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Dr. Bob is Robert Hsiung, MD,
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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
Posted by floatingbridge on August 31, 2009, at 12:33:59
In reply to Re: Going back to old-school - lithium. » SLS, posted by Ron Hill on August 31, 2009, at 9:56:06
Or more.
thinking of you,
fb
Posted by Bob on August 31, 2009, at 13:56:34
In reply to Re: Going back to old-school - lithium. » Bob, posted by SLS on August 31, 2009, at 3:40:27
> 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?__________________________________________________
I have a very different condition than you it seems, dominated by dysphoric anhedonia and depression among other things. The higher the dose or the longer the duration on a certain dose of any anti-manic or calming medicine eventually results in extreme fatigue, apathy and almost absolute indifference. Celexa actually falls into this category too.I have never in my recollection experienced any type of true mania or hypomania in the absence of a psychiatric drug, and I've never experienced pure mania under any circumstances. What I have experienced on many occasions is anxiety, panic, or more likely, agitation, akathisia, irritation, and outright anger. I guess this is why anti-convulsants and mood stabilizers have been tried for me. At higher doses of lithium I just shut down, gain weight, sleep all day, and just... don't... care any longer. Yes, many of these endeavors have involved combinations of drugs such as Welbutrin with lithium. The activating drugs always lose the battle to the less activating ones.
Treat the depression and I get what I call 'active negative symptoms' I mentioned above like anger and dysphoric agitation. Try to tamp that down and inevitably I will switch to being a zombie. There has never been a lasting compromise. I've never felt relaxed yet energized, calm yet interested and engaged. None of this even addresses the litany of serious physical problems I've developed over the years of being treated with these drugs. Add into the mix on top of that a serious intolerance of psychiatric drugs in general with a history of many bad responses and side-effects at uncommonly low doses.
It may sound ridiculous but on many occasions I have wished for a little hypomania or mania after months or years of feeling nothing. I just don't understand why no treatment can give me a calm, useable energy without it turning into anger, irritation, and then eventually sadness and severe depression as the treatment is withdrawn because of inefficacy. I guess some would diagnose me as some treatment resistant variant of BP-III except these days I'm pushed into anger from drugs instead of joy, happiness or contentment. A 'dysphoric mania' of sorts. I like to think of it as all the bad parts of a hypomanic episode with none of the good. Of course, some would say this is not a form of mania/hypomania at all but just an irritable depression.
Sorry about the long response. I do hope your lithium augmentation works as you hope.
Bob
_________________________________________________
>
>
> - Scott
Posted by SLS on September 2, 2009, at 8:05:11
In reply to Re: Going back to old-school - lithium. » SLS, posted by Ron Hill on August 31, 2009, at 9:56:06
Hi folks.
I just wanted to let everyone know that beginning Sunday morning, I began to respond to lithium again. I feel better on it than off it. Lithium has definitely hammered a hole in the brick wall that was the obstacle to responding robustly to treatment. I'm about 40% improved relative to my baseline depression severity.
I am going out of town to visit a friend of mine for about a week starting tomorrow. In case I don't get a chance to post during this time, I didn't want anyone to worry about me.
Remission, here I come!
- Scott
Posted by ColoradoSnowflake on September 2, 2009, at 9:08:22
In reply to Re: Going back to old-school - lithium., posted by SLS on September 2, 2009, at 8:05:11
Posted by floatingbridge on September 2, 2009, at 10:20:23
In reply to Re: Going back to old-school - lithium., posted by SLS on September 2, 2009, at 8:05:11
> Hi folks.
>
> I just wanted to let everyone know that beginning Sunday morning, I began to respond to lithium again. I feel better on it than off it. Lithium has definitely hammered a hole in the brick wall that was the obstacle to responding robustly to treatment. I'm about 40% improved relative to my baseline depression severity.
>
> I am going out of town to visit a friend of mine for about a week starting tomorrow. In case I don't get a chance to post during this time, I didn't want anyone to worry about me.
>
> Remission, here I come!
>
>
> - Scott
Scott, this is super news! 40% is considerable. Have a great trip, and thanks for letting us know--we would worry.And Yikes! What will we do w/o you : D ?
a happy hug,
fb
Posted by maxime on September 2, 2009, at 15:08:24
In reply to Re: Going back to old-school - lithium., posted by SLS on September 2, 2009, at 8:05:11
That's really amazing news! I hope that remission is around the corner for you! Enjoy your trip!
