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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 43. This is the beginning of the thread.
Posted by Squiggles on November 29, 2006, at 14:45:15
Well, i'm pretty well stabilized 100% from
the lithium fluctuation. It is always a
terrible, and time-consuming ordeal. But
with patience i finally reach the normality
plateau.What interests me about this, is that lithium
being an old drug, a lot is said about how
you never get back to normal if you get off,
or you become so depressed you commit suicide,
or lithium in particular has such a narrow
therapeutic index that it is really out of
favour in the drug armamentorium (who applied
this word to psychiatry? must have been the
military, lol);I don't believe any of that stuff;
First of all, you *do* get back to normal
after getting off lithium, but it is very
painful, for me at least. Someone like Dr.
Sheldon Preskorn probably knows why.Second, you do fall into the original illness
for which the drug was given (e.g. manic-depression) and you can kill yourself.
But that is the case with just about any
psychiatric drug. Infact, it's possible to fall into a pre-therapeutic state, without ever having had an illness, if you take drugs. So, it's
probably a change in the brain's chemical state and has not a particular relevance to this say
lithium versus Prozac.And finally, all psychiatric drugs have a therapeutic index. That has got to be a tautology. And I am not so sure that lithium's
narrow therapeutic index has actually been measured against the therapeutic index of the newer antidepressants. There is a lot of mythology that grows in the development of the history of psychopharmacology and taken at face value, without any evidence.Squiggles
Posted by zmg on November 29, 2006, at 15:33:26
In reply to Maybe all drugs are like this, posted by Squiggles on November 29, 2006, at 14:45:15
"And I am not so sure that lithium's narrow therapeutic index has actually been measured against the therapeutic index of the newer antidepressants. There is a lot of mythology that grows in the development of the history of psychopharmacology and taken at face value, without any evidence."
I think this is a good point. I think there's a lot of marketing that goes into that history too.
Posted by linkadge on November 29, 2006, at 16:43:30
In reply to Re: Maybe all drugs are like this » Squiggles, posted by zmg on November 29, 2006, at 15:33:26
I don't know who argued that lithium will make you kill yourself because it does have a documented antisuicide effect.
Infact, lithium and clozapine are the only two psychiatric medications that have a statisically significant proven anti-sucide effect.
>First of all, you *do* get back to normal
>after getting off lithium, but it is very
>painful, for me at least.I'm not saying that everybody who discontinues the drug fails to regain theraputic effect, but it has been documented that some people do fail to regain theraputic effect after discontinuation.
Linkadge
Posted by linkadge on November 29, 2006, at 16:49:58
In reply to Re: Maybe all drugs are like this » Squiggles, posted by zmg on November 29, 2006, at 15:33:26
For instance, I had a good antidepressant effect from lithium alone, the first trial, but when I restarted it, I was never able to regain that same antidepressant effect.
Infact, on subsquent trials the drug seemed to induce rage/irritability reactions.
Dr. Manjii, a cellular biologist studies the cellular actions of mood stabilizers. He commented that lithium may be good for the "early" stages of kindling, wherase valproate may be better for the later stages of kindling.
So, if the disease progesses, lithium alone may be insufficiant. I think Manjii commnents too on the possability of lithium loosing its effect if discontuned too many times or not taken consistently.
My psychiatrist, the chief psychiatrist at Waterloo Univeristy, Ontario, Canada, made that exact comment. When I told him that my use of lithium was periodic, he said "don't take it that way, cause there is the possability that it will stop working".
So, its not complete B.S. But that doesn't mean it happens to everbody.
Linkadge
Posted by Squiggles on November 29, 2006, at 17:00:08
In reply to Re: Maybe all drugs are like this, posted by linkadge on November 29, 2006, at 16:43:30
> I don't know who argued that lithium will make you kill yourself because it does have a documented antisuicide effect.
Yes it is stated in many articles and books, that
mania or depression returning upon discontinuation, can lead to suicide. And I would not argue with that. My question is, how much longer than other drugs that might happen, how much more often. In my experience it took six months to reach manic depression -- that is a pretty good competitive anti-suicidal effect.
So, i am referring to discontinuation or fluctuation in dose.
>
> Infact, lithium and clozapine are the only two psychiatric medications that have a statisically significant proven anti-sucide effect.
>
>
> >First of all, you *do* get back to normal
> >after getting off lithium, but it is very
> >painful, for me at least.
