mikl_pls

300 mg lithium and pharmacology of lithium?

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I just started lithium recently for the first time (3 days ago, today will be the 4th day) at a rather small dose of 300 mg. My pdoc didn't want to give me too much since I'm on so many meds. But she said that such a dose in some of her patients works well with regimens like mine to stabilize them as I have been ultra-rapid cycling between hyperthymia and suicidal, psychotic depression.

I've noticed, however, in this short amount of time, that I've gained 7.5 lb since starting lithium. Is that a coincidence, or is 300 mg lithium still capable of causing weight gain?

Also, I'd like to understand the pharmacology behind lithium. Can someone who understands it explain it to me and/or share some links to some good sources that explain it well?

Thanks. :)

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I'm on 600mg of Lithium, so only a little more than you. I started at 300mg too. I have recently had to add an antidepressant, Effexor XR, because it just wasn't cutting it with the Lithium alone. It helps my upswings though, I'm not as irritable or angry, racing thoughts, etc.

Anyway, I hope it works for you.

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38 minutes ago, Fur said:

I'm on 600mg of Lithium, so only a little more than you. I started at 300mg too. I have recently had to add an antidepressant, Effexor XR, because it just wasn't cutting it with the Lithium alone. It helps my upswings though, I'm not as irritable or angry, racing thoughts, etc.

Anyway, I hope it works for you.

Thanks! It already seems to be working. I already feel calmer, more mellow, happier, and more "content." No more ups and downs, especially no more psychotic, suicidal depression. Glad that's over. That may be also in part due to her increasing my Geodon to 60 mg 2x/day. I was on 20 mg 2x/day and it did nothing, so I got out some old Latuda and went all the way up to 120-160 mg and it was mildly effective but gave me akathisia and pseudo-parkinsonism.

I'm just concerned about the weight gain though, as I'm already pretty heavy and I'm trying hard to lose the weight I gained on Parnate earlier this year.

Good luck with the lithium + Effexor combo!

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I gained weight on lithium too but it was all water weight. Lithium carbonate is a salt so it causes water retention, or at least that's how it was explained to me.

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It would be quite odd to gain 8 pounds of actual weight in 3 days from any medication.  Lithium can cause some water retention, so if you're feeling a bit puffy, it may be that, or it may be unrelated.

What did you specifically want to know about lithium pharmacology?

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27 minutes ago, jt07 said:

I gained weight on lithium too but it was all water weight. Lithium carbonate is a salt so it causes water retention, or at least that's how it was explained to me.

I've heard that, and I'm hoping, if it is related to lithium, that that's all it is.

26 minutes ago, tryp said:

It would be quite odd to gain 8 pounds of actual weight in 3 days from any medication.  Lithium can cause some water retention, so if you're feeling a bit puffy, it may be that, or it may be unrelated.

 

That's my thoughts exactly.

27 minutes ago, tryp said:

What did you specifically want to know about lithium pharmacology?

Well, I'd like to know its mechanism(s) of action. I read on Wikipedia a little bit about how it works, about how it decreases norepinephrine and increases serotonin, has neuroprotective mechanisms and antiapoptotic mechanisms, modulates dopaminergic binding to G-protein receptors, modulates glutamate levels, competes with magnesium for binding to NMDA glutamate receptors, etc. But I figured Wikipedia was more of an overview of its mechanism of action, and that there may be a source out there with a more wholesome explanation of its mechanism of action.

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I also agree with lithium weight gain being water retention. I didn't experience much weight gain, just the initial adjustment. I took it for a couple years.

It wasn't the right med for me, but absolutely everyone I knew said I was easier to be around because I was calmer.

Edited by paintedsky
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3 hours ago, paintedsky said:

I also agree with lithium weight gain being water retention. I didn't experience much weight gain, just the initial adjustment. I took it for a couple years.

It wasn't the right med for me, but absolutely everyone I knew said I was easier to be around because I was calmer.

That further affirms my suspicions of water retention as the cause of weight gain. I've read that the potassium-sparing diuretic amiloride (Midamore) is safe to use with lithium (doesn't increase lithium blood concentrations). I wonder if that could be a possibility for reducing the water retention with lithium? I might ask my pdoc about it next time I see her.

