Posted by SLS on February 16, 2005, at 6:58:08
In reply to Tapering off lithium, posted by wearybuthopeful on February 15, 2005, at 17:59:36
> For several reasons, including lithium-induced thyroid problems that were corrected for quite a while with Synthroid, my shrink has advised I get off lithium with intention of starting lamictal later.
> We're talking bipolar depressionLamictal is a great choice of medication under these circumstances. I've seen others successfully make the switch from lithium to Lamictal and remain asymptomatic for depression. However, I believe it would be MUCH smarter to taper the lithium very slowly while at the same time titrating the Lamictal. There is no danger in taking lithium and Lamictal at the same time. They are often combined on purpose.
I know one woman who recently made the switch successfully. She suffered predominantly from bipolar depression, and lithium worked like magic. She, too, was experiencing thyroid abnormalities. However, she used the gradual taper/titration strategy. It took several months to accomplish. She did not experience a single day of depression over this period of time. The problem is this: if one comes off of lithium too quickly, the rate of relapse is much greater than if a gradual taper is used. My concern is that you will not be on a prophylactic dosage of either drug for an extended period of time. Lamictal must be titrated very slowly. It might take two months for you to get to 200mg, which is the average dosage for bipolar depression.
Of course, if lithium isn't helping at all, then you can discontinue it immediately. No taper is necessary. There is no real withdrawal syndrome. Since you have been on it for 14 months, though, I would proceed as if it really is helping, and not remove it until you reach a therapeutic dosage of Lamictal.
I guess your decision depends on the urgency to discontinue Lithium. I am not familiar enough with the course of lithium-induced hypothyroidism to know what are the consequences of continuing lithium for another two months.
Good luck.
- Scott
poster:SLS
thread:458555
URL: http://www.dr-bob.org/babble/wdrawl/20050214/msgs/458646.html