>
> I'm not saying that everybody who discontinues the drug fails to regain theraputic effect, but it has been documented that some people do fail to regain theraputic effect after discontinuation.Well, this is the interesting point -- is this discontinuation the same, and also taking into account the cyclical nature of manic depression, are we comparing apples and oranges?
Squiggles
>
Posted by Squiggles on November 29, 2006, at 17:18:56
In reply to Re: Maybe all drugs are like this, posted by linkadge on November 29, 2006, at 16:49:58
> For instance, I had a good antidepressant effect from lithium alone, the first trial, but when I restarted it, I was never able to regain that same antidepressant effect.
Did you stay on it? Are you on it now?
>
> Infact, on subsquent trials the drug seemed to induce rage/irritability reactions.
>
There is what I call the "Twilight Zone" -- the interim between just beginning to recover, and actual stabilization. Within this agitated period is where you might find the greatest number of suicides and violent acts. That would apply to the more agitating ADs as well, e.g. Prozac. I got the same thing with psychomotor agitation.
> Dr. Manjii, a cellular biologist studies the cellular actions of mood stabilizers. He commented that lithium may be good for the "early" stages of kindling, wherase valproate may be better for the later stages of kindling.Yes, that is consistent with the fact that Benzodiazepines are so good for this period of adjustment. Valproate like Klonopin is an anti-convulsant. That may be his actual discovery, NOT that lithium will not work eventually. I've been on lithium for 25 years, and each time a fluctuation occurs, it takes about 30 days to get well again. That is a pattern. The only exception was the counterfeit batch, or weaker batch, that took six month before I hit true manic-depression as i remember it 25 years hence.
So, valproate is not necessarily proof of superiourity to lithium but rather appropriate dampening of a brain state, which lithium will correct given a concurrent dose of benzos.
>
> So, if the disease progesses, lithium alone may be insufficiant. I think Manjii commnents too on the possability of lithium loosing its effect if discontuned too many times or not taken consistently.It has not been my experience, with all due respect to the neurologically innovative work of Dr. Manjii.
>
> My psychiatrist, the chief psychiatrist at Waterloo Univeristy, Ontario, Canada, made that exact comment. When I told him that my use of lithium was periodic, he said "don't take it that way, cause there is the possability that it will stop working".I am sceptical about that given my experience.
Squiggles
Posted by Crazy Horse on November 29, 2006, at 18:52:10
In reply to Re: Maybe all drugs are like this, posted by linkadge on November 29, 2006, at 16:43:30
> I don't know who argued that lithium will make you kill yourself because it does have a documented antisuicide effect.
>
> Infact, lithium and clozapine are the only two psychiatric medications that have a statisically significant proven anti-sucide effect.
>
>
> >First of all, you *do* get back to normal
> >after getting off lithium, but it is very
> >painful, for me at least.
>
> I'm not saying that everybody who discontinues the drug fails to regain theraputic effect, but it has been documented that some people do fail to regain theraputic effect after discontinuation.
>
> Linkadge
>
>
> If only Curt Cobain had known this! Actually this is not funny, however i do believe had he been taking lithium he (Cobain) would most likely be with us today.-MJ
>
>
Posted by Phillipa on November 29, 2006, at 19:23:24
In reply to Re: Maybe all drugs are like this » linkadge, posted by Crazy Horse on November 29, 2006, at 18:52:10
Gee my 85year old ex-father-in-law has been on and off lithium for years. He goes off it twice a year to try and lose weight (not now he's being monitored in a care facility) but after two weeks of mania he would crash go back on lithium and always stabalize. Love Phillipa
Posted by linkadge on November 29, 2006, at 21:23:38
In reply to Re: Maybe all drugs are like this » linkadge, posted by Squiggles on November 29, 2006, at 17:18:56
Like I said, we cannot base the experience of many doctors on just one case. We could ask other people on this board. Its not just an old wives tale. I'm sure SLS has heard of the phenomina.
Again, I am in no way saying that this is a guarenteed thing, there is just a possability that it will not work if you discontinue and start again.
I don't think that valproate has gained this reputation. Ie, I don't think there are a substantial number of cases suggesting that valproate looses effect if discontinued and restarted.
Lithium is acutally proconvulsant. It is not good in cases of epileptiform brain activity. I was under the impression that my rage reaction to lithium was due to some sort of temporal lobe proconvulsant activity. The rage was even more pronounced if I combined it with an SSRI. Lithium made the music in my head much worse, it also worsened my insomnia, wherase valproate did not.
