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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Solstice on February 27, 2012, at 14:33:56
Today is day six.
She was in pretty good shape yesterday. Took her sixth dose of saphris last night, got sleepy within a half hour and went to bed. She got up fine. She looked good this morning. She was excited and joyful. Since she wasn't *excessively* talkative - or at least it wasn't excessively fast - I decided she was just in the upper level of *her* normal mood.
Went to first period class and made it to the end of first period, but then went to the nurse 2nd and 3rd period. She called me.. is terribly shaky (tremors), including her head. Her vision is a problem. Said everything looks like a 'magic eye' book - she can't tell how far away anything is, so her walking is unsteady. The nurse checked her bp, and it was 140/90.
She made herself go to 4th period, but then was back in the nurse's office for 6th period, called me again. Nurse checked her bp again - 133/90, pulse 114.
I have a call into the psychiatrist. I just wish I knew what to do.
Solstice
Posted by Twinleaf on February 27, 2012, at 14:54:11
In reply to Saphris - more reactions, posted by Solstice on February 27, 2012, at 14:33:56
Sometimes the combination of lithium and drugs in the Saphris class will cause extra-pyramidal symptoms, when either one alone will cause either mild or no symptoms.
In this situation, I think I would really want to know if Saphris can help. Could you withdraw the lithium and see how she does on the Saphris? If she does well, you can build her treatment plan around that; if she doesn't, you will know for sure that the Saphris is not helping. Possibly lithium could be re-introduced later at a much lower level, say 150 or 300 mg. per day.
Posted by Solstice on February 27, 2012, at 15:03:38
In reply to Re: Saphris - more reactions, posted by Twinleaf on February 27, 2012, at 14:54:11
> Sometimes the combination of lithium and drugs in the Saphris class will cause extra-pyramidal symptoms, when either one alone will cause either mild or no symptoms.
>
> In this situation, I think I would really want to know if Saphris can help. Could you withdraw the lithium and see how she does on the Saphris? If she does well, you can build her treatment plan around that; if she doesn't, you will know for sure that the Saphris is not helping. Possibly lithium could be re-introduced later at a much lower level, say 150 or 300 mg. per day.
Thanks for the idea, Twin. I'm waiting for the psychiatrist to call me back right now.. so I'll ask if she thinks we should withdraw lithium. My daughter's bipolar is difficult to characterize right now. It was initially clearly hypomania - pretty much constant hypomania. There was no obvious depression, but the irritability that she's experienced during this episode could either be depression - or part of the hypomania. But if her irritability is hypomania and not depression, then the lithium might be the one to drop.Anyway, I'll post again after I hear from the dr.
Solstice
Posted by ed_uk2010 on February 27, 2012, at 15:21:35
In reply to Re: Saphris - more reactions » Twinleaf, posted by Solstice on February 27, 2012, at 15:03:38
What dose of Saphris is she taking now, Solstice?
Posted by Solstice on February 27, 2012, at 15:28:16
In reply to Saphris - more reactions, posted by Solstice on February 27, 2012, at 14:33:56
Okay.. just got off the phone with the dr. She said to stay at 600 lithium (the on-call dr over the weekend said to drop to 600 after these symptoms popped up Saturday night), and to withhold the Saphris tonight. She seemed to think that the vision problems pointed to Saphris. I'm supposed to call her tomorrow to let her know if the symptoms resolve.I just really want the Saphris to work.. because I'm so worried about my daughter refusing to take anything that causes weight gain.
Solstice
> Today is day six.
>
> She was in pretty good shape yesterday. Took her sixth dose of saphris last night, got sleepy within a half hour and went to bed. She got up fine. She looked good this morning. She was excited and joyful. Since she wasn't *excessively* talkative - or at least it wasn't excessively fast - I decided she was just in the upper level of *her* normal mood.
>
> Went to first period class and made it to the end of first period, but then went to the nurse 2nd and 3rd period. She called me.. is terribly shaky (tremors), including her head. Her vision is a problem. Said everything looks like a 'magic eye' book - she can't tell how far away anything is, so her walking is unsteady. The nurse checked her bp, and it was 140/90.
>
> She made herself go to 4th period, but then was back in the nurse's office for 6th period, called me again. Nurse checked her bp again - 133/90, pulse 114.
>
> I have a call into the psychiatrist. I just wish I knew what to do.
>
> Solstice
Posted by Solstice on February 27, 2012, at 15:29:19
In reply to Re: Saphris - more reactions, posted by ed_uk2010 on February 27, 2012, at 15:21:35
> What dose of Saphris is she taking now, Solstice?
>10mg, once each night. None in the morning.
