Posted by Ron Hill on March 19, 2002, at 21:27:11
In reply to Lithium for BPII or cyclothymia? NEED HELP, posted by Peter on March 19, 2002, at 17:26:43
Peter,
You and I have traveled similar roads. The good news is that, at long last, I've got a med combo that works great. Perhaps, you may find it worthwhile to look into it. I'm BPII and I take 600 mg/day Lithobid and 400 mg/day SAM-e. I'll respond to some of your questions and close by routing you to prior posts that explain my history and the solution my current pdoc found for me (i.e. SAM-e).
> Well, after another trial with a new medication cocktail prescribed by my pdoc, I'm still miserable. Since 1997, this guy has had me on various combinations of depakote, neurontin, a slew of SSRI's, Wellbutrin, Effexor, dopamine agonists, stimulants, klonopin, and more. He had diagnosed me with mild bipolar, some panic, social phobia, and possible ADD.
My ordeal started in 1996 when I was misdiagnosised as ADHD and put on ritalin. When I started to get moody a couple of months after starting ritalin, the idiot pdoc added Paxil. The ritalin and paxil combo pushed me (a BPII) into a full blown mania as any good pdoc would fully expect. Adding insult to injury, the two hundred dollar an hour pdoc did not recognize the mania but, instead, kept writing scripts for the pstim and AD (can you say malpractice?). Once a guy gets his brain chemistry so screwed up, it's hard to get it squared away. I will not bore you with all the details because it sounds like you know the road all too well. Again, the good news is that with the help of my current pdoc and many people on this board, I've got it solved. Now it’s my responsibility to help others, if I can.
>He said I should taper off all the meds I'm on now (Neurontin, adderall, and klonopin), and begin a simple combo of Lithium and Depakote.
Did you tell him about your "wet blanket effect" response to Depakote when you took it previously. Why not try lithium by itself first, with the option to add-on an AED latter if it turns out to be needed?
>I always thought Lithium was only prescribed for people with intense BP I, with acute manias and suicidal depressions.
Yes, the general rule is, as I understand it, Li for BP I's and AED's for BP II's. But there are, of course, many exceptions to the general rule. I fall into the exception category by default since I am allergic to the AED's. I liked the mood stabilizing effect of Lamictal but I got a severe rash (even using the low and slow dosing required with Lamictal). Depakote also caused a rash and a bunch of other stuff like weight gain, depression, hair loss, etc.
>I've never had acute mania-in fact, I don't ever recall having a manic episode, but he thinks I am BP. Does anyone know if Lithium can be used for milder BP disorder? If so, does anyone have any succes stories?
Yes, I'm BP II and I've been on Lithobid for almost three years. Lithobid is the only brand of lithium that I have tried. It is time-released and gentle on the stomach. It works well for me as a mood stabilizer, however, it does not help my depression. As a result, I have spent the past three years trying various AD's hoping to find one that would work long-term with minimal side effects and no poop-out. I discuss this AD issue more fully in my prior posts linked below, which I encourage you to read. The bottom line, however, is that what ends up being the answer for me is SAM-e (a prescription medication in Europe but an OTC in the US).
>I would love to once and for all be stabilized without constantly switching from one cocktail to the next for the rest of my life!
I hear ya! I had almost lost hope for this vision until my pdoc put me on SAM-e.
>Finally, I'm aware of the need for monitering and blood checks while on Lithium, but is it safe and effective at the right dose?
I think so. There are some data that support the position that Li is actually neuroprotective (i.e. it's actually good for the brain). For maintenance purposes, the desirable serum lithium levels of bipolar patients are 0.6 to 1.2 mEq/l. For BP II patients, my pdoc shoots for the 0.6 mEq/l level. I prefer these lower levels because patients unusually sensitive to lithium may exhibit toxic signs at serum levels around 1.0 mEq/l. That's not the usually case, of course, but I like to play it safe. As far as on-going monitoring goes, it’s not like you're running to the hospital vampire every other day. Once the pdoc gets your dose adjusted, your serum lithium levels typically do not change much provided your dose stays constant. You will want to monitor your thyroid (TSH, T2, T3, etc.) and it might be beneficial to get a baseline thyroid blood test for subsequent comparative purposes.
>Does it help depressive states characterized by apprehension, social phobia, and irritability?
>Sorry, I forgot to add my last question. It seems that my main trouble with SSRI's was that they'd make me emotionally numb, which would in turn cause me to turn to alcohol and drugs to FEEL something. Likewise, depakote and neurontin stabilized me, but below the normal level, so I was as a result more depressed and withdrawn (what I call the 'wet blanket effect'). This doctor Klein told me that Lithium is different-that it really evens out the mood without unwanted sedation or emotional numbness. Has anyone seen this to be the case with Lithium?
Read the linked posts below regarding the emotional blunting issue.
Here are the two prior posts I'd like you to read:http://www.dr-bob.org/babble/20020313/msgs/97982.html
http://www.dr-bob.org/babble/20020318/msgs/98710.html
Here are a couple more good articles I came across:http://www.iherb.com/same2.html
poster:Ron Hill
thread:98867
URL: http://www.dr-bob.org/babble/20020318/msgs/98909.html