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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 37. Go back in thread:
Posted by BorderlinePersona on November 8, 2005, at 19:08:42
In reply to Re: ANY info on Lithium » Bobby, posted by CareBear04 on November 8, 2005, at 10:38:21
So its my second day on lithium. side effects so far : sweating, dazed feeling, slight nausia, some sleeping difficulty (nothing new) and a strong metalic taste when i smoke a cigarette. i cant even finish a whole cigarette. But im not complaining as ill soon be giving up. The dazed out feeling itself is actually quite comfortable but probably wouldnt be the best if i had a more active lifestyle. anyway ill see how it goes, just lettin everyone know the situation.
Posted by Squiggles on November 8, 2005, at 19:10:40
In reply to Re: ANY info on Lithium: Day 2 Li, posted by BorderlinePersona on November 8, 2005, at 19:08:42
Sounds high to me;
Squiggles
Posted by BorderlinePersona on November 8, 2005, at 20:02:54
In reply to Re: ANY info on Lithium: Day 2 Li, posted by Squiggles on November 8, 2005, at 19:10:40
are you suggesting my lithium levels may b 2 high allready? or are u saying 'high' as in the state its put me in ahaha. im a lil worried all the negativity ive read on Li may effect the way i think its working. does anyone actually know HOW it helps/works? Ive read some on its connection to glutamate. all very scientific and sometimes hard to follow.
:S dunno
Posted by Squiggles on November 8, 2005, at 20:12:03
In reply to Re: ANY info on Lithium: Day 2 Li » Squiggles, posted by BorderlinePersona on November 8, 2005, at 20:02:54
It's the sweating that is unusual,
i think. I don't mean to alarm you
as your doctor is probably monitoring
you, but the sweating unlike the other
symptoms made me suspicious that it
may be too high.Squiggles
Posted by BorderlinePersona on November 8, 2005, at 20:17:38
In reply to Re: ANY info on Lithium: Day 2 Li, posted by Squiggles on November 8, 2005, at 20:12:03
thanx for the concern. more info: i live on the gold coast in australia, its a tropical environment with alot of humidity. I think that may explain my sweating, if i were peeing more than usual on top of the sweating i may be a bit more alarmed but theres been no increase there. I also drink 2.5+ litres of water a day.
Posted by Squiggles on November 8, 2005, at 20:43:15
In reply to Re: ANY info on Lithium: Day 2 Li » Squiggles, posted by BorderlinePersona on November 8, 2005, at 20:17:38
Borderline,
If you check the keywords
lithium
sodium
sweating
urinationyou will find many sites indicating the
danger of sweating too much for whatever
reason -- if not dangerous, it will at least
raise your lithium level, esp. if you
are not voiding.Here is a similar example to the topic:
http://www.bipolarworld.net/Phelps
"Q: Relationship of Lithium, Salt & Loss of Body Fluids
Dear Dr. Phelps,I suffer from Bipolar I and I have been taking lithium for the past year. In addition to lithium, I control my symptoms through diet and lots of exercise, mostly walking, biking and swimming. Given the hot summer months, I am sweating more than ever and I would like you to explain the relationship of lithium and salt and the loss of body fluids. I always drink tons of water after exercise and I eat pickles to replenish my salt levels, because that's what it says to do on my medication instructions. But I'd like to know how it works.
Thanks for helping bipolar patients everywhere.
Nancy
Dear Nancy --
I love it when people "want to know how it works". There's a pretty simple explanation which also helps understand why anything that makes you lose water can raise your lithium level, and it's useful to know, because of another way of becoming dehydrated, namely when you're sick, as you'll see below.Lithium is an "element", as you may recall from high school chemistry. You might even remember that it is closely related to sodium, the "main ingredient" in table salt (and in the brine used to pickle cucumbers, making those pickles you eat). Sorry, the chemists in the crowd are going to choke. I don't think this is too tough. If you had trouble in high school chemistry, don't worry, this is super-simple. Table salt is sodium chloride, remember. That's useful, because the lithium you take is lithium chloride. They're that similar to one another (as you can see on the periodic table of elements, even, where they're next door neighbors: Li and Na).
