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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 34. This is the beginning of the thread.
Posted by cybercafe on March 5, 2003, at 23:32:42
just wondered how it compared to SSRIs
or perhaps Zyprexa?
Posted by Ritch on March 6, 2003, at 9:58:43
In reply to how is lithium for depression?, posted by cybercafe on March 5, 2003, at 23:32:42
> just wondered how it compared to SSRIs
> or perhaps Zyprexa?I was off all meds once and floundering in a really nasty depression (for several weeks) and started 600mg/day and I was in remission within two weeks. I don't know if it would help a unipolar depressive as well. It doesn't zonk you out like an AP can. Doesn't cause startup agitation like an SSRI. I still couldn't do lithium monotherapy and feel relief from depression. It just went from "moderate" to "mild".
Posted by Ron Hill on March 6, 2003, at 10:11:18
In reply to how is lithium for depression?, posted by cybercafe on March 5, 2003, at 23:32:42
Hi Cybercafe,
> just wondered how it compared to SSRIs
> or perhaps Zyprexa?I have been taking 600 mg/day of Lithobid for more than three and one-half years. It is a good moodstabilizer for me but it provides little or no benefit for the depressive phase of my BPII disorder. However, I often see references in the literature to lithium's positive AD properties, so it must provide AD benefit to some patients. As a side note, Enada NADH is currently doing a remarkable job treating the depressive side of my BPII, but that’s a topic for another thread.
I see your question for Dr. Bowden in an earlier thread. His latest research results shows lithium to have rather poor AD efficacy compared to Lamictal. If you haven’t already watched his Ground Rounds presentation wherein he discusses these data, you might find it worthwhile:
http://psychiatry.uchicago.edu/grounds/030303/
-- Ron
Posted by Ritch on March 6, 2003, at 13:21:59
In reply to Re: how is lithium for depression? » cybercafe, posted by Ron Hill on March 6, 2003, at 10:11:18
> I see your question for Dr. Bowden in an earlier thread. His latest research results shows lithium to have rather poor AD efficacy compared to Lamictal. If you haven’t already watched his Ground Rounds presentation wherein he discusses these data, you might find it worthwhile:
>
> http://psychiatry.uchicago.edu/grounds/030303/
>
> -- Ron
>
Ron, I saw the slides but didn't *hear* the presentation (slow-speed connection). I asked a question about the chart he had where it showed rapid cyclers showing a worsened response to lithium, but improved response to valproate. My question was *why* that was the case. Did he mention why during the presentation (if you listened to the whole thing-and you don't mind responding)?thanks for any help
Posted by Ron Hill on March 6, 2003, at 14:23:57
In reply to Re: how is lithium for depression? » Ron Hill, posted by Ritch on March 6, 2003, at 13:21:59
Hi Mitch,
> Ron, I saw the slides but didn't *hear* the presentation (slow-speed connection). I asked a question about the chart he had where it showed rapid cyclers showing a worsened response to lithium, but improved response to valproate. My question was *why* that was the case. Did he mention why during the presentation (if you listened to the whole thing-and you don't mind responding)?
I watched and listened to the web cast archive, but I don't recall Dr. Bowden providing a possible explanation for the differing responses of rapid cyclers to lithium verses Depakote. Therefore, I also am eager to read his response to your question.
-- Ron
Posted by linkadge on March 6, 2003, at 17:57:24
In reply to Re: how is lithium for depression? » Ritch, posted by Ron Hill on March 6, 2003, at 14:23:57
I know its effective for mania,
how good is it for depression ?
Better than lithium ??
Linkadge
Posted by Ron Hill on March 6, 2003, at 18:49:50
In reply to Can depakote elevate mood?, posted by linkadge on March 6, 2003, at 17:57:24
Hi Linkage,
> I know its effective for mania,
> how good is it for depression ?
> Better than lithium ??The answer depends on who you ask. For me, Depakote worsened my depression (and caused hair loss, rashes on my body, and a 30 pound weight gain). Lithium does not help my depression, but it does not make it worse. YMMV.
As a side note, I'm in the sixth week of an Enada NADH trial for treatment of my BPII atypical depression. So far the results are remarkable. However, time will tell regarding its long-term efficacy.
