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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 190 to 214 of 281. Go back in thread:
Posted by Phillipa on November 4, 2009, at 18:55:19
In reply to Re: Going back to old-school - lithium., posted by SLS on November 4, 2009, at 9:22:41
Seriously Scott and this isn't meant to be mean I think I posted it once before but at this time of year you consider going to work and then meds seem to fail. Like me could it be a very scarey thing to think of working again and the responsibility of going to a job? Have you ever considered online work? Love Phillipa
Posted by SLS on November 8, 2009, at 7:07:56
In reply to Re: Going back to old-school - lithium., posted by SLS on November 4, 2009, at 9:22:41
A pleasant surprise: I have had two days in a row of feeling significantly improved. It is a true antidepressant effect rather than a limited increase in energy. I have been taking 900mg of lithium steadily since last week. I guess you never know what can happen if you invest the time to fully explore a treatment.
Currently:
Parnate 80mg
nortriptyline 150mg
Lamictal 200mg
Abilify 10mg
lithium 900mgIt is probably too early to yell "Woohoo!". I have a hell of a case of optimism, though.
We'll see.
- Scott
Posted by SLS on November 8, 2009, at 7:16:51
In reply to Re: Going back to old-school - lithium. » SLS, posted by Phillipa on November 4, 2009, at 18:55:19
> Seriously Scott and this isn't meant to be mean I think I posted it once before but at this time of year you consider going to work and then meds seem to fail.
I don't recall experiencing anything like that. In a way, I wish I could exercise that kind of control over my state of illness by manipulating my environment - both internal and external. No such luck.
Thanks for the concern.
- Scott
Posted by ColoradoSnowflake on November 8, 2009, at 12:54:36
In reply to Re: Going back to old-school - lithium., posted by SLS on November 8, 2009, at 7:07:56
Scott
That's great!! Can we say "waaahooo" for the moment?!!! I'm so happy you're feeling better and posting again!!!!
One day at a time.
I guess it's too much to celebrate more than today.Today it's beautiful in Colorado!! Fall is gorgeous here, esp in the mountains...aspen turning gold etc.
Hugs to you Scott
Gayle
Posted by floatingbridge on November 10, 2009, at 21:03:48
In reply to Re: Going back to old-school - lithium., posted by SLS on November 8, 2009, at 7:07:56
Very cool, Scott. And I see you are at half the abilify. Maybe the decrease will be helpful in the long run.
You know I wish the best for you--.
healing and good thoughts your way,
fb
Posted by Abby on November 11, 2009, at 7:12:11
In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on November 10, 2009, at 21:03:48
Are you in therapy too? I wouldn't be without my meds, but therapy has helped me a lot to level things out and to work on external triggers.
Posted by SLS on November 11, 2009, at 7:36:08
In reply to Re: Going back to old-school - lithium., posted by Abby on November 11, 2009, at 7:12:11
Hi Abby.
I have been in psychotherapy for quite awhile. It has helped me deal with a childhood of abuse and neglect along with cleaning up the mess created in the wake of a protracted severe depression.
Thanks for asking.
- Scott
Posted by floatingbridge on November 11, 2009, at 15:20:10
In reply to Re: Going back to old-school - lithium. » Abby, posted by SLS on November 11, 2009, at 7:36:08
> Hi Abby.
>
> I have been in psychotherapy for quite awhile. It has helped me deal with a childhood of abuse and neglect along with cleaning up the mess created in the wake of a protracted severe depression.
>
> Thanks for asking.
>
>
> - ScottScott, so you, too? I'm sorry--really. I'm in therapy too.
hugs,
fb
Posted by SLS on November 12, 2009, at 9:27:04
In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on November 10, 2009, at 21:03:48
> And I see you are at half the abilify.
You are wonderfully observant. Yes. I am trying to reduce a sense of laziness - amotivation - that I believe is due to taking Abilify. My guess is that it is dosage dependent. I wouldn't mind losing a little weight besides.
> Maybe the decrease will be helpful in the long run.
If reducing the dosage of Abilify resolves the amotivation, I will be significantly more functional and more apt to move ahead in life.
- Scott
Posted by SLS on November 20, 2009, at 16:54:55
In reply to Re: Going back to old-school - lithium. » floatingbridge, posted by SLS on November 12, 2009, at 9:27:04
My lithium blood level at a dosage of 900mg/day is 0.60 mmol/L.
I have been progressing gradually over the last week. I really don't care how long it takes to reach remission, as long as I know that I am on the right drugs at the right dosages.
I remain optimistic.
