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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 60 to 84 of 116. Go back in thread:
Posted by Phillipa on June 25, 2005, at 18:18:31
In reply to Re: barbcat, won't you have to stop the cymbalta? » ravenstorm, posted by barbaracat on June 25, 2005, at 1:11:52
Babaracat, You say you have fibromyalgia. And now you feel good and do a lot. What helped the fibro? I know someone who has it. Thanks Phillipa
Posted by barbaracat on June 25, 2005, at 23:45:44
In reply to Not to Change The Topic, posted by Phillipa on June 25, 2005, at 18:18:31
Sure, be glad to help if I can with the fibro info. There doesn't seem to be any consensus as to what 'causes' fibro, as it's a collection of symptoms that can be triggered by many causes. Some say it's an overall inflammatory condition, others say pathogens, but one thing most seem to agree upon is that it's not a condition that's located in the body, but the brain. That is, although the pain and symptoms are felt in the muscles and organs, the origin of the symptoms occurs neurologically.
For me, I'd have to say that it was inherent genetic tendencies that were exacerbated by the extreme stress I subjected myself to for so long, and eventually something had to give. I'd say some of it is the healing power of time, but mainly it has to do with how my brain was misdirecting my system to assimilate hormones. I'd been building up to fibro for years because a long-standing mood disorder made coping with a high-stress job and lifestyle very difficult. I was able to limp by until I hit menopause.
First of all, conventional medicine was able to do nothing, diddly-squat, nada for me except prescribe pain medications. I went to many doctors and eventually many naturopaths, some better than others, but ultimately it was working with the naturopaths that uncovered the root dysfunctions instead of just handling symptoms.
My first step was to have a hormone panel done and everything was very low. Not surprising since I was going through menopause (interesting the majority of fibro folks are women). I was taking the usual sex hormones but the levels weren't holding. Finally, I had an IGF-1 test which measures pituitary growth hormone and it was very low. Low growth hormone has been implicated in fibro because, among its many important functions, it affects the signalling and feedback loop between the hypothalamus, pituitary and the adrenals - the HPA. These regulate hormonal processes which signal how much of what hormone to produce and how much of it gets into the cells. Childhood stress can impact the HPA as well, and it's also not surprising that an estimated 90% fibro sufferers are women who have had abusive childhoods.
I still have to take supplemental hormones (bioidentical sex hormones and thyroid) but I think the HGH allows my body to use them better. I began to notice real improvement after about 4 months of daily injections (it's no big deal to inject them at all).
Although all hormones are equally important, getting my thyroid levels to a good level was probably the most significant as far as pure fibro symptoms are concerned. Low thyroid symtpoms are almost identical to fibro and there are schools of thought that the inability to adequately uptake thryoid at the cellular level is a key player in fibro. Thyroid test levels are misleading because they don't accurately reflect what's going on cellularly and shouldn't be taken as Gospel. If I were going solely by test results, I'm taking too much thyroid and I'm hyperthyroid, but I show no signs of hyperthryroid at all and feel much better at a higher dose. Apparently, I need more and luckily I have a mainstream doctor who agrees. Realizing how crucial my thryoid health is to all of this is one of the main reasons I'm trying to stop lithium.
Injecting myself with human growth hormone was the turnaround for me but I still have to watch my health habits and stress levels - can't get away with much anymore. I really, really, really have to watch the stress because that will bring me down. I manage it however I can, with lifestyle and with meds. When I'm tired, by God, I now make myself rest.
I still have flares especially with stress or overexertion, but considering that for over 3 years I spent half my life in bed in utter misery, a week every few months is a big improvement.
I also try to do the usual good dietary things, drink alot of water and get as much exercise as I can - sometimes it takes a cattle prod, alas.
Another big step came with getting some intestinal stuff cleared up. Part of fibro is irritable bowel syndrome and the bouts of one way or the other messed up the good bacteria and let in some bad ones. A stool sample confirmed intestinal dysbiosis and when you think about, that in itself can get you feeling pretty, uh, crappy. I took a course of antibiotics to get at the bad guys and then some potent probiotics to replenish the good ones. Staying regular has become a religion for me, it's so important. So, lots of water and psyllium and flax.
