Lithium PRN?

[OscillateWildly]

Has anyone heard of using low dose lithium (e.g. 450mg) PRN for dysphoria/agitation/insomnia as related to bipolar spectrum disorder? Of course this assumes the individual is not being maintained on lithium, and is not using enough daily to reach a theraputic blood level, as that would be dangerous.

I know this probably wouldn't be considered standard practice, but I mean for actual individuals who have bipolar spectrum disorders, have you used lithium "when you feel bad" in order to help you feel better? Did it work for you?

I am not taking any medications for mood stability, but when I do have an extra hellacious bout of symptoms I submit to low dose lithium and it usually helps anywhere between a little to a lot, it works right away (within 20 mins).

It takes away the agitation, it mellows depression, it quiets thoughts, it helps me sleep, etc. Basically, it sucks out the crazy. It doesn't completely fix the problem, but the desperate, scraggly, insomniac, borderline delusional and detatched "aw I'm in it now, oh boy here we go" type crazy depression is resolved greatly. Basically I use it when I feel powerless over the craziness. And it helps a lot.

It's like a lightswitch, 20 minutes, half hour, I feel mostly sane whereas before taking it I was a beast. It's like I come unravelled and it helps organize me again.

Is this a placebo?

(If anyone wonders why I don't take mood stabilizers, it is because my primary problem is depression, and I fear that mood stabilizers EVERY day would make my depression and dysthmic personality worse)

[icebird200]

It was reccommended to me by a pdoc friend to take a single 300-600 mg dose

when I get bad racing thoughts.

He taught me how to mix lithium and valproic acid PRN... 500 mg valproic acid plus 300-450 mg lithium

helps impulsive moodswings.

Perhaps somebody could chime in on more lithium PRN experiences?

You could try lamictal for your moods. It's certianly not a down feeling mood stabilizer. I actually

had to go off it because it was too stimulating. Any mood stabilizer

augmented with an anti depressant shouldnt be a problem,imo.

[SashaSue]

1) What you're describing doesn't sound all that much like depression. I hope you've described it to your pdoc.

2) You should really do more research on mood stabilizers and depression, as your current understanding doesnding doesn't even make sense to me theoretically, and, more importantly, it has nothing to do with how mood stabilizers actually work when used to treat depression.

[Silver]

Has anyone heard of using low dose lithium (e.g. 450mg) PRN for dysphoria/agitation/insomnia as related to bipolar spectrum disorder? Of course this assumes the individual is not being maintained on lithium, and is not using enough daily to reach a theraputic blood level, as that would be dangerous.

Uh, what?

I'm assuming that you mean that "adding 450 mg lithium on top of a therapeutic blood level would be dangerous," not "a therapeutic blood level of lithium would be dangerous as standard care."

PRN lithium isn't standard practice, no. Even those of us who are really swift responders take a few days to show a response.

Adjusting doses - to the level and to the clinical picture, within therapeutic range - is fairly common.

There's also a very long history of using lithium as a treatment for depression as an adjunct treatment. It doesn't induce dysphoria. It does get used, often in lower doses, as a daily maintenance treatment.

When using lithium for unipolar depression, it's generally (not always) dosed lower than for mania.

[AnneMarie]

It sounds like you are describing the relief that comes with taking a positive, therapeutic action. That's normal. The actual efficacy of Lithium, however, is days away. For me, it's been between 7-10 days consistently. So, no, I wouldn't consider it a PRN med. Talk to you pdoc in more depth about how meds work.

[icebird200]

Low dose lithium therapy

http://www.deardrroth.com/LRArticles/Benef...DoseLithium.pdf

[Silver]

Yup. Low-dose daily lithium therapy.

Not prn.

Good link - thanks!

[OscillateWildly]

Seeing as I was asking if what I was experiencing was a placebo effect or not, I don't see any reason why I should have received such hostile responses?

I think most of the relief I am experiencing is that which is related to taking a sedative, calming substance. Lithium is sedating & calming acutely I think we can agree on that? It also helps me to sleep very deeply and restfully, which is a good way to fix my moods.

Lithium does different things at different doses after different lengths of time. For mania it takes days at a "theraputic blood level", for other symptoms it might not. Studies in rats show acute changes in neurotransmitters after a dose, it takes 20 minutes for lithium to be in blood.

