Posted by susan C on October 3, 2001, at 19:00:51
In reply to Re: LITHIUM, as the sole AD? » chloe, posted by Sunnely on October 1, 2001, at 22:48:14
> > > >Many studies have shown that lithium affects the synthesis, turnover, release, and uptake of the monoamine neurotransmitter 5-hydroxytryptamine (serotonin; 5-HT)
> > Hi Sunnely.
> > Your post was extremely informative. But do you have any experience or knowledge of how effective Li is as an AD? I have discontinued the Celexa, and after two days, feel so much calmer and quieter inside. But of course I am a little worried that I will not feel too well without a traditional AD. I only seem to respond to SSRIs. Things like tricyclics, remeron and serzone were not of much use to me. And wellbutrin causes awful night sweats, the drenching kind.
> > I guess my question is, are there some folks (with treatment resistant depression, BP 2, BPD) who get AD effect from Li without a traditional AD on board? I know everyone is different, but does any one have any experience with this?
> > Thanks
> > Chloe
> Hi Chloe,
> The answer to your question will most likely depend on what exactly is your diagnosis. If you are treatment-resistant depression (unipolar depression), then the use of an antidepressant (most probably with an adjunctive treatment such as lithium), is beneficial in a number of cases. However, if you belong to the bipolar disorder spectrum (e.g., Bipolar I, Bipolar II), the use of a mood stabilizer (or combination of mood stabilizers) without antidepressant is more beneficial than with antidepressants.
> Antidepressants may be necessary in acute bipolar depression, but it is recommended that they be tapered and discontinued once the response has been established over 1-3 months. For those patients who relapse into depression, it is appropriate that they be maintained on antidepressants for a longer period of time.
> FYI, the trend in the US among bipolar researchers and some practitioners has been to limit antidepressant use. This view has also tended to be supported by bipolar specialists in some parts of Europe, especially in the more Mediterranean countries, while some bipolar researchers in the US and many researchers in other parts of Europe, particular in the UK and some in Germany, feel less concerned about the drawbacks of antidepressant use in bipolar disorder and are more concerned that bipolar depression will go untreated.
> The risks of long-term use of antidepressants in bipolar depression is acute manic switch or rapid cylcing. In a review done by Goodwin and Jamison, the early literature on tricyclic antidepressants (TCAs) generally suggests a rather high rate of switches to acute mania (in the 30% - 60% range) with those agents. Monoamine oxidase inhibitors (MAOIs) do not have a lower mania switch rate, though they appear to be more effective than TCAs in bipolar depression. Recent clinical studies suggest that the acute manic or hypomanic switch rate with SSRIs in bipolar I and II is not minor - being 15% -27%, even despite concurrent mood stabilizer treatment.
> A number of bipolar disorder experts recommend "aggressive" use of mood stabilizers and brief trials of antidepressants. By "aggressive" use of mood stabilizers they mean routine polypharmacy (multiple mood stabilizers) with two or three mood-stabilizing agents. Since FDA-indicated agents for mania are few, this approach entails frequently using other drugs with mood stabilizing effects that may not be FDA-indicated for mania, such atypical antipsychotics and novel anticonvulsants.
> Bottom line is, in your case, whether to use an antidepressant or not will depend on what exactly your diagnosis is. Some patients initially diagnosed with unipolar depression turn out to be bipolar disorder. Natural history studies largely indicate that untreated bipolar depressive episodes are briefer (mean 3-6 months) than unipolar depressive episodes (mean 6-12 months). Recent data also link a higher likelihood of lithium response for depression to very brief, recent depressive episodes. Post partum depressive episodes are also more frequent in bipolar disoder than unipolar depression. Recently, the antidepressant "wear off" phenomenon or "pooping out" (in which patients exhibit acute, but not prophylactic, response to antidepressants) has been linked to bipolar disorder. Lastly, lack of response to three or more adequate antidepressant treatment trials has long been considered a reason for reassessment of the unipolar depression.
> If your diagnosis is bipolar II, "aggresive" use of mood stabilizers and limited use of antidepressant (only if absolutely necessary) is probably the best treatment approach. Since lamotrigine (Lamictal) appears to be beneficial in patients with bipolar depression, the combined use of lithium and lamotrigine (without antidepressant) may not be a bad idea in your case.
Maybe, just maybe, I am beginning to understand some of what is being said here on this board. The final section of your post is exactly what a 'world famous researcher' diagnosed and recommended for bipolar 2, rapid cycling. If my insurance had not been part of a negotiated coverage, off the street, that advice would have been $400. Again, I am impressed, in general, and in you, Sunnely, Thank you.
Unfortunately I did not respond well to lamitical.
but, 'that's (not) all folks'
Susan C (often self-referred to as mouse)