They're so similar, in fact, that your kidney handles them both in the same way. When your kidney is hanging on to sodium, which is one of its jobs, it hangs on to lithium at the same time. Your kidney filters your blood and the "pulls back" into your system all the things that it filtered out that you want to keep, letting the rest go into your urine. That's how it gets rid of the things its supposed to get rid of. It can even get rid of sodium, if you've got too much, such as when you eat a pizza or chips. It just doesn't re-absorb some of the sodium, letting it go on downstream in the urine. It will lose some of your lithium in this way also, though we don't usually worry about losing a little in this fashion.
The opposite is the problem, when your kidney is holding on to sodium. There's just one more step needed to understand why this works as it does. Sodium, as in table salt, pulls water toward it (remember about "osmosis"?). So when your body wants to hang on to water, it does so by hanging on to sodium. This also ends up stimulating your thirst, so you'll go get something to drink! Ah, but there's the problem: when your body hangs on to sodium, it also hangs on to lithium. If you become very dehydrated, it will hang on to a lot of sodium, and thus a lot of lithium, that it would usually be letting go into the urine.
So while 900 mg or 1200 mg of lithium might give you a blood level of 0.8, if you get dehydrated you can get up to 1.0 or even a bit higher. Side effects like tremor are common as your blood level goes up. So, as you can see, one of the ways to treat a tremor that just comes on once in a while is to have people drink more water: the body will conclude that it doesn't have to hold on to as much sodium, and let go of some lithium in the process, lowering the blood level just a bit, and the tremor can diminish or even stop.
The other main way to lose a lot of water is diarrhea, or vomiting. If you get the "flu" for example, and can't keep fluids down without throwing up (yecch, I hate that); and especially if you have diarrhea at the same time; then you can become very dehydrated, probably much more than you would from sweating or exercise. Some psychiatrists recommend that you stop taking lithium at that point, until you can keep fluids on board. (When in doubt, call her or him and ask). Because if you get a high blood level of lithium, that itself can make you sick and cause nausea and diarrhea, which as you can see could lead to a "loop" in which your blood level goes up and you get sicker and can't keep fluids on board so your lithium level goes up further, and so on. If you're still taking lithium during that loop, that's when you can get far too high a lithium level (beyond 1.5) and get really sick.
However, don't everybody start worrying they're going to end up really sick from taking their lithium, please. I don't think I've ever seen somebody get such a high lithium level from exercise in the sun that they ended up in the emergency room with severe symptoms from this. It could happen, and if you're a serious athlete you definitely have to be careful to stay hydrated. But the main way people end up with too high a lithium level is when they keep taking lithium after they've already had their level get too high for some reason. If something changes your kidney function, for example, such as a new blood pressure medication (most of them shift lithium levels) or a medication for pain (the "non-steroidal anti-inflammatories, or NSAIDS, such as ibuprofen (Motrin), naprosyn (Naproxen), and others can also significantly shift lithium levels), you need to know what has happened to your lithium level. This is by far the most common basis for getting "lithium toxicity".
Thanks for your question.
Dr. Phelps"
Published September, 2005
-------------
hope that helps;
Squiggles
Posted by BorderlinePersona on November 10, 2005, at 0:06:33
In reply to Re: ANY info on Lithium: Day 2 Li, posted by Squiggles on November 8, 2005, at 20:43:15
Wow, i awoke today feeling more relaxed than i have been in a very long time. this feeling has stuck around the entire day. its great. my only doubt is the fact that this early in treatment, lithium couldnt be the cause yet, could it!?
150mg Efexor Xr + 500mg Lithicarb... ive read alot about its success in treatment resistant depression and bipolar. It also just feels right.
blah blah blah... :)
Posted by Squiggles on November 10, 2005, at 8:09:16
In reply to Re: ANY info on Lithium: Day 3 Lithium, posted by BorderlinePersona on November 10, 2005, at 0:06:33
I'd find it surprising too-- whether lithium/and/or
effexor, esp. with the lithium at that tiny dose.
