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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by tensor on January 21, 2005, at 9:22:26
Hi,
I've been on lithium for two weeks 600mg. After one week the lithium level was 0.3 and today it was 0.2. I noticed a slight improvement in mood from yesterday, having a little more energy than before. I know the level should be at least 0.4-0.5, but from experience, has anyone done well at levels lower than that? And at the same time convinced it actually was lithium that helped.
I couldn't reach my pdoc today and will not until tuesday, i did however talked to my therapist(who also is a physician) and told me to increase to 900mg. My next blood test is next thursday so from that point of view it would better to start with 900mg now than on tuesday. Thoughts on this?Thanks,
Mattias
Posted by Ritch on January 21, 2005, at 12:23:40
In reply to Lowest meaningful lithium level, posted by tensor on January 21, 2005, at 9:22:26
> Hi,
>
> I've been on lithium for two weeks 600mg. After one week the lithium level was 0.3 and today it was 0.2. I noticed a slight improvement in mood from yesterday, having a little more energy than before. I know the level should be at least 0.4-0.5, but from experience, has anyone done well at levels lower than that? And at the same time convinced it actually was lithium that helped.
> I couldn't reach my pdoc today and will not until tuesday, i did however talked to my therapist(who also is a physician) and told me to increase to 900mg. My next blood test is next thursday so from that point of view it would better to start with 900mg now than on tuesday. Thoughts on this?
>
> Thanks,
> Mattias
Hi, I was on lithium for about twenty years and took blood tests pretty consistently the first ten or so years. Anyhow *dosage* wise I never had any significant improvement in response to it above 600mg/day. The 'response curve' flattened out pretty good around there for sure. The blood level associated with that flattened area was around .3 .. similar to yours. 300mg clearly helped, 450mg clearly helped a lot more, 600mg helped just a little better than 450mg but not much. Anything higher than 600mg I generally just had worse side effects. I went all the way to 1500mg for quite a while. I had some treatment resistant manic symptoms (I was young then) that lithium just didn't work as well for. As far as an antidepressant the 600mg dose was pretty much its peak effect as well. I tend to respond to low doses of meds (if they work) anyhow though. Hope this helps.
Posted by tensor on January 21, 2005, at 16:02:37
In reply to Re: Lowest meaningful lithium level » tensor, posted by Ritch on January 21, 2005, at 12:23:40
Hi,
thanks for you reply. Based on your experience, would it be wise to wait another week or two? Or do you think i would have gained the energy and lift in mood already at this dose? I think the lithium level will stay in the 0.2-0.3 range with 600mg. As i wrote earlier, i do have slightly more energy now, but i'm very unsure wheather i should stay at 600mg or go up to 900mg.
Thanks,
Mattias
Posted by Ritch on January 22, 2005, at 0:16:19
In reply to Re: Lowest meaningful lithium level » Ritch, posted by tensor on January 21, 2005, at 16:02:37
> Hi,
>
> thanks for you reply. Based on your experience, would it be wise to wait another week or two? Or do you think i would have gained the energy and lift in mood already at this dose? I think the lithium level will stay in the 0.2-0.3 range with 600mg. As i wrote earlier, i do have slightly more energy now, but i'm very unsure wheather i should stay at 600mg or go up to 900mg.
>
> Thanks,
> MattiasI would stick with the same dosage for another couple of weeks before you increase. Give the 600mg range a full month or more. Lithium has slow and subtle effects. It is very helpful for a lot of people. The last thing you want is to bring on undesirable side effects with a dose increase before you experience the full potential benefits of a lower dose that might be sufficient for a longer term. Another thing... get your thyroid (T4, TSH) checked to make sure your thyroid isn't getting suppressed by the lithium. If it is.. thyroxine (T4) and/or T3 supplementation will help with your depression as well.. and you certainly don't want the lithium to *induce* a depression or cancel out its therapeutic effects by depressing your thyroid functioning.
