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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by AWorriedMom on May 10, 2003, at 17:14:42
My16 yr old daughter was dx about 3 years ago with Bipolar I disorder. She doesn't seem to maintain stability on her present meds. She seems always to be depressed and now is also showing symptons of mania returning. Her med history is:
13yrs- Tegretol 400 am / 400 pm; buspar 2x day
seemed ok as far as mania, missed lots of school with "tummy-aches" and various other complaints.
14yrs- Doc switched off tegretol to topomax bc of weight issues. That is when she had a bumpy, manic ride. Later, stopped topomax and back on tegretol. This time tegretol had no effect. She was at the max in the range, but full blown mania with delusional, psychotic like thoughts as well.
Currently-lithium 600am/600pm; depakote 1000am / 1000pm; zyprexa 20mg at bed; 15mg.valium 3xday; 45mg restoril at night. That is current. She was on prozac for a while bc of depression. Stopped and put on lexapro. Emergency appt. doc took off the lexapro and said wait for her reg. doc to return from vacation.
Any words of wisdom or advice so that I can talk to her doc and ask some good questions?
Posted by Squiggles on May 10, 2003, at 18:40:09
In reply to How much depakote and/or lithium is safe?, posted by AWorriedMom on May 10, 2003, at 17:14:42
Typical lithium dose is 600-900mg, often
starting at 1200 if mania is present, and then
lowered; what is significant is the blood
levels (0.5-1.0 or 1.2 is considered safe).
I have a number of articles on lithium dosing
on my site lithium@yahoogroups.com if you
type in the key wordsdose
dosing
lithium dosing
in the blank.
A good palce ot look is the Stanley Institute
as well as Virtual Hospital under the
key wordslithium dosing
Squiggles
Posted by Janelle on May 10, 2003, at 21:40:33
In reply to How much depakote and/or lithium is safe?, posted by AWorriedMom on May 10, 2003, at 17:14:42
This is my OPINION and ONLY my OPINION - For a TEENAGER, those doses of Lithium and Depakote sound a bit high. Again, this is a NON-SCIENTIFIC, not a doctor, just a layperson's opinion.
However, I would add that I myself am on BOTH Lithium and Depakote for BiPolar2 disorder (the so-called *milder* version of BiPolar) and I'm on 450 mg of Lithium (could not tolerate 900, 600 alone did not help mood swings) and 250 Depakote (could not tolerate 500 or 1000 alone). It took a L-O-N-G time and a couple of pdocs before I got to this combo which SEEMS to be working (along with my other meds).
I suggest you talk to your daughter's pdoc about the dosing if you are concerned.
Good luck 2 U.
Posted by AWorriedMom on May 10, 2003, at 23:14:23
In reply to Re: How much depakote and/or lithium is safe? » AWorriedMom, posted by Janelle on May 10, 2003, at 21:40:33
I'm not sure if my previous went through. Thanks for response and info. One curious thing is the blood levels she gets on these meds at these doses. Her depakote is at 60 on a 50-125 therapeutic range and lithium is at .6 I mean for all that truck load of meds, not that much to show for it therapeutically speaking. I can't imagine at these doses that her blood levels are so low relatively speaking. Also, her dad or I always give her the meds and watch that she does take them, so non compliance on meds isn't the issue yet.
Posted by Janelle on May 11, 2003, at 20:33:55
In reply to Re: How much depakote and/or lithium is safe?, posted by AWorriedMom on May 10, 2003, at 23:14:23
What you've reported is very strange - she should be in the so-called normal range, even toward the high side. She's showing levels similar to what I show on the low doses of these meds!
Is it possible the lab made a mistake, or has she had these levels done more than once. I would talk to her pdoc about this.
Posted by judy1 on May 11, 2003, at 22:20:16
In reply to Re: How much depakote and/or lithium is safe?, posted by AWorriedMom on May 10, 2003, at 23:14:23
at those doses I had almost double her blood levels- and I was only given that dose in full blown mania, never as a maintenance dose. I'm sure there are other factors weight? (I'm average build and weight) metabolism?, but still that's really low levels. have you had the testing done at a different lab to recheck the results? take care-judy
This is the end of the thread.
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