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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Don_Bristol on April 28, 2006, at 19:53:08
I need some info to introduce me to lithium.
I've tried many of the antidepressants and so far the best has been Parnate. I am taking 50mg. (Here in the UK we think that is a lot.) The psyichiatrist tried adding the tiniest bit of one of the new neuroleptics (olanzapine) but I had too many side effects.
My psychiatrist detects something in me and my presentation which makes him feel that lithium is worth trying. All I know about lithium is that blood levels need to be carefully monitord and that it is used for bipolar.
Ny psych says "It's not used only for biploar" and I didn't pursue that point. So guys, QUESTION ONE: what else could he be thinking about using lithium for? Does lithium affect serotonin?
QUESTION TWO Is lithium seen as a good med? All that blood testing seems to make lithium a lot of work. But is it worth it?
QUESTION THREE. Can I take lithium with Parnate?
Thank you.
DOn
Posted by strugglingsteve on April 28, 2006, at 20:36:18
In reply to Is lithium any good?, posted by Don_Bristol on April 28, 2006, at 19:53:08
I am on emsam now and am also taking lithium. It calmed me down alot although i still have bad anxiety. I have a friend who takes it for depression and done so for 25 years. It didnt clear my depression and that bummed me out. Lithium is a good med and you can take it with parnate, its just a salt. Its worth a shot, i am just bummed it didnt help me more than it does.
> I need some info to introduce me to lithium.
>
> I've tried many of the antidepressants and so far the best has been Parnate. I am taking 50mg. (Here in the UK we think that is a lot.) The psyichiatrist tried adding the tiniest bit of one of the new neuroleptics (olanzapine) but I had too many side effects.
>
> My psychiatrist detects something in me and my presentation which makes him feel that lithium is worth trying. All I know about lithium is that blood levels need to be carefully monitord and that it is used for bipolar.
>
> Ny psych says "It's not used only for biploar" and I didn't pursue that point. So guys, QUESTION ONE: what else could he be thinking about using lithium for? Does lithium affect serotonin?
>
> QUESTION TWO Is lithium seen as a good med? All that blood testing seems to make lithium a lot of work. But is it worth it?
>
> QUESTION THREE. Can I take lithium with Parnate?
>
> Thank you.
>
> DOn
Posted by Meri-Tuuli on April 29, 2006, at 6:42:42
In reply to Is lithium any good?, posted by Don_Bristol on April 28, 2006, at 19:53:08
Hey! Well, I didn't realise you lived in the UK! I'm guessing Bristol?? I used to live there, and I pretty much liked it. Anyway, thats great that your doc has got you on parnate, well, apparently its difficult to get MAOIs from British pdocs.
Please just be aware of the hypertensive thing and casulty departments. I read from a UK poster (I can't remember his name now) that he had a hypertensive reaction and went to casulty - the docs there didn't understand and tried to give him a shot for serontin syndrome and not the antidote nif(something - I can't remember!) to bring the BP down. He refused the shot and went home and took the antidote that he had....alittle shocking I know....
Anyway here's some info on lithium you might find useful....
http://en.wikipedia.org/wiki/Lithium_carbonate
I don't know if you've tried looking there.
Anyway kind regards,
Meri
Posted by Caedmon on April 29, 2006, at 7:22:53
In reply to Is lithium any good?, posted by Don_Bristol on April 28, 2006, at 19:53:08
>>I've tried many of the antidepressants and so far the best has been Parnate. I am taking 50mg. (Here in the UK we think that is a lot.) >>
Sort of off-topic but what is it with the UK? It's hard to get MAOIs, it's nearly impossible to get benzos. Can you get stimulants? Or maybe I live in the US so I'm too aggressive. <shrug> But my immediate thought was, "Why not increase the Parnate?"
> So guys, QUESTION ONE: what else could he be thinking about using lithium for? Does lithium affect serotonin?>
Li is a commonly-used agent to augment antidepressants in unipolar depression. Well, it's very much studied, I don't know how often it's used in clinical settings. Yes it affects serotonin somewhat and it does some other things that I don't really understand.
> QUESTION TWO Is lithium seen as a good med? All that blood testing seems to make lithium a lot of work. But is it worth it?>
I don't know very much about Li, I know that my pdoc feels it doesn't increase the therapeutic response in unipolar depression very much in most patients, although it's a good choice for bipolar-I.
