Lithium Toxicity

I spent the last year on Lithium extremely concerned about getting lithium toxicity.

(I’m a worrier, did you figure that out yet?)

Lithium is the usual go-to drug for bipolar disorder, as it is the only drug that has been proven to lower suicide rates across the board. Many people are willing to take lithium over other drugs because they consider it a more “natural” option than other chemical compound medications (since lithium is an element that is found in nature).

For those of you unaware, Lithium can be extremely helpful within a specific range of absorption in the bloodstream, but can become toxic and potentially lethal after a certain level of absorption is reached. People taking lithium have to slowly increase the amount they take with blood tests 5-7 days after each increase in dosage and continued blood tests every 3 months or so to continue monitoring lithium levels.

In the span of the last month, I’ve had my dosage of lithium increased twice, hoping to hit that sweet spot. You know, the one where miracles happen.

The journey from 900 mg to 1200 mg was hell for me. Lots of nausea and tremors (involuntary shaking) -even to the point where if I tried to smile my face was twitching. Thankfully after two weeks, that entirely went away, but my doctor wanted me to keep ascending until I hit 1500 mg.

I. Was. Terrified. I was already up near the toxic range when I was tested at 1200 mg, so he said if I started 1500 and began feeling terrible, give him a call and slide back down to 1200.

Well, a week ago I started 1500 mg and to my surprise, didn’t have one incidence of a tremor. A little nausea, but nothing that seemed major.

Cut to yesterday when I was walking down the street to his office. I suddenly realized I was walking like I was drunk (and was dizzy to boot), it was like my coordination had started melting away slowly until my legs couldn’t seem to find the ground in the right place. Not hugely noticeable (thank goodness, it was only noon and I really don’t need to be pinned as the neighborhood lunch drunk, on top of all the true gossip I’ve got going for me) but enough for me to notice, which is enough.

There was also this sort of fog that had been following me around as well. At first I thought it was just me being brain-foggy, but then I realized I had also been having trouble focusing my eyes. It was as if the mental fog was having physical qualities, enough to effect my vision. I kept trying to read the clock on the microwave on the other side of the apartment yesterday morning but couldn’t because it was so blurry. I shrugged this physical fog off as a product of allergies, but as it turns out, I was wrong.

So, I am in my psychiatrist’s office sitting near his desk and he tells me I am definitely at the peak amount of lithium I am capable of taking without overdose, and then he asks if I’ve had any physical signs of lithium toxicity.

“Nothing intense,” I said, “actually my side effects have been a lot less severe than when we increased the dosage the last time around.”

And then I added, as an afterthought,

“I have been walking a little bit like a drunk though, so that’s kind of weird.”

(Oh the cavalier attitude of the hypomanic patient!)

“Loss of coordination,” he replied. I don’t know if it was intended to be a correction, because it was said in that weird, emotionless, statement-ish way psychiatrists have of saying things that aren’t actually replies or answers or questions or even really statements.

“Sure,” I said. “Ok. And my vision is blurry. I’m in a metaphorical and literal fog.”

“So… yes then. Please go back to 1200.” He replied, somewhat earnestly for someone who generally talks to me like a robot.

And that’s the story of how I apparently experienced the beginning stages of lithium toxicity without realizing it.

I’m sure it would have been much easier to realize if I hadn’t been hypomanic and so emotionally impervious to the yuck at the time, but I’ll venture to say that’s what I’ve got a [robot-esque, nerdy] doctor for. 

I had to throw that nerdy part in there because after that discussion he spent the rest of our 15 minutes asking me if my scrap of paper I had written notes on for the appointment did in fact say “Herb Alpert” on the back. Which it did. He went on to feel very smug for noticing, instead of paying much attention to what our next course of action was going to be.

I think if I had been told “feeling drunk for no reason” was a sign of lithium toxicity, I probably would have noticed sooner too. Instead, I was told by my doctor to watch out for:

  • Diarrhea
  • Stomach Pains
  • Vomiting
  • Weakness
  • Nausea

But I didn’t have any of those, so I thought I was in the clear.

Come to find out, lithium toxicity can also include any of the following symptoms as well:

  • Dizziness
  • Hand Tremors
  • Seizures
  • Incoordination of arms and legs (ataxia)
  • Muscle Twitches
  • Slurred Speach
  • Uncontrollable Eye Movement

I find that confusing, because things like hand tremors I was having right in the very beginning… so I guess different doctors consider these each on a bit of a different level.

