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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 18 to 42 of 116. Go back in thread:
Posted by barbaracat on June 16, 2005, at 16:45:51
In reply to Re: I LOVE lithium » barbaracat, posted by yesac on June 16, 2005, at 10:18:08
> > Hi Wonder Druggies,
>
> Who are you callin a wonder druggie?! ;)
>
**Wasn't me!>>I've heard that too-- that lithium works better for bipolar I, and anticonvulsants often work better for "non-traditional" types of bipolar, including BP II, BP NOS, BP spectrum, mixed states, and rapid cycling. But for me, and I am definitely not classic BPI, lithium seems to help me feel better and the other drugs don't.
**I was originally dx'd as BP-II and it seemed to fit in that my typical symptoms were primarily depressed with the occasional hypomanic state. This could be intense productivity or just extreme irritability. I'd also have plain old depression as well. And then normal life for long periods of time.
But SOME of my episodes were real corkers that didn't fit any description. I called them 'depressions' for lack of any other label but these were nightmarish hallucinogenic horrors that scared me and everyone around me. Extreme despair, existential angst, constant wailing, precognitions of doom, combined with constant panic attacks. These were the episodes that no meds helped and I'd just have to live through them and pick up the shattered pieces of my existence afterwards.
Lithium has blessedly stopped these horrors and after much research into the many flavors of bipolar, I've come to the conclusion that these extreme episodes were Bipolar I Mixed-states depression. My impression is that BP-I differs from BP-II primarily in intensity and the presence of psychosis. But note that it wasn't always like this. The gradient moved around.
Now, who knows what these gradients mean? They all get lumped under the term 'bipolar', but maybe they're not just a gradient, but a different condition? I do know that lithium works primarily on the electrical potential of the neuron rather than the chemical messenger system, as most of the other meds do. So maybe that's what needs tweaking and without proper electrical conductivity, all other meds will fail. It would be interesting in your case, if Depakote and Seroquel or some other combo would work as well. Depakote and Seroquel are considered a very good combo. But definitely not for me. It's a crap shoot. But If I had to take any of them, I'd take lithium. It seems to have the most benign s/e profile when taken in moderation. And like you mentioned, even has neurogenesis properties that the others may not.
I know that as long as I have lithium on board, I can experiment with other meds, even SNRI's which before were not a good idea. But I can't do any of the other mood stabilizers or antipsychotics. Weird. Lithium acts very differently from these. So, maybe there is another country where lithium is the language. Who knows. I just know that I have symptoms that are mainly BP-II and occasionally descend into BP-I and lithium works and I need a pinch of an AD. You know, if it looks like a duck, quacks like a duck... As long as the lithium keeps working, the labels are just of academic interest and a guidepost for what to be aware of if things start getting weird.
Good luck to you. I truly hope you're on your way to some lasting relief. - Barbara
Posted by theo on June 16, 2005, at 16:55:07
In reply to Re: I LOVE lithium » yesac, posted by gromit on June 15, 2005, at 18:14:50
Depakote did the same thing to me at 500mg and my doc said to keep taking it for 6 weeks! I even asked the nurse for an appointment and she said "all I can tell you is he said he wants you to stay on it for 6 weeks." I had an upper respiratory infection and finally called another doc who is a friend and had him call me in an antibiotic.
I don't know what it is, but many anticonvulsants (Lamictal, Depakote, Topamax) give me a sorethroat and upper respiratory infection.
Posted by gromit on June 17, 2005, at 2:06:06
In reply to Re: I LOVE lithium » gromit, posted by yesac on June 16, 2005, at 10:48:38
> I have a friend who thinks that I have some kind of drug metabolism situation (fast metabolizer) and that's why I don't respond to so many meds. She thinks that I need to try higher doses of a lot of them. My shink, on the other hand, thinks that for the most part if a drug doesn't work at a reasonable dose, going up to a higher dose won't help. He thinks going up to a higher dose will help when the drug works to some extent at a lower dose. So I don't know.
I think the second theory makes more sense, although if you are tolerating the med pretty well maybe pushing the dose up fairly high is worth trying.
> What happened with the Lamictal?Well I've never been diagnosed with any type of bipolar disorder, I don't know why he insisted on depakote. He wanted to try lithium next but I steered him towards lamactil because I had read that it sometimes has an AD effect. As far as I can tell it did nothing, a short boost every increase but 200 mg wasn't doing anything I could detect.
> Okay now I'm just ranting and raving... well, to wrap the story up, I found my current psychiatrist, who is in private practice, and I've see him for therapy and meds for the past 2 years. He made me realize that there ARE in fact decent psychiatrists out there if you look hard enough.You're right, you can find a good doctor if you keep trying. Sorry to hear you've met some of these people too, it's good you've found someone who will work with you. Your comment about the doctor being late struck a nerve, the last guy was cronically late. His art classes at the local JC were more important. I actually spent probably 30 minutes of one session fixing his computer, on my dime (well my co-pay anyway).
I only have myself to blame, you are bound to run into these kind of people, doctors are not exempt from being total jerks. Once you've identified them, if you have the option to ditch them and you don't, it becomes your fault, you get exactly what you've chosen. My opinion anyway.
