I Need Input on Lithium

[staceyr]

Hi,

Almost one month ago I started taking lithium. I have been on a whole slew of antidepressants since 2001. As a bipolar II patient I am mostly depressed and very rarely hypomanic. I am now in a depressed phase that started the beginning of February.

To be fair to lithium, I was already doing a lot of sleeping - I'd spend days at a time in bed due to depression. Now that I am on lithium I am still spending 15 or 16 hours a day in bed. I feel perhaps it is still depression symptoms but I am not sure because it feels differently than before the lithium. For instance, I am no longer constantly thinking about suicide. (I made two attempts late last year.) I am also no longer constantly thinking about the sad parts of my life. My lithium serum level is still only .5 even though I am on 1200mg of lithium. I feel it's possible the lithium has helped alleviate the suicidal ideations yet since it's still not at a therapeutic level it is not doing all it can for my depression. What do you all think? Did anyone feel the lithium working only slightly when at a smaller dose and then feel it really kick in when at the therapeutic level?

I am trying to figure out if it is my depression that makes me so sleepy or if it is the lithium. My pdoc prescribed some Ritalin to help wake me up a bit. It does help a little bit but I'm still on a small dose. I'd like to just have a normal day on lithium without resorting to a stimulant. I fear I will really come to love that Ritalin wakes me up everyday only to have to one day face growing tolerant of it and thus having it not work anymore.

I'm hoping the lithium will do even more for me when we get to a higher dose, because I love that it's slowed down my suicide obsession. I don't want to go back to that scary place. I'm still depressed but it is a different kind of depression than pre-lithium.

Thanks to all for your thoughts, experiences, ideas, etc.!

P.S. I am also thinking the lithium has made me very apathetic. I haven't communicated online with friends for a long time. I used to love Facebook but now I don't care to go back to it even though I have lots of messages and notifications waiting for me. I also have other friends I've kept in touch with via email but I just can't seem to get motivated to email them.

[gizmo]

Welcome to CB!

I was on lithium for about four years. I took anywhere between 1200-1500mg a day to keep my blood serum level at around 0.8-1.1. I got off of it and on to depakote because my neurologist couldn't prescribe me migraine meds while being on both lithium and an SSRI (increased risk of serotonin syndrome).

I thought it worked, well, ok, most of the time. Not great, but not awful. Now, please keep in mind that depression is not the primary component of my BP - mixed states are. So for me, it was time to try something else. But it worked adequately when I needed it. Lots of people here love lithium for depression.

I took my lithium all at around 7 pm with all my other mental meds to try and avoid the sleepiness or any other side effects. And I never personally slept extended periods of time while on it.

There are a couple of things I'd like to ask about the blood tests. Are you having them done 12 hours after your last dose? That's the best way to get an accurate serum level. If you take it all at once, you would definitely get a better picture of what's going on with the levels.

A lot of people notice a slight "flattening" of their mood once they are on lithium. But it's not always a specific negative side effect of the lithium, it could just be that the med is calming down some hypomanic/OCD like symptoms and smoothing out your personality. But if it is not that case, then you may want to ask your pdoc about it. Also, ritalin should help you with the mood issue - I started on adderall at the beginning of the month for some of the same reasons as you did... so maybe ask your pdoc if an increase could help?

[Guest]

As I recall, your lithium level is a little lower than the suggested range. I believe it needs to be around 0.8 or so. At least that's where we kept mine--somewhere between 0.8 - 1.2.

I've never heard of lithium making someone sleepy. Maybe it can but most likely, it's the depression. Same goes for the apathy.

Be sure and tell your pdoc how you're feeling. It sounds like you're feeling a lot better but are still shy of feeling good. Maybe a med tweak is in order.

[larkspur]

Definitely possible to have relief from suicidal ideation at a subtherapeutic level. I saw relief from suicidal thoughts at .4, and am now stable-ish at .8.

[crtclms]

.6 is technically considered the lowest therapeutic dose, but I think it is unusual for it to be therapeutic at that level, and most people keep their level higher. But I have had a really pronounced turn-around at .5, and we are leaving it alone to see how much I continue improve. It looks like I am going to be okay at .5 Some people get a therapeutic effect at an even lower level.

