Chronic Lithium Toxicity/Nystagmus

After doing some digging, I have found that lithium, when at chronically high doses, can cause scrolling vision (nystagmus) and headaches.  So a few days ago, as an experiment, for which I take full responsibility, I reduced her morning Lithium dose by one pill, 300mg, and the next day she had neither the vision issues or the headaches.  But by the afternoon she was swinging into mania, so we went back to the regular dose the next day, and, voila, scrolling vision and headaches.  Again, I would say, never reduce or stop a medication without doctor's approval!  I only did this knowing we were going to see the psychiatrist within two days and I needed some information to give her regarding the link between the lithium and her headaches.  We have also been doing this for almost ten years, so I know what to watch for.

A month ago, when we mentioned to the nurse practitioner at the psychiatrist's office that she was having these issues, she did not mention this possible connection between lithium toxicity and acquired nystagmus.  Either she wasn't aware of this or just forgot or something.  The bummer is, had we known, maybe we would have reduced the dose weeks ago and she would not have missed so much school and avoided an MRI .  We went back to see her yesterday and this time I insisted on a blood level for Lithium and also to titrate down the dose.  She agreed, so today she got 150mg less than usual in the morning.  We shall see how her day goes. I am really, really hoping this has been the source of the problem.  If she can just stay in school consistently, I just know she would perform so much better.  The weird thing is that if the lithium is at a toxic level, it happened sort of by itself, without an increase in the dose.  I guess these things can happen.

On a brighter note, Caroline's grades are not as bad as we thought they were at the end of the quarter.  She managed to bring one of her grades up from an F to a B- after retaking a test that the Geometry teacher graciously allowed her to retake.  She still has two very low grades in other classes, but the rest are As and Bs.  She knows that she won't be able to play lacrosse in the spring if she has even one failing grade or more than one D.  With that in mind, she is promising to work very hard to bring up her GPA.  She is truly an awesome lacrosse player (says the coach) and it would be such a shame if she is shut out of the game.