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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 85 to 109 of 281. Go back in thread:
Posted by SLS on August 14, 2009, at 6:08:54
In reply to Re: Going back to old-school - lithium. » SLS, posted by hyperfocus on August 14, 2009, at 2:14:39
Hi.
> What I mean is do you think that there is psychological or other work that you need to do that may preclude responding to meds?
You asked the right question. I guess I didn't answer it right.
For me, psychotherapy does nothing for the depression.
I have been in and out of psychotherapy since 1976. I have been in group therapy, too. I am currently seeing a psychotherapist to do work that would need to be done, regardless of the presence of bipolar depression. Then again, I probably would have been able to do much of that work had I never become depressed.
What is certain is that no amount of psychotherapy can affects my depression. I have come to believe that the depression of bipolar disorder and that of unipolar disorder are different. One difference seems to be that bipolar depressions are almost always "hard" and refractory to psychotherapeutic treatments. They are purely a biological disorder of the brain, regardless of how healthy the mind is. In the realm of unipolar depressive disorders, I think a large percentage are more malleable than hard. For these phenotypes, psychotherapy can make a difference as there is a "dance" of interactions between the mind and the brain.
Some people might look at the mind and brain as being the same thing. I won't entertain any debate about this, as I have done so too many times in the past. Suffice it to say that the brain determines the mind as the mind sculpts the brain.
> I was just using my case as an example. There are a couple of axes I proceed along towards hopefully recovering - meds,psychological, philosophical, behavioural, spiritual
For a very long time, I have approached life in a way that has attended to all five of those axes. I think that's why whenever a drug treatment has afforded me some time without depression, I move forward at a great of speed as there is nothing holding me back. I feel like a thoroughbred chomping on the bit and waiting for the gate to open.
> ,...on the psychological axis for example I'm learning to let go of what happened in the past. I've been getting noticeable emotional relief from this which I don't think I could have got from meds alone. If your response to meds is weak or inconsistent could the block be on some other axis?
I only WISH that were my problem. When I first found out that I had a biological disorder in 1982, I was extremely angry. I wanted my depression to be psychological. That way, it would be under my control to work on. I was more than willing to do whatever psychotherapeutic work that was necessary. I felt helpless to know that my brain would not allow me to feel good, no matter what changes I made to my psyche.
> You probably know all this stuff already so bear with me - just trying to help.
You don't know how much I appreciate that. Thank you. When dealing with me, it is best to assume that I don't know anything. There is plenty that I don't know and perhaps don't realize. I would want anyone to give me suggestions that might benefit me.
Thanks again.
:-)
- Scott
Posted by SLS on August 16, 2009, at 6:19:22
In reply to Re: Going back to old-school - lithium. » hyperfocus, posted by SLS on August 14, 2009, at 6:08:54
Since 600mg of lithium has not produced a sustained improvement, I have decided to reduce my dosage down to 300mg and perhaps remain there for the long-term. I find that the higher dosages of lithium blunt my affect and rob me of my personality. I feel worse. These things were starting to appear at the 600mg. I should probably get a lithium blood level after I have been at 300mg for a week or two. I would hope that it be close to 0.3 mmol/L. This is the minimum level that some researchers feel that neuroprotection (bcl-2;BDNF) and neurogenesis (CREB) take place. In the long-term, I don't see how reversing the loss of brain tissue seen in mood disorders could hurt - except, perhaps, if it were to occur in Brodmann area 25 (ventral anterior cingulate cortex). Here, neurons are over-active in depression. Deep brain stimulation (DBS) serves to short-circuit this area, leading to reduced neurotransmission.
- Scott
Posted by floatingbridge on August 16, 2009, at 13:18:42
In reply to Re: Going back to old-school - lithium., posted by SLS on August 16, 2009, at 6:19:22
Scott, I'm sorry the 600 didn't give you the remission-boost you wanted. Blunted affect is a drag. Are you regrouping, restrategizing? I hope so....
fb
Posted by Ron Hill on August 16, 2009, at 14:19:11
In reply to Re: Going back to old-school - lithium., posted by SLS on August 16, 2009, at 6:19:22
> Since 600mg of lithium has not produced a sustained improvement, I have decided to reduce my dosage down to 300mg and perhaps remain there for the long-term. I find that the higher dosages of lithium blunt my affect and rob me of my personality. I feel worse. These things were starting to appear at the 600mg. I should probably get a lithium blood level after I have been at 300mg for a week or two. I would hope that it be close to 0.3 mmol/L. This is the minimum level that some researchers feel that neuroprotection (bcl-2;BDNF) and neurogenesis (CREB) take place. In the long-term, I don't see how reversing the loss of brain tissue seen in mood disorders could hurt - except, perhaps, if it were to occur in Brodmann area 25 (ventral anterior cingulate cortex). Here, neurons are over-active in depression. Deep brain stimulation (DBS) serves to short-circuit this area, leading to reduced neurotransmission.
