Would you do it?

[jillbelle]

erase

[crazynotstupid]

I'd say don't worry, if the lith can replace (hopefully) a couple of your current meds.  It could, possibly, allow you to lower your Lamictal dose too.

Weight issues?  I've had none due to lith, but oooh, that Zyprexa...  Frankly, that Seroquel is as/more likely to cause weight, although the low dosage...  Well let's just say that was my "sleepy time" dosage for when I couldn't fall asleep.

As for side effects: I've been toxic, and really, it wasn't a big deal (though we caught it quick, but still...)  And if you're kidneys aren't hosed, then lotsa water and eating nummy salty foods should keep ya good.  I don't worry about kidney problems, and I've been diabetic for 22 years.  So there ya go, if that helps.

Lith was the med I never wanted to try, and yet, here I am on it! So don't be afraid; either it'll work, or it won't and you'll try something else.  Such is the nutty world we live in.

[Jenni]

I resisted trying lithium too, for the same reasons.  Didn't want to gain weight on lithium, so the doc put me on Zyprexa instead, HA! HA!  Joke was on me, I guess.  After I switched to lithium, I didn't gain any weight from it.

[AirMarshall]

Hi Jillbelle, welcome!

I found Paxil (SSRI) much worse for weight gain.  Much worse. In fact, once I quit Paxil and got on Lithium, my weight stablized.

Kidney damage:  Yes it can, generally this is seen in a small number of users who are on it continuoulsy for 10 -20 years.    Regular annual blood/urine screens for creatainine/BUN (protein spillover) and specific gravity, should pick up any changes before things get bad.

Toxicity:  Normally not a problem if you have a competent Pdoc who does regular blood level checks.  This drug is well understood and not hard to manage.  It is also a simple drug, a salt actually that doesn't get metabolized.  It goes straight into your blood stream like table salt, hits your brain and then goes to the kidneys and out your urine.  Half life is 24 hours. So if you get a little too much, you stop taking it, let it go down, then take a lower dose.

The other good things about lithium is that it can make some of your other meds work better, making it possible, possible, to take each at a lower dose.  Lithium and Lamictal are a good combo (that's me) and work against both mania AND depression. 

Seroquel is a good "knock you down" drug that slooows things down to reduce that hypomania.  I have no experience with Zyprexa.

Not to play doctor but...  He wants to put you on anothe SSRI after triggering mixed episdodes?  Huh?  That is such a typical BP reaction, and why most of us don't take them. Talk with him on this so you understand his reasoning.

Good luck, see you around.

A.M.

[NARS]

Wow, what a cocktail.  Hopefully you'll need lower doses of other meds since you're combining them all, which reduces the risk of side effects from each med. 

If you're still having trouble with mania when you're on all these mood stabilizers, it's surprising your pdoc wants you to add an SSRI, which generally triggers more mania in BPs.  And is it possible that what you think is depression is actually a mixed state that calls for more stabilization?  My pdoc plans to try taking me off of wellbutrin after I've been stable for a while.  Could you hold off on the SSRI until you've tried lithium?  Many have reported that lithium helped relieve their depression, so it may be worth suggesting to the pdoc to hold off.

And it's possible that if you're "naturally thin" you may be fine on lithium.  I dunno, of course, whether it's more or less likely that weight becomes an issue on lithium if you've never had weight troubles.  But again, you may need a lower dose of lithium.

Sigh.  Here I am again, babbling on about a med I've never taken.  There's a lithium thread below with tons of posts that you might find helpful.  More helpful than me.

[NARS]

I'm a total dork who can't swallow pills.

Don't be embarassed; I get the gag thing all the time.  I've had to find the perfect position for my neck and head so that I won't gag at the teensiest pills.

Watch for the sustained release drugs, though.  You can't crush those or you'll get way too much way too fast.  Check your current ADs to see if they're sustained release; if so, you may have to go to multiple doses a day to avoid whizzing around like an unknotted balloon.  And that might make the SSRIs more tolerable while you're getting stable.

[sun_zoom_spark]

I was on Lithobid, Lamictal, Seroquel, Klonopin and Provigil.

No weight increase on Lithobid. Matter of fact I've lost a ton of weight. Don't be afraid, it's the best drug out there if you don't have a bad reaction. Not a great drug for depression. That's why I'm ramping with Lamictal.

Oh....and don't worry about your kidneys, your thyroid may take a beating if you stay on high doses but that's why serum level lab test are mandated.

[Squirlygrl]

I do find that lithium helps with anxiety, depressive obsessions, and hypomanic compulsiveness.

Is your Seroquel helping any?

[Glen]

Can anxiety and OCD be controlled without an SSRI? Does Lithium have any anti-anxiety properties? (I guess this is my main question.)