Getting out of my high stress job was mixed because of the extreme financial stress it caused, and my husband after 4 years is STILL out of work. But having the time to rest as much as I could has been important in reevaluating my life, as has learning to trust that my needs are being met by God, the Universe, or whatever. Trust is a life lesson I'm constantly working on, but it's getting easier. Baby steps.
I'd say finding a way to manage and relieve stress and trust that I was safe no matter what was the most important, but it wasn't possible with all the physical malfunctions I had going on.
If your friend comes to a point of wanting to try human growth hormone, it can be extremely expensive if ordered through the regular pharmacy route. However, I found the least expensive source online at www.clubhgh.com, a reputable Canadian company with high quality HGH. Once the levels and dosage is determined by a medical exam I highly recommend ordering it through them.
Hope this helps and I wish your friend the best. Fibro has been a blessing in disguise. It made me stop and slow down when nothing else could and, you know, whatever it takes to get our attentions. - Barbara
You say you have fibromyalgia. And now you feel good and do a lot. What helped the fibro? I know someone who has it. Thanks Phillipa
Posted by crazyteresa on June 26, 2005, at 21:36:46
In reply to Re: Does anyone like lithium? » crazyteresa, posted by ed_uk on June 25, 2005, at 16:02:13
My little bottle says West-Ward, Inc., Lithium ER, 450 mg., twice a day. I think Lithium is the generic name, isn't it?
I'm a zombie. I have a terrible headache, very nauseated, feel like I have a big head, very tired--if I sit down at my desk at work, I can't hardly make myself get up when a customer comes in, tired but very restless.
I don't have time to feel this bad!
Thanks Ed! crazy t
Posted by ed_uk on June 27, 2005, at 10:36:17
In reply to Re: Does anyone like lithium? » ed_uk, posted by crazyteresa on June 26, 2005, at 21:36:46
Hi crazy!
>I think Lithium is the generic name, isn't it?
Yes.
>I don't have time to feel this bad!
Perhaps the dose is too high. Some people start off on 300-450mg per day. Can you call your doc and ask to reduce the dose?
~Ed
Posted by yesac on June 27, 2005, at 14:11:16
In reply to More newbie Lithium questions » yesac, posted by Sabino on June 24, 2005, at 17:16:28
> Hi. One more. When you say it started to work after 5 weeks, how did it start to work? How did it make you feel versus the way you felt before it worked?
Just less agitated mostly, less mood lability, more calm and "flat", but flat in a good way-- not so moody, not so flipped out or feeling kind of emotionally out of control.
> I was wondering if you experienced any startup SFX, and how long they took to resolve (if they did).
They haven't really resolved, unfortunately. I have shaky hands and I'm more thirsty than before. When I went up to 900 for a few days, I felt really spaced out and nauseus, so I went back down to 600. I think that I said before, the lith *might* be worsening my attention problems, but I'm not completely sure. I'm considering trying to go down to 450 because of these effects, and because I feel tired (but I think that's from the Seroquel, not the lithium.... Plus it is so hot and humid lately, which could be contributing to my lethargy).
> Have you tried the pstims for help with the attention issues yet?
I have tried Ritalin and Adderall. I'm trying to figure out what to do about the attention issues. I haven't tried that aggressively to really find something to help with that because I was always more concerned with my mood problems. I might try Strattera. Oh, I did try Parnate a couple years ago and it was awful! I just felt really lethargic and emotionally/mentally dulled. I didn't like it at all. If it had helped, the diet wouldn't have been that bad, but it was a hassle to have to worry about what's in your food.
> The symptoms of what I call an anxiety attack, I think, are the same as what I've seen referred to as mixed states. Awful. But, maybe with Li I could possibly try that again.
That's how I felt too. A kind of weird, wacked out, depressed mixed state. I wouldn't dare try Prozac again though because it was just so bad. I'm afraid of all of the SSRIs and most antidepressants now too, after that experience. I just don't want to take anything that might destabilize me or derail the semi-okay mood that I've finally attained. But I might have to take some risks if I ever want to try any other drugs!
> Good luck, whatever you decide to try. Let us know how it goes. It's always heartening to see someone that at long last finds some peace of mind.
