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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by preventa on August 2, 2011, at 21:05:54
I have been on varying doses of lithium for over 11 years. It is what saved my life. I had been hospitalized over 5 times in a 4 year span. I began taking lithium consistently in 1999, and I haven't been hospitalized since. My illness is Bipolar I. I have only had manic episodes. During this time I managed to graduate college and function in very good jobs, for long term.
I am currently 35, and for the last 2 years have been trying to figure out why my hair is so brittle and literally falling out. Why I have acne. I have struggled with my weight especially in the last 10+ years. So my psychiatrist thinks I'm crazy---pun intended, sorry--and that I should be able to deal with these side affects. She is cautious since I have had such success and am so high functioning on lithium.
I feel like I wasn't bothered by the thirst, weight gain as much until the brittle/falling out hair and lashes happened this year. I know that it is vain. But I am a female and I kind of liked my hair before now. I already saw my ob/gyn doctor, who ruled out any hormone abnormality that would cause the oily skin and falling out hair.I see a therapist (Psy.D) every two weeks and a shrink (MD) every few months. My therapist is against the change. My shrink is on the fence. Note: My shrink has only known me for 2 years and my therapist has for 12.
My health is of the utmost importance to me. I don't drink or do recreational drugs. I eat well 90% of the time. I just got a level and it was a 0.6. It has always been low. I also have no thyroid reaction. Kidneys still good. So, Shrinky raised my dose one year ago because she didn't like how low my levels came up. I was on 1350mg at night, now I add a morning dose to make it 1650mg.
I am just wanting input if anyone is in a similar situation or knows someone who was.
I have read and been told how the more you go on and off lithium in my situation, the less it works overtime.
At one time we had added abilify to my mix. I am wondering if I would be ok on just that. I have low enough self esteem to be fat, losing hair and have a face full of acne. I'm 35, not 13. Any advice is appreciated. Thanks in advance!
Posted by linkadge on August 2, 2011, at 21:41:28
In reply to unsure about dropping eskalith (lithium), posted by preventa on August 2, 2011, at 21:05:54
Well, I (personally) would not completely discontinue lithium. Lithium is a well studied substace with multiple neurotrophic and neuroprotective cellular targets.
Discontinuing lithium abrubptly has been associated with an increase in suicidality.
You may benefit from a reduced dose (<900mg). If destabilization occurs, your best section option would be to add valproate. Another option is omega-3 fatty acids which have shown benefit in bipolar disorder. They can reduce the overal need for other mood stabilizers.
I certainly do not recomend coming completely off of 1650mg of lithium. But what about say:
600mg of lithium, 250mg valpraote and 2g EPA + DHA
Linakdge
Posted by crazyjoe on August 2, 2011, at 22:53:11
In reply to Re: unsure about dropping eskalith (lithium), posted by linkadge on August 2, 2011, at 21:41:28
thought lithium was a good med for me at about 1500--however my nephrologist(kidney dr.) recommend i know longer continue with it after having some renal function test done...ask you dr. about this
Posted by preventa on August 3, 2011, at 4:25:49
In reply to Re: unsure about dropping eskalith (lithium), posted by linkadge on August 2, 2011, at 21:41:28
I have been on far to long of a road to be naive enough to stop medication abruptly. this is something i am working on with a conscientious plan with my psychiatrist, therapist and primary care. I have never been suicidal. I do not think it would increase suicidiality in my case. i've said I have not yet experienced the "depressive" part of bipolar. I have only had mania in my 16+years of being aware of the disease in me.
I would certainly taper off of the lithium. The only issue of lowering the dose is that my psychiatrist doesn't feel that lithium is therapeutic if my blood level is not within range. My blood already reads low with the 1650mg dose.
I am on this site to see if anyone else has had experience personally with this, not to replace the 4-6 MDs in my life. I'm hoping to get more perspective as the choice bears some risk.
Thank you for sharing. I do appreciate learning about any one who has any long term experience on lithium and their thoughts.
thanks--preventa
Posted by SLS on August 3, 2011, at 9:18:11
In reply to Re: unsure about dropping eskalith (lithium), posted by linkadge on August 2, 2011, at 21:41:28
When I experienced antidepressant-induced mania, I needed a minimum of 1000mg of Depakote to exert an anti-manic effect. For me, the therapeutic effect is quite robust, and is more reliable than lithium. I currently receive antidepressant and mood stabilization benefits from lithium at a dosage of 300mg.
For bipolar depression, I currently take:
Nardil 90mg
nortriptyline 150mg
Lamictal 200mg
Abilify 10mg
lithium 300mgDo you think it would be worth adding valproate?
