Lithium: Some days are diamonds some days are stones

[6un6silent6]

Is it me or does Lithium really throw you for a loop?

Ever since I started Lithium I've had good days and bad days. I'm not referring to bipolar symptoms as those are somewhat under control. I'm referring to physical symptoms. Here's what I'm experiencing, hopefully someone else can shed some light:

Dizziness

Imbalance

Tremor (Currently kept in check with Inderal)

Nausea

Nervousness

Feelings of De-realization

Increased Anxiety

Head feels like Jello or full of liquid and if I move my head I can feel off-balance

Feeling uncomfortable in my own skin

Forgetfulness

Confusion

Extreme trouble reading

Feeling all around sick

Now this is not every day that I feel like shit, but maybe 3-4 days/week I experience many if not all of these side effects. I also take Lamictal which I've heard can exasperate these symptoms, but I'm really getting tired of feeling like crap so much.

I'm not going to quit my medicine, I'm quite rational and realize I need it but damn I seem to suffer from so many side effects it's ridiculous. I'm currently at 1050mg (1200mg made me uber-sick) and run between .6-.7 blood serum levels.

Any thoughts on this? My Pdoc says that it's just side effects and will get better but they haven't seemed to subside fully. Is there anything I can do to help quell this?

I also take .5mg Ambien at night to sleep, and .5mg Clonazepam or .5 Lorazepam PRN for Anxiety.

Sorry for the scattered post, but I'm really frustrated.

[nibblerd]

Make sure you're keeping hydrated, drink at least 64 oz of water a day. Some of it seems like bipolar symptoms aren't being completely controlled, some of it seems like Lamictal titration stuff.. In fact, most of it seems like lamictal titration. You gotta stick this stuff out, most of it will disappear. Maybe the anxiety/derealization won't, but I'm not your doctor and I don't know this for sure.

.6 is technically right underneath the therapeutic window.. .7 to .8 is where my levels sit at, which provides a modest lift from depression and a great filter for hypomania. If you are going from .6 to .7, your dose might not be high enough. I don't know what else to tell you, except that you should have gotten your levels checked when you were on 1200mg.

[6un6silent6]

Make sure you're keeping hydrated, drink at least 64 oz of water a day. Some of it seems like bipolar symptoms aren't being completely controlled, some of it seems like Lamictal titration stuff.. In fact, most of it seems like lamictal titration. You gotta stick this stuff out, most of it will disappear. Maybe the anxiety/derealization won't, but I'm not your doctor and I don't know this for sure.

.6 is technically right underneath the therapeutic window.. .7 to .8 is where my levels sit at, which provides a modest lift from depression and a great filter for hypomania. If you are going from .6 to .7, your dose might not be high enough. I don't know what else to tell you, except that you should have gotten your levels checked when you were on 1200mg.

I'm drinking at least 8 16oz bottles of water per day so I'm staying fairly well hydrated. I'm not sure what you mean by the bipolar symptoms aren't being controlled. I remember being at 900-1050mg of Lithium alone and had mostly good days with little to no hypomania. As soon as I added Lamictal to the mix it seems my side effects increased and I have become more hypo. I rarely if every experience depression or depressive episodes, it's really trying to keep me from getting wound up. Fortunately I've never been full-blown manic but have been hypo off/on for years.

I was only on 1200mg for a few days and my Pdoc said I need at least 7 days on it before I could get an accurate reading. I just heard from him today and he's having me taper off the Lamictal 25mg/week until I'm off it and we'll try upping the Lithium to 1200mg again. He wants to see me at a .8 level which he thinks will stave off most if not all of the hypomania. He's also going to work with me to keep the anxiety down which has been a problem since childhood. From my understanding anxiety and hypomania can run hand in hand and even trigger one another.

I'm doing my best to stick this out but it's hard when you can barely function at work because you're trembling, spacey, and can't remember where you put the stapler you're holding.

Thanks for the feedback.

[6un6silent6]

Wait and see how you feel once you're off the Lamictal. That might be making things worse. I know it did for me. I stayed on it for a long time, but finally decided the side effects weren't worth it anymore. I do much better when my level is at least a .8. It makes a tremendous difference. So, I guess I'm not telling you anything you don't already know. Stick with the plan you and your doctor have and I hope you'll feel a lot better soon.