I've had kind of the opposite experience from yours. My current 10-15 min visits at a (University) public clinic with a resident are way more productive than an "hour" with the expensive private pdoc. Except for the first visit it was never an hour, especially if someone else was waiting. The last 3-4 visits I had with him were 30 minutes which is really more like 20 minutes. He always billed for an hour and I paid the co-pay for an hour. Like I said, completely my fault for putting up with it, I said nothing at the time. That won't happen again. I'm just glad he's in the past, what a tool.
My turn to rant I guess, actually the last post was probably mostly ranting.
> By the way, I've embedded a subliminal message in this post. It's about answers. In fact, it IS the answers. Now you will Know.
Dammit, as usual I was wearing my metallic head protection gear and missed out on the secret information.
Rick
Posted by gromit on June 17, 2005, at 2:18:54
In reply to Re: I LOVE lithium » gromit, posted by theo on June 16, 2005, at 16:55:07
> Depakote did the same thing to me at 500mg and my doc said to keep taking it for 6 weeks! I even asked the nurse for an appointment and she said "all I can tell you is he said he wants you to stay on it for 6 weeks." I had an upper respiratory infection and finally called another doc who is a friend and had him call me in an antibiotic.
You're the only other person I've heard about that had this happen, my pdoc thought the idea was ridiculous. Yeah same thing here, upper respiratory infection plus nasty fungal infection. I felt absolutely horrible the entire time.
> I don't know what it is, but many anticonvulsants (Lamictal, Depakote, Topamax) give me a sorethroat and upper respiratory infection.Lamactil and Dilantin (as a child) didn't do this to me, hmmm. Dilantin did make me feel terrible too but no physical illness that I remember. I just know if I ever get something like that again I'm stopping the med whatever the doctor says.
Rick
Posted by barbaracat on June 17, 2005, at 13:26:39
In reply to Re: I LOVE lithium » theo, posted by gromit on June 17, 2005, at 2:18:54
Your respiratory infection may have a very good explanation. I don't remember exactly where I read it, but I was trawling the net and found an article that Depakote decreases white blood cell counts. So, if you're prone to these things and your immune system is depressed, voila!
Doesn't quite explain the fungal infections, except if you were given antibiotics to combat the respiratory infection and that wiped out the good guys too.
Regarding Lamictal giving you a sore throat, well, that raises some red flags. I became very sick with Stevens Johnson Syndrome - the RASH. I got it after I stopped Lamictal and from a drug in the sulfa family I'd never had any problems with before. I stopped Lam because I was getting strange itching on my skin and a sore throat and what I thought was a yeast infection. Full-blown SJS caused major sore throat because all my mucous membranes were blistered. Even though I didn't get SJS while taking Lam, I'm very sure that Lam started an allergic process.
My intention isn't to needlessly scare anyone, but anticonvulsants especially can cause some bizarre reactions. Before any psychiatrist poo-poos a symptom as ridiculous, he/she ought to look a bit more carefully at the long list of possible side effects. My pdoc never entertained the possibility that my skin sensitivities could be due to Lamictal and jokingly suggested my cats had given me 'fleas'. Don't these folks ever trawl the net for clues like we do?
> > Depakote did the same thing to me at 500mg and my doc said to keep taking it for 6 weeks! I even asked the nurse for an appointment and she said "all I can tell you is he said he wants you to stay on it for 6 weeks." I had an upper respiratory infection and finally called another doc who is a friend and had him call me in an antibiotic.
>
> You're the only other person I've heard about that had this happen, my pdoc thought the idea was ridiculous. Yeah same thing here, upper respiratory infection plus nasty fungal infection. I felt absolutely horrible the entire time.
>
> > I don't know what it is, but many anticonvulsants (Lamictal, Depakote, Topamax) give me a sorethroat and upper respiratory infection.
>
> Lamactil and Dilantin (as a child) didn't do this to me, hmmm. Dilantin did make me feel terrible too but no physical illness that I remember. I just know if I ever get something like that again I'm stopping the med whatever the doctor says.
>
>
> Rick
>
Posted by gromit on June 17, 2005, at 14:30:15
In reply to Re: I LOVE lithium » gromit, posted by barbaracat on June 17, 2005, at 13:26:39
> Your respiratory infection may have a very good explanation. I don't remember exactly where I read it, but I was trawling the net and found an article that Depakote decreases white blood cell counts. So, if you're prone to these things and your immune system is depressed, voila!
>
> Doesn't quite explain the fungal infections, except if you were given antibiotics to combat the respiratory infection and that wiped out the good guys too.What you said makes a lot of sense, yes I did get several courses of antibiotics. My sinuses were really infected, it would clear up for a few days and come right back. It all stopped shortly after discontinuing depakote.
> Regarding Lamictal giving you a sore throat, well, that raises some red flags. I became very sick with Stevens Johnson Syndrome - the RASH. I got it after I stopped Lamictal and from a drug in the sulfa family I'd never had any problems with before. I stopped Lam because I was getting strange itching on my skin and a sore throat and what I thought was a yeast infection. Full-blown SJS caused major sore throat because all my mucous membranes were blistered. Even though I didn't get SJS while taking Lam, I'm very sure that Lam started an allergic process.
