![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by BetterDays on November 3, 2007, at 8:37:06
Hi there,
There appears to be a lot of knowledge and insight within this forum, and am helping for some feedback on my med mix.
I was recently prescribed Lithium (300mg 2x/day) and Seroquel (150mg evening) for Bipolar. My Psych is exploring the path that my addictive behaviors (gambling, alcohol, painkillers) could be a result of Bi Polar II. Not sure if that is the case but I am not going to get stuck on a diagnosis.
He put me on Lithium and Seroquel a couple of weeks ago. I have noticed that I do not have the same intensity of racing thoughts, overwhelming urges to play out my addictions - a good thing!
The bad part of this is that since I've been on the meds I am having almost debilitating panic attacks. I haven't figured out yet if these are caused by my "self-talk" or the meds.
Does anyone know if Lithium could possibly be causing my panic attacks? I've read some data online and it seems that if anything, the Lithium should be helping anxiety. I don't think it could be the seroquel as that seems very specifically to be used for anxiety.
I don't want to go off the Lithium because my initial impression is that it is helping in other areas, but these panic attacks are hard to live with. I've been taking Xanax when I absolutely have to for them, but really want to stay away from any narcotics because of my abuse history.
Any feedback, experiences, insights much appreciated.
Posted by Squiggles on November 3, 2007, at 10:57:57
In reply to Does Lithium typically cause anxiety attacks?, posted by BetterDays on November 3, 2007, at 8:37:06
I don't know about seroquel (i think it's sedating), but regarding lithium, imo, absolutely not. You're taking 600 which is really low. Furthermore, lithium decreases the thyroid rate; e good reason to stop panic-attacks; You say that you have had these, since this med combo? Since i don't know about seroquel, i would say, maybe too low a dose (if you had anxiety attacks before) or the interaction.
I have never had anxiety with lithium- it's a knock-out drug.
Squiggles
Posted by Phillipa on November 3, 2007, at 11:45:22
In reply to Re: Does Lithium typically cause anxiety attacks? » BetterDays, posted by Squiggles on November 3, 2007, at 10:57:57
If you're afraid of the meds it may be self talk. Phillipa
Posted by johnj on November 3, 2007, at 12:55:43
In reply to Does Lithium typically cause anxiety attacks?, posted by BetterDays on November 3, 2007, at 8:37:06
IMHO I think it is seroquel. I would stop it and see if it abates. Even at 25 mg I felt terrible on seroquel and at the time I didn't know it was akathisia. I could not stop my body from almost shaking and I wanted to tap my feet or run 10 miles, it was horrible.
I would go off it and try a beta blocker for a few days to help you relax.
johnj
Posted by bleauberry on November 3, 2007, at 18:31:41
In reply to Does Lithium typically cause anxiety attacks?, posted by BetterDays on November 3, 2007, at 8:37:06
My gut instinct points to seroquel as the culprit. All the antipsychotics are so unpredictable. Sedating it is. But all can cause fierce akathisia, nervousness, panic, etc even in the presence of the sedation. That is a very strange feeling, and I've been there.
That being said, I did try lithium for 3 days once. It was only 300mg a day. And oh my did it increase my anxiety level 10 fold. I thought it was going to calm down these butterflies I got each morning right out of bed. Not. Instead it made me feel totally insane, psychotic, and absotultey terror filled with anxiety. What's the similarity to you??? Well, I was also on zyprexa, an antipsychotic. Maybe the lithium alone would be fine. Or the seroquel alone. Bother together with your unique biochemistry might be super weird for some reason.
Do you get enough magnesium in your diet? Supplements with magnesium? Ever tried taurine? The reason I ask because these essential things accomplish what things like lithium and seroquel do. It could be something as simple as a lack of them in your daily intake, or a logjam causing them to be under-used or under-produced. Nobody ever had a deficiency of seroquel. But magnesium or taurine, very common. The symptoms are identical to what lithium or seroquel are meant to treat the symptoms of (but not the cause).
Posted by BetterDays on November 4, 2007, at 8:54:13
In reply to Re: Does Lithium typically cause anxiety attacks? » BetterDays, posted by Squiggles on November 3, 2007, at 10:57:57
Thanks for the feedback, Squiggles. I think you may have hit on something - I haven't yet had a Lithium / blood panel. I thought 600mg was a high dose. It very well could be that the levels aren't theraputic / high enough since I've only been on the Lithium for a couple of weeks. I will check that one out.
As far as the Seroquel - I hope it isn't that either as it really helps me sleep through the night without benzos. I've heard of people taking Seroquel during the day, but have to work and don't want to be knocked out. Do you know - is 150mg at night very low dose as well?
I hope to stay on (have a Pdoc appt week after next) the Lithium and Seroquel. There are a lot of benefits I'm seeing, which is a bit of a miracle after years of trying a lot of different meds. But the panic attacks have to be resolved. It is really unbearable to panic throughout the day, especially when the situations are not dangerous or threatening.
Thanks again for the insights. I really appreciate it.
Posted by Squiggles on November 4, 2007, at 9:12:36
In reply to Lithium typically cause anxiety attacks?-Squiggles, posted by BetterDays on November 4, 2007, at 8:54:13
> Thanks for the feedback, Squiggles. I think you may have hit on something - I haven't yet had a Lithium / blood panel. I thought 600mg was a high dose. It very well could be that the levels aren't theraputic / high enough since I've only been on the Lithium for a couple of weeks. I will check that one out.
>
> As far as the Seroquel - I hope it isn't that either as it really helps me sleep through the night without benzos. I've heard of people taking Seroquel during the day, but have to work and don't want to be knocked out. Do you know - is 150mg at night very low dose as well?