But -- if it keeps up, why look a gift horse
in the mouth?Squiggles
Posted by Emily Elizabeth on November 10, 2005, at 9:16:17
In reply to Re: ANY info on Lithium: Day 3 Lithium, posted by BorderlinePersona on November 10, 2005, at 0:06:33
I think it is possible that what you are feeling is the Li. It only takes 4 days to stabilize the blood level of Li, so it is possible that you are at (or close to) where you'd be feeling its therapeutic effects.
As an augmenting agent, you can get away with a much lower dose of Li. Pdoc says that blood levels of .4-.6 are sufficient for augmenting (higher is needed for bipolar).
My pdoc also says that if you are having success with it, it is likely that you will continue to do so (unlike some of the others like SSRI's which can stop working after a while).
I've got my fingers crossed for you!
Best,
EE
Posted by ed_uk on November 10, 2005, at 13:54:30
In reply to Re: ANY info on Lithium: Day 3 Lithium, posted by BorderlinePersona on November 10, 2005, at 0:06:33
Hi,
>Wow, i awoke today feeling more relaxed than i have been in a very long time. this feeling has stuck around the entire day. its great. my only doubt is the fact that this early in treatment, lithium couldnt be the cause yet, could it!?
Yes! It could. For some people, lithium can work quickly, and at a low dose.
Ed
Posted by BorderlinePersona on November 11, 2005, at 19:30:31
In reply to Re: ANY info on Lithium: Day 3 Lithium » BorderlinePersona, posted by ed_uk on November 10, 2005, at 13:54:30
so its day 5. ive had some wierd nightmares and waking up suddenly startled if someone wakes me up. im a bit bland today so i dont know what to say except i guess lithium is going well. i must admit im talking a bit more and seem to be a little more outgoing.
woo hoo for lithium
Posted by katekite on November 11, 2005, at 22:21:56
In reply to Re: ANY info on Lithium: Day 5 Lithium, posted by BorderlinePersona on November 11, 2005, at 19:30:31
Hi,
Thanks for posting this way, updating. I would love to keep hearing how it is going.
I have thought a bunch of times about trying lithium in a low dose for anxiety, my doc always puts me off about it (my thyroid is already screwed up so he is cautious about things that could affect it).
But calm sounds pretty nice!
Kate
Posted by BorderlinePersona on November 14, 2005, at 1:21:04
In reply to Re: ANY info on Lithium: Day 5 Lithium, posted by katekite on November 11, 2005, at 22:21:56
I had my blood test today for lithium levels and to check my blood count, liver and thyroid function. Will know the results sometime next week. so far i give a thumbs up to lithium for mood stabilizing. I feel as if a large load of anger has been lifted from my shoulders. Side effects were minimal and short lasting. Slight nausia for the first few days, a dazed feeling (that on the third day turned into an intense relaxation feeling that leveled out by day 5) some confusion and sometimes forgeting what im doing. i feel energised and dont sleep as much during the day either.
:) pleased with lithium.,
Posted by Squiggles on November 14, 2005, at 7:10:45
In reply to Efexor and Lithium 1 Week, posted by BorderlinePersona on November 14, 2005, at 1:21:04
> I had my blood test today for lithium levels and to check my blood count, [liver]? and thyroid function.
Liver?
Squiggles
Posted by yesac on November 15, 2005, at 11:18:09
In reply to Re: Efexor and Lithium 1 Week, posted by Squiggles on November 14, 2005, at 7:10:45
I've been on lithium for about 7 months. I take it for treatment resistant severely agitated depression (possibly some variant of bipolar). Anyways, it's basically the only thing that has ever worked for me, and believe me, I've tried a lot! I take a fairly low dose (600mgs). Last time I got my blood levels checked, I think it was just about 0.6. I have tried going up to a higher dose, and I couldn't tolerate it. I've also tried taking a lower dose, and then it didn't work.
I also take Seroquel, and I think that the two drugs kind of augment each other, because if I try going off either, I fall apart.
The only major side effect I get is the shakiness, which seems to wax and wane. It's really bad right now, driving me crazy-- so I think I might ask my shrink about Inderal/propanolol. Other than that, the only side effect I notice is slight thirstiness, so I need to drink more water/liquids.
