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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 28. Go back in thread:
Posted by Phillipa on January 23, 2012, at 21:18:36
In reply to Re: Lithium's Safety Evaluated Safer Than Thought, posted by crazyjoe on January 23, 2012, at 21:10:26
Hi these are the nursing bulletins I receive. I did know the thyroid controversy didn't know the kidneys. Also knew weight gain. Great to learn some new things. Phillipa
Posted by SLS on January 24, 2012, at 3:41:02
In reply to Re: Lithium's Safety Evaluated Safer Than Thought, posted by Raisinb on January 23, 2012, at 19:12:42
> Man, lithium was tough on me. Severe acne and constipation and I couldn't read or think. If only they could do something about that.
Have there been any other drugs that affected the way you read and think in a similar way?
- Scott
Posted by Raisinb on January 24, 2012, at 7:41:54
In reply to Re: Lithium's Safety Evaluated Safer Than Thought » Raisinb, posted by SLS on January 24, 2012, at 3:41:02
Hi Scott,
No, to my knowledge lithium is the only one that had such a dramatic effect on my cognition. I do remember that after I took ambien at night, I would read a chapter or two of a book and literally remember nothing (I'd have a bookmark but have to move it and start over). That was only at night, though.
Posted by SLS on January 24, 2012, at 8:15:29
In reply to Re: Lithium's Safety Evaluated Safer Than Thought, posted by Raisinb on January 24, 2012, at 7:41:54
> Hi Scott,
> No, to my knowledge lithium is the only one that had such a dramatic effect on my cognition. I do remember that after I took ambien at night, I would read a chapter or two of a book and literally remember nothing (I'd have a bookmark but have to move it and start over). That was only at night, though.Yeah. Ambien is well known to produce amnestic effects, including sleep-walking and sleep-eating.
I was just curious if any serotonergic drugs affected you the same way that lithium did. Lithium has some pro-serotonergic properties. Klonopin acts somewhat like lithium in this regard. You might want to be aware of this should you choose to try it at some point.
- Scott
Posted by Toph on January 24, 2012, at 11:08:05
In reply to Lithium's Safety Evaluated Safer Than Thought, posted by Phillipa on January 23, 2012, at 19:01:09
30 years on lithium. No significant side effects. One manic relapse (when I was careless with my med).
Posted by raisinb on January 24, 2012, at 11:32:50
In reply to Re: Lithium's Safety Evaluated Safer Than Thought » Raisinb, posted by SLS on January 24, 2012, at 8:15:29
I have never tried Klonopin, but I will keep it in mind, since it is a possibility for the future.
I have been on several SSRIs and the effect is noticeably different. On the former I can definitely experience emotional flattening, but it's a circumscribed experience. On Lithium I wouldn't even remember the word "circumscribed," nor how to use it. I remember reading pages and paragraphs over and over again--I read all the words--but the content refused to enter my brain, as if there was a wall between me and my thoughts or understanding.
Posted by SLS on January 24, 2012, at 13:46:20
In reply to Re: Lithium's Safety Evaluated Safer Than Thought, posted by raisinb on January 24, 2012, at 11:32:50
> I have never tried Klonopin, but I will keep it in mind, since it is a possibility for the future.
Klonopin can be a great match for some people, so I wouldn't reject it as an alternative. Just be aware that it can produce a mild to moderate depression sometimes.
- Scott
Posted by papillon2 on January 25, 2012, at 6:46:04
In reply to Re: Lithium's Safety Evaluated Safer Than Thought, posted by raisinb on January 24, 2012, at 11:32:50
> I remember reading pages and paragraphs over and over again--I read all the words--but the content refused to enter my brain, as if there was a wall between me and my thoughts or understanding.
This is exactly what I experience when my lithium level is too 'high' (high for me is ridiculously low for most people). Great description - I think I might borrow it when trying to explain it to others. Thanks.
Posted by Raisinb on January 25, 2012, at 9:25:48
In reply to Re: Lithium's Safety Evaluated Safer Than Thought » raisinb, posted by papillon2 on January 25, 2012, at 6:46:04
Interesting--did you have the blood tests? That is what I was like on a level of .8, which pdoc said was normal. After three months of it I told her I was going off, and she nearly jumped out of her seat. Are you on lithium now?
