Depression As Lithium Withdrawal Reactions

Although little notice was given of the phenomenon within the profession, I recall my own patients telling me about painful emotional reactions that they suffered during lithium withdrawal. The evidence is now substantial in regard to serious adverse psychiatric effects caused by lithium withdrawal. 

Suppes et al. (1991) analyzed 14 studies and found that the rate of relapse into mania increased following the discontinuation of lithium. The patients, who tended to cycle into mania about once a year (mean 11.6 months), developed a new episode less than 2 months (mean 1.7 months) after stopping their medication. In other words, discontinuation of treatment with lithium produced a much more rapid onset of mania than the untreated patients would have endured. 

Numerous studies have now confirmed that withdrawal from lithium causes adverse psychiatric reactions. Cavanagh et al. (2004), in a 7-year follow-up, found that lithium withdrawal caused both mania and depression. They concluded, These results confirm that acute discontinuation of lithium leads to a high immediate relapse rate. However, they did not find that this justified the continuation of lithium. To the contrary, outcome was not worsened by discontinuation.  

Unfortunately, patients who relapse soon after taking lithium are rarely, if ever, told that their relapse was probably caused by lithium withdrawal. Instead, they are told that the new manic episode proves the need to take the medication for the rest of their lives. 

Many psychiatrists advise patients who are diagnosed bipolar or manic that they must take lithium for many years, or even for the rest of their lives. They are told that it is irresponsible for them not to do so. Families and psychotherapists are pressured to urge or coerce patients to take their lithium. The data do not confirm this strong advocacy for the drug. 

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