Lithium Tapering: Guidelines to Help You and Your Medical Caregivers
You wouldn’t try to climb Mt Everest on your own. Neither should anyone attempt Lithium tapering without support at your side to help and guide you. Arranging inpatient treatment for lithium tapering is the most highly recommended path forward for many. You can contact us directly at Alternative to Meds Center to find out if this is the best option for you. Out-patient treatment is another option to consider. But please, never try tapering lithium for bipolar or other symptoms totally on your own.
Below are some general points of orientation, to open up a discussion with the medical professionals you choose to work with.
Lithium Tapering Guidelines Include:
Medical consensus is to follow a gradual step-down in dosage1-4,27
Certain drug interactions, even aspirin, St. John’s Wort, and caffeine, can cause or elevate toxic reactions, and can trigger unmanageable symptoms such as mania, especially while tapering lithium. Drug interactions can stall the taper and may even land you in the hospital. Cut out caffeine and all other stimulants, and before taking any additional medications or over-the-counter drugs, let your care team know.8,26
Each step down needs to be held until a stable point is observed, each resting point perhaps 2-4 weeks, more or less, until the next reduction is attempted. This may lengthen the total time required for safe tapering over several months, but reduces the likelihood of relapse.23,24,27
The prescriber may be able to furnish pills or capsules in the required dosages to work out the math precisely.24
If this requires switching to a different brand, arrange to stay on it for a few weeks before starting the taper so that your body can acclimate to the new version first.25
In the US, Lithium carbonate comes in 300mg, tablets, and 150mg capsules. Oral solutions may also be available. Slow-release tablets may require a different prescription approach.8
The prescriber can help work out what percentage drop would be a good starting point for reducing the dosage. From both published research and our own observations, up to a 10% drop would be the maximum step to begin with.27
For example, if currently taking 3 X 600mg daily (1800mg daily total), a reduction of just under 10% could be achieved taking 1 X 300mg pill + 150mg capsule (450mg total), and then 1 X 600mg pill at the usual intervals over the day & evening, as before. One would stay on this pattern until stable.
If starting from 3 doses of 300mg (900mg daily total), an approximate 10% reduction could be attained using 300mg for the first 2 doses, and then a 150mg capsule for the third dose for the day. These are examples only and one would need to work with one’s medical team to work out the exact metrics to approximate a workable 5-10% drop as needed for individual circumstances.
Having a team or at least one competent partner to work with is advised so that changes can be monitored closely and doses can be adjusted in a timely manner as needed.27
Common to all mood altering medications, It is not unusual for the last adjustments in a taper to be the most difficult and may need extremely incremental cuts to a sub-therapeutic level when nearing the end of a taper.22
*We recommend becoming familiar with the medical research provided at the end of this article, as well as reviewing other information available on our website for tapering antipsychotic and bipolar medications.
Lithium tapering for bipolar, mood disorders, and other conditions, has to be done with safety in mind. Safe tapering relies on the expertise that comes from familiarity with the process, as well as an understanding of the uniqueness of each individual. It also serves to bear in mind the potential harm that can occur from long term use of medications like lithium carbonate.
It’s not possible for a cookie-cutter approach to lithium medication weaning to work for everyone. But there are general guidelines that can help design and plan the process intelligently for both safety and comfort. At Alternative to Meds Center, our approach provides an individualized set of steps that allows comfortable lithium carbonate reduction and the best possible experience and outcome for each client.
Is Lithium necessary to overcome bipolar symptoms?
For about 18 years now, Alternative to Meds Center has helped literally thousands of people to safely reduce and even eliminate their medication, and still manage their bipolar or mood disorder symptoms well. And often, watch as their symptoms just fade away. We have the statistics to clearly demonstrate the success of our protocols. We aim to find root causes for symptoms, instead of solely relying on numbing drugs. For the vast majority, relying on lithium or other medications can be reversed, so they can become less reliant and even completely free of medication while enjoying renewed mental wellness.
15 Years Experience by Professionals Who Understand Your Journey.
Below we discuss some of the side effects that could occur when reducing dosage, followed by some general guidelines that can be put in place to minimize the side effects associated with weaning off lithium.
Each individual has a unique profile, including factors such as how long they have been taking lithium carbonate, their dosage, any genetic factors that can influence drug metabolism and clearing, what it was prescribed to treat, and others. Many off-label uses for lithium occur, such as for headaches and neutropenia, and even if commonly done, these uses are less researched than lithium for bipolar.4,13 So, it follows that not everyone would experience identical side effects when tapering lithium.
One of the most potentially troublesome side effects of stopping lithium medication is the re-emergence of original symptoms such as mania, or other extreme mood swings. And, there are some other commonly reported side effects reported in clinical research on lithium tapering, that are listed below.1-3
Common Side Effects Associated with Tapering Lithium Carbonate include:
Return of mood swings, often extreme
Heightened anxiety
Manic episodes
Depression
Sleep disturbances
Irritability
Side Effects of Lithium Carbonate
Suicide is a risk of the depressive symptoms associated with bipolar disorders, and lithium has been shown to be an effective suicide prevention strategy in such cases.