Sol
Posted by SLS on February 27, 2012, at 15:42:34
In reply to Re: Saphris - more reactions, posted by Twinleaf on February 27, 2012, at 14:54:11
> Sometimes the combination of lithium and drugs in the Saphris class will cause extra-pyramidal symptoms, when either one alone will cause either mild or no symptoms.
>
> In this situation, I think I would really want to know if Saphris can help. Could you withdraw the lithium and see how she does on the Saphris?That's a particularly bright idea. I would not have thought of it.
- Scott
Posted by Phillipa on February 27, 2012, at 17:48:58
In reply to Re: Saphris - more reactions, posted by Solstice on February 27, 2012, at 15:28:16
I would have said the same thing as the lithium will calm down any hypo or mania. I just feel that Sapris isn't the one. How bout Latuda? I think even though your Daughter fears weight gain do you really know if she will gain on another AAP. What about perpazazine sp?. Seems zyprexa the poster takes it with zyprexa and says no weight gain? Just a thought Phillipa
Posted by Solstice on February 27, 2012, at 17:53:31
In reply to Re: Saphris - more reactions » Twinleaf, posted by SLS on February 27, 2012, at 15:42:34
> > Sometimes the combination of lithium and drugs in the Saphris class will cause extra-pyramidal symptoms, when either one alone will cause either mild or no symptoms.
> >
> > In this situation, I think I would really want to know if Saphris can help. Could you withdraw the lithium and see how she does on the Saphris?
>
> That's a particularly bright idea. I would not have thought of it.
>
>
> - Scott
Well... like I said, the doctor wanted me to withhold the Saphris tonight. I did ask about withholding lithium, but she said she'd rather withhold the saphris.When my daughter walked in the door she was bright-eyed and bushy-tailed. I got an email from her 6th period teacher saying that my daughter has been sluggish since last week, and told me about her leaving class today, escorted by another student. When I asked my daughter about her symptoms, she said that they gradually subsided, and she felt fine by the end of 7th period. She then spontaneously offered: "Mom, I think it's the lithium because of all the shaking."
She really wants to go down on the lithium instead of leaving out the saphris.
Question: Since we're kind of doing this on our own - - will it be a problem to go from 600mg to 0? If we have to titrate down then I'll probably be able to talk her into it, but if you all who have taken lithium have had no trouble going from 600 to 0, then that's what we'll do.
Let me know what you think!
Solstice
Posted by Christ_empowered on February 27, 2012, at 18:31:55
In reply to Re: Saphris - more reactions - lithium question, posted by Solstice on February 27, 2012, at 17:53:31
I agree with twinleaf that lithium+neuroleptics sometimes=EPS, even when using atypical neuroleptics at relatively low doses.
I don't know if I'd pick lithium or a neuroleptic in her shoes. The tranquilizers are easier to deal with in some respects, but have their own long-term issues. Tough call.
Anyway, I read a little about it (clearly, I'm not any kind of health expert, and I've never even taken lithium), and it seems that the problems with lithium withdrawal are more common in Bipolar I (the classic type--euphoric mania, severe depressions). In those cases, you can have worse mood episodes after withdrawal than you did before treatment, kind of like how schizophrenia can get worse after long-term antipsychotic treatment is withdrawn.
If there are safety+tolerability issues, and the lithium hasn't been a long-term part of her cocktail, I'd just drop it, personally. I did that with depakote and felt 100 times better once it washed out of my system. I know the 2 meds are very different, but you get the picture: sometimes sudden removal of a medication makes you feel *so* much better, while a protracted taper might just prolong the misery (and shakes, tremor, etc.).
Just my thoughts.
Posted by Solstice on February 27, 2012, at 19:27:47
In reply to Re: Saphris - more reactions - lithium question, posted by Christ_empowered on February 27, 2012, at 18:31:55
Thanks for the input CE.. she's been on Lithium about four or five weeks now. five days at 300mg, five days at 600mg, then five days at 900 mg. had a blood level done a week ago - it was real low - .7. Saturday night she had terrible tremors, so the on-call PDoc said to go down to 600mg.
I hope to hear from some lithium users before she has to take her meds.. to find out if going down to zero all of a sudden will be a problem.
Solstice
> I agree with twinleaf that lithium+neuroleptics sometimes=EPS, even when using atypical neuroleptics at relatively low doses.
>
> I don't know if I'd pick lithium or a neuroleptic in her shoes. The tranquilizers are easier to deal with in some respects, but have their own long-term issues. Tough call.
>
> Anyway, I read a little about it (clearly, I'm not any kind of health expert, and I've never even taken lithium), and it seems that the problems with lithium withdrawal are more common in Bipolar I (the classic type--euphoric mania, severe depressions). In those cases, you can have worse mood episodes after withdrawal than you did before treatment, kind of like how schizophrenia can get worse after long-term antipsychotic treatment is withdrawn.
