"Ken" called to enlist my opinion about getting off lithium. Like many other bipolar support group leaders in the Philadelphia area - and certainly around the country - he had been on lithium nearly 2 decades and wondered at the possibility of going off. Nearly everyone asks their doctor about this. Opinions are mixed. Ken's doctor said she'd take him off but wanted to put him on some of the newer bipolar meds.
What were my thoughts on this? Ken knows I successfully came off lithium in 2000 and am symptom-free. Or, cured as I like to call it for emphasis.
Ken and I came up with a checklist of things. Because he is a support group leader he is an example to many others and his experiences, like mine, will be remembered. Neither Ken nor I are doctors but know ourselves and our minds better than anyone else. Both of us fervently believe in medication for bipolar disorder. But when a person reaches their MID-FIFTIES they may wish to consider going off meds.
If so, a strategy must be in place. Ken and I completed the strategy over the phone.
Since he is not working, he must maintain a strict daily schedule of activity which includes leaving home at least once a day to be among people. He will attend other area support groups to keep busy. He will engage in simple exercise such as walking. But above all, he will not isolate.
He will also not act upon any suicidal thoughts. Lithium is a strong protector against suicide. The ideation may occur but rarely the attempt. It is okay to think about killing yourself, this is an unfortunate symptom of bipolar disorder, but you must redirect your thoughts should they occur. Ken will do that.
I told him when I went off lithium I was assailed by suicidal thoughts. This was due to my doctor's failing to wean or titrate me down. A nice titration, which can be fairly brief in the case of lithium, should avoid this nastiest of all symptoms.
Lending credence to Ken's desire to get off the lithium is his own doctor-supervised titration recently from lithium due to digestive problems. Ken was lithium-free for 18 days. He told me he had never felt better in his life. He said, "I know this sounds funny but I felt like the real me. I felt I had a lot of energy and best of all my mind could think clearly for the first time since I was a young man."
He even had some difficult challenges with new members to his group which he handled beautifully. I commented that this was undoubtedly b/c he's mellowed over time, learned more about himself and life thru counseling and life experience, and that he's fully capable of handling challenges w/o being doped up.
I said that when I was on lithium I never felt truly like myself. It was as if there was an invisible shield between me and the world. We all have our own way of expressing such 'drugged-up' feelings. However, I said, most people I've talked to do not feel that way. They believe lithium normalizes them which is even better.
Ken must be extra-vigilant in gauging his moods to make sure he is not dipping into depression or rising into mania. If so, he must immediately get in touch w/the doctor and therapist for Plan B which may include more meds. We mustn't jeopardize his well-being. Talking things out w/his therapist or a good support person may be enough to sustain him thru any rough waters he may encounter. He must learn to endure any painful feelings such as anxiety, telling himself this is a temporary situation that will pass. This is the natural 'cognitive therapy' people give themselves.
I told him I had a lot of confidence in him and believed he could do it. I forgot to mention the addition of omega fatty acids to his diet, in pill form, but I'll call him tomro to mention it. I myself never got into vitamins b/c I abhor taking pills. I'd rather broil a nice thick piece of wild salmon and eat it on the back porch while listening to the cicadas sing.