Psycho-Babble Medication Thread 486294

Shown: posts 1 to 15 of 15. This is the beginning of the thread.

 

Lithium as an AD Augmentation Strategy

Posted by anneL on April 19, 2005, at 0:16:27

I know that Lithium has been around for ages and that there are tons of studies on it. It apparently is one of the best studied psych meds studied to date. I suppose I feel that it carries a social stigma. Like only really manic people take Li. I certainly am not manic, but my pdoc has offered my Cytomel (jury is still out on this one) or Li as an augmentation strategy to Effexor. I have this unfounded fear that I will never get off of Effexor. Perhaps, purely coincidental, everytime I do the taper thing, something happens that curtails my plans and I end up back at 225 mg. of Effexor. Blast it all!
So now I am looking at Li as an add on. What do I need to know and how effective is it? Thanks for all info, both the good, bad, and the ugly.
:) AnneL

 

Re: Lithium as an AD Augmentation Strategy

Posted by Bill LL on April 19, 2005, at 8:33:36

In reply to Lithium as an AD Augmentation Strategy, posted by anneL on April 19, 2005, at 0:16:27

Lithium is a very popular augmenter of antidepressants, not just for bipolar people.

Cytomel is also very effective in many cases.

Why do you want to discontinue Effexor? Your dose of 225 mg is not very high and I'm wondering if your doctor should try raising it.

> I know that Lithium has been around for ages and that there are tons of studies on it. It apparently is one of the best studied psych meds studied to date. I suppose I feel that it carries a social stigma. Like only really manic people take Li. I certainly am not manic, but my pdoc has offered my Cytomel (jury is still out on this one) or Li as an augmentation strategy to Effexor. I have this unfounded fear that I will never get off of Effexor. Perhaps, purely coincidental, everytime I do the taper thing, something happens that curtails my plans and I end up back at 225 mg. of Effexor. Blast it all!
> So now I am looking at Li as an add on. What do I need to know and how effective is it? Thanks for all info, both the good, bad, and the ugly.
> :) AnneL

 

Re: Lithium as an AD Augmentation Strategy anneL

Posted by Ritch on April 19, 2005, at 10:09:48

In reply to Lithium as an AD Augmentation Strategy, posted by anneL on April 19, 2005, at 0:16:27

> I know that Lithium has been around for ages and that there are tons of studies on it. It apparently is one of the best studied psych meds studied to date. I suppose I feel that it carries a social stigma. Like only really manic people take Li. I certainly am not manic, but my pdoc has offered my Cytomel (jury is still out on this one) or Li as an augmentation strategy to Effexor. I have this unfounded fear that I will never get off of Effexor. Perhaps, purely coincidental, everytime I do the taper thing, something happens that curtails my plans and I end up back at 225 mg. of Effexor. Blast it all!
> So now I am looking at Li as an add on. What do I need to know and how effective is it? Thanks for all info, both the good, bad, and the ugly.
> :) AnneL


Hi, one thing you might find helpful is that you may not need much of a dose to have a clearly helpful effect. A lot of unipolar depressives only need 300-600mg/day to make a big difference (if it is going to work). The side effects can be a hassle (frequent thirst, urination, diarrhea, cognitive problems), but are dose-related. Get baseline thyroid function blood tests before you start. Li can depress thyroid function (often does to some extent). You'll have to get blood draws for serum lithium levels, and after a few weeks at a stable dosage.. need to recheck the thyroid function. It it changes significantly--you may have to quit the lithium or add thyroid hormone back int to offset that effect.

 

Re: Lithium as an AD Augmentation Strategy

Posted by Phillipa on April 19, 2005, at 18:21:19

In reply to Re: Lithium as an AD Augmentation Strategy anneL, posted by Ritch on April 19, 2005, at 10:09:48

I have hypothyroidism. And that's where all my problems started. Even with the correct doseage of synthroid I continue to be anxious and depressed. You are very lucky you have found a med that works for you. Are you functioning, work, etc? I would give anything to be able to do that. Fondly, Phillipa

 

Re: Lithium as an AD Augmentation Strategy Bill LL

Posted by anneL on April 19, 2005, at 20:09:41

In reply to Re: Lithium as an AD Augmentation Strategy, posted by Bill LL on April 19, 2005, at 8:33:36

