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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by JohnX2 on March 10, 2002, at 2:04:02
Hi,
I'm BPII. I was thinking about adding a pinch
of Lithium to my cocktail:Lamictal 150 mg
Serzone 300 mg
Topamax 400 mg
Klonopin 1 mgto see if will smooth out some agitation/cycling and make me more happy-go-lucky.
(Maybe I can back out other meds later too).My doctor has been dropping subliminal hints
about lithium ever since I've seen him....and
I'm off work.....so I don't see the harm in trying
it for a bit.I want to get away with the lowest dosing
schedule possible if I do this since I don't
have side effects from my medicines as is.So what do I need to do? And what should I
expect? (I know, I really should dig through
old posts and links. I'm tired..sorry).Thanks,
John
Posted by Ritch on March 10, 2002, at 14:29:49
In reply to question about Lithium augmentation to Lamictal, posted by JohnX2 on March 10, 2002, at 2:04:02
> Hi,
>
> I'm BPII. I was thinking about adding a pinch
> of Lithium to my cocktail:
>
> Lamictal 150 mg
> Serzone 300 mg
> Topamax 400 mg
> Klonopin 1 mg
>
> to see if will smooth out some agitation/cycling and make me more happy-go-lucky.
> (Maybe I can back out other meds later too).
>
> My doctor has been dropping subliminal hints
> about lithium ever since I've seen him....and
> I'm off work.....so I don't see the harm in trying
> it for a bit.
>
> I want to get away with the lowest dosing
> schedule possible if I do this since I don't
> have side effects from my medicines as is.
>
> So what do I need to do? And what should I
> expect? (I know, I really should dig through
> old posts and links. I'm tired..sorry).You could start off with 300mg generic immediate release lithium tabs that are scored and just take 1/2 tablet at bedtime. I found it always helped me sleep. You might feel a little *foggy* when you get up. You might notice an increased need to urinate-drink water (polyuria/polydyspia). You might notice some deep muscle tendon "thumps" esp. in your legs. I always noticed a mild "okeedokee" SSRI-like feeling from it. It settles you down, you shouldn't feel as restless. If you are feeling a little paranoid it will chill that out. It would be worth a try,
Mitch
Posted by Bob on March 10, 2002, at 16:44:35
In reply to Re: question about Lithium augmentation to Lamictal » JohnX2, posted by Ritch on March 10, 2002, at 14:29:49
> You could start off with 300mg generic immediate release lithium tabs that are scored and just take 1/2 tablet at bedtime. I found it always helped me sleep. You might feel a little *foggy* when you get up. You might notice an increased need to urinate-drink water (polyuria/polydyspia). You might notice some deep muscle tendon "thumps" esp. in your legs. I always noticed a mild "okeedokee" SSRI-like feeling from it. It settles you down, you shouldn't feel as restless. If you are feeling a little paranoid it will chill that out. It would be worth a try,
>
> Mitch==================================================
Mitch:
Two questions:
1 - What is a deep muscle tendon "thump"???
2 - When you say that Lithium gives you an "okee-dokee" feeling, are you saying that it gives you a little apathy?
Bob
Posted by Ritch on March 10, 2002, at 17:43:52
In reply to Re: question about Lithium augmentation to Lamictal » Ritch, posted by Bob on March 10, 2002, at 16:44:35
>
> > You could start off with 300mg generic immediate release lithium tabs that are scored and just take 1/2 tablet at bedtime. I found it always helped me sleep. You might feel a little *foggy* when you get up. You might notice an increased need to urinate-drink water (polyuria/polydyspia). You might notice some deep muscle tendon "thumps" esp. in your legs. I always noticed a mild "okeedokee" SSRI-like feeling from it. It settles you down, you shouldn't feel as restless. If you are feeling a little paranoid it will chill that out. It would be worth a try,
> >
> > Mitch
>
> ==================================================
>
> Mitch:
>
> Two questions:
>
> 1 - What is a deep muscle tendon "thump"???
>
> 2 - When you say that Lithium gives you an "okee-dokee" feeling, are you saying that it gives you a little apathy?
>
> Bob
Oh, the thumps. You know what your muscles do after you have run a mile or two and then cool down and stop? You get that little triggering that continues to fire and you will get these whole muscle "twitches". I call them "thumps" because it is like the entire muscle contracted at the same time.Oh, the "okeedokee" thing. It isn't as good as "allrightee", but it isn't really the apathy part of an SSRI-it is really more like feeling settled, calm, kicked-back. Something other than dashing about like a spider monkey. :-)
Mitch
Mitch
Posted by Chloe on March 10, 2002, at 20:10:03
In reply to question about Lithium augmentation to Lamictal, posted by JohnX2 on March 10, 2002, at 2:04:02
John,
I am surprised, but so glad you have decided to *consider* adding a bit of Li to your mix.For BP2, doses never get toward the toxicity range, and I think the side effeects are quite tolerable.
I highly recommend extended release preparations, as they tend to cause less tremor, nausea, and flucuations in blood levels. I am able to break a 450 mgs Eskilith Controlled release into 4 quarters, taking only 112.5/day. But my recommendation would be to try the Lithobid formula that comes in 300 mgs tabs. That preparation is enteric coated so it isn't even digested in the stomach, hence no nausea/gi upset. 300 mgs is a pretty small dose, and you might adjust to that nicely.
