Lithium-my dosage and my cocktail

[Sam]

Hi!

I know very little about Lithium so if y'all could fill me in a little I would appreciate it.

My regular mix of meds: 200 mg Lamictal, 450 mg Wellbutrin and 20mg Lexapro. A few weeks ago, it became extremely apparent that this mix was not doing the trick. SO, my pdoc prescribed me Lithium. He has me taking 450mg in the am and 900mg at night.

I guess I have been taking this for close to a week now. I called him yesterday to see if he was going to order bloodwork, because my next appointment wasn't for three weeks. He told me yesterday to go ahead and do the blood thing, so I will probably get that done Thursday at the latest.

From what I have read, 1350mg seems rather high to start out with. Maybe that's some sort of crisis dosage? It seems like he would have dropped it down, though. Do the rest of my meds interact with Lithium? I am confused!

Also, when do you find out what your levels are? I have to go to a separate lab to get the bloodwork done. They don't give me the results right then probably, huh? I will have to wait for them to send it over to my pdoc and wait for him to look at it before I will know if he is trying to kill me or not?

This is why I picked Lamictal! I had an allergic reaction to Depakote.

I haven't noticed that I am too stupid yet, but I feel like I have big clown shoes on. Yesterday I didn't eat much and I think I am paying for it today because I feel really woozy. I have been pretty tired, but in a normal way. I thought it would be a drugged up tired, but it's not. I will get plenty of sleep, then be exhausted in the afternoon and want to take a nap, and still be tired early in the evening. Not so bad, really.

Anyway, any words of wisdom, voices of experience, or just plain sound advice would be much appreciated as always!

Thanks,

Sam

[Glen]

IMHO 1350 seems high. If you are currently in an acute phase it might be a prudent way to measure efficacy though without having to factor in dosing requirements. If you find it working but the side effects are troublesome then discuss a slow titration downwards with your pdoc.

For your reading..

http://www.cpa-apc.org/Publications/Archiv...May/Lithium.asp

http://www.ufrgs.br/psiq/textoscelg02.htm

and courtesy of Google's cache...

http://72.14.207.104/search?q=cache:WXMJPw...ename%3Dlrn_004

[synthetic]

I just started Lithium a couple of weeks ago too.  My pdoc usually sends me a letter with my blood test results so it can take up to a week before I know anything.  He always goes over them at the next appt and he lets me know immediately if there is something that needs to be addressed.  I've been kind of drowsy too, but I had the same problem when I started Lamictal, so I am hoping it will go away.  I have noticed that not eating right or not drinking enough tends to make me more drowsy and kind of spacey.  Not particularly helpful, but there you go.

[AirMarshall]

My regular mix of meds: 200 mg Lamictal, 450 mg Wellbutrin and 20mg Lexapro. A few weeks ago, it became extremely apparent that this mix was not doing the trick. SO, my pdoc prescribed me Lithium. He has me taking 450mg in the am and 900mg at night.

Split dosing is a good way to minimize side effects.

**What condition is your doctor treating?

[Sam]

Thanks, Glen. Those were some serious articles! I am hoping that the doc will lower me once he gets my bloodwork back.

And thanks to you, too, syn. I am sort of disappointed that I won

[Sam]

So if I don't have an excruciating headache, I am nauseous. And I am SO tired.

Will this ever go away?

I am not sure I can live like this for an extended period of time. I like Lithium a lot more than I thought I would and I think I actually do feel better. *crosses fingers* But I hate eating because it makes my stomach hurt, and if I don't eat I get all weak and shaky.

The tired is interesting, though. It's more like a calm, sleepy kind of feeling. Not an exhausted feeling. But I feel like an old person. I just told my daughter, after cleaning the kitchen, that I needed to go lay down for a while. WTF?

I can deal with the tired. But the headaches and stomachaches suck. And my head feels weird.

Waaaaah! Done whining.

I did do the blood test thing on Friday, so hopefully pdoc will get with me tomorrow. He was out of town last week anyway.

Guess I just wanted to med-vent. Heh.

Sam

[synthetic]

Don't know what to do about it, but I have been experiencing the same thing.  The part that sucks the most for me is eating.  Don't eat, feel like crap.  Eat, feel like crap.  I do feel like Lithium has been helping me too and I hope these side effects will get better because it would nice to be stable.

