What med next? Lithium?

[papertrees]

Hi,

I've been relatively stable for 7 months, and am on Saphris 10mg, Lamictal 200mg and Valium 10mg (PRN).

 

However, I've had two episodes of hypomania followed by depression.

 

My pdoc is thinking lithium, but I want to know if there are other suggestions out there as lithium isn't that efficacious for rapid cycling.

 

I've tried Depakote and Trileptal, both of which didn't work.

 

This would be my second round on lithium. I only stopped it before due to horrible hair loss.

 

Can't go up on saphris as it's expensive and I'm paying out of pocket.

 

Help.

 

Any input greatly appreciated.

[Butterflykisses]

I take lithium and I still had a breakthrough manic episode. Sometimes medications cant completely stop or prevent episodes. My manic episode was mostly stress induced. I was working all through the night and missing sleep which led to my episode.

 

I would give it a go on the Lithium, then maybe you wont have to spend extra for the saphris.

 

I only take generic meds. No brand names, too expensive.

[papertrees]

Thanks for the input, Butterflykisses.

 

I was just wondering if there are new meds out there that are proven better for rapid cycling than lithium.

 

I guess I'll have to give it a go again.

 

What about carbamazepine? Have you tried that?

[jt07]

I take carbamazepine, not for BP though, and I really like it. It keeps my brain glued together and keeps me out of suicidal depressions. I think that it is worth a shot if your doctor agrees. I don't know how well it would work for you because you said that Trileptal didn't work for you, and carbamazepine is Trileptal's older brother. However, some doctors think that carbamazepine is more effective than Trileptal as a mood stabilizer. I like that carbamazepine doesn't have any bad side effects for me. It's one med that my brain just likes.

 

Nevertheless, lithium is still the gold standard for BP, I think.

Edited February 5, 2014 by jt07

[papertrees]

Well, I'm actually schizoaffective, not BP.

 

But I understand that the treatments tend to run the same.

 

I'm choosing now between carbamazepine and lithium. I'm seeing my doctor next week, and I need med suggestions.

 

One thing though, I read that lithium reduces suicidal ideation. That has been my problem for a long time. Even when I'm happy, the idea of suicide lurks in my mind like a shadow waiting to overtake me. 

[tamagotchi]

Other than the hair loss, was lithium good for you?

[papertrees]

I remember feeling good on it back then. I was also on Topamax and Abilify along with lithium. I had a psychotic episode though, but that doesn't have anything to do with lithium.

 

I just remember the bad hair loss, peeing a lot and drinking up to 6 liters of water a day.

 

I am weird in my reaction to meds. I have been trying to find the right combo since I was diagnosed in 2007. Finally, on saphris and lamictal, I think I'm getting my perfect combo. Except when I had the hypomania followed by depression so bad I don't get out of bed and I lost my job.

 

So yeah, it needs a bit more tweaking and my pdoc has been wanting to see me for the past 3 months. Unfortunately, I'm also paying out of pocket for appointments and I can only manage to see him next week.

[shesellsseashells]

I'm sorry to hear you're having a hard time, and so sorry to hear about your reaction to Lithium.  I experienced pretty much the same: my hair turned to straw, 1/3 of it fell out, and after two years my eyelashes and eyebrows started to go.  In addition to the unquenchable thirst and nonstop peeing (I have an overactive bladder, anyway, so I couldn't go longer than 1/2 hour between bathroom visits), those side effects did me in.  My pdoc has ramped up my Lamictal dose to 400 mg and we're adding Wellbutrin back in next week.  I realize that our diagnoses are different so what I'm on may be in no way helpful information for you, but I recognized those troublesome side effects and thought I'd relate.  I hope you find some relief soon with side effects that are tolerable for you.

[papertrees]

Thank you. I have never taken Lamictal beyond 200mg and I have always been on Lamictal since 2007.

 

I am unable to take antidepressants as I get really manic on them, but thanks for the input.

 

The peeing I experienced on lithium was usually at night- I had to get up 5 or 6 times just to pee and drink water. I don't mind it. What turned me off was the hair loss because the shower drain was becoming clogged due to the amount of hair.

 

I guess lithium would be the way to go then, unless my pdoc suggests something else.

 

I don't like the blood draws either. For a self-injurer like myself, that needle they use to get blood scares me and almost always causes me to faint in fear.

[tamagotchi]

Why didn't you ever try raising Lamictal?  I'm just curious-- I'm not suggesting that you do it right now.  But, I need at least 250-300 mg to get a stabilizing effect and some people need more than that.

[Lavoris]

Is Seroquel an option for you? I am on 200 Lamictal and 150 Seroquel and aside from hypomanic breakthroughs from boughs of insomnia I feel pretty good.  I have no idea if it's right for you.  I experienced hairloss while on Lithium and have been using Minoxodil with ok results.  I am no longer on Lithium, just trying to keep up sleep and stress levels down and aggressively treating hypo episodes when they happen.  The overactive bladder still haunts:(  Just typing this made me have to pee.

