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Re: Lithium in suicide prevention -- short review Jay2112

Posted by SLS on February 5, 2023, at 11:05:42

In reply to Re: Lithium in suicide prevention -- short review SLS, posted by Jay2112 on February 4, 2023, at 19:26:10

Hi, Jay.

> > When I took lithium at high dosages, I felt passive. I wonder if passivity is a component of its anti-suicide properties.

> ...my father died of kidney disease, and I watched him wither on dialysis till the very end. I absolutely do not want to die that way.


I'm sad to hear that.

Harvard used 300-600 mg/day of lithium in their investigations using it as an adjunct to Prozac. 450 mg/day did significantly better than 600 mg/day. My dosage window of lithium is very narrow.

150 mg/day = No response
300 mg/day = Remission
450 mg/day = Relapse

I get the feelings that 600 mg/day is really too high to be effective when using a low-dosage strategy. As an experiment, you could decrease your lithium dosage to 450 mg/day for no longer than 2 weeks. For many people, an improvement emerges in less than a week. If you feel worse, then I guess 600 mg/day or higher will work best for you. The idea is, of course, to find the minimum effective dosage in order to prevent further kidney damage and spare the thyroid. If, however, you feel no worse at 450 mg/day, but have not improved adequately after 1-2 weeks, then reduce the dosage to 300 mg/day and see what happens. If you relapse along the way, you will have found your lowest effective dosage. It equals the dosage of one step above the dosage that allowed you to relapse.

Your dosage of lamotrigine (Lamictal) is unusually high when treating mood disorders. My impression over the years has been that most people respond to 200 mg/day. A minority need to raise the doage to 300 mg/day. Lamotrigine is different from lithium in that it doesn't lose its effectiveness when you go higher than the lowest effective dosage. The only repercussions that I can think of is that you might experience the onset of cognitive and memory impairments or their exacerbation. However, I don't think you can judge so early in treatment as to whether or not these side-effects will resolve after being on the drug for a few months. They could also be start-up side effects that disappear rather quickly. With me, they emerged at 100 mg/day, but mitigated over time at 300 mg/day. The memory and cognitive impairments that I experienced early in treatment have disappeared entirely. Currently, lamotrigine is a staple for treating bipolar depression. I haven't looked for a study that compares the efficacy of lamotrigine in treating unipolar depression versus bipolar depression.

If you take a generic lamotrigine, which company's product are you currently using?

Which company have you found to be best?

Teva pharmaceuticals makes a version of lamotrigine that they call "Lamotrigine XR". Do you know anything about it?

Thanks.


- 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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