I'm taking 450 mg all at once at night. We started out with an even lower dosage, 300mg, because I had become toxic on lithium in the past under vastly different circumstances. After a month, we went up to 450mg, and held.

And I don't know lithium's reputation one way or the other for sedation, but I *feel like* it is sedating, and I feel like it has really helped me get somewhat back on a schedule with my sleep after a LONG period of totally screwy sleep. Maybe it correlated with my depression improving, though.

I think it has flattened me somewhat, and made me a little spacier. It has definitely fucked with my word finding. I feel much, much better mood-wise, and the tradeoff seems completely worth it at this point.

[Squirlygrl]

It's funny -- I didn't have much sleepiness/spaciness/word finding with lithium, but lithium didn't work very well for me either. But with anticonvulsants I have both sedation and effectiveness. So maybe you need one to get the other. I also think the sedation abates around five weeks or so.

That said, you are sleeping a lot for a non-depressed person. When I was in this position (hello, Haldol), I couldn't take stimulants, so I just drank a disgusting amount of coffee.

Yes, I agree that you can get the antisuicidal effect at subtherapeutic levels.

[AirMarshall]

Hi, welcome!

'Theuropeutic level' is a relative term. The figure in the literature of 0.6-1.2 is a typical range. Whatever works is what should be used.

-Lithium is very good at putting a floor under depression. It's not always as good as some of the Antidepressants at lifting mood.

-Lithium can contribute to a lack of initiative (or perhaps a bit decreased energy), but so can depression

-Lithium can be a tad sedating, though depression is much more likely to account for hours of excessive sleep

I take it as a very good sign the suicidality has decreased, that the Lithium is working for you. There is a certain percentage of people who do not get a response.

Take heart that things have improved. Keep working with your pdoc and therapist. Try each day to do the things that get you back into life. Side effects with Lithium and most meds decrease with time (weeks, months). Remember your brain didn't get ill overnight, and it will be a long road to your best recovery. Take heart!

a.m.

[ahalo]

When I first started lithium i noticed the extreme tiredness too. My pdoc did the same thing and upped my stimulant dosage. The tiredness subsided after a few months. Eventually it was the lithium tremor that ended up with me going off it. I had the therapeutic range the whole time but even a decrease from 1200 mg to 900 mg didn't help the tremor.

[Guest]

An alternative view:

You don't say if you're asleep all that 16 hours or not. If you've spent years or months sleeping for 15 hours a day, I'm not convinced that just a therapeutic dose of Lithium can magic you out of that habit. Your body clock will need resetting and the habit energy of that much sleeping will need to be broken. Yes, you have room to increase the dose and this may still be residual depression. But if you've had some improvement, build on it and set that alarm clock an hour earlier and got to bed an hour later till you're back to normal.

I got into a really shitty sleep patterm with my bipolar II. It took concerted effort to break that. 15 hours bed rest will make you feel lethargic and unwell. You won't be getting your sunshine vitamin D, fresh air, exercise, regular meals etc.

[larkspur]

What Titania has said is exactly why I force myself out of bed in the morning...because I know that laying about in bed will make me WORSE! Even if I only make it to the couch, that's something.

If your blood level is low, up your dose. It sounds like you aren't getting side effects aside from the kind of malaise-y tiredness which may be more from your lifestyle, or even more likely, the DEPRESSION than the lithium. Give it a try, maybe 1500/day will bring you up in the .7-.8 range, where you could see better results. Less depression = less tiredness, hopefully!

And don't beat yourself up about needing Ritalin for a while. Whatever gets you up and out is probably good for you. It isn't a crutch, it's a tool that your doctor is using to aid your rehabilitation. Use it as such. I hope you're feeling better soon!

[staceyr]

Hi all,

Thanks for your responses. I apologize for taking so long to respond and thank you.

It has been a real ride since I made my original post. The summarized version of my ride is this - I've been sicker than a dog. The long version goes as follows:

As time went on I became sicker and sicker. I had horrible shakes and tremors - not just in my hands as expected - but throughout my entire body. I started to lose my coordination and balance. Even taking a shower was difficult for me as I'd be so wobbly and dizzy I felt I could fall. Oftentimes I'd walk down the hall of my apartment and almost fall over but for using a wall to catch me. Walking down stairs was risky business as sometimes my feet wouldn't go where I wanted them to. I became ravenous. Not just a little ravenous, but painfully so. I have never felt a hunger that hurt so much. I was eating entire bags of candy bars, copious amounts of ice cream and huge meals at fast food restaurants, like a double-quarter pounder cheeseburger with medium fries and TWO apple pies, yet I'd STILL be hungry. It wasn't the lithium making me so hungry because I'd been on lithium for two and a half months at this point and didn't gain much weight or have such hunger. I was eating everything in sight and quickly gained weight. For most people, Ritalin is known to cause weight loss, but for me it had the opposite effect.

