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Dr. Bob is Robert Hsiung, MD,
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Posted by ColoradoSnowflake on September 2, 2009, at 9:08:22
In reply to Re: Going back to old-school - lithium., posted by SLS on September 2, 2009, at 8:05:11
Posted by floatingbridge on September 2, 2009, at 10:20:23
In reply to Re: Going back to old-school - lithium., posted by SLS on September 2, 2009, at 8:05:11
> Hi folks.
>
> I just wanted to let everyone know that beginning Sunday morning, I began to respond to lithium again. I feel better on it than off it. Lithium has definitely hammered a hole in the brick wall that was the obstacle to responding robustly to treatment. I'm about 40% improved relative to my baseline depression severity.
>
> I am going out of town to visit a friend of mine for about a week starting tomorrow. In case I don't get a chance to post during this time, I didn't want anyone to worry about me.
>
> Remission, here I come!
>
>
> - Scott
Scott, this is super news! 40% is considerable. Have a great trip, and thanks for letting us know--we would worry.And Yikes! What will we do w/o you : D ?
a happy hug,
fb
Posted by maxime on September 2, 2009, at 15:08:24
In reply to Re: Going back to old-school - lithium., posted by SLS on September 2, 2009, at 8:05:11
That's really amazing news! I hope that remission is around the corner for you! Enjoy your trip!
Posted by Phillipa on September 2, 2009, at 20:03:23
In reply to Re: Going back to old-school - lithium. » SLS, posted by maxime on September 2, 2009, at 15:08:24
Scott that is so super have a wonderful time and you definitely will be missed!!!!! Love Phillipa
Posted by SLS on September 3, 2009, at 7:46:13
In reply to Re: Going back to old-school - lithium., posted by Phillipa on September 2, 2009, at 20:03:23
My lithium level at a dosage of 600mg was 0.30 ng/ml. That is lower than I would have expected. I am now taking 450mg, so the level will obviously be lower. I read something that reported 0.30 ng/ml being the minimum level at which lithium exerts its neuroprotective and neurogenic properties. I was hoping to reach that with the 450mg dosage. 600mg made me feel "washed out" and gave me significant tremulousness. I was hoping to avoid those things. I would like to get a blood level at 450mg just to compare.
- Scott
Posted by floatingbridge on September 3, 2009, at 10:39:42
In reply to Re: Going back to old-school - lithium., posted by SLS on September 3, 2009, at 7:46:13
> My lithium level at a dosage of 600mg was 0.30 ng/ml. That is lower than I would have expected. I am now taking 450mg, so the level will obviously be lower. I read something that reported 0.30 ng/ml being the minimum level at which lithium exerts its neuroprotective and neurogenic properties. I was hoping to reach that with the 450mg dosage. 600mg made me feel "washed out" and gave me significant tremulousness. I was hoping to avoid those things. I would like to get a blood level at 450mg just to compare.
>If you don't know this, who would, but...is there a way to increase (enhance) lithium absorption to get blood levels higher w/ a lesser dose? Is the blood level what determines side-effects (tremors, wash-out feeling)? Can something like NAC help with side-effects? Sorry for advice--just care.
fb
Posted by SLS on September 14, 2009, at 8:38:56
In reply to Re: Going back to old-school - lithium., posted by SLS on September 2, 2009, at 8:05:11
Disappointed.
Not much happening.
Damn.
Impatient.
I felt a substantially greater improvement during the first week of lithium therapy than I do now. This is a consistent pattern of my response to medication. When I do respond, the improvement lasts for no more than 3 days. Just what the hell is the significance of 3 days, I just don't know. Someone must know. I don't.
I can only hope that a more stable robust response will occur gradually over the course of months. I have no plans to discontinue lithium at this point. However, my treatment history does not indicate an optimistic outcome.
