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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Denise528 on March 24, 2002, at 11:33:28
Hello,
I am currently taking 60mg of prozac (which doestn't seem to be doing anything) and 600mg of lithium which doestn't seem to be doing anything either, although I am no longer agitated I feel flat, tired, depressed, sick and morose. I was wondering if maybe increasing the lithium would help, I'm not sure what to do, whether to increase it or ditch it. I've been taking the lithium for about 3 weeks now.
I was wondering if anyone out there had had little response on a small amount of lithium only to up the dose and then find it suddenly worked.
Alternatively should I up the Prozac.Note, I am aware that you have to be careful with lithium and have blood levels checked so won't be doing anything stupid.
Denise
Posted by BarbaraCat on March 24, 2002, at 16:03:26
In reply to Should I increase my lithium?, posted by Denise528 on March 24, 2002, at 11:33:28
Denise,
What do your blood results say? Are you in the therapeutic range for lithium? That would be my first line of approach in increasing it or not. When my Remeron gave out, 200 mg was enough to give it zip. Now I'm up to 300 mg and that is enough for a good response.When you say sick, do you mean a bodily sick feeling? The very interesting info I've learned from this board is that not everyone gets bodily somatic symptoms, especially feeling 'sick', with their mood disorders. I have a number of metabolic dysfunctions, i.e., hypothyroidism and fibromyalgia that contribute to my depressive disorder. I get extremely sick and non-responsive to meds if I'm not FIRST attending to the hypothyroid and fibromyalgia conditions. This is probably old news to you, but I felt the need to state that there might be a physical reason you're having such a painful time. - Barbara
Posted by Denise528 on March 26, 2002, at 14:02:19
In reply to Re: Should I increase my lithium? » Denise528, posted by BarbaraCat on March 24, 2002, at 16:03:26
Hello,
Thanks for the advice, to answer your question, no I haven't had my blood levels checked but I am currently taking 600mb of Lithium and my gut feeling is (apart from sick) that it is not working so I reckon I will probably stop the lithium. The zyprexa seems to be helping anyway. I have had my thyroid checked out and I am 1.4 which I believe is well within the normal range, I was really disappointed when I found out, I'd give anything for this to be a physical problem (rather than mental). I'm not sure about fibromyalgia. What is that exactly?
Denise
Posted by BarbaraCat on March 26, 2002, at 15:06:07
In reply to Re: Should I increase my lithium?, posted by Denise528 on March 26, 2002, at 14:02:19
Hi Denise,
I'd trust your instincts on the lithium. You ask what is fibromyalgia? It's very similar to chronic fatigue syndrome and, like chronic fatigue, is a disorder of exclusion, meaning that once every other disorder is checked out (lupus, MS, rheumatoid arthritis) then your symptoms are labled 'fibromyalgia'. It primarily strikes caucasian women and the symptoms are all very similar: a deep muscle ache and tender points, stiffness especially upon arising (sometimes I have to crawl to the bathroom), insomnia, severe fatigue, cognitive problems, inability to handle stress. Depression and anxiety are very frequent but not always present.
I always have some of these symptoms present, but when I undergo a 'flare' (2-3 times a year each lasting 2-4 weeks) all these symptoms become orders of magnitute worse. I become very debilitated, in bad pain, depleted, sick, feel a cellular toxicity, bedridden, despairing and severely depressed. The depression and despondency of ever having a life are the worst of all of these symptoms. I recently went through one of these flares in December through late Jan and this time it became crystal clear that I was really and truly physically sick and needed more than antidepressants, although I seem to require them. I'm applying for Social Security because I can't work - never know when I'm going to be wiped out. Plus I have BPII, which is a chicken and egg question as to what causes what.
At the present time, there's no cure for it, but it's finally become recognized as a true disorder, most likely metabolic, and alot of research is underway. Some theories strongly suggest that too much Substance P is getting made. This is an enzyme-like substance that aids in transmittal of pain signals to the brain along the spinal column. It's also implicated in depression and there are a few AD drugs in the pipeline that are targeted at inhibiting it.