In severe cases, lithium toxicity can cause:

  • Coma
  • Kidney Failure
  • Memory Problems
  • Movement Disorders
  • Trouble Keeping Salt in the Body
  • Psychosis (interestingly enough)

In my mind, lithium toxicity would inevitably occur instantly… and I would wind up suddenly in a coma with no other signs ahead of time, and that was what terrified me about it.

As it turns out, if you are following your doctor’s orders and have plenty of appointments, catching full blown overdose before it happens is much easier.

I would suggest to anyone, if you have recently had a change in medication and suddenly feel drunk for no apparent reason, calling your doctor is probably in your best interest!

I went back to taking 1200 mg last night, and this morning I feel excellent. My vision is nice and crisp, so there you have it. I guess I’ve found my lithium cap.

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25 responses to “Lithium Toxicity

  1. I find this post interesting because I am also on lithium. I am taking 1500mg with minimal side effects. Minor tremors, some stomach issues (but that might be an ulcer which I’ve had before) is all. But, then again, at 1200mg, I had barely reached therapeutic threshold. I do think your psych and pharmacist were remiss in failing to go over all of the signs of toxicity. Glad you were taken down a notch for your safety.

    • Sarah @ bi[polar] curious

      I wouldn’t blame my psychiatrist for what happened, he definitely rattled off several things and my general thought was that everything he rattled off I already seem to experience from other health issues I have. Even the dizziness I have been having the last 3 days or so were not unlike the episodes of vertigo I’ve also had, so I didn’t think I’d be able to discern those side effects from symptoms I have on a regular basis.

      My normal pharmacist would be on top of it, but I recently switched to a big chain pharmacy to get a lower price on my medications (lower price, terrible service). The girl there gets so upset with me every time I go that by the time I pay she tends to walk away, flustered. I think her actions have been more on the side of error, if either of them could be considered at fault. Personally, it is really up to me to pay attention, so I wouldn’t put the blame on anyone at this point. It wasn’t terrible, anyway, so lesson learned.

  2. Thank you for posting this. Although I am no longer on Lithium…..I do have a friend that is taking it. She experienced the toxicity last year. She accidently took an NSAID with it and she was not well. They actually thought she was about to stroke out. Posting this information is great for other’s so they can catch it before it gets to that point! Thank you!!

    • Sarah @ bi[polar] curious

      I am sorry to hear that, that can be a particularly easy mistake to make, too! I’ve had several doctors try to prescribe me ibuprofen in a number of situations, and if I hadn’t known of the potential bad reaction ahead of time it can be easy to just take their word for it.

      I really believe many more people experience symptoms of overdose or withdrawal than actually realize, so knowing what is usual for you and what is unusual is extremely helpful! Thanks!

      • I think this is one reason I research meds to death! I want to know every possibility, just in case! I’m happy you are okay though 🙂

  3. strugglingwithbipolar

    I have been on lithium in the past and my doctor made me well aware of the potential for toxicity. We did weekly or bi-weekly bloodtests to verify that I was at therapeutic levels and not over or under those levels. It’s a good thing we did those because my thyroid levels were off, a potential side effect of lithium, so we had to do some additional monitoring and blood work. Things were OK on later blood tests. I’m now on a different mood stabilizer though and I find it to be more effective with an antidepressant and an antipsychotic. I was not on an antidepressant with lithium so I don’t know what impact that would have had.

    • Sarah @ bi[polar] curious

      It is good you caught that thyroid level when you did, even if things were ok later! Better safe than sorry, really.

      I guess sometimes the therapeutic range (monitored in the blood test) can have varying results for each person -so they may not notice the drug helping until a certain point within that range is met. That’s the only reason I went so high, I met the therapeutic range a while ago but have unfortunately not had any stabilization. I hope that, like you, I can find a different mood stabilizer that winds up working out.

      Thanks!

  4. Extremely informative and valuable information. Thanks for sharing.

  5. Great post. I first was put on lithium in the late 80’s when I found out I had bipolar disorder 1. I took it for quite a while a bunch of years but when I had my first “mixed state” episode around 1998 or so I switched to depakote as the lithium was not working. I also started taking seri quell for the first time then. I was supposed to go off it but I never did because I needed it to stop potential psychosis…now I’m on just seroquel for mood stabilizer. Sorry to go on and on about my meds. I guess all these drugs have potential side effects as well as great potential to stabilize bipolar disorder. I’ve had a long road of living with bipolar…

    • Sarah @ bi[polar] curious

      I’ve been having mixed states while on lithium, so I am hoping to switch to something else. My doctor is trying his hardest to find me something within my price range (aka, poor), but I told him on Monday that I am not concerned about price anymore, just finding something that works.

