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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 49. This is the beginning of the thread.
Posted by capricorn on March 3, 2002, at 4:27:26
Good for (hypo)mania not so good for depression?
That's my experience.How about the rest of you who are on lithium.
Posted by BarbaraCat on March 3, 2002, at 14:08:30
In reply to Lithium, posted by capricorn on March 3, 2002, at 4:27:26
Not on it's own, but it's the spark plug that makes my Remeron work. It's made all the difference, since any antidepressant pooped out on any dose. - Barbara
> Good for (hypo)mania not so good for depression?
> That's my experience.How about the rest of you who are on lithium.
Posted by Denise528 on March 3, 2002, at 16:57:57
In reply to Re: Lithium » capricorn, posted by BarbaraCat on March 3, 2002, at 14:08:30
I started taking lithium two days ago along with prozac which I've been taking for about two months. The prozac has so far been ineffective so I am hoping that the lithium will jumpstart it into action but so far haven't noticed a difference.
Denise
Posted by BarbaraCat on March 3, 2002, at 18:30:59
In reply to Re: Lithium, posted by Denise528 on March 3, 2002, at 16:57:57
How much are you taking? I'm at 300 mg which is low for bipolar treatment, but seems to be doing the trick jump starting the remeron. It took about 2 weeks to feel the full effect, but I started feeling better within 3 days. Do you have symptoms of bipolar II?
> I started taking lithium two days ago along with prozac which I've been taking for about two months. The prozac has so far been ineffective so I am hoping that the lithium will jumpstart it into action but so far haven't noticed a difference.
>
> Denise
Posted by Denise528 on March 4, 2002, at 6:06:45
In reply to Re: Lithium » Denise528, posted by BarbaraCat on March 3, 2002, at 18:30:59
Hi,
I'm taking 200mg daily, I'm not sure whether I'm biopolar II or not as I I don't what the symptoms are. My Psyciatrist seems to thing I have mood changes, although they are not dramatic and in the past I have felt slightly euphoric on ADs, I guess I'm still chasing that feeling. I think the main reason for putting me on the Lithium is to augment the AD and kick start it into working as it doestn't seem to be this time round.
What concerns me is that the Doctor is yet again telling me to give it another 6 weeks and then I'll go and see him again and he'll just increase it for another six weeks, I hate to sound impatient but at this rate I'll spend the rest of my life trying to find the right drug.Denise
Posted by BarbaraCat on March 4, 2002, at 13:41:25
In reply to Re: Lithium, posted by Denise528 on March 4, 2002, at 6:06:45
Six weeks for each new trial seems excruciating. I hope he has you on klonopin in the meantime. It's helped alot of us here with smoothing things out. I don't know what country you're in, but I'm in the US and the managed health care system sucks. It used to be that a doctor would follow up with you much more frequently than 6 weeks and adjust meds as needed. Now, it's 'here try this and call me in 6 weeks'. Have you thought of upping the lithium to 300 mg? That seemed to do the trick for me. Again, not especially for a bipolar response, but enough to supercharge the AD. Good luck to you. - Barbara
> Hi,
>
> I'm taking 200mg daily, I'm not sure whether I'm biopolar II or not as I I don't what the symptoms are. My Psyciatrist seems to thing I have mood changes, although they are not dramatic and in the past I have felt slightly euphoric on ADs, I guess I'm still chasing that feeling. I think the main reason for putting me on the Lithium is to augment the AD and kick start it into working as it doestn't seem to be this time round.
>
>
> What concerns me is that the Doctor is yet again telling me to give it another 6 weeks and then I'll go and see him again and he'll just increase it for another six weeks, I hate to sound impatient but at this rate I'll spend the rest of my life trying to find the right drug.
>
> Denise
Posted by noa on March 5, 2002, at 18:10:29
In reply to Lithium, posted by capricorn on March 3, 2002, at 4:27:26
Make sure to monitor your thyroid levels while on lithium. Lithium can be taken if you have thyroid problems, but you just have to monitor and possibly take thyroid supplements if you find that your thyroid functioning is affected. If your thyroid is affected, it could contribute to depression.
