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Re: Lithium question

Posted by Thomas W on August 3, 2000, at 16:02:36

In reply to Re: Lithium question, posted by Sunnely on August 1, 2000, at 22:12:29

> > My MD is suggesting it to see if it will either identify
> > or eliminate the possibility of bipolar. He says it will help make a
> > determination rather quickly.
>
> This is an illogical way of arriving at a diagnosis of bipolar disorder. It's like putting the cart in front of the horse.
>
> FYI, not everyone who responds to lithium has a diagnosis of bipolar disorder. On the other hand, failure to respond to lithium does not rule out the diagnosis of bipolar disorder.
>
> At present, diagnosing bipolar disorder is still done the old-fashioned way: a thorough history taking (present and past medical/psychiatric history, substance abuse, family/social history, etc.); doing a physical, neurological, and mental status examination (psychological testing may be required); gathering collateral information from family, friends, significant others, etc. Laboratory tests including certain blood tests and brain scan may be ordered not to diagnose bipolar disorder but to rule out other conditions that may mimic bipolar disorder. Oftentimes, several evaluations/follow-up visits may be necessary to arrive at a diagnosis of bipolar disorder. In difficult cases, a second opinion consultation may be necessary to confirm the diagnosis.
> = = = = = = = = = = = = = = = = = = = = = = = = =
>
> > I understand that it requires a good bit of monitoring. Could
> > someone relate their experiences with this.
> >
> > Also, some things to watch for would help.
> > thanks
>
> Certain laboratory tests (aside from the usual physical, neurological, and mental status examination) are required prior to lithium treatment. Since lithium is mainly eliminated by the kidneys, your doctor should order a kidney function test. Since lithium can affect the thyroid, a thyroid function should also be done prior to treatment. If you are over a certain age (45 or more) or have pre-existing heart condition, an electrocardiogram (ECG) should also be done prior to treatment. It is also clinically prudent to have the following tests, too, prior to treatment: complete blood count (CBC) and basic metabolic panel consisting of electrolytes (sodium, potassium, calcium) and glucose, and urine analysis. For age-appropriate women, a pregnancy test should also be included, unless one is sure of the absence of pregnancy.
>
> While you are on lithium, you should have your lithium levels checked periodically, more frequent in the early stage, then less frequent when your levels are more stable (e.g., every 6 months). Also, periodically, your kidney functions (blood test) and thyroid function (blood test) should also be checked every 12 months and 6 months, respectively. Your calcium level should be checked, too, periodically (every 2 years). As lithium may cause underactive thyroid, it may also cause overactive parathyroid (at lesser degree) and parathyroid tumor (parathyroid adenoma), reflected in high calcium levels. An ECG may need to be done, too periodically, depending on your age and health status.
>
> Expect nausea, thirst, frequent urination, and generalized discomfort during the first few days of treatment. Expect a lag of up to 3 weeks before the full beneficial effects of the drug are noticed. Maintain adequate salt and fluid intake; do not go on any special diets without consulting your doctor. Avoid driving a car or operating hazardous machinery until response to the drug is determined. Be aware of signs of early lithium toxicity (diarrhea, vomiting, drowsiness, muscular weakness); if these occur, stop taking lithium and call your doctor immediately. Carry an identification or instruction card with toxicity and emergency information, or wear a medic-alert bracelet. Do not alter your caffeine intake drmatically while taking lithium. Avoid strenuous exercises and other activities (e.g., steam or sauna baths) that can cause significant sweating which can markedly raise lithium level. If you do, make sure you replenish the fluid lost from sweating. Flu symptoms and dehydration can markedly raise your lithium level, too. Certain drugs can interact markedly with lithium. (Ask your doctor or pharmacist for a list of these drugs. Several of them, prescribed and over-the-counter. Even Metamucil can affect your lithium level.)
>
> BTW, do not take your lithium dose the morning of the blood test until after blood is drawn.

THANKS so much for the info. and your time!


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poster:Thomas W thread:41946
URL: http://www.dr-bob.org/babble/20000729/msgs/42112.html