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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by clubfitter on August 8, 2007, at 22:27:21
Been told Lithium may be very helpful in treating my various ailments but don't want to gain a bunch of weight cause I just lost a ton. Any experiences with Lithium for depression and or bipolar? Thanks in advance for you help.
Posted by Squiggles on August 9, 2007, at 16:31:27
In reply to Lithium Good Bad Ugly?, posted by clubfitter on August 8, 2007, at 22:27:21
> Been told Lithium may be very helpful in treating my various ailments but don't want to gain a bunch of weight cause I just lost a ton. Any experiences with Lithium for depression and or bipolar? Thanks in advance for you help.
Yes, you gain weight on lithium. It increases your
appetite, and adds water to the body tissues. But as far as mood stabilizers go, it is the least fattening. You have to watch your diet and exercise to counteract that. Also, if your thyroxine augmentation is too low, you will gain weight from that factor as well. I noticed that when clonazepam was added, there was a substantial increase in weight-- like maybe 25%.Squiggles
Posted by barbaracat on August 12, 2007, at 20:16:03
In reply to Re: Lithium Good Bad Ugly? » clubfitter, posted by Squiggles on August 9, 2007, at 16:31:27
I love lithium. It saved my life. I was on SSRIs for around 20 years at increasingly high dosages that were pooping and sending me into a horrid black psychotic depression that landed me in the hospital. I didn't realize I was a classic Bipolar I (who me?) and high SSRI dosing was killing me. I tried other mood stabilizers and settled on lithium. It calms me and keeps me sane. It also acts synergistically with other meds, i.e., keeps SSRIs from pooping so fast.
I'm on a very low dose, 300mg twice a day - not even near that sacred 'therapeutic window' which would have me taking twice as much. But it has done the trick. No more mixed states delirium, and with a low dose of Cymbalta for the chronic depression and fibromyalgia pain, I do just fine. I also take Adderall, originally for the ADD that fibro tends to exacerbate, but found it an important adjunct for my energy, focus, and lifting of spirits.
Weight - yes, but as long as I can motivate to get good exercise it's not a problem. You really must commit to expending more energy on any of these meds.
I'll repeat this, cause I think it's important. The dosing based on your blood level therapeutic window most pdocs insist on is generally too high - it reflects a person's level in a full blown manic state. Ask to try it much lower. As I said, 600mg works fine for me but yikes, do I ever notice it when I don't take it.
-BarbCat
Posted by Squiggles on August 12, 2007, at 20:54:56
In reply to Lithium Good Bad Ugly? - Very Good, posted by barbaracat on August 12, 2007, at 20:16:03
>
> I'm on a very low dose, 300mg twice a day - not even near that sacred 'therapeutic window' which would have me taking twice as much.That's 3x as much - 900mg is the average;
>
> Weight - yes, but as long as I can motivate to get good exercise it's not a problem. You really must commit to expending more energy on any of these meds.
>
> I'll repeat this, cause I think it's important. The dosing based on your blood level therapeutic window most pdocs insist on is generally too high - it reflects a person's level in a full blown manic state. Ask to try it much lower. As I said, 600mg works fine for me but yikes, do I ever notice it when I don't take it.
>I have always thought this but every time I asked for the dose to be lowered, i was told I was in the normal therapeutic range (0.8-1.2). I figure this is medical policy and any doctor would do the same thing, at least at a university hospital. It's the bloods that count.
Squiggles
Posted by barbaracat on August 13, 2007, at 2:53:49
In reply to Re: Lithium Good Bad Ugly? - Very Good » barbaracat, posted by Squiggles on August 12, 2007, at 20:54:56
>I have always thought this but every time I asked for the dose to be lowered, i was told I was in the normal therapeutic range (0.8-1.2). I figure this is medical policy and any doctor would do the same thing, at least at a university hospital. It's the bloods that count. - Squiggles
I rather think it's how I feel and not the numbers that matter, although I understand they have to have some kind of reference point. I've had pdocs threaten to take me off it if I didn't get up to the range. Every time I did I felt terrible and so now when I get a new doc, I simply explain that I don't do well on a higher dose, refuse their attempts to increase, and they eventually give in.
