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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Maximus on July 27, 2008, at 13:38:53
Hi,
Actually i'm extremely depressed and anxious. What happened? With the permission of my pdoc i've reduced the lithium with the hope of losing weight. But it didn't work. So i resumed the dose of Li.
But now i feel a lot WORSE with a therapeutic dose of Li. I'm extremely sad and melancholic. Moreover i'm anxious too. What the frakk is happening with me?
Current medication: Cymbalta 60 mg, Lithium 1050 mg and Seroquel 100 mg as needed.
The appointment with my pdoc is just in September.
I'm really mesirable. Is there something to do with the medication?
Max.
Posted by bleauberry on July 27, 2008, at 17:19:28
In reply to Extremely depressed, advices needed!, posted by Maximus on July 27, 2008, at 13:38:53
How were you feeling with the reduced dose of lithium? If it wasn't good, I can see why you went back to the higher dose. If was ok, maybe go back down again?
Lithium is scary to mess with. I've heard many stories of people who were stable, changed the dose, and then it was like a completely different scenario when they tried to get back to where they were. Knowing what I know from pbabble, if I were a pdoc and had a patient stable on lithium, I would tell them that is one thing we cannot take a chance on messing with. If there is weight gain, we'll have to figure out something else to deal with that.
Hopefully things will settle down in the coming days. In the meantime, you should definitely call your doctor and let him know you are in trouble. Don't wait till September.
Posted by Maximus on July 27, 2008, at 20:24:14
In reply to Re: Extremely depressed, advices needed!, posted by bleauberry on July 27, 2008, at 17:19:28
> How were you feeling with the reduced dose of lithium? If it wasn't good, I can see why you went back to the higher dose. If was ok, maybe go back down again?
>I was going down hill but still i was feeling a lot better. Yes i'm going to call her to let her know if there is something to do before my appointment. Thanks.
Posted by Marty on July 28, 2008, at 0:17:50
In reply to Extremely depressed, advices needed!, posted by Maximus on July 27, 2008, at 13:38:53
Hi Maximus,As you already know we can only speculate very oversimplistic and naive theory about what's going on. But here's a cute (naive) idea I can come with on the top of my head:
Norepinephrine (NE). You have 2 drugs interacting with those receptor: Lithium which decrease the release of NE and Duloxetine which inhibit its reuptake. Here's how I can imagine NE to be implicated in your crash...
1. BEFORE Lowering Lithium : Lithium decrease the NE 'signal' while Duloxetine amplify it. Your NE receptors are desensitized by the 'increased NE' level caused by Duloxetine in your synaptic gap.
The desensitization level stabilize to a "Lithium(-NE)+Duloxetine(+NE)" sensitivity. Your brain adapts itself to this 'new' level of NE activity.
2. AFTER Lowering Lithium : Lithium NE release inhibition is decreased and so NE release increase. NE receptors desensitize more than before and to an extend greatly magnifigned by the NE reuptake inhibition induced by Duloxetine. More NE release + not-yet-stabilized level of NE desensitization (no dulling/flatening reuptake inhbition receptor desensitization induced effet yet) = Feeling better, feeling more alive. Yet your BP is crawling back and you sense it, but somethings feels better. = in part NE.3. After RISING Lithium again : Let's call this the 'NE Crash'. Your NE receptors are way more desensitized than while you was in #1 by what happened in #2 and so now rising your Lithium to #1 level brings back an NE release inhibition that your NE-numb receptors find hard to deal with. ... And here you have your NE Crash.
