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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 36. Go back in thread:
Posted by BarbaraCat on May 23, 2002, at 0:20:38
In reply to Re:The low down on Lithiums » BarbaraCat, posted by Chloe on May 22, 2002, at 18:54:57
Chloe,
Wow, what a great post! I'm going to take this to my pdoc tomorrow, but I doubt very much he has even a fraction of your knowledge on this subject. THANKS!
Posted by Chloe on May 23, 2002, at 19:10:53
In reply to Re:The low down on Lithiums - great info! » Chloe, posted by BarbaraCat on May 23, 2002, at 0:20:38
Posted by BarbaraCat on May 23, 2002, at 21:14:12
In reply to Re:good luck at pdoc appt! (nm) » BarbaraCat, posted by Chloe on May 23, 2002, at 19:10:53
Well, I'm still taking the generic for Lithonate, which I guess is plain ol' lithium carbonate. Big Brother HMO's don't encourage any new-fangled meds, I guess.
I expressed concern about raising the levels from my current 600mg per day any higher because I don't want to incur any renal damage or otherwise. He suggested taking a full dose at one time, preferably at night. Apparently some new data has shown that taking the full dose at once rather than spreading it out avoids alot of the tremors, renal damage and otherwise. I don't quite get it, but was loath to waste any more of my allotted 20 minutes every 2 months appointment time by asking silly time consuming questions. So, I ask you, my friends - anyone have any data on combined dosing for lithium?
Posted by Squiggles on May 24, 2002, at 12:08:52
In reply to Lithium appointment - combined doses?, posted by BarbaraCat on May 23, 2002, at 21:14:12
Hi Barbara,
I have read many articles from medical journals,
and from doctors's sites about this. It is almost
a legendary advice to do that now. But I am very
sceptical about it - not that I have knowledge
to the contrary (I did read an article on PubMED
saying this is nonsense. It is not coincidence
that those who advise also advise "if there is
tolerance for taking all 900mg at night". I
just don't get it myself, because I think I would
get quite a punch from such a huge dose altogether.Perphaps it does protect the kidneys, but does
it have other adverse effects, would by my question.IHMO I would not do it.
Squiggles
Posted by Squiggles on May 24, 2002, at 12:13:03
In reply to Re: Lithium appointment - combined doses?, posted by Squiggles on May 24, 2002, at 12:08:52
P.S.
the person to consult on this might be
Dr. David Marples, who is an expert on
lithium induced kidney diseases:
http://diabetesinsipidus.maxinter.net/about.htmSquiggles
Posted by Squiggles on May 24, 2002, at 12:41:04
In reply to Re: Lithium - combined doses? Dr. Marples, posted by Squiggles on May 24, 2002, at 12:13:03
http://www.ndif.org/FAQ/faq-ov3.html
Dr. Bichet is right here in my home town
(but not at McGill); so he would be a good
source of info. on this. I wonder if my
doctor is aware of the danger of lithium
induced nephrogenic disorders - I am so
insecure about the medical profession - it's
pathological I hope.Squiggles
Posted by Chloe on May 24, 2002, at 17:54:00
In reply to Lithium appointment - combined doses?, posted by BarbaraCat on May 23, 2002, at 21:14:12
> Well, I'm still taking the generic for Lithonate, which I guess is plain ol' lithium carbonate. Big Brother HMO's don't encourage any new-fangled meds, I guess.
>
> I expressed concern about raising the levels from my current 600mg per day any higher because I don't want to incur any renal damage or otherwise. He suggested taking a full dose at one time, preferably at night. Apparently some new data has shown that taking the full dose at once rather than spreading it out avoids alot of the tremors, renal damage and otherwise. I don't quite get it, but was loath to waste any more of my allotted 20 minutes every 2 months appointment time by asking silly time consuming questions. So, I ask you, my friends - anyone have any data on combined dosing for lithium?
Hi Barbara,
Well, I guess you pdoc had other lithium ideas... I have never heard of taking all the lithium in one dose. I suppose it would not hurt, as (Mitch informed me :)) Lithium does have over a 24 hour half-life. So spreading it out is not essential.My concern, is the stress the body must endure taking all the lithium at one time. Common sense tells me my kideys would be more traumatized by a huge bolus of lithium in one shot, than smaller amounts throughout the day. But I am no scientist! More like a guinnea pig!
