iaawal Posted May 22, 2014 Share Posted May 22, 2014 My pdoc recently confirmed a suspicion I had that he stays on too low of a dose and/or goes up too slowly. When I started my first med (viibryd). He started me on 10mg and 10 days later moved me up to 20 and I stayed there for a month (until I had to come off due to suicidal ideation). With the lamotrigine it took me 4 months to move up to 200mg and this is how it went: - 1 month on 25mg, 1 month on 50mg, 1 week on 75mg, 2 months on 100mg and then 1 week on 150 and then to 200mg. It took me 3 months to move up to 40mg of citalopram. And now with the prozac and lithium he says he'll keep me on 20mg of prozac and 300mg on lithium because he thinks I'll do well on it (that's what he's said in the past about low doses and it was never true). He says the prozac (20mg) will help with OCD. As far as I know, higher doses treat OCD. He said the same thing with the citalopram but I never went to a high enough dose because he believed the low dose would help. When we were talking about the lithium he said he uses it differently and believes that 300mg is a good dose for most people as opposed to the usual 900 - 1200mg. He confused me about that but oh well, we'll see. So I'm wondering how fast y'all increase doses with meds? And if you think your pdoc plays it too safe? Link to comment Share on other sites More sharing options...
MrTastybutt Posted May 23, 2014 Share Posted May 23, 2014 I usually start at the target dose or close to it. It's rarely taken me more than a couple of weeks to titrate to my target dose. I know nothing of lithium though. I don't think my pdoc plays it too safe. I don't experience withdrawal nor do I experience problems adjusting. Link to comment Share on other sites More sharing options...
saintalto Posted May 23, 2014 Share Posted May 23, 2014 In my experience some meds they have increased really fast, some of them just a little bit at a time. I guess it depends on the med. Do you get blood tests to see if your lithium is at a therapeutic level (I think that's the right term)? I'm on 1200 mg of lithium a day because anything under it and I might as well not be taking it at all. I only barely reached therapeutic levels at 1000, now I'm maintaining at a good level. 300 seems awful low, but I'm no doctor so I won't make any judgements. Link to comment Share on other sites More sharing options...
dancingteapot Posted May 23, 2014 Share Posted May 23, 2014 I think it depends on the med. Lamictal has to be slowly titrated...but when I was on it I think my titration schedule was like 25mg for 2 weeks...then 50 for 2...then 100...then just kinda jumped to 200mg. Not sure if that's really the proper way to titrate that med. Pdoc at the time kinda did whatever. I moved relatively quickly with antidepressants...then things would go downhill I get titrated very quickly on antipsychotics. Especially in a hospital setting. I don't remember how other titrations went with the other mood stabilizers I was on. And I think I used to take 900mg of lithium and just barely reached the therapeutic range. Link to comment Share on other sites More sharing options...
shesellsseashells Posted May 23, 2014 Share Posted May 23, 2014 My understanding of Lamictal is the same as teapot's, that it must be titrated up slowly. I was on 200 mg for a couple of years and was recently bumped up to 400 mg over about a month. My pdoc also starts me on low doses. I started with 10 mg of Prozac in December and have just gone up to 60 mg (at my request). He started Adderall at 5 mg. Also, my pdoc will only deal with one med change at a time, so stabilizing is taking FoReVeR. However, I understand why he does that: at least then we know what is causing what rather than trying to guess cause and effect. I think it makes sense for me to start meds on low doses to see how you'll respond and then bump it up if necessary. If there is no adjustment and the med isn't working optimally, that's pretty frustrating. Thinking back on the meds I've tried there were many I took at the starting dose and was then taken off them because they "weren't working" but increases were not tried first. (Some of that may have been due to my young age at the time.) I hope you find relief from your symptoms soon. Link to comment Share on other sites More sharing options...
melissaw72 Posted May 23, 2014 Share Posted May 23, 2014 I agree it depends on the med. Personally when I start a med I don't increase the dose as slowly as you have, but like sylvan said, it is your pdoc's call. About the lithium, when I took it my dose depended on my blood levels, not the mg dosage/day. Have you gotten your blood levels checked recently? Link to comment Share on other sites More sharing options...
MiaB Posted May 23, 2014 Share Posted May 23, 2014 (edited) I agree with the others that it depends both on the medication and your pdoc's standard practice. I've now been on lamotrigine (lamictal generic) for 2 months and have only just switched up to 200mg/day, after starting at 12.5mg. The aim is eventually to get me to 400mg, but that's going to take another month or so. On other medication I've been taken to therapeutic dose levels far quicker. Lithium efficacy is more dependent on blood levels than on the actual number of mg you're taking a day. The typical therapeutic level that I've heard quoted here is 0.6 - 1.2, though my pdoc doesn't like to go above 0.9. I have in the past been at 0.7 on just 750mg, but have seen others report similar levels at over 1000mg a day. Frankly, 300mg sounds low to me, but I am not a doctor, we are all different and again, it all depends on the results of the blood tests which he should be sending you for on a regular basis. Edited May 23, 2014 by miab Link to comment Share on other sites More sharing options...
