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antoinette

Tips for tapering off lithium

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antoinette

*NOTE  For instructions on how to taper Lithium, please scroll down this topic or click here to skip ahead: 

http://survivingantidepressants.org/index.php?/topic/2976-tips-for-tapering-lithium/?p=36863

 


 

I've been on lithium for a month after cold turkey off lexapro. What do you think of tapering off. I'm on 225...since I've been on it a fairly short time do you think I could taper with in a couple weeks time? I know dr. Tracy recommends 1/3 the time tapering that you have been on it. I just want everything out of.my system.

 

 

Please note that this post has been moved from "Recovery Stories" to Tapering. -Jemima

Edited by Altostrata
added note

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Altostrata

antionette, I don't know if there are special considerations in tapering lithium, which is why I suggested you see that doctor.

 

This Web site gives reliable information http://www.comingoff.com/index.php?option=com_content&task=view&id=27&Itemid=47

 

Who are we?

The contributors to the Coming Off Psychiatric Medication web-site include mental health professionals and people who have used mental health services and their relatives. The contributers include (Dr.) Rufus May, who works as a Clinical Psychologist and Adam Jhugroo who works as a Psychiatric Nurse. Professor Phil Thomas of University of Central Lancashire and formerly worked as a consultant psychiatrist, is among the advisors to the Coming off Psychiatric Medication web-site. The website is reccommended by the Department of Health publication:

Medicines Management: Everybody's Business

Withdrawal effects

Much of the research looking at Lithium withdrawal are concerned with whether the actual process of Lithium discontinuation may result in ‘relapse’, particularly whether manic ‘episodes’ occur sooner than would have theoretically occurred if Lithium had not been started. A study by Stuppes and colleagues (1991) analysed all the studies that had previously aimed to answer this question and found that more than 50% of new ‘episodes’ of illness occurred within 3 months of stopping Lithium treatment. Other research studies have since concluded that there is a high risk of individuals becoming manic once Lithium is withdrawn, especially when withdrawn all at once or over a very short period of time.

 

However, studies examining the effects of gradual withdrawal of Lithium have demonstrated that gradual rather than acute discontinuation appears to lower the risk of relapse. In a study by Balderessini and collegues examining effect o gradual versus rapid withdrawal, individuals were just under 4 times more likely to have a relapse if they came off Lithium within 1-14 days, compared to withdrawing over 14-30 days.

 

Other studies have compared the risk of relapse in those remaining on Lithium to those who discontinued. Over a 2 year period, just under 40% of individuals who were taking Lithium experienced a ‘relapse’, suggesting that Lithium for 2 in 5 people will not prevent relapses anyway!

 

Withdrawal rates

The data suggests that if you are thinking of reducing or withdrawing from Lithium, for whatever reason, the slower it is done, the better the outcome. As with withdrawal from all psychiatric drugs, it is wise to plan before you discontinue. Think about introducing other therapeutic activities into your lifestyle before you withdraw, consider whether now is the right time for you to withdraw, what are your current stresses, financial, housing, social etc. Once you have considered these points you could start thinking about rates of withdrawal. As a general rule, the longer you have been taking a drug, the more adapted your brain and body have become to the presence of the drug. Therefore to avoid unwanted effects when withdrawing, you should reduce slowly and in small amounts. If you have been on Lithium for over 2 years, reducing by 10% every month would be a sensible rate of reduction and it would probably be safest to not attempt to reduce any quicker than this. However, you can modify this rate as you feel, after all you know your body best. Should you need to go slower or stop reducing at any time, you can judge this best.

This suggests a trial taper of 10% might be a way you can find out how a reduction might affect you.

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Altostrata

TIPS FOR TAPERING LITHIUM

Splitting Eskalith CR tablets
Here's a discussion of splitting Eskalith CR tablets http://www.jfponline.com/Pages.asp?AID=4895



Dr. Jefferson is correct that Eskalith CR is scored and we too have asked patients to split the pill for many years with no apparent difficulties.

However, the latest Eskalith CR package insert states, “When patients require closer titration than that available with doses of Eskalith CR in increments of 450 mg, immediate-release capsules should be used.” This statement implies that splitting this pill is not recommended.

Additionally, GlaxoSmithKline—the manufacturer of Eskalith CR—informed us that the pill is scored to facilitate dissolution studies on split pills, but these studies were never conducted. Therefore, the company cannot recommend pill splitting for Eskalith CR.

