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Dr. Bob is Robert Hsiung, MD,
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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.
Posted by dragonblack on May 17, 2011, at 14:50:46
In reply to Re: Regular Lithium: better than ER... » dragonblack, posted by SLS on May 17, 2011, at 4:40:09
> > > 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.
>
>
> - ScottIt's pretty complicated, and I could expound at length on my theories regarding alcohol use and abuse and my newfound lithium effect. I'll spare you that... : )
Thanks - and I hope you are finding/having some success of your own.
Posted by SLS on May 17, 2011, at 15:30:54
In reply to Re: Regular Lithium: better than ER..., posted by dragonblack on May 17, 2011, at 14:50:46
> It's pretty complicated, and I could expound at length on my theories regarding alcohol use and abuse and my newfound lithium effect. I'll spare you that... : )
Please don't. I would be very interested to know about your theories.
- Scott
Posted by dragonblack on May 17, 2011, at 18:59:30
In reply to Re: Regular Lithium: better than ER... » dragonblack, posted by SLS on May 17, 2011, at 15:30:54
> > It's pretty complicated, and I could expound at length on my theories regarding alcohol use and abuse and my newfound lithium effect. I'll spare you that... : )
>
> Please don't. I would be very interested to know about your theories.
>
>
> - ScottHmm. Well, when it comes to neurochemistry and psychopharmacology, I know just enough to appear knowledgeable to the clueless and a fool to the clued-in (read: SLS and assorted PB friends). You are right regarding genetics; the incidence of substance abuse in the general population is 7%; among bipolar it is >61%. According to Fredrick Goodwin, coauthor of the physicians desk reference on bipolar, alcoholism and bipolar are almost certainly genetically linked.
It seems to me, however, that in rough terms alcohol essentially causes an increase in serotonin and gaba levels, the latter being the source of its cns depressant status. For a long term drinker, this specific serotonin/gaba cocktail is a biochemical signature that one seeks, psychologically and maybe even physically. Now, it may just be, as you say, that this seeking is garden variety self-medicating, and that by treating the mood disorder and/or depression with lithium, one neednt continue to self-medicate in the old way. I must say, though, it feels far more specific to me. Ive been on other mood stabilizers, and Ive managed to stop cycling before, yet nothing mirrored this effect. Ive also successfully treated my depression in the past, yet never with any effect on my desire to drink. I wonder if lithiums effects on serotonin and glutamate somehow displace or mimic or blunt the effect of that serotonin/gaba cocktail that the drinker seeks out.
This idea that lithium treats alcoholism isnt new orotate is touted for this specifically, but the medical literature refutes it (though its been studied repeatedly, so someone thought it worth testing). I came across an anecdotal account of a woman on askapatient.com that was very similar she said that on lithium she all of a sudden found alcohol repulsive and stopped drinking. I dont find it repulsive so much as I feel completely indifferent to it, and the idea of drinking seems very weird to me, almost like I cant imagine doing it. Maybe its just the case that a subset of people have this response. That the makers or orotate actually market it for this purpose makes me wonder if there isnt a substantial fraction of mood disorder sufferers who will experience this effect on lithium, though not large enough to be vindicated in clinical trials with a verdict that lithium treats alcoholism.
I also wonder if theres anything to the idea that we might be experiencing a certain visceral repulsion to a diuretic with lithiums effects on thirst and electrolytes, and the dehydrated hangover awakening state that the long term drinker knows so well, I wonder if there isnt an (almost) immunological push to avoid that which severely dehydrates. (Then why didnt you give up coffee, you ask? For long-term caffeine users, typical daily doses cease to be diuretic to a meaningful extent (beyond water). Only for novices is caffeine a true diuretic.)
I could go on, but at this point my thoughts become all about how Ive responded to various things in the past, and then its just me, me, me. Ill keep this part of the dialogue internal.
Posted by dragonblack on May 17, 2011, at 19:04:21
In reply to Re: Regular Lithium: better than ER..., posted by dragonblack on May 17, 2011, at 18:59:30
All my hyphens disappeared... : (
This was totally way more smart and accurate with the hyphens, trust me.
Posted by floatingbridge on May 17, 2011, at 19:18:12
In reply to Re: Regular Lithium: better than ER..., posted by dragonblack on May 17, 2011, at 19:04:21
db, reads fine to me :-) Thanks for taking the time to write out your thinking. I have friends and fsmily in recovery whether AA, NA, or going solo.
fb
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