Lithium Withdrawal & Overdose

What is Lithium?

Lab synthesized compounds are produced called lithium salts. Lithium salts such as Lithobid are prescribed for the treatment of mania, bipolar disorders, depression, and PTSD. Natural lithium supplements are available OTC. Prescribed as a mood stabilizer, Lithobid, Lithate, and other brand names, are synthesized forms of lithium that have been studied since FDA approval for their efficacy in treating certain disorders, as well as to explore the potential for unwanted side effects.

Less information is available for clinical trials concerning the non-prescription form of lithium called lithium orotate. Lithium orotate is not available over-the-counter in all countries, due to concerns by regulators over hypothetical rather than observed toxicity dangers should the supplement be taken in extraordinarily large doses. One such occurrence was found in an article published in the Journal of Medical Toxicology, where a woman took 18 tablets (instead of one) of an over-the-counter lithium orotate supplement who became nauseous and experienced light hand tremors, both of which disappeared after 3 hours.

Below is medical information concerning these and other topics related to lithium which may be helpful to those considering starting or stopping a prescription of this type of drug.

Lithium Withdrawal
Abrupt lithium withdrawal can cause pronounced episodes of returning mania as well as Bipolar relapses.

Lithium Withdrawal

Abrupt lithium withdrawal can cause pronounced episodes of returning mania as well as Bipolar relapses. Gradual lithium withdrawal observed in clinical studies demonstrated fewer instances of returning symptoms, and where symptoms did return, patients had less severe versions of their returning symptoms overall.

No published clinical studies were found relating to lithium withdrawal from natural lithium or lithium orotate. At times, a prescribing physician may choose to slowly convert their patient from the prescription form of lithium (lithium carbonate) to lithium orotate as a way to bridge off the drug. This technique involves gradually taking away the medication version and slowly introducing lithium orotate. This is a pragmatic route for many, but it should be discussed with your integrative medical doctor before attempting.

There are reasonable theories regarding the role of trace minerals in respect to mental health. Deficiencies can play a prominent role in preparing for and executing Lithium withdrawal. Pre-taper lab testing is done to establish whether such deficiencies exist and then programs a person for corrective supplementation and diet to resolve these. In general, improving nutrition is beneficial for anyone recovering from medication discontinuation.

It may be possible that a trace mineral deficient person (which is common due to over-farming techniques in agriculture) may respond positively to lithium. An unsubstantiated hypothesis may be that lithium could play a certain role in these deficiencies and possibly covering the function of other similar minerals.

It could be argued that trace mineral supplementation could offer support and that the use of trace mineral supplementation during lithium withdrawal may be of benefit. As this is a bit of a tenuous assertion, please discuss this with an appropriate doctor who has both knowledge of medications as well as supplemental methods before considering this protocol.

A case study published in the 2019 Journal of Advanced Mind-Body Medicine concluded that lifestyle interventions, as well as nutritional interventions, were important components of recovery and remission of symptoms in a medication lithium withdrawal clinically supervised scenario.

Lithium Withdrawal
Gradual lithium withdrawal observed in clinical studies demonstrated fewer instances of returning symptoms, and where symptoms did return, patients had less severe versions of their returning symptoms overall.

What Lithium Medication Is Used For

Lithium had been extensively used for the control of mania since the late 1870s but became an increasingly abandoned practice in psychiatry as new antipsychotic drugs were developed and approved by the FDA and around the world starting in the 1950s for the treatment of mania.

Lithium salts or compounds are used as psychiatric medication (mood stabilizers) and are prescribed for these conditions:

  • ADHD in children
  • PTSD
  • Schizophrenia

Lithium Alternative Names and Slang

Lithium refers to the metal, or mineral, however, the word lithium has become synonymous (although not entirely accurately) with all the various compounds and salts that have been produced in pharmaceutical labs across the world. The natural form of the element is simply called lithium and is not patentable because it is a natural element found in mineral deposits in the earth. It is important to understand the nature and molecular structure of any drug or supplement that one takes.

Various forms of compounds and salts will contain lithium, synthesized using various types of binding agents, such as:

Lithium Withdrawal
Lithium refers to the metal, or mineral, however, the word lithium has become synonymous (although not entirely accurately) with all the various compounds and salts that have been produced in pharmaceutical labs across the world.
  • Lithium fluoride (lithium bound with fluoride, never used due to toxicity in trials)
  • Lithium iodide (lithium bound with iodine, never used due to toxicity in trials)
  • Lithium urate (lithium bound with urine extracts for dissolving uric acid crystals related to gout, but abandoned due to dose-related toxicity)
  • Lithium orotate (lithium bound with a natural chemical called orotic acid, found in breast milk and certain root vegetables, available as a supplement without a prescription)
  • Lithium carbonate (lithium bound with carbon, currently prescribed as a mood stabilizer for mental disorders)
  • Lithium citrate (lithium bound with citric acid, used in original 7-UP soda pop, later banned for toxicity/deaths)
  • Lithium bromide (lithium bound with bromide in table salt, abandoned due to toxicity/deaths)
  • Lithium chloride (lithium bound with sodium chloride, used as a replacement table salt but later banned due to toxicity/deaths)

There have been many other compounds/mixtures produced over the last century and a half. Some of these were found to be toxic, as in the table salt version, and unsuitable for use in food products, as in the 7-UP soda pop of the 1950s. Some have survived and exist in pharmaceutical products used today. Brand names include numerous examples such as Theralite, Efalith, Lito, Prolix, and hundreds of additional trade names.