I also know, from personal experience, that when I raised my lithobid to 300 mgs am/600 mgs pm, I began waking up in the morning with a red rash on my face. It seemed to fade as the day went on. I reported this to the pdoc, and she said take the lithobid TID, 300 am 300 eve 300 bedtime, and my mysterious morning rash went away! But 900 mgs was really too much for me to tolerate. I do better at lower li level. More is not always better in my humble opinion...
If you do combine the doses, do let us know it you notice any difference or change. I am glad you are staying at the current dose. I don't always think the blood level (within reason) is as important as how you FEEL when you are BP2.
Yours,
Chloe
Posted by Ritch on May 24, 2002, at 23:31:50
In reply to Re: Lithium appointment - combined doses? » BarbaraCat, posted by Chloe on May 24, 2002, at 17:54:00
> > Well, I'm still taking the generic for Lithonate, which I guess is plain ol' lithium carbonate. Big Brother HMO's don't encourage any new-fangled meds, I guess.
> >
> > I expressed concern about raising the levels from my current 600mg per day any higher because I don't want to incur any renal damage or otherwise. He suggested taking a full dose at one time, preferably at night. Apparently some new data has shown that taking the full dose at once rather than spreading it out avoids alot of the tremors, renal damage and otherwise. I don't quite get it, but was loath to waste any more of my allotted 20 minutes every 2 months appointment time by asking silly time consuming questions. So, I ask you, my friends - anyone have any data on combined dosing for lithium?
>
>
> Hi Barbara,
> Well, I guess you pdoc had other lithium ideas... I have never heard of taking all the lithium in one dose. I suppose it would not hurt, as (Mitch informed me :)) Lithium does have over a 24 hour half-life. So spreading it out is not essential.
>
> My concern, is the stress the body must endure taking all the lithium at one time. Common sense tells me my kideys would be more traumatized by a huge bolus of lithium in one shot, than smaller amounts throughout the day. But I am no scientist! More like a guinnea pig!
>
> I also know, from personal experience, that when I raised my lithobid to 300 mgs am/600 mgs pm, I began waking up in the morning with a red rash on my face. It seemed to fade as the day went on. I reported this to the pdoc, and she said take the lithobid TID, 300 am 300 eve 300 bedtime, and my mysterious morning rash went away! But 900 mgs was really too much for me to tolerate. I do better at lower li level. More is not always better in my humble opinion...
>
> If you do combine the doses, do let us know it you notice any difference or change. I am glad you are staying at the current dose. I don't always think the blood level (within reason) is as important as how you FEEL when you are BP2.
>
> Yours,
> Chloe
Hi Chloe..Barb,I just *read* stuff a long time ago about combining all of the Li dose at bedtime was a preferred way of doing it. It is supposed to reduce the overall burden on your kidneys' elimination of the lithium. All I can say in personal experience is after 20 years I did *happen* to get a thyroid tumor, and also *happened* to have elevated serum calcium levels (which *can* be indicative of kidney problems). I got CAT-scans done of my kidneys and they were OK. The associated? transient hypercalcemia problem still remains unexplained and is no longer a concern (I have normal serum calcium levels). My advice is to be sure to routinely check your kidney function, TSH, and serum calcium (and other electrolytes) while you are undergoing lithium therapy.
Mitch
Posted by Chloe on May 25, 2002, at 10:59:07
In reply to Re: Lithium appointment - combined doses? » Chloe, posted by Ritch on May 24, 2002, at 23:31:50
Hey Mitch,
When you were taking li, did you take all your dose at bedtime? I ask because I wonder if your unfortunate kidney and thyroid problems were related to once a day dosing, or simply indicative of lithium therapy in general?The potential side effects of these meds can be so frightening. I guess as patients, we really have to advocate for ourselves, and make sure our labs and any "unusual" symptoms are monitored closely...