-- Ron
Posted by cybercafe on March 6, 2003, at 21:42:41
In reply to Re: how is lithium for depression? » cybercafe, posted by Ritch on March 6, 2003, at 9:58:43
> > just wondered how it compared to SSRIs
> > or perhaps Zyprexa?
>
> I was off all meds once and floundering in a really nasty depression (for several weeks) and started 600mg/day and I was in remission within two weeks. I don't know if it would help a unipolar depressive as well. It doesn't zonk you out like an AP can. Doesn't cause startup agitation like an SSRI. I still couldn't do lithium monotherapy and feel relief from depression. It just went from "moderate" to "mild".
>thanks for responding
i hear zyprexa works for depression, but doesn't seem to be doing too much for me
...i wonder if lithium would do more for the depression, and interfere less with ritalini wonder how much 2.5 mg of zyprexa effects ritalin ... doesnt' seem like too much
Posted by cybercafe on March 6, 2003, at 21:44:03
In reply to Re: how is lithium for depression? » cybercafe, posted by Ron Hill on March 6, 2003, at 10:11:18
> Hi Cybercafe,
>
> > just wondered how it compared to SSRIs
> > or perhaps Zyprexa?
>
> I have been taking 600 mg/day of Lithobid for more than three and one-half years. It is a good moodstabilizer for me but it provides little or no benefit for the depressive phase of my BPII disorder. However, I often see references in the literature to lithium's positive AD properties, so it must provide AD benefit to some patients. As a side note, Enada NADH is currently doing a remarkable job treating the depressive side of my BPII, but that?s a topic for another thread.
>
> I see your question for Dr. Bowden in an earlier thread. His latest research results shows lithium to have rather poor AD efficacy compared to Lamictal. If you haven?t already watched his Ground Rounds presentation wherein he discusses these data, you might find it worthwhile:
>
> http://psychiatry.uchicago.edu/grounds/030303/
>
> -- Ron
>thanks for responding Ron
I know lamictal initially seems like a good drug, but it seems to poop out for most, no?
Posted by Ritch on March 6, 2003, at 22:11:08
In reply to Can depakote elevate mood?, posted by linkadge on March 6, 2003, at 17:57:24
> I know its effective for mania,
> how good is it for depression ?
> Better than lithium ??
>
>
> LinkadgeDepakote *aggravates* my recurrent seasonal atypical major depressions compared to lithium (because it intensifies the somnolence and appetite probs), however during the remainder of the year when I am clearly rapid-cycling, sudden intense crashes seem to be lessened compared to lithium (I guess that would be some kind of ultradian feature). The only time I have noticed a mood "elevation" with it is the first day or two I increase the dose in response to bad anxiety/agitation. So I attribute that to a temporary mood elevation due to anxiety reduction.
Posted by Ritch on March 6, 2003, at 22:18:19
In reply to Re: how is lithium for depression?, posted by cybercafe on March 6, 2003, at 21:42:41
> > > just wondered how it compared to SSRIs
> > > or perhaps Zyprexa?
> >
> > I was off all meds once and floundering in a really nasty depression (for several weeks) and started 600mg/day and I was in remission within two weeks. I don't know if it would help a unipolar depressive as well. It doesn't zonk you out like an AP can. Doesn't cause startup agitation like an SSRI. I still couldn't do lithium monotherapy and feel relief from depression. It just went from "moderate" to "mild".
> >
>
> thanks for responding
>
> i hear zyprexa works for depression, but doesn't seem to be doing too much for me
> ...i wonder if lithium would do more for the depression, and interfere less with ritalin
>
> i wonder how much 2.5 mg of zyprexa effects ritalin ... doesnt' seem like too muchI would ask your doctor about the idea. It makes good sense to me. Lithium has better antipsychotic properties than the antimanic AED's.
Posted by Ron Hill on March 6, 2003, at 22:49:37
In reply to Re: how is lithium for depression?, posted by cybercafe on March 6, 2003, at 21:44:03
Cybercafe,
> I know lamictal initially seems like a good drug, but it seems to poop out for most, no?