I remember reading your story about this some time ago, I'm glad you came thru ok. I also vaguely recall my doctor saying something about sulfa drugs and Lamactil but what exactly was said I don't remember. I think you've mixed up my comments with Theo's though, I had no real effects positive or negative from Lamactil. Still, good information.
> My intention isn't to needlessly scare anyone, but anticonvulsants especially can cause some bizarre reactions. Before any psychiatrist poo-poos a symptom as ridiculous, he/she ought to look a bit more carefully at the long list of possible side effects. My pdoc never entertained the possibility that my skin sensitivities could be due to Lamictal and jokingly suggested my cats had given me 'fleas'. Don't these folks ever trawl the net for clues like we do?
Apparently not, my old pdoc would have to consult his PDA or product inserts to make any kind of decision. Forget something relatively uncommon. I've also had family doctors who suddenly seem to start doubting what I say when they find out I'm seeing a pdoc. I find your doctor's "jokes" disturbing, it's a potentionally life threatening reaction after all. Do you still see him?
Rick
Posted by Sabino on June 17, 2005, at 18:06:26
In reply to Re: I LOVE lithium » gromit, posted by barbaracat on June 17, 2005, at 13:26:39
Hi all,
I just started Lithobid 300 mgs yesterday. I was wondering how many times you Lithium vets dose daily?
I have really liked Li so far. I mean, it seems to agree with me after a gazillion failed attempts at other meds. I have an aggitated sort of depression, and within an hour of dosing, my frazzled sort of thinking just calms right out, and I start marvelling at how nice and calm I feel.
I already feel like I'd like to try 600, maybe a morning dose, and an evening one. I've been giving Effexor XR a good trial currently too. I'm just over 7 weeks with that. I'm at 225mgs Eff (the past 9 days), and 15 mgs Remeron for sleep.
Even when I have an AD that sort of works, because of my super fast metabolism, I usually dose, then an hour or two later, I'll feel good for a couple of hours, then crash for the rest of the day. Ultimately, that's just too hard to deal with.
I was hoping that maybe Lithium would smooth things out... you know, get rid of the daily roller coaster. And I thought since when I use an AD, that my garden variety depression turns into anxious depression, that perhaps a good mood stabilizer might be the ticket.
Much to my great surprise, after the very first dose of Li, like I said, I had that great feeling of calm, and just well being. But that wears off after 4 or so hours too. But at least not a hard crash like with AD's.
I know my reactions to meds are not at all standard, and I attribute that to the high metabolism. It's made it very difficult, and I've still not found relief.
Anyway, just wanted to say hi, and that so far, so good with Li. I'd be shocked if after all this time fooling around with AD's, that something as old as Lithium does the trick. That would be a miracle.
I got in such a bad way that 7 weeks ago, I took a leave of absence from work. Tried to go back after 3 weeks, and just wasn't up to it. Another 4 weeks, and another try at returning. I lasted 5 minutes, had a panic attack, and left. Then later the same day (yesterday), tried Li for the first time, and felt a relief I haven't known in some time. Hope it isn't a placebo effect.
Sorry for the long, boring post. Best to you all.
Messed up in Mexico, living on refried dreams.
Posted by theo on June 17, 2005, at 23:46:14
In reply to Re: I LOVE lithium » theo, posted by gromit on June 17, 2005, at 2:18:54
Wow! I actually had to take a liquid, Nystatin, for a yeast, fungal infection!! I'm 41 and NEVER had a fungal infection until Depakote.
Posted by gromit on June 18, 2005, at 0:44:36
In reply to Re: I LOVE lithium » gromit, posted by theo on June 17, 2005, at 23:46:14
> Wow! I actually had to take a liquid, Nystatin, for a yeast, fungal infection!! I'm 41 and NEVER had a fungal infection until Depakote.
Yikes, for me it was 3 months of Lamisil tablets. The treatment was so long because I got nail fungus. Lucky for me my insurance covered it or I might have paid close to $2000 for 3 months worth!!!
I've had athlete's foot or a "personal" fungal infection a couple of times, but it was treatable with OTC products, nothing like this. Lovely stuff huh? At least you'll have something to bring up the next time you have dinner with someone you can't stand.
Did your doctor think the Depakote was to blame?
Rick
Posted by theo on June 18, 2005, at 12:34:46
In reply to Re: I LOVE lithium » theo, posted by gromit on June 18, 2005, at 0:44:36
> > Wow! I actually had to take a liquid, Nystatin, for a yeast, fungal infection!! I'm 41 and NEVER had a fungal infection until Depakote.
>
> Yikes, for me it was 3 months of Lamisil tablets. The treatment was so long because I got nail fungus. Lucky for me my insurance covered it or I might have paid close to $2000 for 3 months worth!!!
>
> I've had athlete's foot or a "personal" fungal infection a couple of times, but it was treatable with OTC products, nothing like this. Lovely stuff huh? At least you'll have something to bring up the next time you have dinner with someone you can't stand.
>
> Did your doctor think the Depakote was to blame?
>
>
> Rick
>Of course not, he prescribed it. Had another doctor prescribed it, I'm sure he would have blamed it on the Depakote!!
Who knows. All I know is it is very frustrating when these meds cause side effects and when I report them to my doctor, he looks at me like I have a third eye, really frustrating.