[Sam]

Synthetic, you and I are going to have to stay in touch. We can be Lithium buddies! It's nice to know that someone is embarking on the same crazy trip!

You know one thing, though? I am glad it doesn't make me hungry. I am kind of liking that part. Maybe I can lose some weight!!! I was so worried I was going to gain, so so far at least there's that!

I took Zyprexa one time and I just couldn't stop eating. Literally. I could not stop. It was awful.

I have just been trying to eat really small portions whenever I feel hungry. It's like I'm not hungry not hungry not hungry until I am STARVING and I can hardly walk. I need to just keep something handy.

Anyway, it's cool that there is someone in the same boat I am! Yay!

Hope we feel better!

Sam

[synthetic]

Lithium buddies it is.  Zyprexa does the same to me, although, the couple of times I have taken it were during mixed states during which my appetite is pretty much zero so being able to eat was a nice change. 

The last couple of days have been better.  Dizzyness and spaceyness have abated for the most part.  As long as I stay hydrated, I've been feeling pretty decent.  It's kind of scary because I haven't felt decent much in the last few years.  When I have, it hasn't lasted.  Fingers crossed Lithium will help me remember what it is like to feel good for an extended period of time and hopefully it will do the same for you, Sam.

[Sam]

Thanks Synth!

I stopped being nauseous about 11:30 and have been okay since then. So how much water are you drinking? I am SUCH a bad water drinker. I DID actually find a cup, wash out a cup, and fill the cup with water from the water cooler today. YAY! Now I will have the cup forever!

You know, it's hard for me to realize that I am not feeling well. Things have to get REALLY bad and then I think, oh, see, I've been on the downhill slide for a few months now!

I hope you will continue to feel good this time. As far as I can tell, Lith is pretty stable and won't change on you. That would be nice. When my meds stop working well, I just figure I have gotten more crazy! And honestly there comes a time when that just isn't all that funny!!! LOL

Take care and keep me posted!

Sam

[synthetic]

I've had to make a concerted effort to drink more water.  I don't know if I am drinking enough, but the side effects haven't been too bad, so maybe I am.  I'm back to being depressed today.  Not horribly bad, but not all that good.  I guess it is a long road to stability with lots of bumps and potholes along the way.

[Sam]

I wonder if that's why I am getting such horrible headaches-not enough water. But we are supposed to drink water to help flush everything out, rather than needing MORE water because Lithium depletes it, right? (Edited to add: I looked this up and I guess we DO need more water since Lithium is a salt. Hmm.)

Honestly I would have to say that I was hoping I would feel better than I am. I am more on the depressed side than I would like to be. Yes, I am better than I was. No, I am not near where I need to be.

My pdoc hasn't even called me with the results of my blood work. I wish he would. I just want to know what's up. That doesn't seem like that bizarre of a thing.

I am tired of the bumps.

Sam

[blackmilk]

Hey Sam

Your dose is pretty tasty for right off the bat, but in the scheme of things it's only your blood level that dictates whether it's high or low. Starting out lower and titrating up slowly might have helped minimize your side effects off the bat (and they should get better, yes, here's hoping) but it may be your doctor thought a more intense intervention was in order. Myself I took 1800mg every day for about a year before backing off a little.

If your pdoc isn't calling you, you can always call him. And as for not wanting water, don't worry, lithium will take care of that soon enough

cheers!

-k

I wonder if that's why I am getting such horrible headaches-not enough water. But we are supposed to drink water to help flush everything out, rather than needing MORE water because Lithium depletes it, right? (Edited to add: I looked this up and I guess we DO need more water since Lithium is a salt. Hmm.)

Honestly I would have to say that I was hoping I would feel better than I am. I am more on the depressed side than I would like to be. Yes, I am better than I was. No, I am not near where I need to be.

My pdoc hasn't even called me with the results of my blood work. I wish he would. I just want to know what's up. That doesn't seem like that bizarre of a thing.

I am tired of the bumps.

Sam

<{POST_SNAPBACK}>

[synthetic]

I am tired of the bumps.

<{POST_SNAPBACK}>

Me, too.  Me, too.

[Sam]

Hey Sam

Your dose is pretty tasty for right off the bat, but in the scheme of things it's only your blood level that dictates whether it's high or low. Starting out lower and titrating up slowly might have helped minimize your side effects off the bat (and they should get better, yes, here's hoping) but it may be your doctor thought a more intense intervention was in order. Myself I took 1800mg every day for about a year before backing off a little.

