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Lithium with Imipramine, please help!


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Hi Everyone,

I have been on  SSRI's for depression and anxiety without bipolar disorder for 20 years. They helped somewhat but had bad side effects such as lethargy, and the last one I was on (Zoloft) stopped working. So I started seeing a Psychiatrist and she prescribed a Tricyclic to see if the side effects would be better. They were, but unfortunately it didn't help my depression at all, actually, it made it worse. I was also at that time diagnosed as having Treatment Resistant Depression. The Psychiatrist then said she would add Lithium to the Imipramine. It took a month or two to get to the effective blood level and I reached that at the beginning of November.  Since then I have found the Lithium difficult to take, causing exhaustion and also it isn't helping my depression that much. I requested that I be taken off the lithium and Imipramine, however my Psychiatrist basically refused, saying that she wants me to stay on this dose until the end of March at the latest! In other words she says we need to wait 6 months to see if the lithium will work or not. Has anyone else ever been told that lithium in combination with another drug can take that long to work? I'd be so grateful for any advice, I feel so alone with this, like my psychiatrist isn't listening and I'm wasting my life on a drug combo that isn't helping me!

Many thanks!

Angie

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18 hours ago, Angie277 said:

Hi Everyone,

I have been on  SSRI's for depression and anxiety without bipolar disorder for 20 years. They helped somewhat but had bad side effects such as lethargy, and the last one I was on (Zoloft) stopped working. So I started seeing a Psychiatrist and she prescribed a Tricyclic to see if the side effects would be better. They were, but unfortunately it didn't help my depression at all, actually, it made it worse. I was also at that time diagnosed as having Treatment Resistant Depression. The Psychiatrist then said she would add Lithium to the Imipramine. It took a month or two to get to the effective blood level and I reached that at the beginning of November.  Since then I have found the Lithium difficult to take, causing exhaustion and also it isn't helping my depression that much. I requested that I be taken off the lithium and Imipramine, however my Psychiatrist basically refused, saying that she wants me to stay on this dose until the end of March at the latest! In other words she says we need to wait 6 months to see if the lithium will work or not. Has anyone else ever been told that lithium in combination with another drug can take that long to work? I'd be so grateful for any advice, I feel so alone with this, like my psychiatrist isn't listening and I'm wasting my life on a drug combo that isn't helping me!

Many thanks!

Angie

6 months SEEMS a tad long, but the reality is that imipramine and lithium both have a myriad of effects. Particularly with lithium, there are changes in gene expression that need to occur for your mind to basically "reset". Lithium can be rapid against (hypo)mania but like many other medications, effects on depressed mood can take time.

That being said, I could NOT tolerate lithium. I made it 10 days slowly increasing from 300mg CR at bedtime to 600mg CR at bedtime and I couldn't get past that dose. And I didn't even make it long enough for a blood test so I have no idea what my level was.

A more tolerable way to augment in treatment-resistant unipolar depression is with lamotrigine, although lithium is the more classical way to do it. Lamotrigine will take longer to titrate up but could have a really solid effect with the imipramine on-board.

Week 1-2: 25mg

Week 3-4: 50mg

Week 5-6: 100mg

...then you can increase 50mg every two weeks until you hit 200mg. Most people don't need to go beyond that for mood disorders.

So the short of it is, your pdoc isn't wasting your time or telling you to deal with it for no reason. There's a very good possibility that your brain might need that long to fully adjust and bring you back to "normalcy". However, there are several other options, and if this one isn't working for you, it doesn't surprise me. Some people just cannot tolerate lithium at all. By contrast, I've found Depakote (valproate) to be a dream drug by comparison as a mood stabilizer. It has a direct impact on my anxiety which has positive downstream effects on my mood. I'm less depressed because I'm less anxious. Granted I am also taking an antidepressant and an antipsychotic that behaves like an antidepressant at low doses, so YMMV.

I made the lamotrigine suggestion because if you go to your pdoc appt and say that lithium isn't working but suggest lamotrigine, your pdoc might go for it because it's a treatment option that would fit with her diagnosis of TRD (treatment-resistant depression).

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