Posted by Chloe on May 25, 2002, at 21:50:31
In reply to Re: Lithium appointment - combined doses? » Chloe, posted by Ritch on May 25, 2002, at 19:00:49
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>> Hi Chloe,
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>> When I first started lithium back in 1979, the doctor *told* me to take all of it at once midday (3x 300mg tabs). It was those green Lithane tabs that dissolve in your mouth half of the time before you can swallow them, yuck! He was wanting to see how I would react to a strong punch of it at once. I handled it OK, but it didn't take long before it started giving me diarrhea (at all times of the day). Then, I went to Lithobid 300mg tabs after that. I would take two at bedtime (600mg), and then take one midday (300mg with lunch). I was on that for a couple of years and then they wanted to boost the dose upupup. I was up to 1800mg/day (600mg 3x daily), then went downdowndown to 600mg (two 300mg lithobid tabs that I took 12 hrs apart). We found that 600mg seemed to be about as good as any other higher dose. Then I went down to 450mg (Eskalith CR), and then finally to just 300mg of (Eskalith IR capsules) at bedtime. The first thing that happened to me before I got off lithium and on anticonvulsants was the hypercalcemia. It wasn't (serum calcium) that high-I think my blood level was around 11.0. The top of "normal" I think is right around 10 or 10.5. The doctor immediately thought it was my *para*thyroid glands that were involved (they regulate calcium in your body). That checked OK, then he thought it might be my kidneys-well that checked OK, too. Did another serum calcium and it was within normal range. ???? Anyhow, I switched from lithium to depakote later that year (and my depression got worse!, but the depakote worked better for everything else the lithium seemed to help-grouchiness-cycling). The thyroid tumor happened two years later (I had been on depakote for 1 1/2 years by then). I was tinkering about with several other meds just before it (the tumor) happened. I was on some Seroquel just before it got discovered. If you read Seroquel's insert it mentions that it can significantly lower TSH levels (or free T4, whatever-I can't remember now). So lithium may have had nothing to do with the thyroid thing. Also my Mom had thyroid cancer, so there is a genetic link. If you look at monographs of the older drugs (lithium, TCA's, etc.), they REALLY look scary. I think a lot of that is primarily due to the wealth of accumulated experience with the medicine. I would bet that a lot of the *newer* stuff around might look equally scary 10-20 years from now. So... in IMO, I wouldn't worry too much about when and how often you take it. If it *works* better and is more convenient for you to take it all at bedtime-that's what I would do. If it seems that you get more benefit from dividing the dose-I would do that.Very interesting, Mitch. I guess the switch was a to Depakote was a good thing. Easier on your gut, kidneys, thyroid and it works better for you!
> >So, you are getting tired and grouchy? If you think an increase would help (lithium), just ask your doctor. I think you are at 450mg/day? So, you are thinking about going from 450mg/day of Eskalith CR to 1 1/2 tabs to 675mg/day? You could try that for a while and see if it helps. If not, you can always back it down again. I think I mentioned this to you before-but do you think your diazepam might be worsening your depression? It definitely made mine worse, and it also made me very grouchy (the worst thing about that particular benzo for me was the loss of impulse control-as in punching people). I think you said that clonazepam made you too tired, right? Just floating some ideas about... I am thinking about asking my pdoc about switching from clonazepam to lorazepam sometime. When I took it a long time ago it didn't seem to make me feel depressed and I definitely didn't get grouchy. The main reason I am thinking about switching is that lorazepam is probably more "liver friendly" than the other benzos (and it also works real well for panic).Mitch, are you having probs with panic attacks now? Ativan clearly does kick in faster, and I think you can take it sublingually. But you will have gaps or have to carry it with you and take it more often...Or is this mainly to protect liver?...
Aren't our livers beyond repair after decades of these meds? Mine must be! Sorry, gallows humor :(I am only at 225 mgs of Li CR (600 neurontin, 250 depakote, 10 valium) at the moment. I am finally getting some relief from neuropathy and dryness, and everytime I adjust a dose of li or neurontin, I get an awful burn for about a week. It really takes a toll on me...I fear all the my *remaining* hair is going to come out, since I can hardly brush it, and it just sheds and sheds...I am sure my pdoc would go for it, but I am going to wait a few more days...And for grouchiness, she often wants to increase valium. I do NOT think this is a solution...But she thinks 10 mgs is a low dose. I think it's adequate+ and occassional 2.5 mg prn.
In terms of the benzos, my pdoc had me first on Ativan, which I felt jazzed up when I took it. No sedative, or antianxiety effect at all. Then we tried Xanax. Really bad reaction to that one. I was living in a tall apartment building in my college city at the time. After one dose of Xanax, I was hanging out the ledge of the windowing thinking it was really funny...If I have fallen it would have been a mortal fall, but I was having so much fun! And I wasn't suicidal.
So, ever since then it's been Valium. And it has always worked well for me. It's vital when I get into pms or psychotic rages (esp. in the absence of AP's). I wish my pdoc would switch me to Klonopin, though. The stigma attached to valium is really hard for me to deal with. I am very uncomfortable about it, but pdoc says, if anyone, ie my GP or GYN has a problem with it, have them call her. So valium it is.
Thanks
Chloe
poster:Chloe
thread:107313
URL: http://www.dr-bob.org/babble/20020525/msgs/107614.html