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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by BorderlinePersona on November 6, 2005, at 22:48:50
I am currently on 150 mg Efexor, and have been advised to augment with Li.
All i've read on it seems very scary.
i want to hear some personal experiences.
much respect.
Posted by med_empowered on November 7, 2005, at 12:27:46
In reply to ANY info on Lithium, posted by BorderlinePersona on November 6, 2005, at 22:48:50
I've always refused to take Lithium...friends of mine who have inevitably gained weight, developed acne, and/or became dull as blazes. But that's just a few people...some people love the stuff, although there is a really high non-compliance rate (60 or 70sumthin percent, I think) so it would appear most people dont like the stuff. Did your doc explain why lithium was the augmenting agent of choice?
Posted by Emily Elizabeth on November 7, 2005, at 13:22:56
In reply to ANY info on Lithium, posted by BorderlinePersona on November 6, 2005, at 22:48:50
Hello,
I take a low-ish dose of Li (600mg)to augment my antidepressants (lexapro, desipramine, dexedrine, neurontin, ambien). It does seem to have made a difference in my mood and I don't really experience many side effects other than what I already had. I've heard that side effects are somewhat dose-related. If you are on a low dose, you are less likely to experience s/e's.
But, it wasn't the 1st thing we tried. If you'd share any other meds that you take, what you have tried before, and what you are trying to treat I;m sure that several of us would have more input.
Welcome to Babble!
Best,
EE
Posted by Squiggles on November 7, 2005, at 15:13:45
In reply to ANY info on Lithium, posted by BorderlinePersona on November 6, 2005, at 22:48:50
> I am currently on 150 mg Efexor, and have been advised to augment with Li.
> All i've read on it seems very scary.
> i want to hear some personal experiences.
> much respect.Hi Borderline Persona,
I just saw your message as I was elsewhere
on the net :-)Lithium is a good drug for bipolar disorder
and a good drug as an adjunct for depression.
My experience with it can only be described
as a very fortunate gift. It has its side
effects of course.I just hope that you have a doctor who can
adjust the drug to your body gradually and
accurately.Hope it works for you.
Squiggles
Posted by Squiggles on November 7, 2005, at 15:30:39
This is an excellent site for
people taking lithium. This group
may have the greatest expertise
in lithium research. It was
started by the pioneer of lithium
medicine - Dr. Mogens Schou of Denmark:IGSLI
International Group for the Study
of Lithium Treated Patients:-----------------
You might also like to look at the textbook
on bipolar with lots of info. on lithium:"Manic Depressive Illness"
by Drs. Frederick K. Goodwin
and Kay Redfield Jamison
Squiggles
Posted by blueberry on November 7, 2005, at 18:05:02
In reply to ANY info on Lithium, posted by BorderlinePersona on November 6, 2005, at 22:48:50
Lithium has been around for decades and has a good track record. As for side effects, the doses needed for depression are low...150mg to 600mg. I've heard people get good antidepressant augmentation effects at just 150mg to 300mg, and that side effects in that range are nil to minimum. I'm considering it myself.
Posted by BorderlinePersona on November 7, 2005, at 20:09:08
In reply to Re: ANY info on Lithium, posted by med_empowered on November 7, 2005, at 12:27:46
yes the range for toxicity and therapeutic benefit is quite close. my doc said lithium because he uses it often in cases lie mine with great success. i started it today and do feel a lil dazed. im just going to see how it goes. thanx for the info
> I've always refused to take Lithium...friends of mine who have inevitably gained weight, developed acne, and/or became dull as blazes. But that's just a few people...some people love the stuff, although there is a really high non-compliance rate (60 or 70sumthin percent, I think) so it would appear most people dont like the stuff. Did your doc explain why lithium was the augmenting agent of choice?