      Thanks for sharing about your journey, I’ve only been actively on my road for about ten years but it feels like it has been an incredibly long one at times, so I can only imagine!

      Thanks!

  6. Hi, there. My Drs were all on a campaign a few months ago to have me switch from Trileptal & Abilify to Lithium. I think you are very brave and completely respect your decision to stay on the drug. Seriously, you post scared the crap out of me! 🙂 And it reinforced why I don’t want to touch the stuff. How are you doing a few days after lowering your dose? Do you find that the benefits of Lithium outweigh the risks? Hope you’re doing well! Vivien

    • Sarah @ bi[polar] curious

      Well Vivien, I actually wound up writing this post because I was amazed at how I wasn’t as scared when it actually happened as I had been been about it for the last year leading up to this point. It didn’t feel entirely bad, just odd… so I wanted to make sure people know that the “odd” feeling can be just as dangerous as feeling terrible.

      I went up to such a high dose because I’ve never hit a point where the amount has been noticeably changing any of my symptoms, and I was nervous about it but more concerned that if I didn’t try it, I might regret it later because I wouldn’t know if it might have worked. Unfortunately, it didn’t work out.

      The night after my appointment I took a lower dose and by the next morning I felt fine. The only remaining side effect I’ve had the last few days is a little weakness periodically, everything else seemed to bounce back quite quickly.

      Honestly, lithium scares me a lot less than many other drugs. With lithium I’ve been monitored so carefully for kidney and thyroid levels, blood levels, and have had my psychiatric appointments much closer together so my doctor can keep tabs on me. I’ve had a much more terrible time with other “safer” drugs because my doctor writes me a Rx and then forgets about me. When I had an allergic reaction to lamictal I wasn’t being monitored in any way, so even though lithium might seem scarier, the level of care I have been receiving while taking it has made me feel much, much safer overall.

      Of course, I wish it had worked… but I am ready to try something else, if my doctor can find something I haven’t tried yet!

      • Hi, Sarah. I can’t thank you enough for your candor and honesty. In retrospect, there was so much pressure put on me to migrate to Lithium from my Dutch Drs in comparison to the track my American psyc was on (no Lithium, ever) – it just unnerved me. It’s really unfortunate it didn’t work out for you, especially after all of the effort you spent following the necessary monitoring schedule. I hope you find something soon that winds up being your silver bullet. 🙂

        Again, thanks so much for the post. Be well! V

  7. Thanks for this post. I have been on lithium for four months and when I first went up to 900mg/day experienced some very unpleasant effects – tremors, shaking and restlessness. I feel much better now. Your post was very informative and helpful.

    • Sarah @ bi[polar] curious

      Glad to hear you’re feeling better! I know it can be really alarming, for me at least, the tremors seemed somewhat terrifying and I was a bit self-conscious about them. Luckily enough, they didn’t last too long, so I am glad to hear you’ve had similar relief!

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  10. Severe LithiumToxicity hit me, with no warning, at 3am in the morning with full psychoses, that landed me in the ICU for 5 days. I had neglected my levels and psydoc had not cut me off to make me do them. I was a Mental Health Counselor…how stupid did I feel?

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  12. eugenejimenez

    Reblogged this on Depression Hub and commented:
    Very well written and evocative account of one person’s experience with lithium toxicity, and the hazards that may await you as you search for that lithium “sweet spot”. Well worth a read for anyone concerned about this issue.

  13. Pingback: Lithium Toxicity: One Person’s Story - black dog pie: a magazine on depression and bipolar

  14. After severe side effects on 1200mg for 3 months will there be permanent damage of any kind?It was a pharmacist’s mistake and I unfortunately wasn’t counting my meds correctly. Iguess I just worry about my ability to recover. Thank you.

  15. I am thinking of taking lithium because I hate the insomnia and racing thoughts. I have cyclothymia or BPII (who can tell?) am also working part time and I cannot function without sleep.
    I take Ambien but that is no picnic either. Which is worse health-wise Ambien or Lithium?

    • Honestly I take both, and while I don’t take the Ambien on a regular basis (as I do the lithium) I definitely have a weird time on it when I need it. For me, many of lithium’s side effects lessened or went away completely over time which has been a relief, but isn’t the case for everyone.

      Overall health…? I don’t think anyone could say for sure which would be “worse”, it probably depends on you and your body’s functioning and how well it handles each drug. At any rate, testing done while starting and maintaining lithium can help your doctor see if it is harming you internally which made me a lot more comfortable going that route.

      Good luck!

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