Posted by noa on March 5, 2002, at 18:12:10
In reply to Re: Lithium, posted by Denise528 on March 4, 2002, at 6:06:45
For me, lithium did seem to add antidepressant effect but then my hypothyroidism acted up and my mood headed south again. I made the decision to discontinue the lithium but that apparently was not necessary--I could have continued the lithium and just increased my thyroid doses.
Posted by Denise528 on March 6, 2002, at 12:23:47
In reply to Re: Lithium » Denise528, posted by BarbaraCat on March 4, 2002, at 13:41:25
Hi,
Thanks to both of you for the advice, I might try upping the dose of Lithium to 300mg, the way I'm feeling right now I'll probably double it. It just doestn't make sense I can't understand why the ADs aren't working this time round, no matter how much I take. I'm also taking St Johns Wort, Sam E, Vitamin B supplments, Omega 3 fish oil, all to no avail. The only thing that is helping me this time round is the Zyprexa but not in the way that I want. Sorry for venting my frustration but I'm so disappointed and scared that nothing will ever work again and that I am stuck like this for ever and ever amen. I just don't understand why they can't do more diagnosis, why its all so hit an miss. Anyway I will get my thyroid checked and thanks again for the tips.
Denise
Posted by BarbaraCat on March 6, 2002, at 12:59:12
In reply to Re: Lithium, posted by noa on March 5, 2002, at 18:12:10
Good point, Noa. I am hypothyroid and have just increased my thyroid dosage as a precaution since I've started lithium. One thing I think is very important - take thyroid with both T4 and T3. The usually prescribed kind is synthroid or generic like levothyroxide which only has T4. This is not enough for folks with depression. We seem to need the T3 which is available in the natural dessicated brand, like Armour, or adding Cytomel, a synthetic form of T3. There's been voluminous data on this and I wonder sometimes how many of us on this board would be greatly helped by adding T3 to their mix. - Barbara
> For me, lithium did seem to add antidepressant effect but then my hypothyroidism acted up and my mood headed south again. I made the decision to discontinue the lithium but that apparently was not necessary--I could have continued the lithium and just increased my thyroid doses.
Posted by BarbaraCat on March 6, 2002, at 13:11:04
In reply to Re: Lithium, posted by Denise528 on March 6, 2002, at 12:23:47
Denise,
So sorry you've been feeling so awful. Could you explain what's going on? If it's any consolation, I'm just emerging from an absolute bummer of a bout with depression and crying jags, despair, fatigue - horrible stuff. I don't even know if it's due to the lithium increase, the thyroid increase, or klonopin increase, the fact that all the above finally kicked the remeron in - I don't know. Maybe the fear/depression finally ran it's course. But I too was at the point of defeat and discouragement to say the least and didn't think I'd ever be feeling better. But I am.It finally turned the corner and the difference now is that I have the inner knowing that I can cope with whatever comes up. I didn't have that before, I was too sick both in mind and body and spirit. Hang in there. It's a crap shoot, but just think of how much stronger we are because of this than the average bear. One other thing about the thyroid. I wrote a post to Noa, but I'll repeat it. Most doctors won't prescribe thyroid unless test numbers definitely show hypothyroidism. Most doctors will then only prescribe synthetic T4. There is much evidence that we mood affectives need the T3 form. If you want to read further, goto www.thyroid.about.com. A great site with wealth of information. Fight the good fight! - Barbara
Posted by noa on March 6, 2002, at 18:05:04
In reply to Re: Lithium » Denise528, posted by BarbaraCat on March 6, 2002, at 13:11:04
yes, the thyroid.about.com site helped me a lot, as did reading the moderator's book, "living well with hypothyroidism" and "the thyroid solution" by Arem.
Also, I found my endocrinologist through the doctor recommendation page at the thyroid site.
Posted by Ritch on March 6, 2002, at 23:48:34
In reply to Re: Lithium; thyroid site, posted by noa on March 6, 2002, at 18:05:04
> yes, the thyroid.about.com site helped me a lot, as did reading the moderator's book, "living well with hypothyroidism" and "the thyroid solution" by Arem.
>
> Also, I found my endocrinologist through the doctor recommendation page at the thyroid site.Hi Noa,
Is it the case now that "hypothyroidism" is considered a subclinical thing that requires treatment now (per the American. Endo. folks)?