Currently:
Parnate 80mg
nortriptyline 150mg
Lamictal 200mg
Abilify 10mg
lithium 900mg
- Scott
Posted by floatingbridge on November 20, 2009, at 17:24:34
In reply to Re: Going back to old-school - lithium., posted by SLS on November 20, 2009, at 16:54:55
Good news, Scott. I share your optimism and, again, am pausing to knock on wood.
Here's to perseverance!
best wishes,
fb
> My lithium blood level at a dosage of 900mg/day is 0.60 mmol/L.
>
> I have been progressing gradually over the last week. I really don't care how long it takes to reach remission, as long as I know that I am on the right drugs at the right dosages.
>
> I remain optimistic.
>
> Currently:
>
> Parnate 80mg
> nortriptyline 150mg
> Lamictal 200mg
> Abilify 10mg
> lithium 900mg
>
>
> - Scott
Posted by morganator on November 20, 2009, at 23:05:06
In reply to Re: Going back to old-school - lithium., posted by SLS on November 20, 2009, at 16:54:55
Scott, are you at all concerned about the possibility of neuroleptics causing brain damage/atrophy? I have read about a few studies on the net.
I want to try abilify as a long term treatment but I am scared by the possibility of damage.
Posted by SLS on November 20, 2009, at 23:48:04
In reply to Re: Going back to old-school - lithium. » SLS, posted by morganator on November 20, 2009, at 23:05:06
Hi.
Thanks for the heads-up. I'll need to review your links more thoroughly.
> Scott, are you at all concerned about the possibility of neuroleptics causing brain damage/atrophy?
Well, I'm not terribly happy to be taking a neuroleptic, but brain shrinkage is not one of the things that has concerned me. Believe it or not, I have some concern about developing tardive akathisia with Abilify.
Schizophrenia is a disease that demonstrates a progressive reduction in brain volume as time passes. Neuroleptics might actually reverse this process in certain brain structures. Also, the degree of tissue loss is positively associated with severity of symptoms and resistance to treatment, particularly in the putamen. It is no wonder that neuroleptic dosage is associated with decreased brain volume. These patients are bound to be treated with higher dosages in an effort to effect any kind of improvement.
I guess I should do some more research.
Thanks again.
- Scott
------------------------------------------
Eur Neuropsychopharmacol. 2009 Dec;19(12):835-40. Epub 2009 Aug 29.
Brain structural changes associated with chronicity and antipsychotic treatment in schizophrenia.Tomelleri L, Jogia J, Perlini C, Bellani M, Ferro A, Rambaldelli G, Tansella M, Frangou S, Brambilla P; Neuroimaging Network of the ECNP networks initiative.
Section of Psychiatry and Clinical Psychology, Department of Medicine and Public Health, University of Verona, Italy.
Accumulating evidence suggest a life-long impact of disease related mechanisms on brain structure in schizophrenia which may be modified by antipsychotic treatment. The aim of the present study was to investigate in a large sample of patients with schizophrenia the effect of illness duration and antipsychotic treatment on brain structure. Seventy-one schizophrenic patients and 79 age and gender matched healthy participants underwent brain magnetic resonance imaging (MRI). All images were processed with voxel based morphometry, using SPM5. Compared to healthy participants, patients showed decrements in gray matter volume in the left medial and left inferior frontal gyrus. In addition, duration of illness was negatively associated with gray matter volume in prefrontal regions bilaterally, in the temporal pole on the left and the caudal superior temporal gyrus on the right. Cumulative exposure to antipsychotics correlated positively with gray matter volumes in the cingulate gyrus for typical agents and in the thalamus for atypical drugs. These findings (a) indicate that structural abnormalities in prefrontal and temporal cortices in schizophrenia are progressive and, (b) suggest that antipsychotic medication has a significant impact on brain morphology.
----------------------------------------------
Schizophr Res. 2009 Mar;108(1-3):49-56. Epub 2009 Jan 25.
Follow-up MRI study of the insular cortex in first-episode psychosis and chronic schizophrenia.Takahashi T, Wood SJ, Soulsby B, McGorry PD, Tanino R, Suzuki M, Velakoulis D, Pantelis C.
