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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Jimmyboy on August 28, 2007, at 12:32:07
I am on 900 mg of Li right now and it has put me at the very low end of the theraputic blood level ( can't remember but its like, .7 or something like that) It has helped the major mood fluctuations but I still have pretty bad and predictable mood swings like before, just not quite as severe. If I take a higher dose and raise the blood level, will that cause the mood swings to be even less --- or once you hit the theraputic range that is that.. no more help no matter how much higher you go?
Thanks for infoJB
Posted by Squiggles on August 28, 2007, at 17:10:22
In reply to Lithium blood levels - is more better?, posted by Jimmyboy on August 28, 2007, at 12:32:07
I think once you hit the therapeutic level,
your moods stabilize; after all that is why
they call it "therapeutic level";Squiggles
Posted by Jimmyboy on August 28, 2007, at 17:13:55
In reply to Re: Lithium blood levels - is more better? » Jimmyboy, posted by Squiggles on August 28, 2007, at 17:10:22
Yes, but some people are on higher doses, there has to be a reason for that...
Posted by Squiggles on August 28, 2007, at 17:18:06
In reply to Re: Lithium blood levels - is more better?, posted by Jimmyboy on August 28, 2007, at 17:13:55
> Yes, but some people are on higher doses, there has to be a reason for that...
could be
- body weight
- sex
- age
- thyroid function
- renal clearance
- manic or depressed state upon commencement of treatment- hope your dr. helps with this;
S
Posted by Larry Hoover on August 28, 2007, at 17:26:19
In reply to Lithium blood levels - is more better?, posted by Jimmyboy on August 28, 2007, at 12:32:07
> I am on 900 mg of Li right now and it has put me at the very low end of the theraputic blood level ( can't remember but its like, .7 or something like that) It has helped the major mood fluctuations but I still have pretty bad and predictable mood swings like before, just not quite as severe. If I take a higher dose and raise the blood level, will that cause the mood swings to be even less --- or once you hit the theraputic range that is that.. no more help no matter how much higher you go?
>
>
> Thanks for info
>
> JBThe potential for therapeutic effects, as well as that for side effects, will increase with increasing dose. Yes, your doctor may increase your dose, to magnify the response. As it stands now, you're barely into the blood concentration range that is considered to be therapeutic (0.6-1.2 mmol/L). Dose is not an infallible measure of blood concentration, which is why you need to get blood work done. Because you have already exhibited some mood stabilization, I would expect your doctor to talk to you about increasing the dose.
Lar
Posted by Squiggles on August 28, 2007, at 17:49:07
In reply to Re: Lithium blood levels - is more better? » Jimmyboy, posted by Larry Hoover on August 28, 2007, at 17:26:19
> > I am on 900 mg of Li right now and it has put me at the very low end of the theraputic blood level ( can't remember but its like, .7 or something like that) It has helped the major mood fluctuations but I still have pretty bad and predictable mood swings like before, just not quite as severe. If I take a higher dose and raise the blood level, will that cause the mood swings to be even less --- or once you hit the theraputic range that is that.. no more help no matter how much higher you go?
> >
> >
> > Thanks for info
> >
> > JB
>Sorry, to interrupt:
> The potential for therapeutic effects, as well as that for side effects, will increase with increasing dose.But not indefinitely-- after a certain point 1200mg i think, it becomes dangerous and has the greater potential for toxicity.
Yes, your doctor may increase your dose, to magnify the response. As it stands now, you're barely into the blood concentration range that is considered to be therapeutic (0.6-1.2 mmol/L).
Europe uses lower therapeutic ranges than the States, Canada, and Australia. I read that somewhere :-)
Dose is not an infallible measure of blood concentration,
dose is an infallible measure of blood concentration in the 24 hour cycle, but not an infallible measure of brain accumulation of lithium [after Schou]
which is why you need to get blood work done. Because you have already exhibited some mood stabilization, I would expect your doctor to talk to you about increasing the dose.
>
> Lar
>
No offense Larry, just some footnotes.Squiggles
Posted by Larry Hoover on August 28, 2007, at 18:03:07
In reply to Re: Lithium blood levels - is more better? » Larry Hoover, posted by Squiggles on August 28, 2007, at 17:49:07
> > The potential for therapeutic effects, as well as that for side effects, will increase with increasing dose.
>
> But not indefinitely-- after a certain point 1200mg i think, it becomes dangerous and has the greater potential for toxicity.No, that is incorrect. Toxicity is not based on dose. It is based on blood concentration. I know someone who takes 1800 mg to achieve a blood concentration of 1.0 mmol/L.
Each person has a linear dose/concentration response, but the slope of each line is different, individual, idiosyncratic.
> Yes, your doctor may increase your dose, to magnify the response. As it stands now, you're barely into the blood concentration range that is considered to be therapeutic (0.6-1.2 mmol/L).