- Scott
Posted by floatingbridge on September 14, 2009, at 17:48:52
In reply to Re: Going back to old-school - lithium., posted by SLS on September 14, 2009, at 8:38:56
Scott,
I'm sorry to hear this. I don't know what to say. 'Hang in there' doesn't seem good enough to address the disappointment and frustration I hear you express right now.
hugs, big time.
fb
Posted by Phillipa on September 14, 2009, at 20:32:17
In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on September 14, 2009, at 17:48:52
Scott so sorry. The number three? Does it mean something to you seriously? Love Phillipa
Posted by SLS on September 18, 2009, at 7:53:43
In reply to Re: Going back to old-school - lithium., posted by Phillipa on September 14, 2009, at 20:32:17
I increased my lithium dosage to 600mg yesterday. I am feeling significantly better today. Unfortunately, I seem to improve transiently to dosage adjustments of certain drugs. I won't get too optimistic too soon on this one. In the meantime, it feels good to feel good.
- Scott
Posted by Bob on September 18, 2009, at 16:18:53
In reply to Re: Going back to old-school - lithium., posted by SLS on September 18, 2009, at 7:53:43
> I increased my lithium dosage to 600mg yesterday. I am feeling significantly better today. Unfortunately, I seem to improve transiently to dosage adjustments of certain drugs. I won't get too optimistic too soon on this one. In the meantime, it feels good to feel good.
>
>
> - Scott
Scott,You're not the only one who only responds transiently to psych meds. That has been the story with me almost from the start. Unfortunately, that duration of transience has gotten shorter and shorter as time goes on. It's really practically gone actually.
Posted by SLS on September 19, 2009, at 6:02:42
In reply to Re: Going back to old-school - lithium. » SLS, posted by Bob on September 18, 2009, at 16:18:53
> > I increased my lithium dosage to 600mg yesterday. I am feeling significantly better today. Unfortunately, I seem to improve transiently to dosage adjustments of certain drugs. I won't get too optimistic too soon on this one. In the meantime, it feels good to feel good.
> You're not the only one who only responds transiently to psych meds. That has been the story with me almost from the start. Unfortunately, that duration of transience has gotten shorter and shorter as time goes on. It's really practically gone actually.
It is demoralizing to contemplate, but it seems that the brain becomes less and less responsive to antidepressants as the number of exposures increases.
- Scott
Posted by Bob on September 20, 2009, at 0:06:43
In reply to Re: Going back to old-school - lithium. » Bob, posted by SLS on September 19, 2009, at 6:02:42
> It is demoralizing to contemplate, but it seems that the brain becomes less and less responsive to antidepressants as the number of exposures increases.
>
>
> - Scott
>
>I absolutely agree with you on that assessment Scott. The brain (at varying rates in different people) sometimes 'adapts' to the treatment being given and the initial response lessens over time. Additionally, that initial response seems to lessen if it is tried again. It truly is demoralizing.
Posted by desolationrower on September 20, 2009, at 0:15:28
In reply to Re: Going back to old-school - lithium. » Bob, posted by SLS on September 19, 2009, at 6:02:42
transient responses are sort of the classic placebo response. So it might be better to work on finding a hope/program that you can do a little bit on everyday to capture that, since there is something there thats working for you, however shortly.
0d.r
Posted by SLS on September 20, 2009, at 6:47:00
In reply to Re: Going back to old-school - lithium., posted by desolationrower on September 20, 2009, at 0:15:28
Hi.
> transient responses are sort of the classic placebo response.
I wish I were the classic patient. When I did come in to see the doctor while feeling these brief improvements, there would be no doubt in their minds that I indeed had a biological affective disorder. The difference was so dramatic. Only did Columbia in 1983 "throw me out" because they thought I was a placebo responder. They hadn't noticed that I was an ultra-rapid cycler when I was first treated by them. They thought that these were emotional highs and lows. They wanted me to see a psychologist instead. I said no. I left, but not before requesting that they put me on bupropion, which had not come out yet. They laughed when I came to them with my own dopaminergic theory of depression. I told them that they should at least try bromocriptine on me. Again, they laughed.