I saw a number a while back and it was TSH >2.0 *now* is considered something that needed to be treated with thyroid hormones.Does that sound right?
Mitch
Posted by BarbaraCat on March 7, 2002, at 0:40:59
In reply to Re: Lithium; thyroid site » noa, posted by Ritch on March 6, 2002, at 23:48:34
Mitch,
Jumping in here. Hypothyroidism is alarmingly prevalent, actually a TSH > 1.5 and some say even >1.0 is hypo. TSH levels can show normal, but symptoms of hypo are present, and many doctors are treating for symptoms. The Endo folks are not necessarily the most respected voices here, and were the last to recognize and acknowledge the validity of the T4/T3 debate in treating depressive conditions.Alot of hypotheses about why there are so many cases (especially among women), but pesticides, stress, flouride, etc., seem to be implicated. I'd suggest you take a look at the about.thyroid.com site if interested. Some pretty fascinating stuff there. - Barbara
> > yes, the thyroid.about.com site helped me a lot, as did reading the moderator's book, "living well with hypothyroidism" and "the thyroid solution" by Arem.
> >
> > Also, I found my endocrinologist through the doctor recommendation page at the thyroid site.
>
> Hi Noa,
>
> Is it the case now that "hypothyroidism" is considered a subclinical thing that requires treatment now (per the American. Endo. folks)?
> I saw a number a while back and it was TSH >2.0 *now* is considered something that needed to be treated with thyroid hormones.
>
> Does that sound right?
>
> Mitch
Posted by Psydoc on March 7, 2002, at 5:05:55
In reply to Re: Lithium; thyroid site » noa, posted by Ritch on March 6, 2002, at 23:48:34
It has long been my impression that most endocrinologists tend to undertreat hypothyroidism in people with mood disorders. The best indicators of the adequacy of the treatment are the feeling of well-being of the person beingh treated and the level of TSH. It usually requires that sufficient thyroid hormones (optimally T-4 + T-3) be administered to cause the TSH to fall to the lowest quarter of the normal range.
If your doctor is reluctant to use the combination of T-4 plus T-3, pringt out the paper from the New England Journal of Medicine at:
http://content.nejm.org/cgi/content/abstract/340/6/424 and bring it to your next visit.Best regards . . .
Ivan Goldberg
psydoc@psycom.net
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
Posted by Ritch on March 7, 2002, at 11:37:21
In reply to Re: Lithium; thyroid site » Ritch, posted by BarbaraCat on March 7, 2002, at 0:40:59
> Mitch,
> Jumping in here. Hypothyroidism is alarmingly prevalent, actually a TSH > 1.5 and some say even >1.0 is hypo. TSH levels can show normal, but symptoms of hypo are present, and many doctors are treating for symptoms. The Endo folks are not necessarily the most respected voices here, and were the last to recognize and acknowledge the validity of the T4/T3 debate in treating depressive conditions.
>
> Alot of hypotheses about why there are so many cases (especially among women), but pesticides, stress, flouride, etc., seem to be implicated. I'd suggest you take a look at the about.thyroid.com site if interested. Some pretty fascinating stuff there. - Barbara
Barb, Thanks for the link (I bookmarked it), I will check into it later. My TSH was 1.4 the last time, but my endo is *deadset* against adding T3 or T3+T4 for my cycling. My pdoc isn't going to rock the boat with my endo by writing for that either. Actually I don't see any harm in adding a *tiny* amount to bring TSH down to around 1.0 (who knows maybe it would help a lot-not just a little)?Mitch
Posted by BarbaraCat on March 7, 2002, at 12:33:11
In reply to Re: Lithium; thyroid site » BarbaraCat, posted by Ritch on March 7, 2002, at 11:37:21
Mitch,
Be wary of getting TSH too low. Hyper symptoms are no fun, and can set off hypomania, agitation, insomnia, headaches. Supplementing with thyroid hormone can also suppress your natural production. Your TSH of 1.4 seems to be in an ideal spot and I'd certainly hesitate to mess with that.If you have doubts about the accuracy of your TSH readings, you might try the basal thermometer test. It's efficacy is somewhat anecdotal, but remains a time honored method of testing. Shake down mercury thermometer before going to bed at night. On waking, before moving around or going to the bathroom, place thermometer in the armpit for 10 minutes. If readout is less than 97.4, chances are you're hypothyroid. - Barbara
Posted by Ritch on March 7, 2002, at 13:51:04
In reply to Thyroid » Ritch, posted by BarbaraCat on March 7, 2002, at 12:33:11
Posted by JackD on March 7, 2002, at 14:05:05
In reply to Re: Lithium » capricorn, posted by BarbaraCat on March 3, 2002, at 14:08:30
> Not on it's own, but it's the spark plug that makes my Remeron work. It's made all the difference, since any antidepressant pooped out on any dose. - Barbara
>Barbara, any helpful feedback you could give me regarding your experience with Remeron in addition to a mood stabilizer would be greatly appreciated. JohnX2 has suggested I may be Bipolar II, and from further research I've done I realize it is more than likely I am. Oh, and I LOVE Remeron... the trick now is for me to "lock onto", as John said, to Remeron's positive effects.
