Posted by Cam W. on January 26, 2000, at 20:31:19
In reply to Lithium loses efficacy once stopped and restarted, posted by Scott L. Schofield on January 26, 2000, at 11:29:40
> Someone recently posted the following:
>
> "Lithium has a reputation of losing its effectiveness when stopping and quitting. So, along my journey of med searches, I kept taking it."
>
> A friend of mine who suffers from bipolar II remained symptom-free for over three years while receiving lithium monotherapy. During this time, she experienced no side-effects, and her thyroid and renal tests were normal. When she relocated, her new doctor decided that she had been taking lithium for long enough, and that it was about time to discontinue it. She weaned off of it gradually over the course of a month or two. She relapsed into severe depression within three months. Of course, the doctor decided to restart the lithium. Fifteen years of unsuccessful drug trials have passed since.
>
>
> - Scott
>
>
> ----------------------------------------------------------------
>
>
> Am J Psychiatry 1992 Dec;149(12):1727-9
>
>
>
> Lithium-discontinuation-induced refractoriness: preliminary observations.
>
> Post RM, Leverich GS, Altshuler L, Mikalauskas K
> Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892.
>
> The authors used a systematic life-chart methodology to observe four patients with bipolar disorder in whom long periods (6-15 years) of effective lithium prophylaxis were followed by relapses on lithium discontinuation. Once the drug was reinstituted, it was no longer effective. The incidence, predictors, and mechanisms underlying this phenomenon all require further systematic study. The current preliminary observations suggest an additional reason for caution when lithium discontinuation in the well-maintained patient is considered.
>
>
> ----------------------------------------------------------------
Scott - We have all seen refractoriness of lithium upon re-institution. Lately though, several articles have been appearing in the literature stating the opposite.{eg. Coryell W, et al. Lithium discontinuation and subsequent effectiveness, Am J Psychiatry 1998 Jul: 155(7):895-8}.
In this study 28 patients who recovered from a manic episode and remained euthymic with lithium had stopped lithium, had a subsequent relapse, and had this mania resolved with the reintroduction of lithium. These authors concluded: "These findings provide no evidence that lithium discontinuation result in treatment resistance when lithium is resumed."
Are there subsets of bipolar patients that will respond to lithium again? We know that if one has more than 10 episodes of mania they will likely be refractory to lithium reintroduction and under 10 episodes the will probably respond to lithium again. I have seen lithium refractoriness in patients who have discontinued only once or twice.
This just confuses me more. I think I will leave this to better minds than mine. - Cam W.
poster:Cam W.
thread:19732
URL: http://www.dr-bob.org/babble/20000112/msgs/19762.html