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Dr. Bob is Robert Hsiung, MD,
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Posted by fattoush on November 24, 2009, at 8:15:01
In reply to Re: Going back to old-school - lithium. » fattoush, posted by SLS on November 24, 2009, at 6:19:30
> Have you tried Lamictal or Trileptal?
>
> Both drugs are anticonvulsant mood stabilizers. Lamictal is not as good for treating mania, but can be helpful for depression. Trileptal is better as a mood stabilizer, as it can be helpful for both phases of bipolar disorder. You might want to start taking the new drug first and gradually discontinue the lithium later.
>
> I would also consider Topamax. It can work wonders in agitated mixed states as what you are describing. The key to avoiding cognitive side effects is to begin at 25mg and raise the dosage by 25mg each week. 100mg might be the ideal dosage for you.
>
>
> - ScottI have tried both Lamictal and Topamax, both twice. And, yes, the two times I titrated very slowly. I don't get only the usual bad side effects, though I get those too. I get very depressed at as soon as 50 mgs of Topamax and entertain suicidal thoughts often at 75 mgs. Yet, it does miracles on my migraines. Lamictal, on the other hand, soon gives me awful headache, like my head is in a vice. Nothing could relieve the pain. I stuck through to 100 mgs, imagine how long it takes...
Whence my gratitude to Lithium.
But, to go back to my original question, if I lowered it to 300 mgs, and with nothing else on board, would I get no anti-depressant effect?
I posted a question below to someone who thinks they, as bipolars, can do well with Lithium and Wellbutrin.
Posted by Phillipa on November 24, 2009, at 20:05:57
In reply to Re: Going back to old-school - lithium., posted by fattoush on November 24, 2009, at 8:15:01
I'm sure you know that lithium isn't good for thyroid disorder and that could account for the hair loss. thyroid does that. Phillipa
Posted by SLS on November 25, 2009, at 0:08:54
In reply to Re: Going back to old-school - lithium., posted by fattoush on November 24, 2009, at 8:15:01
> But, to go back to my original question, if I lowered it to 300 mgs, and with nothing else on board, would I get no anti-depressant effect?
My best guess is that you would not experience a stable improvement with such a low dosage of lithium when it is used as monotherapy. Unipolars can benefit from 300mg, but only when it is used to supplement antidepressants.
> I posted a question below to someone who thinks they, as bipolars, can do well with Lithium and Wellbutrin.
Combining Wellbutrin with lithium is certainly worth a try.
In my case, I am using lithium to supplement four other drugs. I did not experience a stable improvement until my lithium level reached 0.6 mmol/L. For me, that represents a dosage of 900mg.
- Scott
Posted by SLS on November 25, 2009, at 22:39:49
In reply to Re: Going back to old-school - lithium., posted by SLS on November 25, 2009, at 0:08:54
I'm thinking that I might have something to give thanks for this Thanksgiving. Over the past 10 days or so, I have felt a little better each day. It leaves me feeling that I got lucky. I am about 40% improved. I have started exercising again and I am socializing and getting out more. These things are still difficult to accomplish, but I go out of my way to push myself to do them. Otherwise, I still feel like lying on the couch. The thing is, I am trying to get a head-start on participating in life again. I can tell that I am getting well.
Lithium 900mg has made all the difference. It has broken through a barrier that previous treatments had plateaued at. Old drug, new results.
Currently:
Parnate 80mg
nortriptyline 150mg
Lamictal 200mg
Abilify 10mg
lithium 900mg
- Scott
Posted by Phillipa on November 25, 2009, at 23:47:37
In reply to Re: Going back to old-school - lithium., posted by SLS on November 25, 2009, at 22:39:49
Scott and you will!!!!!! Love Phillipa
Posted by morganator on November 26, 2009, at 1:37:39
In reply to Re: Going back to old-school - lithium., posted by SLS on November 25, 2009, at 22:39:49
That's awesome! I really hope this trend continues! Onward and Upward!
Posted by uncouth on November 26, 2009, at 1:49:07
In reply to Re: Going back to old-school - lithium., posted by SLS on November 25, 2009, at 22:39:49
i'm thankful too...except for me, it has been due to the readdition of zyprexa 5mg and the reduction of lithium from 600mg to 300mg. all in the past week. some relief is better than no relief...
happy thanksgiving everyone.