Yeah, it's nice to have found something, that's for sure. At least it gives me some hope, but I certainly can't say that things are perfect. I still have my ups and downs and get upset and a bit gloomy or down. And there are still things in life that can bother me a lot, ya know? But there will always be that, and I have to try to not let myself think that everything's falling apart if I happen to feel down for a few hours, especially if there is a reasonable cause for it.
And like I said before, I do feel like it never ends, which is depressing in itself. Like, I still feel as though I'm working at finding the right drugs--- I feel like I need to tweak my lith and Seroquel, and I feel like I need to try some thing(s) for the attention problems, which might take a long time. And I feel like I need to focus on therapy and trying to figure myself out and work on techniques for dealing with social situations/problems and emotions...... it just seems to go on and on.....
Posted by barbaracat on June 27, 2005, at 16:07:35
In reply to Re: More newbie Lithium questions » Sabino, posted by yesac on June 27, 2005, at 14:11:16
Have you tried to go without Seroquel and just stick with Lithium? Hate to knock Seroquel because I know it's helped many, but I had a rotten time on it. It has a very strong anti-histimine component and unfortunately, it doesn't get any better with a lower dose.
I felt constantly fuzzy headed, tired, and more depressed and it never improved. Yes, it did provide extra anti-mania/anit-anxiety benefits but I'm not always manic and the spaced out feeling produced it's own weird anxiety. If I were in the midst of a raging manic episode I wouldn't hesitate to pop a Seroquel, Zyprexa or any other AP, but as long-term maintenance - why? It doesn't make sense. As a sleep-aid? C'mon, that's a pretty hard hitting sleeper. Dopamine antagonism and Tardive Dyskenesia is alot to risk for a mainly anti-histamine knock-out.
I know that antipsychotics are the current darlings of bipolar polypharmacy but IMHO prescribed far too frequently. The clinical literature is full of hope for it's antidepressant abilities, but the anecdotal reports just don't bear this up.
If I were looking to conduct a controlled trial and wondering which med to tweak first it would be Seroquel, not Lithium. You might do just as well on 600mg Li and take the occasional benzo as needed for sleep and anxiety. On a good mood stabilizing regimen you could try a low dose AD. Maybe not Prozac cause it's so activating, but there are plenty out there to choose from and once you're stable but not comatose, that part should go much more smoothly. - Barbara
Posted by crazyteresa on June 27, 2005, at 18:24:03
In reply to Re: Does anyone like lithium? » crazyteresa, posted by ed_uk on June 27, 2005, at 10:36:17
> Perhaps the dose is too high. Some people start off on 300-450mg per day. Can you call your doc and ask to reduce the dose?
>
> ~EdHey Edward!
She is supposed to call me tomorrow once she gets the results back from my blood test, but told me to keep taking it until then. I'll tell her what you suggested. This really sucks!
Thanks a bazillion!
crazy t
Posted by ed_uk on June 27, 2005, at 19:01:03
In reply to Re: Does anyone like lithium? » ed_uk, posted by crazyteresa on June 27, 2005, at 18:24:03
Hi!
Post your blood results :-)
~Ed
Posted by yesac on June 29, 2005, at 12:12:21
In reply to Lithium - is Seroquel necessary? » yesac, posted by barbaracat on June 27, 2005, at 16:07:35
> Have you tried to go without Seroquel and just stick with Lithium?
Well, I had been on Seroquel for about 6 months before starting lithium. It helped me sleep, maybe helped calm me down a little. But when the lithium started kicking in, I had the same thoughts as you---- I didn't think I needed Seroquel anymore. I thought all it was doing was helping me sleep, and yeah, I figured I could take something else for that. So I went off Seroquel for 4 days. I took trazodone to help me sleep. After about 2 days, I started to completely fall apart, and it got worse and worse. I pretty much slipped right back down into an agitated despairing suicidal depression.
So, lesson learned, I went back on Seroquel, and things got better after a couple more days. So as much as I would like to go off of it because I do think it's probably more responsible for my lethargy and tiredness, basically I'm afraid to. I already tried once and it was a disaster. The thing is, it seems like I need both of them together, because when I was on S alone, it didn't seem to do that much, and when I was on Lithium alone, it didn't seem to do much.
