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I'm actually asking for my wife. She has taken lithium for

Hello, I'm actually asking for...
Hello, I'm actually asking for my wife. She has ta***** *****thium for almost 40 years and now needs to get off. I would like her to get off quicker than the doctor wants her to which is about 2 months.
JA: Have you seen a doctor about this yet? What medications are you taking?
Customer: yes
JA: Anything else in your medical history you think the psychologist should know?
Customer: The reason she needs to get off the lithium is that she has stage 3 kidney disease.
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Answered in 7 hours by:
12/14/2017
Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4,722
Experience: MD Psychiatry
Verified

Greetings.

Welcome to the site.

I am a Psychiatrist and i believe that i can help you with your query.

I can understand that you are concerned about your wife's stage 3 kidney disease and the fact that it can get worse with further use of lithium however after 40 years of use one cannot just abruptly stop the drug because then one has to endure the withdrawal symptoms of the lithium which will further complicate the clinical picture.

So yes one can devise a strategy to bring her off lithium in 3-4 weeks but for that you need to give me details of the doses of lithium with their times of intake and ensure that you discuss my weaning strategy with her primary doctor.

I will get back to you with the withdrawal plan once you reply to me.

Regards

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Customer reply replied 1 month ago
She is currently taking 1- 300 mg. in the morning, and 1- 300 mg in the evening. There is also one more thing I wanted to make known. She has indeed ta***** *****thium for 38 years, however about 15 years ago while faithfully taking the drug she went into a cycling state (very highs and very lows) for about 5 years which included two hospital stays. Towards the end of the five years and while still in the hospital we were considering shock treatments. But first we tried one combination of Serequel and Trileptal. We'll low and behold she snapped out of the cycling and psychotic phase within about 3 days. I couldn't believe it was so quick. And... has not had that happen since. My argument is: Lithium was no longer working for her. I think she may still be in the hospital if she just took lithium. I believe she could of stopped the Lithium back then and the Serequel/Trileptal would of worked fine. With her kidney's in trouble I'm hoping to wing her off asap. I appreciate your professional help.Thank you,
Mark
Thanks for the valuable inputs.
Well, at this moment of time if you plan to wean her off lithium then with the background of rapid cycling epiosdes in the past, it will be prudent to start her on Seroquel at 25 mg at night dose and after two weeks further up the dose to 50 mg / day night time dose. Meanwhile you can consider in her doctor's presence the below mentioned tapering schedule : -
1) 150 mg morning and 300 evening dose for 1 week
2) 150 mg morning and 150 mg evening doses for 1 week
3) Stop morning dose and take only 150 mg evening dose for 1 week
4) Stop 150 evening dose.
So in 3 weeks you shall be able to wean her off lithium while you under her doctor's guidance introduce Seroquel 25 mg at night so as to prevent cycling and also manic symptoms owing lithium withdrawal. If at any point during the withdrawal if you or the doctor or both notice some manic symptoms developing then use Klonopin 0.25 mg bid or TID as per the severity and also raise the dose of Seroquel to 50 mg or even 100 mg as per the severity and judgment of the doctor . Unless and until lithium is not totally withdrawn use of trileptal concomitantly shall be refrained.
I hope this helps.
Wish you all the best.
Please kindly leave a POSITIVE RATING if you are satisfied with the answer.
Regards
Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4,722
Experience: MD Psychiatry
Verified
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Dr. Kaushik
Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4,722
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