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Hi all, was wondering if anyone out there had some advice for me regarding Lithium.

The cocktail in my signature has worked well for me and I thought I was stabilising out, but I seem to have started up with mild hypomanias and depressions again. The frequency and severity of these episodes is worsening, so my pdoc wants to do something now to stop the situation and get me stable. Today she suggested Lithium. In the past she told me it wasn't any good for rapid cyclers like myself, but it seems there's a handful of people who have really benefitted from it and she thinks I may be one of them.

So, my questions. Are you a rapid cycler? If so, how did Li work for you? Even if your cycling is non-rapid, how are you finding Li? What are the side effects like? Was it worth trying it?

My pdoc isn't trying to force Lith on me and the final decision is, at present, down to me. I'd like to be able to make the decision as to what to try whilst I'm still able to (I can just see my lovely psychotic mania rearing it's head again if I'm not careful), so really any advice you can give would be fabulous.

Thanks.

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I am an ultradian cycler and I started off at 1350mg, and now I am down to 900mg. I have heard that is pretty much the average maintenence dose.

I would totally recommend titrating up. The side effects for me I have gotten used to. Splitting the dose into am/pm did not work for me at all because I was exhausted during the day. Now it doesn't affect me during the day. I was nauseous to start out with, so make sure to eat. I had trouble eating but was okay when I ate little meals. At the higher dose, my legs felt weird. But now, no. The shaking can be bothersome but not so much at the lower dose.

As far as the rapid cycling, I am just not sure. I have not been in good shape but I think a lot of that is circumstantial. From everything I have read, Lith is best for regular BP, not rapid cycling. The best for that is Depakote. I am sure it works for some with rapid cycling, but I am not sure it is working for me. Maybe if I was still at 1350mg it would be better.

Anyway, those are my experiences. Maybe it will augment everything else you are on. Hope it works for you!

Sam

Edited because I have no spelling abilities whatsoever.

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Lithium

Lithium (brand names Eskalith, Lithobid, Lithonate), a mood-stabilizing drug, is the most commonly prescribed medicine for people with bipolar disorder. It is helpful in controlling mood swings in both directions from mania to depression and from depression to mania. Lithium will reduce symptoms of mania within two weeks of starting therapy, but it may take weeks to months before the condition is completely controlled. Thus other drugs like antipsychotic drugsantipsychotic drugs or antidepressant drugsantidepressant drugs may also be used to help control symptoms.

Depakote

Depakote is an antiseizure medicine that is also effective for controlling mania. It is highly effective for people with rapid-cycling bipolar disorder. The drug has some side effects, can cause inflammation of the liver, and can decrease the amount of platelets (blood cells needed for blood to clot) that the body makes, so your doctor will monitor levels of Depakote as well as liver function and platelet counts.

http://foxnews.webmd.com/content/article/60/67149.htm

Can we not play "Support our stance via the internet" please? This is not really all that important in the long run.

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I'm not devaluing the effectiveness of depakote as a good first line mood stabolizer, particularily for rapid-cyclers, but with PCOS in my family and hormonal issues I already have, it is not appropriate for me.

I have read all the info on all 3 first-line treatments.  I agree with my pdoc that lithium is the best one to try first on me.  For someone else, depakote may be a better choice, or lamictal if you are more prone to the depressive side.

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Can we not play "Support our stance via the internet" please? This is not really all that important in the long run.

<{POST_SNAPBACK}>

The reason I posted it was not flippant. I have read many times, including here, people suggest divalproex for rapid cycling BD. Dee stated that she is rapid cycling and is starting Li therapy on Monday. Perhaps it would be reassuring to her to know that Li can be just as effacious for rapid cycling BD. The study that I linked to is a double blind RCT which is a standard a high percentage of the other studies lack.

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Glen

Dee has already heard me say that PLUS I am taking Lithium and I am an ultradian cycler myself, as stated above. It was difficult to ascertain your position as you did not write anything yourself in your post.  Whatsgoingon asked for advice and our experiences.

I don't doubt that there are other double-blind studies that indicate that Depakote is more effective for rapid-cycling. I don't think any belief should be based on one experiment.

Anyway, I'm not trying to fight. If I mistook your intent, I apologize.

Sam

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I'm not devaluing the effectiveness of depakote as a good first line mood stabolizer, particularily for rapid-cyclers, but with PCOS in my family and hormonal issues I already have, it is not appropriate for me.

I have read all the info on all 3 first-line treatments.

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Thanks for the replies.

I'm certainly edging towards giving Lithium a go- pdoc and I were actually thinking more along the lines of a Dep/Lith combo, if it makes any difference. Ideally this combo would allow me to ditch the Zyprexa and Thorazine, as it's possible these are causing some of the short dips into depression I experience. Then again, it could be part of the rapid cycling- maybe I'm going to feel the best I'll ever feel on the drugs I take now. Arghhhh!! Decisions, decisions.

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Hey I just noticed you are already on Depakote.  Did you just start it?

Will you be stopping some of the other meds? 

That will be quite the cocktail.  How will they even know what's working or what might be making things worse? 

I want to do the lithium monotherapy first so we know exactly what the lithium is doing on it's own.  I dropped to 37.5 Effex today, so it's almost out of the picture now.  Seroquel and valium I can just drop when I start the lithium, since I don't take high doses of either.

I hope we both have great results on lith. ;)

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aside from last week, lithium kind of messes with my cycle. Usually, its like 5 days up (not necessarily hypomanic, maybe just a good normal) and then slowly work to 5 days down, with some minor variations and some random off days. Lithium turned it into 2-3 each way, with a lot of random days. My mood chart went from a wave to blood spatter the very day I started taking it again.

At 300mg I'm 99% sure i wasn't even close to therapeutic though. If i am, then i"m greatly shocked and amazed. The side effects for me weren't all bad, normal water tasted like sea water, some stomach upset. it all went away.

I'd give it a shot. If it doesnt work out, then you at least know so for future reference.

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