Reader’s Question

I was started on Lithium 200 mg BID two weeks ago for Bipolar Disorder II. A few days ago I gave in to an overwhelming urge to drive as fast and as quick as my car would travel. The sound and feeling were exhilarating and I did it about 5 times that same day. I was on a vacant stretch of highway and even though I know it was not safe to do I want to do it again. I think about it a lot and the risk does not seem to scare me as much as it makes me want to repeat the reckless driving. So, I’d like to know if there is something I can do to stop the desire before I act out again.

Our Clinical Psychologist’s Reply

What you are describing is a hypomanic symptom. We see this when your medication is not in the therapeutic range. Lithium 200 mg BID is actually a low dose. While I’m not a physician or psychiatrist, Jeffrey Hsu M.D. of Johns Hopkins Medical Center suggests the therapeutic dose of Lithium in Bipolar Disorder is 300 to 600 mg BID. Clearly, your medication is not preventing these hypomanic episodes.

You should contact your psychiatrist immediately. Your medication will need an adjustment. Hypomanic episodes like you describe can be very dangerous to yourself and those around you. Bipolar Disorder amplifies our exhilaration and decreases our normal inhibitions — creating a dangerous combination. Fast driving, shopping sprees, sexual misbehavior, aggressive outbursts, etc. are all products of this combination of increased excitement plus reduced behavioral control.