It was two o’clock in the morning on our first night out of town in New Orleans, and I woke up suddenly in the dark hotel room feeling horribly sick and needing to run to the bathroom. What ensued was messy and lasted for two hours. I kept waking up with my head in the toilet to do it again. I used most of the towels in the bathroom to clean up both myself and the mess I had made on the floor. At 4am, exhausted and beyond tired, not knowing exactly how to handle the situation, I opened my hotel room door completely naked, threw the armful of soiled towels into the hallway and went back to bed.
The next morning, I woke up extremely nauseous. I was thankful we had packed a decent amount of THC gummies, as they proved to be a savior for the next few days. The gummies took the nausea down to a level where I was able to function throughout the day, but I was still not feeling right or well. I didn’t know if it was from the previous night’s events, but I felt subdued by a heavy brain fog.
The day progressed slowly, as I was not feeling 100%, but I made it through, enduring other would just get a good night’s sleep and be better in the morning. Yet, without fail, I once more woke up in the middle of the night, more prepared this time, and got sick several times.
I really had no idea what was going on. Once again, I woke up with severe nausea but thought maybe a good breakfast would set me straight.
At the hotel restaurant, I could not tolerate the smell of the food. I could barely drink my coffee. My husband, looking at me searchingly, kept asking if I was okay. I tried to assure him that I would be fine, although I wasn’t sure I believed that myself. He finally said, “I don’t know what to do when my wife looks like she’s about to vomit at any moment.” Remembering how much the gummies had helped me the day before, I decided it was going to have to be another day like that, so I asked him to go up to the room to retrieve one for me. He happily obliged. I ate the gummy and was feeling relief within about 40 minutes. I could finally breathe and begin to perform as a person on vacation.
At restaurants, I noticed that the menus would shake furiously in my hands, as well as my fork and my drinking glass. I brushed it off as my usual lithium tremor combined with low blood sugar. I also noticed that my thirst was unquenchable. At one restaurant, as soon as the waiter set the water on the table, I chugged the glass immediately and instructed him to keep them coming, that I was extra thirsty. My husband looked at me with concern and kept the gummies coming, which were still keeping the nausea at a manageable level. My additional stomach ailments continued, but I pushed through them and tried to make the best of it, still under the spell of a heavy brain fog.
After another night of vomiting and immediately popping gummies as soon as I woke up, my husband and I put our heads together. We ran through the list of symptoms I had been experiencing, coming up clueless. Next, we thought back on anything that had changed recently. Aha! Indeed, my psychiatrist had increased my lithium right before we left for vacation.
Only knowing that connection, we began to research my symptoms plus the keyword ‘lithium’. Immediately, tons of links popped up about lithium toxicity, something neither one of us knew anything about. It seemed serious, but some of the stories I read seemed a lot graver than mine, so I figured I wasn’t in need of emergency care. I simply discontinued the lithium, and we went home the next day. Not getting back until later in the evening, it was the following day before I could go in for an emergency blood draw to check my lithium levels, something that had been done frequently throughout my nearly 25-year history of being on the medication.
I had been put on lithium for my early bipolar (then later schizoaffective) diagnosis when I was 18 years old, after spending the previous year psychiatrically hospitalized seven times for depression, anxiety, psychosis and unstable mood. I was promised mood stability and less suicidal ideation. It was supposedly the leading option, my best line of defense. That is what I was told for the next 25 years, but I was never told about lithium toxicity.
From the start, the side effects were horrible. So much GI distress and unquenchable thirst, which I know now was my kidneys urgently trying to rid my body of the essential poison of the drug. I learned to deal with it. Every now and then, during times of stability, my doctor would agree to let me discontinue it, but it never lasted more than six months. I had spent over half my life on lithium.
I knew from past experience that my lithium level usually landed around .7, a fine, therapeutic level. Once lithium is stopped, the levels decrease pretty quickly. So, after missing two days of medication, I was very surprised when my bloodwork came back with a level of .14. This meant it had to have been even higher in the preceding days. I did indeed have lithium toxicity. Being off the medication, I was already feeling better, so I really felt like if there had been an emergency, it had passed. And thankfully I happened to have an appointment with my psychiatrist that week.
I told her what happened and she was concerned, to say the least, left wondering why it happened. The increased thirst, I learned, was my body’s way of trying to flush the drug out of my kidneys. Since the emergency had passed, my psychiatrist had me do another blood draw, this time the levels amounting to .5, and decided it would be okay to restart the lithium at a reduced dose. Nothing else bad happened for several years.
Many say that lithium is a vile drug to the body. Others say that it is an excellent drug for the mentally ill mind. I would agree with both. It caused a terrible tremor that embarrassed me most of the time. It left me having to run to the bathroom within 10-15 minutes of eating, for years. I would have to plan ahead with Imodium for road trips, airplane rides, and even some social events. For a long time, I was drinking four 40-oz bottles of water a day, which of course left me always having to pee. However, it did seem to work for my mental health. I found it to be a good medication for suicidal ideation, something I deeply struggled with, as well as a stabilizer for my sometimes unmanageable mood swings. For these reasons, despite the physical aggravation, I stayed on the medication.
Fast forward three years later: one evening, about an hour after taking my nightly meds, I once again got very sick. I ran to the bathroom three or four times, purging a total of 20 times that night. My shaking was more pronounced than usual, and something just didn’t feel right. I hadn’t been this wrathfully sick since I had lithium toxicity three years prior. But there had been no increase in dosage, this time. Maybe this was just food poisoning? But deep down, I knew it felt different. I skipped my morning dose of lithium and went to the doctor that afternoon for another emergency blood draw.
My levels were fine at .6. I remained unconvinced, so I did not take my lithium for the next several days, during which I felt fine. I started thinking that maybe it had just been food poisoning after all, and that it was safe to restart the lithium since my levels did not point toward toxicity. I woke up and took my morning dose. Within the next few hours, my nausea began to grow more intense, which continued throughout the day, along with relentless diarrhea. After taking my nightly dose, I had to take a Zofran and crawl into the bed early.
The next day, I bravely took my lithium again first thing upon waking up, with my handful of other meds, and waited. The nausea began and I knew something wasn’t right. Shortly after, I threw up, but since I had not eaten, it was not as severe as the times before. It’s just not agreeing with me anymore, I thought, and made the decision to discontinue until I saw my psychiatrist two weeks later.
During the following two weeks, I experienced some emotional turmoil, but my body had never felt better. My bathroom habits resembled those of a normal person, my shaking had decreased some, I wasn’t guzzling as much water throughout the day, and I felt more clearheaded. As I finally sat down with my psychiatrist, I became very emotional about the whole ordeal. Historically, I felt that lithium had helped me more than hurt me, and with a tearful expression and cracking voice I said, “My body just doesn’t seem to be tolerating it anymore,” as I weepily described the events that had transpired in the previous weeks. Compassionately, she told me we could stay off the lithium for now. I was so relieved.
I have come to learn that in some cases, after long-term use of lithium, the kidneys’ ability to clear the drug changes, so the dose the body had handled for decades can become something it can no longer process the way it did before. I don’t know if I’ll ever be able to get back on lithium, but my mental state is stable and I am on another mood stabilizer, so I can’t complain. It was just a trip to have my body make a decision without me to cease a relationship I’d had with something for so long.
