lithium not keeping me stable, but why should I still take it?

[LWD]

Hi, I was given lithium in 2003 was stable on it until 2006 then I needed an anti-psychotic. Why should I still take lithium alone if it cannot keep me stable? Will taking the anti-psychotic alone be all I need or would that be a bad idea to not keep the lithium?

[Laume]

LWD

Sounds like a cliche, but you need to ask your pdoc.

Everone, and everyone's issues are different.

[bpladybug]

LWD, a lot of people take an AAP with their LIthium. I do. It is all about what you are your doctor decide is best.

Lots of bp 2 folk take an AD with their Lamictal.

It works better for me to have my mood stabilizer and an AAP. They seem to work in conjunction and treat slightly

different symptoms.

[mj1127]

Lithium will protect your brain from the damage to your brain that BP can cause. The anti-psychotic, while it helps to keep you stable, doesn't do that. Also, I've taken an AAP by itself, and I was, while not depressed or manic, very irritable and not nice to be around. I do fine with AAP and lithium. Talk it over with your pdoc, but it does not (to me at least) sound like a great idea to ditch the lithium.

[LWD]

I'll try to get the higher end of therapeutic range I know. My lab results say .7. Then I ask what if I feel the lithium is not working? Did I answer my own question? Is there any other advice available?

[Laume]

Long song and dance of my own short experience with Lithium.

Lithium added to paxil started working within days - had no bad thoughts, calmer all over. blood draw = 0.7.

Upped doseage to 1200 from 900mg and had bad neuro side effects. Obviously the Lithium was doing something but not at a therapeutic level, and could not deal with the increased doseage needed to get it there.

Went back to 900mg. blood draw 0.9 after back on 900 for awhile. Then side effects from paxil started kicking in after being on it more than a year and had 3 bad mixed/dep episodes within 5 weeks (10 day mixed, 2 week-long deps). Blood draw = 0.4

Off lithiumn + paxil.

On depakote + cipralex.

So far so good.

Hard to say what happened but yeah, best to talk to your pdoc - maybe a diff med is needed.

For me Li was a godsend for a while (although very short) and then it just couldn;t do it for me anymore.

[AnneMarie]

I'll try to get the higher end of therapeutic range I know. My lab results say .7. Then I ask what if I feel the lithium is not working? Did I answer my own question? Is there any other advice available?

Are you asking why should you take Lithium as monotherapy now when it did not keep you stable in the past? I'm not clear on your initial question.

As you already figured, Lithium is about blood serum level. The therapeutic range is .6 to 1.2, although most docs will not dose over 1.0. If you were at a low level before, then it makes sense to try at a higher one as monotherapy now. If you were at a high level before and still needed an AAP in addition, it might not make so much sense to try monotherapy again now. But things change, so maybe it does make sense as long as you and your pdoc are watching it closely. Also, if Lithium was partially working before and the AAP was added to get you to a better place, I would expect the AAP alone to not be enough.

FWIW, I feel a big difference between .7 and 1.0. I am much calmer or less depressed depending on why the level was increased.

[LWD]

Lithium has kept me stable in the past but no longer does. I was thinking monotherapy with risperdal.

[SashaSue]

Relatively few people with bipolar disorder are able to remain stable via monotherapy. Why are you wanting to stop the lithium? Are you having side effect issues, or.....?

[LWD]

No side effect issues. I am just wondering if it is not keeping me stable what's the point in taking it?

[nalgas]

I am just wondering if it is not keeping me stable what's the point in taking it?

If it's not helping at all anymore, there might not be much point. However, if it's working, just not as well as it used to be, that's another story. If it's helping somewhat and not causing any real problems, you may be able to get away with adding a much smaller amount (with generally a much smaller risk of side effects) of a different med to even things out than if you put the entire burden of keeping your mood stable on a single med (which you don't even know if it works for you or not yet).

[LWD]

The lithium might still be doing something but if it isn't I want to get rid of it. What I mean by stable is just enough to stay out of the hospital. So your saying I could add a small amount of different med what about depakote? Do you think another mood stabilizer would benefit? Do you think I could be stable on just a mood stabilizer alone? I wouldn't want the sum of two weight gain meds.

[nalgas]

So your saying I could add a small amount of different med

Maybe. It's more likely you'd need less of something else if it were in combination with the lithium than on its own, but no one can guarantee anything.

what about depakote? Do you think another mood stabilizer would benefit?

Maybe. Plenty of people do have good luck combining two of them, just like others do well with a mood stabilizer and an AP or other combinations. Someone who knows your situation better (i.e. your doctor) would have a better idea of what makes the most sense to try for you than some random guy on the Internet (i.e. me), though.

Do you think I could be stable on just a mood stabilizer alone? I wouldn't want the sum of two weight gain meds.

It's possible. Some people do manage to find a single med that works well enough, but it's very, very common to end up needing to combine a couple things together that complement each other for the best results.

As far as the weight gain part goes, don't worry about it too much unless it actually happens. There are some meds that have a reputation for causing people to gain weight, but that's generally because on average more people gain weight while taking them than lose weight. For any given med like that, though, the average amount gained by people who do gain weight is frequently a fairly small amount, and there are a substantial number of people whose weight stays the same or who even lose weight, even on something like Zyprexa. You never know which of those categories you'll fall into until you actually try it and find out.

