Psycho-Babble Medication Thread 470912

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Re: Klono not nearly as effective as X? (Oth. Benz

Posted by SLS on March 16, 2005, at 5:55:41

In reply to Re: Klono not nearly as effective as X? (Oth. Benz, posted by Maxime on March 15, 2005, at 20:03:08

> I think Kolonopin should be in a class of its own because it is NOT like other BENZOS. It is an anti-convulsant first and foremost which is why it used for bipolar illness.
>
> Just my 2 cents. ;)
>
> Maxime


I sort of agree with you. Some of the things I encountered over the years hint that Klonopin can modulate serotonergic activity.


- Scott

 

Re: Klono not nearly as effective as X? (Oth. Benz cache-monkey

Posted by Maxime on March 16, 2005, at 17:42:40

In reply to Re: Klono not nearly as effective as X? (Oth. Benz Maxime, posted by cache-monkey on March 15, 2005, at 22:32:26

Cache-Monkey it is almost 7 pm and you made me smile for the first time today. Thank you.

I hope the valium helps.

Hugs,
Maxime

> Thanks Maxime. That's the difficulty for me with this decision: I'm soft BP, and some of the anxiety might be "mixed state" sorts of stuff. But I feel like the Klonopin just isn't cutting down very much on the anxiety (esp. as compared to a "comparable" amount of Xanax). Plus it might be slowing me down/making me a little depressed.
>
> So I think I'm going to try for Valium (or maybe Ativan) and keep the BP stuff in check with Lithium and/or Depakote.
>
> Anyway, thanks for the input.
>
> I hope that you start feeling well again soon. I know it's hard, but try not to let the posts by a certain (now blocked) babbler get to you. I mostly lurk on this board, and have read a lot of your posts. You're really helpful to a lot of people, me included.
>
> Best,
> cache-monkey
>
> > I think Kolonopin should be in a class of its own because it is NOT like other BENZOS. It is an anti-convulsant first and foremost which is why it used for bipolar illness.
> >
> > Just my 2 cents. ;)
> >
> > Maxime
>
>

 

Re: Klono not nearly as effective as X? (Oth. Benz cache-monkey

Posted by barbaracat on March 18, 2005, at 1:05:35

In reply to Re: Klono not nearly as effective as X? (Oth. Benz mattw84, posted by cache-monkey on March 15, 2005, at 1:35:46

Dear C_Monkey,
I hope Depakote works for you. Unfortunately it did not for me. I have severe mixed-states bipolar depression, probably Bipolar I, and do well on lithium, as long as I can reasonably manage worry and stress. I'm also hypothyroid so my docs ocasionally insist on trying something besides lithium, but I always return to it. Depakote turned me into a drooling stumbling lethargic depressive which then escalated into mixed-states anyway. Not enough mood stabilization. Seroquel was a constant fog - a strong antihistamine effect which did nothing for me.

Anyhoo, I definitely will take Xanax when the panic threatens, have never had a problem with dependence and can take it PRN. Klonopin does not have the same effect, just doesn't. Ativan is a good runner up, as is Valium. I like Gabapentin alot but it does lose efficacy quickly. I take a break from it and need only 300-600mg to produce a nice smooth feeling - for a couple days at least. When I need to really chill, I'll take 1/2 Ambien (usually take it only for sleep). But it sometimes leaves me feeling depressed when it wears off and memory impaired. Better than creepy anxiety, however.

What works best for me on a long-term basis are some nutritional remedies. The amino acid L-Taurine at 1000mg twice a day (up to 2000mg twice a day) has been very effective. It stabilizes electrical potential of smooth muscle and has antiseizure properties. Calcium, Magnesium, Zinc, B6 and Folic Acid are necessary for me as well. Help relax the muscles and promote serotonin production.

Also worth a try is taking 1/2 teaspoon of baking soda and a pinch of sea salt in water or juice (I use cranberry juice). Tastes awful but works to alkalynize the blood pH and carbon dioxide/oxygen and electrolyte balance. These tend to be off during panic attacks and an acidic condition seems to go along with disregulated cortisol production. It's better to be slightly alkaline. I take this concoction on a regular basis before bed and feel it's helping to rebalance my system.

Be aware of your breathing too. Disordered breathing is guaranteed to bring on anxiety. Unfortunately, years of tension and armouring cause tightness in our chest and diaphragm and it's not easy to retrain the breath. There's a good website, www.breathing.com that's devoted to this topic. I got his material and it's pretty good. Stay in the present moment, as well as you can. What's happening in the right now is usually just fine and we forget this. And exercise. This is the best anti-anxiety agent going. We all know this, but it's so damn hard to stir the stumps.

Good luck, fellow mixed-stater. Such an interesting state it is. It ain't easy, but I'm finding my way through this with natural and conventional methods and if I can, anyone can. - BarbaraCat

 

Re: Klono not nearly as effective as X? (Oth. Benz barbaracat

Posted by SLS on March 18, 2005, at 6:05:17

In reply to Re: Klono not nearly as effective as X? (Oth. Benz cache-monkey, posted by barbaracat on March 18, 2005, at 1:05:35

Hi BarbaraCat.

> I hope Depakote works for you. Unfortunately it did not for me. I have severe mixed-states bipolar depression, probably Bipolar I, and do well on lithium, as long as I can reasonably manage worry and stress. I'm also hypothyroid so my docs ocasionally insist on trying something besides lithium, but I always return to it.

If you are inclined to attempt to replace lithium again, you might want to give Lamictal a try. You can begin taking it and wait a few months at a therapeutic dosage (200mg) before removing the lithium very, very gradually. Doing this over the course of months might prevent triggering a relapse and establish a propylaxis with Lamictal.

Be well.


- Scott

 

Re: Klono not nearly as effective as X? (Oth. Benz SLS

Posted by barbaracat on March 18, 2005, at 10:30:00

In reply to Re: Klono not nearly as effective as X? (Oth. Benz barbaracat, posted by SLS on March 18, 2005, at 6:05:17

>
Hi Scott,
Tried Lamictal and it worked well on 75mg for about 6 months and then pooped. As I ramped up I developed early symptoms of The Rash and stopped, as it appeared to have pooped even at higher doses. I eventually developed Stevens Johnson Syndrome, full-blown rash, from an allergic reaction to another drug. I believe Lamictal created an SJS prodromal inflammatory condition that has now become an ongoing allergic sensitivity. It has plagued me with every skin sensitive med I've taken since, antibiotics and such that I've never been allergic to before.

Long story short, thanks for the advice, but even on Lam I needed lithium. I seem to require the particular mood stabilizing properties it provides that no other med seems able to and other than the thyroid thing (which I'm handling with thyroid hormone), it's a wonderful med for me. I like the fact it's also a neuroprotective agent too. I'm doing well on teensy dose Cymbalta, low dose lithium, L-Taurine and other aminos. I take benzos as needed because I've become a fervent believer that by not spinning into a high stress/anxiety state I can maintain pretty well. - Barbara
>
> If you are inclined to attempt to replace lithium again, you might want to give Lamictal a try. You can begin taking it and wait a few months at a therapeutic dosage (200mg) before removing the lithium very, very gradually. Doing this over the course of months might prevent triggering a relapse and establish a propylaxis with Lamictal.
>
> Be well.
>
>
> - Scott
>
>

 

Re: Klono not nearly as effective as X? (Oth. Benz barbaracat

Posted by cache-monkey on March 18, 2005, at 13:43:50

In reply to Re: Klono not nearly as effective as X? (Oth. Benz cache-monkey, posted by barbaracat on March 18, 2005, at 1:05:35

Hi BarbaraCat,

I'm actually not going for the Depakote just yet. I'll wait until my Li level gets into the therapeutic window. (Just started at 1200 mg, and crossing my fingers that this will do the trick.) Did you find that you got thirsty on higher doses, but that this subsided over time?