Posted by Phillipa on September 2, 2009, at 20:03:23
In reply to Re: Going back to old-school - lithium. » SLS, posted by maxime on September 2, 2009, at 15:08:24
Scott that is so super have a wonderful time and you definitely will be missed!!!!! Love Phillipa
Posted by SLS on September 3, 2009, at 7:46:13
In reply to Re: Going back to old-school - lithium., posted by Phillipa on September 2, 2009, at 20:03:23
My lithium level at a dosage of 600mg was 0.30 ng/ml. That is lower than I would have expected. I am now taking 450mg, so the level will obviously be lower. I read something that reported 0.30 ng/ml being the minimum level at which lithium exerts its neuroprotective and neurogenic properties. I was hoping to reach that with the 450mg dosage. 600mg made me feel "washed out" and gave me significant tremulousness. I was hoping to avoid those things. I would like to get a blood level at 450mg just to compare.
- Scott
Posted by floatingbridge on September 3, 2009, at 10:39:42
In reply to Re: Going back to old-school - lithium., posted by SLS on September 3, 2009, at 7:46:13
> My lithium level at a dosage of 600mg was 0.30 ng/ml. That is lower than I would have expected. I am now taking 450mg, so the level will obviously be lower. I read something that reported 0.30 ng/ml being the minimum level at which lithium exerts its neuroprotective and neurogenic properties. I was hoping to reach that with the 450mg dosage. 600mg made me feel "washed out" and gave me significant tremulousness. I was hoping to avoid those things. I would like to get a blood level at 450mg just to compare.
>If you don't know this, who would, but...is there a way to increase (enhance) lithium absorption to get blood levels higher w/ a lesser dose? Is the blood level what determines side-effects (tremors, wash-out feeling)? Can something like NAC help with side-effects? Sorry for advice--just care.
fb
Posted by SLS on September 14, 2009, at 8:38:56
In reply to Re: Going back to old-school - lithium., posted by SLS on September 2, 2009, at 8:05:11
Disappointed.
Not much happening.
Damn.
Impatient.
I felt a substantially greater improvement during the first week of lithium therapy than I do now. This is a consistent pattern of my response to medication. When I do respond, the improvement lasts for no more than 3 days. Just what the hell is the significance of 3 days, I just don't know. Someone must know. I don't.
I can only hope that a more stable robust response will occur gradually over the course of months. I have no plans to discontinue lithium at this point. However, my treatment history does not indicate an optimistic outcome.
- Scott
Posted by floatingbridge on September 14, 2009, at 17:48:52
In reply to Re: Going back to old-school - lithium., posted by SLS on September 14, 2009, at 8:38:56
Scott,
I'm sorry to hear this. I don't know what to say. 'Hang in there' doesn't seem good enough to address the disappointment and frustration I hear you express right now.
hugs, big time.
fb
Posted by Phillipa on September 14, 2009, at 20:32:17
In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on September 14, 2009, at 17:48:52
Scott so sorry. The number three? Does it mean something to you seriously? Love Phillipa
Posted by SLS on September 18, 2009, at 7:53:43
In reply to Re: Going back to old-school - lithium., posted by Phillipa on September 14, 2009, at 20:32:17
I increased my lithium dosage to 600mg yesterday. I am feeling significantly better today. Unfortunately, I seem to improve transiently to dosage adjustments of certain drugs. I won't get too optimistic too soon on this one. In the meantime, it feels good to feel good.
- Scott
Posted by Bob on September 18, 2009, at 16:18:53
In reply to Re: Going back to old-school - lithium., posted by SLS on September 18, 2009, at 7:53:43
> I increased my lithium dosage to 600mg yesterday. I am feeling significantly better today. Unfortunately, I seem to improve transiently to dosage adjustments of certain drugs. I won't get too optimistic too soon on this one. In the meantime, it feels good to feel good.
>
>
> - Scott
Scott,You're not the only one who only responds transiently to psych meds. That has been the story with me almost from the start. Unfortunately, that duration of transience has gotten shorter and shorter as time goes on. It's really practically gone actually.
Posted by SLS on September 19, 2009, at 6:02:42
In reply to Re: Going back to old-school - lithium. » SLS, posted by Bob on September 18, 2009, at 16:18:53
> > I increased my lithium dosage to 600mg yesterday. I am feeling significantly better today. Unfortunately, I seem to improve transiently to dosage adjustments of certain drugs. I won't get too optimistic too soon on this one. In the meantime, it feels good to feel good.
> You're not the only one who only responds transiently to psych meds. That has been the story with me almost from the start. Unfortunately, that duration of transience has gotten shorter and shorter as time goes on. It's really practically gone actually.
It is demoralizing to contemplate, but it seems that the brain becomes less and less responsive to antidepressants as the number of exposures increases.