However, staying on lithium for extended periods also has associated safety concerns, and this could be a deciding factor for many who are considering tapering lithium. Below is a list of those adverse effects from research studies, showing that such side effects are more often seen in long term use, and are also more frequently seen where high dosages are taken or prescribed over a long period of time. Lithium carbonate accumulates in many internal organs over time, most prominently the brain and kidneys.4-6
Thankfully, many of these lithium side effects often reverse back to normal after reducing or stopping lithium carbonate.
Metabolic disruption, including weight gain, diabetes insipidus (low fluid levels in the body), excessive thirst, excessive diluted urination, dehydration, metabolic acidosis5,8
Hematologic (blood disorders) such as hyponatremia8(low salt concentration in the blood)4,5,8,9
Sexual dysfunction, loss of sexual desire, loss of ability to perform7-9
Gastrointestinal, nausea, vomiting, diarrhea8
Protracted sweating8
Encephalopathic syndrome (brain nerve or other tissue injury leading to coma, confusion, “thunder-clap” headaches and other symptoms — often reversible)4,5,8,28
Crosses the blood-brain barrier and the placenta — known to cause birth defects and other fetal risks8
(rare) Serotonin syndrome, especially if combined with other serotonergic drugs5,8
According to the available studies on lithium carbonate accumulation in the body, the longer one takes this drug, the more toxic reactions are likely to occur, leading to potential damage.9
But do remember that in many cases, once lithium tapering is accomplished, a vast majority of drug-induced adverse effects will either partially or completely reverse.
How Long does it Take to Safely Get Off Lithium Carbonate?
How long it takes to taper lithium carbonate in bipolar treatment will differ for each individual. Many factors need to be taken into account to help determine the best rate of reduction, and a workable time frame.
Unless a severe medical emergency has occurred such as serotonin syndrome, lithium poisoning, or other life-threatening level event, the approach should be gradual. Taking it slow can help reduce or avoid rebound phenomena such as manic episodes, or other reactions that are hard to endure.
The half-life of lithium carbonate is between 18-36 hours. However, continual use may prolong the time it takes to clear from the body and can extend the half-life up to an estimated 48 hours.4
More importantly, lithium carbonate is extremely absorbable into the organs and tissues of the human body. It is excreted in the urine in 100% of its original form, rather than being broken down into metabolites. Both of these factors suggest significant implications for effects on one’s internal organs and for mothers both during pregnancy — lithium can pass through the placenta directly into the fetus — and mothers who are or plan to be breastfeeding.4,8
Lithium titration in small, measured increments allows for a gentle reduction over time. Sometimes titration back upwards is needed, i.e., if there are severe reactions to a too-steep dose reduction. In this instance, lithium titration upwards may be temporarily needed to stabilize, before further dosage cuts are made. Getting off lithium carbonate needs patience, precise monitoring and working closely with a prescriber is needed. Careful planning helps make the journey successful. Based on your history, a timeline for getting off lithium carbonate may involve weeks or months as a general estimate.
Tapering from Tapering? Have a Safety Net
Before starting lithium tapering, it is highly recommended to put in place what is sometimes called a voluntary “Ulysses Agreement” for safety.17 This voluntary step can be put in place before beginning a taper, especially useful where inpatient help is not available or accessible to you. The agreement is voluntary and is done in collaboration with those you trust who have agreed to assist you. Let those around you know what your plans are, and how they can best help you.
The agreement is put in writing, and helps ensure that someone will be there to help keep you on your best trajectory, and if you suddenly should decide to disregard your own safety, or that of others, you have a protective safety net in place to prevent things from going completely sideways.
Follow the Plan
The adjustments of dosage would follow a plan carefully worked out with your prescriber, and your care team. Flexibility is a key factor as sometimes a dosage of lithium may need to be titrated up (to restabilize) before taking the lithium dosage back down. Staying in close touch with your caregivers can make it much easier to determine when dosages should be adjusted, or when to allow some additional time or make other changes to ease the process. Making a commitment to yourself to stick with the tapering plan can provide confidence and patience as you navigate the process.
Be a Friend to Yourself — The Basics
Basic recovery tools for successfully tapering lithium include a clean diet, (i.e., nutrient dense foods, no stimulants like caffeine), no alcohol, no recreational drugs, no random over-the counter drugs, getting quality sleep, and often overlooked, exercise such as Qigong, yoga, hiking, swimming, and sports.