If and when I try the Depakote, I'm shooting for a very low dose (e.g. 500 mg/day). It sounds like you replaced Li with the Depakote. Have you ever tried it as an add-on? Also, does the Li alone seem to help with your mixed states?

After meeting with my pdoc, we ended up settling on Xanax XR for a while. I am concerned about the dependency factor. I'm not familiar with Taurine... I suppose I'll go over to the alternative board to find out more, but if you can give me a little more information on it, I'd be much obliged.

In the meantime, I'll check out the website you recommend. I do feel like a chunk of my mixed-states/anxiety comes from breathing issues. And I definitely agree that regular exercise (whether from better breathing or extra endorphins) helps quite a bit.

Thanks for all the info!

Best,
cache-monkey

> Dear C_Monkey,
> I hope Depakote works for you. Unfortunately it did not for me. I have severe mixed-states bipolar depression, probably Bipolar I, and do well on lithium, as long as I can reasonably manage worry and stress. I'm also hypothyroid so my docs ocasionally insist on trying something besides lithium, but I always return to it. Depakote turned me into a drooling stumbling lethargic depressive which then escalated into mixed-states anyway. Not enough mood stabilization. Seroquel was a constant fog - a strong antihistamine effect which did nothing for me.
>
> Anyhoo, I definitely will take Xanax when the panic threatens, have never had a problem with dependence and can take it PRN. Klonopin does not have the same effect, just doesn't. Ativan is a good runner up, as is Valium. I like Gabapentin alot but it does lose efficacy quickly. I take a break from it and need only 300-600mg to produce a nice smooth feeling - for a couple days at least. When I need to really chill, I'll take 1/2 Ambien (usually take it only for sleep). But it sometimes leaves me feeling depressed when it wears off and memory impaired. Better than creepy anxiety, however.
>
> What works best for me on a long-term basis are some nutritional remedies. The amino acid L-Taurine at 1000mg twice a day (up to 2000mg twice a day) has been very effective. It stabilizes electrical potential of smooth muscle and has antiseizure properties. Calcium, Magnesium, Zinc, B6 and Folic Acid are necessary for me as well. Help relax the muscles and promote serotonin production.
>
> Also worth a try is taking 1/2 teaspoon of baking soda and a pinch of sea salt in water or juice (I use cranberry juice). Tastes awful but works to alkalynize the blood pH and carbon dioxide/oxygen and electrolyte balance. These tend to be off during panic attacks and an acidic condition seems to go along with disregulated cortisol production. It's better to be slightly alkaline. I take this concoction on a regular basis before bed and feel it's helping to rebalance my system.
>
> Be aware of your breathing too. Disordered breathing is guaranteed to bring on anxiety. Unfortunately, years of tension and armouring cause tightness in our chest and diaphragm and it's not easy to retrain the breath. There's a good website, www.breathing.com that's devoted to this topic. I got his material and it's pretty good. Stay in the present moment, as well as you can. What's happening in the right now is usually just fine and we forget this. And exercise. This is the best anti-anxiety agent going. We all know this, but it's so damn hard to stir the stumps.
>
> Good luck, fellow mixed-stater. Such an interesting state it is. It ain't easy, but I'm finding my way through this with natural and conventional methods and if I can, anyone can. - BarbaraCat

 

Benzos and other stuff cache-monkey

Posted by barbaracat on March 18, 2005, at 18:52:36

In reply to Re: Klono not nearly as effective as X? (Oth. Benz barbaracat, posted by cache-monkey on March 18, 2005, at 13:43:50

Hi CM,
>
> I'm actually not going for the Depakote just yet. I'll wait until my Li level gets into the therapeutic window. (Just started at 1200 mg, and crossing my fingers that this will do the trick.) Did you find that you got thirsty on higher doses, but that this subsided over time?

**Yes, definitely thirstier. It increases peeing and makes the kidneys work hard. It goes away if you drink extra water and increase salt intake. But definitely NOT table salt which simply causes bloat. You need to replenish electrolytes and minerals that are from a bioavailable source and a good salt will do that.

The best salt I've come across is from a deep mine in the Himalayas and tastes wonderful. I'm totally spoiled on this lovely pink salt. I order it from www.americanbluegreen.com. The website has alot of info on the its benefits. It's expensive, however, around $30 for 2lbs, but I think of it as a necessary medicine. You can get it from other sources which might be slightly less spendy, but this stuff is da kine.

**Another side effect that happened when I increased Li was hand tremors. It was very annoying. It started to subside after 2 months but I went back down to 600mg anyway, which seems to be good enough for me, although far below my therapeutic window.
>
> If and when I try the Depakote, I'm shooting for a very low dose (e.g. 500 mg/day). It sounds like you replaced Li with the Depakote. Have you ever tried it as an add-on?

**No, I didn't do both although I've heard it can be a good combo. I didn't do well on Dep, made me very lethargic, hair started falling out (yes, this is a sx) and did nothing to prevent mania, like racing thoughts in a lethargic body. I was also taking Seroquel for a while with it which made the lethargy worse. I wanted to just stay in bed all day paralyzed with racing thoughts.

>>Also, does the Li alone seem to help with your mixed states?

**That's difficult to say, I don't think so entirely. However, if I don't do lithium, I'm guaranteed one. Stress is my big trigger and if I let anxiety get out of hand it will escalate into a mixed state depression. But as I recall, those were also times when for one reason or another I stopped or reduced Li. Yes, I'd say Li does prevent the bleak awful mixed-states, but I can still get seriously depressed from stress and exhaustion, but it's a different animal from mixed states frenzy. There are times when I do fine on Li alone and other times when I need an AD, which is tricky for BPs. These days I seem to be maintaining on low dose Cymbalta to handle depression and doing what I can to minimize stress - benzos, breathing, walking, keeping on top of my hormones, trying to stay in the moment.

Lamictal is a good combo with Lithium for mixed states. I personally needed Lithium with it, but for some bipolars with depression Lamictal alone is enough. It was pretty activating but I never felt like I was careening off into anything too manic. Unfortunately, it eventually pooped and raising the dose caused an allergic reaction so I can't take it. But it's a good one to keep in mind.

I probably could use to increase the Li but I'm concerned about the thyroid thing and the fact that it makes it real hard to lose weight. All of them do that, unfortunately. My body can't handle complicated metabolic burdens any more and so I'm trying to manage with a minimal number of meds at the lowest doses. It's a lesson in learning to tolerate discomfort and being OK with good enough instead of perfect. A real challenge for me. Besides, I must admit that I like to dance around the edge of hypomania. As long as I can nip the axiety and bring myself down from a hypo buzz, I can still enjoy the many benefits of being bipolar.
>
> After meeting with my pdoc, we ended up settling on Xanax XR for a while. I am concerned about the dependency factor.

**Try not to stress about dependency right now while you're finding the right chemical balance. I know this has been a concern of yours in the past, but I truly think that dependency is more of a problem when your biochemistry is out of whack. When you get to a point where you're stable with the right meds, working on the breathing and exercise and supporting things nutritionally, you'll probably do fine with taking the Xanax only ocasionally. Until then, you gotta do what you can to manage anxiety and trust that you'll be able to wean off when you're ready. IMHO, Xanax XR is as good as a benzo gets, so consider it a helping friend and enjoy.

>>I'm not familiar with Taurine... I suppose I'll go over to the alternative board to find out more, but if you can give me a little more information on it, I'd be much obliged.

**Sure. Here's an article by Margot Kidder about amino acids in bipolar with a good explanation of L-Taurine: http://www.alternativementalhealth.com/articles/aminobipolar.htm
>
> In the meantime, I'll check out the website you recommend. I do feel like a chunk of my mixed-states/anxiety comes from breathing issues. And I definitely agree that regular exercise (whether from better breathing or extra endorphins) helps quite a bit.

