Q:   Lithium in Therapeutic Range & Episodes : Lithium & Semen

My two questions, however bizarre the first one sounds are:

1) My husband is on 1350 mgs of Lithium.  Is it possible for the lithium to end up in his semen?  And if ingested (through his semen) will that affect me?

2) Is it possible for my husband to be within the "therapeutic range" with his lithium, and still have manic episodes?  the lithium doesn't seem to be working as it once did....can my husband become immune to it?

Thanks for your time,
Jenn
 

Dear Jenn -- 
1. "No", and "no". Not enough to matter, in the first case (in his semen) and for sure not enough to make any difference if you were to absorb any. 

2. Unfortunately yes. Sometimes one medication is enough, but often -- more often that not, it appears nowadays -- more than one is needed to prevent manic or depressive episodes. For example, at the bipolar clinic associated with Harvard University they counted up the number of medications their patients were taking. The average was four.  Maybe there patients are a little tougher than average but still, that is a lot of medications.  Recently I've gotten very interested in the possibility that getting too much light at night (because we have electricity) might be part of the problem for at least some patients with bipolar disorder. This raises the possibility that by getting less light at night, people might be more stable (and perhaps require fewer medications?). This line of thought, which is just now beginning to be researched, is explained in my essay about Bipolar Disorder: Light and Darkness. You might find it interesting. 

Dr. Phelps