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Re: Lithium and mixed states cache-monkey

Posted by Ritch on March 5, 2005, at 0:01:21

In reply to Lithium and mixed states, posted by cache-monkey on March 4, 2005, at 13:28:44

> Hey folks,
> I've recently been diagnosed with likely soft bipolar. Depression and anxiety are predominant features when I'm "not feeling well". But I've gone through long and short stretches of feel really great (hypo-hypomanic). Add on a strongly hypomanic response to an SSRI and the DX makes sense.
> I tried Lamictal, but it ended up destabilizing me, plus there were some other side effects that led me to stop. My doctor has me on lithium right now. Was at 600 mg/day, but only got a Li+ level of 0.22, so well below the therapeutic range. We're going to keep pushing up on the Lithium, as I've had no adverse effects yet.
> I think Lithium is potentially good for the depressive side to my downs, and maybe some of the ups that are too up.
> I'm starting to think, though, that maybe what I've been experiencing as "anxiety" is actually a "mixed state". I'm on Klonopin (1.5 mg/day) to deal with that, but I'm not finding it fully effective.
> My understanding is that Lithium is less likely to work in people with mixed states predomninant. (Depakote being the drug of choice there.) But, what I'm wondering is whether it does sometimes (often?) work for people with strong mixed states.
> I guess I'll only know once I hit the therapeutic window with Lithium, but if anyone out there has an experience to share, I'd be much obliged.
> Thanks,
> cache-monkey

Give the lithium a shot well into therapeutic range first for several weeks and see how it works for *you*. It might work quite well. Just because you get mixed stuff doesn't mean it wouldn't work. One thing that I have found for sure... is that there is MORE trouble with *offending* substances and meds aggravating and triggering "mixed" symptoms than there is a lack of efficacy in *treating* those symptoms. Gotta watch what else you are taking with the antimanic (in this case lithium) and chart it carefully. I did rather well on lithium and diazepam for several years at a subtherapeutic dose. If I could have *tolerated* a higher Li dose with the diazepam (w/o AD's or AP's), it might have worked better than Depakote + clonazepam that I now take currently. I can throw in an SSRI with either antimanic and I get mixed stuff (IF the SSRI goes above a very tiny low threshold dosage).




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