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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 36. This is the beginning of the thread.
Posted by SLS on May 15, 2011, at 20:33:54
Does anyone use low-dose lithium as a neurotrophic?
I have become a believer in the utility of using lithium as a neurotrophic agent for both unipolar and bipolar depression at dosages of 300-600mg. Investigations of lithium have shown that it influences the signaling of second messenger cascades to produce nerve growth hormones. One may not feel an improvement immediately, though. In this capacity, lithium is not working as an antimanic nor antidepressant. It serves to enhance the recovery of brain tissue volume and the formation of new connections via the sprouting of neurites. Phosphatidylserine and omega-3 fatty acids (fish oil) further aid in supporting the recovery process via membrane construction. Neuroplasticity is thus facilitated. These things take time. In this role, lithium does not produce acute therapeutic effects, but, rather, works in the background to support the mechanics of positive change.
- Scott
Posted by jms600 on May 16, 2011, at 8:03:05
In reply to How many are taking low-dose lithium?, posted by SLS on May 15, 2011, at 20:33:54
> Does anyone use low-dose lithium as a neurotrophic?
>
> I have become a believer in the utility of using lithium as a neurotrophic agent for both unipolar and bipolar depression at dosages of 300-600mg. Investigations of lithium have shown that it influences the signaling of second messenger cascades to produce nerve growth hormones. One may not feel an improvement immediately, though. In this capacity, lithium is not working as an antimanic nor antidepressant. It serves to enhance the recovery of brain tissue volume and the formation of new connections via the sprouting of neurites. Phosphatidylserine and omega-3 fatty acids (fish oil) further aid in supporting the recovery process via membrane construction. Neuroplasticity is thus facilitated. These things take time. In this role, lithium does not produce acute therapeutic effects, but, rather, works in the background to support the mechanics of positive change.
>
>
> - ScottHi Scott
I take 600mg of lithium carbonate per day. I also take 225mg Effexor and 40mg buspirone. My diagnosis is unipolar depression, severe GAD and panic disorder.
I can't say that the lithium has been totally effective in treating my depression although I think it has helped a bit as an addition to the venlafaxine. Maybe I should consider asking my doctor to increase the dose??
It hasn't helped my anxiety at all.
Posted by floatingbridge on May 16, 2011, at 8:14:17
In reply to Re: How many are taking low-dose lithium?, posted by jms600 on May 16, 2011, at 8:03:05
Scott, is there evidence that the three work best together? And a question I wondered about: does the lithium form matter. When I took 300mg, it was from a pharmacy. Maybe the carbonate mentioned by jms. Oroate is available over the counter. Any thoughts?
Posted by SLS on May 16, 2011, at 9:20:15
In reply to Re: How many are taking low-dose lithium?, posted by floatingbridge on May 16, 2011, at 8:14:17
> Scott, is there evidence that the three work best together?
Not yet. It is, for now, only speculation on my part.
> And a question I wondered about: does the lithium form matter.
I don't know how oratate and carbonate compare, but carbonate works and is dirt cheap. I have been using straight LiCO2. I might change over to sustained release. My guess is that peak plasma levels with sustained release are lower than with immediate release. Perhaps this will help mitigate the toxic side effects of lithium, including thyroid and kidney damage.
- Scott
Posted by floatingbridge on May 16, 2011, at 9:44:31
In reply to Re: How many are taking low-dose lithium? » floatingbridge, posted by SLS on May 16, 2011, at 9:20:15
Controlled release sounds like a good idea for guarding against thyroid. Thanks!
I might discuss w/ pdoc the benefits of re-adding. He's a proponent of low dose Li.
Posted by Phillipa on May 16, 2011, at 11:00:06
In reply to Re: How many are taking low-dose lithium? » SLS, posted by floatingbridge on May 16, 2011, at 9:44:31
Last I read and was told lithium is contraindicated in those with known thyroid disease. In those without it can cause thyroid to develop hypothyroidism. Phillipa
Posted by floatingbridge on May 16, 2011, at 12:16:31
In reply to Re: How many are taking low-dose lithium? » floatingbridge, posted by Phillipa on May 16, 2011, at 11:00:06
Phillipa, I've heard this, too, but on my low Li dose thyroid remained stable and o.k. No indication of progressing hashimoto's.