- Scott
Posted by Bob on September 20, 2009, at 0:06:43
In reply to Re: Going back to old-school - lithium. » Bob, posted by SLS on September 19, 2009, at 6:02:42
> It is demoralizing to contemplate, but it seems that the brain becomes less and less responsive to antidepressants as the number of exposures increases.
>
>
> - Scott
>
>I absolutely agree with you on that assessment Scott. The brain (at varying rates in different people) sometimes 'adapts' to the treatment being given and the initial response lessens over time. Additionally, that initial response seems to lessen if it is tried again. It truly is demoralizing.
Posted by desolationrower on September 20, 2009, at 0:15:28
In reply to Re: Going back to old-school - lithium. » Bob, posted by SLS on September 19, 2009, at 6:02:42
transient responses are sort of the classic placebo response. So it might be better to work on finding a hope/program that you can do a little bit on everyday to capture that, since there is something there thats working for you, however shortly.
0d.r
Posted by SLS on September 20, 2009, at 6:47:00
In reply to Re: Going back to old-school - lithium., posted by desolationrower on September 20, 2009, at 0:15:28
Hi.
> transient responses are sort of the classic placebo response.
I wish I were the classic patient. When I did come in to see the doctor while feeling these brief improvements, there would be no doubt in their minds that I indeed had a biological affective disorder. The difference was so dramatic. Only did Columbia in 1983 "throw me out" because they thought I was a placebo responder. They hadn't noticed that I was an ultra-rapid cycler when I was first treated by them. They thought that these were emotional highs and lows. They wanted me to see a psychologist instead. I said no. I left, but not before requesting that they put me on bupropion, which had not come out yet. They laughed when I came to them with my own dopaminergic theory of depression. I told them that they should at least try bromocriptine on me. Again, they laughed.
I have never had a problem with psychotherapy, as long as it was made clear that I needed somatic treatments as well. I had had quite a bit of psychotherapy before being diagnosed with affective disorder. It, of course, didn't help with depression. I am currently being treated psychotherapeutically. I am grateful to find a therapist who works closely with a psychopharmacologist. It is understood that the priority to treat the depression must be biological since is a biological disorder that I suffer from. I took advantage of the offer for psychotherapy because I wanted to deal with an unhealthy past, have coping tools to live and function while depressed, and to sweep up the psychological mess that the depression produced.
I had been a member at a mental health clinic day program to add structure to my days. However, after 8 years, I felt it was time for me to leave. Taking a few classes at a community college was good for me. Again, it provided structure. At this point, I am working towards seeking employment. Of course, this will be orders of magnitude easier if my improvement to the addition of lithium grows. At the moment, I expect that it will. Of course, I have been wrong countless times before. Stupid optimism.
- Scott
Posted by SLS on September 20, 2009, at 6:48:50
In reply to Re: Going back to old-school - lithium., posted by desolationrower on September 20, 2009, at 0:15:28
Sorry. I forgot to thank you for your concern and thoughtful suggestions.
Thanks.
- Scott
Posted by mogger on September 24, 2009, at 22:37:03
In reply to Re: Going back to old-school - lithium. » desolationrower, posted by SLS on September 20, 2009, at 6:48:50
Scott,
Hang in there man.Your knowledge of treatments is so vast that I am sure you are aware of this but have you tried massive amounts of high EPA fish oil? I mean far past the 3 grams a day of EPA that is mostly prescribed? I take 10 grams a day (20 capsules) and it has been marvelous for my deep depression and rapid cycling. I only have trouble with my ocd which I am still working out (which you have given me great advice on thank you). I take CountryLife Omega 3 Mood and as I say I take 7 capsules morning, 7 afternoon and 6 evening. I tried 3 grams and it didn't cut it so went for the gold and went to 10 grams! :)
Joseph
Posted by SLS on September 25, 2009, at 0:21:49
In reply to Re: Going back to old-school - lithium., posted by mogger on September 24, 2009, at 22:37:03
Hi Joseph.
> Scott,
> Hang in there man.Thanks. :-)
> Your knowledge of treatments is so vast that I am sure you are aware of this but have you tried massive amounts of high EPA fish oil? I mean far past the 3 grams a day of EPA that is mostly prescribed? I take 10 grams a day (20 capsules) and it has been marvelous for my deep depression and rapid cycling. I only have trouble with my ocd which I am still working out (which you have given me great advice on thank you). I take CountryLife Omega 3 Mood and as I say I take 7 capsules morning, 7 afternoon and 6 evening. I tried 3 grams and it didn't cut it so went for the gold and went to 10 grams! :)Wow. I've tried fish oil, but not at that dosage. I will definitely keep that in mind. I bet there is more to fish oil than just a supplement of omegas. I think there is something pharmacological going on there.
Thanks for the suggestion!
- Scott
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