TaperCommunitylithium
Lithium is the gold-standard mood stabilizer for bipolar disorder, with the strongest evidence for reducing suicide risk of any psychiatric medication. It has a narrow therapeutic window — therapeutic and toxic levels are close, requiring blood-level monitoring.
300mg capsules/tablets, 450mg ER, oral solution 300mg/5mL
Capsules: 150mg, 300mg, 600mg; Tablets ER: 300mg, 450mg; Oral solution: 300mg/5mL (citrate)
Category D
Mechanism not fully understood. Inhibits inositol monophosphatase and glycogen synthase kinase-3 (GSK-3); modulates second-messenger systems. Effects on circadian rhythm and neuroprotection are likely contributors.
Very slow taper recommended (months, not weeks). Abrupt discontinuation carries documented mania and suicide risk. Monitor mood and suicidality closely.
Of all psychiatric medications, lithium has the most substantial post-discontinuation risk profile (mania, suicide, refractoriness). Plan very slow tapers with mood monitoring.
Days to weeks after stopping (mania risk peaks 2-12 weeks)
4-12 weeks
Variable — many never re-establish mood stability after stopping long-term lithium
Lithium-discontinuation refractoriness: some patients lose response to lithium if restarted after stopping
Toxicity
NARROW THERAPEUTIC INDEX. Toxicity at levels >1.5 mEq/L: tremor, ataxia, confusion, seizures, renal failure. Chronic use: hypothyroidism (~10-20%), nephrogenic diabetes insipidus, weight gain, fine tremor, cognitive blunting, long-term renal decline. Monitor TSH, creatinine, lithium level.
Pharmacokinetics
Renal — virtually entirely. Sodium/water status directly affects lithium levels.
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