Dancing With Lithium

I remember the first time I became aware of Lithium. Not the battery kind. Lithium carbonate, the gold standard treatment for bipolar disorder. Especially bipolar 1 disorder. It was before I had a definitive diagnosis. In the murky months after I was introduced to mental illness by postnatal psychosis. 

My psychiatrist had said from the beginning that I could have an underlying bipolar disorder, had mentioned Lithium. I rejected this potential differential diagnosis.  

We never got as far as Lithium that first time. I was sucked into a rebound depression that spread from dullness to catatonic in days. It was the necrotising fasciitis of psychiatry. It needed more than pills to stop it. A course of 12 electroconvulsive therapy treatments recovered me to the point of being able to go home with my then four-month-old baby.

I fully recovered.

18 months later I gradually came off all my medications and was fine. I risked smugness. So much for an underlying bipolar disorder. My psychiatrist reminded me patiently that I would have to be symptom free for 3-5 years to rule out bipolar disorder more definitively.

I didn’t make it to 5 years. I got sick again with my second (and last) baby 2 years later, and went on to have classic bipolar 1 episodes every 2-3 years.

By the time my psychiatrist suggested Lithium again, I was in the throes of psychosis, delusional and still in the stage of lacking insight common to early episodes of severe mental illness.

I laughed.

‘I’m not sick enough to need Lithium.’

I was convinced I was being offered it as a test, and that to pass the test, I needed to refuse to take it.

Eventually the trust in my psychiatrist penetrated the delusions, and I was persuaded.

It came with warnings. Stay hydrated. It can give you a metallic taste in the mouth. We need to monitor your kidneys, and thyroid, and most importantly blood Lithium levels. Too high and you risk Lithium toxicity, which can be fatal.

The list of potential side effects is long…like for paracetamol. I weighed them against the potential benefits, which included reducing the severity and frequency of my symptoms. Each bipolar episode had left me sifting the ashes of myself through once capable fingers. I was tired of working hard to re-establish my life only to be levelled again and again.

It’s been fifteen years since I tentatively welcomed my first dose of Lithium into my body. It’s not a cure. It is not solely responsible for reducing symptoms. It is a main character in my cast of management tools. I still get sick enough for hospital every couple of years, but not as severely and not for as long.

Lithium steadies me. It leads when I am the autumn leaf, caught in the whirlwind of my special brain chemistry, crunchy and fragile under life’s boot. It steps back when I settle, just a steady presence, swallowed twice daily. Solid ground in the house of my life. I don’t think about where I’d be without it.

It hasn’t asked for too much in return…so far…

Fine, intermittent hand tremors wobble my liquid eye liner. I could no longer perform surgery… if I still worked as a vet.

My thyroid function is compromised. Thyroxine is an easy fix… Even my endocrinologist agrees it is easier to supplement the thyroid than to attempt my life without Lithium.

Individual responses to Lithium like so many psychiatric medications are variable and fickle. I know someone who almost died of Lithium toxicity, many with impaired thyroid function, others whose kidney function meant they weren’t compatible with lithium, or it just didn’t work for them. It’s not for everyone.

My Lithium levels have always been where they should be. I don’t take that for granted.

But then came Thursday last week, and the unwelcome news of elevated Lithium levels. Not rush me off to hospital high, but high enough to have my psychiatrist and I contemplate the house of cards that is my medication regime.

Neither of us like this. We know from experience that even a gentle tug of one card can send my next several months toppling around my ears. So, we agreed to an almost microscopic reduction in my Lithium dose, hoping to bring the levels down without angering my brain into symptom mode. We’ll recheck levels in a month.

My dance with Lithium has been one of many things that have gifted me a beautiful quality of life. Fingers crossed it stays that way.

Lithium