**Ah yes, lovely endorphins. Wish there was a pill for that. Guess it's called exercise. The breathing is important. Amazing how disordered breathing contributes to all this misery. Try the 1/2 tsp baking soda thing and some extra calcium. If you have uneven shallow breathing, your blood pH is most likely skewed towards acidic - a big player in panic disorder.
>
> Thanks for all the info!
>
**Sure thing, it's been enjoyable! Good luck and keep me posted. - BCat

 

Re: Benzos and other stuff barbaracat

Posted by cache-monkey on March 19, 2005, at 13:29:43

In reply to Benzos and other stuff cache-monkey, posted by barbaracat on March 18, 2005, at 18:52:36

Wow, BarbaraCat! Thank you so much for all the information and counsel.

A couple of brief follow-ups below...

<<Yes, definitely thirstier. It increases peeing and makes the kidneys work hard. It goes away if you drink extra water and increase salt intake. But definitely NOT table salt which simply causes bloat. You need to replenish electrolytes and minerals that are from a bioavailable source and a good salt will do that.

The best salt I've come across is from a deep mine in the Himalayas and tastes wonderful. I'm totally spoiled on this lovely pink salt. I order it from www.americanbluegreen.com. The website has alot of info on the its benefits. It's expensive, however, around $30 for 2lbs, but I think of it as a necessary medicine. You can get it from other sources which might be slightly less spendy, but this stuff is da kine.>>

Hmm. So this is different than NaCl? I'll check out the website. Dehydration is definitely a concern for me. (Even as a child, I would dehydrate very easily.) Are there other sources of electrolytes that you might recommend? E.g. is it possible to go into a GNC and buy some sort of electrolyte powder or pill?

<< Another side effect that happened when I increased Li was hand tremors. It was very annoying. It started to subside after 2 months but I went back down to 600mg anyway, which seems to be good enough for me, although far below my therapeutic window. >>

Luckily, I've escaped this so far. I've always had shaky hands and haven't noticed an appreciable increase. In fact the ride up Li has (knock wood) been remarkable smooth. Hopefully the dose increase (which should get me to therapeutic levels) will be alright.

<< I didn't do well on Dep, made me very lethargic, hair started falling out (yes, this is a sx) and did nothing to prevent mania, like racing thoughts in a lethargic body. I was also taking Seroquel for a while with it which made the lethargy worse. I wanted to just stay in bed all day paralyzed with racing thoughts. >>

Yuck on the side effects. I know what you mean about staying in bed. When the racing thoughts come, I just want to curl up in a ball and reduce all sensory input.

<< Lamictal is a good combo with Lithium for mixed states. I personally needed Lithium with it, but for some bipolars with depression Lamictal alone is enough. It was pretty activating but I never felt like I was careening off into anything too manic. Unfortunately, it eventually pooped and raising the dose caused an allergic reaction so I can't take it. But it's a good one to keep in mind. >>

Yeah, I've heard good things about Lamictal. But, I also found it too activating. It actually set off a full-fledged panic attack for me. Plus it had some annoying side effects. Too bad, although I've heard that poop-out is not uncommon with it...

<< I probably could use to increase the Li but I'm concerned about the thyroid thing and the fact that it makes it real hard to lose weight. All of them do that, unfortunately. My body can't handle complicated metabolic burdens any more and so I'm trying to manage with a minimal number of meds at the lowest doses. It's a lesson in learning to tolerate discomfort and being OK with good enough instead of perfect. A real challenge for me. Besides, I must admit that I like to dance around the edge of hypomania. As long as I can nip the axiety and bring myself down from a hypo buzz, I can still enjoy the many benefits of being bipolar. >>

Yeah, I know what you mean about keeping the hypomania. I've been feeling a little "flat" on the lithium and think this is partially due to losing the hypomanic edge. My pdoc is adamant about getting into the therapeutic range, though, and I figure I'll give it a try for a little while.

<< After meeting with my pdoc, we ended up settling on Xanax XR for a while. I am concerned about the dependency factor.

**Try not to stress about dependency right now while you're finding the right chemical balance. I know this has been a concern of yours in the past, but I truly think that dependency is more of a problem when your biochemistry is out of whack. When you get to a point where you're stable with the right meds, working on the breathing and exercise and supporting things nutritionally, you'll probably do fine with taking the Xanax only ocasionally. Until then, you gotta do what you can to manage anxiety and trust that you'll be able to wean off when you're ready. IMHO, Xanax XR is as good as a benzo gets, so consider it a helping friend and enjoy. >>

Thanks. That's a very comforting perspective. Have you used Xanax XR? If so, I'm wondering if you found that once-daily dosing was enough or whether you had to supplement with a little IR toward the end of the day.

<< Here's an article by Margot Kidder about amino acids in bipolar with a good explanation of L-Taurine: http://www.alternativementalhealth.com/articles/aminobipolar.htm >>

I'll check this one out, too. Thanks!

<< Ah yes, lovely endorphins. Wish there was a pill for that. Guess it's called exercise. The breathing is important. Amazing how disordered breathing contributes to all this misery. Try the 1/2 tsp baking soda thing and some extra calcium. If you have uneven shallow breathing, your blood pH is most likely skewed towards acidic - a big player in panic disorder. >>

Mmmmm. Endorphins. I will try the baking soda thing.

Again, thanks for all the input. It's most appreciated.

All the best,
cache-monkey

 

Re: Benzos and other stuff cache-monkey

Posted by barbaracat on March 19, 2005, at 16:22:36

In reply to Re: Benzos and other stuff barbaracat, posted by cache-monkey on March 19, 2005, at 13:29:43

>
> Hmm. So this [Himalayan salt] is different than NaCl? I'll check out the website.

**The website describes it well. It is NaCl but because it's source is a millions year old ocean salt bed, it has most of the minerals our bodies require in a crystalline form that is bioavailable. Many mineral salts besides simple Sodium. Some claims are made for the energetic properties as well. Also, the mine is very deep in the mountain and has never been exposed to any of the pollutants that are present in most other salts that are collected above ground. This goes for Celtic Sea Salt which is far less superior, in my opinion. The Himalayan has a fantastic taste and texture, almost 'sparkly'. I guess you can tell I love the stuff.

>>Dehydration is definitely a concern for me. (Even as a child, I would dehydrate very easily.) Are there other sources of electrolytes that you might recommend? E.g. is it possible to go into a GNC and buy some sort of electrolyte powder or pill?

**The electrolytes we need are:

sodium (Na+)
potassium (K+)
chloride (Cl-)
calcium (Ca2+)
magnesium (Mg2+)
bicarbonate (HCO3-)
phosphate (PO42-)
sulfate (SO42-)

The only one not prevalent in the salt is bicarbonate, but that's where the baking soda comes in. So, a great electrolyte drink would be to make up a sole which is a saturated solution of the Himalayan salt (you order the large crystals and simply put a bunch in a jar and add water until the crystals no longer dissolve. This is a 28% saturated solution that is basically the reconstituted original seawater.) One teaspoon of this sole and 1/4 teaspoon baking soda in a quart of diluted juice is vastly superior to any sports drink out there. I like cranberry juice and dilute it 1/2 and 1/2 with water, it masks the baking soda somewhat. It doesn't hurt to supplement with extra minerals, but get them in an ionic form for assimilation. A few grains of this salt in drinking water allows it to filter through cell membranes easier. You can drink plenty of water, but if you're 'osmotically challenged', it has a hard time getting into the cells.