I would say that it's a decent choice to try with Parnate, if you're not willing to increase the dose. You'd be using smaller doses than is used normally. I don't know how much blood testing is involved in those smaller doses or not, I'm sure someone else who's been on it can tell us. Good luck!
- C
Posted by Meri-Tuuli on April 29, 2006, at 8:14:54
In reply to Re: Is lithium any good?, posted by Caedmon on April 29, 2006, at 7:22:53
> Sort of off-topic but what is it with the UK? It's hard to get MAOIs, it's nearly impossible to get benzos. Can you get stimulants?
The probablity of getting one is virtually zero. One UK poster got one prescribed, but then the pdoc got fired (not because of that but other things) of malpractice.
Yeah it really angers me that we can't get the drugs that we actually might need here in the UK. Heaven knows what you do if you are an adult with ADD/ADHD - the condition doesn't really seem to exist here, it disappears after the age of 16!!
I think the fundamental difference is that the NHS is funded through tax and is free for all, so we don't the drug reps etc pushing drugs on docs to prescribe and we don't have adverts for prescription drugs and we pay $9 for any/all drugs the doc prescribes. Plus docs have strict prescribing guidelines and they can't 'go it alone' because 99% of docs are employed by the NHS. So they have to adhere to the guidelines the government sets which are strict with regard to stims, benzos and maybe MAOIs.
Plus the most fundamental difference is that if you pay for healthcare (like in the US) it is in the docs/healthcare's best interest to have you on as many drugs, tests, things like that as possible to make money out of you, or rather there's no limit. Here its the other way round. Try to spend as little as possible on you whilst keeping you healthy/functional/alive.
I know I grumble about the NHS re: mental healthcare, but on the whole it is a good thing. You can be as rich as you like and you'll still get the same treatment as a pauper. But then, we pay around 35% income tax which I gather is alot more than in the US, but then you have to pay for health insurance....
Anyway, totally OT!!!!
Posted by Emily Elizabeth on April 29, 2006, at 14:41:53
In reply to Is lithium any good?, posted by Don_Bristol on April 28, 2006, at 19:53:08
I take lots of meds for unipolar treatment resistant depression (lexapro, desipramine, dexedrine, neurontin, lithium, and ambien)
and, honestly, I have not been able to get "well" for over a month within the past 3 yrs. I am once again looking into making some changes, HOWEVER, 2 pdocs and I agree that we don't want to touch the Li. It is one drug that does seem to have made a real dent in the depression. AND I haven't been quite as low as I was prior to the Li (6 mos ago?) One thing that Li is known for is reducing suicidal thoughts/feelings. It has done that for me.I've never tried an MAOI, so I can't compare. (Actually, I can't believe that you pdoc was willing to try that before Li.)
QUESTION ONE: what else could he be thinking about using lithium for? Does lithium affect serotonin?
Probably treatment resistent depression. My pdoc said that a mood stabilizer can be especially helpful for depression where you get a little better on every thing, but not completely better. I don't know if she read that somewhere or it is her observation. I don't think that Li affects serotonin, but I'm not sure. It works differently than most AD's, so it often can work when other things won't. Also, it has been used for many yrs and there have been consistent research findings supporting its use in unipolar dep.
>
> QUESTION TWO Is lithium seen as a good med? All that blood testing seems to make lithium a lot of work. But is it worth it?If you are using it to augment an AD, you won't need to take as much as a bipolar patient. So, the blood levels don't go so close to that toxic line and so you really don't need blood tests often. I've just had one. Pdoc says that it stays pretty stable unless you are having a manic episode. I have had a few more blood tests to check thyroid functioning, b/c Li can interfere. No big deal, though. I think that we were mostly checking b/c we keep wondering if I'm having thyroid probs which are causing depression (nope.)
I would say that Li is seen as a tried and true good med. Some people get a lot of s/e's, but I haven't. Lower doses are helpful w/ avoiding that too.
Hope this helps! Just ask if you have more ?'s.
Best,
EE
Posted by patrickhh on April 29, 2006, at 20:14:48
In reply to Is lithium any good?, posted by Don_Bristol on April 28, 2006, at 19:53:08
> I need some info to introduce me to lithium.
>
> I've tried many of the antidepressants and so far the best has been Parnate. I am taking 50mg. (Here in the UK we think that is a lot.) The psyichiatrist tried adding the tiniest bit of one of the new neuroleptics (olanzapine) but I had too many side effects.