Posted by slinky on January 22, 2005, at 9:21:41
In reply to Re: Lowest meaningful lithium level » tensor, posted by Ritch on January 22, 2005, at 0:16:19
Sorry to butt in Tensor..
I'm now on 800mg of lithium...seems never ever
have I felt so ill mentally-more hostle and irritable than before I took it.Fortunately he increased my neurontin.
I said to my pdoc that I'd give it a go as a trial---no more!..I feel intense disinterest trapped in dis--ease and hypersexed-but my brains not interested in sex..maybe I'm going to try carbamazipine...if lithium doesn't help now it never will.
All I think of is ending my life.
Posted by smith562 on January 22, 2005, at 9:59:58
In reply to Lowest meaningful lithium level, posted by tensor on January 21, 2005, at 9:22:26
Hey Mattias,
I now use lithium 450mg with zoloft. I find none of the antidepressants work unless I have a small dose of lithium on board. 600mg makes me too depressed ... I am considering trying 300mg per day. I use sleep as my gauge .... I adjust the dose of lithium so that I get 8 hours of sleep per night.
Hope you are well ... good luck with lithium.
Smith
> Hi,
>
> I've been on lithium for two weeks 600mg. After one week the lithium level was 0.3 and today it was 0.2. I noticed a slight improvement in mood from yesterday, having a little more energy than before. I know the level should be at least 0.4-0.5, but from experience, has anyone done well at levels lower than that? And at the same time convinced it actually was lithium that helped.
> I couldn't reach my pdoc today and will not until tuesday, i did however talked to my therapist(who also is a physician) and told me to increase to 900mg. My next blood test is next thursday so from that point of view it would better to start with 900mg now than on tuesday. Thoughts on this?
>
> Thanks,
> Mattias
Posted by SLS on January 22, 2005, at 10:40:28
In reply to Re: Lowest meaningful lithium level » Ritch, posted by tensor on January 21, 2005, at 16:02:37
> Hi,
>
> thanks for you reply. Based on your experience, would it be wise to wait another week or two? Or do you think i would have gained the energy and lift in mood already at this dose? I think the lithium level will stay in the 0.2-0.3 range with 600mg. As i wrote earlier, i do have slightly more energy now, but i'm very unsure wheather i should stay at 600mg or go up to 900mg.
>
> Thanks,
> Mattias
There is only one way to be sure that you are getting the most from lithium, and that is to experiment. If you are adding lithium as an adjunct to antidepressants in the absence of bipolar disorder, the range seems to be 300-600mg. For bipolar disorder, the range tends to be higher. However, blood levels of lithium to treat bipolar disorder are well established (.08-1.2 mEq/L). This is not the case with unipolar affective disorder. I think the dosage of lithium for unipolar depression must be titrated clinically. You might yet squeeze out a better response at 900mg. If it were me, I think I would hang out at 600mg for at least two weeks and get a feel as to how robust your response is. Then, you will have something to compare it to at 900mg. As Mitch said, you might not have anything to gain at 900mg. In fact, you might notice a flattening of mood at that dosage. Again, the only way to be sure is to titrate the dosage clinically.Good luck.
- Scott
Posted by Ritch on January 22, 2005, at 12:38:53
In reply to Re: Lowest meaningful lithium level, posted by slinky on January 22, 2005, at 9:21:41
> Sorry to butt in Tensor..
>
> I'm now on 800mg of lithium...seems never ever
> have I felt so ill mentally-more hostle and irritable than before I took it.Fortunately he increased my neurontin.
> I said to my pdoc that I'd give it a go as a trial---no more!..I feel intense disinterest trapped in dis--ease and hypersexed-but my brains not interested in sex..maybe I'm going to try carbamazipine...if lithium doesn't help now it never will.