300mg lithium
5mg zyprexa
5mg abilify
522mg aplenzin
25mg agomelatine
7.5mg deplin
Posted by SLS on November 26, 2009, at 6:26:32
In reply to Re: Going back to old-school - lithium., posted by uncouth on November 26, 2009, at 1:49:07
> i'm thankful too...except for me, it has been due to the readdition of zyprexa 5mg and the reduction of lithium from 600mg to 300mg. all in the past week. some relief is better than no relief...
That kind of positive attitude will get you everywhere. I hope you find wellness sooner rather than later.
Why did you reduce the dosage of lithium?
- Scott
Posted by floatingbridge on November 26, 2009, at 10:49:36
In reply to Re: Going back to old-school - lithium., posted by SLS on November 25, 2009, at 22:39:49
Happy Thanksgiving, Scott!
hugs,
fb
> I'm thinking that I might have something to give thanks for this Thanksgiving. Over the past 10 days or so, I have felt a little better each day. It leaves me feeling that I got lucky. I am about 40% improved. I have started exercising again and I am socializing and getting out more. These things are still difficult to accomplish, but I go out of my way to push myself to do them. Otherwise, I still feel like lying on the couch. The thing is, I am trying to get a head-start on participating in life again. I can tell that I am getting well.
>
> Lithium 900mg has made all the difference. It has broken through a barrier that previous treatments had plateaued at. Old drug, new results.
>
> Currently:
>
> Parnate 80mg
> nortriptyline 150mg
> Lamictal 200mg
> Abilify 10mg
> lithium 900mg
>
>
> - Scott
Posted by SLS on December 2, 2009, at 5:51:06
In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on November 26, 2009, at 10:49:36
Well, I'm afraid that lithium is turning out to be another disappointment. I am getting diminishing returns at 900mg. In addition, the tremulous effect it has on my muscles during and after resistance exercise is rather severe.
I have decided to go back to my original plan and stay with lithium at a dosage of 300mg. Hopefully, the tremulousness will disappear, and I will still get the neuroprotective and neurotrophic benefits it produces.
I started out taking 300mg of lithium not expecting it to affect my depression at all. However, when I experienced a fairly robust improvement within the first week, I was very surprised and delighted. When that improvement disappeared at 300mg, I went to 450mg, then to 600mg, and then to 900mg. Upon each dosage increase, I experienced an immediate improvement followed by a plateau and eventual diminution of the antidepressant effect.
Damned illness.
Damned drugs.
Damned brain.
- Scott
Posted by uncouth on December 2, 2009, at 10:13:20
In reply to Re: Going back to old-school - lithium., posted by SLS on December 2, 2009, at 5:51:06
scott i've said it before but i'll say it again...i urge you to try zyprexa again. im taking it with abilify and its effective, and with the abilify, not hunger promoting.
hope you feel better
Posted by SLS on December 2, 2009, at 10:31:15
In reply to Re: Going back to old-school - lithium., posted by uncouth on December 2, 2009, at 10:13:20
> scott i've said it before but i'll say it again...i urge you to try zyprexa again. im taking it with abilify and its effective, and with the abilify, not hunger promoting.
>
> hope you feel betterThanks!
I'll give it a try.
- Scott
Posted by floatingbridge on December 2, 2009, at 18:40:18
In reply to Re: Going back to old-school - lithium. » uncouth, posted by SLS on December 2, 2009, at 10:31:15
> > scott i've said it before but i'll say it again...i urge you to try zyprexa again. im taking it with abilify and its effective, and with the abilify, not hunger promoting.
> >
> > hope you feel better
>
> Thanks!
>
> I'll give it a try.
>
>
> - Scott
Maybe with the Abilify at the lower dose it would work. And Uncouth, how much zyprexia? I hear that causes weight gain--not for you?Scott, this news is disappointing. I'm sorry. And you've really hung in there with this trial. I'm sure you've tried augmenting w/ segeline--or is that contra-indicated w/ parnate?
You're in my thoughts,fb
Posted by uncouth on December 2, 2009, at 18:43:04
In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on December 2, 2009, at 18:40:18
i am on 5mg zyprexa, potentially going down to 2.5mg if i can stabilize. taking it with 5mg abilify. abilify has attenuated the increased appetite. i also have a trick I use...drink lots of psyllium powder+water solution a few times each day, after meals...it slows digestion, decreases spikes in blood sugar, and makes me feel more full.
