Lithium is a mood stabilizer most often prescribed for the long-term management of Bipolar Disorder, though it also augments treatment for severe, recurrent depression. It helps prevent mood swings, reducing the severity and frequency of manic and depressive episodes. Because Lithium directly influences brain chemistry, any decision to stop must be approached with caution. Discontinuing Lithium should never be undertaken without the direct supervision of a prescribing psychiatrist or medical professional.
Factors Determining If Discontinuation Is Appropriate
The decision to stop Lithium is a complex medical assessment based on a thorough risk-benefit analysis. Clinicians often consider discontinuation only after a patient has been symptom-free for two years or more while on the medication. The initial diagnosis plays a part; patients with Bipolar I Disorder (involving full manic episodes) are at a higher risk of recurrence upon stopping than those with Bipolar II Disorder. The severity and frequency of past mood episodes, especially those involving psychosis or hospitalization, heavily influence the decision to continue treatment.
Discontinuation may also be considered if a patient experiences intolerable or progressive side effects that cannot be managed with dose adjustments. Long-term use can sometimes affect kidney function, leading to chronic kidney disease, or cause thyroid issues like hypothyroidism, which might prompt a medical review of the treatment plan. A patient’s desire to stop is acknowledged, but the psychiatrist ultimately balances the risk of medical harm from the side effect against the high risk of a severe mood relapse.
The Mandatory Tapering Process
Discontinuing Lithium must always be a slow and gradual process, known as tapering, and should never be stopped suddenly. Abrupt cessation is strongly linked to a higher risk of immediate mood destabilization and relapse. The tapering timeline is customized for each patient but typically spans a minimum of four weeks, often extending over two to three months for long-term users.
A common strategy involves reducing the current dose by approximately 10% per week, though a slower reduction of 10% per month is often recommended for long-term users. The goal is to allow the brain and body to slowly adjust to the lower concentration of the medication. Close medical monitoring is required throughout the tapering period, including regular blood tests to check declining Lithium levels and kidney function. This surveillance helps the medical team detect early signs of mood instability or adverse physical reactions and adjust the reduction schedule.
Understanding the High Risk of Relapse
The primary danger associated with stopping Lithium is the high probability that the underlying psychiatric illness will return (relapse or recurrence). Studies indicate that up to 75% of patients will experience a recurrent mood episode within five years of discontinuing the medication. This risk is concentrated immediately following cessation, with over 50% of new episodes occurring within months of stopping the drug.
Stopping the medication rapidly is linked to an elevated risk of recurrence, with data suggesting the likelihood of relapse is increased four-fold compared to gradual tapering. This often involves a “rebound” effect, where the first episode after stopping is frequently manic or mixed. Most concerning is that the rate of suicidal attempts and completed suicides may increase substantially, potentially up to 20-fold, in the first year after discontinuing Lithium. Subsequent episodes can sometimes be more severe, more difficult to treat, or become resistant when treatment is reinitiated.
Acute Withdrawal Symptoms and Post-Cessation Monitoring
In addition to the risk of psychiatric relapse, some patients experience transient physical and psychological reactions as the drug leaves their system. These acute withdrawal symptoms can include temporary nausea, anxiety, insomnia, and increased irritability or mild mood instability. These symptoms typically emerge during the taper or immediately after the last dose and are distinct from the return of the underlying illness.
Even after a patient has stopped taking the drug, ongoing long-term medical monitoring remains necessary. Because Lithium can cause lasting changes to organ function, patients must continue to have their kidney function (measured by eGFR and creatinine) and their thyroid function (measured by TSH) checked periodically. These tests are monitored for up to two years after the final dose to ensure that any delayed effects are promptly identified and managed.