If your pdoc isn't calling you, you can always call him. And as for not wanting water, don't worry, lithium will take care of that soon enough

cheers!

-k

Thanks, I would have to say that makes me feel better. Yes, my pdoc thought a more intense intervention was in order, but from what I read, that is really only for mania, which wasn't my problem at the time. Today is probably the best day I have had so far side-effects-wise.

I HAD called the doc, that's the frustrating thing. But, I called again. I actually am having this weird eye thing today. My eyes won't focus together but I can see out of each fine. Odd. You know, you get to the point where you just blame everything on the meds and it gets rather ridiculous after a while!

Your post was very calming. Thank you.

Sam

[Sam]

I am tired of the bumps.

<{POST_SNAPBACK}>

Me, too.

[Sam]

So, yeah, that was my last good day. It was nice. Since then I have been down the drain for the most part.

Apparently my levels were okay because I was told the doctor signed off on them. I asked AGAIN for him to call me but no dice.

This exhaustion is not helping any. I have gone to sleep the last two nights I got home from work. NOT like me. Especially since I have been getting sleep. Today I am supposed to be working but I am just too tired to focus. And this is after two cups of coffee. Oh well.

Even taking 1350mg of Lithium, I am still REALLY depressed. I think the Lith would be great if my problem was mania. But right now it's not. And hasn't been in quite some time. I just don't know. I was really hoping this would be the answer. I just don't understand why it isn't. Sigh. How can someone be depressed on two mood stabilizers and two anti-depressants? I guess you would have to be seriously jacked up. Yup, that describes me to a T!

Sam

[synthetic]

I was just wondering how you were doing.  I'm still cycling too.  Last few days have sucked.  Feeling a little better today.  I keep telling myself I just have to give it more time.  Supposedly Lithium takes awhile before it really levels you out.  This better be fucking worth it.

[Sam]

Hi Synth!

I am actually better.  I really was NOT well at all. I just doubled up on my Lexapro finally. I just couldn't take it. It was getting to the point that I couldn't function. I wasn't much more motivated today than usual but I DID clean the kitchen. Yay.

I thought the Lith would have started working by now. The Lith plus the extra Lex makes me really shaky. Maybe I wasn't as tired today? It will be easier to gauge tomorrow at work.

You are right about it being worth it. This has been quite an experience. Hang in there-you're not alone!

Sam

[Loon-A-TiK]

Li made me literally forget my address, phone number, and how to drive. I turned left on red all the time and thought stop signs were a nice color, not a law.

I missed job interviews, and couldn't tell them what I had done in my career when asked questions. I kind of bombed those interviews!

I felt stable, but the mental side effects blew it for me. i've been told that at a lower dose I could probably benefit from Li. On Li and Lamictal I felt rock solid and nothing would make me cycle.

[lemonflavor]

I started 300mg Lithium last night. So far don't feel anything which is probably good.

I'd like to continue to hear how Sam, Synthetic and others are doing on it.

[Sam]

Well, I'll tell ya what. I cannot focus. I have no will. I have SO much to do today and tomorrow at my job and all I feel are these waves of exhaustion. I am just SO TIRED.

Just to double check, I made sure to get extra sleep last night and it really isn't helping. I can be like this most of the time, I guess, but if I can't cope during crunch time I don't know what I can do. Even though we aren't supposed to have caffeine I drank some yesterday just to see if it would help me be awake, and it just made me sick to my stomach and have even MORE of a pronounced tremor.

Anyone know what's the worst thing that could happen if I take only 900 rather than 1350? My pdoc is in a not returning phone calls phase. I have an appt with him soon.

I would have to say that I do feel stupider than normal. It also has not helped my apathy. Is that what mood stabilizers are supposed to do? Make you not care? Just really have no feeling one way or another?

Okay. Off to make an attempt at working. Sigh.

Sam

[synthetic]

I'd like to continue to hear how Sam, Synthetic and others are doing on it.

<{POST_SNAPBACK}>

Hard to say.  Some days I feel good.  Some days I feel ok.  Some days I feel like shit.  Could be the Lamictal.  Could be the Lithium not working.  Tonight I feel really depressed.  Tomorrow will probably be something else.

[Sam]

I'd like to continue to hear how Sam, Synthetic and others are doing on it.

<{POST_SNAPBACK}>

Gosh, I just read my last post and realized I needed to update!