BTW, I wish I could bump up my Li just a bit. I feel very depressed, and lifeless. Increasing the celexa by a few drops was a complete mistake. I have been in a dysphoric rage for two days straight, unable to sleep...And I only increased it by 0.1 mgs, to 1.6. Perhaps something else is going on, because a few drops a celexa can't be that powerful. But I am ready to swing back into depression. I hate feeling like I am going to kill someone for no reason. So I am steering clear of people for the moment.
Anyway, a bit more li might smooth things out, enhance my mood, but I am finally getting rid of some of my scalp pain (thanks to FSO). So I am scared to tinker.
Hope you are hanging in there...
Chloe
Posted by BarbaraCat on May 25, 2002, at 15:08:59
In reply to Lithium appointment - combined doses?, posted by BarbaraCat on May 23, 2002, at 21:14:12
I combined my two daily 300mg into 1 600mg dose two nights ago. I woke up feeling shakey, trembly, nauseous, and peed like a racehorse all day. Actually thought I was coming down with something, I felt so crummy. It was my BDay and a beach hike was planned by Hubby, so I really had to force myself out and about.
I noticed some interesting visual effects while I was there. We hiked out to a promontory where I sat blissfully transfixed by the light sparkling on the ocean. The surf booming on the rocks was echoing inside my head. It was very trippy. After that I began to notice that the quality of light was just - different. Colors more bright, scalp was tingling. I still felt physically a bit sick but OK. Overall, it was like a mild dose of psilocybin. The moderately concentrated Li dose is all I can attribute the above to. Be VERY interested if anyone else has had a similar reaction. - Barbara
Posted by Ritch on May 25, 2002, at 19:00:49
In reply to Re: Lithium appointment - combined doses? » Ritch, posted by Chloe on May 25, 2002, at 10:59:07
> Hey Mitch,
> When you were taking li, did you take all your dose at bedtime? I ask because I wonder if your unfortunate kidney and thyroid problems were related to once a day dosing, or simply indicative of lithium therapy in general?
>
> The potential side effects of these meds can be so frightening. I guess as patients, we really have to advocate for ourselves, and make sure our labs and any "unusual" symptoms are monitored closely...
>
> BTW, I wish I could bump up my Li just a bit. I feel very depressed, and lifeless. Increasing the celexa by a few drops was a complete mistake. I have been in a dysphoric rage for two days straight, unable to sleep...And I only increased it by 0.1 mgs, to 1.6. Perhaps something else is going on, because a few drops a celexa can't be that powerful. But I am ready to swing back into depression. I hate feeling like I am going to kill someone for no reason. So I am steering clear of people for the moment.
>
> Anyway, a bit more li might smooth things out, enhance my mood, but I am finally getting rid of some of my scalp pain (thanks to FSO). So I am scared to tinker.
>
> Hope you are hanging in there...
> ChloeHi Chloe,
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.
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
Posted by Ritch on May 25, 2002, at 19:06:14
In reply to Tried combining doses - strange!, posted by BarbaraCat on May 25, 2002, at 15:08:59
> I combined my two daily 300mg into 1 600mg dose two nights ago. I woke up feeling shakey, trembly, nauseous, and peed like a racehorse all day. Actually thought I was coming down with something, I felt so crummy. It was my BDay and a beach hike was planned by Hubby, so I really had to force myself out and about.
>
> I noticed some interesting visual effects while I was there. We hiked out to a promontory where I sat blissfully transfixed by the light sparkling on the ocean. The surf booming on the rocks was echoing inside my head. It was very trippy. After that I began to notice that the quality of light was just - different. Colors more bright, scalp was tingling. I still felt physically a bit sick but OK. Overall, it was like a mild dose of psilocybin. The moderately concentrated Li dose is all I can attribute the above to. Be VERY interested if anyone else has had a similar reaction. - BarbaraHi Barb,
Interesting little experience there. I remember when I first took my lithium I felt spacey. My parent's dog was running about through the house and it seemed like the image of the dog was "trailing" around after it. The latest retrial with lithium (as an augmentor) triggered mild scale illusions-everything seemed "smaller".