Posted by barbaracat on June 18, 2005, at 15:26:04
In reply to Re: I LOVE lithium » barbaracat, posted by gromit on June 17, 2005, at 14:30:15
> > Doesn't quite explain the fungal infections, except if you were given antibiotics to combat the respiratory infection and that wiped out the good guys too.
*You probaby know about taking a probiotic to recolonize the good bacteria? An antibiotic can wipe out your gut for a long time. I have an ongoing condition with this and it contributes to alot of digestive problems which contribute the fibro and on and on.>
> I've also had family doctors who suddenly seem to start doubting what I say when they find out I'm seeing a pdoc.**I've learned through hard experience that they're opinionated and biased like anyone else. I've learned to NEVER mention, not even to my pdocs that I once had an overfondness for amphetamines and alcohol. Even though that's a thing of the past, it has prevented my obtaining legit meds that would have helped in the present. It's too bad because we want at least one place to not only be accepted as we are, but to be genuinely helped. I guess that leaves the sanctity of the confessional. Unless you're an altar b... oh, never mind.
>>I find your doctor's "jokes" disturbing, it's a potentionally life threatening reaction after all. Do you still see him?
**No, I don't see him anymore. No longer have that insurance, but he was actually one of the better ones I'd had. In over 30 years of seeing more than 20 pdocs, I've had 2 that were very good, about 2 that were decent. He's in the decent category. The few that were the spawn of Satan, I won't even go into. Yes, they're only human, but we place our bodies, psyches and a sizable chunk of change into their hands and we deserve more.
At least we have this board. I've learned more here than with ANY pdoc I've ever had. Now, if only we can come up with cyber meds and bypass the middle men.
>
>
Posted by barbaracat on June 18, 2005, at 15:40:56
In reply to Lithium: How many times do you dose per day? » barbaracat, posted by Sabino on June 17, 2005, at 18:06:26
Hi Sabino, and Welcome. Your experience with Li sounds so exactly like mine that it's comforting. I too had relief within hours instead of the weeks they report. A calmness and focus that soothed the shrieking agitated depression like nothing else.
I take 600mg. 300mg in the morning and in the evening. This appears to be the best dose for me and causes no negative side effects whatsoever. I have had difficulty losing weight which would have come off easily before, but I know I have to try harder, move my butt more, and the problem will be solved.
You can try extended release. Some say it has a smoother overall effect, but that probably is more for those who are taking a higher dosage and experience side effects. I do hope you can stay at a low dose and avoid the annoying side effects. Those 'therapeutic windows' shown in blood tests are way too high, in my opinion. They are appropriate for someone in a concurrent mania, NOT ongoing maintenance, and cause more harm than help, so don't let anyone browbeat you into the therapeutic range. You don't mention if you're bipolar (your agitated depression being relieved so powerfully would indicate so), but the fact that you're taking Effexor and Remeron would benefit by a mood stabilizer.
Also, be aware that lithium is in a class by it's own in the way it works. Many pdocs have tried to talk me into the different bipolar meds, with disastrous results. Lithium works, is what I need, and I'm so thankful it's in my life. Good luck and keep us posted. Barbara
> Hi all,
>
> I just started Lithobid 300 mgs yesterday. I was wondering how many times you Lithium vets dose daily?
>
> I have really liked Li so far. I mean, it seems to agree with me after a gazillion failed attempts at other meds. I have an aggitated sort of depression, and within an hour of dosing, my frazzled sort of thinking just calms right out, and I start marvelling at how nice and calm I feel.
>
> I already feel like I'd like to try 600, maybe a morning dose, and an evening one. I've been giving Effexor XR a good trial currently too. I'm just over 7 weeks with that. I'm at 225mgs Eff (the past 9 days), and 15 mgs Remeron for sleep.
>
> Even when I have an AD that sort of works, because of my super fast metabolism, I usually dose, then an hour or two later, I'll feel good for a couple of hours, then crash for the rest of the day. Ultimately, that's just too hard to deal with.
>
> I was hoping that maybe Lithium would smooth things out... you know, get rid of the daily roller coaster. And I thought since when I use an AD, that my garden variety depression turns into anxious depression, that perhaps a good mood stabilizer might be the ticket.
>
> Much to my great surprise, after the very first dose of Li, like I said, I had that great feeling of calm, and just well being. But that wears off after 4 or so hours too. But at least not a hard crash like with AD's.
>
> I know my reactions to meds are not at all standard, and I attribute that to the high metabolism. It's made it very difficult, and I've still not found relief.
>
> Anyway, just wanted to say hi, and that so far, so good with Li. I'd be shocked if after all this time fooling around with AD's, that something as old as Lithium does the trick. That would be a miracle.
>
> I got in such a bad way that 7 weeks ago, I took a leave of absence from work. Tried to go back after 3 weeks, and just wasn't up to it. Another 4 weeks, and another try at returning. I lasted 5 minutes, had a panic attack, and left. Then later the same day (yesterday), tried Li for the first time, and felt a relief I haven't known in some time. Hope it isn't a placebo effect.
>
> Sorry for the long, boring post. Best to you all.
>
> Messed up in Mexico, living on refried dreams.
