Lithium for treatment resistant 'unipolar' depression?

[crazyguy]

I'm just wondering if Lithium is an option as an add-on to antidepressant for depression?    

 

My depression is usually mild-moderate and chronic, but lately I'm going through quite a severe dip that has been going on some months now. I've tried so many antidepressants and while the one I am on at the moment is somewhat helpful, I am still struggling to function day to day and a lot of 'dark' thoughts too. 

 

I have not asked my family doctor to send me to a Pdoc because I fear they will just try and dope me up on AAPs or take me off my antidepressant/benzo  and start me on the SSRI merry-go-round again.  I really don't want to take AAPs.

 

I stumbled across Lithium as a potential augment and it sounds less scary than antipsychotics.  Should I ask my doctor about it or is it mainly for bipolar? 

 

[Unstrung Harp]

Lithium is often used as an adjunct to an AD for treatment resistant depression. I just spent 8 or so months on it and it did seem to noticeably even out my moods (I just got off that and a tricyclic mostly because the tricyclic seemed to be impacting my cognitive function more than I was comfortable with). I don't know that lithium is objectively "less scary" than an AAP, and personally I had more side effects from lithium (dry mouth, shaking hands) than Abilify. Lithium will also require periodic bloodwork (which I don't recall was an issue with Abilify at least).

 

You have probably gotten this feedback here before, but if you have a chronic and especially a treatment resistant mood disorder, it is really not a good idea to rely on a family doctor to treat you, because most of them are not trained in handling chronic mental illness. Once you're talking about trying to get a second med added, you are looking at an added level of nuance that you really should have a psychiatrist handling. Seriously. Not all pdocs will treat you in the same way, and a good one will listen to you and address your concerns rather than "doping you up" on anything. And I would think a fair number of pdocs would switch you to another AD to try (perhaps of a different class) rather than automatically adding something on, but that's probably because in their experience that is more effective than keeping you on the same one that isn't working. I know that's frustrating (believe me I've been there) but sometimes it is necessary. Also, many pdocs do prescribe benzos in the absence of addiction red flags, because they're really useful in treating anxiety. But just as you probably would not trust your GP with a complex fracture but would seek out a specialist referral, so should you seek out a specialist for your psychiatric condition.

Edited February 16, 2014 by Unstrung Harp

[crazyguy]

Lithium is often used as an adjunct to an AD for treatment resistant depression. I just spent 8 or so months on it and it did seem to noticeably even out my moods (I just got off that and a tricyclic mostly because the tricyclic seemed to be impacting my cognitive function more than I was comfortable with). I don't know that lithium is objectively "less scary" than an AAP, and personally I had more side effects from lithium (dry mouth, shaking hands) than Abilify. Lithium will also require periodic bloodwork (which I don't recall was an issue with Abilify at least).

 

You have probably gotten this feedback here before, but if you have a chronic and especially a treatment resistant mood disorder, it is really not a good idea to rely on a family doctor to treat you, because most of them are not trained in handling chronic mental illness. Once you're talking about trying to get a second med added, you are looking at an added level of nuance that you really should have a psychiatrist handling. Seriously. Not all pdocs will treat you in the same way, and a good one will listen to you and address your concerns rather than "doping you up" on anything. And I would think a fair number of pdocs would switch you to another AD to try (perhaps of a different class) rather than automatically adding something on, but that's probably because in their experience that is more effective than keeping you on the same one that isn't working. I know that's frustrating (believe me I've been there) but sometimes it is necessary. Also, many pdocs do prescribe benzos in the absence of addiction red flags, because they're really useful in treating anxiety. But just as you probably would not trust your GP with a complex fracture but would seek out a specialist referral, so should you seek out a specialist for your psychiatric condition.

thanks for the reply.  

Yes I have had that feedback a few times already and I know it is probably good advise.  However, although not a specialist my GP is very good with MI.  I have a long term relationship with my GP and I'm not sure I have the energy to start trying to forge a working relationship with a pdoc and have to explain my complex history. I worry it could take many visits/months before they even know me well enough that I can explain all the issues. Having said that, I would see a Pdoc if the GP recommended a good one. 

 

You are perhaps right in that objectively lithium may be no better than AAP  for side-effects.......  But somehow in my mind it seems like an older/safer medication to try. 

