Q:  Safe Way to Go Off or Reduce Meds?

I have been treated with Lithium 300 mg two tabs, bid for 16 years. I had one attempt at going off the medication with the help of my PCP about 7 years ago and it ended up in a brief in patient stay to get restabilized. I tend to get manic with psychotic symptoms. Is there a safer way to transition off or to manage Bipolar illness with a reduction in meds. When hospitalized I am also on an atypical antipsychotic which I only need while inpatient. My only other hospital stays were at the outset of my illness and I am a very stable, doctorate level working professional. I would appreciate any ideas you have.


Dear J' -- 
There are a few things that help stabilize bipolar disorder besides medications.  A regular sleep pattern tops that list (after avoidance of alcohol and other drugs).  Probably a regular pattern of activity generally is good (this is from the study of "social rhythm therapy", as you'll see it referred to).  Exercise is clearly an antidepressant, and does not tend to cause cycling; and in my opinion, no good data on this, seems to act as a mood stabilizer as well at least in some people.  Keeping stress levels relatively controlled (no one can get to low levels and keep them there these days, it seems; you'd have to be a farmer with great weather or something) is clearly a good thing, but who gets to have good control over that; at least you can avoid sustained relationships with people who repeatedly stress you out, that kind of thing.   Psychotherapy is a good means of keeping stress levels low, as there's someone there to help you process life events and keep from triggering old stresses with current events (or less so, anyway). 

Beyond that, it's medications.  No one has yet shown that you can keep episodes like yours from coming back using anything other than medications.  So as I read your letter, the main question I have is "why are we wanting to get off what seems to be effective -- i.e. effectively keeps episodes from happening -- ?"  I can understand, it seems that everyone wants to get off medications until they've been through a few cycles of what you've been through.  

So, rule number one: your doctor gets to know what you're doing before you do it; at least that way you have some consultation.  Rule number two: if for one reason or another you and your doctor decide you're going to go off lithium, taper it extremely slowly.  I heard one expert talk about taking a year to go off, and have heard several folks talk about at least 6 months; in fact, 6 months is probably a wise minimum, as there's recent new data confirming that stopping lithium is associated with triggering episode recurrence.  

Dr. Phelps