Call me non-compliant, but we're all different and I don't fit into the pigeon hole of those standards. No doubt, they were determined from testing 25 yr old male college students which I definitely am not.
Posted by clubfitter on August 13, 2007, at 10:07:50
In reply to Lithium Good Bad Ugly? - Very Good, posted by barbaracat on August 12, 2007, at 20:16:03
Bcat, thanks for the great info...im looking mostly to lift depression but have been told it really does best in controllin mania..im bipolar but i think more unipolar so its the depression im most concerned with...you mentioned it does great for you derpression?? what about you manic episodes?? thanks again!
Posted by barbaracat on August 13, 2007, at 23:22:51
In reply to Re: Lithium Good Bad Ugly? - Very Good)BCAT, posted by clubfitter on August 13, 2007, at 10:07:50
> Bcat, thanks for the great info...im looking mostly to lift depression but have been told it really does best in controllin mania..im bipolar but i think more unipolar so its the depression im most concerned with...you mentioned it does great for you derpression?? what about you manic episodes?? thanks again!
I'm primarily depressed too, although I've had some real corker manias. Didn't recognize them for what they were at the time cause I was having such fun. Lots of projects started - really good ideas too! But then the inevitable depression would hit and I'd run out of steam and interest. My garage looks like Michael's craft store filled with unfinished grand schems.
My manias (they were all different) and depressions stayed separate for most of my life, but eventually, the depressions and mania started colliding into each other. The dreaded 'mixed states' condition is depression fueled by intolerable anxiety and energy and psychosis of mania. It's nightmarish and I was cycling in and out almost constantly once I hit my mid-40's. This apparently is common when bipolar is not treated and usually hits around then.
For me, it was brought on very strongly because I was taking massive doses of SSRI's for depression before the bipolar was dx'd - the worst thing one can do. SSRI's without a mood stabilizer on-board is deadly for bipolars, so be very careful if you suspect you're a depressed bp because ADs alone can make it worse.
Lithium has the action of augmenting antidepressants, although some say it acts as an AD on it's own. It's not enough for me so I add Cymbalta, an SNRI, and the two together work well. I don't have to take as much of either because of the augmenting action of one upon the other.
Some people who aren't bipolar add lithium because of this augmenting effect and it also prevents or at least delays the poop-out. Some people who are perfectly normal take lithium because it's been shown to grow new neuron dendrites and acts as a protective agent for the brain, a 'smart drug'.
Lithium seems to work best for Bipolar I's, although bp-II's use it successfully. I've tried all the other mood stabilizers, Depakote (drooling zombie), Topamax (too agitating), Lamictal (got the rash). Went back to Lithium and have been very grateful. I've gone off it many times 'just to see' and ended up crawling back on my knees for it. I begin to get disorganized and frazzled but within a week I'm calmed down.
If you haven't read 'An Unquiet Mind' by Kay Redfield Jamison, absolutely do so. That's the closest description I've seen, the mixed-states, as well as her rapturous ecstasies while in a high manic state. I guess those states of bliss are the only things I miss, but meditation fills that gap. She's also a lithium devotee and amazingly productive and creative and successful.
It has not affected my creativity or any other facet of enjoying life, as some claim, but I'm not taking the zombie dosage either. All I can suggest is that you try it (really shoot for a low dose, in fact, ask your pdoc to try you out on 600mg 'just to see'). I've been at 600mg for about 7 years without it wearing off - just stays the same calm, steady state. Would've saved myself untold misery had I known I needed it 30 years ago.
