Delusions or Hallucinations & Missed Lithium Dose
[Home] [Bipolar News] [Bipolar Disorder] [Medications] [Treatments] [Bipolar Disorder/Job/School] [Disabilities] [Ask the Doctor] [Ask David] [Self-Injury] [Personal Stories] [Graham's Column] [Steven's Column] [Storm's Column] [Columnist Archives] [Suicide] [Community Support] [Family Members] [Expressions] [Greeting Cards] [Books] [Awards] [Links & Rings] [About Us] [Contact Us]


Q:  Delusions or Hallucinations & Missed Lithium Dose

My son who is 25 has been diagnosed as bipolar. He is taking lithium and usually does fine. He sometimes has delusions or hallucinations that last for one to two hours and is very tired when this occurs, sleeps most of the day and cannot function as he is so tired. He takes the medicine at night because it makes him sleepy. When he has had these episodes he says he missed a dose the night before. Is this a normal side effect when a dose is missed or could there be something else going on.

Dear Mr. C' -- 
You know the joke when someone poses a question, then offers two possible answers -- and you reply "yes"...

Answer #1: Yes, some patients of mine have told me that they can tell if they miss even a single dose of lithium.  But typically this should not be crucial: we think the goal is to maintain to a sufficient blood level of lithium (the same level we're measuring for when testing a blood sample for lithium concentration); and most people probably are not hovering just above a minimum below which they'll have symptoms. Rather, most people probably have a cushion between their typical lithium level and the point where symptoms would begin to return. 

Moreover, most people don't have symptoms just waiting to recur if some minor dip in their lithium occurs. Often people can stop their lithium and go weeks, or even months, before a recurrence of bipolar symptoms (although most mood experts believe that stopping lithium suddenly can bring on an episode more quickly than it would have occurred if lithium was tapered). But still, according to what I've heard from a few of my patients, sometimes a person can be very sensitive to their lithium dosing.  

Answer #2: yes, it may be that "something else is going on". The fact that he is so sleepy after an "episode" raises the possibility of some sort of seizure-like phenomenon, as profound sleepiness is routinely seen following a grand mal seizure. Your son may already have had an EEG (electroencephalogram) but if he has not had this (they are not routine in the diagnosis of bipolar disorder), you might suggest that he ask his doctor whether that might be wise in light of this post-episode sleepiness. The good news would be that this might suggest new treatment options. The bad news is that if there was a conclusion that your son has "epilepsy", there's a new label with new consequences and stigma (and please note: I'm only suggesting "seizure-like", not seizures per se, so I don't mean to imply this is a search for "epilepsy"). 

Answer number one detail: You've probably already suggested a "pill-minder"; one of my patients who otherwise looks pretty high-functioning but kept missing doses here and there swears this little $5 tool has helped him a great deal. 

Dr. Phelps 

Published October, 2006


Bipolar World   1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014
Allie Bloom, David Schafer, M.Ed. (Blackdog)
Partners:  John Haeckel, Judith (Duff) 
Founder:  Colleen Sullivan

Email Us at Bipolar World


About Us  Add a Link  Advance Directives  Alternative Treatments  Ask the Doctor   Ask Dr. Plyler about Bipolar Disorder   Ask The Doctor/ Topic Archives  Awards  Benny the Bipolar Puppy  Bipolar Chat  Bipolar Children  Bipolar Disorder News  Bipolar Help Contract  Bipolar World Forums  Book Reviews  Bookstore  BP & Other mental Illness   Clinical Research Trials & FDA Drug Approval   Community Support   Contact Us  The Continuum of Mania and Depression   Coping   Criteria    Criteria and Diagnosis  Criteria-World Health Disabilities,  DSMV-IV   Dual Diagnosis  eGroups  Expressions (Poetry, Inspiration, Humor, Art Gallery, Memorials  Family Members   Getting Help for a Loved One who Refuses Treatment  Greeting Cards  History of Mental Illness  Indigo  Job and School  Links  Manage Your Medications  Medications   Medication and Weight Gain    News of the Day  Parent Chat  Pay for Meds  Personal Stories  Self Help  Self Injury  Significant Others  Stigma and Mental Health Law  Storm's Column  Suicide!!!  The Suicide Wall  Table of Contents   Treatments  Treatment Compliance  US Disability  Veteran's Chat  What's New?