I dropped down to 75mg of Lamictal and so far in the last few days I've felt a bit better. Less cognitive issues and less side effects. It's still there but not as bad. A lot of people have warned me that dropping off of the Lamictal can throw me into wild mood swings. I never really hit the depressive side which most say will happen when coming off of Lamictal since it's not an anti-manic. (Hell, it's been making me hypo anyways). Any thoughts on this guys? I've upped my fish oil, keeping my sleep in check, and keeping myself calm in case things come a bit loose.

[6un6silent6]

I came off of Lamictal two or three different times. (I know, I really did try to like that med.) Never did it throw me into wild mood swings. I just checked with a couple of other people who recently came off of Lamictal and it didn't put them into wild mood swings either. Maybe you just got unlucky in talking to those other folks. Seriously, I haven't heard of that so long as you taper the way you're supposed to.

Thanks for the continued sage advice. My pharmacist told me that and a couple of people I read about experienced huge depressive episodes. I was at 100mg and he has me tapering down 25mg/week until I'm off. He said I can drop 25mg every 2-3 days if I want but it'll be up to me and how I feel. I think I'll keep it at 5-7 days. I'm a lot less agitated since I dropped a few days ago, not sure if it's wishful thinking though.

[nalgas]

My pharmacist told me that and a couple of people I read about experienced huge depressive episodes. I was at 100mg and he has me tapering down 25mg/week until I'm off. He said I can drop 25mg every 2-3 days if I want but it'll be up to me and how I feel. I think I'll keep it at 5-7 days. I'm a lot less agitated since I dropped a few days ago, not sure if it's wishful thinking though.

Yeah, it can happen (all sorts of wacky things can with pretty much any med), but, like sylvan, I also don't get the impression it does happen all that often, especially if you weren't taking a whole lot of it in the first place and/or it wasn't doing a ton for your mood in the first place. I do agree with the 25 mg/week thing, though. You can go quicker in an emergency, but that's about the schedule you'd want to be on to minimize any side effects. The reduced agitation certainly could be from the reduced Lamictal, too, even after only a few days, so hopefully that'll keep getting better.

[6un6silent6]

My pharmacist told me that and a couple of people I read about experienced huge depressive episodes. I was at 100mg and he has me tapering down 25mg/week until I'm off. He said I can drop 25mg every 2-3 days if I want but it'll be up to me and how I feel. I think I'll keep it at 5-7 days. I'm a lot less agitated since I dropped a few days ago, not sure if it's wishful thinking though.

Yeah, it can happen (all sorts of wacky things can with pretty much any med), but, like sylvan, I also don't get the impression it does happen all that often, especially if you weren't taking a whole lot of it in the first place and/or it wasn't doing a ton for your mood in the first place. I do agree with the 25 mg/week thing, though. You can go quicker in an emergency, but that's about the schedule you'd want to be on to minimize any side effects. The reduced agitation certainly could be from the reduced Lamictal, too, even after only a few days, so hopefully that'll keep getting better.

Well I'll keep my fingers crossed and hope for the best. I really do need to get my sleep in check, if I don't get 7-8 hours I wake up grumpy and am kinda pissy the entire day. Today is one of those days, so I'm just keeping things low-key and riding it out. I'm hoping things will balance out with the Lithium and we can try upping my dose if removing the Lamictal doesn't help that much with my hypo episodes.

Then there's the whole topic of weight gain. 25lbs in 6 mo is killing me.

[6un6silent6]

Update: 1/6/11

I'm at 25mg and much less agitated, less racing thoughts, etc. Dropping to 50mg I started to feel a bit depressed which I've never felt before (I tend to stay wound up more than down). Pdoc said to taper a bit slower until I'm off for now. In general I feel less sick, less side effects, but am still suffering from a lot of mental and physical effects from the Li+. We're supposed to meet today to discuss options since I'm barely hitting .6 at 1050mg and gaining a lot of weight have experiencing cognitive dulling pretty bad.

I'll keep everyone posted. Thanks for reading.