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cbd oil and lithium

A 13-year-old boy with autism and LGS with a history of 2 prior epilepsy surgeries and vagus nerve stimulator (VNS) placement presented to our comprehensive epilepsy clinic to transfer care. Epilepsy onset was at 18 months, and he had a history of atonic seizures and generalized tonic-clonic seizures, along with focal seizures with loss of awareness. The etiology of his phenotype was unknown. He underwent a full corpus callosotomy at age 4, left frontal lobe resection at age 7, and VNS placement at age 11 (all at an outside institution). His parents described a semiology of staring and behavioral arrest for 2-3 minutes with oral and/or manual automatisms. These seizures were occurring several times per week. Prior antiseizure medication trials included rufinamide, valproic acid, levetiracetam, topiramate, oxcarbazepine, lamotrigine and lacosamide. At the time of presentation, he was taking 2 ASMs at stable doses over 4 months: Felbamate 24 mg/kg/day and Clobazam 0.5 mg/kg/day.

We discuss a patient with LGS and psychiatric comorbidities treated with lithium, who, after initiating CBD, developed symptoms of hypersomnolence, ataxia and decreased oral intake and was found to have lithium toxicity.

Case Description

Upon evaluation in the ED, he was afebrile though somnolent. When arousable and more awake he was ataxic compared to baseline. Blood pressure, blood counts, electrolytes, liver enzyme levels, renal function tests, and clobazam levels were all unremarkable. In contrast, the lithium level was notably elevated at 2.4 mmol/L (compared to his historic baseline of 1 -1.3 mmol/L). Psychiatry and neurology were consulted. Lithium was stopped, and midday doses of clonidine and felbamate were held. He was placed NPO and on twice maintenance intravenous fluids with serial checks of lithium levels and monitoring of urine output, with a targeted goal of 1-2 ml/kg/hr. Lithium levels declined over the subsequent 48 hours, and his mental status improved. He was monitored for 3 days during which time he gradually returned to baseline and remained seizure-free. His parents reported improved behavior and requested that he remain off lithium. On the day of discharge, his lithium level was 0.6 mmol/L, and he remained on perphenazine, quetiapine, and trazodone.

He met criteria for Autism Spectrum Disorder, co-morbid with severe intellectual disability and associated aggressive and self-harmful behaviors and sleep difficulties. At baseline, he was non-verbal with incontinence, though with full strength and ambulation.

Epidiolex ® (Cannabidiol- CBD) is approved for epilepsy associated with Dravet syndrome (DS) and Lennox-Gastaut syndrome (LGS) in patients over 2 years of age. Common side effects include somnolence and diarrhea. Recent studies have demonstrated interactions between cannabidiol and several other antiseizure medications. However, little is known regarding interactions between cannabidiol and other classes of medications. We discuss an autistic patient with LGS and significant psychiatric comorbidities who was being treated with multiple antiseizure and psychiatric medications, including lithium, when CBD was added to his medical regimen. Several weeks after initiating CBD therapy, he developed hypersomnolence, ataxia and decreased oral intake and was found to have lithium toxicity. Lithium was discontinued and his symptoms resolved. He remains on CBD and 2 other antiseizure medications, seizure-free with improved behavior. We review mechanisms of action and pharmacokinetics of CBD and discuss possible explanations for lithium toxicity in this patient.

Regardless of the type of depression one is suffering from, the condition can be severe enough to deteriorate one’s work, school, relationships, and/or social activities. Before discussing CBD and lithium, it is paramount to know the signs and symptoms to look out for.

Hypothyroidism is a potential side effect of long-term lithium use. This is a condition whereby you have low levels of thyroid hormones. Long-term use of lithium-based medication can give rise to rare but dangerous kidney illnesses. In this case you must closely monitor your kidneys and kidney function.

Premenstrual Dysphoric Disorder

It is paramount for individuals suffering from depression or bipolar disorder to ensure CBD products have low THC quantities. THC is the psychotropic compound in cannabis and could have an unpredictable impact on a bipolar person’s mind. CBD is known for being a non-addictive substance. As such, there are no known long-term side effects of taking CBD.

Mental health is increasingly becoming a mainstream topic of discussion. More people are mindful of issues such as depression and bipolar disorder, and how best to treat them. There is a truly vast number of various drugs and practices that are regularly recommended. There is however, a great deal of uncertainty surrounding many of them. Today we will discuss and compare CBD and lithium.

Also known as manic depression, bipolar does not exclusively involve episodes of depression. However, it does include periods of major depression. Additionally, patients will experience manic episodes, characterized by high-energy and euphoric mood. During episodes of bipolar depression, the symptoms are similar to symptoms of major depression.