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Victoria, Australia. tsutomu@med.u-toyama.ac.jp
Morphologic abnormalities of the insular cortex have been described in psychotic disorders such as schizophrenia, but it remains unknown whether these abnormalities develop progressively over the course of the illness. In the current study, longitudinal magnetic resonance imaging data were obtained from 23 patients with first-episode psychosis (FEP), 11 patients with chronic schizophrenia, and 26 healthy controls. The volumes of the short (anterior) and long (posterior) insular cortices were measured on baseline and follow-up (between 1 and 4 years later) scans and were compared across groups. In cross-sectional comparison at baseline, the FEP and chronic schizophrenia patients had significantly smaller short insular cortex than did controls. In longitudinal comparison, the FEP patients showed significant gray matter reduction of the insular cortex over time (-4.3%/2.0 years) compared with controls (0.3%/2.2 years) without significant subregional effects, but there was no difference between chronic schizophrenia patients (-1.7%/2.4 years) and controls. The gray matter loss of the left insular cortex over time in FEP patients was correlated with the severity of positive and negative symptoms at follow-up. These findings indicate that patients with psychotic disorders have smaller gray matter volume of the insular cortex especially for its anterior portion (short insula) at first expression of overt psychosis, but also exhibit a regional progressive pathological process of the insular cortex during the early phase after the onset, which seems to reflect the subsequent symptomatology.
-----------------------------------------------
Posted by Bob on November 20, 2009, at 23:56:52
In reply to Re: Going back to old-school - lithium. » morganator, posted by SLS on November 20, 2009, at 23:48:04
> Hi.
>
> Thanks for the heads-up. I'll need to review your links more thoroughly.
>
> > Scott, are you at all concerned about the possibility of neuroleptics causing brain damage/atrophy?
>
> Well, I'm not terribly happy to be taking a neuroleptic, but brain shrinkage is not one of the things that has concerned me. Believe it or not, I have some concern about developing tardive akathisia with Abilify.
>
> Schizophrenia is a disease that demonstrates a progressive reduction in brain volume as time passes. Neuroleptics might actually reverse this process in certain brain structures. Also, the degree of tissue loss is positively associated with severity of symptoms and resistance to treatment, particularly in the putamen. It is no wonder that neuroleptic dosage is associated with decreased brain volume. These patients are bound to be treated with higher dosages in an effort to effect any kind of improvement.
>
> I guess I should do some more research.
>
> Thanks again.
>
>
> - Scott
>
>
> ------------------------------------------
>
>
> Eur Neuropsychopharmacol. 2009 Dec;19(12):835-40. Epub 2009 Aug 29.
> Brain structural changes associated with chronicity and antipsychotic treatment in schizophrenia.
>
> Tomelleri L, Jogia J, Perlini C, Bellani M, Ferro A, Rambaldelli G, Tansella M, Frangou S, Brambilla P; Neuroimaging Network of the ECNP networks initiative.
>
> Section of Psychiatry and Clinical Psychology, Department of Medicine and Public Health, University of Verona, Italy.
>
> Accumulating evidence suggest a life-long impact of disease related mechanisms on brain structure in schizophrenia which may be modified by antipsychotic treatment. The aim of the present study was to investigate in a large sample of patients with schizophrenia the effect of illness duration and antipsychotic treatment on brain structure. Seventy-one schizophrenic patients and 79 age and gender matched healthy participants underwent brain magnetic resonance imaging (MRI). All images were processed with voxel based morphometry, using SPM5. Compared to healthy participants, patients showed decrements in gray matter volume in the left medial and left inferior frontal gyrus. In addition, duration of illness was negatively associated with gray matter volume in prefrontal regions bilaterally, in the temporal pole on the left and the caudal superior temporal gyrus on the right. Cumulative exposure to antipsychotics correlated positively with gray matter volumes in the cingulate gyrus for typical agents and in the thalamus for atypical drugs. These findings (a) indicate that structural abnormalities in prefrontal and temporal cortices in schizophrenia are progressive and, (b) suggest that antipsychotic medication has a significant impact on brain morphology.
>
>
> ----------------------------------------------
>
>
> Schizophr Res. 2009 Mar;108(1-3):49-56. Epub 2009 Jan 25.
> Follow-up MRI study of the insular cortex in first-episode psychosis and chronic schizophrenia.
>
> Takahashi T, Wood SJ, Soulsby B, McGorry PD, Tanino R, Suzuki M, Velakoulis D, Pantelis C.