> - Scott
Hi Scott,Based on your Li trial, and because of the neuroprotective issues you mention above, I've been considering adding-on 300 mg of lithium. I haven't decided yet.
Although I have never read any research to support it, I have a purely speculative hunch that lithium might reduce rapid cycling tendencies. You've never read anything to support my hunch, have you?
Speaking of rapid cycling, my failed Parnate trial severed to greatly reduce the severity of my rapid cycling. During the three month Parnate trial, I did not rapid cycle. Instead, I was constantly depressed with debilitating levels of anergy and amotivation. Further, having switched back to Nardil about six weeks ago, my rapid cycling has been almost nonexistent. Time will tell if the improvement will last. If my rapid cycling remains diminished, then the four months of hell I experienced during my Parnate trial will all be worth it. The four months consisted of a three-week Nardil washout, a three month Parnate trial, and a one week Parnate washout prior to restarting Nardil.
Scott, given the great results Li gave you in the beginning of your trial, it must be all the more disappointing to feel the improvements fade away. P-disorders and erratic, unpredictable p-med responses should be categorized as War Crimes. Scott, Im sorry that you have been let down yet again. Keep swinging at the ball, my friend. Keep swinging at the ball.
-- Ron
dx: Bipolar II and mild OCPD
600 mg/day Trileptal
200 mg/day Lamictal
500 mg/day Keppra
90 mg/day Nardil
Posted by SLS on August 16, 2009, at 15:00:12
In reply to Re: Going back to old-school - lithium. » SLS, posted by Ron Hill on August 16, 2009, at 14:19:11
Hi Ron.
Thanks for the recognition of my plight. It means alot to me.
> Although I have never read any research to support it, I have a purely speculative hunch that lithium might reduce rapid cycling tendencies. You've never read anything to support my hunch, have you?
Sort of. The NIH performed a few studies that reported that the combination of Lamictal and lithium extended the time between relapses for both depression and mania. I don't recall the dosages used. I think it is a good idea to add lithium to your treatment regime, especially if you have never tried it before.
I'm sorry that you went through such a hellish time with Parnate. These drugs are so unpredictable.
Be well.
- Scott
Posted by SLS on August 18, 2009, at 6:35:32
In reply to Re: Going back to old-school - lithium., posted by SLS on August 16, 2009, at 15:00:12
Yesterday and today, I have been feeling better than I am supposed to. What I mean by that is that I normally wouldn't feel this good unless some treatment was working. I didn't mean mania.
Could it be?
Staying the course...
Optimistic.
- Scott
Posted by ColoradoSnowflake on August 18, 2009, at 11:35:51
In reply to Re: Going back to old-school - lithium., posted by SLS on August 18, 2009, at 6:35:32
FANTASTIC Scott!!!
So good to hear!!!!
gayle
Posted by floatingbridge on August 18, 2009, at 12:42:16
In reply to Re: Going back to old-school - lithium., posted by SLS on August 18, 2009, at 6:35:32
Optimistic, too :D
Posted by Ron Hill on August 24, 2009, at 20:25:17
In reply to Re: Going back to old-school - lithium. » hyperfocus, posted by SLS on August 14, 2009, at 0:09:22
Scott,
This is a worthwhile article regarding lithium. The article was associated with a link recently posted elsewhere on PB. But, I thought it would be good to post the link on your lithium thread.
http://www.jbc.org/cgi/reprint/M705028200v1
-- Ron
Posted by SLS on August 27, 2009, at 15:06:58
In reply to Re: Going back to old-school - lithium. » SLS, posted by Ron Hill on August 24, 2009, at 20:25:17
I saw my doctor today. Of course, he was encouraged that I have received some benefit from lithium 600mg. I told him that I would want to reduce the dosage to 450mg to get rid of that "washed-out" feeling and the tremors. Before doing anything, I am going to get a lithium blood level so that we can see where things are at. Afterwards, I am planning on going down to 450mg to see if the mild benefit I get from 600mg is retained while mitigating the washed-out feeling and tremors.
I retain the hope that I will reach remission with lithium. It just might happen more gradually than I would have liked.
- Scott
Posted by Phillipa on August 27, 2009, at 20:26:30
In reply to Re: Going back to old-school - lithium., posted by SLS on August 27, 2009, at 15:06:58
Scott that's encouraging news. Hope the level is good. Love Phillipa
Posted by floatingbridge on August 27, 2009, at 23:45:15
In reply to Re: Going back to old-school - lithium., posted by SLS on August 27, 2009, at 15:06:58
My hope for you--and the hope of many here for you. Slow going is still movement. Best wishes!
fb
>
> I retain the hope that I will reach remission with lithium. It just might happen more gradually than I would have liked.
