![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Roslynn on March 17, 2012, at 9:02:05
Hi Scott,
I am sorry to bother you again. Just have a question..I had reduced my lithium from 600mg to 300mg, about 3 or 4 weeks ago. At the same time, I am increasing my anafranil and I am on day 6 of my increase from 50mg to 75mg. I am feeling irritable w/a somewhat lower mood, less energy and wanting to sleep more. How do I know if this is maybe a "rebound" and my body adjusting to the lower lithium, or am I starting to relapse? Thank you for any thoughts on this.
I hope you are still doing ok.
Thank you,
Roslynn
Posted by SLS on March 17, 2012, at 13:01:17
In reply to To SLS: lithium question please, posted by Roslynn on March 17, 2012, at 9:02:05
Hi Roslynn.
> Just have a question..I had reduced my lithium from 600mg to 300mg, about 3 or 4 weeks ago. At the same time, I am increasing my anafranil and I am on day 6 of my increase from 50mg to 75mg. I am feeling irritable w/a somewhat lower mood, less energy and wanting to sleep more. How do I know if this is maybe a "rebound" and my body adjusting to the lower lithium, or am I starting to relapse? Thank you for any thoughts on this.
My initial reaction is to say that you are not experiencing a rebound depression due to a decrease in lithium dosage. Too much time has passed since you made the change. It is possible that you are experiencing side effects from the increase in Anafranil dosage. Unfortunately, it would be difficult to be certain that you are not relapsing at this juncture. You should have a better idea during this next week as you might see a more obvious trend in how you are feeling. It does resemble relapse, but give things a bit more time. You might need to increase the lithium or perhaps look to Lamictal as an augmenter to treat depression. Are you experiencing more anxiety than usual?
What is your diagnosis?
How did you come upon being treated with lithium?
What was your maximum dosage of lithium?
In what ways did lithium help you?
Why did you reduce the dosage of lithium?
What dosage of Anafranil does your doctor plan to make the target?
- Scott
Posted by phidippus on March 17, 2012, at 21:06:10
In reply to To SLS: lithium question please, posted by Roslynn on March 17, 2012, at 9:02:05
You lowered your Lithium too much and have raised your Anafranil to a therapeutic level. The increased irritability/mixed mood are symptoms of your bipolar disorder. I would go back up on the Lithium.
I was able to sustain 150 mg of Anafranil while taking 1200 mg of Lithium. I also took Invega to further stabilize my mood.
Eric
Posted by SLS on March 17, 2012, at 21:51:49
In reply to Re: To SLS: lithium question please » Roslynn, posted by phidippus on March 17, 2012, at 21:06:10
> You lowered your Lithium too much and have raised your Anafranil to a therapeutic level. The increased irritability/mixed mood are symptoms of your bipolar disorder. I would go back up on the Lithium.
It might be important to ascertain why lithium was chosen as a treatment in the first place and why its dosage was subsequently reduced. In the absence of undesirable side effects, toxicity, or serotonin syndrome, returning to the higher dosage of lithium seems logical.
> I was able to sustain 150 mg of Anafranil while taking 1200 mg of Lithium. I also took Invega to further stabilize my mood.So, you are bipolar and OCD? I apologize for not remembering this.
My only other comment at this point is that 75 mg of clomipramine might not be therapeutic. If it is tolerated at 75 mg and it does not produce a therapeutic response, I think it would be reasonable to continue titrating up to 150 mg. The waiting is the hardest part.
- Scott
Posted by Roslynn on March 19, 2012, at 16:21:07
In reply to Re: To SLS: lithium question please » Roslynn, posted by SLS on March 17, 2012, at 13:01:17
Dear Scott,
Thank you so much for helping me figure this out!
> My initial reaction is to say that you are not experiencing a rebound depression due to a decrease in lithium dosage. Too much time has passed since you made the change. It is possible that you are experiencing side effects from the increase in Anafranil dosage. Unfortunately, it would be difficult to be certain that you are not relapsing at this juncture. You should have a better idea during this next week as you might see a more obvious trend in how you are feeling. It does resemble relapse, but give things a bit more time. You might need to increase the lithium or perhaps look to Lamictal as an augmenter to treat depression. Are you experiencing more anxiety than usual?
Scott, I agree with what you say above. I think I am going to ask my pdoc to raise me back up to 450mg using an additional script of Li 150mg ER to add to my lithobid 300mg.
To answer your questions, I am experiencing more panic than usual. Oh, and I have tried lamictal which gave me more cognitive problems than any other drug ever.
> What is your diagnosis?
I have atypical depression. Most of the pdocs I've seen do not think I have bipolar.
> How did you come upon being treated with lithium?In the late 80s, I took it to boost prozac. This was successful.
> What was your maximum dosage of lithium?
Can't get above 600 now, though in 1989 I apparently got up to 900mg, but was a lot younger then.
> In what ways did lithium help you?
It may stop my mood from sliding down too far. Hard to tell without going off it completely, but I can't risk that.
> Why did you reduce the dosage of lithium?
Trying to increase my cognitive abilities by taking less meds. Also weight gain...