I've not heard this before, nor have I read this in the literature. That doesn't mean that Lamictal poop-out doesn't exist, but simply that I am not aware of it.
I did a short trial of Lamictal several years ago and I really liked the way the medication felt in my brain. However, I developed a bad rash and, therefore, I discontinued the trial.
-- Ron
Posted by KrissyP on March 7, 2003, at 23:05:03
In reply to Can depakote elevate mood?, posted by linkadge on March 6, 2003, at 17:57:24
Hiya,
I was told that Lithium is the #1 med to balance out mania, I can't take it-I'd gain too much weight-with it being a SALT and all. I gained 30 Lbs in a month on Depakote, and I was losing globbs of hair-NOT FUN.
Just my experience..........
Good luck
Kristen------------------------------------------------- I know its effective for mania,
how good is it for depression ?
Better than lithium ??
Linkadge
Posted by BarbaraCat on March 8, 2003, at 21:26:50
In reply to how is lithium for depression?, posted by cybercafe on March 5, 2003, at 23:32:42
Lithium acts as an augmenter but doesn't have enough punch to act on it's own. It's like a magic potentiator for other meds. None of my ADs work without i. On it's own it's nothing but I really notice it when I don't take it and quickly spiral into an agitated mixed states depression. I'm taking Nortryptaline and lamictal in addition. Lamictal and lithium were not enough to cope with a severe suicidal depression after my mom was killed, hence the Nortrypt. So far, they're all working like a charm. The sum is better than the parts. - Barbara
Posted by JaneB on March 9, 2003, at 7:02:05
In reply to Re: how is lithium for depression? » cybercafe, posted by BarbaraCat on March 8, 2003, at 21:26:50
Posted by BarbaraCat on March 9, 2003, at 16:09:59
In reply to How much of each med? (nm) » BarbaraCat, posted by JaneB on March 9, 2003, at 7:02:05
Here's my brew:
AM
300mg Lithium
50mg LamictalPM
300mg Lithium
25mg Lamictal
75mg NortriptylineI start destabilizing after a few days off Lithium. 600mg is a pretty paltry dose but I was concerned about it because it's made my hypothyroid condition worse. I obviously need it for my BPII. Don't know if I can do without Lamictal yet. I'll try to titrate down once the stress of handling my Mom's estate is over with.
Nortriptyline has been the greatest blessing of all. It's been a miracle med for me - an old tricyclic workhorse of all things! I've been on all the SSRI's and SNRI's never thought I'd 'stoop' to something not on the cutting edge. I'm also taking a load of vitamins and now that I'm feeling better am able to exercise everyday. Exercise is without doubt the most potent antidepressant but when I'm seriously feeling like poo-poo it's the last thing I can manage.
Posted by JaneB on March 9, 2003, at 18:25:40
In reply to Re: How much of each med? » JaneB, posted by BarbaraCat on March 9, 2003, at 16:09:59
> Here's my brew:
>
> AM
> 300mg Lithium
> 50mg Lamictal
>
> PM
> 300mg Lithium
> 25mg Lamictal
> 75mg Nortriptyline
>
> I start destabilizing after a few days off Lithium. 600mg is a pretty paltry dose but I was concerned about it because it's made my hypothyroid condition worse. I obviously need it for my BPII. Don't know if I can do without Lamictal yet. I'll try to titrate down once the stress of handling my Mom's estate is over with.
>
> Nortriptyline has been the greatest blessing of all. It's been a miracle med for me - an old tricyclic workhorse of all things! I've been on all the SSRI's and SNRI's never thought I'd 'stoop' to something not on the cutting edge. I'm also taking a load of vitamins and now that I'm feeling better am able to exercise everyday. Exercise is without doubt the most potent antidepressant but when I'm seriously feeling like poo-poo it's the last thing I can manage.I'm having a real hard time with Lexapro. My daughter keeps telling me nortriptyline worked great for her during postpartum but she couldn't continue beause of weight gain. Therefore, I have been afraid to try it. Why was the Lamictal added and why do you want to discontinue it? I tried it once briefly and couldn't tolerate it (headaches and nightmares.) I have really given the Lexapro a fair trial (since Dec.) I'm needing an alternative. Doctor suggested adding Neurontin but it makes me so dizzy. Thanks for your input.
