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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by SLS on January 17, 2004, at 9:15:09
I've decided to give lithium another try. I have bipolar depression that is very treatment-resistant. Been on everything, including lithium. At dosages of 600mg and higher, lithium makes me feel like crap. It flattens my affect and makes me feel more depressed. It also makes me passive and apathetic, and really takes a toll on creativity. Since I have never combined it with Lamictal or an SSRI, I thought that maybe 300mg would be just enough to act as an augmentor. For unipolar depression, lithium is used as an augmentor of antidepressants in dosages of 300mg-600mg. 450mg seems to be the sweet-spot. That is also the dosage recommendation for using lithium as a neuroprotector/neurotrophic. I can always use some more gray matter.
Sooo, for now this is where I'm at:
imipramine 300mg
Zoloft 200mg
Lamictal 300mg
lithium 300mg
Abilify 10mgCrossing fingers.
- Scott
Posted by Sooshi on January 17, 2004, at 9:50:39
In reply to Just a pinch of salt., posted by SLS on January 17, 2004, at 9:15:09
Scott-Good luck with the lithium! I am BPII-depressed, so I know where you're coming from...I'm struggling right now trying to figure out whether to up my Topamax or add in an augmentor such as lithium (tried Lamictal w/my Effexor..got no effect....wonder if I added it now with Topa would I get a response??). Have you tried Topamax? It has really helped me ALOT, and had a lot less side effects than the lithium did for me (I am actually allergic to lithium I found out...).
Anyway, it sounds like the lower dose of li with the ad's might do the trick! I'll keep my fingers crossed for you,
Sooshi
Posted by sarita0001 on January 17, 2004, at 11:34:43
In reply to Just a pinch of salt., posted by SLS on January 17, 2004, at 9:15:09
HI,
I was on lithium for 7 years and I know it's hard but your idea about trying a low dose first seems like a good one. I didn't get really annoying side effects till about the 5.5 year mark. Anyways, good luck!
Sara
Posted by SLS on January 17, 2004, at 12:43:32
In reply to Re: Just a pinch of salt. » SLS, posted by sarita0001 on January 17, 2004, at 11:34:43
Hi Sara.
Thanks for your response.
I'd be interested to hear what your experience with lithium has been.
1. What is your diagnosis?
2. What was your dosage?
3. How did it affect you?
4. What caused you to discontinue it?Any input is appreciated.
Best wishes,
Scott
> I was on lithium for 7 years and I know it's hard but your idea about trying a low dose first seems like a good one. I didn't get really annoying side effects till about the 5.5 year mark. Anyways, good luck!
>
> Sara
Posted by sarita0001 on January 17, 2004, at 17:08:33
In reply to Re: Just a pinch of salt. » sarita0001, posted by SLS on January 17, 2004, at 12:43:32
Hi Scott,
I'll try to make a long story short. To answer your questions first:
1) I was diagnosed BP at 17 years old. I began having depression/anxiety when I was 13 but was diagnosed with adjustment disorder 13-17. When I was diagnosed BP, I had a classic manic episode. But that year, I'd been drinking and smoking pot more and when the episode happened was using marijuana. That was the only manic episode I had. I was almost always on the depression/anxiety side of the spectrum.
2) Dosage 900mg Eskalith CR. Supposedly the standard adult dosage which from what I've read is pretty low. Some people are on 1200-1300. From Jan 2003-Oct 2003, 675 mg. Went off in Oct. 2003.
3) Here goes. The first 5 and a 1/2 years were tolerable. The most annoying were peeing all the time, affected eczema I already had sometimes, increased appetite. The weight was manageable through diet and exercise during this time. Lithium levels stayed between .7-.8. Good thing was no sexual se's. Also good was since I had to drink water all the time it became a healthy habit. Drowsiness often, some stomach pain the 2nd year.
From May 2001- Dec 2002, I started gaining weight even though I ate well, wasn't exercising as much though, but seemed no matter what I did the weight stayed. I also decided to drastically lower the salt intake on my diet and so the lithium level went up on its own and thus I got more side effects. I was more tired, blunt affect, still peeing all the time, upset stomach, increased sweating. In Dec 2002, I was 25 lbs. overweight and I had had it with the SE's. I'd also have this weird thing where right before I'd go into deep sleep I'd wake up suddenly. It was weird but not scary, you know? It doesn't happen anymore.