Although splitting Eskalith CR pills is common, based on the information above we were conservative in our recommendation and put this medication in the “Do not split” column.

Rakesh Jain, MD, MPH
Director of psychopharmacology research
R/D Clinical Research, Inc.
Lake Jackson, TX

Shailesh Jain, MD, MPH
Assistant professor of psychiatry
University of Texas Medical School
at San Antonio


This is a case of the drug manufacturer not providing complete information. It's obvious that in clinical practice, patients have been splitting the pills.

Using Eskalith immediate-release capsules to taper
See general warnings about lithium http://www.drugs.com/cdi/eskalith.html

From FDA prescribing information http://www.drugs.com/pro/eskalith.html
 

Immediate-release capsules are usually given t.i.d. or q.i.d. Doses of controlled-release tablets are usually given b.i.d. (approximately 12-hour intervals). When initiating therapy with immediate-release or controlled-release lithium, dosage must be individualized according to serum levels and clinical response.

When switching a patient from immediate-release capsules to Eskalith CR Controlled-Release Tablets, give the same total daily dose when possible. Most patients on maintenance therapy are stabilized on 900 mg daily, e.g., Eskalith CR 450 mg b.i.d. When the previous dosage of immediate-release lithium is not a multiple of 450 mg, e.g., 1,500 mg, initiate Eskalith CR at the multiple of 450 mg nearest to, but below, the original daily dose, i.e., 1,350 mg. When the 2 doses are unequal, give the larger dose in the evening. In the above example, with a total daily dose of 1,350 mg, generally 450 mg of Eskalith CR should be given in the morning and 900 mg of Eskalith CR in the evening. If desired, the total daily dose of 1,350 mg can be given in 3 equal 450-mg doses of Eskalith CR. These patients should be monitored at 1- to 2-week intervals, and dosage adjusted if necessary, until stable and satisfactory serum levels and clinical state are achieved.

When patients require closer titration than that available with doses of Eskalith CR in increments of 450 mg, immediate-release capsules should be used.

....
Eskalith Capsules 300 mg are gray and yellow capsules imprinted with “Eskalith” and “SB” on one side of each half of the capsule, in bottles of 100 (NDC 0007-4007-20).

Eskalith CR Tablets 450 mg are round, yellow, biconvex, controlled-release tablets, debossed with “SKF” and “J10” on one side and scored on the other side, in bottles of 100 (NDC 0007-4010-20).


Weigh powder dosage with a digital scale
You may be able to open immediate-release lithium carbonate capsules and weigh out custom dosages with an electronic scale, putting them in empty gelatin capsules.

See http://survivingantidepressants.org/index.php?/topic/1596-using-a-digital-scale-to-measure-doses/

Get dosages compounded
You can get immediate-release lithium carbonate put in capsules in any dosage specified in a prescription from an MD.

Titrate with lithium oral solution
From official FDA information at http://www.drugs.com/pro/lithium-oral-solution.html



Lithium Oral Solution, USP 8 mEq/5 mL (equivalent to the amount of lithium in 300 mg of lithium carbonate) is supplied in pint containers (fill volume 473 mL) as a clear, colorless solution, with a raspberry flavor.


For tapering very gradually, you would be able to measure out very small amounts of the lithium liquid. This would require switching from controlled-release or immediate-release lithium to this oral solution. Confer with a knowledgeable medical practitioner to do this.

Make your own lithium carbonate liquid
Lithium carbonate is sparingly soluble in water http://datasheets.scbt.com/sc-203109.pdf

It is unknown whether you can make your own suspension with water. Proceed with caution.

 

Using a combination of tablets or capsules and liquid

Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in lower-dose tablets or capsules, gradually converting to all liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another.

 

If your doctor prescribes liquid and tablets or capsules at the same time, most likely he or she will have to indicate "divided doses" in the prescriptions to get the drugs covered by insurance.

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Meimeiquest

I am a tad past the halfway mark on my lithium taper, and have a couple of observations to make.

 

First, I mix capsule contents in water, measure into syringes swirling the water as I measure, and keep up to five days at a time in the frig. I use a 25mg/ml concentration to dilute the taste a little, and I take as much in intact capsules as possible because the lithium really tastes nasty. The smallest capsule in the U.S. Is 150mg.