P.S. Sorry to pirate this thread.
Posted by Dave1 on March 7, 2002, at 17:31:32
In reply to Re: Lithium » Denise528, posted by BarbaraCat on March 6, 2002, at 13:11:04
Hi,
I'm taking anafranil - 250mg/day. And lithium - 1200mg/day. It started to help my depression about a week ago.
Bye,
Dave
Posted by BarbaraCat on March 7, 2002, at 18:53:14
In reply to Remeron and Lithium -Barbara, posted by JackD on March 7, 2002, at 14:05:05
Hi Jack,
Glad to offer any help I can. I've had depressions and panic like symptoms periodically since my teens. Was on most of the old antidepressants and finally the SSRI's when Prozac became available. Zoloft was the one I was on for the longest, about 6 years. After 3 years of successful treatment, the depression started breaking through, as well as the panic attacks, so my doc kept upping the dose. This actually made me feel worse and so I tried going off ADs. Four attempts at quitting, some as long as 1 year and I felt OK, but the cycling of depression/panic would start up again and I'd have to go back on. Tried everything, celexa, effexor, paxil, wellbutrin, serzone. They'd all work for a short time then poop out and any increase would leave me feeling agitated and depressed, not to mention sexually and emotionally numb.Remeron was a different feeling altogether from the start and for two months at 30mg I have never felt better. Motivated, happy, calm, wonderful. Then at month 3 it pooped totally and I went into a bleak, dark and scary depression, feeling the rug had been pulled out yet again. This was back in late November.
My pdoc had been suggesting lithium as an augmentor all along, but I resisted, mainly because of the health cautions. Lithium requires monthly blood and urine tests since it has to fall within a window of blood level or can be toxic and cause renal failure. I'm very health conscious and this scared me, but figured the emotional stress I was under was probably killing me so what the heck. I'm also *so far* only taking 300 mg a day instead of the usual much higher doses for bipolar disorders.
While in the midst of a crushing depression, I started feeling better within 3 days of the lithium and could feel the same earlier effects from Remeron kicking in. The two act synergistically. The extra mood elevation has allowed me to get back to exercising which for me is the most effective antidepressant, but totally impossible when my brain in miswired.
I suspect I'm bipolar II as well from my past history of occassional hypomania (never long enough, alas), followed by horrible depression, as well as my non-response to AD's. So to make a very long story come to the point, I once again LOVE Remeron, but without the Lithium (and klonopin and thyroid as well which are crucial for me), it would be worthless. Hopefully I can remain at the low end of 300 mg and avoid the health stuff. Feel free to converse anytime. BTW, what makes you suspect BP-II for yourself? - Barbara
Posted by JackD on March 7, 2002, at 20:50:53
In reply to Re: Remeron and Lithium -Barbara » JackD, posted by BarbaraCat on March 7, 2002, at 18:53:14
Ah, a medicine love story; lithium and remeron. I hope I have as much success... I suspect bipolar since I have had very strong and rapid responses to meds, especially the more activating ones. However, after short while the meds soon stop working and make me even worse off than I was to begin with. I also have ADD, which is often comorbid with Bipolar. From the literature I've read symptoms of Bipolar II seem much more fitting than Bipolar I. Also, in retrospect, I have always been SO inconsistent with almost every aspect of my life. Even as far back as elemtary school through now (college), my teachers have said I'm very unpredictable and inconsistent. I'm sure there are a few more reasons for my prognosis, but I can't think of any off hand. Well, anyway, thanks for your input.
