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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Rani on November 13, 2006, at 5:07:15
Finally got to a Psych this week after waiting 4 months. Since taking SSRI's for one year I noticed that my mood swings were worse. Started Lexapro 4 months ago and have had incredibly great weeks where I feel sooooooOOOO good (not to the extent of doing inappropriate things).
He has not given me a diagnosis but I am assuming I am somewhere in the BPII zone.
I just cant cope with the highs and lows and find it hard to plan my life in advance (eg, want to go back to uni next year but worried I will hit a low)
I wonder if I should just stop demanding so much of myself, stop feeling so 'driven' and relax and just live with the highs and lows or I should try some mood stabilizers and see how I go.
I am a bit scared of the lithium thing.
Anyone out there who can offer some advice?
Posted by tensor on November 13, 2006, at 6:08:42
In reply to Doc wants to try Lithium but nervous!!!, posted by Rani on November 13, 2006, at 5:07:15
Hi,
Lithium is often a first-line treatment option for cases like yours. Your pdoc will probably(certainly) check thyroid function and heart rhythm(ECG) before initating the treatment. You will have to take a blood test for every increase in dosage to monitor plasma concentration.
Your pdoc will also provide you with all information you need, including drink alot of water, to be nice to your kidneys and to avoid dehydration.You will see it's nothing to be scared of.
/Mattias
Posted by lymom3 on November 13, 2006, at 7:16:59
In reply to Re: Doc wants to try Lithium but nervous!!! » Rani, posted by tensor on November 13, 2006, at 6:08:42
Plus you really should at least try it. No one can make you stay on it if you don't like it but you don't have to live with the ups and downs. You are talking now about not even going to school because of it. You will eventually have to work whether you go to college or not. Then what happens? You are going to have the same highs and lows and employers aren't going to be too receptive to that either.
Just a few months ago I realized that I had gotten to the point where I wouldn't plan anything. I couldn't make a plan with a friend on Tuesday to do something with her on Saturday because I couldn't predict if I was going to feel well enough to do it. That was when I truly realized that I had to do something. That is no way to live.
You know that you're not happy now and you don't want to continue that way. I am not saying that medication can fix everything but it can alleviate them and help you to be the person that you want to be. It's always your decision whether to continue the meds , but I sure think that it's worth a shot.
Good luck..
Lisa
Posted by clint878 on November 13, 2006, at 8:39:45
In reply to Doc wants to try Lithium but nervous!!!, posted by Rani on November 13, 2006, at 5:07:15
I'm going to give a bit of different advice here than most people. My experience with medication is that it is usually prescribed too easily, for problems that are too minor. It's important to remember that medications have side effects. When the problem isn't that bad, the side effects are often worse than the original symptoms.
I think the way to go about making this decision is to imagine yourself having a bad reaction to the lithium and dealing with nausea, dizziness, and vomiting for several weeks before you feel better. This may not happen to you, but there are likely to be some side effects. If the image of you feeling like you have a case of the flu while you adjust to the medication sounds better than the way things are now, then it's worth a try. If, however, you can still function and think such a reaction would be far worse than you are now, you probably aren't bad enough to require medication.
This method has always worked for me in the past. There have been times where I fooled myself into thinking the medication would work perfectly without side effects, and those are the times when I eventually decided to discontinue.
Posted by Phillipa on November 13, 2006, at 10:44:08
In reply to Re: Doc wants to try Lithium but nervous!!!, posted by clint878 on November 13, 2006, at 8:39:45
Well no meds for me then. Love Phillipa
Posted by ronaldo on November 13, 2006, at 11:07:37
In reply to Doc wants to try Lithium but nervous!!!, posted by Rani on November 13, 2006, at 5:07:15
> Finally got to a Psych this week after waiting 4 months. Since taking SSRI's for one year I noticed that my mood swings were worse. Started Lexapro 4 months ago and have had incredibly great weeks where I feel sooooooOOOO good (not to the extent of doing inappropriate things).