Lithium Side Effects

A study out of Norway published in the BMC Journal of Psychiatry showed that a majority of the participants discontinued the prescription drug lithium carbonate to avoid the side effects of the drug. Diarrhea, tremors, diabetes insipidus, and weight gain were the 5 most common reasons for discontinuation according to the authors of the study.

According to the FDA label for lithium carbonate, signs of lithium toxicity include a similar list, including diarrhea, vomiting, tremors, ataxia (clumsiness, loss of coordination), drowsiness, and muscular weakness.

Other common reasons for discontinuing the medication due to side effects, according to a study published in the International Journal of Bipolar Disorders include weight gain, cognitive impairment, impaired kidney function, hyperthyroidism, and hypothyroidism. Because of the vast number of potential side effects, we have categorized a sampling of them for clarity. These side effects along with many others are listed on the FDA drug label.

Lithium Withdrawal
No published clinical studies were found relating to lithium withdrawal from natural lithium or lithium orotate.

Lithium carbonate side effects include:

Gastrointestinal & Renal

  • Nausea, vomiting, diarrhea
  • Anorexia
  • Weight loss
  • Weight gain
  • Constipation
  • Increased urination
  • Incontinence of urine or feces
  • Increased thirst
  • Indigestion
  • Abdominal pain
  • Flatulence
  • Dry mouth/ excessive salivation
  • Kidney toxicity (may lead to kidney failure)

Musculoskeletal

  • Hyperreflexia (reflexes become over-responsive)
  • Restlessness
  • Muscle weakness
  • Fatigue
  • Swelling of ankles or wrists
  • Painful joints
  • Tightness in chest
  • Tremors, tics, twitches
  • Cogwheel rigidity
  • Seizures
  • Startled response
  • Uncontrolled tongue movements
  • Ataxia (clumsiness, loss of balance, difficulty walking)

Cognitive

  • Memory loss
  • Mental confusion
  • Poor concentration
  • Loss of alertness (warnings given for those operating heavy machinery or driving)
  • Giddiness
  • Slurred speech
  • Blackout spells
  • Coma
  • Stupor
  • Hallucinations

Dermatological

  • Lithium-associated acne, lesions
  • Alopecia
  • Drying and thinning of the hair
  • Anesthesia of the skin
  • Psoriasis, worsening psoriasis
  • Cutaneous ulcers
  • Swollen lips

Ocular/Aural

  • Blurred vision
  • Blindness
  • Tinnitus

Other Conditions & Disorders

  • Leukocytosis (elevation in white blood cell count)
  • Hypothyroidism (underactive thyroid)
  • Hyperthyroidism (overactive thyroid)
  • Gout (a painful form of arthritis linked to high uric acid levels in the foot)
  • Fever
  • Vertigo, dizziness
  • Goiter (enlargement of the thyroid gland, inflammation/swelling of the neck)
  • Parkinsonism, dystonias, and other movement disorders
  • Headaches
  • Sodium depletion
  • Protracted sweating
  • Dental caries

What to Do in Case of a Lithium Overdose

A lithium overdose is a medical emergency, and emergency services like 911 should be contacted immediately if a lithium overdose is suspected. Lithium overdose symptoms may include:

  • Nausea, vomiting or diarrhea
  • Tremors
  • Heart block
  • Hyperthermia (temperature elevation)
  • Hypotension (decreased blood pressure)
  • Seizures
  • Coma

In the emergency room, providers may administer medication to prevent lithium from being absorbed. The primary treatment for a lithium overdose is the administration of large amounts of fluids to help the body quickly clear any lithium that was absorbed.

Reclaim Your Life From Lithium Withdrawal & Addiction

Lithium addiction is a condition that can cause major health, social and economic problems that should not be taken lightly. We Level Up California can provide you, or someone you love, the tools to recover from addiction with professional and safe detox, that will help you ease symptoms from Lithium withdrawal. Feel free to call us to speak with one of our counselors. We can inform you about this condition by giving you relevant information. Our specialists know what you are going through. Please know that each call is private and confidential.

Sources

[1] FDA drug label Lithobid (lithium carbonate) 

[2] Mitchell PB, Dusan Hadzi-Pavlovic D “Lithium treatment for bipolar disorder” Bulletin of the World Health Organization.

[3] Mander AJ, Loudon JB “Rapid Recurrence of Mania Following Abrupt Discontinuation of Lithium” Lancet clinical trial report PMID 2898622.

[4] Faedda GL, Tondo L, Baldessarini RJ, Suppes T, Tohen M “Outcome After Rapid vs Gradual Discontinuation of Lithium Treatment in Bipolar Disorders” Arch Gen Psychiatry.

[5] FDA label Tegretol (carbamazepine) 

[6] Gitlin M. Lithium side effects and toxicity: prevalence and management strategiesInt J Bipolar Disord. 2016;4(1):27.

[7] LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Lithium.

[8]. Balon R, Yeragani VK, Pohl RB, Gershon S. Lithium discontinuation: withdrawal or relapse? Compr Psychiatry.