Physical symptoms of lithium withdrawal
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Physical Symptoms of Lithium Withdrawal
Introduction to Lithium Withdrawal Symptoms
Lithium is a common treatment for bipolar disorder and other mood disorders. However, discontinuing lithium, especially abruptly, can lead to various physical and psychological symptoms. This article synthesizes findings from multiple studies to provide a comprehensive overview of the physical symptoms associated with lithium withdrawal.
Common Physical Symptoms
Tremor and Muscular Weakness
One of the most frequently reported physical symptoms following lithium withdrawal is a reduction in hand tremors and general muscular weakness. Studies have shown that these symptoms significantly decrease after discontinuation of lithium treatment 14.
Polyuria and Polydipsia
Polyuria (excessive urination) and polydipsia (excessive thirst) are also commonly observed to diminish following lithium withdrawal. These symptoms are often associated with the body's adjustment to the absence of lithium 14.
Dryness of Mouth
Another physical symptom that tends to reduce after stopping lithium is dryness of the mouth. This symptom is part of the broader spectrum of side effects that lithium can cause, which tend to subside once the drug is discontinued .
Controversial and Less Common Symptoms
Heightened Anxiety and Irritability
While some studies report no significant withdrawal symptoms, others have documented heightened anxiety, irritability, and emotional lability following lithium discontinuation. These symptoms were confirmed through case reports and questionnaire surveys, with about 19% of respondents reporting these temporary symptoms 23.
Sleep Disturbances
Sleep disturbances, including insomnia, have been noted as potential withdrawal symptoms. However, the evidence remains controversial, with some studies suggesting these symptoms are more related to the relapse of the primary illness rather than withdrawal itself 34.
Changes in Brain Perfusion
Research using neuroimaging techniques has shown that lithium withdrawal can lead to significant changes in brain perfusion, particularly in the limbic areas and anterior cingulate cortex. These changes are associated with the development of manic symptoms in some patients .
Rebound Phenomenon and Relapse
Rapid Recurrence of Affective Symptoms
Several studies have documented a rapid recurrence of affective symptoms, particularly mania, following abrupt lithium withdrawal. This rebound phenomenon is characterized by an increase in the frequency and intensity of episodes shortly after discontinuation 46.
Hormonal Changes
Lithium withdrawal has also been associated with changes in thyroid and adrenal function. Specifically, there is an increase in plasma thyroxine (T4) levels and a decrease in thyroid-stimulating hormone (TSH) levels, although these changes do not necessarily correlate with the probability of relapse .
Conclusion
The physical symptoms of lithium withdrawal can vary widely among individuals. Common symptoms include a reduction in hand tremors, muscular weakness, polyuria, polydipsia, and dryness of the mouth. Controversial symptoms such as heightened anxiety, irritability, and sleep disturbances have also been reported. Additionally, significant changes in brain perfusion and hormonal levels may occur. Understanding these symptoms can help in managing the discontinuation process more effectively, potentially advocating for a phased withdrawal to minimize adverse effects.
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