Glad you're feeling a little better from the Zyprexa. - Barbara
> Hello,
>
> Thanks for the advice, to answer your question, no I haven't had my blood levels checked but I am currently taking 600mb of Lithium and my gut feeling is (apart from sick) that it is not working so I reckon I will probably stop the lithium. The zyprexa seems to be helping anyway. I have had my thyroid checked out and I am 1.4 which I believe is well within the normal range, I was really disappointed when I found out, I'd give anything for this to be a physical problem (rather than mental). I'm not sure about fibromyalgia. What is that exactly?
>
> Denise
Posted by Zo on March 26, 2002, at 17:05:24
In reply to Lithium and what is fibro » Denise528, posted by BarbaraCat on March 26, 2002, at 15:06:07
You know what, BCat, two years on Neurontin seems to have cured my FM muscle pain and headaches. I've been off it for more than a year now. . with only the merest suggestion of a flareup all winter.
Zo
Posted by BarbaraCat on March 26, 2002, at 17:26:44
In reply to Re: Lithium and what is fibro » BarbaraCat, posted by Zo on March 26, 2002, at 17:05:24
Zo,
Is that so? Do you have any idea how it works? I heard a passing remark from my regular doc about this, but never heard of anyone who actually had a success on it. Can you give me more details? Do you still have the generic fibro symptoms but no flareups? Why were you prescribed it in the first place, how much did you take and why did you stop? Also, any clues as to where your ADD fits into all this? You've been a source of alot of good info for me. Thanks! - BCat> You know what, BCat, two years on Neurontin seems to have cured my FM muscle pain and headaches. I've been off it for more than a year now. . with only the merest suggestion of a flareup all winter.
>
> Zo
Posted by Zo on March 26, 2002, at 18:07:58
In reply to Neurontin and fibro » Zo, posted by BarbaraCat on March 26, 2002, at 17:26:44
Neurontin is a specific for neuropathic pain, among others, and is widely used for FM. It's just tough for some to tolerate ramping up to the pain-free dose--in my case, I was fortunate that two years seemed to provide a cure. I still have tender points, but all the rest is gone. I did do some powerful bodywork too along the way--Tragerwork. The muscles needed help letting go, after so many years. I stopped to see if it was still needed, because I thought it was perhaps too relaxing. It wasn't, but then the pain didn't return, and I went on to something else for sleep, I forget what.
See my other posts to you, if you can find them
It's good to have someone else make use of my experience!
Zo
I'n not sure by what you mean by ADD dx fitting in.
Posted by BarbaraCat on March 26, 2002, at 18:28:34
In reply to Re: Neurontin and fibro » BarbaraCat, posted by Zo on March 26, 2002, at 18:07:58
What I meant by where your ADD fits in is have you been able to see a correlation between the fibro and ADD? I have severe depression with anxiety that comes and goes (but always accompanies a fibro flare). I have fibro flares that come and go. And sometimes I'm just peachy, but that is a minority. I often think they are one and the same malfunction and wondered if your mood disorders were tied in any way to the fibro. However, what it's sounding like from you is that the majority of your fibro symptoms were cleared up by neurontin, but the other affective symptoms, alas, remain. I noticed also that you state CFS as one of your remaining dx's. Can you really separate CFS from the fibro? I realize the muscles aren't so implicated in CFS, but geez, the many other symptoms are the same. -
BCat
Posted by OldSchool on March 26, 2002, at 22:35:50
In reply to Should I increase my lithium?, posted by Denise528 on March 24, 2002, at 11:33:28
> Hello,
>
> I am currently taking 60mg of prozac (which doestn't seem to be doing anything) and 600mg of lithium which doestn't seem to be doing anything either, although I am no longer agitated I feel flat, tired, depressed, sick and morose. I was wondering if maybe increasing the lithium would help, I'm not sure what to do, whether to increase it or ditch it. I've been taking the lithium for about 3 weeks now.
>
> I was wondering if anyone out there had had little response on a small amount of lithium only to up the dose and then find it suddenly worked.
>
>
> Alternatively should I up the Prozac.
>
> Note, I am aware that you have to be careful with lithium and have blood levels checked so won't be doing anything stupid.
