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re: lithium, ECT, etc.

Posted by ed_uk on October 31, 2004, at 12:21:48

In reply to re: lithium, ECT, etc. » ed_uk, posted by CareBear04 on October 31, 2004, at 10:33:57

Hello!
I think you will find psychobabble helpful, but only once people understand enough about you to make some sensible suggestions.

Just a few more questions, hope you don't mind..

1. Why are you taking three benzos all at once? Were they all prescribed by different doctors?
You might be better off just taking one benzo on its own but at a higher dose. Some people find that benzos make them more depressed, is this a problem for you? You definately need to make sure that all your doctors know what the other docs have prescribed. That way they can check for drug interactions.

2. Did your contraceptive pill worsen your mood?

3. Were you taking any other meds at the time your lithium level went through the roof? If you were there could have been an interaction.

A few suggestions....

1. Have you ever had a creatinine clearance test to evaluate your kidney function? Perhaps it would be helpful to have one if you haven't already. If it was normal your pdoc might be willing to start you back on a low dose of lithium (with frequent monitoring of blood levels of course). I get the impression the lithium was really helping, am I right? Since lithium itself can impair kidney function when the blood concentration is high this may explain why your Li level went up even though your dose had been reduced. If your kidney function was impaired, the Li may have been accumulating in your body despite the decrease in dose. Although Li sometimes causes permanent damage to the kidneys this is not likely to have occured in your case. Your kidney function has probably returned to normal now that you've been off the Li for a while. If so, you might be able to tolerate a small dose of Li well. Just be sure to keep your blood Li level well below 1 mmol/litre. Some people do well with Li levels as low as 0.4. It's very important to determine the optimum Li level for each individual patient. Some people need much higher/lower levels than others to get the best effect.

2. Please be really careful not to overdose on your pain meds. Be sure never to take more than 4g (4000mg) of acetaminophen/paracetamol/APAP in any 24 hour period. Never take more that 1g (1000mg) of acetaminophen at once and make sure you leave at least four hours between doses. I was worried that you might be taking doses of vicodin, darvocet and percocet at the same time. So long as you take care not to overdose you should be fine.

3. Hydroxyzine (Vistaril) is commonly used for anxiety, itchy skin or for the relief of nausea/vomiting.

4. Bear in mind Reglan occasionally causes restlessness and emotional distress as side effects.

5. Propranolol sometimes causes depression. Do you find this to be a problem for you?

6. I think it's a bit early to consider ECT. Sadly, some people do report permanent memory loss as a side effect. The antidepressant effect of ECT usually wears off about 4 weeks after the last session. I tend to see ECT as a last resort, the Lamictal could be more helpful in the long run.

Ed


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poster:ed_uk thread:409440
URL: http://www.dr-bob.org/babble/20041029/msgs/409571.html