The lithium did not STOP my mood state, all it did was make it less agitated/dysphoric. This is consistent. My ultimate hope is becoming sedated so that I can sleep like the dead, as the real cure is in the deep restful sleep.

Regarding my post from teh 27th/28th, let me 'splain. Early in the day I was euphoric and a bit delusional/confused, then I started to come down into that familiar type of miserable depressive mood that I get when my energy is hypomanic but my mood is crashing... sort of mood that is like "oh god, here we go" because it will be like sitting in sh*t and waiting it out, and it just won't stop and I won't be able to relax or sleep. It's almost like you're living multiple points of time, because you're panicing about the present, and the future, and you are also experiencing depressive guilt/regret for the past, and basically your thoughts are just piling up and they are all horrible and torturing. And it gets worse and worse until, usually, you sleep. I hate these mood states, and they usually follow the "wow this is awesome!" type moods (although they may exist without ever having that...)

Anyway, I went from that "I'm going to be in hell for awhile, here we go" mood, to simple uncomplicated physical energy/restlessness with racing thoughts (which were neither dysphoric or euphoric just really go go go). I still could not sleep in spite of the lithium and missed out on a lot of hours, but it did take the dysphoric sheen off of the mood and rendered it more neutral emotionally.

The next day my mood was more "calm" (less up and down) but my energy was still very high and I felt restless and uncomfortable physically. But how i FELT was more "anesthetized".

I was looking at another night of not sleeping but I took ambien and did sleep decently, 7ish hours which is still insufficient for me as I require 9.

Today I still have energized symptoms (in that I feel restless energetic and won't be able to sleep), but my mood / emtions are fairly low key and more toward the "feeling good" side rather than the "feeling bad" side.

Why am I saying all this stuff? I don't know.

Right.

Thanks for your replies... especially you icebird, the information you gave was actually constructive and very informative.

[Silver]

Not hostile, SeeSawLiving - certainly not on my part, and, on a third re-read, I don't see hostility on anyone else's part. I see some clear explanations.

Had anyone heard of using prn lithium, as per your OP?

Well, apparently they had not.

Had anyone heard of using low-dose lithium?

Yes, they had.

You're quite welcome. Can we be of more help? It's good to know the low dose is helping and giving you some relief. I suspect it might help even more on a regular basis.

As to the length of time it takes lithium to show effect... you might want to go back and review older posts. Or search for things such as [lithium neurogenesis] or [lithium PKC]; these might help you to understand why lithium as a prn is not optimal.

Considering the rebound phenomena when lithium is discontinued, the use of it as a prn is even questionable.

But, if you've taken offense already, I think I don't want to engage in that discussion with that you right now, because it's a long complex one. Those search terms should be enough to get you going. Dr. Manji's work would be a good place to start.

In general, if affective instability is one of your core problems, treatment would often incorporate therapy to help center you to the here-and-now (rather than living in the future/past) and daily medication, not prn, to stabilize core affect.

In other words, you'd want to get the weathered-in shell and central heating in place as soon as possible, rather than awnings and box-fans (even though those things might be useful as well, ultimately.)

[AirMarshall]

20 minute relief with lithium carbonate? I don't think so. That IS the placebo effect in action (not there is anything wrong with placebos).

For the life of me I can't locate the kinetic pharmacology info for LiCO3. However most tablets take longer than 20 minutes just to dissolve, leta alone get into the bloodstream. Just as a Wag, most meds probably take 2-3 hours to reach peak levels.

Lithium has a half life of about 24 hours. Which means it takes about 5 days to reach a steady state, assuming you are taking regular doses, or have discontinued. Typically lithium takes hold in 3-5 days, assuming daily dosing.

There are a couple reasons to be careful about yoyo-ing lithium. 1. Rebound mania, is very common. (Ask me, I just stupidly went thru this a couple weeks ago). 2. There are reports of lithium losing effectiveness after abrupt discontinuation. less common.

In summary, I've never heard of PRN use. The recommnended practice is to stay on a minimum satisfactory dosage, and then bump up when episodes occur.

a.m.

[OscillateWildly]

Silver -

Your first response was "uh, what?"; just so you know this is considered condescending which is a form of hostility.

It's alright. I don't expect people to acknowledge, or even consciously be aware of ill feelings, though I admit being hurt I also acknowledge I irritated people in the personality disorder thread so I am not surprised.

I do this everwhere, so I suppose my personality is defective. Ironic considering the personality disorder thread.