>
> DeniseNO!! It doesnt work that way. With lithium, you must have blood drawn and get a "lithium level" to see where the levels are. With lithium, the range must be in a very exact spot for it to have a theraputic effect. Too little lithium and you will probably feel like you describe...depressed as dirt, flat, etc. But too high lithium levels and it becomes toxic and can harm you physically. The only way is to have blood drawn, sent to a lab and have your psychiatrist determine whether you need to go to 900 mg or even higher.
Old School
Posted by Denise528 on March 27, 2002, at 10:52:35
In reply to Re: Should I increase my lithium?, posted by OldSchool on March 26, 2002, at 22:35:50
Old School,
Thanks for that advice, I didn't realise I had to get my blood drawn, I spose my psyciatrist hastn't requested I get it drawn because I am such a low dose. However, I'll bear what you said in mind, perhaps I won't give up entirely on the lithium after all.
Denise
Posted by Geezer on March 27, 2002, at 13:48:39
In reply to Re: Should I increase my lithium?, posted by OldSchool on March 26, 2002, at 22:35:50
> > Hello,
> >
> > I am currently taking 60mg of prozac (which doestn't seem to be doing anything) and 600mg of lithium which doestn't seem to be doing anything either, although I am no longer agitated I feel flat, tired, depressed, sick and morose. I was wondering if maybe increasing the lithium would help, I'm not sure what to do, whether to increase it or ditch it. I've been taking the lithium for about 3 weeks now.
> >
> > I was wondering if anyone out there had had little response on a small amount of lithium only to up the dose and then find it suddenly worked.
> >
> >
> > Alternatively should I up the Prozac.
> >
> > Note, I am aware that you have to be careful with lithium and have blood levels checked so won't be doing anything stupid.
> >
> > Denise
>
> NO!! It doesnt work that way. With lithium, you must have blood drawn and get a "lithium level" to see where the levels are. With lithium, the range must be in a very exact spot for it to have a theraputic effect. Too little lithium and you will probably feel like you describe...depressed as dirt, flat, etc. But too high lithium levels and it becomes toxic and can harm you physically. The only way is to have blood drawn, sent to a lab and have your psychiatrist determine whether you need to go to 900 mg or even higher.
>
> Old SchoolOld School is CORRECT as usual.
I am currently at 900mg. Lithium with a Lith. blood level of .55 this blood level is sub-theraputic. I THINK the theraputic range would be .7 to 1.0. I will be increasing Lith. dose to 1200mg. tomorrow (have delayed this a few days to get Lithobid perscription instead of regular Lith. Carbonate prescription from pdoc). I am also taking 1000mg. Depakote - hope to discontinue that gradually if Lith. does the job. May add Lamictal.Geezer
Posted by Ritch on March 27, 2002, at 13:57:27
In reply to Re: Should I increase my lithium?, posted by Geezer on March 27, 2002, at 13:48:39
> > > Hello,
> > >
> > > I am currently taking 60mg of prozac (which doestn't seem to be doing anything) and 600mg of lithium which doestn't seem to be doing anything either, although I am no longer agitated I feel flat, tired, depressed, sick and morose. I was wondering if maybe increasing the lithium would help, I'm not sure what to do, whether to increase it or ditch it. I've been taking the lithium for about 3 weeks now.
> > >
> > > I was wondering if anyone out there had had little response on a small amount of lithium only to up the dose and then find it suddenly worked.
> > >
> > >
> > > Alternatively should I up the Prozac.
> > >
> > > Note, I am aware that you have to be careful with lithium and have blood levels checked so won't be doing anything stupid.
> > >
> > > Denise
> >
> > NO!! It doesnt work that way. With lithium, you must have blood drawn and get a "lithium level" to see where the levels are. With lithium, the range must be in a very exact spot for it to have a theraputic effect. Too little lithium and you will probably feel like you describe...depressed as dirt, flat, etc. But too high lithium levels and it becomes toxic and can harm you physically. The only way is to have blood drawn, sent to a lab and have your psychiatrist determine whether you need to go to 900 mg or even higher.