JaneB
Posted by BarbaraCat on March 10, 2003, at 2:06:24
In reply to Any side effects? » BarbaraCat, posted by JaneB on March 9, 2003, at 18:25:40
Hi Jane,
No weight gain, au contraire. But read on. I've been on most of the newer SSRI's and their analogues since mid 80's. I'd be fine for a while, then poop-out, and every increase would create a nasty agitated depression. I realized I had classic Bipolar II symptoms in late 2001, at which time I was on Remeron (talk about weight gain! I packed on 30 pounds in 6 months.) Same thing, worked fine and then supercrash. My pdoc suggested adding lithium as an augmenter. It helped alot, but I hated the weight gain and felt a SSRI type drug was exacerbating my mixed states episodes. I dropped Remeron and never looked back.So about 1 year ago I started lithium and lamictal which worked fine except nothing would budge my weight. Lithium also is detrimental to my long-standing hypothyroidism (weight gain, increased depression). So I increased the thyroid med but didn't notice much difference. I was doing OK until this past December when my Mother died suddenly under very traumatic circumstances. It was a surreal and very intense time and I slipped off the edge of sanity. I went through what seems like forever but was actually about 6 weeks of suicidal despair and frenzy. Was very very close to spending time under observation.
Since we'd run out of options, my pdoc suggested Nortriptyline and within 3 weeks I was literally saved. Side effects? The only bothersome one is cotton mouth which does not usually go away. I tote water bottles everywhere and suck on Ricola's. I've heard about the weight gain, but it's been just the opposite for me. A few years ago I invested in an expensive rebounder, a mini trampoline. Never used it. I dragged it into my living room where I have to literally walk over it, and have been using it ferociously. I've lost 25 lbs in LESS THAN 1 MONTH!
I can honestly say that the Nortrip has given me back my life force and that spark has inspired me to work out like hell. I could barely drag myself to the bathroom before. So no, I have no problem with the weight thing at all. There is no substitute for exercise. We hate to hear it, but we've got to just accept it. Nothing else will budge that pudge. The secret is to find a way to move your fanny that you'll truly enjoy. I highly recommend a rebounder (the good ones only - about $200).
Posted by Ron Hill on March 10, 2003, at 10:26:38
In reply to Re: Any side effects? » JaneB, posted by BarbaraCat on March 10, 2003, at 2:06:24
Hi Barbcat,
>I was doing OK until this past December when my Mother died suddenly under very traumatic circumstances.
I saw some of your posts regarding your Mom’s passing a few months ago, but I was unable to respond at the time. I am truly sorry for your loss, Barb.
> Since we'd run out of options, my pdoc suggested Nortriptyline and within 3 weeks I was literally saved. Side effects? The only bothersome one is cotton mouth which does not usually go away.
Interesting. First, and foremost, I'm really excited that you have found something that is working. Second, TCA's have a reputation of causing mood instability in BP II patients and, thereby, inducing hypomania. Not the case with you, huh? Just goes to show that blanket statements do not apply in all cases.
You have been taking the TCA for about two months now, right? No hint of hypomania, correct?
>There is no substitute for exercise. We hate to hear it, but we've got to just accept it. Nothing else will budge that pudge.
I agree. Exercise can keep the pudgy factor in check and, even more importantly; exercise plays a key role in keeping the brain healthy. Here's a short quiz: What do exercise, ECT, rTMS, and effective AD medications all have in common? Answer: They all increase BDNF (brain derived neurotrophic factor). An increase of BDNF is correlated to a decrease in depression.