>
> My psychiatrist detects something in me and my presentation which makes him feel that lithium is worth trying. All I know about lithium is that blood levels need to be carefully monitord and that it is used for bipolar.
>
> Ny psych says "It's not used only for biploar" and I didn't pursue that point. So guys, QUESTION ONE: what else could he be thinking about using lithium for? Does lithium affect serotonin?
>
> QUESTION TWO Is lithium seen as a good med? All that blood testing seems to make lithium a lot of work. But is it worth it?
>
> QUESTION THREE. Can I take lithium with Parnate?
>
> Thank you.
>
> DOnActually Don, lithium seems to be the most studied augmenting agent for treatment-resistant depression. Studies show it to be pretty effective when used as an augmenting agent. Unfortunately, we don't know why it helps. It just does.
Blood testing is necessary because lithium has a very narrow therapeutic range. Take a little too much, and it can be lethal. So your doc wants to make sure you're on the right dose, in comparison to your metabolism.
Lithium and Parnate can be taken together.
Posted by linkadge on April 29, 2006, at 20:56:44
In reply to Re: Is lithium any good?, posted by patrickhh on April 29, 2006, at 20:14:48
Lithium does affect serotonin. It works by blocking an inhibitory serotonin autoreceptor (5-h1b) and thus increasing serotonin release.
The effect of SSRI's is thought to be delayed by the time it takes for the drug to desensitize these autoreceptors, but a drug like lithium can affect serotonin release immedately.
Lithium also affects other neurotransmitters as well. Ie it seems to have a stabilizing effect on glutamate. Increasing glutamate if levels are too low, or reducing it when too high.
Some people find it very hard to tollerate. While I did find it had a very good initial antidepressant effect, that seemed to wear off for me.
In Europe, lithium is used a lot more for unipolar depression.
I think its worth a shot.
Linkadge
Posted by Phillipa on April 29, 2006, at 20:56:50
In reply to Re: Is lithium any good?, posted by patrickhh on April 29, 2006, at 20:14:48
Lithium is the oldest mood stabalizer I think . It is a salt that occurrs naturally in a person. Adding lithium the range must never get too hight as that is dangerous too low may not work. But the frequesnt blood testing is necessary because of the theraputic window. Love Phillipa
Posted by capricorn on April 29, 2006, at 21:25:02
In reply to Is lithium any good?, posted by Don_Bristol on April 28, 2006, at 19:53:08
It can be helpful for treatment resistant depression.
Also good for classical bipolar.
Not that good for rapid cycling bipolar,mixed states, or dysphoria.http://www.nami.org/Content/ContentGroups/Helpline1/Lithium.htm
http://www.mentalhealth.com/rx2/bp-can1.html#Head_13
http://bjp.rcpsych.org/cgi/content/abstract/178/41/s184
http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/jpn/vol-29/issue-1/pdf/pg9.pdf
http://tinyurl.com/kha6t (google scholar lithium and unipolar depression)
Posted by omega513 on May 1, 2006, at 2:03:34
In reply to Is lithium any good?, posted by Don_Bristol on April 28, 2006, at 19:53:08
I am currently on 40 mg of parnate and 450mg of Lithium. I do not have bipolar. The combination has worked wonders for me. Due to side effects of the parnate, I may have to switch, but for the past one year, my depression has been in remission.
Posted by Don_Bristol on May 1, 2006, at 8:12:00
In reply to Re: Is lithium any good?, posted by Caedmon on April 29, 2006, at 7:22:53
>>I've tried many of the antidepressants and so far the best has been Parnate. I am taking 50mg. (Here in the UK we think that is a lot.) >>
>
> Sort of off-topic but what is it with the UK? It's hard to get MAOIs, it's nearly impossible to get benzos. Can you get stimulants? Or maybe I live in the US so I'm too aggressive. <shrug> But my immediate thought was, "Why not increase the Parnate?" <<<That is my thought too: "Why not increase the Parnate". But in the UK the max recommended dose is 30mg and not the 60mg it is in the states so a clinician who prescribes a load more does so on his own responsibility.
Stimulants like ritalin are exrememly hard for adults to get here in the UK. I guess I'm lucky that my parnate metabolises to something which is stimulating.
Posted by Don_Bristol on May 1, 2006, at 8:14:31
In reply to Re: Is lithium any good?, posted by patrickhh on April 29, 2006, at 20:14:48
> > I need some info to introduce me to lithium.