Tegretol also did not worsen isomnia,When I restarted lithium, I would have taken it for nearly a year the second time. Although, I never regained the state of wellness that I had when I took it the first time.
Antidepressants were added to no avail.
At this point valproate worked better.
This is not a lithum bashing session on my part, its just my experience thats all.
>So, valproate is not necessarily proof of >superiourity to lithium but rather appropriate >dampening of a brain state, which lithium will >correct given a concurrent dose of benzos.Well, possably. If the lithium benzo combination is working for you than great, no worries.
I had taken lithium + clonazepam, or lithium + lorazepam, but adding the benzos just made depression worse. At this point, like I said, valproate worked better.
This is not a matter of valproate being a better drug, just that it does work better in certain cases, (for instance, valproate is often superior to lithium when it comes to rapid cycling.)
Linkadge
Posted by linkadge on November 29, 2006, at 21:25:52
In reply to Re: Maybe all drugs are like this » linkadge, posted by Crazy Horse on November 29, 2006, at 18:52:10
I don't think cobain was actually bipolar. I think that hollywood was too much pressure for him, I also think his heroin use was what killed him.
Bipolar or not, maybe lithium would have helped.
Linakdge
Posted by linkadge on November 29, 2006, at 21:30:01
In reply to Re: Maybe all drugs are like this, posted by Phillipa on November 29, 2006, at 19:23:24
My mother has been on and off lithium for 30 years. She has also had a number of toxic blood levels due to accidental (I hope) overdoses.
While it still is of some theraputic value, she has been in a deep depression for ~8 years despite theraputic lithium dose.
Doctors are hesitant to add antidepressants since she has such a history of rapid cycling.
She is on,
lithium 1050mg
risperidal 1mg
bromazepam 6mgOverall, I think the lithium is doing something, but she is not well.
Linkadge
Posted by Crazy Horse on November 29, 2006, at 21:44:38
In reply to Re: Maybe all drugs are like this » Crazy Horse, posted by linkadge on November 29, 2006, at 21:25:52
> I don't think cobain was actually bipolar. I think that hollywood was too much pressure for him, I also think his heroin use was what killed him.
>
> Bipolar or not, maybe lithium would have helped.
>
>
> LinakdgeYea, he definitely liked Heroin (self-medication?). What a waste of a life of a young, very talented man!
-MJ
Posted by Phillipa on November 29, 2006, at 21:48:29
In reply to Re: Maybe all drugs are like this, posted by linkadge on November 29, 2006, at 21:30:01
Link is your Mother no better I'm so sorry. But she's able to care for herself isn't she? Love Jan ps I get so scared when I hear of what's happened long term to others even younger than me.
Posted by Squiggles on November 30, 2006, at 8:08:52
In reply to Re: Maybe all drugs are like this, posted by linkadge on November 29, 2006, at 21:23:38
> Like I said, we cannot base the experience of many doctors on just one case. We could ask other people on this board. Its not just an old wives tale. I'm sure SLS has heard of the phenomina.
>
>
.............I respect your experience. I am sorry you had
such troule upon stopping and not regaining
stability. I agree, that this is the kind of
issue that is best tested with large samples
of people and not just on the basis of hypotheses
on the nature of lithium and valproate -- they
are different drugs, but as i have read, actually effect the same areas of the brain. Perhaps dose and speed of reinstatement are variables too.Squiggles
Posted by Squiggles on November 30, 2006, at 8:11:39
In reply to Re: Maybe all drugs are like this » Crazy Horse, posted by linkadge on November 29, 2006, at 21:25:52
> I don't think cobain was actually bipolar. I think that hollywood was too much pressure for him, I also think his heroin use was what killed him.
>
> Bipolar or not, maybe lithium would have helped.
>
>
> LinakdgeI read in a pulp magazine that he was just out of
rehab, when he was found with a bullet in his
head, and something like 10x the amount of heroin
to kill seasoned users. No lithium was mentioned.Squiggles
Posted by Squiggles on November 30, 2006, at 8:15:34
In reply to Re: Maybe all drugs are like this » linkadge, posted by Phillipa on November 29, 2006, at 21:48:29
> Link is your Mother no better I'm so sorry. But she's able to care for herself isn't she? Love Jan ps I get so scared when I hear of what's happened long term to others even younger than me.