>
>
> - Scott
Posted by SLS on August 30, 2009, at 7:39:21
In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on August 27, 2009, at 23:45:15
I never failed a course in school, but it looks like I'm failing this one.
Damn.
At the moment, whatever improvement I might be experiencing with lithium is subtle at best.
I was not in a good place last night. It was the first time in quite awhile that I entertained thoughts of autoeuthanasia.
I took a blood test for lithium level the other day while I was still taking 600mg. The results will provide some insight as to how high I might have to go to achieve a dosage that is appropriate for bipolar disorder. In the meantime I have reduced the dosage from 600mg to 450mg. At 600mg, I felt "washed-out" and experienced tremors that I could do without. Besides, it wasn't helping anyway. My doctor and I agreed on this decrease in dosage. We'll see how high my doctor wants to take this thing in a few weeks based upon the results of the blood test.
Demoralized.
- Scott
Posted by ColoradoSnowflake on August 30, 2009, at 9:57:18
In reply to Re: Going back to old-school - lithium., posted by SLS on August 30, 2009, at 7:39:21
Scott:
You certainly haven't failed in this arena either!! I'd say you have a strong A++ !! in about a hundred others as well.
With your huge knowledge, creativity, courage, exquisite sensitivity, kindness and ability to help so many others, along with new chemicals coming out all the time, you will get there!!
Not only that, but you will help others get there too.
That's not shabby, my friend!!
I'm sorry you're having a setback. That sucks. But I can't believe you don't have lots more tricks up your sleeve!!
Hugs to you this morning!
Gayle
Posted by SLS on August 30, 2009, at 10:20:56
In reply to Re: Going back to old-school - lithium., posted by ColoradoSnowflake on August 30, 2009, at 9:57:18
Thanks Gayle.
You really made my day.
I appreciate your support more than you know.
Thanks again (and again).
- Scott
***********************************************> Scott:
>
> You certainly haven't failed in this arena either!! I'd say you have a strong A++ !! in about a hundred others as well.
>
> With your huge knowledge, creativity, courage, exquisite sensitivity, kindness and ability to help so many others, along with new chemicals coming out all the time, you will get there!!
>
> Not only that, but you will help others get there too.
>
> That's not shabby, my friend!!
>
> I'm sorry you're having a setback. That sucks. But I can't believe you don't have lots more tricks up your sleeve!!
>
> Hugs to you this morning!
>
> Gayle
Posted by morganator on August 30, 2009, at 11:27:12
In reply to Re: Going back to old-school - lithium., posted by SLS on August 30, 2009, at 7:39:21
Damn Scott I'm sorry to hear that man. Hopefully a trial of Agomelatine gives you a much needed boost.
Posted by SLS on August 30, 2009, at 11:45:00
In reply to Re: Going back to old-school - lithium., posted by morganator on August 30, 2009, at 11:27:12
> Damn Scott I'm sorry to hear that man. Hopefully a trial of Agomelatine gives you a much needed boost.
Thanks, Morgan.
I am going to stay with lithium for the long-term. I still haven't given up on the idea that it might produce a significant improvement - even remission. I am coming to understand that I need to treat lithium different than I do antidepressants regarding the time-course of response.
Patience. Gosh, that is such a simple concept to understand, but is so hard to put into practice, especially when you are in pain.
- Scott
Posted by floatingbridge on August 30, 2009, at 12:13:13
In reply to Re: Going back to old-school - lithium., posted by SLS on August 30, 2009, at 11:45:00
we're all pulling for you, Scott. As long as it takes to reach your goal. And I second Gayle's post--we love you!
thank you for all your help and care and kindness and sharing--on a day like today, you need to be reminded that you are a stellar person.
hugs, and a bit of extra patience for the long haul coming your way in a care package,
fb
Posted by ace on August 30, 2009, at 18:13:58
In reply to Re: Going back to old-school - lithium., posted by SLS on August 27, 2009, at 15:06:58
> I saw my doctor today. Of course, he was encouraged that I have received some benefit from lithium 600mg. I told him that I would want to reduce the dosage to 450mg to get rid of that "washed-out" feeling and the tremors. Before doing anything, I am going to get a lithium blood level so that we can see where things are at. Afterwards, I am planning on going down to 450mg to see if the mild benefit I get from 600mg is retained while mitigating the washed-out feeling and tremors.
>
> I retain the hope that I will reach remission with lithium. It just might happen more gradually than I would have liked.
>
>
> - ScottHey Scott- hopes this works out for you mate!
Ace
Posted by Phillipa on August 30, 2009, at 19:02:52
In reply to Re: Going back to old-school - lithium. » SLS, posted by ace on August 30, 2009, at 18:13:58
Me too!!!! Phillipa
Posted by Bob on August 30, 2009, at 23:50:26
In reply to Re: Going back to old-school - lithium., posted by SLS on August 30, 2009, at 11:45:00
> > Damn Scott I'm sorry to hear that man. Hopefully a trial of Agomelatine gives you a much needed boost.