I have never had a problem with psychotherapy, as long as it was made clear that I needed somatic treatments as well. I had had quite a bit of psychotherapy before being diagnosed with affective disorder. It, of course, didn't help with depression. I am currently being treated psychotherapeutically. I am grateful to find a therapist who works closely with a psychopharmacologist. It is understood that the priority to treat the depression must be biological since is a biological disorder that I suffer from. I took advantage of the offer for psychotherapy because I wanted to deal with an unhealthy past, have coping tools to live and function while depressed, and to sweep up the psychological mess that the depression produced.
I had been a member at a mental health clinic day program to add structure to my days. However, after 8 years, I felt it was time for me to leave. Taking a few classes at a community college was good for me. Again, it provided structure. At this point, I am working towards seeking employment. Of course, this will be orders of magnitude easier if my improvement to the addition of lithium grows. At the moment, I expect that it will. Of course, I have been wrong countless times before. Stupid optimism.
- Scott
Posted by SLS on September 20, 2009, at 6:48:50
In reply to Re: Going back to old-school - lithium., posted by desolationrower on September 20, 2009, at 0:15:28
Sorry. I forgot to thank you for your concern and thoughtful suggestions.
Thanks.
- Scott
Posted by mogger on September 24, 2009, at 22:37:03
In reply to Re: Going back to old-school - lithium. » desolationrower, posted by SLS on September 20, 2009, at 6:48:50
Scott,
Hang in there man.Your knowledge of treatments is so vast that I am sure you are aware of this but have you tried massive amounts of high EPA fish oil? I mean far past the 3 grams a day of EPA that is mostly prescribed? I take 10 grams a day (20 capsules) and it has been marvelous for my deep depression and rapid cycling. I only have trouble with my ocd which I am still working out (which you have given me great advice on thank you). I take CountryLife Omega 3 Mood and as I say I take 7 capsules morning, 7 afternoon and 6 evening. I tried 3 grams and it didn't cut it so went for the gold and went to 10 grams! :)
Joseph
Posted by SLS on September 25, 2009, at 0:21:49
In reply to Re: Going back to old-school - lithium., posted by mogger on September 24, 2009, at 22:37:03
Hi Joseph.
> Scott,
> Hang in there man.Thanks. :-)
> Your knowledge of treatments is so vast that I am sure you are aware of this but have you tried massive amounts of high EPA fish oil? I mean far past the 3 grams a day of EPA that is mostly prescribed? I take 10 grams a day (20 capsules) and it has been marvelous for my deep depression and rapid cycling. I only have trouble with my ocd which I am still working out (which you have given me great advice on thank you). I take CountryLife Omega 3 Mood and as I say I take 7 capsules morning, 7 afternoon and 6 evening. I tried 3 grams and it didn't cut it so went for the gold and went to 10 grams! :)Wow. I've tried fish oil, but not at that dosage. I will definitely keep that in mind. I bet there is more to fish oil than just a supplement of omegas. I think there is something pharmacological going on there.
Thanks for the suggestion!
- Scott
Posted by morganator on September 25, 2009, at 1:12:09
In reply to Re: Going back to old-school - lithium. » mogger, posted by SLS on September 25, 2009, at 0:21:49
We should all be taking fish oil regardless of whether we notice a anything significant. It may be doing good things for our brains even if it does not give us a much needed lift.
It is the different types of Omega 3s in fish oil that have different mechanisms. I'm talking about the difference between EPA and DHA. Some do better on fish oil that has a 4 to 1 EPA to DHA ratio. Others do just fine on a 4 to 3 ratio of EPA to DHA.
It is definitely worth trying high doses, maybe 6 to even 10 grams a day.
