Posted by JohnL on February 12, 2000, at 4:24:56
In reply to Feeling drugged, anxious, and a little depressed, posted by Noa on February 11, 2000, at 18:48:32
> I had been feeling increasingly better until last week. Have been at current dose of lithium for about 6 weeks. Suddenly I feel sleepy all the time, like a drugged feeling, hard to keep eyes open, etc. But, the anxious, jittery feeling is still there--my left leg is always shaking.
>
> And I am starting to feel somewhat depressed, not in the usual way, but overwhelmed because I cannot motivate myself or muster up any energy.> Help. I feel lousy, and I don't know why.
>
> Fyi- my meds (in order of appearance in my life):
>
> effexor xr, 375
> cytomel, .0125
> synthroid, .025
> methylphenidate sr, 20 twice a day
> serzone, 225 at night
> lithium carbonate, 600 am and 600 pmSorry it's not working better Noa. I hate to suggest it, but it doesn't seem to me Lithium is the one you were hoping for. Granted it can take longer than six weeks to help with some people. But still, at 6 weeks I would expect more obvious positive results if it was the right one. Sure Lithium works with a lot of people, and a survey of pdocs showed it was a top choice for augmentation, but with you it doesn't seem to be targeting whatever underlying problem exists. If it was, results would be better than they are by now. With some people Lithium works as fast as 48 hours. In those cases it is clearly hitting the nail on the head. In other cases when it misses the target, we have to wait for a trickle down effect that may or may not ever work.
Where to go from here? In your shoes I would discuss the following with my doctor:
1)Mark two weeks on the calendar and begin weening off Lithium if you haven't seen a dramatic improvement by then. Not a so-so improvement. If it's just so-so, forget it. It's not targeting the problem, and we're subjecting the body to unneeded drugs and side effects.
2)Try two or three antipsychotics, two weeks each, with a day or two washout inbetween. Try to get a prescription for short trials of all three in one visit. The idea is to look for a rapid improvement with one of them. That would indicate we're on-target. Up to now we're not on target. So it makes sense to me to look elsewhere. You haven't tried this class of drugs yet, and to me it has become a top priority to do so. Just as a sidenote, I read in a pharmacology book that a psychostimulant combined with a low dose antipsychotic is a wonderful combination when antidepressants aren't doing the trick. Your Ritalin will increase NE/dopamine function in parts of the brain where it's needed, but will also affect other parts where it's not needed. The antipsychotic will counterbalance this.
3)Try a two week trial of each of two other mood stabilizers. If the target is being hit, you'll know inside of two weeks. The longer the wait, the farther we are from the real underlying biological problem.And one final comment. I've mentioned this before, but I'm still suspect of the Serzone in your mix. When Serzone has adverse reactions in some people (including me), the description of those adverse effects sound exactly like what you are describing. Hopefully there might be some ideas here to help you. I sure feel for you. Talk about frustration. I am cheering for you! :) JohnL
Ditch the Lithium. Try antipsychotics.
poster:JohnL
thread:21187
URL: http://www.dr-bob.org/babble/20000209/msgs/21243.html