Mitch
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
>
>> Hi Chloe,
>
>> 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
Posted by Ritch on May 26, 2002, at 0:01:13
In reply to Re: Lithium appointment - combined doses? » Ritch, posted by Chloe on May 25, 2002, at 21:50:31
> 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!
Yes, it is true-Depakote is much easier on my intestines and seems to quell grouchiness like magic. However, I miss the *positive* effects of the lithium. Li settled down agitation and anger without making me so fatigued and tired (which Depakote seems to be so good at). I might get *dazed* from the lithium, but I felt an SSRI-like okeedokee feeling from it that was unique to any antimanic compound I have ever tried (haven't tried Lamictal yet though). Lithium also never generated an anergic depressive blankness that Depakote can induce (while I am depressed). But, that stuff is remarkably effective for hypomanic spells! IOW, it makes for super effective diesel air brakes, but will leave you stranded in the Horse Latitudes if you aren't careful.
>
>
> > >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 :(
Nope, no problems for some time with panic attacks(since I have been on Klonopin!) I have been on Klon. now for several years (albeit at a low dose). If I can flip to lorazepam and get all the benefits with a lower body burden (that sounds so 50's institutional somehow), I think it would be best.
>
> 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.
Oh well, that doesn't sound quite so desperate now. You are ready for a "little click" up to 300mg/day Li.
I remember one psych. I saw back in 1981 who wanted to add Valium to my lithium/doxepin. I thought it was a bad idea at the time and wanted low-dose chlorpromazine instead (WRONG!-I found out later why). I asked him something like-"So you want me to take maybe 5mg daily?", and he replied "No, I was thinking more like 10mg 3x daily".>
> 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.
Oh, just curious about what your diazepam history was :) I was taking it for nearly a decade. There probably were other factors that made a larger contribution to my impulse control issues that I associate with its use. Forget stigmas, that is the last thing we all need to worry ourselves about!>
> Thanks
> Chloe
Posted by BarbaraCat on May 26, 2002, at 1:05:01
In reply to Re: Lithium appointment - combined doses? » Ritch, posted by Chloe on May 25, 2002, at 21:50:31
Hi Mitch and Chloe,
Following your posts and funny thing, I just started taking lorezapam. Still on Remeron, lithium of course, but Klonopin wasn't doing it for me. Really needed something to settle me down when I ran out of lithium recently due to my mail order pharmacy taking it's sweet time. Klonopin has always mellowed me for about an hour and then I felt like the jitters were just under the surface. So, I'm doing this trial with lorezapam 'just to see'. So far it's much more sedating, and that's exactly what I'm looking for in a benzo. When I need to be active, driving, doing Costco, whatever, Klonopin is fine. But sometimes a girl just wants to chill.
Posted by Ritch on May 26, 2002, at 2:46:16
In reply to Re: Lithium appointment - combined doses? Mitch » Chloe, posted by BarbaraCat on May 26, 2002, at 1:05:01
> Hi Mitch and Chloe,
> Following your posts and funny thing, I just started taking lorezapam. Still on Remeron, lithium of course, but Klonopin wasn't doing it for me. Really needed something to settle me down when I ran out of lithium recently due to my mail order pharmacy taking it's sweet time. Klonopin has always mellowed me for about an hour and then I felt like the jitters were just under the surface. So, I'm doing this trial with lorezapam 'just to see'. So far it's much more sedating, and that's exactly what I'm looking for in a benzo. When I need to be active, driving, doing Costco, whatever, Klonopin is fine. But sometimes a girl just wants to chill.
That's interesting. I originally got samples of Ativan long, long ago (1984). They were 2mg white tabs I think (that's the medium dose size?). I used them on my first airplane ride to prevent panic. They worked marvelously. They were a little potent-however. I don't think I could use them at work, except maybe a small dose for a presentation. They didn't do wonders for my mathematical skills. However, I never felt depressed on them (as diazepam did), or sullen (like clonazepam can do), never got grouchy on them that I can remember.Mitch
Posted by BarbaraCat on May 26, 2002, at 12:06:00
In reply to Re: Lithium appointment - combined doses? Mitch » BarbaraCat, posted by Ritch on May 26, 2002, at 2:46:16
>
> That's interesting. I originally got samples of Ativan long, long ago (1984). They were 2mg white tabs I think (that's the medium dose size?). I used them on my first airplane ride to prevent panic. They worked marvelously. They were a little potent-however. I don't think I could use them at work, except maybe a small dose for a presentation. They didn't do wonders for my mathematical skills. However, I never felt depressed on them (as diazepam did), or sullen (like clonazepam can do), never got grouchy on them that I can remember.
