Posted by barbaracat on August 19, 2007, at 20:02:19
In reply to Re: Lithium Good Bad Ugly? -, posted by sac on August 19, 2007, at 7:20:08
Well, feel like I could write a PhD thesis on this one. Although it's tough for me to be brief, I'll try.
First off, are you sure you're BP-II? One of the 'provings' of BP-I is that it responds to lithium better than the others, and BP-II responds to Depakote, Tegretol, etc. much better. The other thing is that 450mg lithium just may be too little. I tried the XR 450's and kept cycling like you described. I went to 300mg twice a day and that did the trick. You won't get any more side effects from the small extra dose and it may be just enough of what's missing. I suspect that the lethargy you feel is not due to lithium (I have none on it), but unresolved depression from the wrong med combo.
The other thing is Prozac. Not the best SSRI for a bipolar and I'm truly surprised your doc is prescribing it for you. Lithium has the effect of augmenting any antidepressant you're on, so I wonder if you're taking too high a dose of Prozac? It's been known to cause rapid cycling.
I've tried them all, every last one, including tricyclics (well, I didn't try Lexapro or the MAOs, maybe should have). Probably the least offensive of them in my book is Zoloft (sertraline). You want to stay away from the SNRI's if you're having cycling like that because norepinephrine will exacerbate anxiety/mania.
However, one theory is that dopamine is deficient and some bipolars augment their brew with Wellbutrin or some other pstim and it seems to help. There's a whole manuscript I got off the web on how pstims have stopped mania it it's tracks. Go figure... I take Adderall for the fibro-induced ADD and I could not do without it. It's like the spark that ignites the chemistry.
I take Cymbalta and like it very much since it really helps with the fibro pain and does a decent job with the depression, although anxiety is still an issue. However, I went real slow with it, titrating up to 60mg over a 4 month period. I'm very, very sensitive to SSRI/NI's, as are all bipolars and pdocs universally don't seem to realize that we have to go extra slow with them.
You didn't say how much Cymbalta you were taking, but in my book, 90mg is the top level any bipolar should go to with Cym, and besides, an SNRI may not be the best for you.
ARe you taking fish oil? Very, very, very important. Too long to go in to all the reasons for it, but trust me on this. About 4-6 grams a day. It's good to also take Flax oil for the Omega balance. Also, you should be taking neuro nutrients 'cause it's hard work on the brain being bipolar (the good news is that lithium is neuro-protective and regenerates neurons - healthy for the brain!). The amino acid L-Taurine is important and some have used it exclusively to manage their bipolar. There's a product called 'Neuro Optimizer' by Jarrow that has a good mix of what the brain needs. Expensive, unfortunately, but some online stores sell it for less.
So, I'd first determine the Bipolar I vs. II question. Here are some sites that have great info:
http://www.mcmanweb.com/bipolar_links.htm - lots of links to bipolar sites
I especially like:
http://www.psycheducation.org/index.html - there's more info in there the deeper you dig and a pretty good explanation of BPI vs. II. If you've ever had a clear-cut mania (this could be extreme irritability, anger, disorganization rather than the typical grandiose behavior) even one time, it's categorized as BP-I. Read up on 'mixed-states', especially.) The difference means the different meds you'll get. In a nutshell, the right amount of lithium, no more, no less.Second, I'd experiment with 600mg of lithium for about 3 months to see if it makes any difference. Since you don't want to change everything at once, stay on the Prozac and see if everything turns out betta. If not, time to try another antidepressant.
I had the best luck on Zoloft. It was mild yet energizing but in a centered way. I had the worst luck on Paxil, Effexor and Prozac.
If nothing helps, after you've given fish oil and other neuronutrients a try, ask your doc for a trial of a pstim. It sounds counterintuitive, but there are plenty of threads on this board that say otherwise, and it was the icing on my cake. Adderall 30mg XR in the morning and I sleep just fine on it and drag my moping fanny around when I don't take it.
One last thought - hormones. There are quite a few methods to get your saliva hormone levels tested (let me know if you want some sources). If you're nearing peri-menopause, likely your progesterone levels are low and your estrogens are high. This can cause all these symptoms and more. Been there, done that. I take a custom compounded sublingual lozenge of the hormones I was deficient in and it's helped. Thing is, if your hormones aren't in balance, they are contributing to your woes. The brain has more receptors for estrogens than any other organ of the body and is needed to produce serotonin!
So, it sounds like a complicated lot of info, but not really, it's just a matter of tweaking and balance. Try one thing at a time, but in the meantime, see if you can get your hormone levels checked (after 2 pregnancies especially). A regular doctor won't be able to do this, relying on blood serum levels only. It's generally done through a naturopath, but the web has kits for do-it-yourself.
I wish you the very best from someone whose been through hell and came back hopefully wiser for the experience.
-BarbCat
> Hello, I've suffered from bipolar II for roughly 6 years, prior to that (and my two pregnancies) I was on AD's for about 10 years for unipolar depression. I've been on most of the meds: depakote, lamictal, neurontin, tegretol, etc. etc. I've had the most success with lithium slow release form. I am determined to keep the dose as low as possible at 450mg/day of the slow release form. with this I get a blood level of .5
> I am trying to avoid side effects like MORE hair loss, weight gain, etc. I also take 20-30 mgs. Prozac daily. I feel like I constantly go around in circles wondering which med makes me feel like c***. I always blamed the lithium for my apathy/anhedonia but never had success going off...would get agitated in a couple days. I wonder if the SSRI exacerbates my cycling. I have a pretty clear cut case of weekly cycling. I've noticed that I have good energy/motivation one week only to be followed by extreme fatigue/depression the following week and this pattern continues. Sometimes I just want to throw in the towel with SSRI's and just stick with lithium..though it's like I'm scared and I don't trust myself to be able to deal with life without my Prozac. Oh, and by the way, I have been on Cymbalta too but had to stop due to heart palps. Any ideas/experiences with combined SSRI/lithium treatment? thanks so much.
poster:barbaracat
thread:774956
URL: http://www.dr-bob.org/babble/20070815/msgs/777181.html