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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by sackhoullier on November 10, 2003, at 14:29:10
Hi,
I'm a thirty year old male who has been fighting fires every time I've had a depressed or anxious episode over the past fifteen years. I've only ever been to my GP until recently, but as things have got even harder to handle (big manic episode in August) I'm now seeing a pysch - who has told me that I'm a classic bipolar type II - and that makes sense to me. I normally go a few months feeling healthy and then I'll either spin out with crazed anxiety or downwards with depression. Thing is, I have a pretty intense job (MD of a busy software house), and I'm scared to take anything that is going to sedate me so that I can't perform - however, I can feel a depression coming on and that usually means four weeks hiding from people trying not to curl up into a ball followed by another four feeling sick off SSRI's and not getting any work done anyway. How no one notices is beyond me. What I'd like to know is, what can I expect if I start taking lithium? - Basically, what I'm saying is, I like the idea of being levelled out, but I'm scared of side effects that are going to slow me down and potentially lose me my job.
Thanks for any help. Mark.
Posted by linkadge on November 10, 2003, at 15:33:35
In reply to Advice needed - should I start on Lithium?, posted by sackhoullier on November 10, 2003, at 14:29:10
I am taking a low dose of lithium 600 mg. At first it will seem to slow you down, it inhibits glutamate release, but over the course of a month or so, you will find your cognition is pretty reasonable, considering its benefit.
There are other mood stabalizers, and sometimes lithium is combined well with antiseizure meds such as lamictal, and/or depakote. There are mixtures that will leave you with half a brain.
Another thing to consider is that lithium grows new brain cells - looks up lithium + 'grey matter' on search engines you will find the studies that link it to increased total grey matter volume, as well as hippocampal regeneration.
The main thing is to get yourself stabalized, start with lithium, and then let your doc know how it goes cognative wise (as there are things to do). I am in university, although It slows me down a little (I will admit) I certainly feel that I have all my resources to tap into.
Linkadge
Posted by sackhoullier on November 10, 2003, at 16:05:16
In reply to Re: Advice needed - should I start on Lithium?, posted by linkadge on November 10, 2003, at 15:33:35
Thanks for that. I think I'll leave the cocktails until I can see what it's doing by itself. How does the first week normally go? I've got a prescription in front of me but I've got friends coming to stay at the weekend and we're meant to be going out. As you can see, I've got pill apprehension - based on my experiences with the ultimately beneficial SSRI's I've taken.
Thanks again, Mark.
Posted by sarita0001 on November 10, 2003, at 16:56:25
In reply to Re: Advice needed - should I start on Lithium?, posted by sackhoullier on November 10, 2003, at 16:05:16
Hi Mark-
I was on lithium for 7 years and was able to graduate college and now I am in grad school- so it shouldn't interfere with your work in the long term. The drowsiness is worst in the beginning, but it should decrease later or at least become tolerable. What dosage are you starting at and/or working up to? Are you taking controlled release? I took Eskalith CR 900 mg for 6.5 years and was at 675 for 6 months. I began to have trouble with it in summer of 2002. I didn't know why then but it was because the level was too high 1.2. Because I was having some trouble then, the Dr. did not lower it. This was affecting me my 1st semester of grad school but I made it and then lowered the dosage 2nd semester and was much better.
The main thing is to know what your lithium level and figure out what works for you. Always ask for a copy of your blood test or ask to see it when you get the results. Some doctors will tell you not to lower it because it is below the "therapeutic dose" but the dosage is less important when it comes to lithium. The LEVEL is the key to effectiveness. I did well at .7-.9, but like I said for some reason the level stayed high after 6 years on it. Taking the entire dose at night can lessen drowsiness. When I used to take split dosages, I would feel tired one hour after (that is usually when lithium hits peak levels in your body).
If you have any questions, let me know. I have a lot of experience with lithium.
Sara
Posted by sackhoullier on November 11, 2003, at 1:02:17
In reply to Re: Advice needed - should I start on Lithium?, posted by sarita0001 on November 10, 2003, at 16:56:25
Thanks Sara. The doctor said he'd start me on 400mg and raise it as necessary after my bloodwork at the end of the first week.