By the way, I resisted taking lithium for a really long time, due to all of the negative things I had heard about the drug. I was so afraid of gaining weight, getting skin problems, needing to pee a lot, and all the other stuff you hear. But honestly, it's not a bad drug at all. I am just so glad to have found *something* that works. It's certainly not perfect, but I'm glad that I have it.
Posted by Squiggles on November 15, 2005, at 12:02:06
In reply to My 2 cents, posted by yesac on November 15, 2005, at 11:18:09
So glad to hear more positive reports
about lithium. I am very biased about
it. However, I am not sure about its
combination with other ADs - have you
checked the Drug Interactions Checkers
on the net?Or maybe one or the other drugs
could be shuffled in dose?Bring it up with your doc.
Squiggles
p.s. you are fortunate to take a low
lithium dose; the therapeutic ones
have to be watched -- we need a li-detector!
Posted by yesac on November 15, 2005, at 12:20:36
In reply to Re: My 2 cents, posted by Squiggles on November 15, 2005, at 12:02:06
> So glad to hear more positive reports
> about lithium. I am very biased about
> it.Biased in a good way, I'm assuming?
> combination with other ADs - have you
> checked the Drug Interactions Checkers
> on the net?I have, and I came up with all kinds of weird rare interactions with everything I take, even including caffeine. So I didn't give it much credit. There is such a thing as being too cautious.
Seroquel is technically classified as an antipsychotic, not antidepressant. However, there have been some studies demonstrating it's antidepressant properties for some people. It seems to do that for me, in addition to helping calm me down and tame my feelings of distraughtness. And it helps me sleep. I feel like I sleep better than I ever have in my life.
> Or maybe one or the other drugs
> could be shuffled in dose?What do you mean? Because of my shakiness?
> p.s. you are fortunate to take a low
> lithium dose; the therapeutic ones
> have to be watched -- we need a li-detector!
Yes, my doses of both lithium and seroquel are quite low. I'd like to try more seroquel when I get more money (I don't currently have prescription coverage). The only issue with seroquel is sedation/ sleeping too much.When I tried to take 900mgs of lithium, I started to feel very spaced out and weird. So I cut it back to 600, which seems to be enough to do the trick. I might even try 450 to see if the shakiness improves but the drug still works. When I tried to take only 300, I completely fell apart.
Posted by Squiggles on November 15, 2005, at 12:37:14
In reply to Re: My 2 cents » Squiggles, posted by yesac on November 15, 2005, at 12:20:36
> > So glad to hear more positive reports
> > about lithium. I am very biased about
> > it.
>
> Biased in a good way, I'm assuming?Miracle drug.
>
> > combination with other ADs - have you
> > checked the Drug Interactions Checkers
> > on the net?
>
> I have, and I came up with all kinds of weird rare interactions with everything I take, even including caffeine. So I didn't give it much credit. There is such a thing as being too cautious.
>
Yeah, i know what you mean. I checked
PubMed and there are diverse views on this
topic. Some papers point to the advantage
of the newer APs with lithium in contrast
to the old ones, but other point to the
preference of other classes than APs for
lithium combinations. It's like Disney
World has opened up an international
MacDonald's outlet.> Seroquel is technically classified as an antipsychotic, not antidepressant. However, there have been some studies demonstrating it's antidepressant properties for some people. It seems to do that for me, in addition to helping calm me down and tame my feelings of distraughtness. And it helps me sleep. I feel like I sleep better than I ever have in my life.
I don't know what to say. I am not a dr.
I do know that benzos with lithium are
compatible, if insominia and anxiety are
your problem, from my own experience.>
>
> > Or maybe one or the other drugs
> > could be shuffled in dose?
>
> What do you mean? Because of my shakiness?No, I mean lower the dose of one, increase
the dose of the other;
>
> > p.s. you are fortunate to take a low
> > lithium dose; the therapeutic ones
> > have to be watched -- we need a li-detector!
>
>
> Yes, my doses of both lithium and seroquel are quite low. I'd like to try more seroquel when I get more money (I don't currently have prescription coverage). The only issue with seroquel is sedation/ sleeping too much.Then a lower dose would make sense, no?