 

Second, one of the disconcerting things to me was that it seemed one just reduced the dose and either made it off or suddenly went crazy without warning. That has not been my experience at all...I have clear withdrawal symptoms, extreme irritability being the clearest. Fatigue, listlessness, dizziness, poor concentration, insomnia, and skin and mouth lesions have developed as well. I had one episode of "racing thoughts" which resolved with an Epsom salts bath. I don't know if I just relaxed or if the claims of the salts pulling stress hormones out are true.

 

Good luck to anyone embarking on this journey (and to me as I tackle the second half which no doubt will be trickier).

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Luna

I am researching how to taper off lithium and I am not finding enough information about it.

 

I currently take 750mg of ER Lithobid.

 

I am so sensitive that when the generic brand even gets switched I become extremely irritable and experience a sort of withdrawal.

 

My idea was to switch to Regular Lithium Carbonate and take the next 2-3 years very slowly weaning off by weighing the powder.

 

I am being this cautious because I have spent the last 3 years coming off Lamictal and zoloft and it was the most suffering I could have never imagined up and after skin burning sensations and losing my ability to eat and sleep for two months... I want to go snail speed.

 

I am very worried that I might experience withdrawal simply from switching from Lithobid ER to lithium carbonate... I have considered shaving off small amounts and weighing the ER tabs but some sources say not to do this because the medication is not evenly distributed in the pills. 

 

I just want to know what people have done and what people recommend because every prescriber I have called seem like less of an expert than I.

 

I realize this forum is surviving antidepressants but I know there is a wealth of knowledge here.

 

p.s. I survived over a year or withdrawal symptoms from zoloft and It does get better :) wow. I can say that now!

 

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Meimeiquest

Hi Luna, Well, I am up reading this in the night thanks to lithium or the lack thereof. This is the official thread on tapering it: http://survivingantidepressants.org/index.php?/topic/2976-tips-for-tapering-lithium/?hl=%2Btips+%2Bfor+%2Btapering+%2Blithium

 

In theory the half-life is a good twenty-four hours, but once we have been through previous tapers, all bets are off as far as what small change might trigger symptoms, so I don't know now you might react to the change in dosage forms. I have been on immediate release capsules since very, very early in therapy. I make a water-based solution/suspension. JanCarol and I (Meimeiquest) are the "frequent flyers" here who are tapering lithium right now. I think we'd both say we are flying by the seat of our pants :). But I guess that counts! I have read of many people who came off without any difficulty, but I am not one. If you are able to write of your experiences, I am sure that will be valuable to someone down the road. Good luck!

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Meimeiquest

From reading the prescribing information for Lithobid, the extended release mechanism is in the tablet coating. So cutting the tablet will destroy that mechanism. What do you do to get from 600 to 750mg? Maybe you are sensitive to something in the generic powder, it is hard to know. But irritability when your brain isn't happy with this med is something I know all too well.

 

I wonder if you determined your daily dose and then divided it into three doses that it might create an ER effect that you could live with.

 

Also, you probably know lithium comes in liquid form? Another option might be to take Lithobid 300 twice a day and then take the remainder of your tapering dose divided between those two stable doses. Just some ideas...you have been through a lot and I am sure you will do well overall with a "turtle taper."

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Luna

I used to take 900.

I don't need an ER effect anymore I simply want to slowly get off the drug with a little withdrawal as possible.

 

I feel fear every time I think of switching from ER to LI carbonate because I just do not want to cause upheaval in my CNS. When the pharmacy has simply switched generic brands on me without telling me I knew because I got angry and irritated and it turned my vacation into yet another time in my life I had to manage instead of joyfully live. 

 

I have a fear response to all of this because of the agony I have endured over the last 3 years getting off of lamictal and zoloft. 

I want all of this to be behind me so I can be free of psychiatry and recovered.

 

Has anyone ever made the switch from ER to immediate release? 

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Meimeiquest

I did, but it was just a short time into taking it, maybe a month or two. My brain wasn't sensitized like it is now. I had no symptoms with the change, but I have no symptoms with brand changes either. I am also thinking you could take the Lithobid as it fits and make a solution for the part that isn't intact. You must be taking a half tablet now to round everything out?

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Luna

I take one 300mg in AM tablet and one 450mg tablet in PM both ER...

 

I wonder which scenario makes more sense:

 

1) switch completely to Lithium Carbonate and slowly decrease via the 10% rule.

