brain" which i've never had chemo.... thanks

Dear Ms. S' -- 
During my training I recall hearing the idea that one episode of lithium toxicity  could cause some permanent brain changes; and that lithium should not be used again after an episode of lithium toxicity.  I did not get a reference for this idea then, nor try to chase one down, then; so off I go now to find one. 

Well, that was tough: it may be a very rough indicator of how obscure this idea is that I had so much trouble finding a reference for it.  Had to use "after lithium toxicity" in quotes (makes the search engine look only for the entire phrase). But using that approach, I found this in the notes for a British psychiatry training program: 

"Permanent neurological damage can occur after lithium toxicity including... intellectual impairment." 

The document gave no reference for this assertion. I'm sure I could find some similar assertion in some standard Psych' texts. The problem is, I've seen quite a few patient after lithium toxicity, some of them for years, and I have not been impressed by "intellectual impairment", either in my own observations nor based on their complaints about it. So I don't think that obvious "intellectual impairment" is a routine result of lithium toxicity; nevertheless, it does occur, we can say that much. And it sounds like it has happened to you. 

On the other hand, because all this is so fuzzy, I don't think you can necessarily conclude that what has happened to you is "permanent". Even if it was, the brain has remarkable reshaping capacities and could build you a work-around solution on its own. Or the effect could prove to be less than permanent for some other reason. So I don't think you can necessarily plan on your current level of difficulty with the symptoms you describe: they could get better, or they could stay the same. I hope they don't get worse (I suppose we have to include that in the "don't knows", even though this is not something I've heard about, this most negative outcome). 

Dr. Phelps

Published Sept. 2006


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