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Re: CYMBALTA ratings 1-10, and effects on anx and dep » Cindy Lou

Posted by barbaracat on March 28, 2005, at 22:02:29

In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep » barbaracat, posted by Cindy Lou on March 27, 2005, at 21:50:24

Dear Cindy,
I'm not a doctor, but hopefully I can help out by thinking some of this through with you.

> I take Lithium, but I'm having a hard time figuring out what dose to take. I was taking 450 mg. for several months, but having bad gastrointestinal issues (went through a CAT scan and the whole works since my doctor thought it was a gallbladder issue.) I am thinking the stomach issues were from the Lithium, since they started around the time I started taking it.

**Lithium can cause stomach upsets but unless you're exceptionally sensitive to it, 450mg is not a significant dose.

>>Also, I tried taking up to 1200 mg. of the Lithium for awhile (before the stomach issues), but was having toxic symptoms even though my blood levels were normal. For us med-sensitive people, could it be that our blood levels do not reflect what is really going on?

**The therapeutic range is based on the average of a sample population. But therapeutic for anti-manic has no relation to toxicity for you in particular if something else is going on. For example, was recently talking with cache-monkey on this board who had started lithium and was doing well on 900mg but wasn't at the therapeutic level. His doctor pushed him up to 1200mg and he started developing urinary problems not uncommmon with lithium toxicity.

Whether or not he had a urinary tract weakness before this isn't clear, but this higher dose of lithium, even though it wasn't even in therapeutic, much less toxic range, caused a potentially dangerous condition to surface.

For me, 600mg is plenty, although I'm well below the therapeutic range. Any more than that doesn't improve anything and leaves me with tremors and nausea. We're all unique in our chemistry and those numbers are simply averages. It seems to me that the patient's response and not the numbers should dictate the dosage. I suspect that in your case, more is going on health-wise than sensitivity to lithium, although lithium can cause strange interractions that affect some people and not others.
>
> Here's another issue -- since you have a science background, maybe you can help me figure this one out: When I had a CBC recently, I was shown to have "atypical lymphocytes" and "slightly elevated amalyse." Would that have anything to do with the Lithium? My doctor thought I might have Mono.

**Increased or atypical size lymphocytes show a viral infection and are a typical marker of mono, which is caused by the Epstein Barr virus. Amylase is an enzyme that breaks down bile from the liver to the gallbladder and so gall stones may be a cause, but pancreatitis is another thing to look out for since this enzyme usually shows up in pancreatic problems. If your lipase enzymes are also elevated, this would be even more an indication of pancreatic involvement. Since pancreatitis is not a viral but an inflammatory condition, you'd see other markers like high monocytes and white blood count instead of the lymphocyte count.

So this suggests a viral infection that involves liver function (amylase is a liver enzyme). This certainly sounds like mono since mono involves liver function and the two together are suspicious. But other things involve liver and viral, such as Hepatitis.

Another thing to have checked is for tick borne Lyme Disease, which can show these two elevated markers and can cause alot of neurological symptoms. Hopefully, its just mono cause that's not a a biggie to recover from, but you've GOT to really chill out and recover because it can get much worse and compromise liver function for a long time. I had it when I was 18, didn't take care of myself and ended up quite sick for months.
>
> I also seemed to feel a bit more irritable/agitated on the Lithium (and felt the same way on Lamictal when I tried it in the past.) They almost make me feel more volatile rather than stable.

**I felt activated on Lamictal everytime I increased it but can't say I've felt edgy on Lithium. I'm trying to remember how it was when I had tremors from it - maybe 'off' because it was just too much, but not volatile.
>
> Still, I don't want to give up on the Lithium since my pdoc thinks it will help keep the other meds from pooping out on me (which happens all the time.)

**Whatever is going on that's showing up in your blood work has to be dealt with before anyone can expect lithium or any other mood med to make a lasting difference. If you have mono even at a low level, you're going to feel abolutely rotten. Tired, overwhelmed, irritable, depressed. One way or another, your liver seems to be involved. The liver metabolizes many of our meds so if there's something going, detoxification will be affected.

Lithium is excreted through the kidneys, not the liver, so slower liver detox wouldn't be involved with higher circulating levels, but meds that depend upon the kidneys for excretion may be affected. Lithium can throw off electrolyte levels and this can affect enzymes, one of which is - ta da - amylase! So, it's a real sleuth job to untangle all this.

However, the liver is probably the biggest player and if anything's going on with it, the whole body suffers. All kinds of hormonal systems depend on cholesterol metabolism via the liver and hormones are the chemical messengers throughout the body and brain. The liver is also the seat of anger and depression in Chinese medicine. So, my girl, your physical health has to come first right now.

I'd love to talk more with you about this, suggestions how to deal with it, but since it's off topic on this board, how would you feel about using Babble mail? You can just click on my 'Posted by' name and we can chat about this offline and it'll still be anonymous. - Barbara


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