> >
> > Old School
>
> Old School is CORRECT as usual.
> I am currently at 900mg. Lithium with a Lith. blood level of .55 this blood level is sub-theraputic. I THINK the theraputic range would be .7 to 1.0. I will be increasing Lith. dose to 1200mg. tomorrow (have delayed this a few days to get Lithobid perscription instead of regular Lith. Carbonate prescription from pdoc). I am also taking 1000mg. Depakote - hope to discontinue that gradually if Lith. does the job. May add Lamictal.
>
> GeezerHi,
I thought you were going to play around with Zonegran, what happened? :-) From what I have read over the years about lithium levels .5-1.5 mEQ is used for "short-term acute control" with .6-1.2 mEQ used for "maintenance". There have been some studies showing that maintenance blood levels all the way down to .3 mEQ are effective for some folks. Usually a min. of .45 is a target. FWIW, I found the "subtherapeutic" blood levels to be "therapeutic" for BPII symptoms.
Mitch
Posted by BarbaraCat on March 27, 2002, at 14:24:00
In reply to Re: Should I increase my lithium? » Geezer, posted by Ritch on March 27, 2002, at 13:57:27
Ah, Mitch, my man. Just the post I wanted to see. I just sent off a question to Geezer which you might have read, but I'm interested in info about subtherapeutic levels of lithium and BPII. My level is .5 and it seems to be doing the trick with the Remeron. My pdoc wants me to push it up but I sure don't want to fix anything that ain't broke. I'd much prefer not to deal with the tremors and renal problems from a higher dose. Any of your thoughts on this would be appreciated. - BCat
From what I have read over the years about lithium levels .5-1.5 mEQ is used for "short-term acute control" with .6-1.2 mEQ used for "maintenance". There have been some studies showing that maintenance blood levels all the way down to .3 mEQ are effective for some folks. Usually a min. of .45 is a target. FWIW, I found the "subtherapeutic" blood levels to be "therapeutic" for BPII symptoms.
>
> Mitch
Posted by Geezer on March 27, 2002, at 14:36:02
In reply to Re: Should I increase my lithium? » Geezer, posted by Ritch on March 27, 2002, at 13:57:27
> > > > Hello,
> > > >
> > > > I am currently taking 60mg of prozac (which doestn't seem to be doing anything) and 600mg of lithium which doestn't seem to be doing anything either, although I am no longer agitated I feel flat, tired, depressed, sick and morose. I was wondering if maybe increasing the lithium would help, I'm not sure what to do, whether to increase it or ditch it. I've been taking the lithium for about 3 weeks now.
> > > >
> > > > I was wondering if anyone out there had had little response on a small amount of lithium only to up the dose and then find it suddenly worked.
> > > >
> > > >
> > > > Alternatively should I up the Prozac.
> > > >
> > > > Note, I am aware that you have to be careful with lithium and have blood levels checked so won't be doing anything stupid.
> > > >
> > > > Denise
> > >
> > > NO!! It doesnt work that way. With lithium, you must have blood drawn and get a "lithium level" to see where the levels are. With lithium, the range must be in a very exact spot for it to have a theraputic effect. Too little lithium and you will probably feel like you describe...depressed as dirt, flat, etc. But too high lithium levels and it becomes toxic and can harm you physically. The only way is to have blood drawn, sent to a lab and have your psychiatrist determine whether you need to go to 900 mg or even higher.
> > >
> > > Old School
> >
> > Old School is CORRECT as usual.
> > I am currently at 900mg. Lithium with a Lith. blood level of .55 this blood level is sub-theraputic. I THINK the theraputic range would be .7 to 1.0. I will be increasing Lith. dose to 1200mg. tomorrow (have delayed this a few days to get Lithobid perscription instead of regular Lith. Carbonate prescription from pdoc). I am also taking 1000mg. Depakote - hope to discontinue that gradually if Lith. does the job. May add Lamictal.
