Q. I am a  women with bipolar disorder II, age 45. I experience debilitating depressions and "mixed states" which get me into trouble with friends and family. My hypomanic episodes are of almost no consequence. 

After trying a myriad of different drug combinations, I seemed to have found mood stabilization and sanity with Wellbutrin 150mg/day and lithium 300mg/day. My blood levels of lithium are below 0.4mEq/l....."trace amounts" as my doctor says. I am feeling fine but he would like me to increase to 600mg/day to "boost" my blood lithium to above 0.5mEq/l. Would you leave well enough alone? Is it absolutely necessary to have lithium blood levels in the >0.5mEq/l "therapeutic range"?


  A. After doing psychopharmacology for a number of years, the one thing I have learned is that nothing is certain but uncertainty. If you are feeling okay, the lithium level you have may be adequate. Alternatively, you might do better on a higher dosage. If the side effects are not an issue, I would give it a try. Perhaps you can start by splitting the difference and using 450 mg of lithium daily. Lithium also comes in 450 mg sizes, so it will only be a single pill to take still.

If your doctor has helped you thus far, it would probably be worthwhile to give him or her a chance to help you further. If side effects increase or become problematic, you can always go back to your current dosages.