Mania from lithium withdrawal

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. ... 

Withdrawing from lithium must be treated as a potentially high-risk event requiring clinical monitoring and as much family support as possible. Although the data are sparse, any drug used as a mood stabilizer should be considered a risk for causing withdrawal mania. 

If rapid withdrawal from high lithium levels can produce mania and disable neurologic reactions, then it is probable that rapid withdrawal from lower levels may produce more subtle adverse reactions. 

Identical twin brothers, aged 37 years, had both suffered from bipolar disorder since their early twenties and had been treated with chlorpromazine, haloperidol, lithium, and carbamazepine before developing priapism. One of them developed priapism after taking trazodone 400 mg/day, and in the 2 years after the initial episode he suffered recurrent painless erections. Initially they occurred daily and lasted 4-5 hours. During a relapse of mania at age 37, he was given oral zuclopenthixol 40 mg/day. On the tenth day he presented with priapism of 4 days duration, which persisted despite zuclopenthixol withdrawal, needle aspiration, and phenylephrine instillation, but subsided 2 weeks later with conservative management. The... 

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