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Hello all!

I'm a 40 year old male who has fought depression for as long as I can remember. In the last few years my depression has become almost debilitating. I never sought meds until 3 years ago and I have tried most all the A/D Meds and only felt the side effects, or nothing at all. My Pdoc says I am "treatment resistant"

I am currently on

1 mg 2/day Clonzapam ( this does help with shakey hands/anxiety....this was the first med I was put on 5-6 years ago)

300 mg Wellbutrin ( helps a little and I have no side effects )

10 mg 2/day Ritalin (kind of pumps me up)

My doctor gave me a diagnosis of "Melancholic Depression" and has suggested ECT and I did agree to go to a consultation. But I highly doubt I will go that route. I asked him if we have exhausted all my med options and he said, " there are some old school meds (he told me the class of med , I dont remember) but they are rarely used anymore or we could try Lithium but your going to have to get regular blood test." I agreed to the Lithium but told him I wanted to start off slow. So he has started me on 150 mg of Lithium IR for 2 weeks and if everything is going ok he'll start increasing the dose. I have some concerns and questions that I am sure you guys and gals have answered many times before, I appoligize. I have been reading all day about lithium and I stumbled on to this site which is actual people with experience instead of all the studies and facts I have been reading. This is refreshing.

I started 4 days ago on 150 mg of Lithium, Here we go...

Is that metallic taste in my head or could I have developed this side effect in just 4 days?

I see most of you are "manic" or "Bipolar" and few have just severe depression like myself, is this an appropriate med and if so does this mean I will be on the low end of the dosage range?

In a attempt to go to war with this I have started running on a treadmill, is this overheating thing I have read something I really need to worry about?

The caffine thing....I LOVE COFFEE! Do I need to give it up or just cut back?

Sex drive...mine is high even if it is just with my right hand. Have any of your sex drives been killed by Lithium? I can remember Effexor ER killed my desire and Ability. That was a nightmare drug all around for me.

I occasionally and I am being honest with this, occasionally I take a couple hits off a bong. 2-3 times a month and I just like to get high and listen to music, not get stoned stupid staring at the TV with my mouth agape. I like the short escape, if only for a couple hours a few times a month. I was honest with all of you, please be honest with me, do any of you partake?

Are Kidney and Thyroid problems frequent?

With all the blood test, will I be adjusting my dosage all the time?

have any of you tried 5-HTP?

Like I said, I am at war with this and I am open to all suggestions. I am 40, half my life has been spent with some degree of depression and I feel it is only going to get worse. For some reason I am a little scared of this med, at the same time I am optimistic that it is going to work for me. I have never felt this way about taking a med, although I was a little gun shy after Effexor.

Thanks for any input. And excuse any misspellings. (Is Misspelling 1 or 2 S's)

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I tried lithium for my unipolar depression. Didn't do squat for me, but I apparently have EXTREMELY treatment-resistant depression. Currently undergoing ECT myself.

Hope someone else here will have more encouraging answers for you, since I'm useless as far as suggesting things that have worked for me med-wise.

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Let's see. You've got a lot of questions, some of which I can help with.

Lithium is totally an appropriate med for you. For depression, it's usually used to augment other meds. With lith, it's not so much about the dosage, but about your blood levels. Odds are your doctor will be looking to keep your levels on the low side, but it just depends on where it works best for you.

The blood tests don't mean you'll be changimg your dosage all the time. It's just that it's hard to predict what dosage will result in the level you want, so the blood tests are especially important in the beginning. Once you get to an effective dose, you won't have the blood tests as often.

As far as caffeine, as my pdoc explained it, caffeine will lower your level, but if you have basically the same amount of caffeine on a daily basis, it has a consistent effect, and that's fine. It's when you drink a lot more than usual, or cut way back, that you can run into problems.

I'm not aware of overheating being a problem so much, more the importamce of staying hydrated.

I didn't have any sexual side effects from lithium, nor do I think that's a common issue.

Kidney and thyroid problems happen, but they aren't common. In addition to having your lithium levels checked, you should be getting general bloodwork done, to keep an eye on their functioning.

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I'm MDD and I augmented Cymbalta with Lithium. Before the augment, I was suicidal.. after, I wasn't. So yeah, it did alot of good while it lasted.

I drank lots of coffee (but around the same amount each day), stayed hydrated, and kept the salt in my diet at the same level.

I started off at 300mg once a day and ended up at 300mg 3x a day. That's when I just barely hit the therapeutic level in my blood.

The metallic taste is the Lithium. Lithium kicks in fairly quickly.. it works alot different from other meds that take weeks to a month or more because it's more or less just taking the place of salt in your cells to make them work better. It's the latter that takes the time, and even then not alot.

It can definitely be an appropriate med, and no the dosage will not be different based on your diagnosis. It's purely measured by "what level within this range is enough to help." There is no set number.

Starting exercise will be harder on you than continuing to exercise. I'd get yourself to where you want to go now that the dose is low and you don't really have to worry about it, then stay at around the same fitness or move gradually. It's not the exercise that's bad, but trying to make sure you drink enough water.

