Q:  Duralith Not as Effective as Before?

My former psychiatrist once told me that when you discontinue lithium therapy it loses its effectiveness when you try to resume it. Have you ever heard this before?

I think this may be what has happened to me. My current psychiatrist recently took me off duralith (no weaning) and I had a very bad manic episode shortly after that. This happened in April and I still haven't recovered my sleep patterns and I don't feel right. I resumed lithium therapy but it seems I now need additional drugs for sleep. For the most part, lithium alone has always worked just fine (since I was diagnosed in 1992). I also notice that my mood is down. Since I was diagnosed with bipolar disorder, I have never had a depressive episode.

Do you think it's possible that the duralith is not as effective as before?  I'm really beginning to think that may be the case. Maybe it's time for a medication change.

Hope to hear from you soon.



Dear Ms M' -- 
You could be right, and you're right that can happen, but it doesn't always, in fact probably less than half the time (we don't have good numbers on that).  Here's another potential explanation: you went into a manic episode; lots of people go into a depressive phase coming off a manic one.  You might be in that.  Lithium might not be enough to get you out, but might be enough, later to keep you from cycling.  In other words, it might still be as effective as before.  Or close.  Or, unfortunately, not enough and you'll have to add something.  But that's not a major problem; it's common for a lot of folks to require more than one mood stabilizer.  For example, you can read on my site about treating with lithium and Depakote together (see "treatment" under BPII section).  

Dr. Phelps