I do wonder if there are any metabolic disturbances that lithium might cause. Anyone know about that?

 

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16 hours ago, Fur said:

I'm on 600mg of Lithium, so only a little more than you. I started at 300mg too.

Hey that's how they did it with me. I'm on 600mg and they started me at 300mg. My pdoc says it takes 5 days for the lithium to reach full blood levels in the body. So if you miss a dose, you can't get drawn for another 5 days. I learned that the hard way, oops.

Anyway I gained about 9 lbs since starting lithium and no matter what I do, it doesn't drop. I am still at the same exact weight I was 1 month ago. It is frustrating but worth it. I've had 2 episodes since Lithium and they were MILD. Mild!!! So happy to say that. Usually my moods get blown up into psychosis but Lithium tamps it down quite a bit. So the pros outweigh (no pun intended) the cons.

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19 hours ago, mikl_pls said:

Well, I'd like to know its mechanism(s) of action. I read on Wikipedia a little bit about how it works, about how it decreases norepinephrine and increases serotonin, has neuroprotective mechanisms and antiapoptotic mechanisms, modulates dopaminergic binding to G-protein receptors, modulates glutamate levels, competes with magnesium for binding to NMDA glutamate receptors, etc. But I figured Wikipedia was more of an overview of its mechanism of action, and that there may be a source out there with a more wholesome explanation of its mechanism of action.

I believe the technical explanation is "shit works, and we don't fully know why."

It appears to be all over the map, but it's also not an engineered drug like most modern pharmaceuticals. It's been trial and error with it over the past century.

It generally is better at controlling mania than depression, although for some people it helps even out the cycles. I found it to be extremely rough on my GI system and never could fully tolerate it, even after a year. My last set of labs (while I was on it) showed my thyroid was getting out of line, and I had developed a slight tremor from it. I was on 900mg, split 300 am/600 pm, and I never gained any weight on it.

I was extremely glad to get off of it, I had so many side effects, and it did very little for my depression. I hope it works for you!

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11 hours ago, Alien Navel Cord said:

Anyway I gained about 9 lbs since starting lithium and no matter what I do, it doesn't drop. I am still at the same exact weight I was 1 month ago. It is frustrating but worth it. I've had 2 episodes since Lithium and they were MILD. Mild!!! So happy to say that. Usually my moods get blown up into psychosis but Lithium tamps it down quite a bit. So the pros outweigh (no pun intended) the cons.

Glad to hear that it's working well for you! So far so good for me (only been taking for a few days and already feel more mellow and more stable). I am probably going to ask about Midamore ( a potassium-sparing diuretic that is said in a book for the management of side effects of psychiatric drugs to be safe to take with lithium) to possibly reduce the water retention and hopefully the weight gain. I'm hoping no weight gain occurs due to metabolic disturbances though.

7 hours ago, dtac said:

I believe the technical explanation is "shit works, and we don't fully know why."

It appears to be all over the map, but it's also not an engineered drug like most modern pharmaceuticals. It's been trial and error with it over the past century.

It generally is better at controlling mania than depression, although for some people it helps even out the cycles. I found it to be extremely rough on my GI system and never could fully tolerate it, even after a year. My last set of labs (while I was on it) showed my thyroid was getting out of line, and I had developed a slight tremor from it. I was on 900mg, split 300 am/600 pm, and I never gained any weight on it.

I was extremely glad to get off of it, I had so many side effects, and it did very little for my depression. I hope it works for you!

Yeah, the main reason I wanted to get put on it was to even out my ultra-rapid cycling and the antisuicidal properties. I have definitely noticed a horrible increase in my already bad tremor. That's amazing you didn't gain weight on it though!

Thanks! It does seem to be helping with my depression, which is a bonus. I mainly got it, like I said, to stabilize me and keep me out of the depths of suicidal, psychotic depression that I've been having lately. I hope to not have to take it very long and hope I can get off of it soon or eventually. But if I start cycling again, I guess I know what drug to go back to. I've heard Depakote is good for that too, but I'm a little afraid of some of its side effects (then again, lithium itself has some scary side effects too...)

