Mood stabilizer (alkali metal salt)

Lithium (lithium carbonate / lithium citrate) Withdrawal

Lithium has a unique discontinuation profile distinct from antidepressant or benzodiazepine withdrawal. The pharmacology doesn't produce a classical "withdrawal syndrome." The clinically important phenomenon is the risk of mania or rapid-cycling on discontinuation, particularly with abrupt cessation. Patients with bipolar disorder who stop lithium are at substantially elevated risk of relapse, sometimes more severe than their pre-treatment episodes.

By Dr. Ben Soffer, DO — board-certified physician, at-home ketamine therapy in Florida and New Jersey.

Half-life

~18-24 hours.

Withdrawal timeline

Onset— 1-7 days for any pharmacologic effects; weeks to months for mood relapse

No acute withdrawal symptoms in the SSRI sense.

Peak risk window— Months 1-6

The risk of manic or depressive relapse is highest in the first 6 months after stopping.

Resolution / stabilization— Variable

Re-stabilization depends on whether the patient is on alternative mood stabilization and how the underlying disorder responds.

Common symptoms

  • Return of mood symptoms (mania, depression, or mixed)
  • Sleep disturbance
  • Mood lability
  • Anxiety

Less common

  • Mild GI changes
  • Tremor changes (lithium causes a fine tremor that can resolve when stopped)

Notable / pattern-defining symptoms

The defining concern with lithium discontinuation is not withdrawal symptoms per se but RELAPSE of bipolar disorder. Abrupt lithium discontinuation has been associated with manic episodes more severe than pre-treatment episodes in some studies.

Lithium withdrawal can also unmask suicidal ideation in patients with bipolar depression. This warrants close monitoring.

Tapering guidance

  • NEVER stop lithium abruptly in bipolar patients. The relapse risk is substantial and the relapse can be severe.
  • A typical taper reduces by 150-300 mg every 2-4 weeks over a period of months.
  • Coordinate the taper with the prescribing psychiatrist. Plan for close monitoring during and after the taper.
  • Patients tapering lithium often benefit from cross-tapering to another mood stabilizer or starting one before the lithium taper completes.

Where ketamine therapy fits

Lithium and ketamine can be used together for bipolar depression with close monitoring. Lithium is one of the recommended mood stabilizers to have on board if ketamine is being considered for bipolar depression, because the mood stabilizer reduces the risk of ketamine precipitating mania. Continue lithium as prescribed during ketamine treatment unless the prescribing psychiatrist advises otherwise.

Check ketamine therapy eligibilityMedication safety with ketamine

Frequently asked questions

Why is stopping lithium dangerous in bipolar disorder?

Abrupt lithium discontinuation has been associated with severe manic relapse, sometimes more severe than the patient's pre-treatment episodes. Lithium also has specific anti-suicide effects beyond its mood-stabilizing properties, which means discontinuation can unmask suicidal ideation in bipolar depression. Always coordinate any taper with the prescribing psychiatrist.

How long does lithium withdrawal last?

There is no acute withdrawal syndrome in the SSRI sense. The clinically important window is the 1-6 month period after discontinuation, when mood relapse risk is highest.

Can I do ketamine therapy on lithium?

Yes, with close coordination. Lithium is one of the recommended mood stabilizers to have on board when ketamine is being considered for bipolar depression, because it reduces the risk of ketamine precipitating mania. Continue lithium as prescribed unless the prescribing psychiatrist advises otherwise.

Important: This page is informational and does not constitute medical advice or a recommendation to start, stop, or change any medication. Tapering psychiatric medications should always be coordinated with the prescribing physician. Compounded ketamine for anxiety, depression, PTSD, and chronic pain is not FDA approved.

Browse all medication withdrawal guides.