Posted by Sabino on June 18, 2005, at 19:04:51
In reply to Re: Lithium: How many times do you dose per day? » Sabino, posted by barbaracat on June 18, 2005, at 15:40:56
Thanks for the info Barb. I don't know if I'm bipolar or not. I've suffered from depression, anxiety, and, to my mind, ADD. These last couple of years have really taken a toll on me cognitively. Very poor memory, and at times, very poor concentration. Diagnoses are such a hodgepodge anyway, with so many overlapping areas.
Complicating things for me is a super fast metabolism. The very first AD I ever took was Zoloft. That was back in 94. The first day I took it, I was so energized, I remember I actually ran to a nearby tennis court. Most AD's I've quit after the first day. Looking back, I can say that Prozac caused a mixed state. At the time, I just knew I felt horrible and anxiety ridden. Other AD's leave me wiped out on the couch, barely able to drag my behind to the refrigerator. In any case, I never found the relief I sought. Best they ever offered me was a couple hours of hypomania followed by a crash for the rest of the day.
And I've gone on all sorts of different trails in search of relief. Tried Ritalin; too much anxiety, didn't like it at all. Adderall, only sightly better. Never got prescribed Dexadrine, but I'm pretty sure I would have liked it. The thing is, I liked amphetamines when I was a kid some 30 years ago. I know about the tolerance developed with those, and didn't really want to pursue that.
From reading here on PB, I used to go to my Dr. with all sorts of ideas, and as long as the idea wasn't outrageous, he was amenable to letting me try stuff out. Hated almost everything I tried. I tried Provigil for a few days. I would come on to the stuff within an hour of dosing and crash a mere hour and a half later. Tried Adrafinil after a girl on this site touted its efficacy. No luck.
Even went so far as to try Nardil after reading so many of the Nardil Champ's glowing reviews. Made me feel really badly, and dumb as a rock.
Tried Strattera (Lord, what a nightmare that was). Tried Zyprexa for one night. Hated it.
Clonazepam has been a friend for years. I barely take any at all. I used to take 1/3 of an Ambien, and 1/4 of a clonazepam just to help with sleep.
Oh yeah, Paxil was sort of beneficial, but only at a really microdose, I mean like 3mgs (most would say why bother), but I got some benefit, and any more left me wiped out.
The AD with the least side effects for me was Remeron. And that's really not that it doesn't have side effects, but that it's main one (causing sleep) was not undesirable. Even with my fast metabolism, I'd want to eat anything not nailed down, and gained close to 10 pounds.
Last, as I said in my last post, I've been giving Effexor a trial. And this time, at full dose. I got all the way up to 225mgs, along with 15mgs Remeron for sleep. I felt some good things from Effexor on the startup kit. Still with the come up, wear off and crash stuff though.
And, like I said, I was in such a bad way that I had to take a leave of absence for the first time. Always before, I hung on by my fingernails and always worked, but this time, I thought, I either need to get better, or end this charade, because I had become so reclusive, and I was feeling overwhelmed at work too.
A basic meltdown, you might say. So then, a few days ago, I went back to pdoc to get the 'Fit to return to work' note from him. And, I asked if I could try Lithium, which he agreed to. Well, I didn't really feel up to returning, but I went in the next day anyway, and immediately had a panic attack.
There were other meds tried too (I've got what I call 'the shoebox of shame'), but I've wasted too much band width already. Anyway, thanks for the response and encouragement. Early returns are positive on the Li. It really does feel like the best med I've ever tried.
The only side effect that I've had from it thus far is that there's a little hangover effect in the a.m. Does that go away?
Posted by Sabino on June 18, 2005, at 19:23:33
In reply to Re: Lithium: How many times do you dose per day? » barbaracat, posted by Sabino on June 18, 2005, at 19:04:51
This is only my third day of Li, but I've found that instead of making me tired, it actually energizes me, and clarifies my thought too.
Just thought that was interesting because I think Li is known more for making people tired, and is a cognitive duller from what I've read.
I feel fortunate thus far (keeping fingers crossed).
Posted by ed_uk on June 18, 2005, at 19:58:22
In reply to Re: Lithium: How many times do you dose per day? » barbaracat, posted by Sabino on June 18, 2005, at 19:04:51
Hi Sabino,
I hope you don't mind me asking.........
What side effects did you get when you tried Nardil, Strattera and Zyprexa??
~Ed
Posted by ed_uk on June 18, 2005, at 19:59:26
In reply to Lithium: How many times do you dose per day? » barbaracat, posted by Sabino on June 17, 2005, at 18:06:26
>This is only my third day of Li, but I've found that instead of making me tired, it actually energizes me, and clarifies my thought too.
>Just thought that was interesting because I think Li is known more for making people tired, and is a cognitive duller from what I've read.Ahhh, the benefits of a nice low dose!!
~Ed
Posted by barbaracat on June 18, 2005, at 21:14:00
In reply to Re: Lithium: How many times do you dose per day? » barbaracat, posted by Sabino on June 18, 2005, at 19:04:51
Wow, we could enter the semi-twins contest as far as symptoms and med trials. Interestingly, I enjoyed the heck out of amphetamines in my younger days too. It calmed me and un-depressed me. I tried a trial with Ritalin a few years back when nothing else was working and I was so disorganized that I'd find my car keys in the fridge and so on. It didn't help at the time, however, lately I've been taking some from my old prescription to help with focus as I plow through my years of bipolar clutter. I find that it does help alot more, maybe due to adding lithium. There's so much overlap with ADD and bipolar anyway. When I'm manic, my cognitive skills go from super sharp to utter chaos. But I can be normally focused and as I understand it, ADD is pretty much a constant thing.