4)Ok. Since I was 13, I went to therapy and it didn't help much. I was super busy after college working and stuff and didn't want to deal with med changes, etc. Plus I'd never known any other med you know? So, in the summer of 2002 I was having a lot of anxiety, OCD symtoms(obsessional thoughts) because I was stressed about being home. The only thing the dr. changed was he told me to take the 900mg at night to minimize fatigue, previously i did divided doses. I didn't tell the dr. about the OCD cuz I was scared.
Then, I started grad school Aug 2002. Started having more anxiety troubles than I ever had. I was fine from 17-23. So I went to a psychiatrist in Nov 2002 and she diagnosed me OCD/BP. She gave me an anti-depressant and I was worried about weight gain so I only took it for 5 days. it sedated me way too much with the lithium.
She suspected my manic episode may have been substance induced (pot, alcohol).I went to my original psychiatrist in Jan 2003, and he gave me TOpamax b/c my main concern was weight- even though it really should have been the anxiety. I was having suicidal thoughts and was really down. So I went down to 675 mg Eskalith, 100 mg Topamax. I felt so much better, more energy, less peeing, I could exercise longer and better. Didn't feel so blunted. Topamax was fine for a while but wouldn't recommend it.
In March 2003, I tried going off both meds but didn't b/c I was in the middle of the semester and was scared. I also didn't know anything about withdrawal and what to expect. Went off Topamax in May, stayed on 675mg. Saw original dr. and he thinks it might have been a substance induced mood disorder too.
In May 2003, I tapered down to 225mg lithium and was doing baaadd. Called the dr. and put me back on 900mg for 2 weeks, then went back to 675mg.
So from May- Oct things were ok. Struggling bad with social anxiety at school so went to see a new dr. She took me off lithium because the anxiety/OCD was making things hard for me. I went on Prozac for 3 weeks to get through school/withdrawal. Totally off meds since 1st week of December 2003. The dr. gave me Lorazepam for when I feel anxious, like when I have a presentation or something. She thinks it was a substance induced mood disorder too.
Finally, I started intense therapy in Sept 2003. I discovered I'd always had anxiety. My dad has bad OCD-compulsive type, so it also made more sense. My therapist says 17 is also a young age to diagnose BP and that adolescence is such a hard time and things are changing alot. I also felt emotionally negelected and always tried to get attention, and this was most likely driving the mania too. The lithium did help me, although I don't think I needed it for that long. When the anxiety symptoms began to show more than depression or anything else, that was addressed. And since I was told BP is permanent, I always thought that was true. But things can change with the mind for some.
If you have other diagnoses besides BP, you should know that Dr's will try to treat the BP first and then anxiety, other stuff. Anxiety is tricky with BP because SSRI's supposedly cause mania.
Ok. So I feel alot better now being drug free and knowing where a lot of my symptoms come from and why I feel the way I do instead of covering everything up. I was also in tons of denial and that prevented me from getting to my issues earlier. Therapy helps a lot. If you have any other ?'s, I'd be happy to answer.
Good luck
Sara
Posted by SLS on January 17, 2004, at 18:36:40
In reply to Re: Just a pinch of salt., posted by sarita0001 on January 17, 2004, at 17:08:33
Hi Sara.
> I'll try to make a long story short.
I would hate to see the long story! :-)
I really, REALLY appreciate the time you took to respond to my questions. Your answers were very helpful.
Did you experience the emotional blunting at 675mg?
Thanks again.
- Scott
Posted by sarita0001 on January 17, 2004, at 19:43:43
In reply to Re: Just a pinch of salt. » sarita0001, posted by SLS on January 17, 2004, at 18:36:40
Hi,
It really was not as bad. Very little. But comparing it to 900mg, a huge improvement. And I don't know how much your other meds will affect this as well. Just remember to drink a lot of water and eat more salt. I love salt so it wasn't a problem for me. Keep us updated on your progress. Do you mind if I ask what your other diagnoses are if you have any others?
Sara
Posted by Maxime on January 18, 2004, at 23:49:06
In reply to Re: Just a pinch of salt. » SLS, posted by sarita0001 on January 17, 2004, at 19:43:43
Hello.
BP type 1 here. Diagnosed about 10 years ago, I am now mid 30's. I was BP in my late teens though but not diagnosed.
Tried lithium and at 300 mg went toxic. Was always throwing up. Couldn't stop sleeping when I wasn't throwing up.
Went down to 150 mg. Same side effects only less but Lithium had no positive effect. This was all in 1997.
In 2002, had a new PDOC who insisted I try it again and you will never guess what happened? The same bloody thing ... imagine that! Grrrr.
Needless to say it's not the med for me. I'm trying to find the right MS. I started trileptal about a month ago and still titrating upwards.
Maxime
This is the end of the thread.
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