Recovery in an inpatient setting is structured for the very best in comfort and ease. We understand that not everyone has access to this type of lithium tapering program. To that end, the guidelines here have been offered to assist. Aim to arrange your daily routine to include the basics, outlined earlier, and if possible, you may want to forego or at least lessen your work/school schedule. At least until your bipolar or other symptoms are feeling stabilized, eating well, and are getting adequate rest on a regular basis.
Let’s not forget, there is recovery of the body, and there is also recovery of “you.” This important area of healing can be explored in counseling. And practicing patience, self-compassion, and self-love, can also be explored in meditation. Practicing self-compassion has been clinically shown to reduce depression, and other symptoms of distress as in PTSD or other trauma. Some may think about it like exercising a muscle you haven’t paid much attention to — and evidence shows there is much to be gained from doing so for one’s personal and authentic sense of well-being.18,19
Lithium Orotate — Can it Have a Role in Recovery?
In some cases, the use of dietary lithium orotate has been found helpful in transitioning from Lithium carbonate primarily because lithium in dietary orotate form does not present the same toxic liabilities. It’s superior ability to permeate the blood brain barrier means much less is needed for optimum effect. Support before, during and even after lithium carbonate tapering might benefit from diet modification, certain supplements, clearing neurotoxic load from the body, and other strategies.11,12 You can find out more about these on our lithium withdrawal and lithium alternatives pages.
Inpatient Lithium Tapering at Alternative To Meds Center
We truly believe that food is medicine, including probiotics and supplements that can be total game changers during and after a taper. Exercise, counseling, IV treatments, and diet upgrades have been proven over and over to be effective treatment methods for even the most challenging of mental health symptoms.14-16
We understand the double-edged sword of drug-based therapy for mental health. Lithium compounds are powerful and potent mood stabilizers that can not only cause significant side effects during use, but can lead to serious withdrawals and rebound effects when you try to stop taking lithium.
“Tapering s l o w l y from lithium is exponentially safer than trying to stop using lithium “cold-turkey.”
However, we also realize that a person may or may not be able to eliminate 100% of their prescription medicine. But our aim is to help you get as close to your lithium tapering goal as possible while still achieving improved quality of life, and we have the treatment protocols in place to get you there.
Our professional team is here at Alternative to Meds Center to help ensure you minimize the risks of withdrawal, avoid symptom relapse, and find true, lasting relief of your mental health symptoms. We offer a vast range of holistic drug tapering and recovery services that are specifically designed for easing the transition.
If you are, or your loved one want to find a more natural path to wellness, please reach out to us. We can answer any questions you may have about our protocols, length of programs, or any other information you would like regarding safe inpatient lithium tapering and treatment for bipolar symptoms without the risks associated with heavy-hitting bipolar medications like lithium.
3. Balon R, Yeragani VK, Pohl RB, Gershon S. Lithium discontinuation: withdrawal or relapse? Compr Psychiatry. 1988 May-Jun;29(3):330-4. doi: 10.1016/0010-440x(88)90056-9. PMID: 2897893. [cited 2024 Aug 30]
4. Chokhawala K, Lee S, Saadabadi A. Lithium. [Updated 2024 Jan 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519062/[cited 2024 Aug 30]
5. Hedya SA, Avula A, Swoboda HD. Lithium Toxicity. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499992/ [cited 2024 Aug 30]
28. Koksel Y, McKinney AM. Potentially Reversible and Recognizable Acute Encephalopathic Syndromes: Disease Categorization and MRI Appearances. AJNR Am J Neuroradiol. 2020 Aug;41(8):1328-1338. doi: 10.3174/ajnr.A6634. Epub 2020 Jul 2. PMID: 32616580; PMCID: PMC7658879. [cited 2024 Sept 11]
Originally Published September 11, 2024 by Diane Ridaeus
This content has been reviewed and approved by a licensed physician.
Dr. Samuel Lee
Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente. He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.
Diane is an avid supporter and researcher of natural mental health strategies. Diane received her medical writing and science communication certification through Stanford University and has published over 3 million words on the topics of holistic health, addiction, recovery, and alternative medicine. She has proudly worked with the Alternative to Meds Center since its inception and is grateful for the opportunity to help the founding members develop this world-class center that has helped so many thousands regain natural mental health.
Medical Disclaimer: Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.
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Each step down needs to be held until a stable point is observed, each resting point perhaps 2-4 weeks, more or less, until the next reduction is attempted. This may lengthen the total time required for safe tapering over several months, but reduces the likelihood of relapse. 23,24,27
Renal impairment, chronic kidney disease, kidney failure 4,5,8
The half-life of lithium carbonate is between 18-36 hours. However, continual use may prolong the time it takes to clear from the body and can extend the half-life up to an estimated 48 hours.4
We understand the double-edged sword of drug-based therapy for mental health. Lithium compounds are powerful and potent mood stabilizers that can not only cause significant side effects during use, but can lead to serious withdrawals and rebound effects when you try to stop taking lithium.