In many ways, drugs really suck.
I suppose I could try something else instead of the Seroquel, but at this point, I feel like I've just barely reached some kind of stability and feeling somewhat okay, so maybe I should just stay put for the meantime. I've switched regimens so much over the past few years that it might be time to just stay where I am and try to tweak that. Honestly, I just don't know what to do.
> If I were looking to conduct a controlled trial and wondering which med to tweak first it would be Seroquel, not Lithium.I might try to take less Seroquel instead of less lithium. I need to talk to my psychiatrist to help me decide. One thing is that I think lithium augments Seroquel for me, and so it's like I need less Seroquel to get the same or even better benefits than when I was on it alone.
> On a good mood stabilizing regimen you could try a low dose AD. Maybe not Prozac cause it's so activating, but there are plenty out there to choose from
I'm thinking about it. Maybe Zoloft? I had a really bad experience with Prozac even when I was on lithium, so I doubt that I'd ever try that again.... plus, it makes me worry about any antidepressant, even though they're not all so activating.
Posted by barbaracat on June 29, 2005, at 13:04:40
In reply to Re: Lithium - is Seroquel necessary?, posted by yesac on June 29, 2005, at 12:12:21
>
> I might try to take less Seroquel instead of less lithium. I need to talk to my psychiatrist to help me decide. One thing is that I think lithium augments Seroquel for me, and so it's like I need less Seroquel to get the same or even better benefits than when I was on it alone.
>
**That's what I suspect too. Lithium does seem so augment many meds. Not benzos for me, unfortunately, but I need less of everything else.Obviously there's something going on with Seroquel that is helping you. Antipsychotics usually work their magic on schizoprenics by decreasing dopamine. Serotonin has an inverse effect on dopamine. I'm just scratching my head here, but increasing serotonin might be one way to do the same thing but without the histamine thing.
This morning I have first hand experience of that. I couldn't sleep last night and grabbed two of what I thought were temazepams from the cabinet. This morning could not rouse myself until the pee problem got critical and I'm still wobbling around forcing myself to not go back to bed. Looked at the pill bottle I'd left on the counter and it was doxepin, not temazepam! Dox is a heavy histamine hitter and every time I take one of those kinds of meds I feel out of it the whole day.
So, working with your pdoc you might be able to come up with something that can substitute the positive benefits.
>
> I'm thinking about it. Maybe Zoloft?**Zoloft is a darn good AD. It was the only one I could tolerate for long periods of time and on high doses, even not being on lithium. So far I'm happy with Cymbalta at a micro dose, but if I were to switch it would be back to Zoloft.
>>I had a really bad experience with Prozac even when I was on lithium, so I doubt that I'd ever try that again.... plus, it makes me worry about any antidepressant, even though they're not all so activating.
**I understand. Sometimes I become convinced that once you start taking them, a permanent change occurs and you need them for life. But considering the dramatic change for the better I now feel after restarting a very small dose of an AD with lithium after years of being off, I know I need something.
When we're depressed we don't track right and worry about things that generally have solutions. It's usually when I'm not taking a med, or too little of the right one that I worry I'll need it forever. I worry about everything when I'm in an anxious depression. It's when I'm feeling good I usually have more enjoyable things to think about and my heart is filled with thanks for the little chemistry elves who make my pills. Good luck and hope you get the right combo. - Barbara
>
>
Posted by barbaracat on June 29, 2005, at 15:39:36
In reply to Re: barbcat, won't you have to stop the cymbalta? » ravenstorm, posted by barbaracat on June 25, 2005, at 1:11:52
Hi All,
Wanted to keep you posted on my attempts to wean off lithium. I guess it was a total of 3-1/2 weeks of reducing from 600 to 300mg and stayed there for a week. I started to feel just not good. Mildly depressed wanting to sleep all day and yet slightly agitated too. Colors not as bright, vaguely irritated and wanting a drink REAL bad.The slow titration down didn't produce any glaring symptoms but I was beginning to realize that, along with the mild depression and agitation, I wasn't thinking as clearly. It's hard to recall lessons previously learned at such a cost, it's hard not to feel cynical about attempting to be positive, and all those worthy resolutions to go out and get more exercise and blah blah go out the door when the brain and body aren't tracking well. When I'm chemically challenged, I become a different person with different memories and attitudes. I'm lucky, I pulled back early enough in time before getting caught in a nose dive in a plane whose controls aren't responding.