>
> Thanks, Morgan.
>
> I am going to stay with lithium for the long-term. I still haven't given up on the idea that it might produce a significant improvement - even remission. I am coming to understand that I need to treat lithium different than I do antidepressants regarding the time-course of response.
>
> Patience. Gosh, that is such a simple concept to understand, but is so hard to put into practice, especially when you are in pain.
>
>
> - Scott
Yes Scott... You have to hang in there. So many of us on this board have been through so many med trials, and invariably there are some very rough spots. This will undoubtedly abate.Bob
Posted by Bob on August 30, 2009, at 23:57:59
In reply to Re: Going back to old-school - lithium., posted by SLS on August 30, 2009, at 11:45:00
> > Damn Scott I'm sorry to hear that man. Hopefully a trial of Agomelatine gives you a much needed boost.
>
> Thanks, Morgan.
>
> I am going to stay with lithium for the long-term. I still haven't given up on the idea that it might produce a significant improvement - even remission. I am coming to understand that I need to treat lithium different than I do antidepressants regarding the time-course of response.
>
> Patience. Gosh, that is such a simple concept to understand, but is so hard to put into practice, especially when you are in pain.
>
>
> - Scott
FWIW, during the times I've been on lithium (years altogether) I've never done well on higher doses so I was often on 225-450mg total.Bob
Posted by Bob on August 31, 2009, at 0:01:54
In reply to Going back to old-school - lithium., posted by SLS on July 3, 2009, at 6:42:30
> Lithium. I hate that damned drug. It has always made me feel worse. At 600mg, it flattens me out, makes me more numb to my surroundings, pacifies me, and takes away just about everything that makes Scott Scott. I've run out of ideas, though. I guess I am reaching for anything at this point. I am only going to take 300mg (150mg twice a day). I started it yesterday. I already feel the numbing pacifying stuff happening. It is disgusting. However, the folks up at Harvard determined that the range of efficacy when using lithium FOR DEPRESSION as an adjunct to antidepressants is 300-600mg. (At this low dosage, lithium does little to act as a true mood stabilizer). One thing nice about using lithium in this role is that if it is going to work at all, it usually begins to show results within 2 weeks. Most often, results are seen during the first week. One thing that I keep in mind is that, although the few manias I had have been drug-induced, their severity (psychosis) places me closer to the Bipolar I category. Lithium is particularly effective for this type of bipolar illness. I have been stuck at about a 35% improvement for quite awhile now. My brain will just not allow for a more robust improvement.
>
>
> - Scott
>
>
Scott,I may have missed it, but what specific symptoms or situation brought you around to giving the lithium a go? Were you experiencing instability, or maybe the AD cocktail just wasn't making you feel as good as you thought it could be? I guess stated another way I'm wondering if you were looking for a 'smoothing out' or maybe an actual augmenting boost to your antidepressants?
Bob
Posted by SLS on August 31, 2009, at 3:40:27
In reply to Re: Going back to old-school - lithium. » SLS, posted by Bob on August 31, 2009, at 0:01:54
Hi Bob.
I really appreciate your concern and input. I am particularly grateful for your sharing that it was the lower dosages of lithium that you did best with.
> I may have missed it, but what specific symptoms or situation brought you around to giving the lithium a go?
1. Simple clinical logic: I never tried lithium with the combination of drugs that I have been taking.
2. My illness is probably closer to being bipolar I disorder than bipolar II because of the severity of my drug-induced manias. Bipolar I disorder is more amenable to lithium treatment than is bipolar II. It is interesting that lithium never acted as an antimanic drug for me. Higher dosages were of little value to control my mania acutely. Depakote and Zyprexa are far more effective for me.
3. I wanted to take lithium indefinitely for its potential to produce neuroprotection and neurogenesis.
4. Desperation.
> Were you experiencing instability,
No. I was quite stable in my depressed state.
> or maybe the AD cocktail just wasn't making you feel as good as you thought it could be? I guess stated another way I'm wondering if you were looking for a 'smoothing out' or maybe an actual augmenting boost to your antidepressants?
There was really nothing to smooth out. My objective was to use lithium as an augmenter of antidepressants in the low dosage range that it is often employed when it is used in this role (300-600mg). I am more comfortable at 450mg than I was at 600mg.
In what ways were higher dosages of lithium not good for you?
- Scott
Posted by Ron Hill on August 31, 2009, at 9:56:06
In reply to Re: Going back to old-school - lithium., posted by SLS on August 30, 2009, at 7:39:21
> I was not in a good place last night.
I love you like a brother, Scott.
-- Ron
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