Expert: Ivan Goldberg, M.D. - 1/31/2010

Question
QUESTION: Hi- My psychiatrist added lithium to the lamictal that I was taking for bipolar II. One week later I had a blood test for lithium levels.The lithium levels were in the normal range but the test showed creatinine and BUN levels were off,enough so that my psychiatrist was concerned.He stopped the lithium and sent me to my GP who retested with the same test results. My GP told me that it's possible for kidney problems to happen quickly with lithium. My psychiatrist said no way it would happen that quickly, so he asked me to switch to another GP,which I did. The new dr. did another blood test with the same results and also told me it can happen quickly and recommended that I stop lithium. I did,and my blood tests are now in the normal range.So,now I have an unhappy psychiatrist who says that a nephrologist can monitor the kidneys closely enough so he can try to start lithium again. I'm confused. Are my GP's correct about lithium as the cause for the kidney problem, evidensed by blood levels that returned to normal after stopping lithium, or is the psychiatrist correct who contends that it isn't possible that it caused a problem in so short a period?

ANSWER: Hi . . .

The combination of Lamictal and lithium is a very useful combination for treating people with bipolar II disorder. Unfortunately, lithium can have negative effects on kidney function and in some instances on the structure of the kidney too.

Most usually, decreased kidney function, as shown by increased creatinine and BUN levels take years to develop. But in some individuals such changes can develop rapidly.

If I were in your situation I would consult a nephrologist, NOT selected by my psychiatrist, prior to restarting lithium for a discussion of just how risky lithium might be. A personal or family history of high blood pressure, diabetes, or kidney disease are additional risk factors for kidney damage as is the use of analgesic drugs such as Motrin or Alive.

Best regards . . .

Ivan
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---------- FOLLOW-UP ----------

QUESTION: Thank you, I'm going to seek out a nephrologist as you suggested and not involve any of those 3 docs. I've asked each of the GPs at least twice,very politely, perhaps very naively, to confer with the psychiatrist.They agreed, but neither of them has ever called. My question is,how can I get them to call without any feelings or egos getting hurt? Do I have the right to ask this from them since they each feel I'm their patient? and realistically,is it going to happen?

Answer
Hi, again . . .

I think your decision to seek an opinion from an independent nephrologist makes good sense.

While doctors should cooperate regarding mutual patients, all too often it fails to happen. You certainly have the right to ask them to do so, but have little recourse if they fail to do so. To maximize the likelihood they they talk to each other, I would give your psychiatrist written permission to discuss your lithium treatment with the GPs and send the GPs a letter by certified mail (return receipt requested) in which you say something like, "I have previously verbally asked you to discuss my response to lithium with my psychiatrist, Dr. X whose phone number is XXX-YYY-ZZZZ. I am now formally requesting that you discuss my situation with him within the next 7 days."

Best regards . . .

Ivan
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