Staying hydrated is key!

No, I don't partake in pot, but it shouldn't matter with Lithium. Booze however will due to the water issue.

Lithium can damage your thyroid causing you to become Hypothyroid and necessitate being on medication for the rest of your life. In general, if you don't have Thyroid problems - take the Lithium, it's not a for certain thing. If you do - the general consensus is to think long and hard about taking it.. but even then the benefit may outweigh the cost. I don't know how much if any Lithium contributed to my Thyroidism, but I stopped taking it because it became ineffective, not because of my Thyroid. I figure that you're already going to be on this Thyroid medication forever, so what does it matter what dose it is if the Lithium helps?

I haven't tried 5-HTP. It's generally a bad idea when you're on a med that messes with serotonin. Since you have already tried the serotonin meds (SSRI's) and they didn't work, the 5-HTP shouldn't either.

Edit: Were the old-school meds tricyclic antidepressants by chance? Oh, and trying Lithium isn't an either or type of deal.. you can still try other meds too.

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I've never had a metalic taste from Lithium.

Lithium is appropriate and often effective treatment for treatment resistent MDD.

It is very important to stay hydrated while on Lithium. Low hydration is the quickest way to drive up your Lithium level which can eventually go toxic. At low levels, this is not the same issue as it is at high levels. Lithium does not affect your internal temperature guage like certain other meds can.

I drink coffee. Drink the same amount more or less and you'll be fine. As SashaSue said, it's more of a steady state thing than anything else.

Lithium is not known for affecting sex drive or ability.

I don't smoke, so I can't say.

Thyroid and Kidney problems tend to be more associate with start up or long term use at higher levels. They are why you have routine comprehensive blood panels every six months or so, to forewarn of problems so that action can be taken before permanent problems.

Blood tests are greater when starting, and usually taper off. Lithium levels do change for non-specific reasons but they shouldn't be moving all over the map.

Serotonin makes me crazy, so no 5-HTP for me.

When you say you've tried a lot of antidepressants, do you mean that in addition to SSRI and SNRIs you've tried a few different tricyclics, at least one MAOI, and an antipsychotic or two like Abilify and Seroquel? There are a lot of different meds to treat depression. A lot of people don't realize how many. If you haven't tried some meds in these classes, and Lithium augmentation doesn't work (which hopefully it will), I'd find another pdoc before going to ECT.


Forgot to say that I really like Lithium. It is an antimanic, but I appreciate it more for the antidepressant it acts like for me.

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Hey Shotster,

I'm in a similar place to you at the moment. I've been on Lithium for about 2 months now, and I have BPD with treatment-resistant depression. I'm taking the Lithium to augment my other meds, although pdoc just put be back on Citalopram last week as well.

I still have my 'meltdown moments' as I like to call them, but on the whole I do think the Lithium has helped improve my general mood, and I self-harm less often. I'm on 600mg at the moment, and my last blood test last week came back 0.53 so I'll prob stay at this dose.

I've not got the metallic taste yet, and I've kept my diet pretty much the same (am doing weight watchers so on healthy diet anyway) The only thing I've changed is my water intake, as I do feel dry if I don't drink, and you have to keep hydrated anyway.

I've had thyroid and kidney function done, but now I think it'll only get checked every 6months, IIRC. Nothing suspicious. I asked for ECT when I was in hospital following an OD in august. They seemed reluctant to give it to me, I think because of my age. I know younger patients have had it so it's somewhat confusing. Although it came up at my last pdoc appt and he seemed to think it would be considered now that therapy and drugs aren't working very well.

Lithium seems to be one of the best drugs I've had for a while, so it's worth any potential side effects for me.


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Thank You everyone. When he said "old school" tricyclic and maybe teratricyclic. He said if I wanted to try those he would refer me to a different Pdoc who had more experience using those meds. He said they are typically full of side effects and knowing me he didn't think they were worth visiting. So no I have not tried them or MAOIs.

I have been on 10-15 SSRI and SNRIs and also Seroquel. I also have side effects that are not typically associated with certain meds I have been on and some cases the opposite of a side effect that is associated with a med. Example: med usually give you dry mouth and I'm slobbering like an english bulldog. When I used to have different side effects I would look them up online and then be afraid to bring them up with Pdoc because they were exactly the opposite. I thought he would think I was lying.

My Pdoc just called and asked how things were going, I told him my slight side effects and mentioned that the past few nights that I wake at 3:00 am wide awake when I just went to bed at 11:30. He laughed and said that he is no longer suprized by anything I report back to him. He said he would call on Friday and see where I'm at. My Pdoc wrote a medical paper on my withdrawls from Effexor because they were so intense. I was out of commision for 2 1/2 months and scared as hell the whole time, I could tell he was a little concerned too. So He may not recomend certain meds based on some of my atypical history. I really like the dude because he does care and I dont feel like I'm on the HMO assembly line. Anyway, thats a little more history.

So what do you think about the tricyclics?

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He said they are typically full of side effects and knowing me he didn't think they were worth visiting. So no I have not tried them or MAOIs.

So what do you think about the tricyclics?

