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Lithium Withdrawal

What Is Lithium?

Lithium (lithium carbonate) is an antimanic agent, a mood stabilizer prescribed to treat mental health conditions, including depression, bipolar disorder, and schizophrenia. Lithium works to treat affective disorders by reducing abnormal activity in the brain. According to the National Institute of Health (NIH) [1], lithium is available as a capsule, immediate-release, and extended-release tablets, and liquid solution consumed orally by mouth. Brand names for lithium include Lithobid and Eskalith.

For the treatment of a bipolar disorder, also formerly known as manic depression, lithium can be used in independently or combination with other medications such as the following:

For the treatment of a bipolar disorder, also formerly known as manic depression, lithium can be used in independently or combination with other medications such as the following:

Lithium withdrawal
Drinking alcohol while on lithium can cause lithium toxicity due to dehydration from alcohol intake.

Lithium is typically prescribed as maintenance therapy in between manic episodes in people with bipolar disorder. To effectively prevent manic and depressive recurrences of bipolar disorder, lithium should be administered to maintain a blood concentration of 0.60–1.20 mEq/L

What are Mood Stabilizers?

Mood stabilizer medications are drugs prescribed to treat manic and depressive psychiatric conditions. Mood-stabilizing drugs are most commonly prescribed to treat bipolar disorder in individuals.

Bipolar disorder affects the way an individual feels emotionally and functions mentally and is characterized by extreme changes in energy levels and emotions. Mood stabilizers lessen the mood swings of this manic depression or help control the mood swings from happening.

The effects of mood-stabilizing drugs include:

  • Relief from depressive episodes, or low energy levels, despair, sadness, hopelessness, and feelings of low self-worth
  • Prevention of seizure activity
  • Relief from manic episodes, or extreme energy, anxiety, irritability, poor judgment, impulsivity, and risk-taking behaviors
  • A more stable emotional state and more manageable, predictable behavior

According to the National Institutes of Health (NIH) [2], bipolar disorder affects 3.9% of adults in the U.S. In addition, individuals struggling with bipolar disorder have a higher rate of abusing alcohol or drugs, getting into fights, engaging in impulsive behaviors, shoplifting, and taking risks than individuals without bipolar disorder.

Common Mood Stabilizers

The oldest mood-stabilizing drug and the most commonly used is lithium, a chemical element that restricts the actions of the muscles and nerves. 

Lithium is a strong, potentially toxic drug that can cause serious side effects when levels of the chemical get too high. Individuals taking this medication must be monitored carefully and receive regular blood tests to make sure they are getting the accurate dose of the drug.

Other common examples of prescription mood stabilizer pills include:

  • Carbamazepine (Tegretol, Equetro)
  • Divalproex or valproic acid (Depakote, Depakene)
  • Lamotrigine (Lamictal)
  • Gabapentin (Neurontin)
  • Topiramate (Topamax)

These prescription drugs regulate brain activity, preventing overstimulation from minimizing the intensity of bipolar mood swings. Mood stabilizer pills are usually prescribed in conjunction with an antidepressant and other drugs that help manage moods.

Doctors also use mood stabilizers to treat:

  • Schizophrenia and its related depressive episodes
  • Some types of seizures, as mood stabilizers are anticonvulsants
  • Alcohol and drug abuse and addiction, and its associated depression and anxiety

Lithium Side Effects

According to the US Food and Drugs Administration (FDA) [3], signs of lithium toxicity includes vomiting, diarrhea, tremors, ataxia (clumsiness, loss of coordination), drowsiness, and muscular weakness. Other common side effects, include weight gain, cognitive impairment, impaired kidney function, hyperthyroidism, and hypothyroidism. Below are a number of possible side effects of Lithium; we have categorized them for clarity. Along with many others, these side effects are listed on the FDA drug label.

Lithium carbonate side effects include:

Gastrointestinal & Renal:

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

Musculoskeletal

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

Cognitive

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

Ocular/Aural

  • Blurred vision
  • Tinnitus
  • Blindness
Lithium withdrawal
The risks of drinking on lithium involve your health and your mental status.

Other Conditions & Disorders

  • Leukocytosis (elevation in white blood cell count)
  • Headaches
  • Hypothyroidism (underactive thyroid)
  • Fever
  • Hyperthyroidism (overactive thyroid)
  • Gout (a painful form of arthritis linked to high uric acid levels in the foot)
  • Goiter (enlargement of the thyroid gland, inflammation/swelling of the neck)
  • Parkinsonism, dystonias, and other movement disorders
  • Sodium depletion
  • Protracted sweating
  • Dental caries
  • Vertigo, dizziness
  • Use of lithium carbonate in pregnancy is potentially associated with birth defects, specifically in the malformations of the heart known as Ebstein’s anomaly.