-BCat
Posted by sac on August 19, 2007, at 7:20:08
In reply to Re: Lithium Good Bad Ugly? - Very Good)BCAT » clubfitter, posted by barbaracat on August 13, 2007, at 23:22:51
Hello, I've suffered from bipolar II for roughly 6 years, prior to that (and my two pregnancies) I was on AD's for about 10 years for unipolar depression. I've been on most of the meds: depakote, lamictal, neurontin, tegretol, etc. etc. I've had the most success with lithium slow release form. I am determined to keep the dose as low as possible at 450mg/day of the slow release form. with this I get a blood level of .5
I am trying to avoid side effects like MORE hair loss, weight gain, etc. I also take 20-30 mgs. Prozac daily. I feel like I constantly go around in circles wondering which med makes me feel like c***. I always blamed the lithium for my apathy/anhedonia but never had success going off...would get agitated in a couple days. I wonder if the SSRI exacerbates my cycling. I have a pretty clear cut case of weekly cycling. I've noticed that I have good energy/motivation one week only to be followed by extreme fatigue/depression the following week and this pattern continues. Sometimes I just want to throw in the towel with SSRI's and just stick with lithium..though it's like I'm scared and I don't trust myself to be able to deal with life without my Prozac. Oh, and by the way, I have been on Cymbalta too but had to stop due to heart palps. Any ideas/experiences with combined SSRI/lithium treatment? thanks so much.
Posted by barbaracat on August 19, 2007, at 20:02:19
In reply to Re: Lithium Good Bad Ugly? -, posted by sac on August 19, 2007, at 7:20:08
Well, feel like I could write a PhD thesis on this one. Although it's tough for me to be brief, I'll try.
First off, are you sure you're BP-II? One of the 'provings' of BP-I is that it responds to lithium better than the others, and BP-II responds to Depakote, Tegretol, etc. much better. The other thing is that 450mg lithium just may be too little. I tried the XR 450's and kept cycling like you described. I went to 300mg twice a day and that did the trick. You won't get any more side effects from the small extra dose and it may be just enough of what's missing. I suspect that the lethargy you feel is not due to lithium (I have none on it), but unresolved depression from the wrong med combo.
The other thing is Prozac. Not the best SSRI for a bipolar and I'm truly surprised your doc is prescribing it for you. Lithium has the effect of augmenting any antidepressant you're on, so I wonder if you're taking too high a dose of Prozac? It's been known to cause rapid cycling.
I've tried them all, every last one, including tricyclics (well, I didn't try Lexapro or the MAOs, maybe should have). Probably the least offensive of them in my book is Zoloft (sertraline). You want to stay away from the SNRI's if you're having cycling like that because norepinephrine will exacerbate anxiety/mania.
However, one theory is that dopamine is deficient and some bipolars augment their brew with Wellbutrin or some other pstim and it seems to help. There's a whole manuscript I got off the web on how pstims have stopped mania it it's tracks. Go figure... I take Adderall for the fibro-induced ADD and I could not do without it. It's like the spark that ignites the chemistry.
I take Cymbalta and like it very much since it really helps with the fibro pain and does a decent job with the depression, although anxiety is still an issue. However, I went real slow with it, titrating up to 60mg over a 4 month period. I'm very, very sensitive to SSRI/NI's, as are all bipolars and pdocs universally don't seem to realize that we have to go extra slow with them.
You didn't say how much Cymbalta you were taking, but in my book, 90mg is the top level any bipolar should go to with Cym, and besides, an SNRI may not be the best for you.
ARe you taking fish oil? Very, very, very important. Too long to go in to all the reasons for it, but trust me on this. About 4-6 grams a day. It's good to also take Flax oil for the Omega balance. Also, you should be taking neuro nutrients 'cause it's hard work on the brain being bipolar (the good news is that lithium is neuro-protective and regenerates neurons - healthy for the brain!). The amino acid L-Taurine is important and some have used it exclusively to manage their bipolar. There's a product called 'Neuro Optimizer' by Jarrow that has a good mix of what the brain needs. Expensive, unfortunately, but some online stores sell it for less.