I'm on Elavil (Amitriptyline). My only side effects are a fast heartbeat (so don't take it if you have a history of heart problems), acne, sedation (so I take it at night), and increased orthostatic hypotension (blood draining from your head when you stand up quickly making you dizzy for 10-15 seconds - I already had this so I'm more prone to this side effect). I have noticed that the OH has gotten better over time with this drug.

These meds are absolutely worth trying. Sometimes doctors don't like to rx them because it's easier to OD, but that's on purpose.

It's the MAOI's that you have to be really careful with due to food issues and contradictions with other meds. However, when you've tried everything else - including the tricyclic's - it makes sense to give them a try.

So, yeah, I disagree with your pdoc.

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I would definitely try a few tricyclics before ECT. I would also give EMSAM, MAOI, a try. I would give Lamictal, an anticonvulsant with strong AD effects, a shot. I also would try Abilify, Geodon, and probably another antipsychotic augmenting your best experienced ADs. Before that, I would take Lithium up to a blood level near or at 1.0, possibly with two different ADs, again the ones that worked best for you. Perhaps one of them should be a tricyclic. Dunno. I'm not a doc. You don't have a doc experienced to say, either, from what you say.

There are a variety of tricyclics that work differently. You want someone who understands them and can choose the most appropriate types.

ECT can be very effective but it always causes some memory loss. It also doesn't always work.

Have you had your thyroid checked?

In general, it is more effective to try a few classes of meds than to continue trying every one one in a class that's not working. You pdoc is not comfortable with ADs other than the recent ones. That does not mean older ADs will not work for you. It means your pdoc is limited in his treatment of depression. Tricyclics are very effective ADs for some people. MAOIs work for others. Antipsychotics do it for some. Lamictal does it for others. There are many different medications for depression that are appropriate to try before ECT. Trying them first is the route most people take.

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My pdoc has said he is not comfortable with the tricyclic and is more than willing to give me a referal to a different pdoc. He has refered several of his treatment resistant patients for ECT and had nothing but good results and some side effects, he also has patients that have received TMS with some success and absolutley no side effects. (my insurance will not cover TMS) ECT really isn't on the menu for me, I am just trying to gather some more experienced opinions on combo therapies that I can suggest to him. I'm hoping this Lithium takes and at least makes some difference so we can finally get on a trail of a treatment. We really have not had anything to lead us in any particular direction. I don't know, I'm just fustrated and somewhat desperate to know what it feels like to be truely happy. Its been so long I forget.

Stacia, if routine bloodworks consist of a thyroid check then yes I have. I'm a pretty healthy guy besides having a tremor and a slight case of the gout.

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Pretty much any AD's have fewer side effects than ECT. I mean, with ECT you have to go under general anesthesia--I'm having fairly significant memory loss with it, including having been in a minor car accident which I remember none of. It's disconcerting, for sure. The doctor overseeing my ECT is the head of the neurotherapeutics program at McLean and strongly suggested TMS to me. I wanted to try it before ECT, but my insurance wouldn't cover it, and I certainly don't have the $5000 a week it costs.

Shotster, what is your psychiatrist's specific objection to trying tricyclics? They are easy to overdose on, but my doc and I get around that issue by having them dispensed to me weekly. (I take them for a sleep disorder.) MAOI's are certainly worth trying too--there's a Dr. Jonathan Stewart out of Columbia University who's still doing research into MAOI's, and he does do consultations--though they take a while to schedule.

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He is not opposed to tricyclics, he just has no experience with them. He's already told me he will refer me to another pdoc with more experience. I asked his opinion about the meds and he said that they are being rx less and less with all the advancements in meds. If my current cocktail doesn't do anything I will look into them. I'm really not a risk of suicide, it goes through my head allot but it really is just that...fleeting thoughts. I'm too stubborn for suicide, I think.

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The doctor overseeing my ECT is the head of the neurotherapeutics program at McLean and strongly suggested TMS to me. I wanted to try it before ECT, but my insurance wouldn't cover it, and I certainly don't have the $5000 a week it costs.

$5000 WTF

You would think that insurance companies would cover it (TMS), if just to find out if it is a viable treatment. I'm sure the machines are expensive but compared to ECT having to be put under, sometimes hospitalization and the dangers that there are and I am sure there are numerous lawsuits. Shit if the success rate is only 5% for TMS, thats beter than some meds.

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  • 5 weeks later...

So I have been on 300mg Lithium for over a month and I take it every night a 7 pm, by 10pm I feel very anxious and fall asleep around 12 or 1 am. When I wake around 7am, I have been having a pretty bad headache and nausea (my mouth is watering and I sometimes get a dry heave) this lasts until about 1 pm.

Anyone else have reactions like this?

300mg is nothing right?

Also when I first started on 300mg I really had no side effects except a metal taste in my mouth.

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If you are feeling nauseous on 300mg, call you doc. If you aren't on the XR version, changing to it might help a lot.

I got very sick about a month after I started Lithium. I had few symptoms before but got so sick I had to stop. Lithium did enough for my brain that we slowly started again. I now have nearly no side effects from Lithium.

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