> >
> > I've tried many of the antidepressants and so far the best has been Parnate. I am taking 50mg. (Here in the UK we think that is a lot.) The psyichiatrist tried adding the tiniest bit of one of the new neuroleptics (olanzapine) but I had too many side effects.
> >
> > My psychiatrist detects something in me and my presentation which makes him feel that lithium is worth trying. All I know about lithium is that blood levels need to be carefully monitord and that it is used for bipolar.
> >
> > Ny psych says "It's not used only for biploar" and I didn't pursue that point. So guys, QUESTION ONE: what else could he be thinking about using lithium for? Does lithium affect serotonin?
> >
> > QUESTION TWO Is lithium seen as a good med? All that blood testing seems to make lithium a lot of work. But is it worth it?
> >
> > QUESTION THREE. Can I take lithium with Parnate?
> >
> > Thank you.
> >
> > DOn
>
>
>
> Actually Don, lithium seems to be the most studied augmenting agent for treatment-resistant depression. Studies show it to be pretty effective when used as an augmenting agent. Unfortunately, we don't know why it helps. It just does.
>
> Blood testing is necessary because lithium has a very narrow therapeutic range. Take a little too much, and it can be lethal. So your doc wants to make sure you're on the right dose, in comparison to your metabolism.
>
> Lithium and Parnate can be taken together.
>
>
>
>
>patrick thank you for your level headed and informative reply.
Posted by Don_Bristol on May 1, 2006, at 8:17:31
In reply to Re: Is lithium any good?, posted by Meri-Tuuli on April 29, 2006, at 6:42:42
> Hey! Well, I didn't realise you lived in the UK! I'm guessing Bristol?? I used to live there, and I pretty much liked it. Anyway, thats great that your doc has got you on parnate, well, apparently its difficult to get MAOIs from British pdocs.
>
> Please just be aware of the hypertensive thing and casulty departments. I read from a UK poster (I can't remember his name now) that he had a hypertensive reaction and went to casulty - the docs there didn't understand and tried to give him a shot for serontin syndrome and not the antidote nif(something - I can't remember!) to bring the BP down. He refused the shot and went home and took the antidote that he had....alittle shocking I know....
>
> Anyway here's some info on lithium you might find useful....
>
> http://en.wikipedia.org/wiki/Lithium_carbonate
>
> I don't know if you've tried looking there.
>
> Anyway kind regards,
>
> Meri
>Sh*t, Meri, I replied but it got lost. maybe didn't press the send button twice.
Posted by patrickhh on May 1, 2006, at 9:36:13
In reply to Re: Is lithium any good?, posted by omega513 on May 1, 2006, at 2:03:34
> I am currently on 40 mg of parnate and 450mg of Lithium. I do not have bipolar. The combination has worked wonders for me. Due to side effects of the parnate, I may have to switch, but for the past one year, my depression has been in remission.
The lithium may be what's helping you the most. You might try swtiching the Parnate for an SSRI and see what kind of response you get.
Posted by patrickhh on May 1, 2006, at 9:37:16
In reply to Re: Is lithium any good? » patrickhh, posted by Don_Bristol on May 1, 2006, at 8:14:31
> patrick thank you for your level headed and
informative reply.Glad to help anyway I can! We're all in this together.
Posted by patrickhh on May 1, 2006, at 9:38:27
In reply to Re: Is lithium any good?, posted by patrickhh on May 1, 2006, at 9:36:13
> The lithium may be what's helping you the most. You might try swtiching the Parnate for an SSRI and see what kind of response you get.
>
>Even if you didn't get response from SSRI's before, they seem to work pretty well in combination with lithium. With lithium on board at this point, SSRI's might indeed word. Wellbutrin with lithium is another option.
Posted by ed_uk on May 1, 2006, at 10:43:45
In reply to Re: Is lithium any good? » Caedmon, posted by Don_Bristol on May 1, 2006, at 8:12:00
Hi Don
>But in the UK the max recommended dose is 30mg and not the 60mg it is in the states so a clinician who prescribes a load more does so on his own responsibility.
There isn't a maximum dose in the UK as such. The official data sheet just says 'doses above 30 mg daily under close supervision only' or something like that. I think you might be able to encourage your doc to let you try 60mg, since this is the maximum recommended dose in the US.