So, I'd first determine the Bipolar I vs. II question. Here are some sites that have great info:
http://www.mcmanweb.com/bipolar_links.htm - lots of links to bipolar sites
I especially like:
http://www.psycheducation.org/index.html - there's more info in there the deeper you dig and a pretty good explanation of BPI vs. II. If you've ever had a clear-cut mania (this could be extreme irritability, anger, disorganization rather than the typical grandiose behavior) even one time, it's categorized as BP-I. Read up on 'mixed-states', especially.) The difference means the different meds you'll get. In a nutshell, the right amount of lithium, no more, no less.Second, I'd experiment with 600mg of lithium for about 3 months to see if it makes any difference. Since you don't want to change everything at once, stay on the Prozac and see if everything turns out betta. If not, time to try another antidepressant.
I had the best luck on Zoloft. It was mild yet energizing but in a centered way. I had the worst luck on Paxil, Effexor and Prozac.
If nothing helps, after you've given fish oil and other neuronutrients a try, ask your doc for a trial of a pstim. It sounds counterintuitive, but there are plenty of threads on this board that say otherwise, and it was the icing on my cake. Adderall 30mg XR in the morning and I sleep just fine on it and drag my moping fanny around when I don't take it.
One last thought - hormones. There are quite a few methods to get your saliva hormone levels tested (let me know if you want some sources). If you're nearing peri-menopause, likely your progesterone levels are low and your estrogens are high. This can cause all these symptoms and more. Been there, done that. I take a custom compounded sublingual lozenge of the hormones I was deficient in and it's helped. Thing is, if your hormones aren't in balance, they are contributing to your woes. The brain has more receptors for estrogens than any other organ of the body and is needed to produce serotonin!
So, it sounds like a complicated lot of info, but not really, it's just a matter of tweaking and balance. Try one thing at a time, but in the meantime, see if you can get your hormone levels checked (after 2 pregnancies especially). A regular doctor won't be able to do this, relying on blood serum levels only. It's generally done through a naturopath, but the web has kits for do-it-yourself.
I wish you the very best from someone whose been through hell and came back hopefully wiser for the experience.
-BarbCat
> Hello, I've suffered from bipolar II for roughly 6 years, prior to that (and my two pregnancies) I was on AD's for about 10 years for unipolar depression. I've been on most of the meds: depakote, lamictal, neurontin, tegretol, etc. etc. I've had the most success with lithium slow release form. I am determined to keep the dose as low as possible at 450mg/day of the slow release form. with this I get a blood level of .5
> I am trying to avoid side effects like MORE hair loss, weight gain, etc. I also take 20-30 mgs. Prozac daily. I feel like I constantly go around in circles wondering which med makes me feel like c***. I always blamed the lithium for my apathy/anhedonia but never had success going off...would get agitated in a couple days. I wonder if the SSRI exacerbates my cycling. I have a pretty clear cut case of weekly cycling. I've noticed that I have good energy/motivation one week only to be followed by extreme fatigue/depression the following week and this pattern continues. Sometimes I just want to throw in the towel with SSRI's and just stick with lithium..though it's like I'm scared and I don't trust myself to be able to deal with life without my Prozac. Oh, and by the way, I have been on Cymbalta too but had to stop due to heart palps. Any ideas/experiences with combined SSRI/lithium treatment? thanks so much.
Posted by sac on August 21, 2007, at 6:57:18
In reply to Some advice » sac, posted by barbaracat on August 19, 2007, at 20:02:19
Thank you for your reply. I will consider upping the lithium. As for the bipolar I vs. II, I never had a truly manic episode only hypomanic but lots of depressive episodes. The cymbalta, I think I recall being on 60mgs.
I really have a problem with lethargy, weakness, cognitive problems, and often flu-like feelings in the afternoons. I always thought this was the lithium side effects or possibly the combo of lithium and prozac. What are "pstim", I am not familiar with this.
I've had a whole hormonal workup as well, deficient in estrogen and progesterone. I am 39 yrs. old. Don't know how to treat this since the doctor I go to only suggested DHEA which I am taking.