Jill :-)

<{POST_SNAPBACK}>

Sometimes anxiety is a result of the manifestations of moods.  A stabilized mood enables one to be calm and rational thereby helping oneself to overcome anxiety, which is usually irrational itself.

http://www.medscape.com/viewarticle/492123_1

Further, benzodiazepines are not effective in OCD. Thus, those with bipolar disorder and OCD are faced with a difficult, though not insurmountable, dilemma. Serotonin reuptake inhibitors (SRIs), the drugs most commonly used for the treatment of OCD, can destabilize bipolar disorder by causing manic episodes or a long-term worsening of the course of bipolar illness (rapid cycling, or more and more mood episodes over time). However, SRIs may be needed to treat OCD. In this situation, the clinician and patient need to work together to reach the best compromise. Of the SRIs, the one that has been studied most extensively in bipolar depression (and that is associated with at least a relatively low rate of immediate mania) is paroxetine.[9]Thus, I generally recommend using this agent as opposed to other SRIs in bipolar depression in general, but especially in bipolar disorder with OCD. Further, there is some evidence that some atypical neuroleptic agents can improve OCD symptoms, especially when combined with SRIs.[10] My practice, in order to avoid antidepressant-related worsening of bipolar disorder, is to begin with standard mood stabilizers (namely lithium, divalproex, or carbamazepine) plus atypical neuroleptics in persons with bipolar disorder plus OCD, and then to follow up with paroxetine or other SRIs if OCD symptoms persist. The added benefit of this sequence is that the presence of atypical neuroleptics plus mood stabilizers provides added protection against possible induction of mania when antidepressants are added later.[11]

It is also worth mentioning that, many times, antidepressants and benzodiazepines are not even needed in the treatment of bipolar disorder with comorbid anxiety conditions. This is because anxiety symptoms often resolve when the mood disorder is treated. This falls within a hierarchical approach to diagnosis and treatment that has a long tradition in psychiatry, as follows: Mood disorders trump psychotic disorders which trump anxiety disorders. In other words, if someone has a mood disorder (such as bipolar disorder) plus delusions, one should diagnose and treat bipolar disorder first, not schizophrenia, and often the psychotic symptoms resolve with treatment of the mood symptoms. Further, if someone has bipolar disorder plus GAD, I would recommend initially treating the bipolar disorder with a standard mood stabilizer, and then only adding an antianxiety treatment if anxiety symptoms persist despite improvement of mood symptoms with adequate treatment with a mood stabilizer.

[Lisa_K]

I was put on Topamax and Keppra for seizure control, and my doc wanted to put me on Depakote ER for extra seizure control and as a mood stabiliser...I was kinda freaked. Im not as much of a vain person, but I didnt like the the idea of waking up and potentially looking like a bald, overweight 'man' with a mustache....this of course, didnt happen.

Alot of people have experienced different side effects on different AC's...it all just comes down to that person...I personally have found depakote ER to be a life saver in many ways...a few annoying side effects...but nothing like what I heard they can be like...but like I said...it all comes down to the person...everyone's body is a unique and different chemistry set.

[myrkkyhammas]

i used t be pretty mortified of lithium, too.

but it's really fricken sweet.

seriously.

[blackmilk]

I, too, was totally tweaked about it. But it's worked wonders.

-

k

[seven]

Count me in too. Absolutely scared of Lithium. Thought it would give me lead boots and have me wretching all the time.

Not true. I've had NO side effects. And I am wierdly even, pleasant, cheery.

Seroquel is often good for anxiety. As for the lith alone, not as much, but better than no lith.

7

[sun_zoom_spark]

On what board should I post the following question: I'm still not stabilized. How often should my pdoc be seeing me? Is it normal for him to have me wait 2.5 weeks until we de-crazify me? Do I just tough it out or go the hospital where they can get me better faster?

[NARS]

On what board should I post the following question: I'm still not stabilized. How often should my pdoc be seeing me? Is it normal for him to have me wait 2.5 weeks until we de-crazify me? Do I just tough it out or go the hospital where they can get me better faster?  sad.gif  (Someone please help!)

Help are us.

You can post the question here which you already have, and the bipolar forum further down on the main page also has good advice (with many of the same posters you've met here).

And I think you should call your doctor's office and tell them exactly how you feel.  Drop off a printout of your posts here so he can read it and tell how desperate you are.  Keep calling until he has you come in.  It should be this week.

If I'm not functioning well, if it's impairing work, home life & relationships, if I feel uncontrolled, depressed, manic or some combination of symptoms, I call or email my pdoc right away, and he gets me in ASAP.  He puts a high value on my daily functioning, so he doesn't leave me just hanging out there.  I've got insurance, can afford my co-pays, but I'm sure he'd work hard for me even if I were tight on money.  When I was badly depressed last summer I saw him almost every week.  When I got mixed states from over-medication this fall he again saw me every week, then every 10 days, and now that I'm happy & stable, every 6 weeks.  We only go back to once every three months when I'm doing well.

So I do think 2 1/2 weeks is way too long to suffer.  Even if his idea is to give the meds time to work, IMHO he should check at least weekly while you're unstable.  There are lots of things to do to make med adjustments more tolerable, including PRN benzos, zyprexa, seroquel, whatever.  Stability is key; until you level out, it can be impossible to tell which way you'll go with the meds.

[AirMarshall]

Another satisfied customer! Yay.

A.M.