> What dosage of Anafranil does your doctor plan to make the target?I don't know. In the past I had a hard time tolerating anything about 50mg.
Thank you!
Roslynn
Posted by Roslynn on March 19, 2012, at 16:24:36
In reply to Re: To SLS: lithium question please » Roslynn, posted by phidippus on March 17, 2012, at 21:06:10
Hi Eric,
I'm in agreement with what you said, and I think I have to increase the lithium back up.
I don't really have bipolar though..this is weird...don't know what's going on in my brain.
Thanks so much for providing your input!
Roslynn
> You lowered your Lithium too much and have raised your Anafranil to a therapeutic level. The increased irritability/mixed mood are symptoms of your bipolar disorder. I would go back up on the Lithium.
>
> I was able to sustain 150 mg of Anafranil while taking 1200 mg of Lithium. I also took Invega to further stabilize my mood.
>
> Eric
>
Posted by Roslynn on March 19, 2012, at 16:31:48
In reply to Re: To SLS: lithium question please, posted by SLS on March 17, 2012, at 21:51:49
Hi Scott,
>It might be important to ascertain why lithium was chosen as a treatment in the first place and why its dosage was subsequently reduced. In the absence of undesirable side effects, toxicity, or serotonin syndrome, returning to the higher dosage of lithium seems logical.
The pdocs keep using lithium to try and augment my other meds.
> So, you are bipolar and OCD? I apologize for not remembering this.I have atypical recurrent MDD, no OCD though I had it as a child. Bipolar runs in my family but my current pdoc doesn't think I'm bipolar.
> My only other comment at this point is that 75 mg of clomipramine might not be therapeutic. If it is tolerated at 75 mg and it does not produce a therapeutic response, I think it would be reasonable to continue titrating up to 150 mg. The waiting is the hardest part.
>
I have a hard time tolerating it about 50mg..I was hoping if I reduced my lithium I could tolerate more clomipramine...Thanks,
Roslynn
Posted by SLS on March 19, 2012, at 17:16:20
In reply to Re: To SLS: lithium question please » SLS, posted by Roslynn on March 19, 2012, at 16:31:48
> The pdocs keep using lithium to try and augment my other meds.You do what works. I am finding lithium 300 mg helpful. Going up any higher in dosage does not bring a greater therapeutic effect, only undesirable side effects. Lithium at a dosage of 450 mg/day is what the research team at Harvard found was the most common effective dosage to augment antidepressants. They used Prozac as the antidepressant.
> > So, you are bipolar and OCD? I apologize for not remembering this.
Sorry. I meant that to be a question for Phiddipus.
> I have atypical recurrent MDD, no OCD though I had it as a child. Bipolar runs in my family but my current pdoc doesn't think I'm bipolar.
Based upon you family history, it is likely that you have a soft bipolar presentation. You might not ever get manic, but your depression might respond better to drugs known to help in bipolar disorder.
Do you recall what dosage of Lamictal you were taking when you experienced the cognitive side effects? Did it help with depression?
What is it about clomipramine that you have a difficult time tolerating?
- Scott
Posted by phidippus on March 19, 2012, at 20:43:01
In reply to Re: To SLS: lithium question please » phidippus, posted by Roslynn on March 19, 2012, at 16:24:36
it might do you some good to clarify with your doctors whether you are bipolar or not.
If going back up on the Lithium helps, the chances of you being bipolar are greater.
Eric
Posted by Roslynn on March 20, 2012, at 16:37:49
In reply to Re: To SLS: lithium question please » Roslynn, posted by phidippus on March 19, 2012, at 20:43:01
> it might do you some good to clarify with your doctors whether you are bipolar or not.
>
> If going back up on the Lithium helps, the chances of you being bipolar are greater.
>
> EricThanks Eric, I don't know why the pdocs can't decide on my diagnosis. One of them said definitely bipolar, now my current doc does not think so, although after my reaction to the lithium reduction during the last few days he may start to think differently.
Thanks
Roslynn
Posted by Roslynn on March 20, 2012, at 16:45:47
In reply to Re: To SLS: lithium question please » Roslynn, posted by SLS on March 19, 2012, at 17:16:20
Hi Scott,
Just to respond to your points...
> Lithium at a dosage of 450 mg/day is what the research team at Harvard found was the most common effective dosage to augment antidepressants. They used Prozac as the antidepressant.
My pdoc last night said he would write a script for Eskalith 450mg, though I have since found out it is not covered by my insurance so I will have to go with one of the generic lithium carbonate ER forms.
> Based upon you family history, it is likely that you have a soft bipolar presentation. You might not ever get manic, but your depression might respond better to drugs known to help in bipolar disorder.
I am starting to think so too.
> Do you recall what dosage of Lamictal you were taking when you experienced the cognitive side effects? Did it help with depression?
Only 25mg lamictal. I couldn't read clearly; I was reading "11:00" as "1:00". It was really weird. I never felt any relief of my depression symptoms from it.
> What is it about clomipramine that you have a difficult time tolerating?
When I try to go above 50mg clomipramine I get a weird sensation in my head, sort of like lightheadness although it feels "heavier." Almost like dizziness.
Thank you for listening!
Roslynn
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.