Posted by Ron Hill on September 26, 2009, at 2:46:05
In reply to Re: Going back to old-school - lithium. » mogger, posted by SLS on September 25, 2009, at 0:21:49
> Wow. I've tried fish oil, but not at that dosage. I will definitely keep that in mind. I bet there is more to fish oil than just a supplement of omegas. I think there is something pharmacological going on there.
I'm sure most of us are familiar with the 1999 study by Andrew Stoll MD which showed efficacy in the treatment of bipolar disorder with omega-3 fatty acids.The source of the omega-3 fatty acids was menhaden fish body oil concentrate. Subjects received a total daily omega-3 fatty acid dosage of 6.2 g of eicosapentanoic acid (EPA) and 3.4 g of docosahexanoic acid (DHA).
Stoll discusses the pharmacological action of omega-3 fatty acids. There are similarities to the action of lithium. In particular, regarding the pharmacological action of omega-3 fatty acids, see the "Introduction", the last section of the paper titled "Comments", and the cool diagram in Figure 3.
Here is a link to the full text paper:
http://archpsyc.ama-assn.org/cgi/content/full/56/5/407
The downside to this treatment is the expense. Using a high quality liquid fish oil like Carlson's, the dosage set forth in Stoll's paper costs me more than $60 per month.
However, prescription grade omega-3 fatty acid oil is available. So, if the patient can talk his/her p-doc into writing a script, it can become more affordable.
-- Ron
dx: Bipolar II with ultra rapid cycling and mild OCPD
600 mg/day Trileptal
200 mg/day Lamictal
500 mg/day Keppra
90 mg/day Nardil
Posted by desolationrower on September 26, 2009, at 3:23:39
In reply to Re: Going back to old-school - lithium. » SLS, posted by Ron Hill on September 26, 2009, at 2:46:05
w-3s do lots of things.
but theres no need for "high quality fish oil" unless you already bought celtic sea salt and still have more money than you want
-d/r
Posted by SLS on September 26, 2009, at 5:20:38
In reply to Re: Going back to old-school - lithium. » SLS, posted by Ron Hill on September 26, 2009, at 2:46:05
I bet there is more to fish oil than just a supplement of omegas. I think there is something pharmacological going on there.
> Stoll discusses the pharmacological action of omega-3 fatty acids. There are similarities to the action of lithium.
I hadn't read that. This was just a deduction on my part. Thanks for the link.
I am encouraged to see you posting again. Keep them coming!
:-)
- Scott
Posted by Ron Hill on September 26, 2009, at 5:26:12
In reply to Re: Going back to old-school - lithium., posted by desolationrower on September 26, 2009, at 3:23:39
Hi d/r.
> but theres no need for "high quality fish oil" unless you already bought celtic sea salt and still have more money than you want
I don't like mercury.
-- Ron
Posted by morganator on September 28, 2009, at 22:57:39
In reply to Re: Going back to old-school - lithium. » desolationrower, posted by Ron Hill on September 26, 2009, at 5:26:12
Unless companies like Kirkland are lying, there are undetectable levels of mercury, pcb's, and other toxins in many fish oil products that are VERY affordable. Kirkland enteric coated capsules go for about 17 dollars for 180 capsules and the normal capsules go for about 10 dollars for 400-Dirt Cheap!!!! The only drawback to buying Kirkland fish oil may be that you have to settle for the typical 4 to 3 DHA to EPA ratio.
I know companies like Carlson's and Nordic naturals are producing high quality fish oil, but how much higher quality is it and is it worth paying the price for?
Scott, I think the pharmacological activity comes from the 2 distinct types of omega 3s that are found in fish oil, DHA and EPA.
Posted by desolationrower on September 29, 2009, at 16:38:47
In reply to Re: Going back to old-school - lithium., posted by morganator on September 28, 2009, at 22:57:39
fish oil is mostly made from cheap tiny fish like sardines, anchovies, herring, etc. the big apex predator fish are mostly used for more expensive preprations like sushi
-d/r
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Dr. Bob is Robert Hsiung, MD,
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