[mj1127]

Having taken Depakote, I would say that if there is any way you can stay on lithium instead of taking Depakote, I would do it. Most people find the side effect profile of Depakote to be much harsher that lithium. It is very possible that you will gain weight, a lot of weight, on Depakote. People frequently lose hair, have digestive problems, have tremors, dizziness, insomnia and in extreme cases can have liver failure. It can cause horrible depression in some (myself included). I still was not stable on Depakote monotherapy. If you feel you must do the experiment, then do it, but I would really advise against. You could be one of those people who has no side effects, but you could also be one of the people who does have side effects. I would take lithium over Depakote any day, and I think most people who have taken both would also.

The question is are you stable on lithium and risperidone? If you are, why would you possibly want to change your meds and risk becoming unstable?

The lithium does not have to pull the whole load to work. Imagine you have something heavy to move, say a dresser, and you ask a friend to help you. You discover that you and your friend aren't strong enough to carry the dresser by yourselves. Are you going to send your friend away and look for someone stronger, when your friend is perfectly capable of lifting part of the load, or do you go next door and ask another friend to help the two of you? Let the lithium and the risperidone each carry part of the burden as long as that combination keeps you stable. If things start to go downhill, then worry about changing.

[SashaSue]

What makes you think the lith isn't doing anything anymore? If you're stable one your current meds, it doesn't really make sense to change things.

[SashaSue]

Lithium will protect your brain from the damage to your brain that BP can cause. The anti-psychotic, while it helps to keep you stable, doesn't do that

Actually, there are a ton of studies showing that AAP's are in fact neuroprotective.

http://onlinelibrary.wiley.com/doi/10.1002/jnr.10290/full

http://onlinelibrary.wiley.com/doi/10.1046/j.1460-9568.2003.02590.x/abstract

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6SYR-4C5PXJY-1&_user=10&_coverDate=06%2F04%2F2004&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1543591049&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=52fc09847045f3addefa3e61a055841b&searchtype=a

http://www.ingentaconnect.com/content/adis/cns/2007/00000021/00000009/art00002

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6SYR-4C82F30-2&_user=10&_coverDate=06%2F11%2F2004&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1543595743&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=de3f267f809e9c06f3a0383f6462dcb1&searchtype=a

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T0G-44XK8SR-K&_user=10&_coverDate=03%2F15%2F2002&_rdoc=1&

_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1543602349&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=4de536c7ae194e442bc9e60c96f7987e&searchtype=a

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6SYT-4M57P2Y-1&_user=10&_coverDate=12%2F11%2F2006&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1543610627&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=f01e190a0588da47a3e4a4bbbd1f9fab&searchtype=a

[netsavy006]

I notice that for me, I thought that my lithium had stopped working recently (even though the levels was in the normal range), but then they told me that Lithium just helps to even out the moods, and make them less frequent and lessen the intensity. So even though it may not be keeping you 100% stable like it use to, if it's reducing the intensity of the episodes and it's working well in combination with an AP then it might be worth it taking the 2 together. I take Lithium with an antipsychotic for mania (Clozaril) and it works great for me.

[Guest Robin]

You need to seriously talk to your pdoc about your meds since you are so uncomfortable with them. I would suggest you stop fretting over the number of meds. My doctor has me on lithium, Lamictal, and Abilify.

[crazynotstupid]

My question would be, exactly what has been the situation where you say the lith is "not working"--i.e., spiralling out of control, just feeling "off", whatever. There's "golly, things are out of whack" which can be taken care of by dose adjustment and maybe adding something in, and there's "aw fuck I'm losing it man" in which case everything needs to be totally reevaluated.

Sit down with the doc and figure out which category you're in. I've only ever med-hopped due to serious circumstances (job loss, for instance, or extremely serious side effects). So far as I know, lithium is just plain one of those meds that totally does not lose its staying power. It is, as they say, the gold standard.

And just remember that anyone with bp can, at anytime, go from generally stable to whichever end of the spectrum regardless of how well the meds are working. just part of the nature of the disease. And did you happen to notice that the seasons are changing? Yeah, that'll do it too. Maybe it's not the lith. Maybe it's just you.

Talk to the doc. Don't just toss a good med.

[Guest LWD]

The seasons changing has a big thing to do with it. Especially with depression. Although I can't explain why. I did have an "aw fuck I'm losing it man" moment where I went to the hospital, and I thought lithium was suppose to be keeping me stable at the time. I was on it the whole time and I still kept getting crazier and wound up in the hospital. I would not like it being in my system and it not doing anything. That's what I feel like it's doing. You know when I take my anti-psychotic I can tell when it's working, but with my lithium it's like invisible. I can't tell whether it's having a positive, negative effect or whatever.

[LWD]

Well it's approaching 2012 I've still been on lithium this whole time haven't stopped taking it. Although I am contemplating going monotherapy with Invega. I won't be able to tell how much effect if any in my case lithium is having on my moods. That's why I have been reluctant all this time to not stop lithium. I will for the sake of possibly getting rid of unwanted side effects attempt to just get by on invega alone. See how it goes. If I suspect moodiness then I'll know for sure not to drop the lithium. Thanks take care.

[Closure]

Just because you do not think the lithium is doing anything does not mean it is doing something, which you might only notice if you go of it, and things fall apart - and then there is the likely change that it will not work as well as it had been working when you try to go back on it again.