If this is happening AND significant at all it could only be a part of the whole thing. Lithium and Duloxetine both plays also with Serotonin where Li increase its synthesis and Duloxetine inhibit its reuptake.. that's just another thing one could try to see how it played into what's happening to you. Could it be possible that 5-HT2a/2c sensitized while your lithium holiday and now that the serotonergic effect of lithium is back those 2a/2c are hitten too strongly for your brain taste ? Not sure how your antipsychotic modulate this in his 5-HT2 antagonist role. I find it harder to theorize on 5-HT than NE since in mood disorders I find NE nature/role to be way less dichotomous than 5-HT or dopamine.SOOOO... If true what does it mean for you ? (after all that's what important, not the intellectual mast*rbation part)
... I think it means your receptors are readapting to your therapeutic dosage of Lithium and while it does that you feel the pain. NE or not, I think that's true for 'something' and probably ALOT OF THINGS. (NE Upregulation, 5-HT Downregulation and some more profound neuronal plasticity... etc). Time could be all you need to feel better. But while it happen I wonder if there's something 'Bp safe' for you that could ease the pain ..What is your precise Dx and do you switch easily into (hypo)mania ?
/\/\arty
Posted by Polarbear206 on July 28, 2008, at 8:03:56
In reply to Re: Extremely depressed, advices needed! » Maximus, posted by Marty on July 28, 2008, at 0:17:50
Hi Maximus
You could temporarily up your dose of cymbalta to get over the hump until you feel better, then back off. I think it does have to do with the NE as stated above, esp. that melancholic type. I hope you feel better soon!!
PB
Posted by Marty on July 28, 2008, at 9:14:23
In reply to Re: Extremely depressed, advices needed!, posted by Polarbear206 on July 28, 2008, at 8:03:56
> You could temporarily up your dose of cymbalta to get over the hump until you feel better, then back off. I think it does have to do with the NE as stated above
---
Hi PolarBear,Increasing Cymbalta(Duloxetine) would result in even more desensitized NE receptor and I wonder if that's a good thing. It may provide a relieve in the short term but when he would decrease his Cymbalta dose after a while it could be as much difficult to deal with than what he's dealing with right now. That said, if the pain is very acute it may be a risk worth taking and knowing about the NE issue Maximus could reduce his Duloxetine dosage progressively when the time comes in order to avoid the "NE Crash".
Not a bad idea I guess. I wish we would have more opinion on this from other babblers. Also the 5-HT2a/2c is something that would be interesting looking into and see what could be done to help at this level. (ie. rising or lowering his antipsychotic slightly for a couple days)
/\/\arty
/\/\arty
Posted by Maximus on July 28, 2008, at 12:09:31
In reply to Re: Extremely depressed, advices needed!, posted by Polarbear206 on July 28, 2008, at 8:03:56
> Hi Maximus
>
> You could temporarily up your dose of cymbalta to get over the hump until you feel better, then back off. I think it does have to do with the NE as stated above, esp. that melancholic type. I hope you feel better soon!!
>
> PBHi Polarbear,
I have an unused bottle of Effexor 75 mg. Yesterday, i tried one cap of 75 mg with my medication and i got a good relieve.
There were fewer surprises on Lamictal, although it was somewhat less effective than Li. There is matter to think about it here.
Nice to see you and thanks again.
Max
Posted by Maximus on July 28, 2008, at 12:43:52
In reply to Re: Extremely depressed, advices needed! » Maximus, posted by Marty on July 28, 2008, at 0:17:50
> What is your precise Dx and do you switch easily into (hypo)mania ?
>
>
> /\/\artyHi Marty,
My dx is bipolar II. I'm not prone to hypomania at all but recurrents depressions and anxiety. Rarely a mixed state shows its head.
Seroquel (as needed) has been prescribed to me for anxiety and/or agitation.
So in short, you suggest to me to wait and see? My pdoc should call me back tomorrow.
Today i'm less depressed but the anxiety is more present.
Bye for now and thanks for your inputs. Max.
Posted by Maximus on August 2, 2008, at 13:53:40
In reply to Re: Extremely depressed, advices needed! » Marty, posted by Maximus on July 28, 2008, at 12:43:52
Hi,
Yes, i'm almost stable. I feel that Li is doing its job again. Lamictal has been added "again" to my cocktail.
Thanks for your support... Max.
Posted by Marty on August 2, 2008, at 14:32:36
In reply to Re: Partly solved!, posted by Maximus on August 2, 2008, at 13:53:40
This is the end of the thread.
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