I took Remeron for a short time and gained 40 pounds. I would literally find myself snarling as I wolfed down old frozen stale deserts. It worked for a while then pooped, as all my ADs eventually did until lithium. Prozac wound me up so badly I thought I was in orbit. Zoloft was the only one that was effective (pre lithium) but pooped and then was tanked up to so high a dose that I ended up hospitalized.
I do very poorly on Seroquel, Zyprexa or any of the APs. They leave me feeling drunk and more depressed and sometimes wired. I frequently get paradoxical reactions from drugs.
Your micro-dosing ADs situation is not that uncommon, as I'm finding out as I research this stuff. Recently I was put on Cymbalta the 'new Effexor' because lithium, while great, is not enough to combat periodic depressions. I was put on the typical 30mg starting dose and almost took off into space. It was a wild, wild ride. But I felt something positive immediately and so experimented with micro doses. A 30mg capsule has 300 tiny pellets. I was on 3 of these pellets for over a week, slowly titrating until now, after almost 5 months I'm stable at 80 pellets, or 8mg. It is truly the best AD I've been on and a shame that more people who would benefit are scared off by the intense effects of simply too much.
I've communicated with a number of people who have had a similar experience, most notably with
Cymbalta (the norepinephrine kicks in almost immediately), but have found micro-dosing to work with other ADs as well. All of these people are bipolar. Those with unipolar depression without significant agitation seem to tolerate much higher doses.By fast metabolizer, I suspect you have a genetic susceptibility for a subisozyme, 2D6, of your liver cytochrome CP450 enzymes to lack inhibitors. This would break down the med superfast, and ADs depend on this 2D6 isozyme for detoxification. I have a theory that someday soon we're going hear about bipolars having a genetic malfunction with this enzyme system and why we're so dang sensitive to certain drugs.
What you've described so far rings true as far as bipolar symptoms. Yep, what's in a name and all that as long as the medicine works, but it's good to know because bipolars are a different animal biochemically and it's beneficial to know what helps and what to avoid. One thing that has helped me, on the same line as lithium, is L-taurine, an amino acid that acts as a mood stabilizer and muscle and cell electrical stabilizer.
There's a wonderful website that's devoted to information about bipolar and agitated depression you might want to check out. You could spend weeks following the links.
www.psycheducation.org
> Thanks for the info Barb. I don't know if I'm bipolar or not. I've suffered from depression, anxiety, and, to my mind, ADD. These last couple of years have really taken a toll on me cognitively. Very poor memory, and at times, very poor concentration. Diagnoses are such a hodgepodge anyway, with so many overlapping areas.
>
> Complicating things for me is a super fast metabolism. The very first AD I ever took was Zoloft. That was back in 94. The first day I took it, I was so energized, I remember I actually ran to a nearby tennis court. Most AD's I've quit after the first day. Looking back, I can say that Prozac caused a mixed state. At the time, I just knew I felt horrible and anxiety ridden. Other AD's leave me wiped out on the couch, barely able to drag my behind to the refrigerator. In any case, I never found the relief I sought. Best they ever offered me was a couple hours of hypomania followed by a crash for the rest of the day.
>
> And I've gone on all sorts of different trails in search of relief. Tried Ritalin; too much anxiety, didn't like it at all. Adderall, only sightly better. Never got prescribed Dexadrine, but I'm pretty sure I would have liked it. The thing is, I liked amphetamines when I was a kid some 30 years ago. I know about the tolerance developed with those, and didn't really want to pursue that.
>
> From reading here on PB, I used to go to my Dr. with all sorts of ideas, and as long as the idea wasn't outrageous, he was amenable to letting me try stuff out. Hated almost everything I tried. I tried Provigil for a few days. I would come on to the stuff within an hour of dosing and crash a mere hour and a half later. Tried Adrafinil after a girl on this site touted its efficacy. No luck.
>
> Even went so far as to try Nardil after reading so many of the Nardil Champ's glowing reviews. Made me feel really badly, and dumb as a rock.
>
> Tried Strattera (Lord, what a nightmare that was). Tried Zyprexa for one night. Hated it.
>
> Clonazepam has been a friend for years. I barely take any at all. I used to take 1/3 of an Ambien, and 1/4 of a clonazepam just to help with sleep.
>
> Oh yeah, Paxil was sort of beneficial, but only at a really microdose, I mean like 3mgs (most would say why bother), but I got some benefit, and any more left me wiped out.
>
> The AD with the least side effects for me was Remeron. And that's really not that it doesn't have side effects, but that it's main one (causing sleep) was not undesirable. Even with my fast metabolism, I'd want to eat anything not nailed down, and gained close to 10 pounds.
>
> Last, as I said in my last post, I've been giving Effexor a trial. And this time, at full dose. I got all the way up to 225mgs, along with 15mgs Remeron for sleep. I felt some good things from Effexor on the startup kit. Still with the come up, wear off and crash stuff though.
