Lithium therapeutic level clarification

[Amy10]

Hello!

I am a bit confused about Lithium as there is so much info out there and some of it may not be reliable.

Anyway, last Friday I had my first Li blood test after a week of taking it. My GP called with my results today. Electrolytes and creatinine fine and Li levels at 0.5.

She said anything below that would be below the therapeutic level so she's happy for me to carry on at 600mg and get me tested every month unless I feel something is wrong/not working, in which case I should come in for a blood test immediately.

I just thought it was weird that I was within the range, if only by a hair's breadth, at 600mg, seeing as so many need to be at 900 - 1200mg judging by this board and other stuff on the net.

I know that cutting out smoking and drinking (which I have done) usually means one metabolises anything from some drugs to coffee more slowly. This could mean their effects are stronger and can be reduced to obtain the same desired effect. However, I am worried that being on that cusp might be an issue, even if my GP doesn't think it is.

God, I know I sound like a worry wart! I should be grateful it isn't taking much Li to get in the range. I just don't feel that comfortable being at the absolute minimum of the therapeutic range. My GP said the real issue was too high levels spelling toxicity and that I should go with well-being for the time being.

Also, I am not sure if it is too early to tell if it's going to be the average blood level since I had only been on it for a week before the blood test. Does the blood level tend to increase with time and level out?

Thanks and excuse the long post!

Amy

[Amy10]

Hi,

I take 800 mg, that was a high dose given to me because I was in a real crisis at the time. My levels a week after starting were 0.7, a month after 0.7, and now they are 0.5, so I too am at the low end of the therapeutic range. I know my doctor is concerned about my kidneys, as I have been on a lot of meds that affect my liver and he doesn't want to weaken my kidneys too. I feel fine.

How do you feel, in yourself, do you feel that the Li is working?

Yes, I got the impression from some of your posts (while I searched for Li related stuff) that you'd had a tough time before going on it in Autumn(?) last year. Glad to hear you feel better!

I do feel better. Within two days, obsessive suicidal ideation had disappeared and my mind slowed down. Miraculous. I have had ups and downs this week but the downs were externally related. I.e. I talked a lot about abusive, alcoholic parents, years of bullying at school and a 3 yr relationship with a psychopathic bully before i left him and ended up in the loony bin (with my counsellor)! So yes, v likely to feel sad afterwards!

I am calmer, more balanced and this is the first drug i have been on where I cannot detect ANY side effects! None! Well, maybe some bloating but who gives a fuck? I am on the low end of average ok BMI so whateva .Still some obsessive ruminating, but it's hard to detect how much of that is mixed state related (the main issue) or psychological or both. It would make sense for it to be psychological.

Anyway, I have great hopes for this drug. Some things in life feel worth living for now. Before Li, I was planning my will and investigating mentalist charities to leave my flat/money to. I can't identify with that anymore in spite of the lows. The intensity has gone.

To cut a long story short, I suppose it's great if i can have such a low dose and stay at 0.5.

Thanks for your input!

[Silver]

"Therapeutic level" is a somewhat misleading term. There are people who do well at 0.4-0.5 as a maintenance level (and some people do well with 0.3 for a maintenance level as an add-on for depression), but then need it turned up a bit for acute episodes.

And because there's such huge variance in how people clear the drug, that's why blood levels are ordered in the first place.

Don't be too surprised if you need the dose bumped up a bit in the spring, by the way.

But, hey... you're a thrifty lithium (wow, try saying that three times fast) shopper for now... it's not a bad thing.

You weren't taking ibuprofen, naproxen, or any NSAIDs along with it, were you?

[AnneMarie]

I'm another that tests close to the mg, .6sl on 600mg, .8/.9 on 900mg, and 1.2sl on 1200mg. Real predictably, too. I take 900mg maintenance because that level is better at managing the illness for me. That's what should drive your dossage, too. If .5sl does, yay! If not, then maybe you need a little more or an add on depending.

Since my labs come back good and I have very steady Li levels, I'm tested quarterly unless my mood goes wonky. In time, perhaps your testing will be moved out, too.

[Amy10]

I did try saying it three times in a row, quickly..forget it. Especially cos I was eating a sausage bagel at the same time..

I did take a few ibuprofen caps the first day or two of taking Li as it was my time of the month. Not sure if that was enough to make a difference.

It's good to know it's not that odd. I'm going to see how it goes in the next couple of weeks before i have another blood test. Wow, Stacia, that is regular and by the mg!

Thanks for the info and reassurance, anyway

[AirMarshall]

Thrify shopper, heh, polite way of saying 'cheap date/drunk" etc.

Don't get sidetracked into thinking that being at 0.5 you aren't getting an effective dose. The key is how are you responding to the med! Your doctor is showing she is treating your symptoms and not just rxing meds based on a chart. That's good. Also its nice to know that should you worsen at some point, you have lots of leeway to up the dosage without danger.

Clarification: Lithium Carbonate is a salt and is not truly "metabolized", rather is is excreted by the kidneys into the urine. The nice thing is that it doesn't add any load to the liver, nor block any metabolic pathways that might interfere with other drugs. Coffee, cigarettes, alcohol, and fast cars wont' alter the clearance rate. We don't want lithium hanging around the kidneys though, since there is a small chance that it can affect kidney function. Usually this is seen in people who take it for long periods at higher dosages, e.g. +10-20 years. Thats why it is important to drink a couple liters of water a day.

I love my lithium, and the longer I'm on it the better I like it.

Regards, a.m.

[Silver]

Coffee, cigarettes, alcohol, and fast cars wont' alter the clearance rate.

Er, except that coffee - the caffeinated kind - really does affect the clearance rate. Significantly, depending on your brew of choice. (I can drop my level by 0.3 with 2 cups of French press locally roasted high-test.)

So does dark chocolate, in PMS-type-plus-breakup-with-partner quantities. (If you eat the whole chocolate Easter bunny every day, it's a noticeable drop. The occasional Hershey's bar isn't.) Theobromine is another xanthine, similar to caffeine, and increases lithium clearance.

Caffeine, theobromine, and theophylline (old-school asthma remedy) will all increase lithium clearance. So if you dramatically change your regular daily caffeine or real chocolate (the wimpy stuff doesn't count) intake, lithium monitoring may be required.

However, fast cars won't affect clearance rate much. I drive a fairly zippy car, and lithium level remains steady, I'm happy to report.

[Amy10]

Yeah, I saw some stuff on those substances increasing clearance of Li. Thanks, Silver.

Thanks guys for all the advice and input.

My psychiatrist called today (wow, she and my GP are being v speedy and proactive!) and said she wasn't too happy with it being at 0.5 and wants me to increase my dose to 700mg from 600mg and then get another test in a week.

I feel happier with her advice, to be honest, and am going to do that from tonight and see what the result is next week. Feeling low and shitty today so hope increased Li tonight will give me some sort of fuzzy in a bubble feeling tomorrow. Please. Big Spaghetti Monster.

cheers.

[SnowWhiteQueen]

I guess I'm a weird one, as my lithium dosage had to be bumped up to 1500mgs/day just to get me into the therapeutic range. *shrug* My last SL was 0.8, so it's at a good level now. Any way, good luck to you with the lithium. Everybody's different I guess.