- Scott
Posted by linkadge on August 3, 2011, at 10:11:19
In reply to Re: unsure about dropping eskalith (lithium) » linkadge, posted by SLS on August 3, 2011, at 9:18:11
I think that the anti-manic effects of lithium take a little longer to kick in than those of valproate.
The whole "theraputic" blood level thing is a bit controversial. Yes, many studies indicate that patients tend to respond better when they are within a certain blood range. However, this is not a certainty for all patients. My psychiatrist found that lithium blood levels are "highly individual".
I personally don't think its a binary thing. I.e. as soon as you drop below a certain level, you're going to go into intense mania.
Lower doses would probably still have a preventitive effect on mania (IMHO).
You are a bit atypical in that you have not experienced major depression. Another strategy might simply be to slowly taper the lithium down to a level where the side effects are more tollerable. In conjunction you could keep a secondary antimanic substance (i.e. olanzapine, depakote, clonazepam, magnesium) on hand if you have a breakthrough episode.
I still think though that any breakthrough episodes you have on lower lithium doses, would be much less insense than those that happen on no lithium.
Linkadge
Posted by linkadge on August 3, 2011, at 10:29:30
In reply to Re: unsure about dropping eskalith (lithium) » linkadge, posted by SLS on August 3, 2011, at 9:18:11
I wouldn't add valproate for bipolar depression unless there is notable cycling, mania, or some other unresolved bipolar related issues (anxiety, insomnia, drug/alcohol use). I would not use valproate if depression is prominant (unless it is part of a larger cycling pattern).
There are longstanding debates on how to approach bipolar depression. Some advocate the use of antidepressants, others prefer to add more mood stabilizers. There is evidence to support both approaches and I don't know which data is more reliable.
As a crazy theory, perhaps you are getting too much monoamine activity in relation to cholinergic activity. If I take antidepressants too long, I become anhedonic, and the only way to fix that is to reduce the antidepressant for some time.
Linkadge
Posted by Phillipa on August 3, 2011, at 11:07:26
In reply to unsure about dropping eskalith (lithium), posted by preventa on August 2, 2011, at 21:05:54
What is your total cocktail of meds? For some reason I don't see it. Phillipa
Posted by SLS on August 3, 2011, at 13:01:47
In reply to Re: unsure about dropping eskalith (lithium), posted by linkadge on August 3, 2011, at 10:29:30
Thanks, Linkadge.
I really appreciate your sage advice.
I wish I had as many ideas to help you solve your health issues as you have had for mine.
I'll give some thought to cholinergic overdrive. I have already tried biperiden (Akineton) to treat my depression. It didn't help.
- Scott
Posted by linkadge on August 3, 2011, at 13:22:22
In reply to Re: unsure about dropping eskalith (lithium) » linkadge, posted by SLS on August 3, 2011, at 13:01:47
No, actually I meant cholinergic underdrive.
Posted by SLS on August 3, 2011, at 14:11:16
In reply to Re: unsure about dropping eskalith (lithium) » SLS, posted by linkadge on August 3, 2011, at 13:22:22
> No, actually I meant cholinergic underdrive.
I hadn't considered that.
- Scott
Posted by morgan miller on August 3, 2011, at 23:57:37
In reply to unsure about dropping eskalith (lithium), posted by preventa on August 2, 2011, at 21:05:54
If you are not already, you may want to consider supplementing these:
Inositol
L-Methylfolate
A good Multivitamin
Fish oil
Vitamin E mixed tocopherols with tocotrienols-Vibrant Health has a good oneHow were you feeling on the 1350 mg dose? Did you start to feel noticeably less stable? If not, I think going up to therapeutic blood levels is a bunch of bull. Sh*t, you might be just fine on 1000 mg. I just don't buy that blood level b*llsh*t for someone that has been stabilized for a while and is doing well in life. It may be best for most acute sever episodes, but I do not believe it is necessary for maintenance for many people.
Morgan
Posted by morgan miller on August 4, 2011, at 0:09:13
In reply to Re: unsure about dropping eskalith (lithium), posted by linkadge on August 3, 2011, at 10:11:19
I agree with what Link said about lower mood stabilizer doses. I definitely experience this. I will take a little healthy mania, without this, I have no spirit.
Posted by Preventa on August 4, 2011, at 6:16:11
In reply to Re: unsure about dropping eskalith (lithium), posted by morgan miller on August 4, 2011, at 0:09:13
Thanks everyone for all the info and advice. I should mention That my current doc has only been with me for 1.5 years. Before that I also had a short term doc who first raised me from 900 to 1250mg because the blood level. With my current psychiatrist, i was going under a great deal of job related stress and her being new to me, raised it all the way to 1650mg
I see her in a couple of weeks and i think im going to start tapering to eventually900mg. again. Especially after reading your advice.