>
> MitchMitch, the ones I got are tiny little white .5 mg (my pdoc is faily conservative). At the 2mg dose you mentioned I'd be zonked. Your 'sullen' description of clonezapam is a good one. So far I believe I like lorezapam the best. A few years ago when I was experiencing fierce panic attacks I was finally given ativan and it did wonders for me, especially with the quick onset. It also has a shorter half life than clonazepam. Remeron on it's own makes it hard enough to shake off morning grogginess and the 12 hours half life of clonezapam was adding to it. Lorezapam is helping getting to sleep and although I still stumble around for awhile in the morning, alertness comes soon and clearer. Of course, all meds have their tolerance point, so we'll see how things go after a month or so. - Barbara
Posted by Chloe on May 26, 2002, at 20:31:55
In reply to Re: Lithium appointment - combined doses? Mitch » Chloe, posted by BarbaraCat on May 26, 2002, at 1:05:01
> Hi Mitch and Chloe,
> Following your posts and funny thing, I just started taking lorezapam. Still on Remeron, lithium of course, but Klonopin wasn't doing it for me. Really needed something to settle me down when I ran out of lithium recently due to my mail order pharmacy taking it's sweet time. Klonopin has always mellowed me for about an hour and then I felt like the jitters were just under the surface. So, I'm doing this trial with lorezapam 'just to see'. So far it's much more sedating, and that's exactly what I'm looking for in a benzo. When I need to be active, driving, doing Costco, whatever, Klonopin is fine. But sometimes a girl just wants to chill.Barbara
Wow, what a "trip" you described when you took all your Li at once. I imagine your body thought that you were doubling the dose, and it just wasn't ready for it. Have you stuck with it, to see if your body adjusts, or was one day of that enough? I would be interested to hear.It's nice to have a benzo if you need it. And isn't fascinating how everyone's "mileage varies" with meds. For me, lorazapam wound me up! And K seems to do that to you after an hour or so. Very strange. So glad you got a good "chill pill." :)
Chloe
Posted by BarbaraCat on May 26, 2002, at 21:11:40
In reply to Re: Lithium appointment - combined doses? Mitch » BarbaraCat, posted by Chloe on May 26, 2002, at 20:31:55
Chloe,
One day of that was enough. The trippy stuff was fun but the nausea and tremors weren't - don't think we're going to be seeing lithium as the new rave drug. I'm back to taking 300mg twice a day as before. It's doing the trick for me and I don't have any major side effects that I'm aware of. This once a day dosing method seems very bizarre to me. I'll bet whoever came up with the idea was not bipolar and did not self test.About the paradoxical benzo effect - how do you do on opiods? When I take hydrocodone I'm ready to go out on the town. I know this is not uncommon as Elizabeth on this board has had great AD response from an opiod. The whole subject of paradoxical drug responses is fascinating. I think I'll start a thread on that one. - Barbara
> > Hi Mitch and Chloe,
> > Following your posts and funny thing, I just started taking lorezapam. Still on Remeron, lithium of course, but Klonopin wasn't doing it for me. Really needed something to settle me down when I ran out of lithium recently due to my mail order pharmacy taking it's sweet time. Klonopin has always mellowed me for about an hour and then I felt like the jitters were just under the surface. So, I'm doing this trial with lorezapam 'just to see'. So far it's much more sedating, and that's exactly what I'm looking for in a benzo. When I need to be active, driving, doing Costco, whatever, Klonopin is fine. But sometimes a girl just wants to chill.
>
> Barbara
> Wow, what a "trip" you described when you took all your Li at once. I imagine your body thought that you were doubling the dose, and it just wasn't ready for it. Have you stuck with it, to see if your body adjusts, or was one day of that enough? I would be interested to hear.
