![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 33 to 57 of 281. Go back in thread:
Posted by bleauberry on July 4, 2009, at 19:36:14
In reply to Going back to old-school - lithium., posted by SLS on July 3, 2009, at 6:42:30
I know my comments sometimes go against the grain of academia. But I believe shooting for a predetermined target dose of anything, including lithium, based on a general consensus of what happens in the general population, is bogus. I think it causes more failure than success. I think more success is attainable by slowing increasing doses, after starting at very low doses, so as to find "the" place and not shoot past it. If the mind numbing stuff of lithium is already kicking in, the dose in my opinion is already too high. It perhaps needs a lower dose and longer time, versus higher dose and shorter time. Lithium should feel invisible at the right dose.
Totally different drug, but an example. My LLMD claims to have never had a failure at fixing anyone's depression. His arsenal consists mostly of just lexapro or zoloft. The trick is not the drugs, but the doses. He has patients in complete remission from treatment resistant drug sensitive depression on things like: 1 drop of liquid lexapro up to 5mg of lexapro. 1 drop is 1/10th of 1mg. Psychiatrists and pharmicists would scoff at the idea and probably laugh hysterically. The only problem is, it works over and over in very difficult populations.
We accept dosing targets as if they came out of a bible. They didn't. They are just as flawed as the clinical studies they came from.
I see no problem with lithium except in two areas:
1)When it is combined with a serotonin med, which in your case doesn't apply, so that's cool. I think it works best in norepinephrine or multi-neurotransmitter meds, but not pure serotonin meds.
2)When a preconceived dose target is set, as if anyone on the planet could have the slightest clue how much lithium you need. Example, I know someone who had the lithium numbing at 300mg, totally zombied at 600mg, but pleasantly energized and feeling good at 75mg.
I think the version of lithium you take is also important. They are not the same. If one bombs, try the other. I don't know if you have the citrate version or what, but they are different.
Posted by SLS on July 4, 2009, at 20:23:01
In reply to Re: Going back to old-school - lithium., posted by bleauberry on July 4, 2009, at 19:36:14
> 2)When a preconceived dose target is set, as if anyone on the planet could have the slightest clue how much lithium you need. Example, I know someone who had the lithium numbing at 300mg, totally zombied at 600mg, but pleasantly energized and feeling good at 75mg.
Hmm. Thanks, Bleauberry. Maybe I'll give 150mg a shot. That was also the advice Linkadge gave.
- Scott
Posted by Phillipa on July 4, 2009, at 23:51:25
In reply to Re: Going back to old-school - lithium. » linkadge, posted by SLS on July 4, 2009, at 10:32:28
Scott just home but what is DST? know you're sleeping. Love Phillipa
Posted by SLS on July 5, 2009, at 6:03:52
In reply to Re: Going back to old-school - lithium. » SLS, posted by Phillipa on July 4, 2009, at 23:51:25
> Scott just home but what is DST? know you're sleeping. Love Phillipa
DST = dexamethasone suppression test
If you give a healthy person dexamethasone, it turns off the production of cortisol (suppressors), which is measurable in the blood. If a person does not react to dexamethasone this way (non-suppressors), it indicates that something is wrong. It is used to diagnose Cushings Disease, a condition where the body produces too much cortisol. Cortisol is secreted by the adrenal cortex, not the adrenal medulla where adrenalin is secreted.
It was found that a major portion of people seeking treatment for depression are DST non-suppressors. This test was used frequently in the 1980s. Because it doesn't "catch" all cases, it is not considered valid anymore. It is my guess that the DST is selective for certain subtypes of depression and bipolar depression. I think it might be useful to help diagnose, however, it would be only to confirm certain presentations. It might not work for atypical depression without psychomotor retardation. I haven't followed it for a long time.
- Scott
Posted by linkadge on July 5, 2009, at 11:16:28
In reply to Re: Going back to old-school - lithium. » linkadge, posted by SLS on July 4, 2009, at 10:39:20
>Do you think the ability for low dosages of >lithium to augment antidepressants has anything >to do with it perhaps reducing the excitability >of neurons along the pathways that flow through >the subgenual cingulate (Brodman's) area 25? >Maybe it is acting like DBS in this regard.
Could be. Lithium has a stabilizing effect on glutamate reuptake.