> He has not given me a diagnosis but I am assuming I am somewhere in the BPII zone.
> I just cant cope with the highs and lows and find it hard to plan my life in advance (eg, want to go back to uni next year but worried I will hit a low)
> I wonder if I should just stop demanding so much of myself, stop feeling so 'driven' and relax and just live with the highs and lows or I should try some mood stabilizers and see how I go.
> I am a bit scared of the lithium thing.
> Anyone out there who can offer some advice?Firstly there is nothing to be afraid of with Lithium. The only thing to be afraid of is a wrong diagnosis. You don't want to spend your life taking drugs that you don't need to take.
I have taken Lithium for about 25 years. I didn't notice any bad side effects except perhaps flat/blunted affect - your emotions get stuck in the neutral zone.
I take 900 mg at night, used to be 800 mg but I needed more stability so I increased it to 900. My Lithium blood levels are 0.8 mMol/L, within the therapeutic window (0.7 to 1.0). I could still use alcohol while on Lithium. All in all it is a pretty user-friendly drug.
Posted by tensor on November 13, 2006, at 11:43:10
In reply to Re: Doc wants to try Lithium but nervous!!! » Rani, posted by ronaldo on November 13, 2006, at 11:07:37
>I could still use alcohol while on Lithium. All in all it is a pretty user-friendly drug
I had very weird experiences taking alcohol while on lithium. I only drank alcohol twice and I blacked out completely, became aggressive, had hallucinations and managed to get black listed on two night clubs at the same night. Strange, I'm not an agressive person. It must have been the lithium, I don't what else could have caused it. I guess anything is possible.
/Mattias
Posted by madeline on November 13, 2006, at 12:54:30
In reply to Re: Doc wants to try Lithium but nervous!!! » ronaldo, posted by tensor on November 13, 2006, at 11:43:10
were you drinking tequila?
It has that effect on a lot of people - NOT that I would know...
Posted by corafree on November 13, 2006, at 12:57:58
In reply to Re: Doc wants to try Lithium but nervous!!! » Rani, posted by ronaldo on November 13, 2006, at 11:07:37
Do you still have the blunted/flat affect Ronaldo?
cf
Posted by tensor on November 13, 2006, at 12:59:29
In reply to Re: Doc wants to try Lithium but nervous!!! » tensor, posted by madeline on November 13, 2006, at 12:54:30
>were you drinking tequila?
No, ONLY vodka, whiskey and cognac. I have taken alcohol once on this Lamictal trial and it was no problem.
/Mattias
Posted by Squiggles on November 13, 2006, at 13:00:53
In reply to Doc wants to try Lithium but nervous!!!, posted by Rani on November 13, 2006, at 5:07:15
Lithium saved my life. The most common
side effects, are thirst, frequent urination,
weight gain, flat affect, a narrow therapeutic
index, hypothyroidism, some people report tremor,
some skin conditions, kidney and heart effects
depending on your original state and age.I just read the side effects in a magazine for
ABILIFY -- a new drug for major bipolar, and I was amazed that they would want
to add another drug like this to lithium. These side effects I mention for lithium sound severe but to me at least they do not feel "artificial"; lithium is not metabolized and that may be why it has a "clean" feel when in the right range.But ABILIFY actually has 3 alarming side effects
among others:Neuroleptic Malignant Syndrome (rare)
Akathisia (while on the drug)
Sertonin syndromeand many nasty day to day effects.
I don't understand the drug companies.
Squiggles
Posted by clint878 on November 13, 2006, at 14:11:06
In reply to Re: Doc wants to try Lithium but nervous!!! » Rani, posted by Squiggles on November 13, 2006, at 13:00:53
Not to mention tardive dyskinesia and all sorts of other movement disorders.
I don't see why people would prescribe Abilify unless the person is suicidal with psychosis. The risks seem too high for me. Anticonvulsants and lithium are much safer.
Don't get me wrong; there may be some people who have decided they will accept this risk, and I'm not criticizing them. I do criticize the doctors who don't warn their patients about these possibilities.