>
> I hope to stay on (have a Pdoc appt week after next) the Lithium and Seroquel. There are a lot of benefits I'm seeing, which is a bit of a miracle after years of trying a lot of different meds. But the panic attacks have to be resolved. It is really unbearable to panic throughout the day, especially when the situations are not dangerous or threatening.
>
> Thanks again for the insights. I really appreciate it.
>
>
>I'll get to some seroquel reading later. May i
recommend Dr. Nemeroff's book if you have a chance to look at it: "Recognition and Treatment of Psychiatric Disorders: A Psychopharmacology Handbook for Primary Care".
Just a cursory glimpse on Seroquel--a new antipsychotic metabolized by CYP3A4 (maybe you don't have that enzyme- test?)usual starting dose at 25mg BID; no mention of panic, to the contrary somnolescence and related effects. And lithium is unlikely to bring on panic attacks.You say you are taking benzos-- i wonder if you stopped at some point, and what you are experiencing is withdrawals from them.
Lithium monotherapy starts at 600 or lower and then raised to as high as 1200mg;
To you, it is being given as an adjunct, that may be why it is still 600.I have not read about the superiourity of mixing
these two drugs rather than lithium monotherapy.
I guess it depends on your initial condition.
I am personally very cautious about mixing drugs, and would only let Dr. Sheldon Preskorn practice that on me, :-) just kidding. Seriously though,
polypharmacy is very tricky becaause the chemical factors are not just add this drug to that drug in this class, but variable and endless results can occur for some reason. I recall when I was taking Xanax and Clonazepam and lithium, i would get a very strange effect of having to arch my back in order to breathe-- i still don't why that happened, but when i quit Xanax, it stopped-- could have been timing, interaction between, one or two or three, or who knows.
Squiggles
Posted by johnj on November 4, 2007, at 14:13:45
In reply to Lithium typically cause anxiety attacks?-Squiggles, posted by BetterDays on November 4, 2007, at 8:54:13
You need to check out the seroquel. It CAN cause anxiety in people, me being one of them. There is only one way to tell and that is to stop taking one of them. Akathisia is very real on seroquel.
Posted by Squiggles on November 4, 2007, at 15:17:54
In reply to Re: Lithium typically cause anxiety attacks?-Squiggles » BetterDays, posted by johnj on November 4, 2007, at 14:13:45
Seroquel:
Among the side effects, i checked (Medline for example, Rx) very rapid heartbeat, sweating,
fainting, and breathing problems--- that could
mimic a panic attack.Squiggles
Posted by johnj on November 4, 2007, at 17:09:05
In reply to Re: Lithium typically cause anxiety attacks?-Squig, posted by Squiggles on November 4, 2007, at 15:17:54
Yeah, just like I have been saying it is probably the seroquel. Lithium never caused those effects in me but seroquel was nasty.
Posted by BetterDays on November 5, 2007, at 11:49:42
In reply to Re: Lithium typically cause anxiety attacks?-Squig » BetterDays, posted by Squiggles on November 4, 2007, at 9:12:36
Hi Squiggles,
Thanks for the information. It does appear that both Lithium and Seroquel should be helping my anxiety versus triggering panic attacks. I am open to possibility that I could be talking myself in to these - my self talk and hyper vigilence when it comes to meds is powerful- but it just seems like a huge coincidence that within a week of starting the Lithium / Seroquel that the panic attacks started.
I hope my Dr can figure this out. I really do have a lot of hope for the Lithium as it seems to have helped so many people.
Posted by BetterDays on November 5, 2007, at 11:51:24
In reply to Re: Lithium typically cause anxiety attacks?-Squig » Squiggles, posted by johnj on November 4, 2007, at 17:09:05
Hi John,
Thanks. I think my first line of attack will be switching the Seroquel. Hopefully there is something in the same class of drugs that can help with the sleep. I haven't found anything that is as good as Seroquel in helping me sleep (outside of benzos which only brings a few hours of restful sleep versus Seroquel which I can sleep 8-9 hours peacefully).
Posted by Squiggles on November 5, 2007, at 11:54:30
In reply to Re: Lithium typically cause anxiety attacks?-Squig, posted by BetterDays on November 5, 2007, at 11:49:42
> Hi Squiggles,
>
> Thanks for the information. It does appear that both Lithium and Seroquel should be helping my anxiety versus triggering panic attacks. I am open to possibility that I could be talking myself in to these - my self talk and hyper vigilence when it comes to meds is powerful- but it just seems like a huge coincidence that within a week of starting the Lithium / Seroquel that the panic attacks started.
>
> I hope my Dr can figure this out. I really do have a lot of hope for the Lithium as it seems to have helped so many people.
>
>Good luck -- i would drop the seroquel and take
a higher lithium dose, but i have never tried
seroquel -- from reading about it though it does
not seem as clean a drug "consciousness"-wise.Squiggles
Posted by BetterDays on November 5, 2007, at 11:54:48
In reply to Re: Lithium typically cause anxiety attacks?-Squig, posted by Squiggles on November 4, 2007, at 15:17:54
Hi Squiggles and John,
Thanks a bunch for the feedback and insights. It appears that it is more likely the Seroquel versus the Lithium. And I may not be on high enough dose of Lithium.
Good stuff for me to take to the PDOC Monday. In the meantime, when the panic gets too bad I am nibbling on a Xanax (versus taking several which I would do in my previous benzo abuse days).
Posted by Squiggles on November 5, 2007, at 12:11:23
In reply to Re: Lithium cause anxiety? Appears likely Seroquel, posted by BetterDays on November 5, 2007, at 11:54:48
I think lithium is not as popular anymore
because of the necessity for many blood
tests - it is expensive for the hospital.
But if seroquel works, that's good.Squiggles
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.