> >
> > Geezer
>
> Hi,
>
> I thought you were going to play around with Zonegran, what happened? :-) From what I have read over the years about lithium levels .5-1.5 mEQ is used for "short-term acute control" with .6-1.2 mEQ used for "maintenance". There have been some studies showing that maintenance blood levels all the way down to .3 mEQ are effective for some folks. Usually a min. of .45 is a target. FWIW, I found the "subtherapeutic" blood levels to be "therapeutic" for BPII symptoms.
>
> MitchHi Mitch,
The Zonegran trial is gone for now. Its very involved but it came down to what had the best chance of doing the job. I have a "treating" pdoc and the "research" pdoc - they are finally talking to each other - now we try the Lithium trial, I have given up thinking about what might come next......if anything. The research pdoc mentioned .6-1.2 mEQ level, can't offer any opinion on the other readings. I can proclaim with certainty that .55 mEQ has done nothing for my Bipolar II Depression. With my history I tend to get "Maxed Out" on all drug trials - to be expected I suppose with so few options left. I have told the pdocs I will try Parnate if the depression doesn't break.....would love to add some Dex. but that's out due to previous abuse.
Geezer
Posted by OldSchool on March 27, 2002, at 21:10:32
In reply to Re: Should I increase my lithium - Old School, posted by Denise528 on March 27, 2002, at 10:52:35
> Old School,
>
> Thanks for that advice, I didn't realise I had to get my blood drawn, I spose my psyciatrist hastn't requested I get it drawn because I am such a low dose. However, I'll bear what you said in mind, perhaps I won't give up entirely on the lithium after all.
>
> Denise
Yes, Denise this is basic lithium 101 stuff. You MUST get a lithium level drawn in order to determine if the level is within the theraputic window. It has to be exactly perfect,or the lithium simply will not work. Also, many psychiatrists simultaneously run basic thyroid tests with lithium levels, this is to see if the lithium is making you hypothyroid at all, a common side effect of longterm lithium usage.Lithium is worthless if its not in the right theraputic window.
Old School
Posted by BarbaraCat on March 27, 2002, at 21:32:39
In reply to Re: Should I increase my lithium - Old School, posted by OldSchool on March 27, 2002, at 21:10:32
Okay, so Mitch says that a subtherapeutic dose is actually indicated for BPII. I know that my very sub level (.5) has been enough to give the Remeron a kick to make it work. I hate to raise it and subject myself to the lithium side effects if it seems to be doing the trick, even tho at a low level. What say you to this? - BCat
> > Old School,
> >
> > Thanks for that advice, I didn't realise I had to get my blood drawn, I spose my psyciatrist hastn't requested I get it drawn because I am such a low dose. However, I'll bear what you said in mind, perhaps I won't give up entirely on the lithium after all.
> >
> > Denise
>
>
> Yes, Denise this is basic lithium 101 stuff. You MUST get a lithium level drawn in order to determine if the level is within the theraputic window. It has to be exactly perfect,or the lithium simply will not work. Also, many psychiatrists simultaneously run basic thyroid tests with lithium levels, this is to see if the lithium is making you hypothyroid at all, a common side effect of longterm lithium usage.
>
> Lithium is worthless if its not in the right theraputic window.
>
> Old School
Posted by OldSchool on March 27, 2002, at 21:40:54
In reply to Re: Should I increase my lithium - Old School » OldSchool, posted by BarbaraCat on March 27, 2002, at 21:32:39
> Okay, so Mitch says that a subtherapeutic dose is actually indicated for BPII. I know that my very sub level (.5) has been enough to give the Remeron a kick to make it work. I hate to raise it and subject myself to the lithium side effects if it seems to be doing the trick, even tho at a low level. What say you to this? - BCat
>
> > > Old School,
I dont know, do whatever works for you. But the generally accepted rule of thumb is that lithium doesnt work unless you get it in the right level. If subtheraputic lithium works for you, then go with it. Obviously you arent manic though.