 

2) Switch to taking two 300mg ER in the evening and take 150mg of lithium carbonate and taper that down to 600mg. And make slow shifts off the ER in increments.

 

What a mess! Its overwhelming to think about.

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Meimeiquest

I don't know what the deal is...I can't find anything but 300mg as a dosage form for Lithobid in google. The 450 tablet probably has writing on one or both sides. If you put that in a search engine you can usually find the product and manufacturer. I would probably take Lithobid 300mg every twelve hours and then add a commercial or homemade liquid to it to fill out the dose. But no idea if that is right for you :)

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Meimeiquest

Well, my new dr. asked me to hold right now and concentrate on getting off the benzo....the one before said I had to get off lithium in a month (that would have been catastrophic). I am 87.5mg above one third of the original dose. Irritability is huge. With a bigger cut, symptoms hit with a dizzy wipe-out feeling 2 or 3 hours before the exact four day mark. Once I had racing thoughts pretty bad with a total appetite cut off. That is always a serious symptom for me...when the appetite leaves I am escalating into hypomania or something like it. But "cured" with Epsom salt bath. I posted some symptoms on Oct. 1 above in this thread.

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Luna

Mei mei sorry if I am asking questions you have already answered...

 

When you were reducing the lithium how much were you reducing by?

 

Thanks.

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Meimeiquest

I did it multiple ways, depending on how I felt. Most recently, 25mg cuts, frequency as tolerated. But something will have to give at that rate :).

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Altostrata

I would not be surprised if the magnesium in the Epsom salts bath modified the general mineral balance in your body and thus helped the lithium withdrawal symptoms.

 

...
Also, you probably know lithium comes in liquid form? Another option might be to take Lithobid 300 twice a day and then take the remainder of your tapering dose divided between those two stable doses. Just some ideas...you have been through a lot and I am sure you will do well overall with a "turtle taper."

 

This is a very good idea, to take part of the dose in ER release tablet form and part in liquid form, tapering the liquid slowly.

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JanCarol

My pdoc gave me scripts for 450 mg XR (extended release) and 250 mg "fast" release. 

 

She says I can break the 450's anytime and make them "fast" as long as I am taking 2 doses a day.  So I have been switching with each taper between XR and not XR, I start cutting the XR on my next taper.  This has gone smoothly so far.  My next taper will be 225 (1/2 a 450) am and 250 (whole "fast tablet") pm.  Then when I stabilize, I will switch to 225 am & pm, and will be completely off of the XR.

 

My last taper took me off the XR, and it has been smooth.  Because I've gone slow, and if there is ANYthing happening in my life, I'm patient.  I wait.  I don't need "dramatic events" in my life, and I feel I have some measure of control over the taper.

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Meimeiquest

I would not be surprised if the magnesium in the Epsom salts bath modified the general mineral balance in your body and thus helped the lithium withdrawal symptoms.

 

I don't know if it matters, but I have been trying to get plenty of Himalayan sea salt, which contains other trace minerals, to try and make sure I have plenty of whatever is needed to fill in as the lithium comes out. Also eating Gouda and Brie cheese for vitamin K2 which works in calcium and Vit D utilization. My calcium is finally down to high normal (from hyperparathyroidism from the lithium), trying to ensure that calcium goes to the right places.

 

JanCarol, so glad you taper is going so well in this stressful time. You're rocking it!

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Altostrata

Good to hear, meimei. Sounds like you're addressing some fundamental health issues.

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Meimeiquest

Recently I listened to a Q and A session hosted by Kelly Brogan. She seems to be a psychiatrist who really sees the complexities of coming off psych meds, but still has an attitude of "let's at least try this." Someone asked about coming off lithium. She said it is associated with a high incidence of "relapse symptoms." In other words, the withdrawal symptoms are very much like the symptoms it would be prescribed for. I took that to mean as different from antidepressant withdrawal symptoms which can involve many symptoms not normally associated with depression.

 

With all meds, she does a pretty big initial cut, usually 25%, just to see what will happen and gauge that person's sensitivity. I assume she goes back up to a smaller percentage cut if needed. She says some patients can go all the way off In 150mg increments (smallest capsule size) as long as they leave "several months" between cuts, but some have to go very slowly. She said the lowest she has had to go so far is 10 mg/reduction. And, of course, a big part of the withdrawal process is sorting out what caused the initial symptoms the drug was prescribed for.