Linkadge
Posted by linkadge on July 5, 2009, at 11:18:33
In reply to Re: Going back to old-school - lithium., posted by bleauberry on July 4, 2009, at 19:36:14
SSRI's have been shown to substantially increase allopregnanalone at doses much lower than needed to significantly affect serotoin reuptake.
I can notice as little as 1mg of citalopram or about 5mg of venlafaxine.
Linkadge
Posted by linkadge on July 5, 2009, at 11:19:45
In reply to Re: Going back to old-school - lithium. » Phillipa, posted by SLS on July 5, 2009, at 6:03:52
I have been having some definate improvement with about 50mcg of chromium.
Linkadge
Posted by SLS on July 5, 2009, at 11:34:03
In reply to Re: Going back to old-school - lithium., posted by linkadge on July 5, 2009, at 11:19:45
> I have been having some definate improvement with about 50mcg of chromium.
I hope it continues.Good luck.
- Scott
Posted by SLS on July 5, 2009, at 11:39:00
In reply to Re: Going back to old-school - lithium., posted by linkadge on July 5, 2009, at 11:16:28
> Lithium has a stabilizing effect on glutamate reuptake.
I didn't know that. That is HUGE.
It might not be too far-fetched to combine Lamictal and lithium for some people.
- Scott
Posted by Phillipa on July 5, 2009, at 19:36:42
In reply to Re: Going back to old-school - lithium. » Phillipa, posted by SLS on July 5, 2009, at 6:03:52
Scott thanks thyroid normal? Phillipa
Posted by SLS on July 5, 2009, at 19:43:05
In reply to Re: Going back to old-school - lithium. » SLS, posted by Phillipa on July 5, 2009, at 19:36:42
> Scott thanks thyroid normal? Phillipa
Yeah. The last time I had it checked was about a year ago. It was normal at that time.
- Scott
Posted by SLS on July 8, 2009, at 14:42:11
In reply to Re: Going back to old-school - lithium. » Phillipa, posted by SLS on July 5, 2009, at 19:43:05
I actually began to feel better within 36 hours of adding lithium.
I am now feeling better, although not great. That I am improved at all is extremely encouraging. It has been less than a week since I added lithium. My best guess is that, even under the most optimum of conditions, it will be a very gradual process of recovery. I have to expect that it will take months to experience a robust improvement. I will evaluate my improvement week by week rather than day by day. If I attain remission, it will be well worth the wait.
That disgusting lithium malaise that I experience at higher dosages is dissipating quickly.
Currently:Parnate 80mg
nortriptyline 150mg
Lamcital 200mg
Abilify 20mg
lithium 300mg
- Scott
Posted by Frustratedmama on July 8, 2009, at 16:11:50
In reply to Re: Going back to old-school - lithium., posted by SLS on July 8, 2009, at 14:42:11
Posted by floatingbridge on July 8, 2009, at 17:11:53
In reply to Re: Going back to old-school - lithium., posted by SLS on July 8, 2009, at 14:42:11
Posted by Phillipa on July 8, 2009, at 19:50:20
In reply to Re: Going back to old-school - lithium., posted by SLS on July 8, 2009, at 14:42:11
Scott that is fabulous. Love Phillipa
Posted by SLS on July 9, 2009, at 5:17:24
In reply to Re: Going back to old-school - lithium. » SLS, posted by Phillipa on July 8, 2009, at 19:50:20
> Scott that is fabulous. Love Phillipa
We'll have to see. I have been disappointed before when something would begin to work well, only to stop working 3-4 days later.
Perhaps I spoke too soon.
- Scott
Posted by Phillipa on July 9, 2009, at 20:41:04
In reply to Re: Going back to old-school - lithium. » Phillipa, posted by SLS on July 9, 2009, at 5:17:24
Scott program you brain l000 times repeat lithium is working and I'm in remission and it is going to last for many years to come. Love Phillipa
Posted by SLS on July 12, 2009, at 7:46:30
In reply to Re: Going back to old-school - lithium. » SLS, posted by ricker on July 3, 2009, at 19:14:35
> Wouldn't that be a kick in the butt if, after having tried countless exotic treatments, it turns out that lithium ended up being the last key necessary to unlock the cage door?
No such luck.
Lithium stopped helping me after three days had passed. I had been feeling significantly improved.
I wonder what this three-day remission thing is all about with me. It doesn't matter what I take or how much of it I take. Like clockwork, when something triggers an antidepressant response, it always poops-out after three days.