Posted by Phillipa on May 16, 2011, at 13:08:15
In reply to Re: How many are taking low-dose lithium? » Phillipa, posted by floatingbridge on May 16, 2011, at 12:16:31
FB you took lithium with hasimotos? Seriously haven't heard of that before. Interesting seriously. Love Phillipa
Posted by SLS on May 16, 2011, at 13:41:32
In reply to Re: How many are taking low-dose lithium? » floatingbridge, posted by Phillipa on May 16, 2011, at 11:00:06
> Last I read and was told lithium is contraindicated in those with known thyroid disease. In those without it can cause thyroid to develop hypothyroidism. Phillipa
Yes. This is a well-known side effect that is dosage-dependent. At "therapeutic" dosages (900-1500mg), the incidence of hypothyroidism is approximately 10 percent. I haven't seen estimates of how often low dose (300-600mg) produces this effect. Women are more likely to be affected than men. Interestingly, the rate of hypothyroidism in untreated bipolar disorder is greater than in other populations. This must be considered when evaluating statistics.
http://www.ncbi.nlm.nih.gov/pubmed/11958781
- Scott
Posted by Phillipa on May 16, 2011, at 19:21:39
In reply to Re: How many are taking low-dose lithium?, posted by SLS on May 16, 2011, at 13:41:32
Scott thanks interesting for sure. Same with inderol. My doc wouldn't allow me to take it. As usual women!!!! Phillipa
Posted by Phillipa on May 16, 2011, at 19:31:34
In reply to Re: How many are taking low-dose lithium? » SLS, posted by Phillipa on May 16, 2011, at 19:21:39
Goggled women and hasimotos and bipolar and if this wiki link works. This is what came up. Will try with low dose lithium also. Phillipa
http://www.endocrineweb.com/conditions/hypothyroidism/causes-hypothyroidism
Posted by Phillipa on May 16, 2011, at 19:52:49
In reply to Re: How many are taking low-dose lithium? » Phillipa, posted by floatingbridge on May 16, 2011, at 12:16:31
This one was interesting to me as if have the thyroid issues prior to starting lithium kind of different. Phillipa
http://www.psycheducation.org/depression/meds/LithiumRisks.htm
Posted by dragonblack on May 16, 2011, at 20:56:39
In reply to Re: How many are taking low-dose lithium? » floatingbridge, posted by SLS on May 16, 2011, at 9:20:15
I'm new to lithium, I've only been on it for 2 months, but I've been reading a lot about it. While titrating up, I've concluded that, for myself, I think I will be sticking with the regular form, rather than seeking the ER form, as well as once nightly dosing, regardless of doseage, as long as I can tolerate it.
Jim Phelps's site makes mention of single dosing resulting in a slight reduction in the risk of kidney problems. I also came across a medical text in google books (can't remember what) which reviewed Lithium studies and advocated once nightly dosing. The reasons stated were: 1) compliance was increased over split dosing, while preserving the mood stabilizing effect; 2) side effects were mitigated by virtue of the fact that peak plasma levels occurred in subjects' sleep, side effects were heaviest in the morning, a more "convenient" time, for most people, and thereafter lessened in severity during the day. 3) Finally, with once daily dosing, there is a reduced incidence of kidney problems, likely stemming from the fact that there is a window of time prior to the next dose (18-24 hours after a nightly dose) during which the kidneys get a reprieve, and such "rest" does not occur with split dosing.
Posted by floatingbridge on May 16, 2011, at 22:19:03
In reply to Regular Lithium: better than ER..., posted by dragonblack on May 16, 2011, at 20:56:39
Hi, dragonblack.
That's the site I was just reading. Phillipa posted the thyroid link. What an interesting site. I book marked it.
Are you new here? If so, welcome. What Are you treating with lithium?
fb
Posted by dragonblack on May 16, 2011, at 22:49:15
In reply to Re: Regular Lithium: better than ER... » dragonblack, posted by floatingbridge on May 16, 2011, at 22:19:03
> Hi, dragonblack.
>
> That's the site I was just reading. Phillipa posted the thyroid link. What an interesting site. I book marked it.