It might be good to get a general check-up,
and if facilities permit, an EEG.Squiggles
Posted by linkadge on November 30, 2006, at 10:12:14
In reply to Re: Maybe all drugs are like this » linkadge, posted by Squiggles on November 30, 2006, at 8:08:52
>actually effect the same areas of the brain
Lithium and valproate are similar on certain domains. Their ability to inhibit PKC-epsilon, GSK-3b, and increase BCL-2, and BDNF, but they are *not* identical in all their actions.
If they were identical in their actions, then lithium would be effective for epilepsy which it is not. They have similarities, but the sum of a lot of experience says that the two are usefull for different varients.
There are people who respond to one and not the other, for instance.
Linkadge
Posted by linkadge on November 30, 2006, at 10:14:41
In reply to Re: Maybe all drugs are like this » Phillipa, posted by Squiggles on November 30, 2006, at 8:15:34
The sees doctors all the time. There is nothing medically wrong except bipolar.
Each member of my family can attest to the fact that there were clear cut deteriorations in her state after each toxic lithium event.
Linkadge
Posted by Squiggles on November 30, 2006, at 10:51:22
In reply to Re: Maybe all drugs are like this, posted by linkadge on November 30, 2006, at 10:12:14
> >actually effect the same areas of the brain
>
> Lithium and valproate are similar on certain domains. Their ability to inhibit PKC-epsilon, GSK-3b, and increase BCL-2, and BDNF, but they are *not* identical in all their actions.
>
> If they were identical in their actions, then lithium would be effective for epilepsy which it is not. They have similarities, but the sum of a lot of experience says that the two are usefull for different varients.
>
> There are people who respond to one and not the other, for instance.
>
>
>
>
>
>
>
> Linkadge
>I can't argue with that :-)
How about a combination of lithium and
valproate? Right now, i think the clinical
guidelines are to give lithium with clonazepam,
which present serious problems upon withdrawal,
or maybe even displacement in dose fluctuations.
I read in the Merck that one drug can displace another. Excuse my layman's understanding.
Clonazepam presents serious withdrawal, like
epileptic fits upon "displacement[if that is
what is happening in lithium dose fluctuation];Squiggles
Posted by Squiggles on November 30, 2006, at 11:03:44
In reply to Re: Maybe all drugs are like this, posted by linkadge on November 30, 2006, at 10:14:41
> The sees doctors all the time. There is nothing medically wrong except bipolar.
>
> Each member of my family can attest to the fact that there were clear cut deteriorations in her state after each toxic lithium event.
>
> LinkadgeThat's not good. Why are her doctors still
keeping her on lithium, given that deterioration?Squiggles
Posted by Squiggles on November 30, 2006, at 11:20:48
In reply to Re: Maybe all drugs are like this, posted by linkadge on November 30, 2006, at 10:14:41
I thought Dr. Bob's Forum was private;
this looks too public for my liking.http://www.neurotransmitter.net/wiki/tiki-index.php?page=Psycho-Babble+by+Dr.+Bob
Squiggles
Posted by linkadge on November 30, 2006, at 16:47:23
In reply to Re: Maybe all drugs are like this » linkadge, posted by Squiggles on November 30, 2006, at 10:51:22
If the combination of lithium and clonazepam is keeping you stable don't change it.
Yeah, benzo withdrawl or anticonvulsant withdrawl can cause status epilepticus.
Linkadge
Posted by linkadge on November 30, 2006, at 16:51:52
In reply to Re: Maybe all drugs are like this » linkadge, posted by Squiggles on November 30, 2006, at 11:03:44
Well, lithium has been the only one that worked to any degree in the past.
She went toxic a few times by double or tripple dosing.
She would forget that she had taken the drugs and then take them again.
Thats what she said. It could have been a suicide attempt as she has made actual attepts in the past.
Linkadge
Posted by linkadge on November 30, 2006, at 16:53:20
In reply to NOT SURE I LIKE WHAT I FOUND ON THE NET » linkadge, posted by Squiggles on November 30, 2006, at 11:20:48
Yeah, strange.
Linkadge
Posted by Squiggles on November 30, 2006, at 17:02:43
In reply to Re: NOT SURE I LIKE WHAT I FOUND ON THE NET » Squiggles, posted by linkadge on November 30, 2006, at 16:53:20
> Yeah, strange.
>
> LinkadgeYour ears are too big. I'm going to have
to speak softly and carry a big stick. :-)Squiggles
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