Posted by SLS on July 24, 2012, at 18:57:06
In reply to Scott- Feel like crap on meds..., posted by Sheilac on July 24, 2012, at 18:15:29
> My doc would rather I pick just one. Either lithium or Trileptal.
>
> Which do you think is better, safer med?
More effective? With these drugs, there really is no such thing. Each person's neurobiology is unique. There are some people for whom lithium is useless or worse. I'm sure the same can be said of Trileptal.Safer? I guess Trileptal would be considered safer. Toxicity is not generally a concern with Trileptal as it is with lithium. Lithium can interfere with kidney and thyroid function, sometimes damaging them. With Trileptal, the only thing to worry about is hyponatremia (low blood sodium). This occurs infrequently.
If a mixed-state hypomania with impairments in impulse control is the main problem, it can be argued that Trileptal would be worth trying first. However, you are now reporting that lithium is working at 600 mg/day. This is not really a high dosage. It is still below the average dosage range of 900 - 1500 mg/day used for bipolar disorder. The side effects of lithium are dosage-dependent, so 600 mg/day might be a very safe and tolerable dosage for you. If, after an extended period of stability on lithium you wish to try switching to Trileptal, you can work with your doctor as to how to go about this. Of course, having your lithium blood level tested at any dosage is important.
Do what works for now. You can try substituting drugs anytime. I take lithium, even though it might not be critical to my treatment response. I do think it helps, but I also like the ideas of its contributing to the recovery of brain tissue and to its possibly preventing Alzheimers Disease.
It is up to you as to how much time you are willing to invest in experimenting with drugs while continuing to feel like crap. You can go with lithium and feel better, knowing that there are moderate risks to the kidneys, thyroid gland, and the potential to develop of toxicity. However, if you can afford to feel bad for another few weeks, you should know rather quickly if Trileptal will produce an improvement in your condition. You should have an answer in a few weeks. If it is going to help with mania, I would expect it to work within three days at dosages of 600 mg/day or higher. If your depression gets worse than usual and stays worse for longer than a week, I would consider aborting the trial.
Just to remind you, some people respond better to a combination of lithium + Trileptal than to either drug alone.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1022042
URL: http://www.dr-bob.org/babble/20120718/msgs/1022062.html