>
> Europe uses lower therapeutic ranges than the States, Canada, and Australia. I read that somewhere :-)That's where I included 0.6. I recalled references to a therapeutic range of 0.8-1.2, but I revised my post according to a more liberal range used elsewhere in the world.
>
> Dose is not an infallible measure of blood concentration,
>
>
> dose is an infallible measure of blood concentration in the 24 hour cycle,No, it is not.
> but not an infallible measure of brain accumulation of lithium [after Schou]
Brain accumulation is a function of blood concentration which is a function of dose. Each function has different coefficients in different individuals. Brain equilibration is a term that is appropriate, not accumulation. It is believed to take about six weeks after a stable blood concentration is created, before the brain lithium concentration equilibrates.
> which is why you need to get blood work done. Because you have already exhibited some mood stabilization, I would expect your doctor to talk to you about increasing the dose.
> >
> > Lar
> >
>
>
> No offense Larry, just some footnotes.
>
> Squiggles<Spock eyebrow>
Lar
Posted by Jimmyboy on August 29, 2007, at 9:56:09
In reply to Re: Lithium blood levels - is more better? » Squiggles, posted by Larry Hoover on August 28, 2007, at 18:03:07
Thank you both for the info.. I have had blood work done several times and it alwas comes out around .7 . I have a awhile until I see my doc again, but I am certainly going to see if he thinks it would be beneficial to bump my dose up a bit.
JB
Posted by Jimmyboy on August 29, 2007, at 11:14:29
In reply to Re: Lithium blood levels - is more better?, posted by Jimmyboy on August 29, 2007, at 9:56:09
Is anyone out there taking above 900 mgs of Lithium. If so how much are you taking and could you tell a difference as you raised the dose?
Thanks
JB
Posted by CareBear04 on August 30, 2007, at 20:39:43
In reply to Re: Lithium - anyone taking over 900 mg???, posted by Jimmyboy on August 29, 2007, at 11:14:29
Hey-- I'm not currently taking lithium, but I have a pretty extensive history with it. When I first started it, I was on 900mg a day. It stabilized my moods, but at a level below baseline. I discontinued it and restarted about six months later. I started at 450mg and increased over a few months to 1800mg of day. At that point, my pdoc said I have "youthful kidneys," and at that dose, I only had a lithium level of 1.12! I felt calmer and was able to get off some of my other meds, but I also had an increase in side effects. For example, I was really thirsty all the time, craving sweet drinks and having to pee all the time. I eventually went down to about 1500mg. Over time, my kidney function has really decreased. Last summer, I had a level of 1.1 on only 450mg a day. I guess that's why blood levels are so important-- lithium levels can increase and decrease based on any number of things like weight changes, hydration, and other meds. I can definitely feel when my level is too high and I'm toxic. I think beneficial effects increase as you go up the therapeutic range, but as you go up, you risk more side effects and toxicity. Good luck!
CB
Posted by Squiggles on August 30, 2007, at 20:49:15
In reply to Re: Lithium - anyone taking over 900 mg??? » Jimmyboy, posted by CareBear04 on August 30, 2007, at 20:39:43
Thanks CareBear04,
Watch out for dehydration, take your dose
with food, drink lots of water, orange juice,
don't cut down your salt intake, if dieting
make sure your salt intake is the same, and
be careful to supplement exercise sweating with
water.There's a good guide on Amazon by Dr. Schou if you like more;
p.s. your dose is high - cute kidneys ;-)
Squiggles
Posted by Jimmyboy on September 4, 2007, at 10:43:54
In reply to Re: Lithium - anyone taking over 900 mg??? » Jimmyboy, posted by CareBear04 on August 30, 2007, at 20:39:43
Thanks carebear,
I have increased my dose to 1050 from 900 about a week ago.. In the last day or so I think I might be a feeling a bit better, but it could be placebo. How long after an increase in dosage did you notice an effect on your mental state? Also did you find Lithium to be helpful for anxiety, if you had that? ThanksJB
Posted by CareBear04 on September 4, 2007, at 20:27:59
In reply to Re: Lithium - anyone taking over 900 mg??? » CareBear04, posted by Jimmyboy on September 4, 2007, at 10:43:54
Hey JB!
My pdoc said to me once that the good thing about lithium is that you know pretty soon whether it's working or not. It's not like starting an antidepressant where it takes at least four weeks to start seeing an effect. After increasing my lithium dose, I would usually start to feel a difference after one to two weeks, so I think it's very possible that you're experiencing real relief and not just placebo. I do have a lot of anxiety-- before I was diagnosed with bipolar, I was thought to have any number of anxiety disorders. Before I went back on lithium, I was on an antidepressant, an atypical, a high dose of Xanax, and Ambien or something for sleep. My pdoc was embarrassed about how "inelegant" this treatment approach was, and so he was very hopeful that lithium would help us peel away some of the other meds. I did feel less anxious and had better sleep with lithium on board. I hope it addresses your anxiety, too. Good luck!
CB
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