Lithium in mood disorders: increasing evidence base, declining use?

[Penny Century]

Lithium in mood disorders: increasing evidence base, declining use?

Use of lithium for the treatment of bipolar disorder may be declining even as knowledge of the efficacy and side-effects of lithium has increased. Recent meta-analyses confirm the benefits of maintenance lithium treatment and show that it reduces suicide and suicidality. Psychiatrists should continue to utilise this efficacious treatment for bipolar disorder.

How many of us on here are on lithium? How many have ever tried it? I know I was offered every AAP and anticonvulsant out there before lithium.

[redwarrior]

I never was on lithium (that I can remember anyway...ECTs will do that!), but I have been on pretty much every other anticonvulsant out there, I think. I think the main reason that pdocs avoid Lithium are the side effects and the problems with Lithium toxicity. Personally, if I thought it would help, I'd probably try it, but my current problems seem to be more of the anti-psychotic sort.

Have you had any bad side effects from it? I have heard of weight gain as generally being the worst. From what I've heard, Lithium toxicity can be deadly but is rare. Of course, sometimes I think pdocs are almost a little too excited to try out the latest and greatest drug out there rather than sometimes sticking to what is proven.

[Penny Century]

Have you had any bad side effects from it? I have heard of weight gain as generally being the worst. From what I've heard, Lithium toxicity can be deadly but is rare. Of course, sometimes I think pdocs are almost a little too excited to try out the latest and greatest drug out there rather than sometimes sticking to what is proven.

i get mild nausea from it. so, actually, i've lost weight. one day i didn't drink enough water and got the shakes. otherwise i'm very pleased with the lack of side effects.

[Christian82]

I'm taking it, in combination with Effexor it seems to have evened things out for me. My number one side effect is fatigue, lethargy, extreme lack of motivation. From those I have spoken to, it seems this is somewhat typical of Lithium.

[crazynotstupid]

Lithium. The Gold Standard. Quite frankly, when I came to my doc, he was hot for me to be on lith--I was on topamax. The topa worked, against all norms. I did swittch to lith when my insurance died. I thought he was gonna bake me a cake! BUT lith was not for me. YMMV as always; topa is MY gold, lith is my coal. Does A job, but not THE job.

I have, however, always been curious if maybe a low dose would help repair any possible grey matter damage said to be caused by repeated manias. That thought has always interested and disturbed me. A little bit of cheap lith probably wouldn't do any harm...maybe some day.

Side effects? I've been toxic on lithium. Nasty-bad. It's a bitch. But if people are gonna wuss out cuz of potential toxicity--shit, I'll take tremors and crickets (fuck can't remember the word, you know, ear ringing shit--oh yeah, tinnitus) and diarhhea (fuck I can't spell that either) (I think) over batshit mania.

For all its inefficacy, lith DID keep me from going off the deep end. That's all I really need, at least for $27/month without insurance. A little toxicity never killed anyone. A lot of mania? Well...just ask why I ever came to be on the boards in the first place.

[ShadowCat]

Actually its the first thing they ever offered me and I said no because I'd heard bad things, then later on when 1500mg Sodium Valproate wasn't keeping the lid on a mixed ep a few months back it was either Lithium or hospital they said. So what choice did I have, they would have put me on Li if I went to hospital anyway.

Good: it stabilised me quickly

Bad: toxicity which just kept increasing even when they cut the dose. Instant Hypothyroid. And got to the point I felt so weak I could hardly walk and as my job then entailed quite a bit of physical activity had to quit it, aside from the exponential weight loss (went up to .5kg/day at the end) I won't go into some of the details cos they're gross Sorry having a bitch there but you asked. Worse (mentally) things happened when I went off it of course and thats part of the reason I never wanted to go on it in the first place.

But if it works for you, great stick with it, I've heard some people really like it and get on well with it. I guess part of the reason its losing popularity is new and more effective meds like Lamictal coming on the market (I am hoping this one will work for me, trying it soon)

[SunshineOutside]

Penny,

Thanks for the link!

I've bee on Lithium (serum level 1.0) for several years. I effectively stopped the hypo mania. It's mild anti depressant effect did nothing for the Bipolar II

Depression nor the Suicidal Ideation. After about a year I was diagnosed with (Hypothyroidism) (Good God!!!) I still am not stable with that yet and it contributes to depression!

My best,

SO

[Anelize]

I've never taken it. My psych hates the stuff. I don't know why, but if I have a choice, I'd rather not take something requiring me to keep a certain blood level. *shrugs*

[Penny Century]

I have, however, always been curious if maybe a low dose would help repair any possible grey matter damage said to be caused by repeated manias. That thought has always interested and disturbed me. A little bit of cheap lith probably wouldn't do any harm...maybe some day.

i wonder about this too. (so does my whole family since i told them. heh.)

Side effects? I've been toxic on lithium. Nasty-bad. It's a bitch. But if people are gonna wuss out cuz of potential toxicity--shit, I'll take tremors and crickets (fuck can't remember the word, you know, ear ringing shit--oh yeah, tinnitus) and diarhhea (fuck I can't spell that either) (I think) over batshit mania.

For all its inefficacy, lith DID keep me from going off the deep end. That's all I really need, at least for $27/month without insurance. A little toxicity never killed anyone. A lot of mania? Well...just ask why I ever came to be on the boards in the first place.

staying in the shallow end of the pool for $27 a month ... there's something to be said for that.

better to have complete stabilization, of course.

[MiaB]

I've heard SO many people on CB say that it was their doctors' first choice stabiliser for them upon receiving the BP dx. In my case though, I went through 3 or 4 other meds before starting lith. Admittedly I fought this all the way, but finally capitulated when nothing else seemed to be working. (not that it seems to be doing a great job now, since I still need another 5 or so meds to get by) Because I am on so many meds it's very hard for me to tell how much good the lith is actually doing. The only way to figure that out would be to drop everything except the lith, then re-add the other meds slowly, and I'm NOT going down that route! The side effects suck, but at this stage I'd rather stay on it just in case it IS keeping something horrible inide my head in check.

[jmb252]

my pdoc did not want me to go on lithium. (he also didn't want me to go on risperdal, and absolutely refused to prescribe zyprexa after my weight gain on seroquel.)

after we tried pretty much everything, which was a process that involved me going to a bunch of abdominal specialists because i was getting bad pains that ended up being a nasty side effect of topa, he gave it to me, not thinking it would help much.

it was the best thing ever for me. it was the same big lift of a yucky bp cloud that i got when he finally gave me risperdal. the lithium stabilizes me like nothing else could, and gives my ad combo a kick in the ass.

i had to go off it for a few months when i moved here and it was horrible. i knew exactly when the last pill left my system.

i will never go without it again.

i do have minor side effects from my whole cocktail -- loss of appetite, a bit of weight loss, and killer thirst. nothing unbearable, though. (the weight loss is nice since i'm still carrying the 100+ lbs i gained on seroquel.)

[Antiks]

I've tried lithium and last until I was brought up to 1200 mg a day. At that point I had some nausea, psychosis, and just generally feeling like I was on weed.

[Newtonium]

My pdoc didn't want to prescribe lithium, and having taken it, I understand why. I had such a bad tremor I couldn't even eat with a spoon, it shut my thyroid down (causing a whole host of other unpleasant symptoms), and gave me diarrhea. Plus I got so sick of pushing the fluids I felt like throwing up every time I looked at a glass of water. Also, it did nothing to control my moods.

I know there are a lot of people who love lithium, but it didn't work for me. OTOH, I think Seroquel shits gold, while a lot of folks hate it. This is a complicated disease we have, isn't it?