Posted by papillon2 on January 25, 2012, at 20:24:43
In reply to Re: Lithium's Safety Evaluated Safer Than Thought, posted by Raisinb on January 25, 2012, at 9:25:48
I am currently on 125mg (level .12) but I'm taking a little hiatus from Lithium until I speak with my psychiatrist in 2 weeks (reasons below).
On 500mg (level .8) I experienced:
- severe cognitive problems (the "wall") - confusion; difficulty thinking, talking and understanding others when spoken to; word find problems and occasionally saying the wrong words in sentences.
- nausea from even just moving my head
- dizziness
- stumbling around
- trembling
- massive headache and eye pain
- slowed movements in addition to the slowed thinkingOn 250mg (level .2) I had occasions where I experience the above, as opposed to a constant presentation. These were usually preceeded by slight dehydration and a marked increase in that horrible Lithium metallic taste. On one instance I also had a freaky experience where my eyes were constantly and uncontrollably darting from side to side even when my eyelids were closed. I think it's called nystagmus.
So, the reason for my hiatus? Three nights ago I had cognitive problems again (though not to the same degree), the massive headache and eye pain that comes with the cognition problems, and a full colour visual hallucination that was terrifying.
I'm not sure if the hallucination was related to Lithium. There's a small chance I may have had a seizure due to a sudden spike in my Lamictal level (an interaction with the contraceptive pill). The hallucination that I had, which was of being attacked by a purple/blue geometric shape with a bright light, is apparently frequent with ocipital seizures. But I'd rather not risk it.
I am mainly terrified that I am developing psychotic features but hoping it's just something called hypnopompic and hypnocogic hallucinations.
Wow, I've rambled. Anyway, I wish I weren't so sensitive to Lithium because the low dose I have as an adjunct to my anti-depressant would otherwise be quite safe, it is proven to reduce suicide rates* and has neuroprotective features. If someone had a choice between Lithium and an atypical anti-psychotic as a mood stabilizer, I would definitely suggest first trying Lithium.
*For example, there's one study where they found that towns in... I think it was Sweden or Switzerland... with higher levels of Lithium in the drinking water had less suicide attempts and deaths than towns with lower Lithium levels. They made adjustments for other factors like population and mental illness rates.
Posted by raisinb on January 28, 2012, at 21:09:20
In reply to Re: Lithium's Safety Evaluated Safer Than Thought » Raisinb, posted by papillon2 on January 25, 2012, at 20:24:43
I have heard of hypnagogic hallucinations--sometimes I get the auditory kind. I read on Wikipedia that they are actually fairly common. Still a scary, scary experience.
But the side effects were more than enough to worry about the Lithium before your hallucination.
From all the studies I read about Lithium, it ought to be the perfect drug for me--I have bipolar II, depressed--that is, until I actually take it. Worst side effects I've ever had from anything.
Posted by SLS on January 29, 2012, at 6:51:06
In reply to Re: Lithium's Safety Evaluated Safer Than Thought, posted by raisinb on January 28, 2012, at 21:09:20
> From all the studies I read about Lithium, it ought to be the perfect drug for me--I have bipolar II, depressed--that is, until I actually take it. Worst side effects I've ever had from anything.
That totally sucks. Sorry.
I thought that lithium was not very effective for treating BPII. Maybe this is an old idea. Valproate had been the drug of choice for this indication before the AAPs came to market.
What were the side effects that you had with lithium?
- Scott
Posted by raisinb on January 29, 2012, at 11:50:03
In reply to Re: Lithium's Safety Evaluated Safer Than Thought » raisinb, posted by SLS on January 29, 2012, at 6:51:06
I was hospitalized in the fall, and both the pdocs there and my regular pdoc thought Lithium should be my drug of choice. I guess it's the reducing suicidality piece.
I had bad cystic acne I couldn't get rid of, despite all the topical, antibiotic, and natural remedies I tried. I even had some accutane from sources I won't mention, and that only helped a bit.
I also had severe constipation. Again, no mild remedies helped; despite water, exercise, fiber, and stool softeners, I had to take stimulant laxatives a few times a week. Not to provide TMI, but safe to say, that's no way to live!
I also had the cognitive effects I mentioned above. Felt like my brain was encased in cement.
It stabilized my moods, but did it to the point of anhedonia. I just felt nothing all the time.
I gave it three months; I don't know if that's an adequate trial, but I got fed up. The blood level was .8, which was not too high. The pdoc was strongly against me ditching it, but agreed to put me on Trileptal. It seems to be going okay, but not ideal. When I get severely stressed, I need to attack my moods with extra therapy, hard exercise, and total social withdrawal. I guess I'd rather spend several days in my apartment playing video games than deal with Lithium.