If you want a something premixed, a product called 'Hydralyte' is great. You can order it at www.gookinaid.com. I think the Fruit Punch tastes the best. It's a great site that explains all about the horrors of dehydration. Something we Lithium users have to take seriously. By all means, stay away from those crappy commercial sports drinks. No good. It's amazing they get away with that marketing bullsh*t.
>
> In fact the ride up Li has (knock wood) been remarkable smooth. Hopefully the dose increase (which should get me to therapeutic levels) will be alright.

**Well, good. Hopefully you're one of the lucky ones that can benefit from lithium, as I do. I've found it very smooth and calming. It's a very interesting drug. Do a Google search on neuroprotective+lithium or neurogenesis+lithium and you'll be pleased at how good it actually is for the brain. Life extention folks use it for anti-aging.
>
>
> Yeah, I know what you mean about keeping the hypomania. I've been feeling a little "flat" on the lithium and think this is partially due to losing the hypomanic edge. My pdoc is adamant about getting into the therapeutic range, though, and I figure I'll give it a try for a little while.

**That therapeutic window is getting lower all the time. Used to be in times of old that at least 1400-1800mg was the starting dose producing dull drooling zombies with kidney problems. Now, they're looking at more like 900-1200 as the average max to produce enough of a therapeutic benefit without the high dose problems.

My pdoc was frustrated with my refusal to ramp up to the therapeutic window, but I didn't like how I felt at those doses and figured it was my body, not his. He finally came around to being OK with it.

Between 600 and 900mg is my therapeutic dose, no matter what the 'window' dictates. But I'm also taking a small dose of an AD which keeps the depression demon at bay. Lithium will augment most antidepressants, so I think the combo is working synergistically. I don't know if a higher dose of Lithium would provide more AD benefits or not for me.

Like I mentioned, managing my anxiety and making sure my metabolic systems are in balance seems to be the key. Lithium keeps me from the extremes of up and down. Some existential angst keeps me honest, I welcome productive hypomanias and I certainly don't want to flatline. Those therapeutic ranges are based on an average control population and everyone's chemistry is different. You have to play with it until you know what's right for you.
>
Have you used Xanax XR? If so, I'm wondering if you found that once-daily dosing was enough or whether you had to supplement with a little IR toward the end of the day.

**I recently had a sample pack of it and liked it very much. My doctor didn't want to prescribe it just yet because I had a big Klonopin prescription filled and I think she'd feel more comfortable waiting. They're like that. Once a day worked fine for me, but I don't usually take benzos on a daily schedule, just as needed. But if I need another later on in the day, then why suffer?
>
**Are you taking fish oil, BTW? I don't think we've talked about that, but it's a big piece in my recovery. It seems to be so important to cellular health in general. The one I take is Carlson's Fish Oil, 2 Tbl a day. I get it from www.iherb.com. Pills aren't such a good idea because you have to take a handful to get the optimal amount (9-12G) and the oil is frequently rancid in pills. The Carlson's is lemon flavored and actually tasty. I'll tell you, though, all this mixing potions and stuff takes time. And money.

Well, this has been a nice way to spend a lovely rainy day in Oregon. I love the rain, luckily. So do those big fir trees outside my window. It's helped me to put my regimen down on paper and appreciate everything this wild journey has taught me. - Barbara

 

Re: Benzos and other stuff

Posted by cache-monkey on March 20, 2005, at 19:00:55

In reply to Re: Benzos and other stuff cache-monkey, posted by barbaracat on March 19, 2005, at 16:22:36

<< The electrolytes we need are:

sodium (Na+)
potassium (K+)
chloride (Cl-)
calcium (Ca2+)
magnesium (Mg2+)
bicarbonate (HCO3-)
phosphate (PO42-)
sulfate (SO42-)

The only one not prevalent in the salt is bicarbonate, but that's where the baking soda comes in. So, a great electrolyte drink would be to make up a sole which is a saturated solution of the Himalayan salt (you order the large crystals and simply put a bunch in a jar and add water until the crystals no longer dissolve. This is a 28% saturated solution that is basically the reconstituted original seawater.) One teaspoon of this sole and 1/4 teaspoon baking soda in a quart of diluted juice is vastly superior to any sports drink out there. I like cranberry juice and dilute it 1/2 and 1/2 with water, it masks the baking soda somewhat. It doesn't hurt to supplement with extra minerals, but get them in an ionic form for assimilation. A few grains of this salt in drinking water allows it to filter through cell membranes easier. You can drink plenty of water, but if you're 'osmotically challenged', it has a hard time getting into the cells. >>

Quite a cocktail. Alright, I'll check out the Himalayan salt, already! Sheesh.

<< If you want a something premixed, a product called 'Hydralyte' is great. You can order it at www.gookinaid.com. I think the Fruit Punch tastes the best. It's a great site that explains all about the horrors of dehydration. Something we Lithium users have to take seriously. By all means, stay away from those crappy commercial sports drinks. No good. It's amazing they get away with that marketing bullsh*t. >>

That actually seems quite cheap, or comparable to Gatorade in price, at least. Is Gatorade one of the "crappy" drinks to stay away from? How come?

<< > In fact the ride up Li has (knock wood) been remarkable smooth. Hopefully the dose increase (which should get me to therapeutic levels) will be alright.

**Well, good. Hopefully you're one of the lucky ones that can benefit from lithium, as I do. I've found it very smooth and calming. It's a very interesting drug. Do a Google search on neuroprotective+lithium or neurogenesis+lithium and you'll be pleased at how good it actually is for the brain. Life extention folks use it for anti-aging. >>

Yeah, so this last dose adjustment has been a little less smooth. I've been noticing some definite polyuria action. I posted further down the board about this, but my bladder and prostate actually feel a little sore right now. It's kind of annoying, and I hope it subsides with time. If it doesn't, I'll have to push for a "sub-clinical" dose of Li with my pdoc. He won't be happy, though, since he (like your pdoc) is fixed on a magical number for for the lithium serum level. Anyway, time will tell, I suppose.

[...]
<< Are you taking fish oil, BTW? I don't think we've talked about that, but it's a big piece in my recovery. It seems to be so important to cellular health in general. The one I take is Carlson's Fish Oil, 2 Tbl a day. I get it from www.iherb.com. Pills aren't such a good idea because you have to take a handful to get the optimal amount (9-12G) and the oil is frequently rancid in pills. The Carlson's is lemon flavored and actually tasty. I'll tell you, though, all this mixing potions and stuff takes time. And money. >>

I tried fish oil for about three, with the goal of getting 1000 mg EPA (and, based on the formulation I was using, 200 of DHA). I think that it might have been making me more anxious and discontinued about two weeks ago. I rechallenge with it at some point, but for now I want to figure out what the Lithium is doing.

<< Well, this has been a nice way to spend a lovely rainy day in Oregon. I love the rain, luckily. So do those big fir trees outside my window. It's helped me to put my regimen down on paper and appreciate everything this wild journey has taught me. - Barbara >>

It's been definitely good for me to get feedback from someone who's a bit ahead of me in the game. You've definitely provided me a number of avenues to explore, as well as a comforting voice in the middle of all my mental health anxiety. Rain's on the way out here, now (New England), which always makes me feel a little bluer. Luckily I'm moving to slightly clearer skies in a few months. Hopefully I'll be taking a clearer, healthier head with me.