iaawal Posted May 23, 2014 Author Share Posted May 23, 2014 Lithium efficacy is more dependent on blood levels than on the actual number of mg you're taking a day. The typical therapeutic level that I've heard quoted here is 0.6 - 1.2, though my pdoc doesn't like to go above 0.9. I have in the past been at 0.7 on just 750mg, but have seen others report similar levels at over 1000mg a day. Frankly, 300mg sounds low to me, but I am not a doctor, we are all different and again, it all depends on the results of the blood tests which he should be sending you for on a regular basis. Well he said that if I got my blood levels tested (big IF, I don't think he's planning on it soon), I would have a very low level because he doesn't believe that lithium levels should be that high. Not sure if I should find that concerning. He's a nice doctor and one of the few that my insurance takes that 1) doesn't work with me and 2) takes patients under 25. Link to comment Share on other sites More sharing options...
melissaw72 Posted May 23, 2014 Share Posted May 23, 2014 Lithium efficacy is more dependent on blood levels than on the actual number of mg you're taking a day. The typical therapeutic level that I've heard quoted here is 0.6 - 1.2, though my pdoc doesn't like to go above 0.9. I have in the past been at 0.7 on just 750mg, but have seen others report similar levels at over 1000mg a day. Frankly, 300mg sounds low to me, but I am not a doctor, we are all different and again, it all depends on the results of the blood tests which he should be sending you for on a regular basis. Well he said that if I got my blood levels tested (big IF, I don't think he's planning on it soon), I would have a very low level because he doesn't believe that lithium levels should be that high. Not sure if I should find that concerning. He's a nice doctor and one of the few that my insurance takes that 1) doesn't work with me and 2) takes patients under 25. IMO it is concerning that your pdoc is not getting your lithium blood levels tested (at least at the moment). Link to comment Share on other sites More sharing options...
iaawal Posted May 23, 2014 Author Share Posted May 23, 2014 Lithium efficacy is more dependent on blood levels than on the actual number of mg you're taking a day. The typical therapeutic level that I've heard quoted here is 0.6 - 1.2, though my pdoc doesn't like to go above 0.9. I have in the past been at 0.7 on just 750mg, but have seen others report similar levels at over 1000mg a day. Frankly, 300mg sounds low to me, but I am not a doctor, we are all different and again, it all depends on the results of the blood tests which he should be sending you for on a regular basis. Well he said that if I got my blood levels tested (big IF, I don't think he's planning on it soon), I would have a very low level because he doesn't believe that lithium levels should be that high. Not sure if I should find that concerning. He's a nice doctor and one of the few that my insurance takes that 1) doesn't work with me and 2) takes patients under 25. IMO it is concerning that your pdoc is not getting your lithium blood levels tested (at least at the moment). Yeah, you're right it is concerning. I have an appointment with him in 2 weeks, if he doesn't mention it, I will. Link to comment Share on other sites More sharing options...
rowan77 Posted May 23, 2014 Share Posted May 23, 2014 My previous pdoc was very cautious. He was always hesitant about starting new meds or increasing the dose. It was only when he took a career break and went abroad did I realise that not all pdocs are so cautious. He told me that there was no real need to increase my prozac even though I was still depressed on 20mg. Link to comment Share on other sites More sharing options...
iaawal Posted May 23, 2014 Author Share Posted May 23, 2014 My previous pdoc was very cautious. He was always hesitant about starting new meds or increasing the dose. It was only when he took a career break and went abroad did I realise that not all pdocs are so cautious. He told me that there was no real need to increase my prozac even though I was still depressed on 20mg. Did you decide to switch pdocs because of that or did you go along with it? Link to comment Share on other sites More sharing options...
iaawal Posted May 24, 2014 Author Share Posted May 24, 2014 Have you asked him about research to back up the low Li thing? I'd be interested in reading it if he has some. I know that sometimes it's used to augment an antidepressant but if you're BP and not in the theraputic range then what's the point? The range is there for a reason. It is expected that for it to work the way it should, you should be in the 0.6-1.2 range. It has been studied and proven. Like I said, if he has other info, I'd love to see it. Oh, and for sure, if you're on Li, you need to get a blood draw. The amount of Li an individual needs cannot be determined without a blood test. I haven't and didn't even think about asking him about it. I will ask next time and if he has any I'll make sure to post here. Link to comment Share on other sites More sharing options...
rowan77 Posted May 24, 2014 Share Posted May 24, 2014 My previous pdoc was very cautious. He was always hesitant about starting new meds or increasing the dose. It was only when he took a career break and went abroad did I realise that not all pdocs are so cautious. He told me that there was no real need to increase my prozac even though I was still depressed on 20mg. Did you decide to switch pdocs because of that or did you go along with it? I live in Ireland so can't pick and choose pdocs. You can be lucky and get a great one or the complete opposite. It depends on your catchment area. That pdoc that I just spoke about was actually a really good pdoc but was just cautious about meds. He was my pdoc for 14 years and was all I really knew. He is now teaching medical students in Malaysia, was supposed to be only gone for 2 years but he hasn't returned yet. I liked him because he was familiar, but now that he's gone a while I'm not really too bothered whether he returns to Ireland or not Link to comment Share on other sites More sharing options...
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