>
> Are you new here? If so, welcome. What Are you treating with lithium?
>
> fbHi FB, thanks for the welcome. I'm actually not new, I used to post here a few years ago, but my condition (and life) worsened considerably and I haven't been able to do things like read or post in a long time. Same song, different singer, right?
Anyway, my Dx is Bipolar II, GAD/PD, plus some old substance abuse issues that come and go. After moving and going off all meds (involuntarily - no way to obtain them) I have recently gotten off the wait list and into a free clinic and sort of started over. I'm taking lithium, 900 mg; Parnate, 50 mg; and Klonopin, .5 mg BID/PRN. Doing better than I have in quite some time, though still LOTS of room for progress : )
I've read lots of your posts scavenging this site for information on lithium and parnate lately (I've been lurking for a good month) but I don't recall your particular "affliction." Anyway, I hope things are going well for you. It's nice to be back - I love this place, lots of knowledgeable and kind people!
Best,
db
Posted by dragonblack on May 16, 2011, at 22:59:20
In reply to Regular Lithium: better than ER..., posted by dragonblack on May 16, 2011, at 20:56:39
> I'm new to lithium, I've only been on it for 2 months, but I've been reading a lot about it. While titrating up, I've concluded that, for myself, I think I will be sticking with the regular form, rather than seeking the ER form, as well as once nightly dosing, regardless of doseage, as long as I can tolerate it.
>
> Jim Phelps's site makes mention of single dosing resulting in a slight reduction in the risk of kidney problems. I also came across a medical text in google books (can't remember what) which reviewed Lithium studies and advocated once nightly dosing. The reasons stated were: 1) compliance was increased over split dosing, while preserving the mood stabilizing effect; 2) side effects were mitigated by virtue of the fact that peak plasma levels occurred in subjects' sleep, side effects were heaviest in the morning, a more "convenient" time, for most people, and thereafter lessened in severity during the day. 3) Finally, with once daily dosing, there is a reduced incidence of kidney problems, likely stemming from the fact that there is a window of time prior to the next dose (18-24 hours after a nightly dose) during which the kidneys get a reprieve, and such "rest" does not occur with split dosing.I meant to add to this that the authors also specifically identify regular lithium as requisite for the "give the kidneys a rest" strategy, as the ER form, like split dosing, doesn't give you the needed rest window. Naturally, some tolerate the ER form better and that may trump other concerns. If one tolerates the regular form, though, it seems to me that this idea is compelling and makes a lot of sense to me.
Posted by floatingbridge on May 16, 2011, at 23:04:14
In reply to Re: Regular Lithium: better than ER..., posted by dragonblack on May 16, 2011, at 22:49:15
Nice to meet you! Thanks for the introduction. Glad you are doing better (wow--med-free. Whew. How did you manage?), and looking towards improvement.
I am currently dealing with MDD and c-ptsd. I was dx'd BPnos for years. Who knows? I have BP I relatives.
I know that song, too : P
Best of luck with your recovery, and see you around :-)
Posted by dragonblack on May 16, 2011, at 23:21:27
In reply to Re: Regular Lithium: better than ER... » dragonblack, posted by floatingbridge on May 16, 2011, at 23:04:14
> Nice to meet you! Thanks for the introduction. Glad you are doing better (wow--med-free. Whew. How did you manage?), and looking towards improvement.
>
> I am currently dealing with MDD and c-ptsd. I was dx'd BPnos for years. Who knows? I have BP I relatives.
>
> I know that song, too : P
>
> Best of luck with your recovery, and see you around :-)Going off meds, which I was terrified of doing and unable to prevent, was tons of fun. It was pretty bad, actually, and I started drinking again after 22 months sober (which honestly helped me get through it - I don't feel too bad about it, other than the loss of the symbolic time quantity). It did allow me to trace my headaches and migraines to my prior med combo (Wellbutrin XL, Trileptal - the combo itself, I think...?), so that turned out to be a huge help. Also, since going up to 900 mg lithium I haven't even wanted a drink, which is bizarre. I keep reading that there's no evidence that lithium helps alcoholics...I've NEVER not wanted a drink before.
