Mood disorders Manic episode after abrupt termination of 36-years of lithium usage

Bipolar disorder is an episodic, lifelong illness that requires a long-term maintenance treatment. Lithium has been the first line treatment of bipolar disorder for 60 years. In the presented case, a manic episode occurred after abrupt termination of 36-years of lithium usage. A 58-year-old female, who applied to our clinic with symptoms of lithium toxicity. She was diagnosed with bipolar disorder after having a manic episode at the age of 22 and has been using 600 mg/d of lithium, since then. However, she suddenly ceased taking lithium, and two weeks later she experienced a manic episode. Lithium usage has been started and increased to 1200 mg/d in one week by another clinician. After increasing the lithium dose, she had the symptoms of lithium toxicity. She was admitted to the hospital, and given a supportive treatment. A manic episode treatment has been given to the patient, whose clinical findings and lithium blood level were normal. Lithium has been given again under outpatient clinic control.