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Struggling With Lithium After Initial Success


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I've had bipolar 2 my whole life but rarely had it diagnosed properly, leading to a revolving door of medications that would work initially for my depression but not for more a few weeks. I had decent luck getting off meds without side effects, and most of the side effects were livable... except the brain fog on antipsychotics. I've only been on true bipolar meds twice before lithium, and both times the side effects left me feel less than functional. In the gap between treatments, a long gap without insurance, I developed a drinking problem and got my first taste of how much chemical withdrawal can suck.  I eventually got the drinking under control, although I still drink more than I should during periods I decide to drink. 

During a dry period when I was feeling particularly low, I managed to convince my doctor to let me try lithium. He's a med student in his final year, so he didn't know much about the drug and prescribed 900mg to start with another 300 to be added after a week. I wasn't sure what to expect, but I felt great that first week, so great I didn't increase my dose until the following week, when I was supposed to check in with him.  Throughout the first two weeks, I drank a little at first, and then pretty steadily once I realized how well my body was tolerating the lithium.  Had one night I overdid it and slowed down again for a few days.  On the doctor's advice, I lowered the dose again to 900mg spread throughout the day.  If I did well enough like that, he even wanted me to try a dose of 600mg, but I started feeling a bit off in the third week and went up again.

Some of the issues I was having with motivation by then, I'm sure it was the drinking to blame. It was so easy to fall back on old habits when I kept waking up anxious and needing something to bring me down. My doctor was always hesitant to prescribe benzos for anxiety, so having a few shots of whiskey to get back to normal was an old standby, if not a particularly healthy one.

Then somewhere during that week, the lithium started working against me. I felt shaky, weak, with trouble focusing at times. When I got scared and skipped several doses, I felt even worse, like I was hit with some weird flu.  I realized I was going to keep feeling worse if I didn't take at least some lithium(and taper off alcohol, just to eliminate the extra stress on my body). I'm down to 600mg, one pill in the morning and one with dinner, but I'm worried these side effects aren't going away. It's been only a few days on the lower dose, and I've been drinking water like crazy.  I don't know if it's worth waiting a few more days to go down to one pill and then none, or whether it needs time for my body to readjust.

It's just so frustrating. I felt normal at first, and even the nausea and anxiety went away, then the tremors crept in and the weakness, and now I have that and the nausea/anxiety back. I was just about ready to give up on medication altogether before trying lithium.  I had a pretty good thing going with daily exercise and other goals, and then the soul-crushing depressive cycle finally came back around, and I felt like I needed to do something. If I'm going to keep feeling like this, I don't know how I'm ever going to be functional again.  Or if I'm just missing another medication that will balance me out more reliably than timed release whiskey, like a low dose of Xanax or Ativan.  I don't know what to do, and I thank any of you more experienced people with advice to give.

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This might not be the most popular opinion, but I'm thinking you haven't really tried lithium yet. Not really.

Combining it with alcohol is a big mistake. Lithium and alcohol do not play nice with each other. It's important to remember that lithium operates through the bloodstream (not through the liver) so playing with your lithium level and you blood alcohol content at the same time is asking for trouble.

You haven't mentioned any lab work. Lithium requires lab tests to find a therapeutic level. By changing up the dose so often, you're not giving your body time to find and settle into a level - whether or not it's therapeutic.

The increased thirst is a side effect of lithium therapy. If you don't want it, then lithium is not the drug for you.

Nausea can be dealt with in a number of ways: extended release formulations, lithium carbonate versus lithium citrate, taking it with a meal, etc. Also, if you're treating your nausea with antacids, that can make your levels move around.

The situation you're describing is just loaded with danger. Lithium therapy requires at least one person who really knows what he/she is doing. Put bluntly, it doesn't seem ike you've got that going on in your current situation.

It's unlikely that you'll get symptoms from stopping, but safe tapering is always best.

To find out what lithium can or can't do for you, you need a new MD with more experience and a commitment to try a steady dose, with labs, long enough to see if side effects subside after a bit.

Sorry if this is harsh, but your situation really alarms me.

Jennifer

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You're not being harsh. I'm not in a good situation, and I've been worried for a while before I started taking lithium or any other medication that my doctor didn't know enough. And I've just been assigned to another even less experienced doctor.  I have trouble paying medical bills and haven't been able to self-pay for a lithium level yet, but my doctor's last advice was to get as low a level as possible rather than trying for a traditionally therapeutic level. he also advised taking the pills throughout the day instead of all at once, which seems to run counter to what people here have said.  I'm thinking it might be safer to lower my dose to one pill a day after a few more days and do that for 5-7 days before stopping altogether. Without insurance, I can't afford a decent psych doctor or the multiple visits and blood tests it's going to take to find the right combination of medications.

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If you can't do the blood tests, you really shouldn't take lithium. It's only required frequently the first few months, and then you don't have to do them as often; I get a blood test every 6 or 7 months. That doesn't change that it is too expensive for you.

The only thing I would add, is that lithium is one of the cheapest, if not *the* cheapest psychoactive medications. So you would have a big front end, but after that, it wouldn't be very expensive.

Also, I just read if you ask the doctor (or receptionist or whatever) what the insurance companies pay, you might only have to pay that amount. But you have to ask. Also, some places give a cash discount. I can't promise that either of these options are available to you. But it is worth asking before you make an appt.

And I agree, you haven't really tried lithium. Look up what the symptoms of lithium toxicity, just to see if that might be what was going on before (although it is unlikely). I can't even remember the symptoms, but 900mg made me toxic; that is an unusually small amount to get toxic on, but everyone's different. I'm on 600mg, and have a therapeutic blood level. I also have no idea why your medical student would say you shouldn't go for a therapeutic blood level. A) then what's the point of taking the med, and B) how can the Dr. tell if you're toxic?

Please keep trying; I understand you may have to wait until you are in a better financial situation, but go when you have the money. Even if you tried a ton of meds, there are probably still some to try, and sometimes cocktails work better than one med.

I know I am going on and on, but if you are drinking that much, benzos are a bad idea. I am a fan of benzos, but combining them with alcohol is *strongly* contraindicated.

 

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