 

I guess I would throw out the huge caveat that her patients have her support...if you are doing it on your own (which includes doing it with a doctor who knows less than you do), I would be more cautious.

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Altostrata

Very interesting, thank you, meimei.

 

You are correct, the reason we suggest testing the waters with a 10% taper is because we cannot take responsibility for what happens should a larger cut go wrong.

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Tchi

Hi

 

I've been tapering off lithium since september .

It's in capsule form , so I open the capsule and divide the powder in regular amounts and take what I need .

It's getting tedious....am considering switching to oral syringe + container .

 

My question is :  if I use 30mg powder , how does that come into the equation of ml ?

30mg = 30 ml + ( 10 ml water ) = 40 ml ?

10% of 40 ml = 4 ml taper ?

 

OR  do I just calculate 10% of 10 ml ?

 

Thank you

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Tchi

Since October , I've been tapering lithium this way:

Initial dose : 600mg minus 60 = 540mg

                    540mg minus 50 = 490mg   

                    490mg minus 50 = 450mg

All is going well , no withdrawal , no depression , no mania.

I've also been tapering from Paxil ( 30mg to 20mg ), it's a tad more difficult than the llithium .

There IS hope .

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Altostrata

Very good to hear. Please update your Intro topic.

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Cayperz

Are there any success stories about tapering off Lithium?

 

I'm down to 750mg (from 1000mg) and have been okay so far. A little bit light-headed in moments and a wee bit moody but other than that, I'm okay...

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Optomistic

Hello everyone.  I'm new to the group.  I've been on lithium for more than 3 years.  Lately, my memory loss has been worse, I've been having frequent nighttime awakening to go to the restroom because of the Lithium so over the past year my sleep has been off.  I am exhausted and extremely frustrated that they pushed a label on me to begin with when I was finally discovering myself.  In any case, I don't have a  lot of support from my husband or psychiatrist and my psychiatrist is recommending that I switch to Depakote because of the side effects of the Lithium.  So I know that in order to get off the medication without having a manic episode, I need to do it slowly and i obviously can't continue with lithium for that long.  Do I introduce Depakote in the meantime and drug myself up with both until I get to a stable dose?  Is Depakote hard to get off of? What do you recommend?

 

I don't get it.. I had infections both times that I had a manic episode, plus both times I got my period in the hospital.  Both times I was sleep deprived beforehand... and my psychiatrist even admitted to me that sleep deprivation causes people to lose some of their inhibitions. I was also going through profound transformations at the time and getting in touch with emotions and parts of myself that I hadn't allowed myself to be and what gives them the right to tell me I have bipolar when they can't even explain the physical/emotional components?  Plus I have MTHFR (a genetic mutation) and some other sensitivities and deficiencies like anemia (not iron deficiency).  

 

Thank you.  Looking forward to your input.

 

I tried to reply in length earlier, but a moderator moved my reply. Hopefully this reply is more adequate. I have some knowledge about this.

 

Basically, I wanted to let you know from my own experience that mixing Lithium with divalproex at high enough doses can zombify you - like slow you down way too much to the point that you are out of it completely. So adding divalproex to your current lithium dose might mess you up and if that happens, now you know why. Plus, divalproex has it's own side effects you might not be happy with. I always read the "prescribing information" for a medication before deciding to take it, I suggest you do too.

 

Then there is still potential to have a manic episode during the switch if you're not careful. One of the most common discontinuation symptoms of lithium is mania (there are more). Tapering lithium carefully seems to be highly recommended to prevent this high chance of relapse and perhaps withdrawal. I'd definitely make sure you are taking steps to prevent mania while you are tapering lithium (slowly). Alternating titrating divalproex and tapering lithium under close supervision might be the best way to go to prevent these problems - ask your Dr. about it. I took both meds at the same time, but the dosages had to be adjusted to prevent me from being a zombie.

 

As far as difficulty stopping divalproex, you risk mania or other (perhaps exaggerated) relapse type symptoms. Cold turkey can definitely cause destabilisation, so, taper it if you ever decide to stop... though it seems you can go faster than with some other drugs (according to what I understand, have heard/read and experienced).

 

Good luck

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Optomistic

If you are urinating so frequently that it's causing a problem, please have it looked into. A nephrologist can help. It can be a sign of kidney problems (diabetes insipidus/other). Maybe something can be done about it. You could potentially end up with kidneys that fail to process lithium, resulting in lithium toxicity.