Is Lithium Addictive?

Despite lithium’s potency as a mood stabilizer and the hesitation to prescribe it in the United States, lithium is not addictive except in the sense that anything can become psychologically addictive.

One of the fundamental signs of addiction is that when a person stops taking the drug, they start to go through withdrawal, experiencing sweats, pain, anxiety, and above all, an urge or craving to retake the drug. In advanced dependence or addiction, all the person wants to get more of the drug.

Lithium causes no such craving, and any symptoms felt after use of the drug is stopped are symptoms of the underlying cause, the depression or mania that initiated the use of the drug in the first place.

On the other hand, one reason that doctors may have been reluctant to prescribe lithium in the past is that lithium can be or can become toxic.

Lithium Toxicity

Lithium toxicity happens when someone takes too much of this drug, either way too much on one occasion or a little too much over a long period of time. This isn’t necessarily on purpose because other factors can contribute to how lithium affects them. Other contributing factors include the body’s water and sodium levels and what other medications people are using.

According to some researchers, lithium has a narrow range of safety, making a lithium overdose or lithium toxicity all too easy. But others claim that any such toxicity can easily be fixed by lowering the dose. According to most, side effects from normal amounts of lithium are rare, especially severe ones.

Abusing Lithium and other Mood Stabilizers

While mood stabilizers, such as Lithium, are not considered addictive drugs, longtime users can become psychologically or physically dependent on the effects of the medication. Quitting these drugs too abruptly or without clinical supervision may cause a sudden return of symptoms.

Mood-stabilizing medications do not trigger the compulsive use or addictive behaviors that stimulants and narcotic pain medications do. Furthermore, mood stabilizers do not create a high like euphoria or high energy. Misuse of mood stabilizers usually comes from individuals looking to experiment with prescription drugs, hoping to control their moods or attempting self-harm.

An individual can easily overdose on lithium, as the therapeutic and lethal doses are not far off. This is why people with mood stabilizer prescriptions must participate in regular blood work to monitor the levels of the drug.

People who are emotionally unstable or have bipolar may be prompted to overdose on mood-stabilizing drugs when they are depressed or experiencing suicidal thoughts. Taking large doses of lithium or any anticonvulsant medication can cause severe side effects or even death.

Lithium Overdose


A lithium overdose is a medical emergency, and emergency services like 911 should be contacted immediately if a lithium overdose is suspected.


Symptoms of overdose may include the following:

  • Diarrhea
  • Vomiting
  • Drowsiness
  • Muscle weakness
  • Loss of coordination
  • Giddiness
  • Blurred vision
  • Ringing in the ears
  • Frequent urination
  • Tremors
  • Heart block
  • Hyperthermia (temperature elevation)
  • Hypotension (decreased blood pressure)
  • Seizures
  • Coma

Lithium Withdrawal

According to the National Center for Biotechnology Information (NCBI) [3], it has long been considered that lithium therapy could be abruptly stopped because it was guessed that lithium salts did not induce Lithium withdrawal symptoms. However, several open and controlled studies have shown that lithium discontinuation was linked with possible Lithium withdrawal symptoms and rebound effect.

Lithium withdrawal symptoms have been described in some individuals. Still, it is not easy to differentiate them from depressive or manic symptoms because no specific somatic lithium withdrawal symptoms have been observed. The most important risk related to lithium discontinuation is the early recurrence of bipolar illness. Mainly, it has been shown that the risk of manic recurrences is increased in the first weeks after discontinuation of lithium medication and that this risk is higher than the one predicted by the natural history of the manic-depressive illness.

Relapses can happen even when lithium is stopped only for a few days. Sudden discontinuation of lithium seems to be associated with an increased risk of recurrence. The root cause of this rebound effect is still unknown. In clinical practice, lithium discontinuation has to be gradual when possible. Also, studies are needed to identify at what time the risk of lithium withdrawal syndrome develops after starting lithium medication. It is also essential to establish more precise clinical guidelines for lithium discontinuation [4].

Lithium Withdrawal Symptoms

Recent research coins the term “SILENT” to describe the Syndrome of Irreversible Lithium Effectuated Neurotoxicity. These are lithium carbonate neurotoxic side effects that don’t go away even though the drug is discontinued. The most common symptom of SILENT is cerebellar dysfunction, a form of brain damage affecting the cerebellum. The cerebellum is the coordinator for gait, balance and can affect motor movements and speech, as seen in Parkinsonism, muscular dystrophy, dementia, and other conditions. 

Similarly, other side effects that emerged during treatment with lithium carbonate, such as renal impairment, may not go away even after stopping lithium. 