Posted by Toph on January 30, 2012, at 10:08:42
In reply to Re: Lithium's Safety Evaluated Safer Than Thought, posted by raisinb on January 29, 2012, at 11:50:03
Almost half a million Americans are treated with lithium. I imagine that probably at least that many have tried it and found it ineffective or the side effects unacceptable.
Posted by papillon2 on January 30, 2012, at 18:02:31
In reply to Re: Lithium's Safety Evaluated Safer Than Thought, posted by raisinb on January 28, 2012, at 21:09:20
> I have heard of hypnagogic hallucinations--sometimes I get the auditory kind. I read on Wikipedia that they are actually fairly common. Still a scary, scary experience.
>
> But the side effects were more than enough to worry about the Lithium before your hallucination.
>
> From all the studies I read about Lithium, it ought to be the perfect drug for me--I have bipolar II, depressed--that is, until I actually take it. Worst side effects I've ever had from anything.Yeah, you're right. I just... I really wanted Lithium to work, you know? I can tell you know. It took me ages to garner up the courage to try it, and that was only because I was in hospital (4 months!) with three docs wanting to give me ECT and they said if I couldn't make a decision - augment with Lithium or ECT or both - then they would have me declared legally unfit and they'd make the decision for me.
I hate anti-psychotics, they make me feel worse. All the fat meds make me feel worse, too much anxiety. I don't want ECT messing with my brain, I've already lost my brain to depression as it is. And all the meds just keep getting worse and worse and more and more intolerable.
Sh*t, everything is freaking hopeless.
Posted by raisinb on January 30, 2012, at 19:45:28
In reply to Re: Lithium's Safety Evaluated Safer Than Thought, posted by papillon2 on January 30, 2012, at 18:02:31
WTF, can they legally do that? Are you in the US?
Yeah, I know how you feel--I desperately needed something to work, too. Finally a combo of things did, just not Lithium. I'm in remission now and have been for a few months, but suicidal depression has been a regular part of most of my life.
Posted by papillon2 on January 30, 2012, at 20:33:02
In reply to Re: Lithium's Safety Evaluated Safer Than Thought, posted by raisinb on January 30, 2012, at 19:45:28
> WTF, can they legally do that? Are you in the US?
I'm from Australia, relevant legislation here: http://www.legislation.nsw.gov.au/fullhtml/inforce/act+8+2007+FIRST+0+N refer to section 3.
I know you can be forcibly admitted and treated against your wishes in the US, but I'm not sure if such treatment extends to ECT.
Posted by papillon2 on January 30, 2012, at 20:39:40
In reply to Re: Lithium's Safety Evaluated Safer Than Thought, posted by raisinb on January 30, 2012, at 19:45:28
Sorry, that should be Chapter 3 (section 12 onwards) and for ECT, see Divison 3 (section 87 onwards)
Posted by Raisinb on January 31, 2012, at 16:59:45
In reply to Re: Lithium's Safety Evaluated Safer Than Thought, posted by papillon2 on January 30, 2012, at 20:39:40
I didn't know that. Sobering. Glad you were able to avoid the ECT.
Posted by crazyjoe on February 1, 2012, at 21:28:07
In reply to Re: Lithium's Safety Evaluated Safer Than Thought, posted by Raisinb on January 31, 2012, at 16:59:45
why does know one ever discuss lithiums effects on the kidneys
Posted by ed_uk2010 on February 2, 2012, at 6:26:49
In reply to Re: Lithium's Safety Evaluated Safer Than Thought, posted by crazyjoe on February 1, 2012, at 21:28:07
>why does no one ever discuss lithium's effects on the kidneys
Lithium is now generally used at lower doses than previously, which may be less toxic to the kidneys. Rather than using very high doses of lithium, it is usual to combine a moderate dose of lithium with another medication (eg. Depakote or Zyprexa) if the response is not sufficient.
Regular blood tests are recommended to assess lithium level, renal (kidney) function, thyroid function and according to this article, calcium levels. The dose is adjusted based on patient response, tolerability and lithium level. Additional treatment with thyroid hormones may be needed if hypothyroidism occurs. If there was a large decrease in renal function, lithium would have to be stopped. Fortunately, it's much more common to see small changes in renal function which would be monitored with further blood tests.