Does three days ring a bell for anyone? What physiological process takes three days to occur?
I wonder if this is hypothalamus stuff. Bipolar disorder seems to be oscillatory, especially when one looks at ultra-rapid cyclers. I was an ultra-rapid cycler for a number of years prior to my first exposure to lithium. Lithium took away my upswings and left me in a state of severe depression. My 11 day cycle had been comprised of 8 days of depression followed by 3 days of euthymia. There's that three-day thing again.
- Scott
Posted by Frustratedmama on July 12, 2009, at 11:29:22
In reply to Re: Going back to old-school - lithium., posted by SLS on July 12, 2009, at 7:46:30
SLS
I wish I knew the answer but I, too,find the 3 day phenomena.... :(
FM
I did talk to my pdoc about it....not real clear answers except that my meds arent preventative for me and instead the illness is more "chronic, relentless" in nature than others.... so, my theory is that bipolar (for me) may not be the currect diagnosis in that I dont really cycle without meds I just stay irritable and depressed....its the meds that "help me cycle" so to speak as they offer the releif....unfortunately that releif is sort lived.... Also, I dont get depressed until I releive the irritability (or is it severe GAD?) Just thinking aloud....
I wish you had releif and that lithium was the answer....
Sorry and here for you if you want to chat....
FM
Posted by SLS on July 12, 2009, at 12:29:38
In reply to Re: Going back to old-school - lithium. » SLS, posted by Frustratedmama on July 12, 2009, at 11:29:22
> I wish you had releif and that lithium was the answer....
> Sorry and here for you if you want to chat....
> FMThanks FM.
:-)
- Scott
Posted by Phillipa on July 12, 2009, at 20:33:47
In reply to Re: Going back to old-school - lithium. » Frustratedmama, posted by SLS on July 12, 2009, at 12:29:38
Scott so you're think ultra rapid cycle of three days that's the same as the Deplin was also kind of as I remember a blip of feeling good on day three wasn't it? Sorry about the lithium. How frustrating. Love Phillipa
Posted by ricker on July 12, 2009, at 21:55:48
In reply to Re: Going back to old-school - lithium., posted by SLS on July 12, 2009, at 7:46:30
> Lithium stopped helping me after three days had passed. I had been feeling significantly improved.
>
> I wonder what this three-day remission thing is all about with me. It doesn't matter what I take or how much of it I take. Like clockwork, when something triggers an antidepressant response, it always poops-out after three days.Hi Scott, sorry to hear the lithium did not provide long-term relief.
I had mentioned in one of my earlier posts...last year I believe, that I've often questioned why some of us experience chronic failure? I guess that's where "treatment resistant" rings true.
Have you ever considered that perhaps that "magic key" may not be a missing drug, but rather the way the drugs are administered?
Maybe the lithium is telling you it will help, if you try taking it every 3rd day or such? I wonder if you administered your "staple" meds daily along with intermittent dosing of other meds that provided previous benefit? Kinda like water treatment and adjusting chemical dosage so as to "shock" the system.
I could be totally out to lunch with my theory, but hey, I would love to eat prime rib daily, but the occasional cheeseburger tastes great! ;)
Take care, Rick
Posted by SLS on July 15, 2009, at 17:27:31
In reply to Re: Going back to old-school - lithium. » SLS, posted by ricker on July 12, 2009, at 21:55:48
Hi Rick.
I have decided to continue taking lithium 300mg. I do feel somewhat better on it than off it. My hope is that it might improve the health of the areas of the brain that have atrophied. Who knows? Maybe long-term, it might set up for a more robust antidepressant response. For now, this low dosage does not seem to be hurting me. That's good news because 450mg and higher actually makes me feel considerably worse.
Holding on to hope...
- Scott
Posted by ricker on July 15, 2009, at 23:15:05
In reply to Re: Going back to old-school - lithium., posted by SLS on July 15, 2009, at 17:27:31
Sounds like a good idea Scott. As I mentioned, 300mg helped with my depression although it took a month or so before the stabilizing effect took hold.
Lets hope it does continue to prove positive in your treatment.Regards, Rick
Posted by Frustratedmama on July 17, 2009, at 7:29:58
In reply to Re: Going back to old-school - lithium., posted by SLS on July 15, 2009, at 17:27:31
Scott, hoping it helps you ALOT not just a little :)
FM
Go forward in 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.