Chances of Success w/Going Off Meds ?
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Q:  Chances of Success w/ Going Off Meds?

Dr. Phelps:

I have been taking lithium carbonate for a bipolar disorder for eleven years, my doctor, an MD is suggesting that I get off the medication.  I am now 32 years old and feel somewhat ok about getting off the meds, what do you think my chances will be of succeeding?  I have never tried getting off my meds before..


Dear Vicki -- 
If you have gone these 11 years without any evidence of mood cycling, you may be a good candidate for a trial of "no medication".  I once heard Mauricio Tohen, the Harvard bipolar expert who has studied life-patterns of bipolar disorder as much as anybody in the world, say that as many as 1 person in 10 who has a manic episode will not have one again.  Reviewing his published research on this topic, I can see that some of this assertion was based on people who may not have had bipolar disorder, and some of it is based on studies that went as long as four years (but not longer, so his assertion should be qualified as "will not have one again in at least a 4 year period"; however, he has probably been following this group of patients forward in time and just hasn't published again on them, so I suspect he has been watching them for much longer than 4 years, thus his assertion as quoted originally above.  Mind you, I could have heard him wrong). 

The point of all that was.... it is fairly well accepted, as near as I can tell, to try a period of time off of lithium after a long phase of no symptoms.  The MOST IMPORTANT POINT about doing so, however, is not so much when to do this, as HOW: it is clear that tapering off very slowly is crucial.  One other mood expert I heard discuss this (Steve Dubovsky from Univ. of Colorado) says that he will take as much as an entire year to taper off lithium.  

So, as you and your doctor have probably already discussed, it would be wise to taper down slowly and in very small steps.  I  use 150mg steps for my patients and have been glad I didn't take bigger steps sometimes, though usually that was in patients who were tapering because we wanted to go to a different agent (e.g to get rid of a tremor) and where I was concerned we might indeed lose control of their symptoms.  By contrast, in your case, I would not be as worried about sudden loss of control of symptoms -- but still, as long as you're going to taper, and if you're going to take a really long time to do it, why not go by tiny steps?  You'll get to feel like you're actually taking steps more often, even if they're tiny!  

Finally, as you probably have also discussed with your doctor, there needs to be some sort of "safety net" of people who know you and know what symptoms to look for if signs of bipolar disorder are recurring.  The tightness of the "net" depends on how severe your symptoms were in the first place, i.e. very tight if you were very or dangerously ill the first time.  

I hope that helps, and that it was not more information than you were looking for.  It's a long answer because we don't really know enough to give you a short, straight one. 

Dr. Phelps 

Published April, 2002


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