Posted by papillon2 on February 8, 2012, at 20:30:08
In reply to Re: Lithium's Safety Evaluated -Safer Than Thought » crazyjoe, posted by ed_uk2010 on February 2, 2012, at 6:26:49
So I saw my psychiatrist yesterday who agreed with me on the likelihood of Lithium being responsible for my confusion, hallucination, etc two weeks ago. She also agreed that I made the right call in discontinuing Lithium. But she wants me to resume taking it (and have weekly appointments) as I have a stressful 2 months ahead of me. So back I go.
This could get interesting. :/S
Posted by SLS on February 9, 2012, at 5:09:09
In reply to Re: Lithium's Safety Evaluated -Safer Than Thought, posted by papillon2 on February 8, 2012, at 20:30:08
> So I saw my psychiatrist yesterday who agreed with me on the likelihood of Lithium being responsible for my confusion, hallucination, etc two weeks ago. She also agreed that I made the right call in discontinuing Lithium. But she wants me to resume taking it...
If your doctor is convinced that lithium was the cause of adverse effects, it doesn't seem like a very sound decision to resume taking it.
1. Have you ever experienced confusion, hallucinations, etc. before? What were the other symptoms included in "etc."?
2. What dosage of lithium had you been taking before, and what is your dosage now?
3. What is your psychiatric diagnoses?
4. If you are bipolar II, perhaps using another drug would be more helpful, e.g. anticonvulsant, antipsychotic.
5. What are the symptoms of your illness when it is unmedicated or at baseline?
- Scott
Posted by papillon2 on February 9, 2012, at 7:55:24
In reply to Re: Lithium's Safety Evaluated -Safer Than Thought » papillon2, posted by SLS on February 9, 2012, at 5:09:09
> 1. Have you ever experienced confusion, hallucinations, etc. before? What were the other symptoms included in "etc."?
Easiest if you read this:
http://www.dr-bob.org/babble/20120120/msgs/1008404.htmlI have not otherwise experienced hallucinations. That particular type of confusion is something I only get on Lithium.
> 2. What dosage of lithium had you been taking before, and what is your dosage now?
Ref to above. Back to taking 125mg.
> 3. What is your psychiatric diagnoses?
Severe melancholic depression which is apparently "textbook". I've received the same diagnosis from 3 different psychiatrists. They do not think I have bipolar disorder.
My depression has been labelled treatment-resistant but I am getting some relief from my current meds so not sure if that still applies.
Years ago:
Major Depression with PTSD features (never fully remitted then worsened into melancholic depression)
Anorexia nervosa (recovered)> 4. If you are bipolar II, perhaps using another drug would be more helpful, e.g. anticonvulsant, antipsychotic.
I take Lamictal. I refuse to take anti-psychotics as the increased appetite and uncontrollable weight gain is extremely triggering eating disorder-wise and the anxiety is intolerable. I took Epilim (valporate) for about a month, my psychiatrist took me off it when I developed tremors. Not sure it helped.
I am open to suggestions but I'm not sure there are any options.
> 5. What are the symptoms of your illness when it is unmedicated or at baseline?
Severe psychomotor retardation
- barely able to think, walk, move limbs, eat/drink, talk/converse. I basically wind up in hospital, mute and in a wheelchair.
Loss of appetite/weight
Severe suicidal ideation
Leaden paralysis
Anhedonia
Overwhelming fatigue
Poor memory, concentration, attention
Insomnia presenting as frequent wakenings and early morning wakening
Diurnal mood variation
Increased feelings of guilt
Inability to make decisions
Non-reactive mood
Unable to get fired up to do anything, even basic self-care tasks, don't want to say how basic as it's embarrassing.
and depressed mood, obviouslyCurrent meds
Nortriptyline 100mg (blood level 5.1)
Lamictal 200mg
Lithium 125mg (blood level something like .12)
Melatonin 3mg
And a whole bunch of supportive stuff
Posted by SLS on February 9, 2012, at 8:15:51
In reply to Re: Lithium's Safety Evaluated -Safer Than Thought, posted by papillon2 on February 9, 2012, at 7:55:24
Thanks for the reply. You sure are sensitive to lithium. It certainly sounds like the wrong drug for you.
Look into using prazosin (Minipress). It might be good for a depression that is driven or complicated by PTSD. It is cheap and generally benign. I am currently getting good results with prazosin at a dosage of 6 mg/day.
Currently:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 6 mg- Scott
This is the end of the thread.
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