Expert: Ivan Goldberg, M.D. - 7/15/2007

Question
Doctor:  This was my original question, and below is a follow up from a recent visit to my mothers psychiatrist......Doctor, a few years ago a doctor my mother had said that sometimes older people do better on lower doses of lithium, my mom age 67 now, has been on lithium for about 13 years and as of late she has been having some issues with confusion, my question is two fold, 1. can lithium still be of a benefit even if the level is not at the .6 miniumum level? and 2. Can lithium cause issues of confusion, and problems with walking even if the levels are within normal for lithium.?  The reason i ask that is over the years her creatine has been elevated about 1.3 and recently she skipped two days of her lithium and she seemed markedly better and my thought was that perhaps her body may not be eleminating the lithium.   

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Answer
Hi . . .

The answer to both of your questions is, "Yes."

"Subtherapeutic" doses of lithium can be an effective treatment . . . especially in older people. And, even at therapeutic levels, lithium can have significant side-effects.

The increased creatinine is not an indication of an abnormal accumulation of lithium in the body, only an elevated lithium level would indicate such an accumulation.

You might discuss with the psychiatrist who is prescribing the lithium the possibility of her/him lowering the dose.

Best regards . . .
Ivan
-----------------------------FOLLOW UP FROM VISIT

My mothers doctor thought it best to try her on abilfy 5mg, and discontinue the lithium.  Also she is on 3mg of navane a day he stated his ultimate goal was to see if she could just be on the abilfy.  Is it ok for her to be on the navane and abilfy, ?  She has been on it for a week and she seems good.  Thank you for all your help Doctor.

Answer
Hi . . .

I can understand the lithium being discontinued with a creatinine of 1.3 and the confusion you describe.

Combinations of antipsychotic medications such as Abilify and Navane are sometimes used to control the moods of people with bipolar disorder.

Best regards . . .
Ivan
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