Q:  Cycling Caused by Taking Desmopressin and Also Stopping Lithium?

Dr. Phelps,

My husband is 42 and has suffered from bipolar for 20 years...this past spring he had to stop taking lithium because he was diagnosed with diabetes insipitus.. since then we have been on a rollercoaster of what i think to be hypomania.. my question is could that have resulted from taking Desmopressin Acetate and also stopping the lithuim at once instead of doing it gradually... he has been in a number of hospitals since and we cant seem to get the right help any info you could give me would be gratefully appreciated.

Sincerely,                

 Dear Ms. N

There are two reasons to blame stopping lithium alone: first, we know that it is an effective anti-manic, and anti-cycling agent. Thus, simply from stopping it, one would worry that symptoms could return. Secondly, there is some suggestion, although not confirmed, that stopping lithium quickly can lead to a more rapid or vigorous return of symptoms and if it is tapered slowly, overly several months. It may have been that your husband's kidney function did not allow a slow taper.

On that basis, it would be hard to know whether desmopressin played a role or not. I'm not aware of evidence implicating it.

The challenge now is to find a replacement for lithium. I've been through this with several of my patients. It is difficult to let go of something that worked so well, particularly 11 has difficulty finding something that works among the first few things that are tried as a substitute. I hope the search proves more fruitful soon. 

Dr. Phelps