>
> And, like I said, I was in such a bad way that I had to take a leave of absence for the first time. Always before, I hung on by my fingernails and always worked, but this time, I thought, I either need to get better, or end this charade, because I had become so reclusive, and I was feeling overwhelmed at work too.
>
> A basic meltdown, you might say. So then, a few days ago, I went back to pdoc to get the 'Fit to return to work' note from him. And, I asked if I could try Lithium, which he agreed to. Well, I didn't really feel up to returning, but I went in the next day anyway, and immediately had a panic attack.
>
> There were other meds tried too (I've got what I call 'the shoebox of shame'), but I've wasted too much band width already. Anyway, thanks for the response and encouragement. Early returns are positive on the Li. It really does feel like the best med I've ever tried.
>
> The only side effect that I've had from it thus far is that there's a little hangover effect in the a.m. Does that go away?
Posted by Sabino on June 19, 2005, at 9:17:19
In reply to Re: Lithium: How many times do you dose per day? » Sabino, posted by ed_uk on June 18, 2005, at 19:58:22
Hi Ed,
Nardil was occasionally effective for social anxiety issues, but far more often than not, I was very exhausted on it, and really cognitively dulled. I work in IT, and my work noticeably suffered. This is a med that I think I gave a legit shot too. Think I tried it for a good two months at a therapeutic level. I actually tried Parnate for a couple of days too, but it caused a lot of anxiety. That was my trip down MAOI lane.
A lot of my one or two day trials had everything to do with bad initial effects, and if I'd have had the luxury to stay at home for a couple of months, maybe I'd have ridden out the sfx's and found success, but the need to earn the paycheck always precluded that... until, one gets to the point where you seriously have to do everything possible to get better, or you don't want to stay around, money be damned.
Strattera made me confused, agitated, and just out of it, which, of course, is very depressing.
I don't remember what I didn't like about Zyprexa.
Anyway, so far, so good with Li. I take it from your 'benefits of a low dose' comment that my energizing and non-cognitive impairment response is quite typical on a low dose. I suspect I won't need more than 600 mgs. I'm scaling back on the Effexor now too.
All of which says, I guess, that I aint where I want to be yet, but I'm still in the game.
The fact that I still have not returned to work is huge. My company has been extraordinarily understanding, but they can't be in limbo forever.
As a famous lady once said, 'I'll think about that tomorrow'.
Posted by Sabino on June 19, 2005, at 9:28:10
In reply to Re: Lithium: How many times do you dose per day? » Sabino, posted by barbaracat on June 18, 2005, at 21:14:00
Barb, thanks for all the useful info. Interesting about the fast metabolism. Surely makes med taking more problematic.
Zoloft was the one that actually made me feel the best too (but only for 3 hours or so daily). For those 3 hours though, I felt great. That's a rough ride every day, up and down.
I'm taking Lithobid 300. I think it is an extended release formula, but I think I'll cut them in half, and dose around every few hours to see how that goes. Will ask the pdoc to prescribe 600 daily when I see him on Monday.
You sound happy and content. That's terrific.
Thanks a bunch for all the support.
Posted by ed_uk on June 19, 2005, at 11:26:47
In reply to Re: Lithium: How many times do you dose per day? » ed_uk, posted by Sabino on June 19, 2005, at 9:17:19
Hi Sabino,
Thank you for your reply :-)
>MAOI
I think you said you live in Mexico. How easy was it to get hold of Nardil and Parnate? Cliffstone - who lives in Mexico, wants to try an MAOI.
Kind regards,
Ed.
Posted by Sabino on June 19, 2005, at 12:38:32
In reply to Re: Lithium: How many times do you dose per day? » Sabino, posted by ed_uk on June 19, 2005, at 11:26:47
Hey Ed,
I'm not really from Mexico. That's just a silly line from a song... and I have no idea why I threw that in there. I get a little goofy sometimes.
Hey, just out of curiousity, what meds are you on now, and are you doing well?
Best
Posted by ed_uk on June 19, 2005, at 18:11:17
In reply to Re: Lithium: How many times do you dose per day? » ed_uk, posted by Sabino on June 19, 2005, at 12:38:32
Hi Sabino,
>I'm not really from Mexico. That's just a silly line from a song... and I have no idea why I threw that in there. I get a little goofy sometimes.
LOL!
>Hey, just out of curiousity, what meds are you on now, and are you doing well?
I'm on citalopram 60mg for OCD. It seems to be helping some :-)
Kind regards,
Ed.
Posted by yesac on June 20, 2005, at 12:58:43
In reply to Re: Lithium: How many times do you dose per day? » barbaracat, posted by Sabino on June 18, 2005, at 19:04:51
Wow, Sabino, you sound just like me! I too have been on a zillion different drugs with pretty bad results or basic lack of efficacy. I don't know if I'm bipolar either, but I have severe agitated depression and have some anxiety, and I have a lot of attention issues as well (possibly ADD-- not really sure-- like you said, it's all ambiguous and there's so much overlap).
Prozac caused pretty much of a mixed state for me too. And I didn't like Adderall and Ritalin that much-- they seemed to worsen my mood lability. I haven't tried Dexedrine or Strattera yet but probably will soon.
