Posted by medlib on April 30, 2002, at 18:34:57
In reply to Blood Pressure med /ADs and downward plunge, posted by mashogr8 on April 25, 2002, at 21:36:43
Hi M.?--
Welcome to PB!; I haven't seen your handle before (which isn't saying a lot, since I haven't been here much lately). I'm posting now because I'm concerned that some of the information you've received is not entirely correct. On this PB board we generate ideas and alternatives, and we share our own med experiences, and, sometimes, our information. We trust that you will consider everything you read here to be opinion, which you will check out at reputable web sites and with qualified medical specialists--before making any med changes.
BP-lowering meds are NOT the opposite of antidepressants. Lisinopril is an ACE inhibitor, a family of BP-lowering meds which has no history of causing or worsening depression. On the contrary, a few scattered anecdotal reports suggest that captopril may have slight antidepressant properties (no studies published yet which confirm this).
Different families of cardiac drugs lower BP by very different physiological mechanisms, so comparisons between families on strength or efficacy are ambiguous. Suffice it to say that it's best to match the med used to the needs of the patient, then adjust the therapeutic response by dosage level.
That said, if your GP knew that you were taking lithium, lisopril probably should not have been his first choice for lowering BP. A number of published case studies (easily available to any MD or pharmacist) have reported that combining lithium with lisinopril (or captopril) has led to lithium toxicity. This isn't an immediate problem for you since your lithium dose is so low--as is, I assume, your lisinopril dose. Lithium is one med whose dosage *must* be monitored by blood levels. It has a relatively narrow therapeutic window; that is, there's not much room between "enough to work well" and "too much to tolerate." A number of things can affect lithium levels in the blood (diuretics, level of iodized salt intake, etc.) and lithium itself affects other systems (it reduces thyroid functioning, for example). It's my impression that lithium, for most people, does a better job of preventing mania than it does alleviating depression. There are other mood stabilizers which may have more of an antidepressant effect--Lamictal, Topamax, Depakote, etc. All meds have side effects, though. If you and your pdoc want you to remain on Lithium, the dosage may need to be increased to reach the optimum therapeutic level; in which case, you will want to change to a different BP med. You might ask your GP about Verapamil, a frequently prescribed calcium channel blocker which has mild antidepressant effects for some.
Since both Wellbutrin and thyroid meds can raise BP, if you've taken each at least a month with NO improvement in symptoms, you might question whether either is worth keeping. Many pdocs have found that augmentation of psych drugs with thyroid meds is not helpful unless there is a preexisting hypothyroid condition.
Bottom line? The med literature suggest that lisinopril is unlikely to have caused your mood decline. If anything, it might have increased the blood levels of lithium which could have *improved* your mood. But, psych meds cause infinitely more variability in individual responses than do all the other classes of meds combined. So, almost anything is possible.
There are many possible permutations and combinations in current drug therapy; it takes quite a bit of patience and persistence to find one that works. Hope something in here helps. If I've managed to create more confusion than clarity, please let me know. We might be able to offer a bit more help if we had a few more details.
Well wishes---medlib
P.S. I lost track of the time--can't stop to proofread this and I'm an abysmal typist. Sorry!
poster:medlib
thread:104158
URL: http://www.dr-bob.org/babble/20020425/msgs/104570.html