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Re: Lithium levels Markwell

Posted by SLS on July 15, 2021, at 9:58:13

In reply to Lithium levels, posted by Markwell on July 14, 2021, at 10:37:45

> I am currently on 900 mgs of lithium for BPD. I am currently 65 years old and have been on this amount for 5 years. I am afraid of developing a kidney issue as I age and continue on this dose. The lithium has been effective for me and I do horribly with AP's. One doctor suggested dosing once in the evening to help the kidneys. I also read where patients over 65 can use less dosage. Any thoughts or insights?
> Mark

What dosage of lithium do you take?

Your doctor is right about taking one dose at night.

Kidney issues are dosage-dependent. If you are not sure what the minimum dosage of lithium that produces the same degree of improvement you have now, you can SLOWLY titrate downward.

Have regular blood tests for kidney and thyroid function. This should prevent damage and ease your mind.

Can you describe your symptoms? Any mania at all? Any rapid cycling? When you were ill, was morning the worst time of day for you? What about early-morning awakenings? Psychomotor retardation? Constant melancholic thoughts?

All in all, depending on your current dosage, I think you should stay on lithium at and follow up with regular blood tests if you are concerned - which you should be.

If bipolar depression is your only problem, you can consider substituting lamotrigine for lithium. If you experience a mild response or a brief strong response to lamotrigine alone, I would then begin trialing antidepressants. Avoiding antidepressants to treat bipolar depression is a school of thought that should be buried.

If mania is a persistent problem, valproate (Depakote) or oxcarbazepine (Trileptal) should be considered. , probably should be a consideration. Levetiracetam (Keppra)is a strange one. It was studied, perhaps 20 years ago, for bipolar disorder. It was reported to treat rapid-cyclicity, but I don't know what follow up work has been done since.

Unfortunately, lithium sometimes displays "lithium-induced lithium refractoriness". That's a fancy term. Simply put, when someone who was kept well for many years on lithium discontinues it, it doesn't work when it is restarted to treat a relapse. That happened to a friend of mine. She was in remission of 8 years on lithium alone. When a new doctor had her stop taking it, she relapsed into depression three weeks later. Restarting Lithium didn't work at all. She has been treatment resistant for at least 30 years.

If you indeed have Unipolar Major Depression, you might think about trying to lower your dosage of lithium (gradually) to 300-450 mg/day and ignore blood levels. Lithium displays a bimodal (biphasic) response. At low dosages, it helps with depression without helping mania. At higher dosages, it helps mania, but can make depression worse. Perhaps not so coincidentally, lithium displays a bimodal pattern for regulating glutamate levels. Low dosages inhibit glutamate activity while high dosages increase it. My own experience with lithium bipolar depression reflect this bimodal behavior. 300 mg/day. 450 mg/day produces dysphoria, emotional numbing, and apathy.

I hope this was helpful.

- Scott

Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.




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