Posted by Cam W. on February 11, 2000, at 22:04:47
In reply to Feeling drugged, anxious, and a little depressed, posted by Noa on February 11, 2000, at 18:48:32
> I had been feeling increasingly better until last week. Have been at current dose of lithium for about 6 weeks. Suddenly I feel sleepy all the time, like a drugged feeling, hard to keep eyes open, etc. But, the anxious, jittery feeling is still there--my left leg is always shaking.
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> And I am starting to feel somewhat depressed, not in the usual way, but overwhelmed because I cannot motivate myself or muster up any energy.
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> Is it my meds? Can this suddenly happen?
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> Despite fatigue, my sleep isn't the greatest. First of all, lots of interruptions to pee, from the lithium. But also, that jittery feeling makes me not want to go back to sleep.
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> Have been using cafeine to try to counteract the tiredness, but it seems to make me even sleepier. I think I will stop cafeine again.
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> About two weeks ago, I went to give blood at a work-based blood drive. My temp was 99.7 the first time, but the tech wanted to take it again, and the second time it was 99.4, which was acceptable (99.5 is the limit). Thing is, I usually run a low temp, altho maybe not with all these meds, esp. the thyroids. Could my sleepiness be related to that, even tho it was Jan. 24, which is almost two weeks ago? Could it be related to giving blood, which never bothered me before?
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> Help. I feel lousy, and I don't know why.
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> Fyi- my meds (in order of appearance in my life):
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> effexor xr, 375
> cytomel, .0125
> synthroid, .025
> methylphenidate sr, 20 twice a day
> serzone, 225 at night
> lithium carbonate, 600 am and 600 pmNoa - I hope you will allow me to think out loud for the next little while as I try to review your med file. My books are at work, so I will have to restrict my comments to what I know. First, some questions.
1) Are you taking any herbs, nutraceuticals, large amounts of grapefruit juice, etc?
2) Have you changed your diet recently? (eg restricted salt, increased liquids greatly & such)
3) You said your body temperature was up; have you a fever, are your lips, nostrils (mucous membranes) dry?
4) Have you been sweating a lot?
5) Are the side effects like fatigue, dazed feeling, and restlessness worse approximately 2 to 3 hours after taking the lithium?
6) Have you had your lithium, electrolyte and thyroid levels done recently?
7) Are you taking the regular or XR version of Effexor?
Now to my wandering mind. The symptoms you are describing sound like they may be adrenergically mediated (caused by too much norepinephrine).They could also be due to the lithium (fatigue, dazed feeling, etc. sometimes coincide with peak blood levels). These can also be side effects of Effexor when doses are at or above 300mg/day.
Effexor also has a short half life (5 hr; active metabolite ODV = 11 hr). If you are taking the short acting you may be going into a mild withdrawl from Effexor every day. Withdrawl effects of Effexor can mimic depressive symptoms or flu-like symptoms (fatigue, malaise, etc.). This is probably not too likely, but your Effexor dose should be divided to at least twice (to three times) daily with the short acting formulation.
A minor side effect of Effexor, that has been reported in the literature, is hyponatremia (low body salt level). When taking lithium you need to eat a diet consistent in its level of salt (sodium) to keep your lithium levels within a therapeutic range. Checking lithium and electrolytes levels is an easy way to see if this is a problem.
Fever can lower body water levels, increasing lithium levels, as can crash diets and dehydration (sweating). Again a lithium level will show this.
Caffeine in the short-term can worsen lithium-induced tremor and long-term can lower lithium levels by inhibiting ADH (antidiuretic hormone) which your body uses to draw water back from your kidneys (concentrating urine). A similar inhibition of ADH occurs after 3 or 4 alcoholic beverages and your body starts excreting more water than it takes in. With caffeine or alcohol you can lower lithium levels by peeing it away (if you maintain adequate hydration) or raise lithium levels (if you dehydrate). In short - Stop the caffeine.
The Serzone dose is at a sub-therapeutic level for antidepressant activity. Serzone absorption is weird, as low doses are not absorbed well. Are you sensitive to the ADs like Paxil or Prozac? If so, you could be a slow metabolizer of the cytochrome P450-2D6 system. In people who are slow metabolizers of this system, a minor metabolite of Serzone (mCPP) can cause increased anxiety and worsen sleep patterns (opposite of what Serzone does). Large amounts of grapefruit juice can also raise mCPP levels.
Conclusion - One or more of these mechanisms MAY be causing some of your problems, but then again, MAYBE NOT. These are just flowings from an overactive mind. Maybe others can add to this or subtract from it. I hope it helps a little. Take care and good luck (hope you feel better soon) - Cam W.
poster:Cam W.
thread:21187
URL: http://www.dr-bob.org/babble/20000209/msgs/21217.html