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12 hours ago, mikl_pls said:

(then again, lithium itself has some scary side effects too...)

I've heard this but yet to have any. We thought that one time I had gone over my levels or something, because I was having some issues, but we determined my levels were fine and it wasn't the lithium. You just have to drink lots of water and avoid some things. I'm getting used to that.

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12 hours ago, mikl_pls said:

Yeah, the main reason I wanted to get put on it was to even out my ultra-rapid cycling and the antisuicidal properties. I have definitely noticed a horrible increase in my already bad tremor. That's amazing you didn't gain weight on it though!

Thanks! It does seem to be helping with my depression, which is a bonus. I mainly got it, like I said, to stabilize me and keep me out of the depths of suicidal, psychotic depression that I've been having lately. I hope to not have to take it very long and hope I can get off of it soon or eventually. But if I start cycling again, I guess I know what drug to go back to. I've heard Depakote is good for that too, but I'm a little afraid of some of its side effects (then again, lithium itself has some scary side effects too...)

The constant GI upset prevented me from gaining any weight. My stomach was upset pretty much every day, so I didn't eat nearly as much. Lithium did have a ton of side-effects for me, and I tried it for a solid year before I quit it. 

Depakote is better for rapid-cycling and killing mania; it did nothing for my depression, but I did gain a ton of weight on it, and started losing hair. My appetite went through the roof when I hit 1000mg, and was insatiable at 1500mg. But I think AEDs don't typically do much for me, as none of them have really done anything for my depression, including Lamictal.

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23 hours ago, Alien Navel Cord said:

I've heard this but yet to have any. We thought that one time I had gone over my levels or something, because I was having some issues, but we determined my levels were fine and it wasn't the lithium. You just have to drink lots of water and avoid some things. I'm getting used to that.

I'm definitely feeling the increased thirst, and I'm pushing a lot of water, which seems to be helping with the water retention. I've been really strict on my diet for the last few days and lost 5 lb in the last two days. :) 

23 hours ago, dtac said:

epakote is better for rapid-cycling and killing mania; it did nothing for my depression, but I did gain a ton of weight on it, and started losing hair. My appetite went through the roof when I hit 1000mg, and was insatiable at 1500mg.

2

See, all that is what I'm afraid of... The hair falling out, polyphagia, increased appetite to voracious levels, and doing nothing for depression. The rapid-cycling benefits would've been nice, but lithium has conferred a bonus anti-depressant effect without increasing my appetite and apparently my weight is manageable so long as I drink plenty of water and restrict carb intake. Sorry that you went through what you did with both lithium and Depakote... :( 

23 hours ago, dtac said:

including Lamictal.

I question Lamictal's efficacy for me anymore. At first, it was a life saver, but now it's kinda meh. I'm thinking about getting off of it because it just increases my already bad tremor, causes acne and other skin problems, and have read if you have certain types of epilepsy, if your dose is too high, it can cause seizures, so I wonder if I get off Lamictal and just stay on Zonegran if all those will improve in me. Zonegran is a good enough mood stabilizer on its own to help me with depression I think, I've only been on it before (but I was also on Keppra at the time), but I'd need another anticonvulsant to boost it a little in terms of mood stabilizing from below and in terms of controlling seizures since my pdoc won't raise it beyond 300 mg. (May be a different story whenever I get around to seeing a new neurologist though...)

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14 hours ago, Iceberg said:

u said some good experience with tegretol/trileptal what about them?

Well, I had some good results. Tegretol seemed like it could've helped my depression had I taken a larger dose, but then again it could've just caused more side effects and more depression. Trileptal made me feel more at ease, but it was such a low dose I couldn't possibly have predicted how I would've responded to a larger dose. I know Trileptal increases serotonin and dopamine in the hippocampus, so it has to have some positive effect on mood, but my pdoc insisted that any higher of a dose would depress me.

Overall, Trileptal was more pleasant and easier on side effects than Tegretol though.

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just a thought.. Cuz I know you've tried most of them. The only one I could think of is gabitril, which supposedly can help mood a little I guess  

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1 minute ago, Iceberg said:

just a thought.. Cuz I know you've tried most of them. The only one I could think of is gabitril, which supposedly can help mood a little I guess  

I've thought about trying that one, but I worry about side effects like induced seizures and weight gain. I do appreciate you giving it thought though!