I also didnt mention my insomnia and migraines. So currently take lunesta 2mg, Eskalith er 1650mg.At the end of my first group of hospitalizations from oct-feb 1995, i was on depakote for 6months where i gained 85 lbs.
At this point, although i am not a pharmacologist, i know my body. I never tried valaproate. I may just go back to what i was on for 5 years which was simply 900mg of lith and add the abilify in the morning. I did that combined cocktail for a couple of years too.
But if i keep losing hair at that point, i will have to consider something else.
I am going to try some of those vitamins/ minerals that Morgan mentioned. I have heard some about fishoil.Thanks for the perspective on this. It helps a great deal! Preventa
Posted by Shes_InItForTheMoney on August 4, 2011, at 7:17:21
In reply to unsure about dropping eskalith (lithium), posted by preventa on August 2, 2011, at 21:05:54
I know that sounds reactive and all, but you may also never get the benefit again you have been from Lithium if stopped. (and even started again.) Like Link said, reducing or stopping Lithium majorly puts you at risk for suicide.
About the other stuff...talk to a gyno or have your GP run all tests on your hormones. I am thinking you may have some slight testosterone elevation (eg. acne, hair falling out.)
Best wishes,
Jay> I have been on varying doses of lithium for over 11 years. It is what saved my life. I had been hospitalized over 5 times in a 4 year span. I began taking lithium consistently in 1999, and I haven't been hospitalized since. My illness is Bipolar I. I have only had manic episodes. During this time I managed to graduate college and function in very good jobs, for long term.
> I am currently 35, and for the last 2 years have been trying to figure out why my hair is so brittle and literally falling out. Why I have acne. I have struggled with my weight especially in the last 10+ years. So my psychiatrist thinks I'm crazy---pun intended, sorry--and that I should be able to deal with these side affects. She is cautious since I have had such success and am so high functioning on lithium.
> I feel like I wasn't bothered by the thirst, weight gain as much until the brittle/falling out hair and lashes happened this year. I know that it is vain. But I am a female and I kind of liked my hair before now. I already saw my ob/gyn doctor, who ruled out any hormone abnormality that would cause the oily skin and falling out hair.
>
> I see a therapist (Psy.D) every two weeks and a shrink (MD) every few months. My therapist is against the change. My shrink is on the fence. Note: My shrink has only known me for 2 years and my therapist has for 12.
>
> My health is of the utmost importance to me. I don't drink or do recreational drugs. I eat well 90% of the time. I just got a level and it was a 0.6. It has always been low. I also have no thyroid reaction. Kidneys still good. So, Shrinky raised my dose one year ago because she didn't like how low my levels came up. I was on 1350mg at night, now I add a morning dose to make it 1650mg.
>
> I am just wanting input if anyone is in a similar situation or knows someone who was.
>
> I have read and been told how the more you go on and off lithium in my situation, the less it works overtime.
> At one time we had added abilify to my mix. I am wondering if I would be ok on just that. I have low enough self esteem to be fat, losing hair and have a face full of acne. I'm 35, not 13. Any advice is appreciated. Thanks in advance!
Posted by morgan miller on August 4, 2011, at 11:52:49
In reply to Re: unsure about dropping eskalith (lithium), posted by Preventa on August 4, 2011, at 6:16:11
Preventa, almost everyone should consider taking fish oil, especially those of us with mental illness. I we all ate things like wild alaskan salmon and sardines 4 times a week, we wouldn't need to supplement, but this is not the case for the majority of people out there.
You've been taking a high dose of lithium for quite a while now. I'm surprised nobody ever mentioned the possibility of drugs like lithium depleting certain essential micronutrients. Basically, over the years, you may have body may have been deficient in some nutrients that are causing hairloss, and potentially other health issues down the road. This type of neglect by doctors is one reason why I think the field of medicine is in a sad sad state.
Did I mention that I now take 250 mg Depakote, 240 mg lithium orotate, 100 mg Zoloft(sertraline), and 2.5 mg Lexapro? I have bipolar I. I'm doing pretty good right now, despite having other things going on with my health, things I'm working on. Just trying to make the point that with time, diet, exercise, supplementation, friends and family, and good hard emotional work in therapy, some of us with bipolar can get away from more conventional treatments that can do more harm than good in the long run.
Posted by Phillipa on August 4, 2011, at 20:02:36
In reply to Re: unsure about dropping eskalith (lithium), posted by morgan miller on August 4, 2011, at 11:52:49
Morgan in all seriousness this is working for you as so many negative posts on meds and their ability to work especially the SSRI's. Thanks Phillipa
This is the end of the thread.
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