I kept in touch with my doctor throughout all this and kept her informed of all my symptoms. She just kept telling me to get a general practitioner and that she didn't think it was the lithium that was making me sick because my blood levels kept coming back sub-therapeutic.

Last Wednesday - on my birthday! - I became so weak, wobbly and faint that I required an ambulance ride to the emergency room. The doctor on shift that night immediately recognized my symptoms as coming from the Ritalin. He said I was "hyper-reflexive". He told me to discontinue the Ritalin. So, I did, and ever since I have been slowly recovering. I am still at times weak and wobbly but I am MUCH better than I was.

I am now looking for a new psychiatrist because I am irked that she did not think to look into the possibility that it could be Ritalin making me ill. Since I was blaming the lithium, I cut my dosage down from 1200mg to 300mg. Now I know of course that it wasn't lithium toxicity making me sick, but I must admit I feel even better without the extra lithium because it was making me zombie-fied. I had so much apathy that I ignored all my friends, even when time-after-time they'd inquire as to my whereabouts. This went on for months. I had no interest in anything and let my apartment turn into a disaster, which is very much unlike the "normal" me. At the time I was more than happy to be this way because - even though I was still depressed - I wasn't having constant suicidal thoughts, the same thoughts that led me to make two attempts to end my life late last year. I was willing to pay a large price to get rid of those dark ideations, but now I have discovered that even on a small dose the suicidal thoughts have not returned. I never reached a "therapeutic" level of lithium but to be honest I don't want to try to reach it anymore. I would like to try Wellbutrin but I am going to wait until I have a new doctor. I've had several problems with my current doctor, which in the beginning I forgave her for because she's new and young, but there have been too many mistakes. The first one occurred when she gave me a prescription for Effexor. It made me ill for several days and it turned out it was because it wasn't the extended-release version which I had taken for years. The second came when I was looking for reasons why I might be so sick on lithium and mentioned the possibility of hypothyroidism. I told her if I was coming down with hypothyroidism she would have to prescribe me something to bring the thyroid back into balance. She said that couldn't be done and after I insisted it could be, she finally got up to grab a book off her shelf and looked it up and said, "Oh. You're right." The third came when for two weeks I was explaining to her my worsening symptoms, and she kept telling me to get a regular doctor, yet an emergency room doctor recognized what was wrong right away. It seemed he had much more knowledge on psychiatric medications than she did, and he wasn't much older than her. The fourth occurred when she used the wrong code to order my lithium serum level, which delayed my going to the emergency room because we were waiting to see if I was toxic on lithium. I could have gone to the ER two days earlier since I would have known it wasn't the lithium making me sick. But then again, I wouldn't have had to go to the ER in the first place if she'd have considered it could be the Ritalin at fault, especially since the timing of my symptoms nearly coincided with the time I started taking it.

*sigh*

Anyway, I've been too sick to do much of anything. However, now instead of sleeping 15-16 hours a day I am down to about 12 hours. I hope to make progress and get on something resembling a "normal" schedule.

For those of you on multiple forums, I posted this inquiry on about four other websites back in May so I am just going to cut and paste my response. Therefore, if you frequent the other forums, you may see this post again.

Thanks!

[sircuit]

Lithium made me very, very physically sick. Seems to work for about 65% of users for a while anyway.

[crtclms]

I got toxic the first time I tried lithium, but my pdoc started me at 900mg (which isn't insane, but my current dosage is 450mg, so it was too high for me). Plus, she didn't tell me I needed blood tests, plus she didn't warn me about Nsaids being a no-no. So I was pretty sick. But to be honest, there is a lot I can't remember from that period.

This time I am upset because it is working so well that I wanted to go up to 600mg, but my kidneys can't handle it. I've never been upset that I couldn't raise the dosage of a medication before. That's how much I like it;.