I dropped the morning dose of 450mg. I am still taking 900mg at night. It has completely improved my daytime sleepiness. I can focus A LOT better at work. I could tell the very next day.

As far as my moods go, anyone's guess is as good as mine.

Yesterday was one of the worst days I have had in months. Just from the get-go. I got up and thought I was okay, but my daughter started in on me and I ended up sobbing in a corner on the floor, and I haven't done that since before I was on meds I don't think. And the mood continued throughout the day. Sometimes when I am sad, I just throw everything else in that I have to be sad about on top and just cry all day about it all. So that was my entire day.

The day before that, though, I had a good day at work, felt relatively competent, and was sort of happy.

I am pretty much feeling completely unmedicated at this point. I mean, I don't want to know what that would actually be like, but this is how I remembered it being. Not knowing how I really feel. When I am happy, nothing really gets to me and I can handle things, when I am down, everything gets to me, and don't forget to throw in the past, present and future (or lack thereof) and anything else that has ever happened in the history of the universe, including sad news stories. And the feeling I remember well....what's real? How do I really feel? I just feel like I am cycling every single day. How can that be when I take so many freaking drugs?

Aaaaanyway, that's how I am doing. I have a pdoc appt on Monday so hopefully....hell, I don't know if I have any freaking hope.

I have a friend who used to work for the state school. We were talking about the Lithium and he said, "Yeah, I didn't think that was for you...that's some serious shit. A LOT of our really messed up clients were on that!" I said, "HELLOOOOO!!!!" It's funny how no one wants to know how bad it is.

Ooookay, TMI!

Sorry!

Sam

[lemonflavor]

I have a friend who used to work for the state school. We were talking about the Lithium and he said, "Yeah, I didn't think that was for you...that's some serious shit. A LOT of our really messed up clients were on that!" I said, "HELLOOOOO!!!!" It's funny how no one wants to know how bad it is.

<{POST_SNAPBACK}>

How true. People don't want to even think how much others can suffer long term, and I suppose that's somewhat understandable. I used to even have a pdoc who would say, "So you're looking pretty good." And I'm like no I'm not. These antidepressants are pooping out on me and not working well anymore. "So what would you like me to prescribe?" How about another doctor (which I did).

So I'm not too off topic, a few days on the Lithium and I have slight nausea but tolerable. Not noticing anything else yet other than getting slightly stupider.

[synthetic]

I got the results of last weeks blood tests today.  Lithium level is still .6 and my Free T4 (whatever that is) is low.  So, still not at a therapeutic dose and now it is messing with my thyroid.  Fucking awesome!  I'm still having the same issues I have for the last month, cycling every couple of days.  I had a string of good days a little while back, but since then, not too many good days.

[Sam]

I got the results of last weeks blood tests today.

[Sam]

How true. People don't want to even think how much others can suffer long term, and I suppose that's somewhat understandable. I used to even have a pdoc who would say, "So you're looking pretty good." And I'm like no I'm not. These antidepressants are pooping out on me and not working well anymore. "So what would you like me to prescribe?" How about another doctor (which I did).

So I'm not too off topic, a few days on the Lithium and I have slight nausea but tolerable. Not noticing anything else yet other than getting slightly stupider.

<{POST_SNAPBACK}>

This made me laugh out loud! Another doctor! Ha!

I had a tdoc who told me that I looked fine and I had a job and I was smart, what could be wrong with me? Idiots.

Yeah, the nausea is weird. I still don't eat normal meals. I eat part of a meal here and part of a meal there.

And the stupid thing. I find this rather alarming. I haven't noticed that I have been stupider. Is that because I am always stupid? Or I am as stupid as I can get already? That very well could be the truth. The sad thing is I don't think I can blame it on the meds!

You keep us posted, too, lemon!

Sam

[lemonflavor]

The thing I am hating is that I will have a good day, and I will think that I am done with the bad days, only to lather, rinse, repeat. I had a shitty day at work today but I am still feeling mostly sane-ish, so that's good for me. The Lamictal really snips the ends off of my emotional spectrum, so maybe I will be noticing something soon.

Here's hoping that Lith works for us all-

Sam

<{POST_SNAPBACK}>

I will have a good part of a day and then it crumbles. I'm extremely mixed and agitated right now and hope a higher dose lf Lithium will help this. However I'm getting more nauseated so I may stay at 300 for two weeks instead of one before I go up.