Question about increasing Lithium and the levels

[netsavy006]

I want to know because I want to be able to take an antidepressant in the future for my anxiety condition after getting off of Remeron (possibly Effexor XR; don't know yet, will discuss with pdoc after the intake).

But what might be preliminary to prevent another manic episode would be to adjust my lithium.

I'm on 900mg of Lithium per day (300AM / 600HS)

At the beginning of this month I went for my Lithium level and it was .7

I know from being in the hospital that the range is .6 to 1.2

So is it possible and I know a doctor would know better, but I'm hoping some have some experience with this, if you can go from 900 - 1200mg of Lithium (This is IR version), without going to toxic level?

(what are the available options for taking 1200 - 1pill AM / 3pills HS or 2pills AM and 2pills HS)

I'm just curious because I find that even though I'm properly tapering the Remeron, the anxiety is coming back. I'm had a panic attack yesterday around 1:45pm and just general anxiety today in Pathmark when I had to wait in line around 11:30am. I want to say off of Remeron though because Remeron causes too much sedation for me so I'm hoping Effexor for example might be "different".

Of course I'll be careful and speak to a psychiatrist about my options.

But for know if someone knows anything about my Lithium questions, could you please let me know.

Thanks,

Andy.

[AnneMarie]

Andy, do you keep a diary of all your thoughts on medication? It might be useful for you to review how your thinking on a particular med change before you go to a pdoc appt. You switch opinions a lot, probably more than you realize. A diary on the subject would help you be more aware of this.

Safe out patient levels of Lithium are usually considered between .4-1.0. Yes, 1.2 is still non-toxic, but most docs consider it too close to toxic to allow for hydration and other variability during a day or over time. That's my impression, at least. Anyway, it would seem that you have room to go up since your level is .7. That is assuming that you are at a steady state. Keep in mind that you've complained in the past about Lithium causing cognitive dulling. That's more likely at higher doses.

My impression is that Effexor is more prone to flip someone with bipolar hypo/manic than other ADs. I could be wrong, I know it's person specific, and am sure others will weigh in.

Anyway, yes, you could try raising your Li level to counter an AD's potential to flip you manic. If you are as sensitive as you were saying a week or so ago, you'd probably have to stick to low levels of any AD.

Andy, dealing with meds like this is a reason why you need to stick with one pdoc over time. The pdoc needs to learn what you can and can't tolerate in order to prescribe the best plan for you.

[netsavy006]

I understand what you are saying and should I get accepted for psychiatric services at place x, I will have a more permanent tdoc and pdoc.

It's just that I'm not even off the Remeron yet and I need something to help with the anxiety. Is it something that could pass because it's the medication coming out of my system or is it the return of original symptoms and how do you tell the difference?

(edit: oh and just to clarify, it wasn't the Lithium that I said was with the cognition issue, it was the Topamax, but since increasing the dosage on that, it seems to have improved, weird though)

[domovoi]

i used to take 1200 and my level was .9 but this is saying nothing because we are different people. i think if you want to prevent mania you would have to adjust your dose much earlier than attempting something that might cause imbalance. i don't remember what lithium half-life is, but in any case, the mania preventive effect of a higher dose won't kick in overnight. i don't think that there is a high risk of extreme toxicity if you go 300 mg up from .7 but this is fairly unpredictable and i wouldn't do it unless you have your levels done within 2 weeks max from raising dosage.

as for Stacia's comment, i have read that antidepressants' ability to induce mania is substantive, though sometimes overrated. by which i mean, i don't think you should be too scared of trying effexor for this reason at least, but be wary, it depends on the person. good luck to you!