> All I think of is ending my life.Slinky, it definitely sounds like lithium is not agreeing with you at all! I would definitely tell him next time you want on something different. I think the carb. add to your neurontin would be a logical next step. Sorry, it all went so crappy for you. I think there was a study somewhere.. that Li wasn't very effective for rapid-cyclers.. I would have to say that as far as the *cycling* patterns go it didn't do that much for me. Hope you find some relief with a different med! -- Mitch
Posted by HappyGirl on January 22, 2005, at 13:19:53
In reply to Re: Lowest meaningful lithium level, posted by slinky on January 22, 2005, at 9:21:41
Hi slinky:
In my opinion on the Lithium through the experience, .... it's a good 'mood-stabilizer' with a bit of 'anti-dep.' efficacy. However, if your Bp is in the moderate range, it does NOT work on you good. It's VERY sure for this, because I was once before 'the Lithium' only. Even, the higher dosage, somewhere around 1200 mg. - 1500 mg. didn't help the 'moderate to severe form' of my Bp II with ultra-rapid cycler. After the change of new pdoc.(current pdoc.), he put me on the Zyprexa 2.5 mg. to 5.0 mg. that made my Bp 'turn the corner.'After 'so' much turmoils, heart-aches along with a lot of money spending, I finally got my Bp stabilized, ... of course some days are still crappy, ... but well tolerable to the point 'normalcy' I feel in my heart.
However, any anti-psycho. meds. have some 'unpredicable' side-effects, then I can't be sure an A.P. is for you, but try to speak to your pdoc. about some more 'potent' med. to combat your Bp. at your next appt.
H.G.
Posted by tensor on January 22, 2005, at 15:47:28
In reply to Yes .... Low levels work for me » tensor, posted by smith562 on January 22, 2005, at 9:59:58
Hi Smith!
Nice to hear you're doing fine on lithium. I have a feeling it might work for me too. My mood is a bit wobbly, but i feel i have more interest to do things and i do actually get things done. But i'm not *there* yet. Anyway, do you know what your lithium level currently is?
Thanks,
Mattias
Posted by tensor on January 22, 2005, at 15:57:03
In reply to Re: Lowest meaningful lithium level, posted by slinky on January 22, 2005, at 9:21:41
Hi slinky,
> Sorry to butt in Tensor..
don't be!
>..I feel intense disinterest trapped in dis--ease and hypersexed-but my brains not interested in sex..
It's quite the opposite for me, i have noticed an increased interest in sex. But my physical ability is about the same(i.e. ok).
>maybe I'm going to try carbamazipine...if lithium doesn't help now it never will.
There's always options, you will find one that works!
> All I think of is ending my life.
I'm sorry to hear that. One day you will feel better. I promise.
Hugs,
Mattias
Posted by tensor on January 22, 2005, at 15:58:34
In reply to Lowest meaningful lithium level, posted by tensor on January 21, 2005, at 9:22:26
Posted by smith562 on January 22, 2005, at 16:43:00
In reply to Re: Yes .... Low levels work for me » smith562, posted by tensor on January 22, 2005, at 15:47:28
I was on lithium once before (imipramine and 900 of lithium) and my level with 900 mg was 0.6. So for me, 300mg equals about 0.2 blood level ... thus at 450mgs I bet I am about 0.3 now.
This is my take on dose of medication. Any disease has a spectrum of severity ... like hypertension. I know people with mild hypertension and require a small dose of one medication and I know people with severe hypertension needing whopping doses of three medications to control there blood pressure. Mood disorders are no different ... some people need smaller or larger doses then the "recommended" "traditional" doses. So just titrate lithium to the dose that works best for you ... forget about the levels (but watch you thyroid and renal blood work).
Hope your better soon!
Smith
> Hi Smith!
>
> Nice to hear you're doing fine on lithium. I have a feeling it might work for me too. My mood is a bit wobbly, but i feel i have more interest to do things and i do actually get things done. But i'm not *there* yet. Anyway, do you know what your lithium level currently is?
>
> Thanks,
> Mattias
This is the end of the thread.
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