I don't claim to know how any of these meds work, but understand that the means by which lithium works seems to involve a delicate balance of ionic calcium levels within the neuron to allow appropriate firing down axon's path. What I was beginning to experience was the hint of disruption of this smooth firing.
It was a good trial, good to know that I do better with lithium and should not stop, and good that I didn't just stop like I've done in the past with severe mixed states results every time. Humbling knowing that I'm so beholden to a med that has it's own separate problems (weight gain, thyroid), but in the end thankful that it exists and it makes this imperfect physical vehicle able to navigate life better. - Barbara
Posted by crazyteresa on June 29, 2005, at 19:16:30
In reply to Re: Does anyone like lithium? » crazyteresa, posted by ed_uk on June 27, 2005, at 19:01:03
> Hi!
>
> Post your blood results :-)
>
> ~EdThey called me at Tues. morning to tell me the lab had spilled my sample and to come in and give a new one. Figures! I stopped the Lithium. I can't take it. Haven't had any for several days and am feeling better. What should I try next? See the md next week.
Posted by crazyteresa on June 29, 2005, at 19:18:57
In reply to Re: Does anyone like lithium?, posted by crazyteresa on June 29, 2005, at 19:16:30
Posted by ed_uk on June 29, 2005, at 21:14:49
In reply to Re: Does anyone like lithium?, posted by crazyteresa on June 29, 2005, at 19:16:30
Hi!
Can you try 450mg/day. It can be so much better when the dose is right :-)
~Ed
Posted by Dave001 on June 30, 2005, at 12:55:01
In reply to Does anyone like lithium?, posted by yesac on June 8, 2005, at 14:02:37
I've never touched lithium so I can't comment from experience, but it's interesting to note that in animal studies, the effects of lithium seem to be counteracted by inositol, which is not surprising since inhibition of inositol monophosphatase is supposedly the mechanism through which lithium exerts its therapeutic effect.
Posted by barbaracat on June 30, 2005, at 13:06:52
In reply to Re: Does anyone like lithium?, posted by Dave001 on June 30, 2005, at 12:55:01
> I've never touched lithium so I can't comment from experience, but it's interesting to note that in animal studies, the effects of lithium seem to be counteracted by inositol, which is not surprising since inhibition of inositol monophosphatase is supposedly the mechanism through which lithium exerts its therapeutic effect.
>**There's alot of contention on that, with some studies showing that myo-inositol helps with depression via the second messenger system. The question remains, when to take it? Probably not in a manic phase but maybe in a depressive bipolar stage. I've personally found it very helpful but I don't take it all the time, and it's indicated to give it a periodic rest.
Posted by Maximus on June 30, 2005, at 13:57:13
In reply to Back on lithium, posted by barbaracat on June 29, 2005, at 15:39:36
>I started to feel just not good. Mildly >depressed wanting to sleep all day and yet >slightly agitated too. Colors not as bright, >vaguely irritated and wanting a drink REAL bad.
Hi Barbaracat,I really feel the same. I'm like you. I'm bipolar II, mainly on the depression side. I've tried everything known to the mankind on earth. Lithium remains the only thing which stabilizes me. Of course i have read a lot on mental illness, mostly on bipolar disorder. But do you have an idea why we share this characteristic, i.e. to be VERY good responder to lithium?