-- Ron
Posted by BarbaraCat on March 10, 2003, at 12:27:20
In reply to Re: BP II taking a MS and TCA. Any side effects? » BarbaraCat, posted by Ron Hill on March 10, 2003, at 10:26:38
Hi Ron,
Thanks for your always enjoyable posts. No full-blown hypomania yet however I have noticed a definite and welcomed increase in energy and drive and some speeding thoughts since starting Nortrip. This is usuallly a warning sign of hypomania, and although very nice, can quickly become a disorganized mixed-states hell. What keeps it from careening into full-blown hypomania (shopping sprees, cleaning marathons) has been lithium, and of late bouncing on that rebounder til I'm ready to drop. So I can say that the threat of hypomania is present but held in check by lithium and to a lesser degree lamictal.I stopped Lithium for a week or so last month while on Nortrip because of the hypothyroid concern and soon began fragmenting and becoming increasingly obnoxious and hypercritical of my husband. Poor man, good thing he loves me. Within 2 days of restarting I smoothed out - this was a good reality check of how Lithium has become necessary to my sanity.
I'm sure you also know that Lithium has been shown to increase BDNF and act in other brain protective ways. Do you know anything about Lithium Orotate vs. our standard Lithium carbonate? It's been showing up in some over the counter products (Serenity is one) and binding it with orotic acid purports to more easily cross the bbb, hence the need for less thus reducing side effects. Probably a marketing ploy, but if true, it sounds intriguing.
Posted by Ron Hill on March 10, 2003, at 13:30:38
In reply to Re: BP II taking a MS and TCA. Any side effects? » Ron Hill, posted by BarbaraCat on March 10, 2003, at 12:27:20
Barb,
> I stopped Lithium for a week or so last month while on Nortrip because of the hypothyroid concern and soon began fragmenting and becoming increasingly obnoxious and hypercritical of my husband. Poor man, good thing he loves me.
I also am very lucky to have a spouse that loves me. Most women would have kicked me to the curb two minutes after she saw my first dysphoric mood state.
> I'm sure you also know that Lithium has been shown to increase BDNF and act in other brain protective ways.
I knew that lithium has neuroprotective properties, but I didn't know that it increases BDNF. Thanks for the information. This being the case, I'm surprised that lithium does not provide more AD efficacy. Maybe the BDNF verse depression relationship is not a direct correlation.
>Do you know anything about Lithium Orotate vs. our standard Lithium carbonate? It's been showing up in some over the counter products (Serenity is one) and binding it with orotic acid purports to more easily cross the bbb, hence the need for less thus reducing side effects. Probably a marketing ploy, but if true, it sounds intriguing.
I've heard of it but I've not looked into it (yet). My first reaction is that a Li ion, is a Li ion, is a Li ion. But maybe there is more to it than I know.
-- Ron
Posted by BarbaraCat on March 10, 2003, at 17:02:17
In reply to Re: Is Lithium Orotate merely a marketing ploy? » BarbaraCat, posted by Ron Hill on March 10, 2003, at 13:30:38
Here you go, Ron. A good article on lithium and BDNF.
http://hdlighthouse.org/see/drugs/lithium2.htm
I didn't realize that exercise increased BDNF, so thanks for that info.
One more question perhaps you know the answer. I don't know if this is still the party line, but the action of lithium was supposed work by inhibiting inositol uptake. This surprises and confuses me because inositol is normally beneficial for depression (especially in myo-inositol form). Some studies say 'yes it helps BP' other say stay away from it. Do you know anything about this? I've got a dozen bottles of pharm grade myo-inositol that are confused about their purpose in life (so are we all it seems).
Also, was that you taking SAM-e? Are you still? I (400mg) am and it seems to help with focus and fibro pain, but I'm wary of anything that could incite hypomania. However, for my husband who gets low level dysthymia it works very well at 400mg.
Posted by Ron Hill on March 11, 2003, at 11:47:28
In reply to Re: Lithium and BDNF » Ron Hill, posted by BarbaraCat on March 10, 2003, at 17:02:17
Barbcat,
> Here you go, Ron. A good article on lithium and BDNF.
Good article. Thanks for the link.
> One more question perhaps you know the answer. I don't know if this is still the party line, but the action of lithium was supposed work by inhibiting inositol uptake. This surprises and confuses me because inositol is normally beneficial for depression (especially in myo-inositol form). Some studies say 'yes it helps BP' other say stay away from it.
It is my understanding that some of lithium's anti-manic qualities may be attributed to its interaction with inositol. Inositol is thought to help relieve depression (in some cases), but it can also contribute to the onset of mania. I've not done much research on inositol, so I don't know much about the topic. If I remember correctly, IsoM knows about inositol. I was taking it several months ago to see if it would help my then present depression. However, I quit when I read the same thing that you did (i.e.; that the action of lithium is thought to work, in part, by inhibiting inositol uptake).
