How Long for Lithium to Take Effect

I haven’t posted here in a long time so here’s some background information.  My husband is BP and suffers from mania only – no depression. We have known each other for over 8 years and been married for 4.5 years.  We’ve gone through many of his episodes and hospitalizations since we’ve been together. He was extremely non-compliant with his meds in the past but after his most recent episode in the  beginning of February that led to another hospitalization, me leaving the house for a few days, him then going to Florida “to get away” and our marriage almost ending, he agreed to see a pdoc regularly and take his meds as prescribed.  He is currently taking 600 mg of lithium twice a day and has Seroquel XR and Xanax but takes those only “as needed.”

 

This past Saturday we had a St. Patrick’s Day party and he drank quite a bit.  He did not take his meds Saturday or Sunday.  Yesterday he received some phone calls from two friends and a family member that he found very annoying and stressful.  When I got home from work, (he is currently unemployed) he admitted that he was tense/edgy from the phone calls and that his lithium level was probably down a bit. He didn’t come to bed until 3:00 am but did take his lithium, a .5mg Xanax and a .5mg Seroquel.  He did have two glasses of wine with dinner. Unfortunately he didn’t sleep more than 2 or 3 hours all night. (I thought Seroquel was supposed to knock you out!)  He did take another Seroquel this morning around 7:00am and when I talked to him, he sounded tired.

 

He’s still a little edgy but he isn’t at the stage where he’s in a manic episode.  I would say he’s still in the therapeutic range but slightly lower than where he was. I guess what I am wondering is about how long will it take for the lithium to take effect and get him back to his pre-Saturday level?  I know everyone is different but a ballpark answer is plenty.

 

Thanks

Hi there! I read your post and would like to point out a few important things for your husband to know. Firstly, I dont know when he started on Lithium but it usually takes between 1 - 3 weeks before you start feeling the benefits. Secondly, take your lithium at the same time everyday AND DO NOT SKIP A DAY! Thirdly, ALCOHOL AND MEDS IS A DEFINITE NO! Fourthly, I am also on Seroquel and it is definitely not a medication that is to be taken as needed. If you start on it, stay on it, and it will work for you. The secret is to take your meds the same time everyday and to try to go to bed at the same time every night. Getting enough sleep is very important! Work with your meds, be comitted and you will benefit. Hope things improve for your husband. Thinking of you both!

Taking Lithium for a month then skipping a weekend is hardly compliant. Bipolar is a very serious illness. Skipping meds for a weekend of drinking is irresponsible. I rarely drink but when I do, there is no way I can miss my meds and get away with it. If his meds and alcohol don't go well together, it is the alcohol that he needs to skip. Lithium is very quick to be absorbed as well as very quick to drop in serum levels. Missing two days could very easily put him back to square one. Don't get any serum levels taken until he has been on the same dose within a week. Taking medication in an ad hoc way might be only slightly better than taking no medication at all - his body wouldn't know what is going on, and it could be more destabilising. I also take Seroquel each day. 50mg of Seroquel is a tiny dose for a man. I'm a small woman with liver issues and I'm on 50mg Seroquel. I know you are saying, him missing meds and drinking is an exception rather than the rule, but I think that really needs to be addressed before adding any further medication. Whether someone likes it or not, bipolar changes your life forever, and lifestyle (not drinking, daily exercise, good nutrition, meditation, good sleep hygiene) is the only foundation for any med regime. At the moment he seems to be screwing up the help he has and then feeling sorry for himself when his symptoms are exaccerbated by his counter productive actions? I'd be disappointed too, if I were you. Maybe you need to step away from his care and have him take on more responsibility for himself? If your marriage falls apart because of his lack of responsibility, so be it, because bipolar doesn't give him the excuse to give up responsibility for himself, it actually demands he to take more responsibility for himself. This fable was hit me between the eyes. You may be able to relate. http://www.thecruxmovie.com/pdf/TheBridgeShortStory.pdf . I really feel for you BPWife and wish you all the best in your journey.

Hey you :) - I understood the improvements he's made; I can also understand the strain you are still under. What I do hope you do do is take time to look after you. You can't get away without self care as a long time carer - or you will burn out. You are a loving caring soul. You deserve to have R & R regardless. Big Hugs - and be kind to you. Jade x

LW - thank you! I actually was at my therapist's last night and he said the same thing. I need to let him manage his illness while letting him know that I am there for him and to support him. I have to take a step back as he sees my caring as trying to control and "mother" him. It's going to be SO hard because I don't want to see him fall but I have to. I think I am going to book myself a spa day for this weekend.

