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Dr. Bob is Robert Hsiung, MD,
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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
Posted by Phillipa on November 25, 2009, at 23:47:37
In reply to Re: Going back to old-school - lithium., posted by SLS on November 25, 2009, at 22:39:49
Scott and you will!!!!!! Love Phillipa
Posted by morganator on November 26, 2009, at 1:37:39
In reply to Re: Going back to old-school - lithium., posted by SLS on November 25, 2009, at 22:39:49
That's awesome! I really hope this trend continues! Onward and Upward!
Posted by uncouth on November 26, 2009, at 1:49:07
In reply to Re: Going back to old-school - lithium., posted by SLS on November 25, 2009, at 22:39:49
i'm thankful too...except for me, it has been due to the readdition of zyprexa 5mg and the reduction of lithium from 600mg to 300mg. all in the past week. some relief is better than no relief...
happy thanksgiving everyone.
300mg lithium
5mg zyprexa
5mg abilify
522mg aplenzin
25mg agomelatine
7.5mg deplin
Posted by SLS on November 26, 2009, at 6:26:32
In reply to Re: Going back to old-school - lithium., posted by uncouth on November 26, 2009, at 1:49:07
> i'm thankful too...except for me, it has been due to the readdition of zyprexa 5mg and the reduction of lithium from 600mg to 300mg. all in the past week. some relief is better than no relief...
That kind of positive attitude will get you everywhere. I hope you find wellness sooner rather than later.
Why did you reduce the dosage of lithium?
- Scott
Posted by floatingbridge on November 26, 2009, at 10:49:36
In reply to Re: Going back to old-school - lithium., posted by SLS on November 25, 2009, at 22:39:49
Happy Thanksgiving, Scott!
hugs,
fb
> 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
Posted by SLS on December 2, 2009, at 5:51:06
In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on November 26, 2009, at 10:49:36
Well, I'm afraid that lithium is turning out to be another disappointment. I am getting diminishing returns at 900mg. In addition, the tremulous effect it has on my muscles during and after resistance exercise is rather severe.
I have decided to go back to my original plan and stay with lithium at a dosage of 300mg. Hopefully, the tremulousness will disappear, and I will still get the neuroprotective and neurotrophic benefits it produces.
I started out taking 300mg of lithium not expecting it to affect my depression at all. However, when I experienced a fairly robust improvement within the first week, I was very surprised and delighted. When that improvement disappeared at 300mg, I went to 450mg, then to 600mg, and then to 900mg. Upon each dosage increase, I experienced an immediate improvement followed by a plateau and eventual diminution of the antidepressant effect.
Damned illness.
Damned drugs.
Damned brain.
- Scott
Posted by uncouth on December 2, 2009, at 10:13:20
In reply to Re: Going back to old-school - lithium., posted by SLS on December 2, 2009, at 5:51:06
scott i've said it before but i'll say it again...i urge you to try zyprexa again. im taking it with abilify and its effective, and with the abilify, not hunger promoting.
hope you feel better
Posted by SLS on December 2, 2009, at 10:31:15
In reply to Re: Going back to old-school - lithium., posted by uncouth on December 2, 2009, at 10:13:20
> scott i've said it before but i'll say it again...i urge you to try zyprexa again. im taking it with abilify and its effective, and with the abilify, not hunger promoting.
>
> hope you feel betterThanks!
I'll give it a try.
- Scott
Posted by floatingbridge on December 2, 2009, at 18:40:18
In reply to Re: Going back to old-school - lithium. » uncouth, posted by SLS on December 2, 2009, at 10:31:15
> > scott i've said it before but i'll say it again...i urge you to try zyprexa again. im taking it with abilify and its effective, and with the abilify, not hunger promoting.
> >
> > hope you feel better
>
> Thanks!
>
> I'll give it a try.
>
>
> - Scott
Maybe with the Abilify at the lower dose it would work. And Uncouth, how much zyprexia? I hear that causes weight gain--not for you?Scott, this news is disappointing. I'm sorry. And you've really hung in there with this trial. I'm sure you've tried augmenting w/ segeline--or is that contra-indicated w/ parnate?
You're in my thoughts,fb
Posted by uncouth on December 2, 2009, at 18:43:04
In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on December 2, 2009, at 18:40:18
i am on 5mg zyprexa, potentially going down to 2.5mg if i can stabilize. taking it with 5mg abilify. abilify has attenuated the increased appetite. i also have a trick I use...drink lots of psyllium powder+water solution a few times each day, after meals...it slows digestion, decreases spikes in blood sugar, and makes me feel more full.
Posted by Phillipa on December 2, 2009, at 23:12:22
In reply to Re: Going back to old-school - lithium., posted by SLS on December 2, 2009, at 5:51:06
Scott I'm truly sorry. Just home and reading mail. I too hope the tremulousness disappears for you . I do know you love to excercise. Love Phillipa
Posted by RocketMan on December 3, 2009, at 12:33:08
In reply to Re: Going back to old-school - lithium., posted by SLS on December 2, 2009, at 5:51:06
Scott, I agree with you lowering your dose to 300mg. Also, have you considered reducing your lamictal from 200mg to 150mg. I've been thinking about your regime and have a theory that the lamictal may be preventing the parnate/nortrip from achieving their potential due to a "top heavy" restriction from lamictal? Maybe even reducing it to 100mg if you realize some benefit after reducing down to 150mg. I think sometimes one drug can interfere with the overall success when not dosed properly. Low dose lithium/lamictal may prove more of a benefit, nothing to lose, and much to gain.
Just a suggestion.
Regards, Rick
Posted by SLS on December 3, 2009, at 21:58:26
In reply to Re: Going back to old-school - lithium., posted by RocketMan on December 3, 2009, at 12:33:08
> Also, have you considered reducing your lamictal from 200mg to 150mg.
I think I'll try that, if for no other reason but to see if I can reduce the cognitive impairments I experience. I don't know how much of it is due to the depression and how much is produced by the Lamictal. I'll need to establish the lowest effective dose of lithium first, though.
Interesting theory.
- Scott
Posted by SLS on December 4, 2009, at 8:15:46
In reply to Re: Going back to old-school - lithium. » RocketMan, posted by SLS on December 3, 2009, at 21:58:26
Well, at least I know that lithium is doing something positive. After being at 300mg for a few days, my depression worsened. After increasing the dosage to 450mg, I improved again. I'm still disappointed that I am not in remission, of course. However, I am grateful for any improvement in my condition that these drugs can offer.
- Scott
Posted by RocketMan on December 4, 2009, at 12:14:22
In reply to Re: Going back to old-school - lithium., posted by SLS on December 4, 2009, at 8:15:46
Glad the increase to 450mg offered some improvement! It is still a relatively small dose so that's a positive in itself. You may find your ability to exersice is not inhibited although a bottle of gatorade and a banana wouldn't hurt as well. ;)
On another note, I have always had this underlying need to fit myself into the bipolar 2 spectrum. After many unsuccessful trials with full-dose mood stabilizers, and help from my p/doc, I have learned that a-typical depression is more of my "flavor" and responds to the lower dosing of stabilizers. My p/doc has insisted that keeping my lamictal at 100mg is more than enough to aide in lifting depression along with the other meds I take. He says too high of a dose can hinder the therapeutic gains that may be recognized. I know when I increase my lamictal over 100mg, I get an immediate lift for several days and then the lid is screwed down.....depression sets in! As I previously mentioned, lithium at 300 -450 mg and lamictal 100mg may be a worth while trial. But, as you pointed out, it is just a theory. Best of luck with your recovery.** Rick
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