Posted by Ritch on March 27, 2002, at 23:44:51
In reply to Subtherapeutic doses of lithium? » Ritch, posted by BarbaraCat on March 27, 2002, at 14:24:00
Hi Barb,
For the first several years I was on lithium (from the med gitgo), I was always taking blood draws constantly and my pdocs always kept me "well within the range". In my case, what that boiled down to was 900mg/day yielding about .6-.9 mEQ depending on what time of year it was. Well, during this time I was also on high-dose doxepin and at *certain* times of the year I had a lot of breakthrough hypomania and hostility, so my lithium got pushed up even further into the "therapeutic range". I think I hit a max of 1800mg of lithium a day there for a while getting a blood level of 1.2-1.3 mEQ from what I remember. Whoa, talk about dazed and confused! Well, the long and short of it was that it didn't really help any better! I just had more side effects and still acted stupid and broke chairs, duked it out with Dad (who was also bipolar IMO) a time or two, etc. So...we started to back it off slowly. I would drop 300mg/day for a month, take a blood draw, see how I was doing (better/worse/nochange?), and then drop another 300mg for another month. Interestingly, I didn't notice any *worsening* of symptoms until I went below 600mg/day. And that was very slight. With all of the years of playing with lithium my optimum dose is 450mg/day, 300mg/day will get me by, 600mg/day works good, but too many side effects, found that 450mg/day is almost indistinguishable from 600/day as far as desired effects go. What we found out was the DOXEPIN was causing most of the problem. They were giving me that for anxiety probs. with the lithium from the start. Well, once that got reduced all of the way down to 25mg/day, and then eventually dropped and replaced with diazepam, voila! nearly all of the hostility and most of the hypomania vanished (go figure).
Don't get suckered into this "we gotta push it up to a therapeutic dose" crap. They are just guinea-piggin' ya. This therapeutic dose blarney with Lithium and Depakote is just a result of treatment of *acute bipolarI mania* (probably inpatient ER presentation, etc.), period.
hope this helps some,
Mitch
> Ah, Mitch, my man. Just the post I wanted to see. I just sent off a question to Geezer which you might have read, but I'm interested in info about subtherapeutic levels of lithium and BPII. My level is .5 and it seems to be doing the trick with the Remeron. My pdoc wants me to push it up but I sure don't want to fix anything that ain't broke. I'd much prefer not to deal with the tremors and renal problems from a higher dose. Any of your thoughts on this would be appreciated. - BCat
>
> From what I have read over the years about lithium levels .5-1.5 mEQ is used for "short-term acute control" with .6-1.2 mEQ used for "maintenance". There have been some studies showing that maintenance blood levels all the way down to .3 mEQ are effective for some folks. Usually a min. of .45 is a target. FWIW, I found the "subtherapeutic" blood levels to be "therapeutic" for BPII symptoms.
> >
> > Mitch
Posted by Ritch on March 27, 2002, at 23:52:12
In reply to Re: Should I increase my lithium?, posted by Geezer on March 27, 2002, at 14:36:02
> > > > > Hello,
> > > > >
> > > > > I am currently taking 60mg of prozac (which doestn't seem to be doing anything) and 600mg of lithium which doestn't seem to be doing anything either, although I am no longer agitated I feel flat, tired, depressed, sick and morose. I was wondering if maybe increasing the lithium would help, I'm not sure what to do, whether to increase it or ditch it. I've been taking the lithium for about 3 weeks now.
> > > > >
> > > > > I was wondering if anyone out there had had little response on a small amount of lithium only to up the dose and then find it suddenly worked.
> > > > >
> > > > >
> > > > > Alternatively should I up the Prozac.
> > > > >
> > > > > Note, I am aware that you have to be careful with lithium and have blood levels checked so won't be doing anything stupid.
> > > > >
> > > > > Denise
> > > >
> > > > NO!! It doesnt work that way. With lithium, you must have blood drawn and get a "lithium level" to see where the levels are. With lithium, the range must be in a very exact spot for it to have a theraputic effect. Too little lithium and you will probably feel like you describe...depressed as dirt, flat, etc. But too high lithium levels and it becomes toxic and can harm you physically. The only way is to have blood drawn, sent to a lab and have your psychiatrist determine whether you need to go to 900 mg or even higher.
> > > >
> > > > Old School
> > >
> > > Old School is CORRECT as usual.