Genetic - I also agree with you about the drinking. He is definitely self medicating as I know he is not happy about where he is right now. He sees that a lot of the people he worked with when he was younger now have successful titles. Meanwhile he is struggling to find a job, is 42 years old, has interviewed with people who are younger and more successful than him and it's definitely getting the better of him. I wish he wouldn't drink at all but he is an adult and as LW and my therapist said, I can't tell him how to live his life or manage his illness.

Thank you again for your support and kind words. I am only hoping that this doesn't spin into a manic episode and he goes back to where he was before Saturday.

Genetic - thank you for your post. As much as I knew this was going to be hard, I had no idea I'd be going it alone and without him doing much. I wish he would come to his senses and see that his illness is serious and he needs to make life changes in order to have the successful life he wants.

My therapist made the suggestion of having him manage his illness 100% (with my support and help when asked) because my husband sees my helping him as "mothering" or "controlling" him. The reason behind my taking a step back is so he is forced to take responsibility for his illness and I start taking care of myself.

In the state he's in right now, if I even slightly mentioned that he should stop the drinking altogether, it will lead to a HUGE fight with him saying that I am controlling him and I do not tell him how to live. I hope that very soon he is at a point where I can discuss with him that drinking alcohol is the worst thing he can do and it will destroy him. Unfortunately I don't think we are anywhere near that right now.

I'm very worried about this weekend and keep praying to God that my husband will see that he is on a path to destroying everything he has and wants.

Well, you understand BPwife, and that's the important thing: you are not without knowledge regarding the whole situation. That is very much in your favor and will continue to keep you strong.

Glad to see you relying on your faith, as well.

Take care of yourself.

It's Genetic

It takes time, BPwife, for the meds to take full effect. If he hasn't asked for
a sleeping aid from his psychiatrist, it might be a good idea to ask him if he
needs assistance with that at least temporarily.

Lack of sleep can really make one irritable--in addition to other things, such as alcohol and caffeine.

Keep your chin up; any receptivity is a step forward on his part.

It's Genetic

You are going well, and don't be confused, just take each day as it comes. While BP will never go away, this situation will find its right outcome for you. You will survive this and you will be happy again. Have faith in that and focus on positive things in your life for some respite. Hugs x

Yes, pray and looking after you. This situation is not related to who you are. There is so much more to your life than this one relationship. Yes he is betraying his word atm and that is extraordinarily painful. Feel your pain and cry your tears of despair. Rage if you have to, but at the end of the day these emotions will change, the situation will shift in various ways. Get support for you. And I don't mean counselling. Just hang out with friends and people who support you and care about you. Don't make excuses for him, just because he has an illness. He is being irresponsible, selfish and has broken his word. That is not bipolar; that is just him being selfish. Try to feel your pain, but not let it loose either. Focus more on introducing at least one really lovely experience into each day despite the current impasse. Big hugs xx

I don't know why you are taking on these "controlling and mothering" allegations.

This illness and his poor management of it affects you severely, you have every right to step back - as well as intervene - as you believe is effective in the management of it.

Your husband seems blind to the impact of his actions on others, particularly you.

Having a fight isn't wrong. You stood up for your needs and that is 100% acceptable.

You seem to be negotiating the labyrinth of a BP spouse admirably. Keep getting support for you, and doing nice things for you.

Life isn't all about hard work; it is also to be enjoyed as well x

I'm glad you are focussing more on you. Afterall, that is the only thing you can control in this ordeal. If you are a genuine caregiver and nurturer, you should be able to turn that in on yourself and spoil yourself rotten! :) Enjoy creating joyful, lightheartedness in your world x

The good thing is that there is so much wriggle room in the capacity to get his illness stabilised. It's all there - he's just got to put the right stuff at the right dose at the right time down his gob. Bingo - normal life.

This little bipolar had a pretty good day. I found a service that may accept me even though I'm only well enough to work 8 weeks a year. Then I went to lunch with my exercise class and then a friend took me out to dinner for my (belated) birthday. We had a fabulous time.

I'm a bit hypomanic, so I'm going to get to bed now (10.30pm) because I have a big day ahead tomorrow.

I'm so glad that you are standing back and focussing on you. I think we all have to do that whether we are well or unwell. It's just a lot tougher for bp spouses, who's partner's illness can turn them into a ticking time bomb at any time.

It is important you have a place here to vent - that illness you are married to has significant repercussions for you.

Do you feel comfortable telling us more about you, what you are doing for you, and what you are enjoying in your life atm.

Be as verbose as you like... I'd really like to hear about YOU as a person, both - with and without - your hubby's illness.

Nite,

Jade