Psycho-Babble Medication Thread 1115968

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Lithium levels

Posted by Markwell on July 14, 2021, at 10:37:45

I am currently on 900 mgs of lithium for BPD. I am currently 65 years old and have been on this amount for 5 years. I am afraid of developing a kidney issue as I age and continue on this dose. The lithium has been effective for me and I do horribly with AP's. One doctor suggested dosing once in the evening to help the kidneys. I also read where patients over 65 can use less dosage. Any thoughts or insights?
Mark

 

Re: Lithium levels

Posted by linkadge on July 14, 2021, at 11:53:58

In reply to Lithium levels, posted by Markwell on July 14, 2021, at 10:37:45

Are blood tests indicating any issues with your kidneys? Many patients can take lithium long term without any serious kidney issues.

What are your blood levels of lithium? Have they changed?

There is some evidence that once daily dosing is a bit easier on the kidneys, so it might be worth considering. If there is any kidney impairment, this may lead to higher lithium levels allowing for a lower dose.

If your kidneys are fine and your blood levels are fine I see no reason why to make any adjustments.

Linkadge

 

Re: Lithium levels

Posted by Markwell on July 14, 2021, at 16:19:33

In reply to Re: Lithium levels, posted by linkadge on July 14, 2021, at 11:53:58

I'm getting blood levels next week. This may be helpful. I'm concerned because I'm 65 years old, I've been on lithium for 5 years and I'm experiencing lower back pain.
Mark

 

Re: Lithium levels

Posted by linkadge on July 14, 2021, at 18:14:22

In reply to Re: Lithium levels, posted by Markwell on July 14, 2021, at 16:19:33

If a blood test is not indicating any issues with the kidneys, then the lower back pain likely has nothing to do with your kidneys.

My mother took lithium for over 40 years. She was very overweight and had diabetes. Yet, after all this time there was only evidence if 'mildly' decreased kidney function.

The question is whether the lithium is working for you. 5 years on lithium is nothing compared to the typical duration. Many people take this medication for decades without any major issues.

Linkadge

 

Re: Lithium levels

Posted by Markwell on July 14, 2021, at 20:53:22

In reply to Re: Lithium levels, posted by linkadge on July 14, 2021, at 18:14:22

Thanks Linkadge for your helpful response.
Mark

 

Re: Lithium levels Markwell

Posted by SLS on July 15, 2021, at 9:58:13

In reply to Lithium levels, posted by Markwell on July 14, 2021, at 10:37:45

> I am currently on 900 mgs of lithium for BPD. I am currently 65 years old and have been on this amount for 5 years. I am afraid of developing a kidney issue as I age and continue on this dose. The lithium has been effective for me and I do horribly with AP's. One doctor suggested dosing once in the evening to help the kidneys. I also read where patients over 65 can use less dosage. Any thoughts or insights?
> Mark


What dosage of lithium do you take?

Your doctor is right about taking one dose at night.

Kidney issues are dosage-dependent. If you are not sure what the minimum dosage of lithium that produces the same degree of improvement you have now, you can SLOWLY titrate downward.

Have regular blood tests for kidney and thyroid function. This should prevent damage and ease your mind.

Can you describe your symptoms? Any mania at all? Any rapid cycling? When you were ill, was morning the worst time of day for you? What about early-morning awakenings? Psychomotor retardation? Constant melancholic thoughts?

All in all, depending on your current dosage, I think you should stay on lithium at and follow up with regular blood tests if you are concerned - which you should be.

If bipolar depression is your only problem, you can consider substituting lamotrigine for lithium. If you experience a mild response or a brief strong response to lamotrigine alone, I would then begin trialing antidepressants. Avoiding antidepressants to treat bipolar depression is a school of thought that should be buried.

If mania is a persistent problem, valproate (Depakote) or oxcarbazepine (Trileptal) should be considered. , probably should be a consideration. Levetiracetam (Keppra)is a strange one. It was studied, perhaps 20 years ago, for bipolar disorder. It was reported to treat rapid-cyclicity, but I don't know what follow up work has been done since.

Unfortunately, lithium sometimes displays "lithium-induced lithium refractoriness". That's a fancy term. Simply put, when someone who was kept well for many years on lithium discontinues it, it doesn't work when it is restarted to treat a relapse. That happened to a friend of mine. She was in remission of 8 years on lithium alone. When a new doctor had her stop taking it, she relapsed into depression three weeks later. Restarting Lithium didn't work at all. She has been treatment resistant for at least 30 years.

https://www.google.com/search?q=%22lithium-induced+lithium+refractoriness

If you indeed have Unipolar Major Depression, you might think about trying to lower your dosage of lithium (gradually) to 300-450 mg/day and ignore blood levels. Lithium displays a bimodal (biphasic) response. At low dosages, it helps with depression without helping mania. At higher dosages, it helps mania, but can make depression worse. Perhaps not so coincidentally, lithium displays a bimodal pattern for regulating glutamate levels. Low dosages inhibit glutamate activity while high dosages increase it. My own experience with lithium bipolar depression reflect this bimodal behavior. 300 mg/day. 450 mg/day produces dysphoria, emotional numbing, and apathy.

