Lithium for non-bipolar disorder?

[Jamison]

Has anyone ever heard of lithium being used for severe depression in people who can not be treated with anything else? I have serious liver problems, so I am VERY limited in my medications. My doctor prescribed me low doses of lithium for depression, even though he says I do not have bipolar disorder. I will be taking 400mg a day split into 2 doses.

Anyone? Anyone have any studies for me to reference?

[AirMarshall]

Yes. Lithium can be used alone for depression or as an adjunct to Antidepressants. It is labelled as a Mood Stabillizer and other than Lamictal, is the only mood stabilizer officially approved by the FDA for depression. Lithium also is the only med proven to reduce suicide rates. It really has antidepressant powers.

Lithium is a salt, so it requires no metabolism by the liver. It is excreted by the kidneys into the urine.

From my experience, lithium acted weeks faster and had more antidepressant effect than Paxil. It generally starts to work in 5 -7 days. It had the sudden effect of putting a 'floor" under my emotions, keeping me from falling into that black hole. It may make you feel a bit 'flat' emotionally, but that passes or can be reduced by lowering the dosage.

Lithium is underappreciated these days, since many docs are lazy and don't want to bother with the minimal and easy blood checks.

Dr. Phelps comments on taking lithium:

http://www.psycheducation.org/depression/meds/lithium.html

and his comments on using lithium as an adjunct for major depression:

http://www.psycheducation.org/PCP/programs/LithiumPrimer.htm

Rxlist doesn't show any warnings or contraindications for liver problems:

http://www.rxlist.com/cgi/generic/lithium_wcp.htm

Good luck.

a.m.

[Jamison]

Do you think 400mg a day will be too low of a dose to see any benefit on depression? My doctor says we will not go above 400mg so I am worried that it will not work at 400mg.

TY, AirMarshall.

[Jamison]

Let me clarify a little bit.

My doctor says that we can not go above 400mg a day because I have Graves Disease and going above that my really have an adverse effect on my thyroid gland.

Autoimmune Hepatitis and Graves Disease. What a joy for my depression and life in general.

[sheerah]

Jamison---

FWIW my pdoc put me on depakote because of the effects of lithium on the thyroid.

I had a partial thyroid-ectomy and only have about 15% left.

I know some of the others can explain it correctly but from what I understand is that lithium works through the thyroid / builds up in the thyroid???? sorry I'm not very well informed.

I'm assuming he doesn't want your dose to go any higher because of it. If he does routine labs on lit and thyroid, he'd be able to know if it had ill effects and make changes right away.

Best of luck

Sandy

[grousemouse]

oh boy, a med post i can actually respond to.

i have major depression. i guess it is recurrent because it keeps happening again and again. my gp thinks i might by bpII, but my pdoc and previous pdoc and tdoc don't

so anyway, i am on 1200 mg lithium. i am also taking seroquel (150 mg), escitalopram (20mg - major brand name in NA is cipralex, and is related to citalopram/celexa). as of today i am now on 150 mg wellbutrin too.

i was put on lithium when i was being taken off effexor, or effexorcist as i like to call it (nice withdrawal syndrome guys, thanks for that. i really like it when my brain spins around inside my skull).

i don't know what all the lithium does for me. although it was my gp who started my on it, my current pdoc has continued it because he has found that it can help in cases of mdd. he says it acts like a ratchet that keeps your mood from slipping downward.

naturally, ymmv.

grouse.

[AirMarshall]

Let me clarify a little bit.

My doctor says that we can not go above 400mg a day because I have Graves Disease and going above that my really have an adverse effect on my thyroid gland.

Autoimmune Hepatitis and Graves Disease. What a joy for my depression and life in general.

Well, this throws you into a very rare and special group, where Endocinology, Gastroenterology and Psychiatry overlap. As you know, Graves Disease is also an autoimmune disorder wherein the body is attacking itself. There probably aren't any textbook psychiatric answers for you, and protecting your remaining liver function is undoubtedly the most critical concern for your doctors.

I cannot find any way to judge whether your dosage can be increased above 400mg. That is a judgement call by your doctors. However, note that pill dosage is not directly correlated with blood level due to individual factors such as kidney efficiency, other meds being taken, sodium intake, etc.... which is why we do blood testing after each dosage change. To be precise, your doctor should actually have a specifc blood level limit that he wants. From a pragmatic perspective, he may just use dosage level as a rule of thumb since there probably isn't any formal research published on this.