I was (mis)diagnosed as MDD too, repeatedly! Ah, multiple years of AD monotherapy - those were the days! : )
Take care,
db
Posted by SLS on May 17, 2011, at 4:31:25
In reply to Re: Regular Lithium: better than ER..., posted by dragonblack on May 16, 2011, at 22:59:20
> > I'm new to lithium, I've only been on it for 2 months, but I've been reading a lot about it. While titrating up, I've concluded that, for myself, I think I will be sticking with the regular form, rather than seeking the ER form, as well as once nightly dosing, regardless of doseage, as long as I can tolerate it.
> >
> > Jim Phelps's site makes mention of single dosing resulting in a slight reduction in the risk of kidney problems. I also came across a medical text in google books (can't remember what) which reviewed Lithium studies and advocated once nightly dosing. The reasons stated were: 1) compliance was increased over split dosing, while preserving the mood stabilizing effect; 2) side effects were mitigated by virtue of the fact that peak plasma levels occurred in subjects' sleep, side effects were heaviest in the morning, a more "convenient" time, for most people, and thereafter lessened in severity during the day. 3) Finally, with once daily dosing, there is a reduced incidence of kidney problems, likely stemming from the fact that there is a window of time prior to the next dose (18-24 hours after a nightly dose) during which the kidneys get a reprieve, and such "rest" does not occur with split dosing.
>
> I meant to add to this that the authors also specifically identify regular lithium as requisite for the "give the kidneys a rest" strategy, as the ER form, like split dosing, doesn't give you the needed rest window. Naturally, some tolerate the ER form better and that may trump other concerns. If one tolerates the regular form, though, it seems to me that this idea is compelling and makes a lot of sense to me.
I often wonder if statements like this are nothing more than one's own theory rather than an evidence-based prescription. Did the authors support their contention with empirical studies? Perhaps the best way to verify it is to do retrospective studies of human dosing behaviors and their association with thyroid or kidney function. To do a prospective study would take years. Maybe one already exists.This is a very important issue to me that I should explore more thoroughly. Reading is still difficult for me, though. I apologize if I missed something.
- Scott
Posted by SLS on May 17, 2011, at 4:40:09
In reply to Re: Regular Lithium: better than ER..., posted by dragonblack on May 16, 2011, at 23:21:27
> > Nice to meet you! Thanks for the introduction. Glad you are doing better (wow--med-free. Whew. How did you manage?), and looking towards improvement.
> >
> > I am currently dealing with MDD and c-ptsd. I was dx'd BPnos for years. Who knows? I have BP I relatives.
> >
> > I know that song, too : P
> >
> > Best of luck with your recovery, and see you around :-)
>
> Going off meds, which I was terrified of doing and unable to prevent, was tons of fun. It was pretty bad, actually, and I started drinking again after 22 months sober (which honestly helped me get through it - I don't feel too bad about it, other than the loss of the symbolic time quantity). It did allow me to trace my headaches and migraines to my prior med combo (Wellbutrin XL, Trileptal - the combo itself, I think...?), so that turned out to be a huge help. Also, since going up to 900 mg lithium I haven't even wanted a drink, which is bizarre. I keep reading that there's no evidence that lithium helps alcoholics...I've NEVER not wanted a drink before.
>
> I was (mis)diagnosed as MDD too, repeatedly! Ah, multiple years of AD monotherapy - those were the days! : )
>
> Take care,
>
> db
Alcoholism and bipolar disorder are often comorbid. If depression drives alcohol consumption, perhaps reducing depression will also reduce alcoholic behaviors. Effective treatment with lithium might therefore help with alcoholism, but only if it is associated with bipolar disorder (and perhaps unipolar depression). The other possibility is that lithium targets processes that have nothing to do with depression. As you noted, though, you found no evidence of this. Whatever it is, I hope for you continued success.
- Scott
Posted by floatingbridge on May 17, 2011, at 8:24:28
In reply to How many are taking low-dose lithium?, posted by SLS on May 15, 2011, at 20:33:54
Scott, are you maintaining at 300-600 mg Li these days?
My doctor is quite a proponent of this, and I imagine, he'd like me back on. Not that he knows everything. The older drugs he knows fairly well enough and called lithium neurogenic.