> > > I am currently at 900mg. Lithium with a Lith. blood level of .55 this blood level is sub-theraputic. I THINK the theraputic range would be .7 to 1.0. I will be increasing Lith. dose to 1200mg. tomorrow (have delayed this a few days to get Lithobid perscription instead of regular Lith. Carbonate prescription from pdoc). I am also taking 1000mg. Depakote - hope to discontinue that gradually if Lith. does the job. May add Lamictal.
> > >
> > > Geezer
> >
> > Hi,
> >
> > I thought you were going to play around with Zonegran, what happened? :-) From what I have read over the years about lithium levels .5-1.5 mEQ is used for "short-term acute control" with .6-1.2 mEQ used for "maintenance". There have been some studies showing that maintenance blood levels all the way down to .3 mEQ are effective for some folks. Usually a min. of .45 is a target. FWIW, I found the "subtherapeutic" blood levels to be "therapeutic" for BPII symptoms.
> >
> > Mitch
>
> Hi Mitch,
>
> The Zonegran trial is gone for now. Its very involved but it came down to what had the best chance of doing the job. I have a "treating" pdoc and the "research" pdoc - they are finally talking to each other - now we try the Lithium trial, I have given up thinking about what might come next......if anything. The research pdoc mentioned .6-1.2 mEQ level, can't offer any opinion on the other readings. I can proclaim with certainty that .55 mEQ has done nothing for my Bipolar II Depression. With my history I tend to get "Maxed Out" on all drug trials - to be expected I suppose with so few options left. I have told the pdocs I will try Parnate if the depression doesn't break.....would love to add some Dex. but that's out due to previous abuse.
>
> GeezerHi G.
Thanks for replying. Well, the "1st line-meds" probably ought to be explored first anyways. I think Parnate would do me a lot of good. But, the last two pdocs were too paranoid to write for it. The current one doesn't have any problem writing for dexedrine however (weird, huh?). You might consider asking about Selegiline. I asked about that one and got a big NOT. Lithium by itself worked OK for my bp depression, but not as well as Neurontin. I have NO idea why that is. You might consider bugging them for a Neurontin add-on to your current dose of lithium without upping it and see what happens. Hey, if that doesn't help much you still have got Lamictal, and T4. Some people say that Depakote helps for BP depression, but not many.
good luck,
Mitch
Posted by BarbaraCat on March 28, 2002, at 1:11:42
In reply to Re: Subtherapeutic doses of lithium? » BarbaraCat, posted by Ritch on March 27, 2002, at 23:44:51
Thanks Mitch. Yes, that does help alot, especially since I'm going to see Pdoc tomorrow. Your 'duking it out with Dad' brought back lovely memories of my relationship with my undiagnosed but obviously Bipolar father. I marvel that I'm still alive.
Where are those bipolars who have the wild and wacky creative genius type manias? The ones I've seen (and am) usually manifest frenzy, rage, or cluttered messy minds and lives. On the other hand, I've often been the last one on the dance floor, ready to still go go go, get more buzzed, reel from delerium long after everyone else is dropping on their feet. Yeah, my malady has shown me some good times indeed. But oy! the payback! - BCat
> Hi Barb,
>
> For the first several years I was on lithium (from the med gitgo), I was always taking blood draws constantly and my pdocs always kept me "well within the range". In my case, what that boiled down to was 900mg/day yielding about .6-.9 mEQ depending on what time of year it was. Well, during this time I was also on high-dose doxepin and at *certain* times of the year I had a lot of breakthrough hypomania and hostility, so my lithium got pushed up even further into the "therapeutic range". I think I hit a max of 1800mg of lithium a day there for a while getting a blood level of 1.2-1.3 mEQ from what I remember. Whoa, talk about dazed and confused! Well, the long and short of it was that it didn't really help any better! I just had more side effects and still acted stupid and broke chairs, duked it out with Dad (who was also bipolar IMO) a time or two, etc. So...we started to back it off slowly. I would drop 300mg/day for a month, take a blood draw, see how I was doing (better/worse/nochange?), and then drop another 300mg for another month. Interestingly, I didn't notice any *worsening* of symptoms until I went below 600mg/day. And that was very slight. With all of the years of playing with lithium my optimum dose is 450mg/day, 300mg/day will get me by, 600mg/day works good, but too many side effects, found that 450mg/day is almost indistinguishable from 600/day as far as desired effects go. What we found out was the DOXEPIN was causing most of the problem. They were giving me that for anxiety probs. with the lithium from the start. Well, once that got reduced all of the way down to 25mg/day, and then eventually dropped and replaced with diazepam, voila! nearly all of the hostility and most of the hypomania vanished (go figure).