All the best,
cache-monkey

 

Re: Benzos and other stuff cache-monkey

Posted by barbaracat on March 21, 2005, at 2:36:35

In reply to Re: Benzos and other stuff, posted by cache-monkey on March 20, 2005, at 19:00:55

Hey, I lived in New England for 5 years. Loved it. Some more thoughts. The start of lithium therapy can be a rollercoaster while your therapeutic levels are being established. I doubt if any doctor will risk tampering with toxicity on one hand or a sub therapeutic weak response on the other and must go by set rules. I got up to the therapeutic range but did not like how I felt and knew it would not be long before I was 'uncomplying'. My main concern was that my thyroid could not hold a stable level, I felt shaky and clumsy. I backed off slowly, noticing very carefully my response and asking my husband to monitor me for extra weirdness while I reduced. I was able to halve my dose from the therapeutic 1200mg to 600mg and luckily, this seems to be the magic number for me. It could be that with all the other stuff I take I'm synergistically affecting the mood stabilizing properties and thereby need less lithium, but maybe I just need less to do the job - not perfectly, but well enough so that I'm not veering too far off center line.

Perhaps when you get to a therapeutic level you'll even off with fewer side effects. This frequently happens after a few weeks. A time-released brand can help with sx's (but not with polyuria). Hopefully you can maintain a stable response at a level where, despite the numbers, it works for you. This is the point where my pdoc said 'oh OK, it shouldn't be working, but I guess it is' and no longer insisted on that window.

My situation is that I've had disastrous and near fatal reactions to health-care and I'm not bloody likely to take anyone's word for anything if it doesn't feel right. I've had to advocate for myself and become my own test case, but I don't advise this for anyone not prepared to put alot of time, effort and risk-taking into it.

With that caveat, I will say this: if you're having uncomfortable and potentially unhealthy effects from lithium, the question is are you in a crisis that warrants ramping up so quickly? Can the dose increase be more gradual? Some recent articles state that 600-900mg is proving to be as effective and the current therapeutic window and dosages should be reevaluated. Perhaps your doctor is aware of these studies. Can you live with 'skirting the edge of hypomania', and find healthy lifestyles methods as enhancers to lithium's efficacy?

My case has been quite serious, resistant, and confounding to most health practitioners I've been to. They do what they can based on what they've learned, but I most definitely do not attribute the gains in my physical and mental health to their limited protocols. As I said, if I can get better, ANYONE can and I hope that gives some measure of hope. But I admit it took alot of tweaking. Enuff said on that.
>
About hydration:
> [Hydrlite] actually seems quite cheap, or comparable to Gatorade in price, at least. Is Gatorade one of the "crappy" drinks to stay away from? How c

**Yeah, Gatorade ranks pretty low. Drink it if you like it, but not for its hydrating properties. Too much sugar or fructose - don't you feel the stickiness afterwards? - not enough minerals and hardly any bicarbonate. Plus the artificial flavors and colors. Ick. Most of the sports drinks are in this category.

Hydralite tastes quite good and you're correct, compared to store bought brands, very cost effective. I heard about it when I was hiking in Idaho and got sick from high elevation dehydration. Cured the muscle and stomach cramps within the first day of taking it.

The only think I can think of to watch for is the sugars. He uses glucose and this is a good thing since as sugars go since glucose gets converted immediately to energy and metabolizes cleanly. But lithium can raise insulin levels (yet another reason to not bulk up on it) and I don't know how glucose affects this. As a sport drink/rehydrator, glucose is a necessary ingredient, along with the rest of the ingredients in their proper balance. Hydralite contains much less sugar than the others. I like it alot, but don't drink it all the time and depend more on the salt and bicarb to deal with the lithium/kidney thing.


>
> << > In fact the ride up Li has (knock wood) been remarkable smooth. Hopefully the dose increase (which should get me to therapeutic levels) will be alright.
>
> **Well, good. Hopefully you're one of the lucky ones that can benefit from lithium, as I do. I've found it very smooth and calming. It's a very interesting drug. Do a Google search on neuroprotective+lithium or neurogenesis+lithium and you'll be pleased at how good it actually is for the brain. Life extention folks use it for anti-aging. >>
>
> Yeah, so this last dose adjustment has been a little less smooth. I've been noticing some definite polyuria action. I posted further down the board about this, but my bladder and prostate actually feel a little sore right now. It's kind of annoying, and I hope it subsides with time. If it doesn't, I'll have to push for a "sub-clinical" dose of Li with my pdoc. He won't be happy, though, since he (like your pdoc) is fixed on a magical number for for the lithium serum level. Anyway, time will tell, I suppose.
>
> [...]
> << Are you taking fish oil, BTW? I don't think we've talked about that, but it's a big piece in my recovery. It seems to be so important to cellular health in general. The one I take is Carlson's Fish Oil, 2 Tbl a day. I get it from www.iherb.com. Pills aren't such a good idea because you have to take a handful to get the optimal amount (9-12G) and the oil is frequently rancid in pills. The Carlson's is lemon flavored and actually tasty. I'll tell you, though, all this mixing potions and stuff takes time. And money. >>
>
> I tried fish oil for about three, with the goal of getting 1000 mg EPA (and, based on the formulation I was using, 200 of DHA). I think that it might have been making me more anxious and discontinued about two weeks ago. I rechallenge with it at some point, but for now I want to figure out what the Lithium is doing.
>
> << Well, this has been a nice way to spend a lovely rainy day in Oregon. I love the rain, luckily. So do those big fir trees outside my window. It's helped me to put my regimen down on paper and appreciate everything this wild journey has taught me. - Barbara >>
>
> It's been definitely good for me to get feedback from someone who's a bit ahead of me in the game. You've definitely provided me a number of avenues to explore, as well as a comforting voice in the middle of all my mental health anxiety. Rain's on the way out here, now (New England), which always makes me feel a little bluer. Luckily I'm moving to slightly clearer skies in a few months. Hopefully I'll be taking a clearer, healthier head with me.
>
> All the best,
> cache-monkey

 

Re: Benzos and other stuff barbaracat

Posted by cache-monkey on March 21, 2005, at 12:43:27

In reply to Re: Benzos and other stuff cache-monkey, posted by barbaracat on March 21, 2005, at 2:36:35

Hey,

<< Some recent articles state that 600-900mg is proving to be as effective and the current therapeutic window and dosages should be reevaluated. Perhaps your doctor is aware of these studies. >>

I'm not aware of these studies, and my doctor for sure doesn't know about them. (He claims that below a level of 0.6, Lithium will do nothing.) If you have any references, could you please pass them along?

<< Can you live with 'skirting the edge of hypomania', and find healthy lifestyles methods as enhancers to lithium's efficacy? >>

I might just have to. The whole thirst/dehydration/urination thing is really hard to live with right now.

<< The only think I can think of to watch for is the sugars. He uses glucose and this is a good thing since as sugars go since glucose gets converted immediately to energy and metabolizes cleanly. But lithium can raise insulin levels (yet another reason to not bulk up on it) and I don't know how glucose affects this. As a sport drink/rehydrator, glucose is a necessary ingredient, along with the rest of the ingredients in their proper balance. Hydralite contains much less sugar than the others. I like it alot, but don't drink it all the time and depend more on the salt and bicarb to deal with the lithium/kidney thing. >>

Interesting about the insulin. Again something I wasn't aware of. You really have done your research on this!

Thanks again,
cache-monkey

 

Re: Benzos and other stuff cache-monkey

Posted by barbaracat on March 21, 2005, at 14:45:38

In reply to Re: Benzos and other stuff barbaracat, posted by cache-monkey on March 21, 2005, at 12:43:27


>
> << Some recent articles state that 600-900mg is proving to be as effective and the current therapeutic window and dosages should be reevaluated. Perhaps your doctor is aware of these studies. >>
>
> I'm not aware of these studies, and my doctor for sure doesn't know about them. (He claims that below a level of 0.6, Lithium will do nothing.) If you have any references, could you please pass them along?