I totally hear you on the leave of absense thing. I have been back in school for a year (1st year grad school). Now it's summer break, thank god, but I had a very grueling struggle trying to get through this past year. Thank goodness I'm only in a 2 year program. My attention problems and organization problems have gotten so bad. I kind of got into trouble and had to meet with this committee because I skipped an important exam one day. I don't know what on earth possessed me to do that, but I woke up and just decided not to go. Hard to explain. I don't even understand it myself. But there has hardly been a day that went by that I haven't thought about taking time off from school. Ultimately though, I sort of think that it might be best if I just grit my teeth and get through it if at all possible.
Anyways, I'm on lithium now too, and Seroquel, adn they are the first drugs that I am finding very helpful in terms of overall mood state. I feel much less agitated and more calm. I still have my attention problems pretty badly, and I still feel somewhat depressed-- more of a mild, gloomy feeling kind of depression.
I am glad you found something and hope it works out for you.
Oh I take my whole dose (600mgs) at night. I wonder if there's some advantage to splitting it. I had never thought of that.
Posted by yesac on June 20, 2005, at 13:14:16
In reply to Re: Lithium: How many times do you dose per day? » Sabino, posted by barbaracat on June 18, 2005, at 21:14:00
> But I can be normally focused and as I understand it, ADD is pretty much a constant thing.
Yeah that's what I understand too... but for me, it's hard to tell because I have attention problems pretty much all the time, but for the most part I have mood probs all the time too! But now the mood probs are much more "tame" because of li++/Seroquel, but my attn problems are as bad as ever.... so I don't know.
Did you say Ritalin was better when you were on lithium?
>
> Your micro-dosing ADs situation is not that uncommon, as I'm finding out as I research this stuff.
> I've communicated with a number of people who have had a similar experience, most notably with
Cymbalta (the norepinephrine kicks in almost immediately), but have found micro-dosing to work with other ADs as well. All of these people are bipolar. Those with unipolar depression without significant agitation seem to tolerate much higher doses.That's interesting. I've tolerated fairly high doses of a lot of drugs (ADs and others). Most seemed to basically do nothing, even at high doses. But others wacked me out, for example Cymbalta... and I wonder if a low LOW dose might be useful. I'm looking for an antidepressant now, as it happens, so maybe that's something to consider. They never seem to make me happy though, just worsen my agitation and increase suicidal/homicidal ideation and aggression and hyped-up-ness.
>
> www.psycheducation.org
>That's a great website. It is what got me really considering if I might have some kind of bipolar variant.
Posted by barbaracat on June 20, 2005, at 15:25:10
In reply to Re: Lithium: How many times do you dose per day? » barbaracat, posted by yesac on June 20, 2005, at 13:14:16
> > But I can be normally focused and as I understand it, ADD is pretty much a constant thing.
>
> Yeah that's what I understand too... but for me, it's hard to tell because I have attention problems pretty much all the time, but for the most part I have mood probs all the time too!**I look back on growing up and can recognize typical attention problems along with mood problems. No matter how I tried, my room was always a disaster area. I crave order and neatness but it's beyond me. My ADD can be either total disorganization, which runs hand in hand with the frenzy of bipolar - I'll be doing one thing and my attention is captured by a new idea or distraction, so I leave a trail of unfinished projects. Or, I can be so hyperfocused that nothing can distract me even when it should. So, I'd say that I have an ADD-type disorder.
It all probably falls within the same glitch area in my brain that causes the rest of it. I am considering talking to my pdoc about some treatment for it. I was given Ritalin a few years back but any agitation was the last thing I needed since I was so exhausted at that time. But now, I'm doing so much better physically and psychically and able to start tackling things that were left to rot for years and years. I have alot more motivation in general and am much healthier, so I think I can tolerate a stimulant. However, even though I have the will and the energy, I still need help with the organization and focus part and found the Ritalin helps now where it didn't before. I'm even able to sleep on it, which tells me something.
So, whether it's a product of lithium making it work better or differently, or me just being in a stronger place in general I don't know. All of the above, probably. I'd like to try a few different ones to see what works best. All I know is that my drug of choice when I was going through very difficult late teens was meth. Taking meth and dancing were the only times I remember being happy back then.
> That's interesting. I've tolerated fairly high doses of a lot of drugs (ADs and others). Most seemed to basically do nothing, even at high doses. But others wacked me out, for example Cymbalta... and I wonder if a low LOW dose might be useful.
**When you say wacked out?? Cymbalta has a strong norepinephrine kick that hits right off the bat. The NE is stronger at lower doses and serotonin kicks in at higher. Even though I'm still prone to anxiety, the NE doesn't seem to bother me with Cymbalta. It's a bit of a pain counting out those miniscule pellets but I'll gladly do it to feel better. I've tried a full 30jmg capsule a few times now that I've been on it for 5 months and nope, can't take that much. My pdoc says she's been having a mixed bag as far as results with her clients. Some people do horribly on it and some think it's the best thing they've ever done, however, I'm the only one of her clients on a micro dose. If nothing else has worked, I'd encourage you to give it a try.
> That's a great website. It is what got me really considering if I might have some kind of bipolar variant.
**Isn't it? Have you delved into the mixed states area? You'll probably go 'huh, that's me!'. I think it's a link in one of the main articles, but like the whole website, you can immerse yourself deeper and follow links forever.
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