I hope this was helpful.


- Scott

 

Re: Lithium levels SLS

Posted by undopaminergic on July 15, 2021, at 11:52:02

In reply to Re: Lithium levels Markwell, posted by SLS on July 15, 2021, at 9:58:13

Informative post, SLS. Thanks.

>
> Unfortunately, lithium sometimes displays "lithium-induced lithium refractoriness". That's a fancy term. Simply put, when someone who was kept well for many years on lithium discontinues it, it doesn't work when it is restarted to treat a relapse. That happened to a friend of mine. She was in remission of 8 years on lithium alone. When a new doctor had her stop taking it, she relapsed into depression three weeks later. Restarting Lithium didn't work at all. She has been treatment resistant for at least 30 years.
>
> https://www.google.com/search?q=%22lithium-induced+lithium+refractoriness
>

They say this happens with antipsychotics, especially clozapine. And I've heard of it happening with antidepressants.

-undopaminergic

 

Re: Lithium levels Markwell

Posted by SLS on July 15, 2021, at 21:57:41

In reply to Lithium levels, posted by Markwell on July 14, 2021, at 10:37:45

What I wrote is confusing.

If you take lamotrigine and benefit from it, keep taking it while you trial antidepressants.

Sorry,


- Scott

 

Re: Lithium levels - Additional thinking.

Posted by SLS on July 16, 2021, at 8:38:38

In reply to Lithium levels, posted by Markwell on July 14, 2021, at 10:37:45

I'm sorry, for posting again, but I thought of a better way to navigate reducing lithium and adding lamotrigine:


1. Leave your dosage of lithium alone and *add* lamotrigine 200-300 mg/day. If you feel the same or better with lamotrigine and experience minimal side effects, you can then try:

2. Reducing the dosage of lithium gradually, if or until you reach a dosage that causes you to deteriorate into depression. If you relapse, you would still be on lithium, so I doubt you would risk losing any effectiveness. However, you would want to return to a higher dosage of lithium immediately, although somewhat gradually. Titrate at a rate that will allow you to find the lowest effective dosage.

3. If you get no side effects from the lamotrigine, leave it in place and try . Often, mild memory and cognitive impairments appear early in lamotrigine treatment, but will probably disappear with continued use.


- Scott

 

Re: Lithium levels

Posted by PeterMartin on November 22, 2021, at 13:00:15

In reply to Lithium levels, posted by Markwell on July 14, 2021, at 10:37:45

> I am currently on 900 mgs of lithium for BPD. I am currently 65 years old and have been on this amount for 5 years. I am afraid of developing a kidney issue as I age and continue on this dose. The lithium has been effective for me and I do horribly with AP's. One doctor suggested dosing once in the evening to help the kidneys. I also read where patients over 65 can use less dosage. Any thoughts or insights?
> Mark

There's a new study (Sept '21), which found Metformin attenuates kidney damage caused by Lithium in rats. Based on Metformin's track record it's likely that it would also help in humans.

Metformin is very cheap, and pretty easy to get prescribed. It has a lot of benefits and is pretty tolerable. I still take a small amount (500mg) to prevent antipsychotic weight gain, and for neuroprotective effects.

If I were you I'd ask your doctor to consider it.

https://europepmc.org/article/med/34595852

Protective effect of metformin on lithium-induced nephrogenic diabetes insipidus: An experimental study in rats.

Abstract

Background
Lithium is widely used in the treatment of bipolar disorders and may lead to nephrogenic diabetes insipidus (NDI), following long-term treatment. Metformin is considered the preferred initial therapy for patients with type 2 diabetes mellitus (T2D).

Objectives
To investigate the protective effect of metformin on the kidney damage caused by lithium administration.

Material and methods
Using an animal model of chronic lithium-induced NDI, rats were divided into 4 groups: sham, metformin, lithium, and lithium + metformin. The effects of these treatments were examined using serum electrolytes, blood and tissue total antioxidant status, total oxidant status, the oxidative stress index, urine and blood osmolality, and tissue aquaporin-2 (AQP2) levels. Additionally, histopathological changes, including congestion, hydropic swelling, tubular necrosis, tubular atrophy, and Bowman's capsule dilatation, were evaluated. The total histopathological score was obtained by summing the scores for each pathological finding.

Results
In the lithium group, biochemical variables indicating NDI, including sodium, chloride and blood osmolality, increased, and urine osmolality decreased, compared to the sham group. With metformin treatment, the blood osmolality decreased from 328.17 mOsm/kg to 306.33 mOsm/kg, and urine osmolality increased from 349.67 mOsm/kg to 754.50 mOsm/kg (p = 0.004 and p = 0.001, respectively). Tissue AQP2 levels decreased with lithium administration but stabilized with metformin treatment. Additionally, in comparison to the lithium group, the total histopathological score in the metformin group declined from 8.0 to 2.0 (p = 0.002).

Conclusions
Metformin may help protect the kidneys from lithium-induced NDI through the AQP2 regulating effect and a reduction in oxidative stress.


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