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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 RiFi on March 12, 2012, at 19:04:51
Hi All,
Perhaps the title should read Lithium 'potentiated' hypomania and anxiety, but I wanted to make it searchable for those who've experienced a similar paradoxical effect.
Short version:
Lithium potentiated (increased the potency of) the effect of my anti-depressant and caused serotonin syndrome. For me, the symptoms included: hypomania, increased anxiety and irritability, excessive rumination, diarrhea, headaches, body aches, stiffness (the muscles in my neck and shoulders became rock hard), heightened tendency to startle and excessive sweating. I am a slow metaboliser (a term that used to confuse me because of the rapid onset of drug effects I always experience) which means that the blood levels of medication remain high for much longer and the body isn't able to clear the drug as quickly as other people.Long version:
I have Bipolar II and over the last 3 years have trialled at least 5 mood stabilisers, the latest one being Lithium. Each time I started the new medication I'd feel better within hours - mood lifted, increased energy and motivation. The positve effects would last for about 3 days, then anxiety would kick in, my mood would drop, and 2 days later I'd have an enormous crash. As I'm sure many of you have experienced, if you have bipolar, sometimes these crashes can be fundamentally different from good old depression. For me I can go from feeling flat but ok, to an one hour later being on my knees with the deepest, darkest sadness where tears, unbidden, roll day my face and my heart aches with emotional pain. Cont...
Posted by RiFi on March 12, 2012, at 19:22:08
Hi All,
Perhaps the title should read Lithium 'potentiated' hypomania and anxiety, but I wanted to make it searchable for those who've experienced a similar paradoxical effect.
Short version:
Lithium potentiated (increased the potency of) the effect of my anti-depressant and caused Serotonin Syndrome. For me, the symptoms included: hypomania, increased anxiety and irritability, excessive rumination, diarrhea, headaches, body aches, stiffness (the muscles in my neck and shoulders became rock hard), heightened tendency to startle and excessive sweating.I am a slow metaboliser (a term that used to confuse me because of the rapid onset of drug effects I always experience) which means that the blood levels of medication remain high for much longer and my body isn't able to clear the drug as quickly as other people. The combined effect of being a slow metaboliser and the Lithium potentiation of my anti-depressant meant that my seratonin blood levels rose too high for too long, resulting in Seratonin Syndrome.
Continued below...
Posted by RiFi on March 12, 2012, at 20:30:08
continued from above...
Long version:
Firstly, I should state that Serotonin Syndrome can be life threatening, so call your doctor if youre feeling some of the of the symptoms I described above and go to emergency if youre feeling many of them.Ive had Bipolar II since child but was only diagnosed 3 years ago. For the past 20 yrs Ive tried almost every anti-depressant under the sun and it wasnt until my diagnoses that I finally understood why so many of them started out so well but ended in disaster. Im currently on Cymbalta (an SNRI which is typically an absolute no no with bipolar because of the tendency of many SNRIs and indeed SSRIs to kindle mood instability, especially those prone to rapid cycling. But I have severe interstitial cystitis and its the only medication thats ever brought me relief from the constant pain, without sending me completely tropo). I also take Lamictal (which seems to suit me) and Seroquel (which has been an absolute gift for my lifetime of severe insomnia). Unfortuantely though, this drug combination hasnt been quite enough to keep me stable or functioning.
Over the last 2 years I have trialed at least 5 add-on mood stabilisers, the last one being Tegratol. Each time I started a new mood stabilser I'd feel better within hours my mood would lift and my energy and motivation would significantly increase. Id think Wow, so this is how the other half lives! This drug is great - I finally feel not only happy but functional! The positive effects would last for about 3 days, then sadly, anxiety would kick in, my mood would drop, and a few days later I'd have an enormous emotional crash.
So last week I began another trial, this time with Lithium of a tiny, tiny dose of 50mg. I was prepared for the feeling of tiredness and flatness etc that people so often describe with Lithium, but within 4 hours of taking it I felt the very familiar lift in mood, energy levels and motivation. My heart sank and my mind boggled (surely not Lithium??) because I knew hypomania was making another unwelcome appearance.
I scoured the PubMed jounals looking for documented cases of Lithium induced hypomania and found nothing. So then I searched for Lithium-induced anxiety, and thats when I found 2 documented cases of Lithium potentiating the effect of anti-depressants, leading to Serotonin Syndrome. If you go to drugs . com, youll find a myriad of drug families than can potentiate anti-depressants effects leading to raised levels of serotonin, norepinephrine and/or dopamine. So next time youre adding on a new drug, you might want to do the homework most psychiatrist don't!
PS I realise now Ive experienced at least two episodes of Serotonin Syndrome in the past (but luckily stopped taking the offending drug immediately). As many of the symptoms of hypomania and Serotonin Syndromes overlap, its not always easy to tell them apart. From my experience, its when you start to feel physical (stiffness, aches, flu-like symptoms) and fairly extreme psychological changes that you should sit up and take notice.
Sorry for the long, long blurb but Im hoping the details might help others work out a possible cause for paradoxical drug effects.
Posted by linkadge on March 12, 2012, at 22:15:12
In reply to Lithium induced hypomania and anxiety cont..., posted by RiFi on March 12, 2012, at 20:30:08
Lithium is a funny medication. With me, it tends to increase energy and cause activation early in treatment. This will settle down and you will get more of an antimanic effect.
If hypomania is a problem, increase lithium and decrease the antidepressant. Lithium *won't* act like this forever. In the short term, lithium increases glutamate release, but over time, it stabilizes glutamate (keeping it in a narrow, low range).
Linkadge
Posted by RiFi on March 16, 2012, at 6:19:56
In reply to Re: Lithium induced hypomania and anxiety cont..., posted by linkadge on March 12, 2012, at 22:15:12
Hi Linkadge,
Thanks so much for your post. I hung in there for a few more days but, despite lowering the dose of my antidepressant and lithium, my symptoms continued to get worse. I rang my pdoc and he thought definitely serotonin syndrome, especially as I've had it once before (when we trialled a tiny, tiny dose of dexamphetamine in addition to SNRI).
I've experienced 'activation' and drug-induced hypomania many times, but this was fundamentally different - extreme anxiety, rumination, the muscles in my back and shoulder became harder and harder, and every muscle in my body feels like it's run it's own marathon - very sore and stiff, tremor, agitation, and I can't overstate the anxiety which I've beaten for the last decade with meds.
I stopped taking lithium yesterday morning and have kept my SNRI dosage low, and the symptoms are slowly subsiding.
Regardless, thank you for the heads up regarding the activiation you experience with Lithium. Who'd have thought! Especially when it has a reputation of turning people into tired, flat logs (though of course not everyone and I know it can be a wonderful, wonderful drug for many).
Ri
Posted by phidippus on March 17, 2012, at 19:42:51
In reply to Lithium induced hypomania and anxiety, posted by RiFi on March 12, 2012, at 19:04:51
Lower the dose of the antidepressant and maybe even the Lithium.
Eric
This is the end of the thread.
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