My main issue is that I don't want to be zombified. I know that being analytical isn't a good thing when you tend towards anxiety and depression - but I still like to analyse. When I'm well I'm very active, I love having my kids around me and doing what they want to do. I'm petrified that I'll get on this drug and end up sitting on the couch watching soap operas. I don't want to sleep more than eight hours a night, I've got too much to do at work and at home - but I suppose an extra hour or twos sleep is a small price to pay for sanity...
I wish I could just deal with this on my own, but I can't.
I was on Remeron for a month in the summer and I hated myself. I put on tons of weight and managed to stay awake for about 10 hours per day. It fixed me, but as soon as I knew my head was straight I came off it. I guess I'm just worried that Lithium will act the same way.
I don't want to be a zombie!
Posted by sackhoullier on November 11, 2003, at 3:34:50
In reply to Re: Advice needed - should I start on Lithium?, posted by sackhoullier on November 11, 2003, at 1:02:17
Oh yeah, I forgot to mention that I will be taking the whole dose in one go at bedtime.
Posted by sarita0001 on November 11, 2003, at 4:53:43
In reply to Re: Advice needed - should I start on Lithium?, posted by sackhoullier on November 11, 2003, at 1:02:17
Hi,
I know what you mean. I felt mostly zombieish when there was too much in my system. Hopefully it should only be in the beginning, and if it continues your or the doctor could change to lithium + another drug instead. Otherwise it was helpful for me. I went off because my therpaist and I discovered I had more of a problem with anxiety (which lithium somewhat controls) and OCD. Wish you luck.
Sara
Posted by sarita0001 on November 11, 2003, at 4:57:02
In reply to Re: Advice needed - should I start on Lithium?, posted by sackhoullier on November 11, 2003, at 3:34:50
Hi,
If you're really symptomatic right now it could be a good idea to start slowly. I told me new dr I am afraid of side effects with Prozac and she is increasing the dose every few days. It seems to work because I don't tolerate drugs well. The other thing with lithium is that you are going to be urinating more often, especially in the beginning, but that is good because you are supposed to drink a lot of water.
Sara
Posted by sackhoullier on November 11, 2003, at 5:16:09
In reply to Re: Advice needed - should I start on Lithium? » sackhoullier, posted by sarita0001 on November 11, 2003, at 4:57:02
I'm not uber symptomatic at the moment - I'm just worried about being worried (I guess you know what I mean) and particularly concerned that I won't be able to concentrate on my work if I start on lithium.
Am I likely to start dozing off in meetings? Is driving advisable?
Thanks, Mark
Posted by Adam Donahue on November 11, 2003, at 9:03:22
In reply to Advice needed - should I start on Lithium?, posted by sackhoullier on November 10, 2003, at 14:29:10
Yours sounds almost /exactly/ like my situation. Problem is, I don't tend to get depressed unless I do something that triggers the depression -- these wild mania episodes where I feel like I MUST do something -- drink -- and it inevitably leads to my overdrinking and being depressed.
Am I alcoholic, bipolar, both? My pdoc says I'm bipolar II, a classic case, but I wonder if certain aspects of my bipolarism aren't simply aspects of my actual personality. I've /always/ been energetic -- it's just when I started to drink that things got out of control.
(I'm on Celexa, too, which may be the reason my BAL shoots up so high so damn quickly.)
My doc also prescribed lithium, but I haven't yet taken it. I am currently depressed from a Friday night drinking binge that left me hospitalized. I feel like a zombie, like there is a 'hole' in my brain. This usually passes after a week or so -- of course I always panic it won't -- but I'm wondering if I should start the lithium now, or wait until I start feeling 'normal' again. My doc, my family -- everyone says 'now' -- but I'm worried that it will make me feel changed, and inside I'll still think I'm not 100%.
Like you, I am highly motivated, I have an intense job that I love, I'm very intelligent (in certain areas at least!), and I have a great, friendly personality. I don't want to lose any of this ... especially the energy, drive, and intelligence that generally gives me my edge in my industry.
Adam
Posted by sackhoullier on November 11, 2003, at 11:07:06
In reply to Re: Advice needed - should I start on Lithium?, posted by Adam Donahue on November 11, 2003, at 9:03:22
Er, are we brothers? My big dip in August was caused by a week long session on the uberlash in Amsterdam. Like you, I hate myself for it afterwards, and then do it again just as soon as I'm fixed... This time I got the message and took ten weeks off, for the first time since adolesence - and felt great for a while - but then I noticed myself going downhill even without the booze. Hence, I'm back on it.
