Q: Med-induced Lupus from Lithium?
I was diagnosed with manic-depression in March 1980 but have been stable
on lithium and an anti-depressant since 1982.
But now I've tested three times with high ANA that a specialist is now saying it
is med-induced lupus from the lithium. At first they took me off lithium but I
went manic in three weeks. What do you recommend?
Dear J’ -
First thing I had to do was search lupus lithium on PUB MED (the search
engine for our National Library of Medicine), as this is a connection I’d not
heard of. It’s not an unreasonable consideration, though; for example,
psoriasis is an autoimmune phenomenon which lithium is known make worse.
than a 1994 article in which lithium was used for two patients with lupus, to
treat depression, with good effect (Terao),
I found nothing.
the same terms in Google (sometimes it picks up legitimate connections that PUB
MED doesn’t – and of course, a whole lot of garbage too…). Oh, look: someone
similar question in 2004 here on BipolarWorld and I did a similar search
right off the bat then too!
“drug-induced lupus”. As you’ve probably learned, drug-induced lupus also can
cause ANA elevations, but is characterized by “rapid improvement” when the
offending drug is stopped. Interestingly, one can have been on the drug for
several years when the reaction finally occurs, but the improvement in lupus
symptoms when the drug is stopped usually occurs within 2 weeks (although one
source said “2 weeks to 2 months”, which would make things much harder to sort
enough, on emedicine, a pretty reputable site,
lithium is included on the long list of medications that can cause
If you and
your doctor(s) reach the conclusion is that lithium really is the culprit, then
you probably have to move on to other treatment options. Going manic in three
weeks was likely a pretty bad experience in some ways (it usually is), but
doesn’t mean you have to go back to lithium.
of lithium very quickly can induce a rapid return of bipolar symptoms, manic or
depressed, so in some respects the fact that you quickly developed manic
symptoms may not mean your bipolar disorder is just waiting to spring forth and
that you have to retreat to lithium. Rather, it could be that several of the
alternative medications (divalproex, for example, particularly if you’re
post-menopausal; it can cause a menstrual cycle derangement called PCOS if you
are younger than that) will work quite well. If you’re back on lithium and the
lupus symptoms are not terrible, perhaps this time your doctor would consent to
a slower taper off of it, with an alternative treatment already in place. I’m
not recommending that, just offering the idea for consideration. To my knowledge
your situation in uncommon enough that there is no standard recipe for handling
you’re able to work out some solutions to these puzzles soon.
Published May, 2010