>
> It's nice to have a benzo if you need it. And isn't fascinating how everyone's "mileage varies" with meds. For me, lorazapam wound me up! And K seems to do that to you after an hour or so. Very strange. So glad you got a good "chill pill." :)
>
> Chloe
Posted by Chloe on May 27, 2002, at 18:58:21
In reply to Re: Lithium appointment - combined doses? » Chloe, posted by BarbaraCat on May 26, 2002, at 21:11:40
> Chloe,
> One day of that was enough. The trippy stuff was fun but the nausea and tremors weren't - don't think we're going to be seeing lithium as the new rave drug. I'm back to taking 300mg twice a day as before. It's doing the trick for me and I don't have any major side effects that I'm aware of. This once a day dosing method seems very bizarre to me. I'll bet whoever came up with the idea was not bipolar and did not self test.Barbara,
I sure wouldn't want to take all my Li at once! I can imagine you felt nauseated, shaky and fuzzy. What a shock to the system IMHO. These pdocs don't take the drugs, just tell us how to take them. You were brave to try, and the day before your birthday??? Do I remember that right? Ugh. It's awful when you have to "fake" like you feel well when you want to just tell everyone, how horrible you feel.. Well, I am glad you are back to a more comfortable dosing pattern!
> About the paradoxical benzo effect - how do you do on opiods? When I take hydrocodone I'm ready to go out on the town. I know this is not uncommon as Elizabeth on this board has had great AD response from an opiod. The whole subject of paradoxical drug responses is fascinating. I think I'll start a thread on that one. - BarbaraBarbara,
I have never tried opiates. I have to say I probably have some experience with every other class of drug for mood disorders, but not that one. I did, however, like the "euphoria" I got when I was taking percocet after my appendecitis. But I sure did not feel like going out dancing! :( How did you get to take opiates? Are they for your depression or for pain or recreation? Do you take hydrocodone on a regular basis? Sorry for all the Q's, I just know so little about them.All the best,
Chloe
Posted by BarbaraCat on May 27, 2002, at 21:34:55
In reply to Re: Lithium appointment - combined doses? » BarbaraCat, posted by Chloe on May 27, 2002, at 18:58:21
> I have never tried opiates. I have to say I probably have some experience with every other class of drug for mood disorders, but not that one. I did, however, like the "euphoria" I got when I was taking percocet after my appendecitis. But I sure did not feel like going out dancing! :( How did you get to take opiates? Are they for your depression or for pain or recreation? Do you take hydrocodone on a regular basis? Sorry for all the Q's, I just know so little about them.
>
I have fibromyalgia which can cause alot of muscle pain when it flares up, so I get generic Vicodin prescribed. Also, for the occassional dental procedures. It's a good all around nerve pain reliever and probably the most commonly prescribed opiate. It also helps relieve a bad bout of depression. I thought I was the only one who experienced this until I got onto this board and discovered others who regularly take opiods as a first line treatment for depression. It has something to do with dopamine, endorphins, and other chemicals involved in producing a pleasurable cnhanced mood. Percocet is in this class, but I don't get the same energized buzz as from hydrocodone.No, I don't take it regularly. Some drawbacks are constipation, stomach pain, and becoming tolerant. Also, sometimes I feel worse the next day as if something crucial got depleted. All our brains are so different, it must keep our pdocs hopping. What is your dx, Cloe? I do appreciate our gabs. - Barbara
Posted by Chloe on May 28, 2002, at 9:05:17
In reply to Re: Lithium appointment - combined doses? » Chloe, posted by BarbaraCat on May 27, 2002, at 21:34:55
>> I have fibromyalgia which can cause alot of muscle pain when it flares up, so I get generic Vicodin prescribed.Barbara, that's interesting. My mother has FM, but refuses to take any "medicine", just some herby stuff. Sometimes I wonder if I have it. I have some terrible joint pain (Not muscle, I though FM was in the joints, am I wrong...?), esp. my left wrist and thumb (too much typing???), hips and feet, though I do have bunions, genenic and from some ballet...I find neurontin helps with this alot, esp. with sleep. I used to lie in bed and ache. And trying to get off Neurontin has been futile. I get very grouchy, and they my body hurts all over, even with very gradual tapers. So it's a keeper. Have you ever tried N?