> Why do you want to discontinue Effexor? Your dose of 225 mg is not very high and I'm wondering if your doctor should try raising it.
<<<<<<
Poop-out? Tired of being on meds, felt like I was doing reasonably well, good work function. My pdoc and I decided to taper off and see how I would do. I got to 187.5 mg. and then I got into a serious car accident on March 10. Concussion, ruptured breast implants, torn rotator cuff, serious cervical sprain, and car completely totalled. I was rear-ended by a driver doing 50 MPH while I was sitting at a red light. He did not see me as he was talking on his cell phone(!)
I am not able to work, do not know when I will be able to return to work and have to have one or more surgeries. Quite a mess. So my Pdoc raised my Effexor back to 225 mg. and was going to start me on Neurontin but my insurance denied it. So we are going to try Lithium. It just scares me to add something else. I have so much going on medically now.

 

Re: Lithium as an AD Augmentation Strategy anneL

Posted by Phillipa on April 19, 2005, at 20:12:19

In reply to Re: Lithium as an AD Augmentation Strategy Bill LL, posted by anneL on April 19, 2005, at 20:09:41

Anne, I'm sorry to hear of all your recent problems. No wonder you're depressed. Fondly, Phillipa

 

Re: Lithium as an AD Augmentation Strategy Ritch

Posted by anneL on April 19, 2005, at 20:15:20

In reply to Re: Lithium as an AD Augmentation Strategy anneL, posted by Ritch on April 19, 2005, at 10:09:48

Sounds like something to look forward to! I am euthyroid on levothyroxine 0.15 mg. daily. I developed Hashimoto's thyroiditis after the birth of my first child, some 20 years ago and have been on thyroid replacement since. Had a TSH drawn on 2/5 and it was perfect at 0.88. Pdoc said start Li at 300 mg. at bedtime x 4 days, then increase to 600 mg. at bedtime x 4 days, then 300 mg. in am and 600 mg. at bedtime x 5 days then have blood levels checked. With so much going on, I just wonder if I need anything more to worry about. That's all I need is to get diarrhea, etc!

 

Re: Lithium as an AD Augmentation Strategy Phillipa

Posted by anneL on April 19, 2005, at 20:18:38

In reply to Re: Lithium as an AD Augmentation Strategy anneL, posted by Phillipa on April 19, 2005, at 20:12:19

Phillipa,

Thank you so much. You have a wonderful sense of compassion and caring. I hope you are doing OK.
:) AnneL

 

Re: Lithium as an AD Augmentation Strategy anneL

Posted by Phillipa on April 19, 2005, at 20:58:47

In reply to Re: Lithium as an AD Augmentation Strategy Ritch, posted by anneL on April 19, 2005, at 20:15:20

Thanks, I needed that. It's been a rough past 2 1/2wks. I didn't know you could take lithium if you had a thyroid problem. I also have Hashimotos. I recently read in Women's Day or Family Circle that this is the most common type. And here i thought all along it only occurred with a lot of other autoimmune diseases. Fondly, Phillipa

 

Re: Lithium as an AD Augmentation Strategy

Posted by Emily Elizabeth on April 19, 2005, at 21:27:11

In reply to Lithium as an AD Augmentation Strategy, posted by anneL on April 19, 2005, at 0:16:27

I haven't been on Li, but I have very difficult to treat depression and I thought that I'd pass along some of the other things that my pdoc and I have tried. Maybe one of these might also be a good option.

1. Diff SSRI's (settled on Lexapro)
2. Adding Wellbutrin (made me too anxious)
3. Added Desipramine, a TCA, helped a good deal, but not completely
4. Added Lamictal, a mood stablizer that didn't help me, but helps a lot of people (I stopped it after 3 mos)
5. Added Dexedrine, a stimulant, so far it is great, but i've only been on it abt 2 weeks. I have my fingers crossed that it keeps working!

I'll do Li next if this doesn't keep helping. My pdoc also said that atypical antipsychotics can help for severe depression even w/o psychosis.

Good luck to you. Depression is the pits.