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RainbowDbc

Hi

I'm new here and very concerned with any recommendations on this particular drug. It seems like such a basic drug, yet much more unpredictable. I have been experiencing a tendency to over activate myself very uncomfortably before anxiety comes when I dont take lithium for many hours. I have a fear psychosis will come through. Its a flooding sensation in my head and I cant find this reaction in ppls posts. I can stop this reaction with a benzo I also take. But I need to know how to leap into a further taper before having a full blown out mania like experience.  Id like to have longer spaces between lithium but dont know how. If anyone has a lot of experience with lithium in particular please write...... thank you....

Like I said I am.new here and very clumsy trying to.learn where to go, an old post with this similar question would help.  This is not anxiety persay, its more like an overwhelmed brain very active...is this mania? Im not feeling fast or wreckless just very active......I dont recognize manic patterns in me, just a direct step towards psychosis..and I cant afford going to a psyche ward Ive progressed this far!

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RainbowDbc
On 11/14/2014 at 1:49 AM, Luna said:

I am researching how to taper off lithium and I am not finding enough information about it.

 

I currently take 750mg of ER Lithobid.

 

I am so sensitive that when the generic brand even gets switched I become extremely irritable and experience a sort of withdrawal.

 

My idea was to switch to Regular Lithium Carbonate and take the next 2-3 years very slowly weaning off by weighing the powder.

 

I am being this cautious because I have spent the last 3 years coming off Lamictal and zoloft and it was the most suffering I could have never imagined up and after skin burning sensations and losing my ability to eat and sleep for two months... I want to go snail speed.

 

I am very worried that I might experience withdrawal simply from switching from Lithobid ER to lithium carbonate... I have considered shaving off small amounts and weighing the ER tabs but some sources say not to do this because the medication is not evenly distributed in the pills. 

 

I just want to know what people have done and what people recommend because every prescriber I have called seem like less of an expert than I.

 

I realize this forum is surviving antidepressants but I know there is a wealth of knowledge here.

 

p.s. I survived over a year or withdrawal symptoms from zoloft and It does get better :) wow. I can say that now!

 

I like your story. Im new at tapering and have been doing so with lithium.I also notice much of what Ive had to do is change my lifestye and go very slowly. Painfully slow...to survive from wirhdrawal. The issue is having a relapse of mania or psychosis. The rest of the symptoms are relatively manageable. Sleeping well eating foods that calm you and.maybe supplements can help as theyve helped me...

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RainbowDbc
On 6/29/2016 at 7:04 AM, Optomistic said:

 

I tried to reply in length earlier, but a moderator moved my reply. Hopefully this reply is more adequate. I have some knowledge about this.

 

Basically, I wanted to let you know from my own experience that mixing Lithium with divalproex at high enough doses can zombify you - like slow you down way too much to the point that you are out of it completely. So adding divalproex to your current lithium dose might mess you up and if that happens, now you know why. Plus, divalproex has it's own side effects you might not be happy with. I always read the "prescribing information" for a medication before deciding to take it, I suggest you do too.

 

Then there is still potential to have a manic episode during the switch if you're not careful. One of the most common discontinuation symptoms of lithium is mania (there are more). Tapering lithium carefully seems to be highly recommended to prevent this high chance of relapse and perhaps withdrawal. I'd definitely make sure you are taking steps to prevent mania while you are tapering lithium (slowly). Alternating titrating divalproex and tapering lithium under close supervision might be the best way to go to prevent these problems - ask your Dr. about it. I took both meds at the same time, but the dosages had to be adjusted to prevent me from being a zombie.

 

As far as difficulty stopping divalproex, you risk mania or other (perhaps exaggerated) relapse type symptoms. Cold turkey can definitely cause destabilisation, so, taper it if you ever decide to stop... though it seems you can go faster than with some other drugs (according to what I understand, have heard/read and experienced).

 

Good luck

Hi Optomistic, I am currently on lithium from your response I can sense you tapered lithium..........I would love to know more about tjw wothdrawal effects you had even the unusual ones. How did you cope with mania? 

Whats the safest way to taper this drug since.its.prone to relapse out of nowhere...I am hylersensitive to change and very prone to agitated states and mania...depression doesnt.concern.me I can cope with it. Would appreciate any feedback..I.also take klonopin 

 

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