>>Also, for the occassional dental procedures. It's a good all around nerve pain reliever and probably the most commonly prescribed opiate. It also helps relieve a bad bout of depression. I thought I was the only one who experienced this until I got onto this board and discovered others who regularly take opiods as a first line treatment for depression. It has something to do with dopamine, endorphins, and other chemicals involved in producing a pleasurable cnhanced mood. Percocet is in this class, but I don't get the same energized buzz as from hydrocodone.Very interesting. I don't think my pdoc would use opiates as first line for me. AD's tend to push me into mixed states of aggression and irritability. Though I swear, we have tried most everything else!
>> No, I don't take it regularly. Some drawbacks are constipation, stomach pain, and becoming tolerant. Also, sometimes I feel worse the next day as if something crucial got depleted. All our brains are so different, it must keep our pdocs hopping. What is your dx, Cloe?
Well, when I was 13 I was first hospitalized for major depression, then later I was labeled major depression and BPD (I think that is a teen age diagnosis...Everyone my age was BPD!) About a year ago I was diagnosed BP2 with psychotic features. So I need a whole mix of meds to keep my mood stable. I think the li helps keeps the "distorted thinking" in line. It is known to be useful in this way. As I recall you just go a BP2 diagnosis as well?
>>I do appreciate our gabs. - Barbara
Ditto! :)
Chloe
Posted by BarbaraCat on May 28, 2002, at 17:51:19
In reply to Re: Fibromyalgia, opiates, li, etc. » BarbaraCat, posted by Chloe on May 28, 2002, at 9:05:17
>Sometimes I wonder if I have it. I have some terrible joint pain (Not muscle, I though FM was in the joints, am I wrong...?), esp. my left wrist and thumb (too much typing???), hips and feet, though I do have bunions, genenic and from some ballet...I find neurontin helps with this alot, esp. with sleep. I used to lie in bed and ache. And trying to get off Neurontin has been futile. I get very grouchy, and they my body hurts all over, even with very gradual tapers. So it's a keeper. Have you ever tried N?
>
I'm going to ask my primary care doc this Friday about adding Neurontin. I've heard from a number of people that it helps fibro pain. As far as the pain, no it's not usually in the joints, but feels like the achiness you get with a bad case of flu. Aching all over is a good description. Pain and stiffness are there all the time, manageable with exercise, but during a flareup it's impossible to do anything because of the extreme fatigue. I'm in bed for 2-3 weeks feeling pretty awful. If your Mom has it, it might be worth exploring further. On the other hand, there's not much you can do about it so you probably don't need the aggravation of sleuthing it out.>I think the li helps keeps the "distorted thinking" in line. It is known to be useful in this way.
Distored thinking, huh? I'd like to find out more about this. My depressions can be like something out of a Steven King novel.
>As I recall you just go a BP2 diagnosis as well?
Yes, just recently in fact thanks to what I've learned from this board. I wasn't responding to ADs and every pdoc I went to said 'Oh, just double the dose', which made me worse - panic attacks, frenzied thinking. When I read here that this kind of response is typical of BP2, I started digging back in my memory banks about any hypomanic episodes and sure enough, there were plenty and some full blown mania as well. Fun, but so disruptive.
As I've gotten older, however, I don't get the standard hypomania symptoms (although I have definitely had a few not so long ago). It's more like my depressions are extremely agitated. I get severe insomnia and the moods are black wailing despair. I hear about others despression symptoms, lack of feeling, dull, and I think that mine are so different. They're so nightmarish that I have to think there's some psychotic overtones. So, my pdoc started me on lithium since even if I wasn't BP2, lithium at least was an AD augmentor. That was back in February and immediately I felt an inner peace and smoothness.
I recently ran out of lithium for almost 2 weeks and plunged into a full bore hypomanic state. Started it up again and I'm fine. So all in all, I pronounce myself at the very least BP2. I'm also taking Remeron and it's the first AD that doesn't make me feel more crazy.