Sheerah:

...from what I understand is that lithium works through the thyroid / builds up in the thyroid????

No. Lithium works directly in the brain, apparently on sodium channels, however its mechanism of action is not understood. Lithium does not work through the thyroid nor accumulate in the thyroid. Lithium has been "associated" with hypothyroidism in a small number of bipolars and with hyperthyroidism (i.e. Graves Disease) in an very small number. I haven't seen any discussion of lithium and thyroid problems other than in bipolars. Whether lithium is the direct cause of thyroid problems is a matter of debate among doctors since research has not identified any mechanism. Studies show that bipolars in general have a significantly higher than average level of thyroid problems even without being treated with lithium. So, it may be that lithium merely unmasks an underlying condition.

Jamison, I"m sure that you have a bevy of doctors on your dance card. You might investigate talking to a "psychopharmacologist"; Someone who specializes in drugs, their mechanism in the body and how they are used for psychiatry. He might be ablet to sort through all your restrictions to identify various medications that would be safer to use. A university teaching hospital might be a good place to look for one. Your conditions may be rare enough for them to be really interested. They aren't common, but several members at CB have mentioned seeing one.

Best, a.m.

p.s. Philosophical question: What's the difference between a Bipolar whose mood cycles between normal and depressed, and someone with Recurrent Depression whose mood fluctuates between normal and deeply depressed?

p.p.s. (too little sleep last night) Will 400mg work for you? It may not be dramatic but any little bit that helps....well, helps! Considering your limitations and lack of success with other meds, take what you can get. The effect might be subtle, and easy to overlook. I would suggest that you keep a daily mood diary that records your moods, meds, sleep, etc. After several months you may see some trends which help you decide whether it has helped. The tough part is evaluating what "didn't" happen. You may get depressed next month, but how do you judge whether the lithium kept you from being deeply depressed, or flat out suicidal? That's where the diary can be more accurate than vague memory, and allow you to compare recent trends to your historical depressions. There are links to some mood diarys in my pinned Bipolar Resources post, in the bipolar section. Let me know if you need help finding one.

here is one form I like: http://www.psycheducation.org/PCP/handouts/Mood_Chart.doc

[Jamison]

I don't have much to say except for "Thank You". :-))

[seven]

p.s. Philosophical question: What's the difference between a Bipolar whose mood cycles between normal and depressed, and someone with Recurrent Depression whose mood fluctuates between normal and deeply depressed?

this is so bizarre, i have to say something. there is no such thing as a bipolar who cycles from normal to depressed. bipolars cycle from depressed to normal to (hypo)manic. nowhere but on these boards have i seen this bizarre theory that going from normal to depressed and back is a cycle and therefore bipolar. but the episodic nature of depression is already built into the definition of depression (2 wks, 2 years, recurring).

the argument seems to be that "normal" for some depressives is their "hypomania" high note. Ok. let's say you have a dysthymic whose normal is a pervasive depression. The object of treatment is not to help this person stay their normal depressed self. The object is to help the person hit that "hypomanic" high note for good--that is the true normal. Because the fact is, that really is their biological brain normal, same as for the rest of us with a little wiggle room for individuality.

Now, take a bipolar. if their "mania" is merely "normal", would pdocs want to tame that "mania" back down to mildly depressed? ludicrous. normal is normal. that's baseline. no true (hypo)mania equals no bipolar. check the dsm. that's it.

now, it's very well possible i have grossly misunderstand air marshall, but still, i have seen this profound theory floating about here. why would a depressive bend over backwards to try to be labeled bipolar?

