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Lithium and other mood stabilisers

Explains how lithium and other mood stabilising drugs work, how they might help you, whether to take them if you're pregnant or breastfeeding, and what alternative treatments are available.

How long should I keep taking mood stabilisers?

If you speak to your doctor about this, their advice is likely to follow the National Institute for Health and Care Excellence (NICE)'s guidelines. These recommends the following:

  • If you have had an episode of bipolar disorder and take mood stabilisers as a long-term treatment, you should continue with your medication for at least two years. This is to reduce the risk of relapse. If you have a history of frequent relapses, you may need to continue with your medication for longer.
  • If you are just starting lithium treatment, is it recommended that you stay on it for at least 6–12 months. This is to help find out whether it will be an effective treatment for you. If you've been completely free of relapses after taking lithium for 3–5 years, you may be able to see if you can manage without it.

In the longer term, it will depend on how much you feel your medication helps you, and what you and your doctor agree is best.

You might prefer to take medication for many years, if it helps you to remain stable and get on with your life. Or you might take medication to start with, but then develop other ways of coping without medication. You may also already have views on how long you will need to take medication for, based on your past experiences.

"When I am taking lamotrigine, things are generally more stable. I feel calmer and less at the mercy of unpredictable and extreme mood changes. I find it hard to commit to taking medication on a long-term basis, but I know that I would find things easier if I did."

How can I come off mood stabilisers safely?

If you decide you want to come off your medication, it's important to do this safely. If you are comfortable speaking to your doctor about this, they can help you develop a personal plan for coming off. This should include ways to spot and manage relapses. Our pages on coming off medication have more information about this.

It's very helpful if you monitor your mood carefully when coming off mood stabilisers. You could try using a mood diary to help manage this. See our page of useful contacts for links to mood diaries online.

Coming off lithium

The NICE guidelines for bipolar disorder recommend that you gradually reduce your dose of lithium over at least four weeks. Ideally, you would reduce it over a period of up to three months. This is to lower your risk of relapse.

While you are reducing your dose, your doctor should monitor you closely for early signs of mania and depression. They should also do this for three months after you stop your lithium treatment.

There do not appear to be any physical withdrawal symptoms with lithium.

Coming off anticonvulsants

The NICE guidelines for bipolar disorder recommend that you gradually reduce your dose of anticonvulsants over at least four weeks. This is to lower your risk of relapse.

Some of the withdrawal symptoms of anticonvulsants may include:

  • mood swings, anxiety and irritability, which may feel very similar to the symptoms of bipolar disorder
  • headaches
  • dizziness
  • stomach and gut problems
  • coughs and colds
  • liver problems
  • anaemia
  • pancreatitis
  • difficulties with memory, learning and thinking
  • eye and sight problems
  • sensory disturbances
  • abnormal menstrual periods
  • difficulty sleeping and fatigue
  • weight gain
  • muscle spasms, twitches and shaking
  • fits, even if you have never had one before.

Coming off antipsychotics

The NICE guidelines for bipolar disorder recommend that you gradually reduce your dose of antipsychotics over at least four weeks. This is to lower your risk of relapse. 

See our page on coming off antipsychotic medication for more information, including some of the possible withdrawal symptoms.

This information was published in June 2020. We will revise it in 2023.

References are available on request: email our info team.

If you would like to reproduce any of this information, see our page on permissions and licensing.

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