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I have been on lithium since 1983 when I was first diagnosed…

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I have been on lithium...
I have been on lithium since 1983 when I was first diagnosed with bipolar disorder. Worked very well for decades (no manic episodes). Then had an incident of Lithium toxicity in 2015 and again in January of this year. My dosage has been changed from 900 to 600 to currently 150 mg per day. My most recent lithium level was 0.2. I think this is too low to protect me from a relaspe. What do you think?
Submitted: 3 months ago.Category: Mental Health
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Customer reply replied 3 months ago
My G.P. has been monitoring my lithium levels since about 2008 when my psychiatrist retired. My levels had been very stable, so my psychiatrist thought it was ok for my G.P. to do this. I have researched online and find 0.4 to be the lowest therapeutic lithium level. My reaction to dosage is very predictable. If I was prescribed 300 mg per day instead of 150 mg, I am sure my level would go to 0.4. I don't know why my G.P. has prescribed only 150 mg, but it was in consultation with medical staff at the hospital that treated the lithium toxicity.
Answered in 16 hours by:
3/23/2018
Mental Health Professional: Dr. Kaushik, Psychiatrist replied 3 months ago
Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4,778
Experience: MD Psychiatry
Verified
Greetings.
Welcome to the site.
I am a Psychiatrist and I believe that I can help you with your query.
Well first and foremost serum lithium levels need to be correlated with clinical symptoms and if your clinical symptoms of bipolarity are well managed at 0.2 level then you should only be happy and content to keep the dose to the lowest effective dose of 150 mg per day. You see one must avoid a repetition of lithium toxicity since it may lead to damage of several organs of the body including the brain, hence I feel your GP is extra cautious about keeping lithium levels lower and I believe for a person like you who has managed on lithium for so long , if you want your body to tolerate this drug for longer duration then you should let the GP keep the levels low to 0.2.
If you have some of the symptoms of bipolar disorder returning then you may ask your GP to use an anti Psychotic drug like quetiapine or olanzapine to subdue the symptoms of bipolar while keeping lithium as it is on 150 mg dose. Once the symptoms have been managed by the chosen anti psychotic medication then it can be tapered off.
I hope this makes sense and hopefully you can appreciate the plausible reason behind your GP's restrained approach.
Wish you all the best.
Please kindly leave a POSITIVE RATING if you are satisfied with the answer.
Regards
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Customer reply replied 3 months ago
In response to your answer, I am perplexed. I realize I am not a doctor and don't have access to medical journals but I do have access to sites such as the NIH and the national health system in the UK. I find very consistently that the lowest therapeutic dose of lithium is 0.4. I have found no sources that say 0.2 is therapeutic. In fact, I have found sources that say patients with a level of 0.2 or less are more likely to relaspe. Can you send me any links to studies which support the 150 mg dosage? Also, while lithium toxicity is very serious, my last manic episode in 1982 included a high speed chase with the police on a freeway which resulted in a crash that resulted in compression fractures to two vertabrae. I could have easily been killed or paralyzed. I believe the 150 mg is an overaction to the lithium toxicity, and the danger of relaspe has not been accounted for. Also, I am 63 and it seems too old to consider new anti-mania medications - how could I know if they would be as effective as lithium to control my particular bipolar symptoms, if they return?
Customer reply replied 3 months ago
I do appreciate your response. I would feel more comfortable with the 150 mg per day dose of Lithium if I could read some studies or summaries that supported that.
Customer reply replied 3 months ago
I don't understand. Were my responses to Dr. Kaushik inappropriate? I meant no disrespect. I am just quite concerned and looking for verified support of the 150 mg daily lithium/0.2 serum blood level.
Customer reply replied 3 months ago
Can anyone let me know when this new mental health professional will respond to my questions? Briefly, I am looking for links or other information to support the effectiveness of 150 mg of Lithium, once per day, resulting in a serum blood level of 0.2. That is, how is this dosage effective in preventing a relaspe of the manic phase of bipolar disorder?
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