Barbara
So, I started taking
Posted by Chloe on May 28, 2002, at 20:20:18
In reply to Re: Fibromyalgia, opiates, li, etc. » Chloe, posted by BarbaraCat on May 28, 2002, at 17:51:19
> >I'm going to ask my primary care doc this Friday about adding Neurontin. I've heard from a number of people that it helps fibro pain. As far as the pain, no it's not usually in the joints, but feels like the achiness you get with a bad case of flu. Aching all over is a good description. Pain and stiffness are there all the time, manageable with exercise, but during a flareup it's impossible to do anything because of the extreme fatigue. I'm in bed for 2-3 weeks feeling pretty awful. If your Mom has it, it might be worth exploring further. On the other hand, there's not much you can do about it so you probably don't need the aggravation of sleuthing it out.
Hi Barbara,
Yes, I don't really want to know if I have FM! I do know I have pain. But I am the sort that pushes myself to move, even when depressed or miserable. I remember during a BAD slump last winter, I would go on these walks in the dark, and just cry and cry with every step. I have trouble resting when I need to...But I am getting better at listening to my body. I have shut it out for so many years because of emotional pain, that understanding my own needs can be hard at times.One way of controlling cycling, for me is to just cut off all communication with my body, it's needs and drives. Before I got treated for BP2, I would tune all imput out, often have distorted perceptions of what people were saying to me, or what I percieved they were thinking of me. It was really crumby. But this was effective for shutting down the pain, the elation followed by a nasty crashes, over and over...But Li does seem to have antipsychotic properties. AP's definitely work better, but I have mild TD from years of using a typical AP. So those are out.
>> Distored thinking, huh? I'd like to find out more about this. My depressions can be like something out of a Steven King novel.That sounds very frightning. I can relate. Some of my downswings can really take on a life of their own. And when I "wake up" or the pendulum goes the other way, I wonder what the hell was I thinking? Wow, was that me who was thinking those things? Sort of a dissociative experience, I guess.
>>Yes, just recently in fact thanks to what I've learned from this board. I wasn't responding to ADs and every pdoc I went to said 'Oh, just double the dose', which made me worse - panic attacks, frenzied thinking. When I read here that this kind of response is typical of BP2, I started digging back in my memory banks about any hypomanic episodes and sure enough, there were plenty and some full blown mania as well. Fun, but so disruptive.
I can relate to AD just making things WORSE. Irritability, extreme anxiety, pressured feeling and speech, inability to stay still or sleep. Just so uncomfortable inside. I like to feel calm. :)
>>As I've gotten older, however, I don't get the standard hypomania symptoms (although I have definitely had a few not so long ago). It's more like my depressions are extremely agitated. I get severe insomnia and the moods are black wailing despair. I hear about others despression symptoms, lack of feeling, dull, and I think that mine are so different. They're so nightmarish that I have to think there's some psychotic overtones. So, my pdoc started me on lithium since even if I wasn't BP2, lithium at least was an AD augmentor. That was back in February and immediately I felt an inner peace and smoothness.
I am so glad Li is giving you some "inner peace." What a gift!
>>I recently ran out of lithium for almost 2 weeks and plunged into a full bore hypomanic state. Started it up again and I'm fine. So all in all, I pronounce myself at the very least BP2. I'm also taking Remeron and it's the first AD that doesn't make me feel more crazy.
Sounds like you have found a good cocktail. I am glad Li+Remeron are making you feel better.
I hope your mail order pharmacy is more on the ball next time. Or perhaps your pdoc can write it, so you have a few extra, if such a thing happens again.Yours,
Chloe
Posted by BarbaraCat on May 28, 2002, at 20:40:12
In reply to Re: Fibromyalgia, opiates, li, etc. » BarbaraCat, posted by Chloe on May 28, 2002, at 20:20:18
Your walks in the dark are a blessing. At least you can keep your energy from getting stuck by moving. The dark can be such a healing place if we're not afraid of it.
All this has got me wondering about the differences between bipolar and unipolar depressions. I'm going to be posting a new thread on it so keep a look out if this topic is of interest to you.
All the Best,
Barbara
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