**I'll look for them. Some of them, as I recall, are from mags I receive in the mail. But I'll look. I'd like to pass them along to my new doc who thinks the therapeutic levels way but is willing to reconsider anything, given my highly unusual but effective experience with low dose Cymbalta. IN the meantime, there are quite a few references online referring to .4 as being the lower end of the window. Just do a search on lithium+"therapeutic range" or to that effect.
>
> << Can you live with 'skirting the edge of hypomania', and find healthy lifestyles methods as enhancers to lithium's efficacy? >>
>
> I might just have to. The whole thirst/dehydration/urination thing is really hard to live with right now.
>
**How much Li are you taking?

**But lithium can raise insulin levels (yet another reason to not bulk up on it) and I don't know how glucose affects this. >


> Interesting about the insulin. Again something I wasn't aware of. You really have done your research on this!
>
**Jeez, seeking answers to what has been going on with me has become my raison d'etre. Once I get strong enough and reasonable well from fibromyalgia I hope I can apply what I've learned somehow. BTW, many ingredients interract with lithium. Caffeine, psyllium, ibuprofen. It's possible that something else you're taking could be raising the levels. This may come to light in a blood test (how often are you getting blood and urine tests? And YOU ARE getting thyroid panels, aren't you?). Did you recently increase the dose and started experiencing worse sx/s?

As I recall, you were having a pretty smooth ride until hitting a certain point. Just my opinion, but if it were me and my bod, I'd go back to a level that was tolerable and live with it for a while to see how I was feeling overall, therapeutic window derived for the generic everyman be damned.

>

 

Re: Benzos and other stuff

Posted by Phillipa on March 21, 2005, at 17:08:11

In reply to Re: Benzos and other stuff cache-monkey, posted by barbaracat on March 21, 2005, at 14:45:38

I worked with a pdoc that didn't think the levels meant a thing unless they were too high. He believed that how the pt felt, and acted were a lot more important than that so called theraputic level. Fondly, Phillipa

 

Lithium levels - amen to that Phillipa

Posted by barbaracat on March 21, 2005, at 17:51:13

In reply to Re: Benzos and other stuff, posted by Phillipa on March 21, 2005, at 17:08:11

Totally agree. Besides, the levels are calibrated for an average population which does not necessarily reflect what on'es own levels should be. If you can locate any online articles to support this, please pass on to Cache-Monkey. Thanks. Barbara


> I worked with a pdoc that didn't think the levels meant a thing unless they were too high. He believed that how the pt felt, and acted were a lot more important than that so called theraputic level. Fondly, Phillipa

 

Re: Benzos and other stuff Phillipa

Posted by cache-monkey on March 21, 2005, at 22:37:02

In reply to Re: Benzos and other stuff, posted by Phillipa on March 21, 2005, at 17:08:11

> I worked with a pdoc that didn't think the levels meant a thing unless they were too high. He believed that how the pt felt, and acted were a lot more important than that so called theraputic level. Fondly, Phillipa

I've actually heard that this is the case particularly for BP II. It's good to know, though, that there are people out there who are more sensitive to the patient's response.

Best,
cache-monkey

 

Li levels, polyuria, etc. barbaracat

Posted by cache-monkey on March 21, 2005, at 22:47:08

In reply to Re: Benzos and other stuff cache-monkey, posted by barbaracat on March 21, 2005, at 14:45:38

[...Disucssion about lower-than-historical lithium levels being therapeutic...]

<< IN the meantime, there are quite a few references online referring to .4 as being the lower end of the window. Just do a search on lithium+"therapeutic range" or to that effect. >>

Found one such site, summarizing a number of studies pointing to 0.4 as being a potentially therapeutic lower bound:
http://www.vh.org/adult/provider/psychiatry/CPS/22.html

I've passed this on to my psychiatrist.

<< > The whole thirst/dehydration/urination thing is really hard to live with right now.

**How much Li are you taking? >>

Just went up to 1200 mg/day and it got really bad. It was only mildly annoying at 900 mg/day and had gotten better after two weeks at that dose.

<< Jeez, seeking answers to what has been going on with me has become my raison d'etre.>>

Amen. Although for me it borders on obsession. I guess in more favorable terms it's a "hobby".

<< Once I get strong enough and reasonable well from fibromyalgia I hope I can apply what I've learned somehow.>>

I totally understand. I'm, too, am hoping that once I'm well for a while I can use this storehouse of knowledge that I've been building somehow.

<< BTW, many ingredients interract with lithium. Caffeine, psyllium, ibuprofen. It's possible that something else you're taking could be raising the levels. This may come to light in a blood test (how often are you getting blood and urine tests? And YOU ARE getting thyroid panels, aren't you?). >>

I'm getting blood draws for Li and TSH every time I raise my dose. (Every two weeks or so right now.) My TSH is fine (0.9), and they did a baseline T3/T4 which was well within the range of normal. I haven't gotten a urine test done.

<< Did you recently increase the dose and started experiencing worse sx/s? As I recall, you were having a pretty smooth ride until hitting a certain point. Just my opinion, but if it were me and my bod, I'd go back to a level that was tolerable and live with it for a while to see how I was feeling overall, therapeutic window derived for the generic everyman be damned. >>

Well, I called my pdoc and reported my symptoms. He's advising discontinuing completely. I'm going to try going to 600 mg for a few days. If the symptoms don't resolve, I guess I'll d/c and rechallenge later. Hopefully they will resolve, in which case I'd like to get back up to 900 mg (with a level of 0.4) and stay there.

I'll keep you posted.

All the best,
cache-monkey

 

Re: Li levels, polyuria, etc. cache-monkey

Posted by barbaracat on March 22, 2005, at 8:38:55

In reply to Li levels, polyuria, etc. barbaracat, posted by cache-monkey on March 21, 2005, at 22:47:08

>
> Found one such site, summarizing a number of studies pointing to 0.4 as being a potentially therapeutic lower bound:
> http://www.vh.org/adult/provider/psychiatry/CPS/22.html I've passed this on to my psychiatrist.
>
**That's a good article. There were a few posts on this board as I recall saying that they were doing well on 600mg and even lower. Might be worth a Babble search.
>
> Well, I called my pdoc and reported my symptoms. He's advising discontinuing completely.

**That's unfortunate. I guess he's concerned about your past prostate problems?


>>I'm going to try going to 600 mg for a few days. If the symptoms don't resolve, I guess I'll d/c and rechallenge later. Hopefully they will resolve, in which case I'd like to get back up to 900 mg (with a level of 0.4) and stay there.

**That sounds like a wise idea, but a suggestion is to back down slowly to 900mg first. Don't want to exacerbate a switch or anything.

In my experience, doctors get a little trigger happy with lithium and err on the side of too much too quickly and then want to throw the baby out with the bath water when s/x start. It's truly a wonder drug if you can hit the sweet spot. Others have found alot of help with Trileptal (one I haven't tried). But for me, lithium seems to be the only one with true mood stabilizing properties. Whatever is unique about it, it's what this poor fried brain requires and I bless it every day.

It sounds like you're taking things into your own hands and making decisions for your own best interests. I don't mean to badmouth pdocs entirely, but they rarely see us or know us enough to be our experts. Nor have they tried taking most of these meds. We have to be proactive within the bounds of good sense. Good luck, my friend. Please keep me informed. - Barbara

> I'll keep you posted.
>
> All the best,
> cache-monkey

 

Re: Li levels, polyuria, etc. barbaracat

Posted by cache-monkey on March 22, 2005, at 13:11:25

In reply to Re: Li levels, polyuria, etc. cache-monkey, posted by barbaracat on March 22, 2005, at 8:38:55

Ugh. So my pdoc is adamant about discontinuing completely. He wants me to get some urine analysis done to rule out a UTI and check on my kidney function. He's concerned about "diabetes insipidus". I don't know anything about it, so I'll have to do some internet research. If you have anything to pass on, I'd appreciate it.

Suck. I was actually feeling almost stable!