I'm still not sure about an er or regular for thyroid. Kidney is not the issue for
me. Previously, I took 300 regular w/o a blip in tsh tests.What seems to have thrown a wrench in the works is switching from synthetic t4 to armour t4/t3. Still recovering from a hypo spike.
Posted by SLS on May 17, 2011, at 8:35:48
In reply to Re: How many are taking low-dose lithium? » SLS, posted by floatingbridge on May 17, 2011, at 8:24:28
> Scott, are you maintaining at 300-600 mg Li these days?
300mg seems to be the optimum dosage for me.
> My doctor is quite a proponent of this, and I imagine, he'd like me back on. Not that he knows everything. The older drugs he knows fairly well enough and called lithium neurogenic.
It certainly appears to be. Everywhere you turn, they are discovering something new about the actions of lithium. Linkadge has contributed a great deal to PB on the properties of lithium. If you want to learn more, search for Manji, an investigative psychopharmacologist specializing in the study of lithium.
- Scott
Posted by floatingbridge on May 17, 2011, at 8:40:59
In reply to Re: How many are taking low-dose lithium? » floatingbridge, posted by SLS on May 17, 2011, at 8:35:48
> > Scott, are you maintaining at 300-600 mg Li these days?
>
> 300mg seems to be the optimum dosage for me.That's great.
>
> > My doctor is quite a proponent of this, and I imagine, he'd like me back on. Not that he knows everything. The older drugs he knows fairly well enough and called lithium neurogenic.
>
> It certainly appears to be. Everywhere you turn, they are discovering something new about the actions of lithium. Linkadge has contributed a great deal to PB on the properties of lithium. If you want to learn more, search for Manji, an investigative psychopharmacologist specializing in the study of lithium.
>
>Thanks. I will.
Have a good morning, please.
fb
> - Scott
>
>
Posted by SLS on May 17, 2011, at 8:47:14
In reply to Re: How many are taking low-dose lithium?, posted by floatingbridge on May 17, 2011, at 8:40:59
> Have a good morning, please.Thanks. I will.
- Scott
Posted by dragonblack on May 17, 2011, at 14:47:51
In reply to Re: Regular Lithium: better than ER... » dragonblack, posted by SLS on May 17, 2011, at 4:31:25
> > > I'm new to lithium, I've only been on it for 2 months, but I've been reading a lot about it. While titrating up, I've concluded that, for myself, I think I will be sticking with the regular form, rather than seeking the ER form, as well as once nightly dosing, regardless of doseage, as long as I can tolerate it.
> > >
> > > Jim Phelps's site makes mention of single dosing resulting in a slight reduction in the risk of kidney problems. I also came across a medical text in google books (can't remember what) which reviewed Lithium studies and advocated once nightly dosing. The reasons stated were: 1) compliance was increased over split dosing, while preserving the mood stabilizing effect; 2) side effects were mitigated by virtue of the fact that peak plasma levels occurred in subjects' sleep, side effects were heaviest in the morning, a more "convenient" time, for most people, and thereafter lessened in severity during the day. 3) Finally, with once daily dosing, there is a reduced incidence of kidney problems, likely stemming from the fact that there is a window of time prior to the next dose (18-24 hours after a nightly dose) during which the kidneys get a reprieve, and such "rest" does not occur with split dosing.
> >
> > I meant to add to this that the authors also specifically identify regular lithium as requisite for the "give the kidneys a rest" strategy, as the ER form, like split dosing, doesn't give you the needed rest window. Naturally, some tolerate the ER form better and that may trump other concerns. If one tolerates the regular form, though, it seems to me that this idea is compelling and makes a lot of sense to me.
>
>
> I often wonder if statements like this are nothing more than one's own theory rather than an evidence-based prescription. Did the authors support their contention with empirical studies? Perhaps the best way to verify it is to do retrospective studies of human dosing behaviors and their association with thyroid or kidney function. To do a prospective study would take years. Maybe one already exists.
>
> This is a very important issue to me that I should explore more thoroughly. Reading is still difficult for me, though. I apologize if I missed something.
>
>
> - ScottWell, ideally I would recall where I read this. Failing this, here's another source that states that once daily dosing reduces the incidence of adverse renal effects relative to split dosing.
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