> Also, was that you taking SAM-e? Are you still? I (400mg) am and it seems to help with focus and fibro pain, but I'm wary of anything that could incite hypomania. However, for my husband who gets low level dysthymia it works very well at 400mg.
SAM-e got the boot about ten months ago. After five months of good AD benefit, 200 mg/day of SAM-e started to induce extreme irritability (flash rage). I dropped down to 100 mg/day, but it still caused irritability. I took a break from it and tried it again, but it still caused flash rage.
Barb, as you know, I'm BP II and I've been taking Lithobid for three-and-one-half years. Lithobid does a good job of controlling my hypomania but does little or nothing for the depressive side of my disorder. After I kicked the SAM-e to the curb last spring, my depression began to return. However, the depression did not become debilitating until November when I fell into a very deep atypical depression that I could not get out of.
My wife is used to me going into depressions periodically, but when it extended into the third month, she called my pdoc to make an appointment. This forced me to crawl to my keyboard and begin to do some research in preparation for the appointment. That's when I came across some information on Enada NADH (coenzyme 1).
A little more than six weeks ago I added Enada NADH to my 600 mg/day of Lithobid and it has provided remarkable effectiveness for my BP II atypical depression (low motivation, anergy, anhedonia, hypersomnia) and extreme irritability (dysphoric mood states). It took a little trial-and-error to figure out the correct dose. Ironically, if I take too high of a dose it actually induces irritability.
It’s still too early in the trial to be making predictions regarding its long-term effectiveness, but it is currently working remarkably well. My motivation is back, my energy is up, my love of life has returned, I’m not sleeping all the time, and I’m no longer a rage-alcoholic. Needless to say, my wife prefers the “new and improved me”.
Barb, click on the link below if you want to read about what I’ve learned via my dosing trial-and-error:
http://www.dr-bob.org/babble/20030306/msgs/206934.html
If you or your husband want to know more about Enada NADH, let me know and I’ll sent you some links.
-- Ron
Posted by BarbaraCat on March 11, 2003, at 14:10:19
In reply to Re: SAM-e is out and Enada NADH is in » BarbaraCat, posted by Ron Hill on March 11, 2003, at 11:47:28
Ron,
Yes, I would like your dosing regimen. I was taking NADH for a while because its supposed benefit to fibromyalgia and chronic fatigue. I recall that it did perk things up considerably but it was so expensive at that time that I could no longer justify the expense with the effect. My depressions usually go from vegetative to agitated so I never know which middle ground is safe. I think I'll try it again for my husband. He gets into 'the gray zone' where he sits around and plays computer solitaire for hours and hours, no motivation, sighs alot. He doesn't realize he's really depressed until I mention it.I'm sorry to hear about your slide into depression. Sometimes there's nothing to be done about it except wait for the chemicals to shift and trust that they will. Of course, one of the hallmarks of depression is no trust. Given the choice I'd take anergic over agitated anyday. At least you can sleep through the worst of it, instead of pacing and wailing which I tend towards.
It sounds like NADH is doing the trick. I've recently read that it's helping Parkinson's patients as well because it works primarily on increasing dopamine and to a lesser extent NE. Have you ever tried a pstim along with your med regimen? I personally like the idea of NADH better than an amphetamine, however, you might have a real need for that dopamine zing.
Posted by Ron Hill on March 12, 2003, at 10:56:26
In reply to Re: SAM-e is out and Enada NADH is in » Ron Hill, posted by BarbaraCat on March 11, 2003, at 14:10:19
Barbcat,
> Yes, I would like your dosing regimen.
Looks like I accidentally confused you, Barb. The link I included in my previous post will take you to a discussion of what I've learned so far regarding my Enada NADH dosing schedule. For convenience, I will repeat the link here.
http://www.dr-bob.org/babble/20030306/msgs/206934.html
-- Ron
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Dr. Bob is Robert Hsiung, MD,
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Script revised: February 4, 2008
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