>
> Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Victoria, Australia. tsutomu@med.u-toyama.ac.jp
>
> Morphologic abnormalities of the insular cortex have been described in psychotic disorders such as schizophrenia, but it remains unknown whether these abnormalities develop progressively over the course of the illness. In the current study, longitudinal magnetic resonance imaging data were obtained from 23 patients with first-episode psychosis (FEP), 11 patients with chronic schizophrenia, and 26 healthy controls. The volumes of the short (anterior) and long (posterior) insular cortices were measured on baseline and follow-up (between 1 and 4 years later) scans and were compared across groups. In cross-sectional comparison at baseline, the FEP and chronic schizophrenia patients had significantly smaller short insular cortex than did controls. In longitudinal comparison, the FEP patients showed significant gray matter reduction of the insular cortex over time (-4.3%/2.0 years) compared with controls (0.3%/2.2 years) without significant subregional effects, but there was no difference between chronic schizophrenia patients (-1.7%/2.4 years) and controls. The gray matter loss of the left insular cortex over time in FEP patients was correlated with the severity of positive and negative symptoms at follow-up. These findings indicate that patients with psychotic disorders have smaller gray matter volume of the insular cortex especially for its anterior portion (short insula) at first expression of overt psychosis, but also exhibit a regional progressive pathological process of the insular cortex during the early phase after the onset, which seems to reflect the subsequent symptomatology.
>
>
> -----------------------------------------------
>
>
Amount of brain atrophy has been linked to illness severity and treatment resistance? Wow, that's depressing. Might explain why as time goes on, I have more and more trouble maintaining a response to these drugs. I don't respond like I used to, that's for sure. Where can I read more about this?
Posted by floatingbridge on November 21, 2009, at 11:05:32
In reply to Re: Going back to old-school - lithium. » SLS, posted by Bob on November 20, 2009, at 23:56:52
> Amount of brain atrophy has been linked to illness severity and treatment resistance? Wow, that's depressing. Might explain why as time goes on, I have more and more trouble maintaining a response to these drugs. I don't respond like I used to, that's for sure. Where can I read more about this?
My comment is pretty unscientific. My old psyd cbt therapist and my another pdoc (my current) have said that the damage might be less attributable to the medication then to not finding the therapeutic treatment to address the illness. So the faster one gets the 'right' treatment, the more the brain is protected. Not exactly cheerful news for those who are treatment resistant, but a more benign comment on most meds themselves.
I also think there are a few supplements that can help promote brain health--maybe taken in conjunction w/ meds? Like NAC and (I know, I know, everyone's tired of this one) fish oil.
Hey, I'm a luddite w/ a computer. My comments for what they are worth.
Best to you, Bob in healing and remission,
fb
Posted by floatingbridge on November 21, 2009, at 11:12:30
In reply to Re: Going back to old-school - lithium. » morganator, posted by SLS on November 20, 2009, at 23:48:04
Scott,
I thought that signs of tardive akathisia show fairly soon upon treatment. How long have you been on abilify? Are chances are affected by dosage?
(I might be confusing this w/ tardive dyskensesia.)
fb
Posted by desolationrower on November 21, 2009, at 15:49:31
In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on November 21, 2009, at 11:12:30
> Scott,
>
> I thought that signs of tardive akathisia show fairly soon upon treatment. How long have you been on abilify? Are chances are affected by dosage?
>
> (I might be confusing this w/ tardive dyskensesia.)
>
> fbtardive=gradually or delayed appearance, from the latin tardus, or late.
akithisia usually does show up early, and is quite common on aripiprazole (more common than benefit, i think)
-d/r
Posted by SLS on November 21, 2009, at 18:27:23
In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on November 21, 2009, at 11:12:30
The difference between acute akathisia and tardive akathisia is that acute akathisia can appear immediately upon beginning treatment and is often reversible upon the discontinuation of the offending drug. Tardive akathisia shows up later and tends to persist.
- Scott
Posted by floatingbridge on November 21, 2009, at 19:45:35
In reply to Re: Going back to old-school - lithium., posted by SLS on November 21, 2009, at 18:27:23
Thanks d/r and Scott for the clarification. Scott, I wish you the best. If I come across any pertinent info on Abilify, I'll direct it your way.
fb
> The difference between acute akathisia and tardive akathisia is that acute akathisia can appear immediately upon beginning treatment and is often reversible upon the discontinuation of the offending drug. Tardive akathisia shows up later and tends to persist.
>
>
> - Scott
Posted by fattoush on November 24, 2009, at 4:14:36
In reply to Going back to old-school - lithium., posted by SLS on July 3, 2009, at 6:42:30
I'm posting late in the thread but I hope to get some comments. I now take only Lithium, I'm at 450 mgs. I do have to take Synthroid 100 mcgs for my hypothyroidism. After years and years of misery, I was diagnosed Bipolar II. Every type of Anti-Depressant flips me into a hypomania. Often an inner-agitated anxious state type. I credit Lithium in particular for having saved me more than once, cause I'd stop it, from suicidal thoughts. So, I owe that drug, whatever else it does to me, and it does... I don't know what libido means, I lost most of my hair, I keep gaining weight, and I have acne. But my children have a rather functioning mother.
I hate AAPs and other mood stabiliziers did not work as well.