Posted by Phillipa on December 2, 2009, at 23:12:22
In reply to Re: Going back to old-school - lithium., posted by SLS on December 2, 2009, at 5:51:06
Scott I'm truly sorry. Just home and reading mail. I too hope the tremulousness disappears for you . I do know you love to excercise. Love Phillipa
Posted by RocketMan on December 3, 2009, at 12:33:08
In reply to Re: Going back to old-school - lithium., posted by SLS on December 2, 2009, at 5:51:06
Scott, I agree with you lowering your dose to 300mg. Also, have you considered reducing your lamictal from 200mg to 150mg. I've been thinking about your regime and have a theory that the lamictal may be preventing the parnate/nortrip from achieving their potential due to a "top heavy" restriction from lamictal? Maybe even reducing it to 100mg if you realize some benefit after reducing down to 150mg. I think sometimes one drug can interfere with the overall success when not dosed properly. Low dose lithium/lamictal may prove more of a benefit, nothing to lose, and much to gain.
Just a suggestion.
Regards, Rick
Posted by SLS on December 3, 2009, at 21:58:26
In reply to Re: Going back to old-school - lithium., posted by RocketMan on December 3, 2009, at 12:33:08
> Also, have you considered reducing your lamictal from 200mg to 150mg.
I think I'll try that, if for no other reason but to see if I can reduce the cognitive impairments I experience. I don't know how much of it is due to the depression and how much is produced by the Lamictal. I'll need to establish the lowest effective dose of lithium first, though.
Interesting theory.
- Scott
Posted by SLS on December 4, 2009, at 8:15:46
In reply to Re: Going back to old-school - lithium. » RocketMan, posted by SLS on December 3, 2009, at 21:58:26
Well, at least I know that lithium is doing something positive. After being at 300mg for a few days, my depression worsened. After increasing the dosage to 450mg, I improved again. I'm still disappointed that I am not in remission, of course. However, I am grateful for any improvement in my condition that these drugs can offer.
- Scott
Posted by RocketMan on December 4, 2009, at 12:14:22
In reply to Re: Going back to old-school - lithium., posted by SLS on December 4, 2009, at 8:15:46
Glad the increase to 450mg offered some improvement! It is still a relatively small dose so that's a positive in itself. You may find your ability to exersice is not inhibited although a bottle of gatorade and a banana wouldn't hurt as well. ;)
On another note, I have always had this underlying need to fit myself into the bipolar 2 spectrum. After many unsuccessful trials with full-dose mood stabilizers, and help from my p/doc, I have learned that a-typical depression is more of my "flavor" and responds to the lower dosing of stabilizers. My p/doc has insisted that keeping my lamictal at 100mg is more than enough to aide in lifting depression along with the other meds I take. He says too high of a dose can hinder the therapeutic gains that may be recognized. I know when I increase my lamictal over 100mg, I get an immediate lift for several days and then the lid is screwed down.....depression sets in! As I previously mentioned, lithium at 300 -450 mg and lamictal 100mg may be a worth while trial. But, as you pointed out, it is just a theory. Best of luck with your recovery.** Rick
Posted by Phillipa on December 4, 2009, at 19:41:54
In reply to Re: Going back to old-school - lithium., posted by RocketMan on December 4, 2009, at 12:14:22
Rick you get the three day response to meds also? Phillipa
Posted by RocketMan on December 4, 2009, at 20:17:50
In reply to Re: Going back to old-school - lithium. » RocketMan, posted by Phillipa on December 4, 2009, at 19:41:54
> Rick you get the three day response to meds also? Phillipa
Yes, more often than not...unfortunately :-(
I recall a med switch about 7 years ago where I went from 6 months of Luvox straight over to Effexor 75mg. That is the best I have felt in 22 years..... it lasted a short 3-5 days.
Posted by Phillipa on December 4, 2009, at 21:13:26
In reply to Re: Going back to old-school - lithium. » Phillipa, posted by RocketMan on December 4, 2009, at 20:17:50
Another piece of the puzzel first was when I discovered the majority of the patients on the psych unit I nursed on had thyroid disorders, now there is autoimmune involved, and this three day response? Please brains not mine put the missing piece in this puzzel. Love Jan
Posted by RocketMan on December 4, 2009, at 21:24:54
In reply to Re: Going back to old-school - lithium. » RocketMan, posted by Phillipa on December 4, 2009, at 21:13:26
> and this three day response? Please brains not mine put the missing piece in this puzzel. Love Jan
Not to take from Scott's thread, but I've often wondered if the 3 day response was akin to a form of mini ECT? Kinda of scrambling the chemicals for a short period of time. I know it would be impractical, and maybe unethical to have a prescription for 10 different A/D'S taken on a rotating weekly schedule, but, if anyone has ever tried, I would certainly like to here from them!!!!
