Hi Dr. Phelps,
My 20 y/o son was dx with Bipolar disorder, but recently the Pdoc is changing his mind. My sons substance use could have caused a misdx and soon the doc will be taking him off lithobid to see what is what. He has been on it for 6 months. I was wondering what the reaction of a nonbipolar person would be on lithobid(.8 600mgs)? Would the medication effect anything(either positively or negatively)like moods,anxiety,sleep,or temperment of a non BP person? Have you ever put a person who is not BP on lithium and if so what was the persons reactions? TIA


Dear H' -- 
A very good and appropriate question.  There is a fairly large body of experience, including some research, on giving lithium to people who clearly don't have bipolar disorder.  For example, it's routinely used as an "adjunct" medication for people with "unipolar depression", i.e. not bipolar depression, and it has substantial positive effects there.   (I have always wondered if a large portion of the "responders" might have had a "bipolar" depression that was not recognized as such, but theoretically the patients were screened for bipolar disorder and determined not to have it in these studies).  

Another example: many years ago when the ethical procedures of research were not as tightly controlled, half of the inmates in a certain prison were given lithium while the other half were not.  Presumably there were a lot of guys in there who didn't have bipolar disorder, but the group that got the lithium had many fewer incidences of violence than the "control" group.  

There is also substantial evidence that lithium has a "non-specific", i.e. not specific to bipolar disorder, effect on lowering the risk of suicide.  The mechanism in the brain for such an effect is not at all clear -- e.g. whether one would have to have some sort of "bipolar" process in order to benefit from lithium in this particular way.  

So, the general answer to your question:  there may well be some sort of mood stabilizing benefit of lithium in people who don't have "bipolar disorder" per se.  However, since "bipolar disorder" per se is not really understood, these boundaries (e.g. if you were trying to draw some sort of Venn diagram of all this) are very poorly defined, so the answer to your question should -- in my opinion -- be recognized as necessarily similarly vague.  

In any case, I would hope that the lithium would be tapered off very slowly, as there is also some evidence  that stopping lithium quickly can bring back symptoms more dramatically than if the medication is tapered.  Ok, so what's "slowly"?  At least more than a month to stop, and many mood experts recommend longer, like six months, and I heard one say "one year".  That takes a lot of the "zing" away from a stop-the-lithium-as-diagnostic-maneuver move as is now being contemplated for your son, i.e. how are you going to tell anything really over that long a period of time?  won't a lot of other variables enter in over that time?  will he really be able to stay substance-free for that long, for example?  As opposed to stopping quickly and seeing symptoms return quickly -- wouldn't that be a good idea, so as to learn more from this step?  In my opinion, the answer to that latter question is no:  the evidence is too clear that stopping lithium quickly is a bad idea.  If the "bipolar" diagnosis is correct, such a quick move is potentially perilous, outweighing -- in my opinion -- the value diagnostically, in just about any case.  However, obviously I don't know your son's history, so I can't really comment in any specific way and would have to defer to your son's doc'. 

Dr. Phelps