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Dr. Steve
Dr. Steve, Psychologist
Category: Mental Health
Satisfied Customers: 370
Experience:  19 years conducting therapy; book author; newspaper columnist; former co-host of radio show
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As a mental health service user for more than 20 years and

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As a mental health service user for more than 20 years and being diagnosed as bipolar taking lithium carbonate at a dose of 600 mgs. I am seriously thinking of coming off this medication. My question is what is the worst case scenario, apart from the obvious of my sympstoms returning. I have never been suicidal, my problems being my relationship with my husband which is now definitely at an end. My mother was a long-term user of Codeine tablets for depression/guilt at the death of my younger brother and I have always been anxious about my own mental health after witnessing and enduring prolonged neglect and personal unmet needs. I fear I may also die a young woman like my mother if I carry on taking medication long-term. I have asked other professionals to advise me but I don't get the answer I want and need, i.e. "let's tread very carefully and gradually titrate the dose bit by bit so that you don't become ill again". I value your opinion.

Greetings:

This is an excellent question, but I am afraid that the answers you have been receiving have been in your best medical interest. True, Lithium carbonate does not contain any addictive substances and therefore withdrawal should be relatively smooth. Still, because of your lifelong history with bipolarity, the eased titration is beneficial because it will scratch the surface of the manic symptoms rather than flood you with them. Sleeplessness is typically the first indicator of mania's return, at which case a different medication may need to be substituted for the Lithium.

Too, long-term effects of lithium treatment are not nearly as noxious as long term treatment with atypical anti-psychotics for bipolarity, so if there is no Lithium toxicity, then it will remain the treatment of choice.

Anyway, I think your actual "withdrawal" should be reasonably painless - but I would be very hesitant to advise you to pursue this route without the supervision of your physician. And look at it this way, if you goal is to come off of the medicine anyway, and you have been on the med for quite some time, what difference does it make if you titrate in a day or a month? Two months? A year? In other words, you will eventually come off of the medication regardless of how you choose to do it, so why not take the safe road instead of a riskier one? Heck, if your goal is long term health (your reason for wanting less medication rather than more - which I wholly support), then why take a chance with your health in the short run?

My two cents. As always, you are advised to consult with the prescribing physician before making any decisions regarding medication. I wish you well though! If you are satisfied with the response, please hit "Accept." That is the only way I can receive credit for my answer. Thanks-

Dr. Steve

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