I'm fixing to have a new neurologist, and what I'm hoping he'll do is just let me try Zonegran monotherapy for my seizures and bipolar, but just raise the dose anywhere from 400-600 mg and my pdoc won't have a say in it (she might alter my regimen though). If that doesn't stop my seizures (complex-partial) and/or help my bipolar, then maybe add something I've tried before but only tried low doses of, like Trileptal, or something new like Aptiom (which is sorta related).

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5 hours ago, Iceberg said:

Oh she won't raise lamictal past 300?

She wouldn't raise either of my mood stabilizers past 300 mg (Lamictal or Zonegran) during my last visit because she's trying to stabilize me by making as few changes to my regimen at a time as possible, but she has had me on up to Lamictal 400 mg before, but I didn't like it—I had so many memory problems, cognitive issues, and brain fog, it was almost as bad as Topamax. But that's when I started Zonegran, which seemed to cheer me up better than Lamictal and even cleared up the brain fog and cognitive issues Lamictal was causing me. She titrated me down to 100 mg Lamictal and up to 300 mg Zonegran (which is the one she has refused to increase past that dose for the 2 years I've been on it) and eventually discontinued Lamictal altogether and just had the Zonegran which worked fine. I recently was put back on it because of a massive major depressive episode, but it doesn't seem to be doing anything except give me side effects. I'd like to just be on Zonegran again, but a higher dose, but she won't increase the Zonegran. When I see a new neurologist (just got a referral about 30 minutes ago), I hope he'll increase the Zonegran and if need be put me on something other than Lamictal.

Edited by mikl_pls

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did you ever get weight loss from zonegran? ive heard that high doses can be weight beneficial...I think the max is 600 (?)

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16 hours ago, mikl_pls said:

She wouldn't raise either of my mood stabilizers past 300 mg (Lamictal or Zonegran) during my last visit because she's trying to stabilize me by making as few changes to my regimen at a time as possible, but she has had me on up to Lamictal 400 mg before, but I didn't like it—I had so many memory problems, cognitive issues, and brain fog, it was almost as bad as Topamax. But that's when I started Zonegran, which seemed to cheer me up better than Lamictal and even cleared up the brain fog and cognitive issues Lamictal was causing me. She titrated me down to 100 mg Lamictal and up to 300 mg Zonegran (which is the one she has refused to increase past that dose for the 2 years I've been on it) and eventually discontinued Lamictal altogether and just had the Zonegran which worked fine. I recently was put back on it because of a massive major depressive episode, but it doesn't seem to be doing anything except give me side effects. I'd like to just be on Zonegran again, but a higher dose, but she won't increase the Zonegran. When I see a new neurologist (just got a referral about 30 minutes ago), I hope he'll increase the Zonegran and if need be put me on something other than Lamictal.

Ahh the joys of seeing a neurologist and a psychiatrist, where the meds overlap, and so do the egos :) I am fortunate enough that my pdoc and neuro don't touch each other's meds, and will respect the other's choice...just don't tread into their territories. My pdoc was prescribing my mood stabilizers, neuro was fine with that. I stopped Trileptal, neuro started Trokendi, and pdoc will probably be fine with that (we discussed topiramate before, and he said he wouldn't rx it for BP treatment but had no problems if my neuro used it for migraine prophy.) Pdoc is ok with triptans as abortives, even given their primary MOA on serotonin (and Rexulti does touch serotonin more than Abilify does.)

Hopefully you get a progressive neuro who doesn't just wipe your slate and start you on his own preferred cocktail. I hate doctors like that, but unfortunately they are pretty common.

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3 hours ago, dtac said:

Hopefully you get a progressive neuro who doesn't just wipe your slate and start you on his own preferred cocktail. I hate doctors like that, but unfortunately they are pretty common.

Yeah, if he did that I'd be like, "I think I'm going to leave now and get my copay refunded..." There are two neurologists in the clinic. Perhaps if one wants to do that, maybe the other one would be more progressive. One is an MD and the other is a DO.

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