Regards
ED
Posted by Don_Bristol on May 4, 2006, at 10:44:09
In reply to Re: Is lithium any good? » Don_Bristol, posted by ed_uk on May 1, 2006, at 10:43:45
> Hi Don
>
> >But in the UK the max recommended dose is 30mg and not the 60mg it is in the states so a clinician who prescribes a load more does so on his own responsibility.
>
> There isn't a maximum dose in the UK as such. The official data sheet just says 'doses above 30 mg daily under close supervision only' or something like that. I think you might be able to encourage your doc to let you try 60mg, since this is the maximum recommended dose in the US.
>
> Regards
>
> EDEd, that is one hell of a good point about the max dose of tranylcypromine (I will call it that because Parnate does *not* seem to be the trade name in the UK - very odd) .
I am seeing my psychiatrist tomorrow and will put it to him. I was told that the max is 30mg but I see that the BNF says what you state about "close supervision".
Is there another UK source for info about this. I would love to print it off and show it to my doc tomorrow. What I usually get is US info which the UK docs are not obliged to follow.
Thanks
Don
Posted by Don_Bristol on May 4, 2006, at 10:47:59
In reply to Re: Is lithium any good?, posted by linkadge on April 29, 2006, at 20:56:44
> Lithium does affect serotonin. It works by blocking an inhibitory serotonin autoreceptor (5-h1b) and thus increasing serotonin release.
>
> The effect of SSRI's is thought to be delayed by the time it takes for the drug to desensitize these autoreceptors, but a drug like lithium can affect serotonin release immedately.
>
> Lithium also affects other neurotransmitters as well. Ie it seems to have a stabilizing effect on glutamate. Increasing glutamate if levels are too low, or reducing it when too high.
>
> Some people find it very hard to tollerate. While I did find it had a very good initial antidepressant effect, that seemed to wear off for me.
>
> In Europe, lithium is used a lot more for unipolar depression.
>
> I think its worth a shot.
>
> LinkadgeLinkadage, you mention side effects. In practise what side effects do people find most troublesome with lithium.
I find the official data sheets a bit misleading for this info (which is why I am asking you or anyone else who can contribute) because the official sheets can overlook so much. EG the SSRIs came out and sexual side effects hardly got mentioned and yet made 1 person on SSRIs in 4 has that side effect.
TIA for any info.
Don
Posted by Don_Bristol on May 4, 2006, at 10:49:48
In reply to Re: Is lithium any good?, posted by capricorn on April 29, 2006, at 21:25:02
> It can be helpful for treatment resistant depression.
> Also good for classical bipolar.
> Not that good for rapid cycling bipolar,mixed states, or dysphoria.
>
> http://www.nami.org/Content/ContentGroups/Helpline1/Lithium.htm
>
> http://www.mentalhealth.com/rx2/bp-can1.html#Head_13
>
> http://bjp.rcpsych.org/cgi/content/abstract/178/41/s184
>
> http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/jpn/vol-29/issue-1/pdf/pg9.pdf
>
> http://tinyurl.com/kha6t (google scholar lithium and unipolar depression)
Some great links here. Thank you very much. it is appreciated.Don
Posted by ed_uk on May 4, 2006, at 14:22:21
In reply to Re: Is lithium any good? » ed_uk, posted by Don_Bristol on May 4, 2006, at 10:44:09
Hi Don
>Parnate does *not* seem to be the trade name in the UK
Parnate *was* the trade name in the UK. Currently, it is only available as a generic from Goldshield.
>I was told that the max is 30mg....
Your doc is wrong! Tranylcypromine *never* had a maximum dose in the UK.
Your pdoc can check two reference sources......
1. The BNF, which states:
Initially 10 mg twice daily not later than 3 p.m., increasing the second daily dose to 20 mg after 1 week if necessary; doses above 30 mg daily under close supervision only; usual maintenance dose 10 mg daily
The bit about the usual maintenance dose being 10mg should be removed. The idea that patients can be treated effectively with very low maintenance doses of ADs has long since been discarded by psychiatrists. It is now believed that patients should be maintained on the same dose which was originally effective in producing remission eg. 20mg three times a day or whatever......
2. The manufacturers official data sheet (also called the SPC). You pdoc should have access to the compendium of data sheets, where s/he can look up tranylcypromine. The official data sheet states:
A dosage of three tablets a day should only be exceeded with caution.
IMO, this is not an intelligent statement. Clearly, MAOIs need to be treated with due respect. Tranylcypromine does not, however, suddenly become dangerous when the daily dose exceeds 30mg.
Regards
Ed
This is the end of the thread.
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