>
> Don't get suckered into this "we gotta push it up to a therapeutic dose" crap. They are just guinea-piggin' ya. This therapeutic dose blarney with Lithium and Depakote is just a result of treatment of *acute bipolarI mania* (probably inpatient ER presentation, etc.), period.
>
> hope this helps some,
>
> Mitch
>
>
> > Ah, Mitch, my man. Just the post I wanted to see. I just sent off a question to Geezer which you might have read, but I'm interested in info about subtherapeutic levels of lithium and BPII. My level is .5 and it seems to be doing the trick with the Remeron. My pdoc wants me to push it up but I sure don't want to fix anything that ain't broke. I'd much prefer not to deal with the tremors and renal problems from a higher dose. Any of your thoughts on this would be appreciated. - BCat
> >
> > From what I have read over the years about lithium levels .5-1.5 mEQ is used for "short-term acute control" with .6-1.2 mEQ used for "maintenance". There have been some studies showing that maintenance blood levels all the way down to .3 mEQ are effective for some folks. Usually a min. of .45 is a target. FWIW, I found the "subtherapeutic" blood levels to be "therapeutic" for BPII symptoms.
> > >
> > > Mitch
Posted by Ritch on March 28, 2002, at 9:56:54
In reply to Re: Subtherapeutic doses of lithium? » Ritch, posted by BarbaraCat on March 28, 2002, at 1:11:42
No problem. Good luck with the office visit. If you feel 'ok' on your current Remeron/lithium combo, just tell him you would prefer to wait and "diligently mood chart" your progress and see how it pans out through your cycling before you make any dose or med changes. Just turn into a little scientist and try to please his inner scientist.
Creative genius manias? You need some form of occupational structure to focus the energy. There isn't many "occupational structures" out there which are conducive to creativity, sorry to say. You also must have control-there aren't many careers that give people a *lot* of free rein. The closest thing I have *seen* to a "creative genius mania" was a "manic mechanic" I used to know in high school, who just had all sorts of wondrous ways to trick-out and hot-rod ordinary engines.
Mitch
> Thanks Mitch. Yes, that does help alot, especially since I'm going to see Pdoc tomorrow. Your 'duking it out with Dad' brought back lovely memories of my relationship with my undiagnosed but obviously Bipolar father. I marvel that I'm still alive.
>
> Where are those bipolars who have the wild and wacky creative genius type manias? The ones I've seen (and am) usually manifest frenzy, rage, or cluttered messy minds and lives. On the other hand, I've often been the last one on the dance floor, ready to still go go go, get more buzzed, reel from delerium long after everyone else is dropping on their feet. Yeah, my malady has shown me some good times indeed. But oy! the payback! - BCat
Posted by Dave1 on March 31, 2002, at 20:55:43
In reply to Should I increase my lithium?, posted by Denise528 on March 24, 2002, at 11:33:28
Hi,
It seems like everybody has a unique problem, but someone out there has a solution.
Here's my problem - PLEASE help!!!
I was on anafranil for several weeks and got up to 250mg/day. I then added 900mg LI/day for ten days. I did my blood work and it was .4
I thus increased my lithium to 1200mg/day.
Several days later I suddenly felt more talkative and sociable. I was very surprised and felt my depression was lifting. Problem. The effect was only temporary and only lasted 3-4 days.
Should I get another lithium test to see if can increase, if so how high can I go (in terms of blood level , not lithium dosage)
Also, should I get an anafranil level. I know sometimes they do that for tricyclics.
Or did I experience some kind of quick poop and therefore, I should just give up.
Thanks much,
Dave
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