Posted by barbaracat on June 30, 2005, at 14:41:15
In reply to Re: Vive le Lithium! » barbaracat, posted by Maximus on June 30, 2005, at 13:57:13
**Hi Maximus,
I wonder the same thing. None of the other mood stabilizers, anticonvulsants do a thing for me, only lithium. I've been on the trail of how it works for some time and, as with most research when they don't know, theories keep changing. But I'm doubly intent on finding out now after this recent experiment because whatever it is that makes us so susceptible to what lithium does no doubt affects other bodily systems as well.In the end it's probably going to be explained by faulty gene sequencing, but why and how it responds to lithium would be a valuable piece of information. I'll let you know what I dig up and you do the same, OK? - Barbara
>
> I really feel the same. I'm like you. I'm bipolar II, mainly on the depression side. I've tried everything known to the mankind on earth. Lithium remains the only thing which stabilizes me. Of course i have read a lot on mental illness, mostly on bipolar disorder. But do you have an idea why we share this characteristic, i.e. to be VERY good responder to lithium?
>
>
>
Posted by yesac on June 30, 2005, at 17:55:17
In reply to Re: Vive le Lithium! » Maximus, posted by barbaracat on June 30, 2005, at 14:41:15
>> I wonder the same thing. None of the other mood stabilizers, anticonvulsants do a thing for me, only lithium. I've been on the trail of how it works for some time and, as with most research when they don't know, theories keep changing. But I'm doubly intent on finding out now after this recent experiment because whatever it is that makes us so susceptible to what lithium does no doubt affects other bodily systems as well.
Well, I don't know either, I have no idea how it works or why some people respond. But it seems to be basically the only thing that has worked for me so far, out of many many drugs. And, as I've mentioned, I'm not even diagnosed as bipolar, just sort of an agitated depression/ mixed state type thing. Supposedly, lithium works *best* for people who are "classically bipolar" (ie bipolar 1), and anticonvulsants work better for other forms of bipolar and non-classic features like rapid cycling or mixed states. Anyways, I don't know if that holds any truth.But there are some people who do not respond at all to lithium.
I guess it's just like other drugs too. I mean, why did I not respond to so many other things? But some people do. Lots of people do. Why? And why does it seem that I do not respond to stimulants for attention problems, even though so many people do? In the end, no one knows these answers, at least not yet.
Posted by yesac on June 30, 2005, at 18:00:55
In reply to Back on lithium, posted by barbaracat on June 29, 2005, at 15:39:36
I think that every now and then, people feel a need to screw around with their drugs. Nothing's ever perfect, and you want to see if there's some way it could be better. Or, who wants to be on a drug if you don't really need it? There is no way to find the answers except by trying little "experiments".... and it seems like that's what you were doing. Every time we take a drug, in fact, is basically a new experiment. So, you tried it, you got your answer, and now you know.
It does suck to be beholden to a drug or to anything really, to depend on it and know that you must take it, but I guess it's just like with any other illness really.
Posted by yesac on June 30, 2005, at 18:14:51
In reply to Re: Lithium - is Seroquel necessary? » yesac, posted by barbaracat on June 29, 2005, at 13:04:40
> Obviously there's something going on with Seroquel that is helping you. Antipsychotics usually work their magic on schizoprenics by decreasing dopamine. Serotonin has an inverse effect on dopamine. I'm just scratching my head here, but increasing serotonin might be one way to do the same thing but without the histamine thing.Yeah, I don't know how it's working... all I know is that when I was on either one alone, it just didn't cut it.
>
> So, working with your pdoc you might be able to come up with something that can substitute the positive benefits.Well, I talked to him today and decided to try cutting back to only 25mgs of Seroquel, which is a very low dose. He said that it was most likely the S that was causing my tiredness and lethargy, which is what I had suspected. Technically I could go down on either, because if it's true that lith is augmenting S, even reducing the lith should theoretically decrease the effects of S. Just a thought. So I'm gonna go down on Seroquel, if things get worse, then I'll go back up and try reducing the lithium. That's the plan for now.
I haven't been feeling too hot lately anyways, just kind of down and depressed. It probably has a lot to do with my life and my dissatisfaction and my many many issues, and a feeling of hopelessness about everything. But it's still not as bad as before because I'm not agitated and constantly flipped-out and upset. Still, I'd like to feel better. I think the tiredness itself makes me depressed though too, and feeling like I have no energy. I'm worried because it seems like I feel more upset lately.
> **I understand. Sometimes I become convinced that once you start taking them, a permanent change occurs and you need them for life.
Well I certainly don't think that I've become dependent on any antidepressants. None of them have helped me at all to begin with. I would just like it if something could help me. Besides the lith/Seroquel of course.