>
> If there are safety+tolerability issues, and the lithium hasn't been a long-term part of her cocktail, I'd just drop it, personally. I did that with depakote and felt 100 times better once it washed out of my system. I know the 2 meds are very different, but you get the picture: sometimes sudden removal of a medication makes you feel *so* much better, while a protracted taper might just prolong the misery (and shakes, tremor, etc.).
>
> Just my thoughts.
Posted by SLS on February 27, 2012, at 20:02:10
In reply to Re: Saphris - more reactions - lithium question » Christ_empowered, posted by Solstice on February 27, 2012, at 19:27:47
You can stop the lithium all at once.
- Scott
Posted by Solstice on February 27, 2012, at 20:09:08
In reply to Re: Saphris - more reactions - lithium question » Solstice, posted by SLS on February 27, 2012, at 20:02:10
> You can stop the lithium all at once.
>
>
> - Scott
My daughter thanks you for getting this info to me before she has to take her meds!Solstice
Posted by SLS on February 27, 2012, at 20:22:04
In reply to Re: Saphris - more reactions - lithium question » SLS, posted by Solstice on February 27, 2012, at 20:09:08
> > You can stop the lithium all at once.
> My daughter thanks you for getting this info to me before she has to take her meds!
Obviously, you will need to watch for an exacerbation of mania. There really is no rebound effect, but relapse is a possibility. However, your daughter did well on Geodon without lithium, right?
- Scott
Posted by Solstice on February 27, 2012, at 20:49:53
In reply to Re: Saphris - more reactions - lithium question » Solstice, posted by SLS on February 27, 2012, at 20:22:04
> > > You can stop the lithium all at once.
>
> > My daughter thanks you for getting this info to me before she has to take her meds!
>
> Obviously, you will need to watch for an exacerbation of mania. There really is no rebound effect, but relapse is a possibility. However, your daughter did well on Geodon without lithium, right?
>
Yes. The only reason lithium was added was because the Latuda wasn't doing anything. Dr. thought the lithium might be stabilizing while we waited for the Latuda to kick in. I'd really like to see how Saphris does on its own. I asked the dr. how long it should take for Saphris to kick in, and she said that in her experience, for my daughter's type situation, it is quick. She thought Latuda should be quick too. And the Geodon definitely was quick.Fingers crossed...
Solstice
Posted by Phillipa on February 27, 2012, at 21:04:53
In reply to Re: Saphris - more reactions - lithium question, posted by Solstice on February 27, 2012, at 20:49:53
Why not geodon poop out if did so well on it? Phillipa
Posted by Solstice on February 27, 2012, at 21:08:44
In reply to Re: Saphris - more reactions - lithium question » Solstice, posted by Phillipa on February 27, 2012, at 21:04:53
> Why not geodon poop out if did so well on it? Phillipa
After three years and reaching maximum dose, her bipolar symptoms broke through the Geodon :-(
Posted by Phillipa on February 27, 2012, at 21:12:20
In reply to Re: Saphris - more reactions - lithium question » Phillipa, posted by Solstice on February 27, 2012, at 21:08:44
That's a shame. So sorry. Phillipa
Posted by ed_uk2010 on February 28, 2012, at 1:22:47
In reply to Re: Saphris - more reactions - lithium question » Christ_empowered, posted by Solstice on February 27, 2012, at 19:27:47
> Thanks for the input CE.. she's been on Lithium about four or five weeks now. five days at 300mg, five days at 600mg, then five days at 900 mg. had a blood level done a week ago - it was real low - .7. Saturday night she had terrible tremors, so the on-call PDoc said to go down to 600mg.
0.7 isn't that low. It's certainly enough to cause adverse effects, and could be an effective level. I've noticed that guidelines from the US seem to recommend higher levels than elsewhere, which is probably why your doc considers it to be low.
Here, we tend to use 0.8-1.0 for acute manic episodes eg. in hospital, 0.6-0.8 for hypomania and bipolar prophylaxis. 0.4-0.6 is effective for prophylaxis in some cases, it might be suitable for Bipolar II cases where hypomania is relatively mild but an adjunct to antidepressants is required.High-dose lithium is no longer a popular first-line choice for acute severe manic episodes because it is not well tolerated. More moderate doses have a major prophylactic role, however. Acute mania is more likely to be treated with antipsychotics, which tend to work more rapidly. Now that lithium is mainly used for prophylaxis, 0.6-0.8 is the most commonly desired blood level in bipolar disorder.
Since your daughter dislikes lithium, perhaps your doc would consider stopping it and allowing her to try Saphris at the 5mg dose?
This is the end of the thread.
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