:(

cache-monkey

 

Re: Li levels, polyuria, etc. cache-monkey

Posted by barbaracat on March 22, 2005, at 15:33:35

In reply to Re: Li levels, polyuria, etc. barbaracat, posted by cache-monkey on March 22, 2005, at 13:11:25

Weren't you doing OK at lower doses? Remember when I mentioned lithim affecting insulin? That might be your docs concern, which would go along with the excessive uring and thirst. Diabetes incipdus is usually a pituitary dysfunction or damage to the part of the kidneys that controls water retention. Generally, lithium induced NDI is usually nephrogenic form rather than incipidus. It's important to get the right dx since there are many different kinds of this diabetes.

Interestingly, the literature recommends a LOW sodium diet - completely different than the usual recommendation to eat more salt. It is always accompanied by an electrolyte imbalance.

My question to you is, how long have you been taking lithium and when in your trial did you start noticing polyuria and increased thirst to where it was a concern? (I went through all this not too long ago because I had a high metabolite of aldosterone in my urine, which indicates DI. Everything was OK, however and this metabolite appears to be typical with li intake.)

All the literature on lithium related DI states that lithium does not necessarily need to be continued, only reduced. I would have concerns about your doctor pushing the dose to reach the window (which may, for you, have been a toxic level) and then abruply discontinuing it. BTW, carbazamine (Tegretol) seems to be the second line choice if lithium needs to be discontinued. BTW, my blood levels have consistently been at .3 on my 600mg, close enough to the .4 lower level as far as I'm concerned, especially since it's working!

So, here's some info for your research. Good luck. Whew, this is all you need.

http://www.tpmm.com/health/endocrine/insipidus.htm

Here's some more info from www.diabetesinsipdus.org pertaining to lithium induced NDI:

Q: I have lithium-induced NDI.

* Is there anyway to stop having to go to the bathroom even right after I just went?

A. The only treatments for lithium-induced DI are:

1. to stop the lithium, which usually is not acceptable;

2. administer chlorothiazide or amiloride diuretics; and

3. eat a low-sodium diet.

The last is the most often overlooked and it can be quite effective particularly when combined with the thiazide. At best, however, it usually reduces urine volume by only between 50% to 75%, which, depending on how severe your DI was originally, may not be enough to completely eliminate the need to get up at night to urinate.

****** Top of Page ******

Question # 0106 FAQ Keywords: lithium, lithium-induced NDI, dipsogenic DI

Q: If your NDI was caused by taking lithium, is the damage done to the kidneys or brain?

A: Lithium can cause DI in either of two ways. The most common is damage to the part of the kidney that is normally responsible for controlling urine output. This form of lithium-induced DI is called nephrogenic DI. Depending on how long the problem has been present, it may or may not be corrected by stopping the lithium. If it cannot be corrected by stopping lithium, it may be partially controlled by treatment with amiloride or thiazide diuretics as well as a low-sodium diet. The other way that lithium can cause DI is by damaging the thirst mechanism in the brain. It is called dipsogenic DI and is usually reversible if the lithium is stopped. If the lithium cannot be stopped, this type of DI should not be treated with diuretics or antidiuretic hormone since they will induce water intoxication. Determining which type of lithium-induced DI you have would require measurements of plasma vasopressin before and during a fluid deprivation test or a closely monitored therapeutic trial with dDAVP. Either test should be performed only under the supervision of a physician experienced in their use.

****** Top of Page ******

Question # 0455 EWv4n3, 0105 FAQ Keywords: lithium, lithium-induced NDI, prognosis, mortality, diagnosis, diagnostic tests, water deprivation test

Q: I am a 33-year-old female who has been on Lithobid (a brand name for lithium) for quite some time. Today my doctor informed me that I had all the symptoms of nephrogenic DI and must be tested immediately. I had blamed those symptoms on depression, drinking a lot of water, etc. Now Im scared to death that I wont live to see my 5-year-old graduate. Do you have any information about the tests, the treatment, and prognosis? Im desperately worried.

A: Lithium-induced NDI is relatively common. It is uncomfortable but not fatal, provided water intake is not restricted for too long. It can also be treated to reduce the symptoms. However, before starting any treatment, it is a good idea to be tested to verify that the DI is really NDI. These tests include a controlled water deprivation test with various blood and urine measurements as well as a closely monitored trial of treatment with dDAVP.


> Ugh. So my pdoc is adamant about discontinuing completely. He wants me to get some urine analysis done to rule out a UTI and check on my kidney function. He's concerned about "diabetes insipidus". I don't know anything about it, so I'll have to do some internet research. If you have anything to pass on, I'd appreciate it.
>
> Suck. I was actually feeling almost stable!
>
> :(
>
> cache-monkey

 

Lithium, Diabetes Insipidus, new meds :( barbaracat

Posted by cache-monkey on March 25, 2005, at 13:37:53

In reply to Re: Li levels, polyuria, etc. cache-monkey, posted by barbaracat on March 22, 2005, at 15:33:35

I've been away for a few days. Dealing with getting my urinary system checked out and my medications adjusted has taken up the bulk of my time...

So, yeah, I was doing okay at a lower dose (900 mg), and had a level of 0.41, to boot. A little thirst and peeing. But the 1200 set off a full-fledged nephrogenic diabetes insipidus. (Large amounts of dilute and clear urine.) Withdrawing the lithium seems to have brought it under control -- not to be too gross or anything, but I never thought I'd be so happy to see yellow in my pee. It hasn't fully resolved yet, though.

Thanks for the links. I also found this great review article (in a med journal that I can access through my university) on lithium-induced DI. Apparently, it's pretty common (>10%) among long-term users, and usually gets better over a few weeks after discontinuing or lowering the lithium dose. My pdoc is a little hesitant to reinstate lithium, since it's a little strange to develop NDI after such a *short* time on the medication. I'm actually incline to agree, since I still don't feel fully right down there.

But this totally bites, since I was actually getting both stabilization and a mild lift from the lithium.

So, we're going with Depakote, which might be beneficial since I've got mixed and rapid-cycling features to my recent etiology. Hopefully I won't gain too much weight (I can maybe afford 7 lbs) and my hair won't fall out in droves!

My worry there is that I won't get the lift, just the stability. If that happens, I guess we'll add some sort of low-level antidepressant. You've mentioned microdoses of Cymbalta in another thread. I think I might try the low-dose selegiline route, for a variety of reasons.

Anyway, I guess I won't know anything for a couple of weeks, but I'll keep you and the board posted.

