Lithium Discontinuation — MRCPsych Paper B MCQ

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ModerateMood DisordersLithium DiscontinuationMRCPsych Paper B

Following shared decision-making, a 35-year-old woman with bipolar I disorder who is currently euthymic plans to stop maintenance lithium and start another antimanic drug. According to NICE CG185, over what period should lithium be discontinued?

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Correct answer: E — Gradually over at least 4 weeks, and preferably up to 3 months

Explanation lettering: C = shown as B · E = shown as C · B = shown as E

B is correct. NICE CG185 recommends reducing lithium gradually over at least 4 weeks and preferably over up to 3 months. This recommendation still applies when the person has started another antimanic drug. The patient should be monitored closely for early signs of mania and depression during dose reduction and for 3 months after lithium is stopped. Abrupt cessation and tapers lasting only 1 or 2 weeks are therefore too rapid. Option E is incorrect because NICE gives an explicit discontinuation period. The original key was correct, but the item has been revised to remove the potentially distracting implication that the question concerns treatment of an established depressive episode and to provide a precise, current reference.

Reference: National Institute for Health and Care Excellence. Bipolar disorder: assessment and management (CG185), section 1.10, recommendations 1.10.25–1.10.26. Published 2014; updated 2025. https://www.nice.org.uk/guidance/cg185/chapter/Recommendations