Posted by SLS on August 27, 2022, at 9:12:54
In reply to Re: I should learn how to proofread better. » SLS, posted by beckett2 on August 24, 2022, at 16:14:12
Hi, Beckett2.
The point that I have been trying to emphasize is that if you are treating depression in the absence of mania, low dosages are sometimes the bullseye, whereas increasing the dosage above some threshold can actually make you feel worse. It seems that I have been unsuccessful.My sweet-spot for lithium dosage is 300 mg/day. If I take so much as one more 150 mg/day pill, I relapse. 450 mg/day is above my therapeutic window for low-dosage lithium treatment. 20 years ago, Harvard conducted a study of adding low-dosge lithium to an ongoing trial of Prozac 60 mg/day. They defined "low dosage" as being in the range of 300-600 mg/day. The dosage for responders was heavily weighted at 300 mg/day, which, again, yields a therapeutically robust response. If I discontinue lithium, I relapse about 48 hours later. At no time did any dosage above 300 mg/day make me feel better. I reacted to higher dosages by failing to glean an antidepressant response and actually suffereing an exacerbation of depression along with cognitive numbness, emotional flattening, and mild to moderate apathy. People in the arts - music and visual - report losing their creativity at full "therapeutic" dosages. The higher dosages are indeed more efficacious, but for bipolar mania or rapid cyclicity. My own opinion is that (ultra)-rapid-cyclicity, regardless of which mood state predominates, indicates lithium treatment using high-dosages.
An additional benefit of using low dosages of lithium is that side-effects are greatly reduced, including the more toxic thyroid and kidney damage. Side effects are dosage-dependent.
If you haven't yet tried a low-dosage lithium treatment, I suggest that you not abandon lithium until you do. I suggest starting at the lower end of the dosage range - 300 mg/day. I think it makes sense to begin lithium treatment at 150 mg/day. If it is going to work, you should see an improvement by day 7. If there is no response after a minimum of a week, then it makes sense to increase the dosage of lithium to 300 mg/day. Give this dosage a longer trial. Although you would probably respond within a week if it's the right dosage, I would give it a full two weeks, especially if you are beginning treatment by decreasing the dosage of ongoing lithium therapy. It is not a question of lithium's half-life or other pharmacokinetic dynamics. It is a question of waiting for the brain to find a stable dynamic equilibrium from which to move forward.
- Scott
Some see things as they are and ask why.
I dream of things that never were and ask why not.The only thing necessary for the triumph of evil is that good men do nothing.
poster:SLS
thread:1120378
URL: http://www.dr-bob.org/babble/20220530/msgs/1120495.html