Best,
cache-monkey


> Weren't you doing OK at lower doses? Remember when I mentioned lithim affecting insulin? That might be your docs concern, which would go along with the excessive uring and thirst. Diabetes incipdus is usually a pituitary dysfunction or damage to the part of the kidneys that controls water retention. Generally, lithium induced NDI is usually nephrogenic form rather than incipidus. It's important to get the right dx since there are many different kinds of this diabetes.
>
> Interestingly, the literature recommends a LOW sodium diet - completely different than the usual recommendation to eat more salt. It is always accompanied by an electrolyte imbalance.
>
> My question to you is, how long have you been taking lithium and when in your trial did you start noticing polyuria and increased thirst to where it was a concern? (I went through all this not too long ago because I had a high metabolite of aldosterone in my urine, which indicates DI. Everything was OK, however and this metabolite appears to be typical with li intake.)
>
> All the literature on lithium related DI states that lithium does not necessarily need to be continued, only reduced. I would have concerns about your doctor pushing the dose to reach the window (which may, for you, have been a toxic level) and then abruply discontinuing it. BTW, carbazamine (Tegretol) seems to be the second line choice if lithium needs to be discontinued. BTW, my blood levels have consistently been at .3 on my 600mg, close enough to the .4 lower level as far as I'm concerned, especially since it's working!
>
> So, here's some info for your research. Good luck. Whew, this is all you need.
>
> http://www.tpmm.com/health/endocrine/insipidus.htm
>
> Here's some more info from www.diabetesinsipdus.org pertaining to lithium induced NDI:
>
> Q: I have lithium-induced NDI.
>
> * Is there anyway to stop having to go to the bathroom even right after I just went?
>
> A. The only treatments for lithium-induced DI are:
>
> 1. to stop the lithium, which usually is not acceptable;
>
> 2. administer chlorothiazide or amiloride diuretics; and
>
> 3. eat a low-sodium diet.
>
> The last is the most often overlooked and it can be quite effective particularly when combined with the thiazide. At best, however, it usually reduces urine volume by only between 50% to 75%, which, depending on how severe your DI was originally, may not be enough to completely eliminate the need to get up at night to urinate.
>
> ****** Top of Page ******
>
>
> Question # 0106 FAQ Keywords: lithium, lithium-induced NDI, dipsogenic DI
>
> Q: If your NDI was caused by taking lithium, is the damage done to the kidneys or brain?
>
> A: Lithium can cause DI in either of two ways. The most common is damage to the part of the kidney that is normally responsible for controlling urine output. This form of lithium-induced DI is called nephrogenic DI. Depending on how long the problem has been present, it may or may not be corrected by stopping the lithium. If it cannot be corrected by stopping lithium, it may be partially controlled by treatment with amiloride or thiazide diuretics as well as a low-sodium diet. The other way that lithium can cause DI is by damaging the thirst mechanism in the brain. It is called dipsogenic DI and is usually reversible if the lithium is stopped. If the lithium cannot be stopped, this type of DI should not be treated with diuretics or antidiuretic hormone since they will induce water intoxication. Determining which type of lithium-induced DI you have would require measurements of plasma vasopressin before and during a fluid deprivation test or a closely monitored therapeutic trial with dDAVP. Either test should be performed only under the supervision of a physician experienced in their use.
>
> ****** Top of Page ******
>
>
> Question # 0455 EWv4n3, 0105 FAQ Keywords: lithium, lithium-induced NDI, prognosis, mortality, diagnosis, diagnostic tests, water deprivation test
>
> Q: I am a 33-year-old female who has been on Lithobid (a brand name for lithium) for quite some time. Today my doctor informed me that I had all the symptoms of nephrogenic DI and must be tested immediately. I had blamed those symptoms on depression, drinking a lot of water, etc. Now I&#8217;m scared to death that I won&#8217;t live to see my 5-year-old graduate. Do you have any information about the tests, the treatment, and prognosis? I&#8217;m desperately worried.
>
> A: Lithium-induced NDI is relatively common. It is uncomfortable but not fatal, provided water intake is not restricted for too long. It can also be treated to reduce the symptoms. However, before starting any treatment, it is a good idea to be tested to verify that the DI is really NDI. These tests include a controlled water deprivation test with various blood and urine measurements as well as a closely monitored trial of treatment with dDAVP.
>
>
> > Ugh. So my pdoc is adamant about discontinuing completely. He wants me to get some urine analysis done to rule out a UTI and check on my kidney function. He's concerned about "diabetes insipidus". I don't know anything about it, so I'll have to do some internet research. If you have anything to pass on, I'd appreciate it.
> >
> > Suck. I was actually feeling almost stable!
> >
> > :(
> >
> > cache-monkey
>
>

 

Re: Lithium, Diabetes Insipidus, new meds :( cache-monkey

Posted by barbaracat on March 25, 2005, at 14:27:20

In reply to Lithium, Diabetes Insipidus, new meds :( barbaracat, posted by cache-monkey on March 25, 2005, at 13:37:53

Oh wow, what a bad time. Have you had urinary problems before or this a new thing w/lithium? Makes me glad I stick to me guns and not let them increase it, but it still concerns me. Think I'll check out some acupuncture to work on my kidneys.

The microdose Cymbalta is still working beautifully. Some people get good results with Trileptal - don't remember if you've tried this or not. All I can say about Depakote is that it does sedate and does thin out the hair. The sedation you'll probably be able to deal with by tweaking with other meds, but the hair thing... ummm, I don't know. Makes me wonder WHY it makes hair fall out.

By all means, do a search to see what if there are any urinary concerns with DP.


 

Re: Valproate, Divalproex, Valproic acid........ barbaracat

Posted by ed_uk on March 25, 2005, at 15:04:50

In reply to Re: Lithium, Diabetes Insipidus, new meds :( cache-monkey, posted by barbaracat on March 25, 2005, at 14:27:20

>Makes me wonder WHY it makes hair fall out.

.......and sometimes it's curly when it grows back!

Ed.

 

Re: Valproate, Divalproex, Valproic acid........ ed_uk

Posted by barbaracat on March 25, 2005, at 15:11:06

In reply to Re: Valproate, Divalproex, Valproic acid........ barbaracat, posted by ed_uk on March 25, 2005, at 15:04:50

> >Makes me wonder WHY it makes hair fall out.
.......and sometimes it's curly when it grows back!
>
**Sounds like chemo. I'm still losing chunks after 6 weeks off it. My father-in-law's hair grew back strong and thick after his chemo. DP can cause PCOS so something about hormones, perhaps? Also, check out DP and insulin. I recall reading there were concerns.

 

Re: Lithium, Diabetes Insipidus, Depakote barbaracat

Posted by cache-monkey on March 26, 2005, at 13:07:54

In reply to Re: Lithium, Diabetes Insipidus, new meds :( cache-monkey, posted by barbaracat on March 25, 2005, at 14:27:20

I think I've had some urinary problems before. Mostly due to excessive caffeine and alcohol. (I mostly abstain from both now.) But I've never had it like on the higher dose of Li. Maybe I have weak kidneys or something. Although my blood creatinine and urea nitrogen were fine.

It looks like, at least after d/c-ing the Lithium for a few days I've returned to normal. Which I realize still involves drinking and urinating more than normal.

I've not tried Trileptal. I want to try the Depakote first, since it's the other "first-line" beside Lithium. (I tried Lamictal and that was a bust for me.) Hopefully after the Lithium my pdoc is willing to not push the dose too high and let my body and mind tell us whether it's working.

As far as the weight, I'm hoping to get low-dose selegiline added, which should mitigate the appetite effect. (Plus help me get off the darned ciggies.) I've also heard that adding Acetyl l-Cartnine might help in that department. Actually that might have come from you in a different thread. Do you happen to know more about that?

For the hair. Well, I guess I'll try getting Centrum Silver or maybe some selenium. (I already take zinc.) And cross my fingers; I've heard this doesn't happen to everyone.

I have my script for the Depakote, but first I'm cross-tapering from Klonopin to Valium. Xanax XR was kind of a bust. I think my body digested the layering too fast: I got super sedated for like 6 hours and then whatever anxiety prevention I was obtaining fell off after 6 hours. So, I'm going the Valium route. Anyway, since I like to do one variable at a time, I'll start the Depakote in a couple weeks after the cross-taper.

Thanks for all of your input. I'm definitely going to look into that Himalayan salt anyway, given my propensity to dehydrate.

All the best,
cache-monkey

> Oh wow, what a bad time. Have you had urinary problems before or this a new thing w/lithium? Makes me glad I stick to me guns and not let them increase it, but it still concerns me. Think I'll check out some acupuncture to work on my kidneys.
>
> The microdose Cymbalta is still working beautifully. Some people get good results with Trileptal - don't remember if you've tried this or not. All I can say about Depakote is that it does sedate and does thin out the hair. The sedation you'll probably be able to deal with by tweaking with other meds, but the hair thing... ummm, I don't know. Makes me wonder WHY it makes hair fall out.
>
> By all means, do a search to see what if there are any urinary concerns with DP.
>
>
>
>
>


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