I am taking 2 grams fish oil....perhaps I should up to 4-6 as you say.
Again, thanks for your suggestions. Everything helps..Stacey
Posted by Squiggles on August 21, 2007, at 7:03:41
In reply to Re: Some advice, posted by sac on August 21, 2007, at 6:57:18
> Thank you for your reply. I will consider upping the lithium. As for the bipolar I vs. II, I never had a truly manic episode only hypomanic but lots of depressive episodes. The cymbalta, I think I recall being on 60mgs.
> I really have a problem with lethargy, weakness, cognitive problems, and often flu-like feelings in the afternoons. I always thought this was the lithium side effects or possibly the combo of lithium and prozac. What are "pstim", I am not familiar with this.
> I've had a whole hormonal workup as well, deficient in estrogen and progesterone. I am 39 yrs. old. Don't know how to treat this since the doctor I go to only suggested DHEA which I am taking.
> I am taking 2 grams fish oil....perhaps I should up to 4-6 as you say.
> Again, thanks for your suggestions. Everything helps..Stacey
------------I thought you weren't supposed to take SSRIs with
lithium, or if you are bipolar for that matter;Squiggles
Posted by Squiggles on August 21, 2007, at 16:52:37
In reply to Re: Some advice, posted by sac on August 21, 2007, at 6:57:18
This is to leave a report of a personal observation of marked personality change after Serzone (not mine); other factors may have been head injury; i am leaving this here as i have witnessed it because i have no other place to report it which can be taken with any credence due to bureaucratic hospital laws regarding confidentiality. I wonder if they do better with less information, but perhaps this information is just too subjective.
To my knowledge no neurological nor liver tests were taken to see any possible effects, especially after repeated head injuries.
Squiggles
Posted by sac on August 23, 2007, at 7:20:10
In reply to Re: Some advice » sac, posted by Squiggles on August 21, 2007, at 7:03:41
I thought the same too regarding SSRI's. It seems like for the last 5 years or so my moods are not stable enough for even one month. I end up seeing my doctor at least once a month because one week I may be feeling OK, only to be depressed again the following week. He has never suggested to go off the SSRI. In fact, recently he has prescribed 20 mgs. Prozac for 12 days,then upping it to 30mgs. for 18 days (He feels it may be PMDD)???
Posted by BarbaraCat on August 27, 2007, at 18:08:33
In reply to Re: Some advice, posted by sac on August 21, 2007, at 6:57:18
Deficient in estrogen and progesterone, you say? Well, that could be causing a bit of problems! Before the other meds can work, this has to be dealt with.
The way I take my hormones is a sub-lingual customized preparation of natural plant-based hormones. They're prepared by a compounding pharmacy from a doctor's or naturopath's prescription.
However, it's hard to find a doc that knows much about the subject. I was lucky to find a compounding pharmacist that does patient counseling and then faxes her recommendations to my primary-care doc (who is very grateful for her expertise). She's very, very knowledgeable and I got more out of this consultation than with any of my doctors. My husband and I are both taking hormones this way and it's been great. Her consultations are around $60 and worth it.
The prescription info is faxed to your doc and can be filled through this, or any other compounding pharmacy, and mailed to you. Here's the info:
Denise, PhM (don't know her last name)
Creative Compounds
Wilsonville, OR 97070
877-585-6111 or 503-685-6111Hopefully, your current doc will be open to this. Most docs unfortunately don't know how to handle hormonal issues and don't even know about natural hormones. They're so tied into the major pharma companies which are not about to divulge competitive remedies .
- BarbCat
Posted by sac on August 31, 2007, at 5:57:11
In reply to Re: Some advice » sac, posted by BarbaraCat on August 27, 2007, at 18:08:33
Thank you for the information. Yes, it is very frustrating to go around in circles with doctors who don't know how to treat hormonal issues. I will consider this individual you recommended and thanks again.
This is the end of the thread.
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