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Re: New on Lithium

Posted by JohnL on October 1, 2000, at 8:09:49

In reply to New on Lithium, posted by Lankry on September 30, 2000, at 9:52:34

> As a reaction to Paxil I had a manic attack. Doctor has since put me on Lithium which reached therapeutic blood levels (1.0) around 1 1/2 weeks ago. I think I am feeling worse (intense anxiety, thoughts of suicide, depression). Is this possible? How long does it take until the lithium "settles in" my body?
>
> Thanks,
>
> Jodi

Jodi,
Lithium has been the obvious choice for mania for decades. But at therapeutic doses for mania it is not a good treatment for longterm use. Very tough on the kidneys and the body in general. It is much better, much safer, and much more acceptable in smaller doses for other purposes. Granted there are people that can only control their mania with lifetime Lithium. But there are other better alternatives to explore first.

A manic reaction to any antidepressant can happen. I'm not so sure that justifies high dose Lithium. That's definitely from the ancient school of psychiatry, not up to date. There are better ways.

For one, the antipsychotic Zyprexa has been approved for the treatment of mania. It's benefits...it is antimanic, antidepressant, would be excellent for sleep, and could be combined with any antidepressant. It is far safer for your body than Lithium, and much easier to dose. Lithium is a high maintenance treatment. Zyprexa is much easier.

Other choices include Depakote, Tegretol, Lamictal, Neurontin, and Dilantin. Only through personal trial can we find out whether they help, make us worse, or do nothing. But any one of them are good for depression, mania, anxiety. Whether one will have the desired effect or instead the opposite effect can only be discovered through trial. Same with Lithium though. You already know it is not having the desired effect. Time to try another one. Of them all, I think the one with the most solid reputation for being helpful in depression is Lamictal. But like I said, it varies dramatically. You just have to compare them to see what's best for you.

I wouldn't expect things to 'settle'. Lithium does not appear to be the right molecule for your unique chemistry. Don't let your doctor try to convince you more time is needed. Insist on a switch. No compromises. Insist. If suicidal thoughts and worsened depression are happening, that is justifiable cause for immediate stoppage of the medication.

Personally I would think the best route would be to restart an antidepressant at 1/2 the minimum dose and simultaneously start Zyprexa. If a manic reaction occurs that is severe in nature, then one of the other anticonvulsants mentioned should be considered. Hope this helps in some way.

Ditch the Lithium.
John


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