>
> When I tried to take 900mgs of lithium, I started to feel very spaced out and weird. So I cut it back to 600, which seems to be enough to do the trick. I might even try 450 to see if the shakiness improves but the drug still works. When I tried to take only 300, I completely fell apart.
>
It takes a long time to get used to lithium--
you might want to take that into account.
I felt so heavy and slept all aft. in the
beginning, and it was only after 6 months,
with thyroid supplementation that I was
stable. But, this drug literally lifted
me out of very serious psychotic states,
very quickly. So, I did not complain.Squiggles
>
Posted by ed_uk on November 15, 2005, at 15:13:53
In reply to Re: My 2 cents » Squiggles, posted by yesac on November 15, 2005, at 12:20:36
Hi Yesac,
Is haloperidol aggravating your tremor?
Ed
Posted by yesac on November 16, 2005, at 10:34:39
In reply to Re: My 2 cents » yesac, posted by ed_uk on November 15, 2005, at 15:13:53
> Is haloperidol aggravating your tremor?
It could very well be aggravating the tremor. It seems like the tremor worsened after I went up to 3mgs of Haldol. Could be coincidence, or perhaps not. If it is the Haldol, that's another reason to not take it or keep the dose really low. I guess if the tremor gets better after a few days off of Haldol, I'll assume that's what it was.
Posted by ed_uk on November 17, 2005, at 13:32:07
In reply to Re: My 2 cents » ed_uk, posted by yesac on November 16, 2005, at 10:34:39
Hi Yesac
Tremor and akathisia are both extra-pyramidal side effects of neuroleptics. Both symptoms get worse as the dose is increased. Of course, there are many other causes of tremor as well as neuroleptics.
Ed
PS. Someone came to the pharmacy today with a prescription for 20mg haloperidol. Nice!
Posted by sdb on November 17, 2005, at 15:46:32
In reply to Re: My 2 cents » yesac, posted by ed_uk on November 17, 2005, at 13:32:07
ed,
haloperidol? -Did you tell him about haloperidols potent aka. extr.-pyr. sideeffects?
I had a teacher in highschool with definite extr.-pyr. sideeffects (maybe forever). For my collegues very funny to see these attacks. They did not understand. Spent his holidays in psychiatric clinic and told us very lucky of "new" treatment methods of changing serotonin amount between synapsescky.
But anyway as a teacher he knew a lot about literature and he was fair at the exams.
Very interesting docs prescribing substances.
~sdb
> Hi Yesac
>
> Tremor and akathisia are both extra-pyramidal side effects of neuroleptics. Both symptoms get worse as the dose is increased. Of course, there are many other causes of tremor as well as neuroleptics.
>
> Ed
>
> PS. Someone came to the pharmacy today with a prescription for 20mg haloperidol. Nice!
>
>
Posted by ed_uk on November 17, 2005, at 16:06:45
In reply to Re: My 2 cents, posted by sdb on November 17, 2005, at 15:46:32
Hi S,
>Haloperidol?
Yes.... 20mg - a very high dose. He was only 18. I wonder why he was taking haloperidol? He hadn't taken any other APs - according to his records. Perhaps he was being treated for Tourette's syndrome or something.
>Did you tell him about haloperidols potent aka. extr.-pyr. sideeffects?
No, I didn't speak to him. The dispensary is separate from the shop and the pharmacy is so busy that you never have time to speak to anyone for more than 2 seconds!
Kind regards
Ed
Posted by sdb on November 17, 2005, at 18:03:52
In reply to Re: My 2 cents » sdb, posted by ed_uk on November 17, 2005, at 16:06:45
>The dispensary is separate from the shop and >the pharmacy is so busy that you never have >time to speak to anyone for more than 2 >seconds!
Actually bad. The young boy could have spoken to a very knowledgable and fine, friendly person who knows much more in psychopharmacology than many docs...Good for the pharmacy to have you there. They should pay you some extra cash.
In our pharmacies some personal treat you as an idiot or they know nothing or at least standart things.
~sdb
Posted by ed_uk on November 18, 2005, at 13:50:18
In reply to Re: My 2 cents, posted by sdb on November 17, 2005, at 18:03:52
Hi S
Thank you :-) They pay me the minimum they can get away with.
Ed
This is the end of the thread.
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