I find li has some nice AD properties and I usually notice that effect within a day or two. I can relate to Mitch's "Okeedokee"! And I also find it calming in a way that allows me to focus and tune out unnecessary noise/"crap" that would normally truly annoy me. It may take a week or so to kick in. But definitely worth trying, IMHO. It's nothing like Mercury! LOL. ;)
Please keep us informed.
Chloe
Posted by JohnX2 on March 11, 2002, at 0:47:42
In reply to question about Lithium augmentation to Lamictal, posted by JohnX2 on March 10, 2002, at 2:04:02
Hi Gang,Thanks a lot for your support.
Everyone has been so helpful. It's been such
a long journey. I'm surprised I made it this far.I've shunned Li and have also toyed with the
nortriptyline idea for quite a while.My pdoc is very gung-ho Li and against anti-depressants.
We worked hard to avoid AD add ons, but I wasn't
surviving due to chronic myofacial pain and Serzone
had a history of fixing it. So when we dosed it in
and subtracted Zyprexa (which was giving dystonia)
my headaches improved, and frankly my mood has been
better. But my agitation is still a bit bad. So what
I need is "CALM". Sounds like this is what Li
may deliver.I also don't know, and you've given some suggestions
like nortriptyline, if my agitation may be ADD like
related. The big debate. Also I've been told that
some tri-cycs can be good for pain. So I don't know
if the low dose nortriptypline would be good to
contemplate sometime?Anyways, I think my pdoc will just about drop
dead if I mention lithium. Maybe I should buy
some heart defibulators? Do you know where I can
pick some up?Thanks,
John
> Hi,
>
> I'm BPII. I was thinking about adding a pinch
> of Lithium to my cocktail:
>
> Lamictal 150 mg
> Serzone 300 mg
> Topamax 400 mg
> Klonopin 1 mg
>
> to see if will smooth out some agitation/cycling and make me more happy-go-lucky.
> (Maybe I can back out other meds later too).
>
> My doctor has been dropping subliminal hints
> about lithium ever since I've seen him....and
> I'm off work.....so I don't see the harm in trying
> it for a bit.
>
> I want to get away with the lowest dosing
> schedule possible if I do this since I don't
> have side effects from my medicines as is.
>
> So what do I need to do? And what should I
> expect? (I know, I really should dig through
> old posts and links. I'm tired..sorry).
>
> Thanks,
> John
Posted by Zo on March 12, 2002, at 2:47:25
In reply to question about Lithium augmentation to Lamictal, posted by JohnX2 on March 10, 2002, at 2:04:02
Why not cut back on the Topamax? Since it commonly makes people edgy--and I should think Li would be a sort of crude tool compared to Lamictal.Just a thought,
Zo
Posted by Zo on March 12, 2002, at 2:50:35
In reply to Re: thanks and follow up, posted by JohnX2 on March 11, 2002, at 0:47:42
Plus your Lamictal dose is really low--is that for a reason?I'm a great believer in fiddling with one's existing meds until they just can't be fiddled with any more. . .
If you want something mellowing, try Neurontin! Whoo.
Zo
Posted by JohnX2 on March 12, 2002, at 5:31:32
In reply to Re: question about Lithium augmentation to Lamicta » JohnX2, posted by Zo on March 12, 2002, at 2:47:25
Hi Zo,
Less Topamax?
I honestly can't say what topamax has done beyond
helped with myofacial pain. If serzone zapped this
then I could dump Topamax. Serzone worked for this
in the past.Now one thing that is interesting is that my latest
agitation/hypomania really did start post topamax.
But this was concomitant with dropping my klonopin
dose, so our feeling was that it was the klonopin
was destabiling me (Zyprexa was used to fight mania).
This was confirmed when I stopped tapering klonopin;
the bad hypomania subdued.Problem I have with Lamictal is without Serzone/Topamax
I am stuck at 150 mg. If I push the Lamictal dose higher, it exacerbates
my myofacial pain (and numbs my emotions out in a weird way).
I don't know why. I didn't say on the pamphlet.It's possible that with a decent Serzone dose that I could push the
Lamictal higher for more mood stabilization. That would be nice...
cut things down to 2 meds. I've tried this bump Lamictal over 150 mg
strategy many times and it always bombs. But then again
maybe you are suggesting subtracting Topamax may relieve
the agitation as opposed to induce hypomanic symptoms (and stay
with lamictal 150mg ?I really have been on this "find the magic elixer"
which fixes my mood with little "intrusion", and have done
quite well to date. Hate to spoil it. ;(
But I won't know how much I'm trading off
feeling better unless I try alternatives...Argh.
Thanks for sharing your thoughts. I really need
to talk to my pdoc about this residual agitation.
The headaches HAVE to go (well, they are gone, they
must stay that way).Sorry...I ramble.
Best wishes,
John
>
> Why not cut back on the Topamax? Since it commonly makes people edgy--and I should think Li would be a sort of crude tool compared to Lamictal.
>
> Just a thought,
> Zo
This is the end of the thread.
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