My guess is that many doctors are swayed into prescribing Abilify because of advertising. All the drug money is in antipsychotics; why would companies advertise anything else when they can make $10/pill for Abilify?
Posted by lymom3 on November 13, 2006, at 14:52:53
In reply to Re: Doc wants to try Lithium but nervous!!! » Rani, posted by Squiggles on November 13, 2006, at 13:00:53
Right now I'll take my chances on any nasty side effect that Abilify might have. This is the best I've felt since I can remember. I haven't been on it very long, don't know if it will last but I actually feel good. So, it's all a matter of perspective.
Posted by Maximus on November 13, 2006, at 15:11:28
In reply to Re: Doc wants to try Lithium but nervous!!! » Rani, posted by Squiggles on November 13, 2006, at 13:00:53
> I just read the side effects in a magazine for
> ABILIFY -- a new drug for major bipolar, and I was amazed that they would want
> to add another drug like this to lithium.Why? Are you asking seriously? I'm also taking lithium among other drugs. I'm responding partially to it and i do recognize it is a great salt.
But, but Li is not working for everyone. And often li does not address all the symptoms of the illness. Nowadays, competent and clever pdocs will prescribe it with other drugs such as: valproate, lamictal, atypical anti-psychotics (Abilify is one of them) and etc. The bipolarity is not just the typicals highs and lows seen in the movies.
I'm glad you are a good responder. I wish you continue to be well. Bye.
Posted by Squiggles on November 13, 2006, at 15:21:08
In reply to Re: Doc wants to try Lithium but nervous!!! » Squiggles, posted by Maximus on November 13, 2006, at 15:11:28
Polypharmacy - shudder; most can't
even read a solitary monograph. How Prescorns are
there working for the FDA? :-)But trust goes a long way. Good luck
to those to whom it benefits.
Squiggles
Posted by Rani on November 13, 2006, at 15:23:12
In reply to Doc wants to try Lithium but nervous!!!, posted by Rani on November 13, 2006, at 5:07:15
Thank you everyone for your posts.
I can live with the highs and lows but I cannot make big plans for my future and I also have to avoid stress (going back to uni). I do not have to go to uni, not even sure I want to - is just that I get so enthusiastic when I am up and make plans that I am not sure are best for me.
I will try the lithium.
I suppose I am just scared as there is some stigma in my mind attached to it. I hate being labelled.
I suppose I am in the middle range where I can live with my highs and lows but it is the sense of drive and agitation that I find exhausting. I just want to feel stable and I will try lithium to see how it works. He also wants me to continue taking my lexapro as well.
I dont really drink alcohol so thats not a problem. I hate the idea of weight gain!
Posted by Squiggles on November 13, 2006, at 15:43:43
In reply to Re: Doc wants to try Lithium but nervous!!!, posted by Rani on November 13, 2006, at 15:23:12
OK, let us know Rani. The fact that
your dr. has you on two drugs, may
allow you to take a lower lithium dose;
i take the max. I have never taken
anything else, and to be truthful i do
not know what something else would be
like for me. The most devastating
cerebral event i had though came from
the relatively benign clonazepam, in
withdrawal mode. So, i am particularly
sceptical about the knowledge that drs.
have about drugs, esp. when they start
mixing them -- just bad experience for me,
oh yeah the thyroxine loading also put
me in thyrotoxicosis for a few months, and
the Xanax sucked up 10 years of my life
in benign med addiction. And the rivotril
and Xanax combo gave me breathing problems and
postural weirdness.So, that was just bad luck.
Squiggles
Posted by ronaldo on November 13, 2006, at 16:16:36
In reply to Re: Doc wants to try Lithium but nervous!!! » ronaldo, posted by corafree on November 13, 2006, at 12:57:58
> Do you still have the blunted/flat affect Ronaldo?
>
> cfHi cf,
Yes, it is a pillar of my personality now. I have grown so accustomed to it that I just accept it plus I don't have the money to go private and insist on some treatment. Sometimes I think I am dysthymic. I know I've got anhedonia and avolition. Do you know of any book that deals with my condition?