[papertrees]

Hmmm.. I don't know, but none of my pdocs ever suggested raising it beyond 200mg. That's something I have to ask.

 

With seroquel I gained 40 pounds. I can't do that anymore, but I don't like the sedation.

 

So the need to pee persists?

[Lavoris]

Yes, but I'm also now 55, so that's a contributor for sure.  Sorry to hear about weight gain, I have to stick to a strict low glycemic diet but I do crave carbs and sweets a lot more since being on Seroquel.  Or it could just be because carbs and sweets are awesome.  Not to overshare, but kegels and pumpkin seed helps.  All just part of life's rich pageant.

[papertrees]

I used to crave EVERYTHING to the extreme when I was on Seroquel. I would even hide myself and eat because I was ashamed of being seen eating when they know I've already eaten too much. I consumed whole blocks of brownies and left med school classes just to eat in between meals.

 

I ballooned.

 

Besides, I have one to many issues with weight that a weight gain of that magnitude will really kill my already non-existent self-esteem.

 

Abilify was ok. It only relieved psychosis at 30 mg.

 

Risperdal (and Invega and Consta) were ok too, just didn't do anything for me mood-wise.

[tamagotchi]

About raising Lamictal-- if they just haven't ever suggested it, I think it's worth asking.  You're already tolerating Lamictal so you might as well see if a higher dose helps.  At 200 mg it doesn't stabilize me at all, but at 300 mg it is helpful.  I tried going a little higher to see if I could get more out of it, but I start getting side effects if I go much higher, so I figure this is the sweet spot.  There also seem to be plenty of people who find their sweet spot at 400 mg.

[papertrees]

I need something to stabilize both hypomania and depression. Maybe raising lamictal is an option but I need a new mood stabilizer to be added. I understand lamictal isn't that efficacious for hypomania/mania, so I think my pdoc is considering lithium since I already have the lamictal on board.

[tamagotchi]

Oh no, sorry if I was not clear.  If I were in your shoes I would go for lithium now, given all you have said.  I'm only talking about trying more Lamictal as something you may try in the future.   Although it's not good for acute hypomania/mania, it is used for maintenance to reduce frequency and severity of episodes, for both hypomania and depression, and that is what I get from it at 300 mg.

[papertrees]

Sylvan, there's only one reputable pharmacy here in the Philippines, it's called Mercury Drug. If I increase my dose, that would make it 15mg, 1 tablet 10mg and 1 tablet 5mg. I already tried increasing the dose but I felt too zombie-fied on 15mg. I also don't play well with the generic lamotrigine here, it just doesn't work the same. So I'm stuck with brand name for now. Valium is cheap, so it's not a problem. My pdoc gives me cards for Saphris that entitle me for 20 free tablets for every 60 that he prescribes. It helps a lot as I pay out of pocket for everything. Insurance policies here do not cover psychiatric illnesses, I tried availing of a plan but was asked not to disclose my diagnosis. It's tough living in a third world country. I'll ask my pdoc about thyroid meds, that suggestion was wonderful, thank you.

 

tamagotchi, thanks for the input. I guess I'll try lithium first, since that's what he suggested to me. If my depressive episodes don't stop, then I'll talk to him about increasing the lamictal. 

 

I don't have much leeway in terms of meds, in that I'm paying out of pocket for everything including pdoc appointments. It was different when my family supported me before I was working, since I could get on any med I want and can afford all tests required. Since I started working, my family has made me responsible for paying for medical care as well as all my bills. My pdoc doesn't think it's right that they do that, but I think I need to be responsible at some point because I also don't want to depend on someone else for the rest of my life. It's only fair. But yeah, that's what I'm stuck with.

 

I tried generic lamictal, generic risperidone but it didn't play well with me, however, that was all I could afford at the time. Now, I'm earning a bit more, so I was able to move to Saphris and brand name Lamictal. 

[MisterJoshua]

I take lithium for bipolar, and I am still continually haunted by suicidal thoughts. I haven't found it helpful for the depression end of bipolar at all. My tdoc swears that therapy is the only way to get rid of those thoughts. He might be full of hooey (it hasn't worked for me yet) but I thought I would throw that out there. I realize you are in the Philippines so this may not be an option.

[papertrees]

Well, therapy is available here, but it's really expensive. My pdoc, on the other hand, is of the notion that I don't need therapy since I don't have a personality disorder (changed pdocs, haven't updated my signature). He thinks I only need meds and that's it. But he did say I can look into cognitive behavioral therapy if I wanted to. I did and there are only TWO doctors that came out, both of which I have dealt with in the past and one I particularly hate. Not to mention it's very expensive. 

 

My former pdoc (the one who diagnosed me with schizoaffective, borderline and anorexia) does do psychotherapy. However, he came to the conclusion that I was just a spoiled brat who didn't have coping skills. Needless to say, I changed pdocs right away.

 

I read that you can teach yourself CBT, so that's what I'm trying to do now. CBT here costs Php 2,000 per session- around $50. That would be expensive for me since I have said that I pay out of pocket for everything and I only really earn about $500 a month from my online writing job.