Lithium withdrawal symptoms include:

  • Heightened anxiety 
  • Sleep disturbances
  • Return of mania, bipolar, or other original symptoms 
  • Increased suicidal risk, which is lessened with slow and gradual lithium withdrawal

Lithium Withdrawal Timeline

For most individuals, there is no Lithium withdrawal timeline – it’s just a matter of reducing the Lithium intake down to zero. Any prolonged symptoms that someone may be experiencing could result from the body attempting to recover from while taking Lithium. These lithium withdrawal symptoms could also be related to other medications or circumstances that the individual is dealing with.

It is important to keep in mind that you know your mind and body better than anyone else – so you should be able to feel any possible lithium withdrawal symptoms. Some individuals have said that they experience a lithium withdrawal. Still, it is unknown to what degree these symptoms are from coming off of the Lithium or be attributed to something else.

Is it Safe to Mix Alcohol and Lithium?

Drinking alcohol while on lithium is not safe. For individuals on lithium, alcohol may decrease the benefits and increase the adverse effects of the medication.

Because Lithium is commonly prescribed to people with bipolar disorder, it is not recommended to combine alcohol with lithium, because ethanol, the main ingredient in alcohol, also causes mood-altering effects. Both of these drugs impact the central nervous system (CNS).

When alcohol and lithium interact, they can counterbalance each other. Someone who mixes the two may find that their mental state gets worse as a result.

There are other concerns with mixing alcohol and lithium. One of these is the fact that alcohol is dehydrating. Because alcohol dehydrates the body, it can lead the amount of lithium in the blood to rise and become toxic.

People on lithium are advised to maintain a balanced diet, which can be interrupted by alcohol. Because of how heavily lithium affects sodium levels in the blood, it’s essential to be vigilant with salt consumption.

Lithium use is also associated with an increased risk of hypothyroidism. Drinking alcohol also harms thyroid levels.

Other illicit drugs, including marijuana and cocaine, can cause dangerous interactions with lithium. Individuals with substance use disorders should not be prescribed lithium.

Alcohol and Lithium Withdrawal Side Effects

Alcohol abuse complicates the management of bipolar disorder and other mood disorders. Drinking impairs judgment and makes the user more impulsive and more prone to injury or risky behavior.

Lithium and alcohol also increase the risk of suicide. The risk of suicide is nearly doubled in people with bipolar disorder who abuse alcohol compared with people who don’t.

Because alcohol and lithium both affect the central nervous system, taking them together can increase side effects. Some of the side effects that can be amplified by combining alcohol and lithium include:

  • Dizziness
  • Drowsiness
  • Confusion
  • Trouble concentrating
  • Tremors
  • Sedation
  • Cognitive problems
  • Trouble with judgment
  • Coordination problems
  • Liver Damage
  • Nausea and Vomiting
  • Joint and muscle pain

Alcohol and Lithium Withdrawal and Abuse Treatment

Individuals struggling with Bipolar disorder have a high prevalence of comorbid alcohol use and abuse disorders, while chronic alcohol drinking may increase the presence and severity of certain symptoms of bipolar disorder. As such, there may be many individuals that are prescribed lithium to alleviate the manic symptoms of bipolar disorder, but also drink alcohol concurrently. 

People being treated with lithium who continue consuming alcohol may be prescribed another mood stabilizer that does not interact as adversely with alcohol. They should also be referred to alcohol treatment, starting with medically-assisted detox followed by an inpatient treatment program, depending on the severity of their problems.

Find the Right Alcohol and Lithium Withdrawal Treatment at We Level Up NJ

Individuals who are taking Lithium are the same individuals who are suffering from Bipolar disorder. Both Lithium and Alcohol Abuse has a complex impact on the brain. 

In the case of alcohol and lithium withdrawal and abuse with a co-occurring mental condition, such as bipolar disorder, it is best to treat them all together. Ignoring one or the other can mean missing a key part as to why the person turned to addiction. 

If you or someone you love is experiencing polysubstance abuse and co-occurring mental disorder, get them the safest help they need and deserve. We Level Up NJ offers a safe and medically-assisted Addiction Detox Program as part of our Dual Diagnostic approach to Bilolar and Substance Abuse Treatment Program. Contact our team at We Level Up NJ today!

lithium withdrawal
Doctors often recommend medically-assisted drug detox for people who misuse or abuse these drugs so the mood stabilizers can be cleared from their system safely before examining the reason for the abuse and beginning therapeutic rehabilitation.

Sources:

[1] NIH – https://medlineplus.gov/druginfo/meds/a681039.html

[2] NIH – https://www.nimh.nih.gov/health/topics/bipolar-disorder

[3] FDA – https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/017812s033,018421s032,018558s027lbl.pdf

[4] NCBI – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1606889/pdf/brmedj00464-0049d.pdf

[5] We Level UpDual Diagnosis Treatment