Best,
EE

 

Re: Lithium as an AD Augmentation Strategy Phillipa

Posted by Ritch on April 20, 2005, at 0:36:01

In reply to Re: Lithium as an AD Augmentation Strategy, posted by Phillipa on April 19, 2005, at 18:21:19

> I have hypothyroidism. And that's where all my problems started. Even with the correct doseage of synthroid I continue to be anxious and depressed. You are very lucky you have found a med that works for you. Are you functioning, work, etc? I would give anything to be able to do that. Fondly, Phillipa

I've found that 1) I need an antimanic medication, 2) Many medications make things worse, so I take an antimanic med that works and I avoid the stuff that makes things worse. Lithium can mess with thyroid negatively and often isn't good for rapid-cyclers (true in my case), so I'm not on lithium any more, but on Depakote instead.

 

Re: Lithium as an AD Augmentation Strategy anneL

Posted by scatterbrained on April 20, 2005, at 1:57:41

In reply to Re: Lithium as an AD Augmentation Strategy Bill LL, posted by anneL on April 19, 2005, at 20:09:41

anne l wrote "So my Pdoc raised my Effexor back to 225 mg. and was going to start me on Neurontin but my insurance denied it"

Just because your insurance denied it doesn't mean you can't get it covered, you just have to get an authorization from your pdoc stating why you need it(your doctor should have told you this!).As human beings, we deserve the best possible chance at recovery, and if neurontin is what might be the most therapeutic for you then that's what you are entitled to. I've had trouble w/ insurance not covering something. All it took was a phone call and the pharmacy even fronted some pills until it went through.
Depressives are at a disadvantage when it comes to things like this because one manifestation of our illness can involve difficulty fighting for things we need, which inevitably leads to more depression. if you are too debilitated or overwhelmed to deal with all this,let a friend or even a social worker deal with it for you. There is absolutely no reason why you shouldn't be on that neurontin!!!

 

Re: Lithium as an AD Augmentation Strategy Emily Elizabeth

Posted by anneL on April 20, 2005, at 2:05:49

In reply to Re: Lithium as an AD Augmentation Strategy, posted by Emily Elizabeth on April 19, 2005, at 21:27:11

Hi EE,
All suggestions very much appreciated. Thank you so much for your input. A different SSRI was at the top of my list, but in order to do so, I would have to be able to taper off of Effexor. This will have to wait until I am better physically and mentally. I, too, tried Lamictal at 200 mg. daily and all it did for me was cause me to become "angry" and hostile. My pdoc feels that this may have been some kind of "disinhibition" caused by Lamictal and Klonopin. I became intensely dislikable (and for good reason) for about six weeks. Glad my friends still love me! I was hoping that Neurontin would be covered by my insurance, but unless I have post-herpetic neuralgia or a peripheral neuropathic pain, my insurance will not authorize it. I read that Neurontin fared no better than placebo when used as a mood stabilizer, so perhaps I am moving in the right direction with trying Li. Hmmm. Nothing is worth nausea in my book. Hopefully I tolerate it well.
Ill keep you posted on my progress. Thanks again for all your suggestions.

 

Re: Lithium as an AD Augmentation Strategy scatterbrained

Posted by anneL on April 20, 2005, at 2:21:15

In reply to Re: Lithium as an AD Augmentation Strategy anneL, posted by scatterbrained on April 20, 2005, at 1:57:41

So very true. But I have just had enough of being a victim. I have to advocate for myself so that I get all the care that I need so that I can get rehabilitated and get back to work. Work keeps me alive, financially and emotionally. As an RN, I know the medical system inside and out and have thus far been very successful in getting everything that I need in order to get on the road to recovery. My pdoc submitted two prior auths for Neurontin and we both knew it was a gamble. We could appeal the decision, but instead of waiting around, why not try something that is very well-known, and has a fairly successful track record. Who knows, it might work out really well for me (I am crossing my fingers)! Just scared to try "LITHIUM" it just sounds like such a big gun. Thanks for your concern. I'll keep you posted.

 

Re: Lithium as an AD Augmentation Strategy

Posted by Cathybddmom on April 21, 2005, at 10:43:52

In reply to Re: Lithium as an AD Augmentation Strategy scatterbrained, posted by anneL on April 20, 2005, at 2:21:15

Hello, I just looked at this site today. Someone from the naturalthyroidhormone yahoo group mentioned this site. But I saw this post and had to jump in.

First, Phillipa, you mentioned taking synthroid for your thyroid problem and still not doing well. Synthroid contains only T4, and you need both T4 AND T3. Someone with a thyroid problem usually has a problem converting T4 to T3, so you are probably not getting T3, and T3 is very important for your mental health!!!