*Rick*
Posted by Phillipa on December 4, 2009, at 21:28:41
In reply to Re: Going back to old-school - lithium. » Phillipa, posted by RocketMan on December 4, 2009, at 21:24:54
Rick you know I had been thinking the same thing. Brilliant minds work sinergesically!!!!! Love Jan wonder what Scott will think. Maybe this will allow him to find that missing link???
Posted by Questionmark on December 10, 2009, at 4:17:52
In reply to Re: Going back to old-school - lithium., posted by linkadge on July 4, 2009, at 7:42:42
I just happened to look through this thread.
What a great little discussion this was. I'd have to say, as i often do, that i agree with Linkadge on this. And he lays it out brilliantly in this post i think.
But yeah for years i've thought the notion that *having a manic reaction on a drug equals you are bipolar* seemed wildly off base and over-simplistic. Kind of like the idea of, "If you take a stimulant and feel calm and focused then you have ADHD; if you take one and feel restless and energetic then you do not have ADHD."
Ah, psychiatry.
Brilliant, brilliant post. So many good points.
> >Yeah. Those with occult bipolar spectrum >disorders.
>
> Well if your definition of bipolar is an individual who has a manic epsode in response to an antidepressant then yes. Otherwise its just a drug reaction.
>
> >Even depression can be parsed using the
> >body's reaction or non-reaction to the >administration of the drug, dexamethasone.
>
> This is rarely used for diagnostic purposes. Even such, a certain response to dexamethasone does not conclusively indicate depression. The patient could have cushings disease for instance and react to dexamethasone in a similar manner to depression. Do they necessarily have depression? No. That is the danger in trying to classify drug reactions as diseases.
>
> >I just don't think that this kind of mentality >went into the decision reached by William Potter >(NIH) in 1992 to understand my illness as being >a variety of bipolar disorder.
>
> Who knows peoples motives. Have you ever noticed that ever since drugs like seroquel have been approved for bipolar depression, there is this big push on internet banners for patients to consider whether they might have bipolar depression. The drug de jour defines how we classify mental illnesses. We are in a perod of AD backlash. Everyone's got bipolar depression now because a) their SSRI pooped out or b) they had a manic response to an antdidepressant. Keep in mind the SSRI's can cause extreme akathesia for some patients. Many of the symptoms of extreme akathesia overlap well with mania - namely irritability, psychomotor agiation, insomnia, etc. etc.
>
> >Perhaps. The question is whether or not it is >downstream from the pharmacological actions of >the drug. Wellbutrin and Prozac hit different >targets even though many downstream effects are >the same.
>
> This is exaclty what I am saying though. If the patient was bipolar already, one would expect the mood elevation itself to accelerate the cycle.
>
> >I have never heard that. Stimulating, yes. It >might be closer in effect to methylphenidate
> >(Ritalin) or amphetamine (Dexedrine).
>
> Exaclty, drugs which people abuse to get high. People high on stimulants have symtpoms identical to manic episodes.
>
> >I do understand where you are coming from with >all of this. If you really want to do some >digging, you might want to try some empirical >research. For example, at what rate does the >general population respond to amphetamine with a >manic episode versus people who seek treatment >for depression.
>
> Anyone who abuses amphetamine is more or less having a manic episode. Elevated mood, increased energy, goal directed behaviors, increased hedonic capacity, less need for sleep, pressure of speech, grandiose ideas, you name it - its all the same thing.
>
> >If Manji can make rats "depressed", I guess he >can make them "manic". How would he go about >making a person manic? Where on the Net can I >find the Manji quote you cited?
>
> He has done losts of work in rats and what he notices is that high dose amphetamines do cause behavior which is used as a model for amphetamines. How do you think all of these bipolar and schizophrenic drugs are identified? By they activity in reducing the manic like excitement caused by stimulants. Stimulants cause a more rapid elevation in signal transduction systems than antidepressants do. Lithium and valproate direclty block the transducton wherase the AP's block the receptor induced transduction.
> Antidepressants also elevate protein kinase C. Actually, the SSRI's have more potent effects on PKC than bupropion does.
>
> If you could relieve depression without causing mania then do you really have bipolar?
>
> Take yourself for instance, what if you initially took (and got well on) bupropion and not nortriptyline. If you never had a manic response to this drug and remained well, would you still be bipolar????
>
> What about agomelatine? I personally think this drug will have an extrelly low propensity to cause mania. No monoamine reuptake. 5-ht receptor blockade. Completely different profile. I think if drugs like this were used more often for depression we'd have fewer manic reactions and ultimately fewer bipolar diagnosis.
>
>
> Linkadge
>
>
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