Posted by Sabino on June 30, 2005, at 19:33:04
In reply to Re: More newbie Lithium questions » Sabino, posted by yesac on June 27, 2005, at 14:11:16
>> And like I said before, I do feel like it never ends, which is depressing in itself. Like, I still feel as though I'm working at finding the right drugs--- <<
Man, I so completely agree with this. What a struggle. My initial tremendous response to Li is now not as tremendous. Sometimes, when I feel really wound up, and I take at least 150, it calms me right down, and is a godsend. Today makes two weeks that I've been trying it. There have been times these last couple of days that I've felt as nervous as a cat on a hot tin roof. But I've only been taking a small amount.
I guess I really need to try upping the dose to see if that'll be okay. Today I'm almost up to 600mgs. I chip away at the tabs throughout the day to try and even it out, even though they're supposed to be sustained release (damned fast metabolism strikes again.)
Plus, today was just my second day back at work after taking two months off, and truth be told, I don't feel all that much better now than I did two months ago. At least I can joke about it a little bit. Like saying 'what's the office pool up to on how long I'll stay'. See, I tried to go back a couple of weeks ago, and lasted five minutes before my anxiety attack had me heading for the door.
Anyway, I'm still trying to tweak this thing too.
Effexor XR 150mgs
Remeron 15mgs (for sleep)
Lithium (around 500mgs)That's my story and I'm stickin to it... til I find a better one.
Posted by crazyteresa on July 1, 2005, at 10:32:30
In reply to Re: Does anyone like lithium? » crazyteresa, posted by ed_uk on June 29, 2005, at 21:14:49
> Hi!
>
> Can you try 450mg/day. It can be so much better when the dose is right :-)
>
> ~EdI'll try it just for you! ;~}
crazy t
Posted by barbaracat on July 1, 2005, at 13:08:45
In reply to Re: Vive le Lithium! » barbaracat, posted by Maximus on June 30, 2005, at 13:57:13
Hi Maximus,
Most of the research I found was pretty much based on findings new to 1998 when this article was published, but I think this one explains it clearly. I can imagine that they'll find a genetic anomaly in bipolars that account for a faulty glutamate set-point. The questions is, if low glutamate levels supposedly account for the depression phase of bipolar and vice-versa, why isn't glutamate used more to tweak low and high moods? The amino acid L-glutamate is a supercharged excitatory amino acid, so why isn't anyone looking in this area?Newer research also points to glutamate not clearing from the cells because there aren't enough glial cells in bipolars to mop it up. Now, how one gets more glial cells is the questions, however, rumor has it that lithium actually makes more of the little buggers! Good old lithium. Not only makes you feel good - it's good for you!
Here's an article found in a number of websites:
NEW RESEARCH EXPLAINS LITHIUM'S DUAL ANTI-MANIC/ANTI-DEPRESSIVE EFFECT
MADISON, WI. -- July 6, 1998 -- Researchers at the University of Wisconsin Medical School have solved the puzzle of how one drug - lithium - can effectively stabilise both the wild euphoria and the crushing melancholy that are the hallmark of manic depression, or bipolar disorder.
As reported in the July 7 Proceedings of the National Academy of Sciences, the researchers found that in mice brains, lithium exerts a push/pull effect on the neurotransmitter glutamate, eventually causing it to level off in a stable zone where it can control both extremes.
“Glutamate is the primary excitatory neurotransmitter, carrying messages instantaneously from one nerve cell to another in 85 percent of the brain,” said UW Medical School professor of pharmacology Dr. Lowell Hokin, who directed the research. Other neurotransmitters include serotonin, dopamine, norepinephrine and acetylcholine.Under normal circumstances, an impulse from a nerve cell releases a flood of message-bearing glutamate aimed at a neighboring neuron across the synapse. A structure on the end of the releasing nerve cell, called a reuptake transporter, then shuts off the signal by reabsorbing the glutamate, pumping it back into the cell for reuse.
If the reuptake mechanism malfunctions, inappropriate concentrations of neurotransmitter remain in the synapse. Hokin postulates that abnormally low glutamate levels are involved in depression, while elevated levels are responsible for mania.