...ronaldo
Posted by blueberry on November 13, 2006, at 20:11:50
In reply to Doc wants to try Lithium but nervous!!!, posted by Rani on November 13, 2006, at 5:07:15
Ok, so if it is bipolar you are looking at, then you are looking at depakote, lamictal, or lithium. Depakote and lamictal are heavy duty drugs created by man. Lithium is merely a salt extracted from the earth. Lithium in a way can be viewed as natural treatment, and nothing has the track record that it does.
Lithium has several benefits. Sure there will be side effects, most especially in the first couple weeks. But then, there will be with the others too. But overall, in general, lithium has one of the tamest side effect profiles. Start lithium a 150mg for a week, then 300mg for a week, go easy at first, and work your way up. And keep reminding yourself it is just salt.
Do a google search on "lithium mechanism" to discover the various benefits of lithium. It actually has a handful of healthy benefits, along with expected things a salt would do (such as thirst). The drugs don't offer the benefits that lithium does.
I know an excellent orthopaedic surgeon who has been on full dose lithium for over 30 years and you would never know it. He's just a regular healthy guy.
Posted by Squiggles on November 14, 2006, at 6:54:32
In reply to Re: Doc wants to try Lithium but nervous!!!, posted by blueberry on November 13, 2006, at 20:11:50
blueberry,
I am probably one of lithium's biggest fans.
But I am also mindful to its greatest
weakness - "narrow therapeutic index". As
Dr. Schou advised in his booklet for patients
and drs., it is important that drs. understand
what "narrow therapeutic index" means. If you
are lucky you will feel the "over the index"
symptoms and lower the stuff yourself -- but
it's tricky. Going back to a higher dose can
give a surge to the brain- not good. Stability and the right dose are the ideal.The thyroid too must be adjusted.
As for side effects, yes-- it is a very
"clean" drug. But if you get too much of
it in your brain it is as dangerous as the
worst psychiatric drugs. I have come close,
but I don't get tested regularly, and many
things can happen to raise the dose or lower it:- heat
- sweating
- other drugs
- counterfeit accidents
- not drinking enough water
- coffee
- wine
- benzos
- sodium or potassium depletion
Take a look at Dr. Mogens Schou's book for
patients on Amazon.com or other book sites.Squiggles
Posted by Phillipa on November 14, 2006, at 19:21:04
In reply to Re: Doc wants to try Lithium but nervous!!! » blueberry, posted by Squiggles on November 14, 2006, at 6:54:32
Squiggles did you see my thread on thyroid today? I'm so confused. Love Phillipa
Posted by corafree on November 16, 2006, at 17:50:38
In reply to Re: Doc wants to try Lithium but nervous!!!, posted by Rani on November 13, 2006, at 15:23:12
I'm sorry if I'm asking a question already asked, but is there aa approx 'time period' in which one should see 'relief' from lithium?
Can there be 'initial adverse reactions' that will subside. If so, how long should one 'hang in there'?
cf
Posted by corafree on November 16, 2006, at 18:01:25
In reply to Re: Doc wants to try Lithium but nervous!!! » corafree, posted by ronaldo on November 13, 2006, at 16:16:36
> > Do you still have the blunted/flat affect Ronaldo?
> >
> > cf
>
> Hi cf,
>
> Yes, it is a pillar of my personality now. I have grown so accustomed to it that I just accept it plus I don't have the money to go private and insist on some treatment. Sometimes I think I am dysthymic. I know I've got anhedonia and avolition. Do you know of any book that deals with my condition?
>
> ...ronaldo
>
>
No, I don't.dayatatime, cf
Posted by corafree on November 16, 2006, at 18:13:29
In reply to Re: Doc wants to try Lithium but nervous!!!, posted by blueberry on November 13, 2006, at 20:11:50
Blueberry:
What kind of side effects might one have in the first 2wks that will eventually dissipate?
cf
This is the end of the thread.
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