It takes longer than 20 minutes; 20 minutes is how long it takes for it to be in blood stream.

I am entirely aware this is possibly all placebo as I've said before, I am also aware I barely know anything and am often unsure of anything, I'm quite often wrong and I have a horrible time of being convinced I'm right.

I am also indifferent to the fact I am an irritating person, indifferent in that I will not change, emotionally it does cause me a lot of distress, but I can't be agreeable. I suppose it is because I am self centered and have little regard for others or established collective beliefs/thoughts/feelings. I am also loud and opinionated. I am an oldest child.

I'm going to stop posting because it is late and I am rambling.

I knew it was gonna be a mist-ake to post on this board. I suppose that is because I knew what I was going to post was going to have this reaction. See? I am aware of how my behavior affects people, I simply do not care. I do care about the reaction, I don't care other people are feeling it. Therefore I will never function well in society.

Right, about that shutting up, it should probably happen now.

[OscillateWildly]

But I have a pathological inability to STFU, so I'm going to post one more time to point out that icebird (who responded before I had a chance to piss anybody of fmuch, which takes at least a day on any given forum) said that a psychiatrist friend did suggest a PRN dose of lithium to suppress symptoms. Just a FYI, ya know.

I'm sorry, I wont post anymore. I'm less a social phobic and more aware that I am a social defect and this produces logical social inhibition. On the internet, there is no logical inhibition because I can just leave and forget it and it is like it didn't really happen.

[AirMarshall]

Nobody said anthying about you having to STFU.... don't go away mad...

a.m.

[Generica]

No need to go away at all, SeeSawLiving.

Sometimes it is easy to feel a post has got us off on the wrong foot. But honestly it will all be forgotten.

The concept of lithium PRN piqued my interest BTW and I'm sure it did many others.

Relax. You are welcome here. Look forward to your next post.

[Silver]

Has anyone heard of using low dose lithium (e.g. 450mg) PRN for dysphoria/agitation/insomnia as related to bipolar spectrum disorder? Of course this assumes the individual is not being maintained on lithium, and is not using enough daily to reach a theraputic blood level, as that would be dangerous.

Uh, what?

I'm assuming that you mean that "adding 450 mg lithium on top of a therapeutic blood level would be dangerous," not "a therapeutic blood level of lithium would be dangerous as standard care."

Actually, I was in search of clarification of the "that would be dangerous" statement.

But I'll be more clear in future discussions as far as condescension versus confusion.

It's alright. I don't expect people to acknowledge, or even consciously be aware of ill feelings, though I admit being hurt I also acknowledge I irritated people in the personality disorder thread so I am not surprised.

I do this everwhere, so I suppose my personality is defective. Ironic considering the personality disorder thread.

It takes longer than 20 minutes; 20 minutes is how long it takes for it to be in blood stream.

I am entirely aware this is possibly all placebo as I've said before, I am also aware I barely know anything and am often unsure of anything, I'm quite often wrong and I have a horrible time of being convinced I'm right.

I am also indifferent to the fact I am an irritating person, indifferent in that I will not change, emotionally it does cause me a lot of distress, but I can't be agreeable. I suppose it is because I am self centered and have little regard for others or established collective beliefs/thoughts/feelings. I am also loud and opinionated. I am an oldest child.

I'm going to stop posting because it is late and I am rambling.

I knew it was gonna be a mist-ake to post on this board. I suppose that is because I knew what I was going to post was going to have this reaction. See? I am aware of how my behavior affects people, I simply do not care. I do care about the reaction, I don't care other people are feeling it. Therefore I will never function well in society.

Right, about that shutting up, it should probably happen now.

SeeSawLiving: It's the Internets. On the Series Of Tubes, you will ask for feedback, and you'll get it; sometimes it's going to disagree with the schema you came in with.

Around here, the feedback may well be referenced and backed up.

Thanks for pointing out that icebird's psychiatrist had recommended prn lithium (maybe as a standalone, rather than as a 'sliding scale' dose of a maintenance drug.)

People here aren't going to kick you gratuitously, but, yeah, they're probably not going to feed into the cognitive distortions you're displaying, either - the catastrophic thinking, etc.

So - you can elect to STFU (or, as you've said... maybe not... ), and go slink off and be sulky and hated and Never and Always and Doomed about it. Or you can continue to engage and learn and contribute and make some mistakes and get some stuff right like all of us do.

Your call.