Yet, here I am again, wanting to be off every thing. Unyil only two months ago, and for 6 months, I was on only 300 mgs of Lithium. I'm sorry, I only understood from what you were all discussing that 300-600 only works as an additive, to boost something else. Does this mean it would be of no use to me at 300? I have very little very manageable mania. I confess that 450 did me beter alone on the depression front, but I'm tired of balding till there's nothing left.
Posted by SLS on November 24, 2009, at 6:19:30
In reply to Re: Going back to old-school - lithium., posted by fattoush on November 24, 2009, at 4:14:36
Have you tried Lamictal or Trileptal?
Both drugs are anticonvulsant mood stabilizers. Lamictal is not as good for treating mania, but can be helpful for depression. Trileptal is better as a mood stabilizer, as it can be helpful for both phases of bipolar disorder. You might want to start taking the new drug first and gradually discontinue the lithium later.
I would also consider Topamax. It can work wonders in agitated mixed states as what you are describing. The key to avoiding cognitive side effects is to begin at 25mg and raise the dosage by 25mg each week. 100mg might be the ideal dosage for you.
- Scott
Posted by fattoush on November 24, 2009, at 8:15:01
In reply to Re: Going back to old-school - lithium. » fattoush, posted by SLS on November 24, 2009, at 6:19:30
> Have you tried Lamictal or Trileptal?
>
> Both drugs are anticonvulsant mood stabilizers. Lamictal is not as good for treating mania, but can be helpful for depression. Trileptal is better as a mood stabilizer, as it can be helpful for both phases of bipolar disorder. You might want to start taking the new drug first and gradually discontinue the lithium later.
>
> I would also consider Topamax. It can work wonders in agitated mixed states as what you are describing. The key to avoiding cognitive side effects is to begin at 25mg and raise the dosage by 25mg each week. 100mg might be the ideal dosage for you.
>
>
> - ScottI have tried both Lamictal and Topamax, both twice. And, yes, the two times I titrated very slowly. I don't get only the usual bad side effects, though I get those too. I get very depressed at as soon as 50 mgs of Topamax and entertain suicidal thoughts often at 75 mgs. Yet, it does miracles on my migraines. Lamictal, on the other hand, soon gives me awful headache, like my head is in a vice. Nothing could relieve the pain. I stuck through to 100 mgs, imagine how long it takes...
Whence my gratitude to Lithium.
But, to go back to my original question, if I lowered it to 300 mgs, and with nothing else on board, would I get no anti-depressant effect?
I posted a question below to someone who thinks they, as bipolars, can do well with Lithium and Wellbutrin.
Posted by Phillipa on November 24, 2009, at 20:05:57
In reply to Re: Going back to old-school - lithium., posted by fattoush on November 24, 2009, at 8:15:01
I'm sure you know that lithium isn't good for thyroid disorder and that could account for the hair loss. thyroid does that. Phillipa
Posted by SLS on November 25, 2009, at 0:08:54
In reply to Re: Going back to old-school - lithium., posted by fattoush on November 24, 2009, at 8:15:01
> But, to go back to my original question, if I lowered it to 300 mgs, and with nothing else on board, would I get no anti-depressant effect?
My best guess is that you would not experience a stable improvement with such a low dosage of lithium when it is used as monotherapy. Unipolars can benefit from 300mg, but only when it is used to supplement antidepressants.
> I posted a question below to someone who thinks they, as bipolars, can do well with Lithium and Wellbutrin.
Combining Wellbutrin with lithium is certainly worth a try.
In my case, I am using lithium to supplement four other drugs. I did not experience a stable improvement until my lithium level reached 0.6 mmol/L. For me, that represents a dosage of 900mg.
- Scott
Posted by SLS on November 25, 2009, at 22:39:49
In reply to Re: Going back to old-school - lithium., posted by SLS on November 25, 2009, at 0:08:54
I'm thinking that I might have something to give thanks for this Thanksgiving. Over the past 10 days or so, I have felt a little better each day. It leaves me feeling that I got lucky. I am about 40% improved. I have started exercising again and I am socializing and getting out more. These things are still difficult to accomplish, but I go out of my way to push myself to do them. Otherwise, I still feel like lying on the couch. The thing is, I am trying to get a head-start on participating in life again. I can tell that I am getting well.
Lithium 900mg has made all the difference. It has broken through a barrier that previous treatments had plateaued at. Old drug, new results.
Currently:
Parnate 80mg
nortriptyline 150mg
Lamictal 200mg
Abilify 10mg
lithium 900mg
- Scott
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Dr. Bob is Robert Hsiung, MD,
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