Nearly a half century ago, Australian psychiatrist John F. Cade discovered lithium’s mood-stabilizing effect. It has long been the drug of choice in treating bipolar disorder, which affects approximately 2.5 million Americans. Despite some side effects, lithium usually successfully dampens the mood swings that in the most severe cases end in suicide, the dire result for one in five untreated or unresponsive bipolar patients.
In an earlier study (reported in PNAS, Aug. 30, 1994), Hokin and his colleague showed that lithium causes glutamate to accumulate in synapses of mice and monkey brain slices, but exactly how it worked remained unclear until now.
In the current study, functioning slices of mice brain were examined following exposure to lithium, while control slices were not exposed to the drug. The researchers observed that lithium raised the glutamate level by slowing its reuptake. The higher the lithium dose, the greater the inhibition, they found.
To study the chronic effect of the lithium, the UW team administered it to live mice for two weeks. To their surprise, they saw that glutamate reuptake increased. This “up-regulation” resulted in less neurotransmitter in the synapse, which would produce an anti-manic effect.
“We were especially interested to find that the reuptake mechanism in the 18 lithium-treated mice was stabilised in a very narrow range, compared to the 18 controls,” he said.
Hokin speculates a compensatory mechanism in the reuptake system strives over time to reset raised glutamate levels down into a fixed range. When the levels are too low, as postulated in depression, lithium brings them up into the stable region.
The research findings support clinical observations, he noted. “It takes a few weeks before lithium begins to relieve depression and mania in bipolar patients,” he said. “It’s now apparent an adaptive reuptake mechanism that brings glutamate within a ‘normal’ range works over time to curb both the highs and lows.”
What’s more, he added, lithium doesn’t change the moods of people who aren’t bipolar, suggesting that their glutamate levels may be positioned consistently within the set zone, and therefore would not be affected by the drug.
Posted by barbaracat on July 1, 2005, at 13:26:43
In reply to Re: Vive le Lithium! Maximus/Barbaracat, posted by yesac on June 30, 2005, at 17:55:17
I've heard also that lithium responds better to bipolar I and I believe that's what I am. Other mood stabilizers that have worked for BP-II acquaintenances have done nothing for me.Most of my bipolar episodes have fallen in the milder II class, but I have had some absolute corker manias complete with hallucinations and hellish psychotic mixed states depressions which I understand is a BP-I phenomenon. All you need is one truly classic BP-I experience to know how different it is from BP-II. Unlike going from a 3-speed to a 10-speed bike, or dial-up to DSL, it's not just a matter of same thing but higher speed and intensity, but something different altogether. For me, I'd have to say the difference is greater intensity, but with definite psychosis, both enjoyable and horrific.
It feels distinctly electric to me. In fact, with many of the artists labeled 'bipolar', you can see this electric quality to their paintings, jaggy spiky outlines and such.
I read about glutamate, calcium and so on, but my gut feeling is that lithium, being an elemental metallic salt, is primarily electically conductive and that's where the business goes on. - Barbara
> >> I wonder the same thing. None of the other mood stabilizers, anticonvulsants do a thing for me, only lithium. I've been on the trail of how it works for some time and, as with most research when they don't know, theories keep changing. But I'm doubly intent on finding out now after this recent experiment because whatever it is that makes us so susceptible to what lithium does no doubt affects other bodily systems as well.
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> Well, I don't know either, I have no idea how it works or why some people respond. But it seems to be basically the only thing that has worked for me so far, out of many many drugs. And, as I've mentioned, I'm not even diagnosed as bipolar, just sort of an agitated depression/ mixed state type thing. Supposedly, lithium works *best* for people who are "classically bipolar" (ie bipolar 1), and anticonvulsants work better for other forms of bipolar and non-classic features like rapid cycling or mixed states. Anyways, I don't know if that holds any truth.
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> But there are some people who do not respond at all to lithium.
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> I guess it's just like other drugs too. I mean, why did I not respond to so many other things? But some people do. Lots of people do. Why? And why does it seem that I do not respond to stimulants for attention problems, even though so many people do? In the end, no one knows these answers, at least not yet.
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