I would really like to suggest that you check into Armour Thyroid. It contains both T3 and T4 and most find it makes a world of difference!!! My son takes 4 grains of Armour a day. I take 3 grains.

If for some reason you would rather not switch to Armour (or can't find a doctor to switch to Armour) then you could add Cytomel for the T3. If your doc is simply running the TSH and not the Free T3 and Free T4 tests, then there is no way to know what your Free T3 and Free T4 levels look like, except for your symptoms.

Second, let me say that Lithium can definitely affect your thyroid! we learned the hard way! If there is even a chance that you have a thyroid problem I would really encourage you not to take Lithium. If you have a thyroid problem it will only make you worse!

Cathybddmom

Here is a copy of some things I have copied about Lithium.

Lithium
Lithium is the most frequent mood stabilizer prescribed to those with bipolar disorder (manic depression). Lithium helps to even the highs and lows of mood associated with this disorder.

Major Precautions and Warnings

Dietary
Because lithium is related to sodium, it is important to drink plenty of fluids (avoid caffeinated beverages) and have an adequate supply of dietary salt. Too little salt can cause the body to hoard lithium instead, and too little water will decrease urination, which again can lead to lithium buildup.

Pregnancy/Breast-Feeding
Experts recommend that lithium use be discontinued during at least the first trimester of pregnancy, and throughout pregnancy if possible. Breast-feeding mothers should not take lithium.

Drug Interactions
Medications that can interact badly with lithium include:
ibuprofen (Advil, Motrin)
naproxen (Aleve)
diuretics
SSRI antidepressants (Prozac, Luvox, etc.) and several others.

Make sure your doctor has a complete list of both prescription and over-the-counter medications you take regularly or occasionally. Also be sure to tell other doctors who may prescribe for you that you are taking lithium.

The combination of haloperidol (Haldol) and lithium has caused extremely serious complications in a small number of patients. When these two medicines are prescribed together, the patient should be monitored very closely for rigidity and/or very high fever.

Geriatric Use
Elderly patients may develop lithium toxicity at much lower serum levels and so should be monitored appropriately.

Miscellaneous Cautions
Patients with psoriasis should use lithium with caution, as this medication is known to make psoriasis worse.
Care should be used if the patient has:
cardiovascular disease
ANY THYROID DISEASE, or
leukemia.
This is not an all-inclusive list. Read patient information that accompanies prescription and discuss this medication with your doctor.

these were comments made on a board about thyroid problems & lithium:

1. I have been on lithium for just about 5 years. I didn't like it at first, but now, it is great. I did gain about 15 pounds at first, but it could have been cause I was in my late 30's to begin with. I gradually took off the 15 pounds by joining weight watchers and exercising more. I am now going to try to lose about 5 more pounds as I was slightly overweight when I first got on the lithium and I am small framed with not a whole lot of muscle. I am presently 5'4" and 116 pounds and 43 years old. I daily take 1 to 1-1/2 of the 450mg escolith time released form. My blood level ranges from .29 to .33 which my psychiatrist approves of, even though it is lower than the recommended standard. I did develop a thyroid problem from the lithium and now take synthroid, but it is an ok trade off, side effect wise. I have no hand tremors or other major side effects associated with lithium. Let me know if you have any more questions.


2. I was on lithium and depakote at the same time. Now I'm off depakote. Between the two of them, I've gained 70 pounds, and I've tried everything to get it off-it's impossible. Something won't let me. On lithium i got a goiter and i turned hypothyroid. It sucks. I seriously don't recommend lithium to anyone. I know it is a good drug and it also helps a lot, but to me its not worth it. Now it is too late.

3. Anyway regarding the question you asked re the Lithium and does it affect the thyroid gland ... yes, it can do. It's called Hypothyroidism and means the thyroid gland is underactive and not producing enough thyroid hormones through your body. The main effect or symptom is excessive tiredness to the point where you can even feel depressed if you weren't already. This is easily fixed. Your doctor should be giving you regular blood checks to check your thyroid hormone replacement level about every 4-5 months. You can be given replacement hormones in the form of pills which are called levothyroxine. This is very very common among people on Lithium and if it is going to be a problem then usually will start to play up sometime after the first 6 months, and is more prevalent in women.


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