Jamison, when lithium is used for mdd, it's usually done so at low doses and as an adjunct to an ad from what i understand. (where did i read this? i don't know, i'm a font of random excess bp info. lol) it's good for the brain at even very low doses of 150mg. helps rebuild neuronal pathways that get burned out by depression and mania.

oftentimes, since depression also entails a stultifying slowdown, the lithium slowdown can enhance this leaden quality and worsen the depression. on the one hand, depressives are too depressed to commit suicide. which is why the initial mood uplift of an ad can be touch and go, since the depressive finally feels good enough to do it. so...ultimately, lithium alone is not going to be the solution for a depressive. i forget what you're on but something to truly uplift and not just deaden will likely help as well.

good luck,

7

[AirMarshall]

p.s. Philosophical question: What's the difference between a Bipolar whose mood cycles between normal and depressed, and someone with Recurrent Depression whose mood fluctuates between normal and deeply depressed?

this is so bizarre, i have to say something. there is no such thing as a bipolar who cycles from normal to depressed. bipolars cycle from depressed to normal to (hypo)manic. nowhere but on these boards have i seen this bizarre theory that going from normal to depressed and back is a cycle and therefore bipolar. but the episodic nature of depression is already built into the definition of depression (2 wks, 2 years, recurring).

I'm probably the main instigator of this 'bizarre' idea. My general intention is to be thought provoking, and open peoples eyes to the concept of the mood spectrum relating to mood cycling. I'm probably lazy in not laying out a full discourse of the concept everytime with every post. If you want to go by absolute and sharp DSM criteria, then a lot of folks should be tossed out of pdoc offices on their ear and told to come back when they meet the arbitrary classifications. Where does the boundary lie between cyclothymia and a soft Bipolar II? Considering how notoriously difficult it is to dx bipolar disorder, and the fact that patients may minimize symptoms, there is a good possibility that the true illness may go misdiagnosed and incorrectly treated.

Now, take a bipolar. if their "mania" is merely "normal", would pdocs want to tame that "mania" back down to mildly depressed? ludicrous. normal is normal. that's baseline. no true (hypo)mania equals no bipolar. check the dsm. that's it.

Normal is normal? Don't you have a cousin or roommate who is always painfully bright, chipper, and constantly atwitter; always on the go? Isn't there someone in your aquaintance who is a tad lethargic, seldom speaks more than necessary, maybe has a wry and fatalistic outlook on life, but otherwise quietly gets along in life. Which one is normal? Which one needs medication, and what level should we force the depressive to?

now, it's very well possible i have grossly misunderstand air marshall, but still, i have seen this profound theory floating about here. why would a depressive bend over backwards to try to be labeled bipolar?

I haven't suggested that they should. However, if after years of unsuccessful treatment for depression, if one were to perceive a pattern that better fits some flavor, however mild, of mood cycling, it is reasonable to consider alternative diagnoses and discuss them with a pdoc for consideration of using mood stabilizers and non-depression specific protocols. Our membership is replete with people who have been treated for depression unsuccesfully and later changed diagnosis to bipolar or else found relief from depression with mood stabilizers.

Jamison, when lithium is used for mdd, it's usually done so at low doses and as an adjunct to an ad from what i understand. (where did i read this? i don't know, i'm a font of random excess bp info. lol) it's good for the brain at even very low doses of 150mg. helps rebuild neuronal pathways that get burned out by depression and mania.

oftentimes, since depression also entails a stultifying slowdown, the lithium slowdown can enhance this leaden quality and worsen the depression.

on the one hand, depressives are too depressed to commit suicide. which is why the initial mood uplift of an ad can be touch and go, since the depressive finally feels good enough to do it. so...ultimately, lithium alone is not going to be the solution for a depressive. i forget what you're on but something to truly uplift and not just deaden will likely help as well.

The most common protocol is to use lithium as an adjunct to an SSRI or TCA. However, German studies have found lithium alone to be better than placebo in treating depression. Another investigator has had some success in using Lithium as a sequential treatment for depression, following antidepressants. THIS IS SPECIFICALLY THE PROTOCOL JAMISON'S PDOC IS USING!

I am unable to find any reference to lithium worsening depression.

Lithium is the only only medication other than Lamictal proven to reduce suicides. SSRI's, do not provide that protection.

So in conclusion, there is no apparent reason for Jamison to refuse lithium as a treatment from a psych/pharma perspective. His pdoc can always flip the order and add an antidepressant and follow the more common protocol.

a.m.

[edit]

Here is a lengthy but easy reading disussion of the Bipolar or Mood Spectrum by Dr. Phelps at Pyscheducation.org

http://www.psycheducation.org/depression/0...chor-What-60973