Posted by jane d on March 7, 2002, at 23:29:40
In reply to Hypopthyroidism in people wioth mood disorders., posted by Psydoc on March 7, 2002, at 5:05:55
I hadn't realized until now that the NEJM was allowing free access to some (most?) articles over 6 months old including the one recommended by Ivan Goldberg (many thanks!) below. You do need to register for it but that's easy enough. Just wanted to spread the word in case anyone else out there didn't know this.
Jane
> It has long been my impression that most endocrinologists tend to undertreat hypothyroidism in people with mood disorders. The best indicators of the adequacy of the treatment are the feeling of well-being of the person beingh treated and the level of TSH. It usually requires that sufficient thyroid hormones (optimally T-4 + T-3) be administered to cause the TSH to fall to the lowest quarter of the normal range.
>
> If your doctor is reluctant to use the combination of T-4 plus T-3, pringt out the paper from the New England Journal of Medicine at:
> http://content.nejm.org/cgi/content/abstract/340/6/424 and bring it to your next visit.
>
> Best regards . . .
>
> Ivan Goldberg
> psydoc@psycom.net
> %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
Posted by Thrud on March 7, 2002, at 23:52:35
In reply to Hypopthyroidism in people wioth mood disorders., posted by Psydoc on March 7, 2002, at 5:05:55
Hi Psydoc,
Maybe you can help me with a little puzzle that has vexed me for a couple of years.
A couple of years ago I tried l-tyrosine as a monotherapy for depression/panic/crushing fatigue because I was so sick of SSRIs. After about 2 weeks it really kicked in and I excitedly told my family that I felt well for the first time in 10 years. There was one major problem though...it made me completely impotent, more than any SSRI. In the end it pooped out after a couple of months and I had to move on to other meds.
I did a lot of research on l-tyrosine to see where it is used in the body and see if I could pinpoint some biological basis for my problems: I simply shouldn't have felt that good (or that impotent) on a simple amino acid. I was using the standard dose of 1500mg per day.
It seems to be involved in the endocrine system a lot, including the thyroid. I also believe that the thyroid is connected to sexual function (through some hormone I guess) but I could find nothing linking higher levels of l-tyrosine to impotence. In fact the opposite always seems to be reported: the increase in brain dopamine is supposed to increase sex drive. My TSH levels are tested periodically and have always been normal.
I have celiac disease and know that there is some comorbitity with thyroid autoimmune problems. Could there be a thyroid problem which is not reflected in TSH levels? If it helps, I have just been found to be low in testosterone and LH.
I have discussed this all this with my pdoc and he is referring me to an endocrinologist. In the meantime, if you have any insights to offer I would be very, very appreciative.
Thrud
Posted by BarbaraCat on March 8, 2002, at 0:09:45
In reply to Re: Remeron and Lithium -Barbara, posted by JackD on March 7, 2002, at 20:50:53
Yep, your story sounds very similar to mine. I think we may be one of the few folks on this board who are on the lithium/remeron combo so I'll be interested to hear how your faring. Keep in touch. - Barbara
> Ah, a medicine love story; lithium and remeron. I hope I have as much success... I suspect bipolar since I have had very strong and rapid responses to meds, especially the more activating ones. However, after short while the meds soon stop working and make me even worse off than I was to begin with. I also have ADD, which is often comorbid with Bipolar. From the literature I've read symptoms of Bipolar II seem much more fitting than Bipolar I. Also, in retrospect, I have always been SO inconsistent with almost every aspect of my life. Even as far back as elemtary school through now (college), my teachers have said I'm very unpredictable and inconsistent. I'm sure there are a few more reasons for my prognosis, but I can't think of any off hand. Well, anyway, thanks for your input.
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