Q:  Is This Common w/ Lithium

Dear Dr. Phelps

What happens to me is that when Lithium goes too high I have to reduce it (that's obvious) but after that I cannot get back to normal level because my body doesn't tollerate even very low doses.

I have to adjust it very slowly, and it takes some weeks to tolerate a normal 0.70 Meq/L.

When lithium is too high I feel my neck trembling and I just cannot get into a shop and talk to a stranger because it embarace me (I should keep my head still with my hands).

Is it common or is it weird?

Forgive my English (I'm from Italy)
Frank


Dear Frank -- 
This is "normal" as an experience on lithium.  I've heard it said that people should avoid using lithium after having lithium toxicity, because the lithium even at lower levels can irritate the brain after it's been really irritated once.  However, that's not a firm "rule" in practice here in the U.S.  Do you think that a lower dose, that would keep you farther away from the risk of high blood levels, would be sufficient if you added a low dose of another mood stabilizer?  That is a very common strategy for me for patients with experiences like yours, if for some reason I choose not to switch away from lithium entirely.  

Forgive my complete lack of Italian. 

Dr. Phelps