 

I really don't want to start the antidepressant merry-go-round again because this is the only one that has had at least SOME benefit.  SSRIs make me feel worse and agitated.  Tricylics did nothing but make me doped up, constipated and fat. I feel meds in the same class are quite similar in action and I'm not prepared to waste another year trying the 3/4 different SSRIs I haven't been on already. I feel it is time to try something different.

 

But I obviously need to discuss this with my doctor ASAP.

[jt07]

I took lithium to augment an antidepressant for major depression, and from my understanding, it is a rather common practice. Unfortunately, in my case it didn't help.

 

I just want to add that I take an AAP, and I am not "doped up" at all. In fact, it has greatly improved my quality of life.

[Squish]

I've seen a pdoc twice on the NHS. There was one evaluation appointment and a follow up 4 weeks later. I saw a different doctor each time though, so I don't think there's much continuity of care.

 

It turned out that a higher dose of venlafaxine made a big difference (300mg, which doesn't get prescribed except under pdoc supervision apparently), so in the end I didn't have a big med change.

 

If that hadn't worked they said they would have tried combining two antidepressants, so I don't think NHS pdocs automatically reach for AAPs for treatment resistant depression. And they can't force you to take AAPs if you don't want to. If you tell them you don't want to do that then they might come up with an alternative.

[bpladybug]

I agree you need a pdoc, and Lithium is a very good idea. IMHO

[Stickler]

I asked about lithium here.  

The county clinic doc-of-the-month club said they no longer like to prescribe it due to the need for regular bloodwork while using it...that and potential kidney damage from long-term use. 

[mcjimjam]

It is used as an augmenting agent for antidepressants, as well as being used for bipolar d/o. AAPs may be more popular nowadays as augmentors but lithium used to be used a lot for this purpose. 

 

I don't think you should avoid seeing a pdoc because you don't want to take AAPs. My current pdoc hasn't even suggested I take AAPs. If you just say you don't want to take them I think they will try to honor that, especially since you don't have BP or schiz, where AAPs are more a mainstay of treatment.

[San]

Like everyone has said, lithium is terrific for depression. It's not only used for bipolar disorder. It's good for mania and depression and doesn't have a lot of the cognitive dulling anti-convulsant mood stabilizers have. AAP's, like abilify, seroquel, geodon, etc are often used.

 

Lithium is top notch, inexpensive, you do have to go for blood work for levels, once in a while, the longer you take it, the further apart the blood work.

 

Lithium is an excellent medication.

 

Everyone has given excellent replies, so I'll stop there.

[crazyguy]

You're going to have a tough time getting a GP to give you Li. Li is one of the meds where you need regular bloodwork and not just for Li levels. You need createnine and thyroid tests as well. I wouldn't be comfortable with my GP giving me Li even if she was comfortable. If you're ill enough to be considering Li then you probably should see a pdoc. You don't have to do the SSRI thing. I tried a couple years ago and they were pretty much a disaster. What you need is a pdoc that you can partner with to find he right meds for you. It has to be something the pdoc is comfortable prescribing AND it has to be something you're willing to take. 

I intend to ask my GP what other options there may be, rather than ask specifically for X or Y medication.   Having said that even trying to get a Dr appointment at the moment is tricky; nothing available at the moment :-. If the outcome is a  referral to a pdoc then I can only assume that will take months on the NHS as well. sigh.

 

IDK.  The problem is 1) I find it hard to trust doctors in general,  2) you little to no choice of specialist; if you are referred you pretty much take what you are given (plus services in this area of a poor reputation) and 3) natural concerns about psychiatry as a whole.  

 

So for those reasons I'm the opposite to you, I would rather stay out of the higher level 'specialist' care if possible.  If my GP feels comfortable prescribing or treating something then I am happy to go with that, because I believe my GP is good and would not offer a treatment he isn't competent in managing. 

 

I have regular blood work for other issues to that aspect of it doesn't concern me. 

Edited February 18, 2014 by crazyguy

[Level_With_Me]

I have just been told if my antidepressants aren't working well enough by my next appointment then they will probably put me on Lithium. I don't know if they would plan on keeping me on my antidepressants, but I would hope so. I know they don't work completely, but I know they help some. I can't predict the future, but if I do end up still feeling depressed I will let them know and probably get put on Lithium. By the way this was suggested by one of the pdocs at my office.

[chelly]

 

Deleted by member

Edited March 9, 2017 by chelly
too much personal information