Like you I am aware that a part of the thing that makes me go OTT also makes me on top of the game in work. That's why I'm wary of the Lithium.
Posted by Adam Donahue on November 11, 2003, at 11:17:21
In reply to Re: Advice needed - should I start on Lithium? » Adam Donahue, posted by sackhoullier on November 11, 2003, at 11:07:06
Right now I'm in the middle of a major down stage. I feel like garbage, both physically and mentally, and I can't concentrate. My head is cloudy, I'm totally not myself ... I don't even want to be at work right now. This is horrible. I hope this passes.
The bad thing is, I felt almost EXACTLY the same way three weeks ago -- and yet I did the SAME THING to put myself here. And I feel guilty, shamed, and hopeless about it just like I did last time.
I upped my Celexa dose to 80 mg for now -- probably shouldn't be self-medicating, but I'm worried about feeling this way. I wonder if that will help or hurt.
Adam
Posted by sackhoullier on November 11, 2003, at 11:58:52
In reply to Re: Advice needed - should I start on Lithium?, posted by Adam Donahue on November 11, 2003, at 11:17:21
I don't know about celexa specifically, but SSRI's in general make me drink loads more. That's why I haven't had any prescribed to me this year. Although they sort my depression they make me feel jittery and fidgety and I invariably find myself in the boozer at closing time. As you know, you'll get over your depressive hangover pretty soon - but really try to cut back on the booze. I felt great for over two months without it and I never thought that possible.
Posted by karen_kay on November 11, 2003, at 15:47:11
In reply to Advice needed - should I start on Lithium?, posted by sackhoullier on November 10, 2003, at 14:29:10
> Honestly, when I started Lithium (and I have taken it on 2 seperate occassions) I didn't have any of the really uncomfortable side effects. I did have some diarrhea, but I am usually constipated, so it was a relief for me (sorry if that was a bit too much information :). When my levels were a bit high, I had some hand tremors. Where I ran into problems is when I was on several medications at one time (Depakote, Lamictal, Zyprexa, Klonapin, and Lithium). But, people tolerate drugs differently. Being on Lithium the first time brought a stability to my life that I previously thought impossible. It doesn't hurt to give it a shot. Good luck! Karen
Posted by sarita0001 on November 11, 2003, at 16:37:28
In reply to Re: Advice needed - should I start on Lithium?, posted by karen_kay on November 11, 2003, at 15:47:11
Hi,
I think what you could do is try lithium for a few weeks. If you don't like it, then try something else. I'd say give a few weeks for the side effects to pass. As for possible cognitive dulling, it actually helped me focus and I was sharper sometimes because I wasn't so depressed all the time.
Sara
Posted by Adam Donahue on November 11, 2003, at 16:45:32
In reply to Re: Advice needed - should I start on Lithium?, posted by sarita0001 on November 11, 2003, at 16:37:28
This is the kind of feedback I was hoping for. It's a good thing I'm productive at work -- I don't think they notice, too much, my 'down' periods. I feel almost unable to get anything but the minimum done -- I'm not my usual proactive self -- but I'm definitely able to perform up to basic standards. Waiting for this all to pass, again. Ups and downs kill me.
Posted by sackhoullier on November 12, 2003, at 14:16:11
In reply to Re: Advice needed - should I start on Lithium?, posted by Adam Donahue on November 11, 2003, at 16:45:32
Thanks for all the advice here, I'm going to give it a shot.
Posted by Adam Donahue on December 2, 2003, at 17:22:42
In reply to Re: Advice needed - should I start on Lithium?, posted by sackhoullier on November 12, 2003, at 14:16:11
> Thanks for all the advice here, I'm going to give it a shot.
OK -- so I tried lithium for two weeks, off and on, and I'm stopping it now. I didn't like the way it was making me feel -- numb-minded at best -- and also obsessed over the fact that I can't seem to concentrate like I could prior to the binge drinking episode. So my focus is on defeating the alcohol problem first. I'm not saying I won't get depressed again, but I'm afraid enough of alcohol now that it's not going to be drinking that causes another crash. I also want to see if I get my mental abilities back following abstinence from both lithium and alcohol.
Interested to hear how your experience is going with li.
Adam
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