Posted by BorderlinePersona on November 7, 2005, at 20:21:36
In reply to ANY info on Lithium, posted by BorderlinePersona on November 6, 2005, at 22:48:50
I am on 150mg Efexor XR. in the past i have been on zoloft, luvox, citalopram, aropax, mirtazapine, edronax, sodium valproate, xanax, seroquel, temazepam and stilnox. all for different causes, all stopped because of no effect or side effects. im sure ive missed a few out. anyway i have borderline personality disorder (as i understand anyway) i have been given many diagnosis. i have started taking Lithium at 250mg twice daily. that started today. so far just some nausia and dazed out feeling.
going to give it a shot anyway
thanx everyone for your input
Posted by Phillipa on November 7, 2005, at 20:46:21
In reply to ANY info on Lithium:more info, posted by BorderlinePersona on November 7, 2005, at 20:21:36
You did say you were getting blood levels done? Very important as everyone reacts differently to meds. And the two side effects I've seen are trembling hands and wt gain. Fondly, Phillipa
Posted by Emily Elizabeth on November 7, 2005, at 21:03:37
In reply to ANY info on Lithium:more info, posted by BorderlinePersona on November 7, 2005, at 20:21:36
Good luck w/ the Li! The side effects that you mention are what I experienced for the 1st week or so, but then they went away. Hope they do for you too. It sounds like it is probably a good shot for you as you have tried so many things before.
Keep us posted!
Best,
EE
Posted by Bobby on November 7, 2005, at 21:40:11
In reply to ANY info on Lithium, posted by BorderlinePersona on November 6, 2005, at 22:48:50
Lithium was the first drug they put me on. It worked--but my hands shook so bad that I had to stop. I couldn't sign my name on a piece of paper. Best of luck--maybe you won't have that problem.
Posted by CareBear04 on November 8, 2005, at 10:38:21
In reply to Re: ANY info on Lithium, posted by Bobby on November 7, 2005, at 21:40:11
you can always take propranolol for the shakes. i've had good luck with lithium-- it is my mood stabilzier of choice-- though i've also been very toxic more times than i can count. be sure to get the lithium levels monitored, and you'll probably be fine.
Posted by BorderlinePersona on November 8, 2005, at 19:08:42
In reply to Re: ANY info on Lithium » Bobby, posted by CareBear04 on November 8, 2005, at 10:38:21
So its my second day on lithium. side effects so far : sweating, dazed feeling, slight nausia, some sleeping difficulty (nothing new) and a strong metalic taste when i smoke a cigarette. i cant even finish a whole cigarette. But im not complaining as ill soon be giving up. The dazed out feeling itself is actually quite comfortable but probably wouldnt be the best if i had a more active lifestyle. anyway ill see how it goes, just lettin everyone know the situation.
Posted by Squiggles on November 8, 2005, at 19:10:40
In reply to Re: ANY info on Lithium: Day 2 Li, posted by BorderlinePersona on November 8, 2005, at 19:08:42
Sounds high to me;
Squiggles
Posted by BorderlinePersona on November 8, 2005, at 20:02:54
In reply to Re: ANY info on Lithium: Day 2 Li, posted by Squiggles on November 8, 2005, at 19:10:40
are you suggesting my lithium levels may b 2 high allready? or are u saying 'high' as in the state its put me in ahaha. im a lil worried all the negativity ive read on Li may effect the way i think its working. does anyone actually know HOW it helps/works? Ive read some on its connection to glutamate. all very scientific and sometimes hard to follow.
:S dunno
Posted by Squiggles on November 8, 2005, at 20:12:03
In reply to Re: ANY info on Lithium: Day 2 Li » Squiggles, posted by BorderlinePersona on November 8, 2005, at 20:02:54
It's the sweating that is unusual,
i think. I don't mean to alarm you
as your doctor is probably monitoring
you, but the sweating unlike the other
symptoms made me suspicious that it
may be too high.Squiggles
Posted by BorderlinePersona on November 8, 2005, at 20:17:38
In reply to Re: ANY info on Lithium: Day 2 Li, posted by Squiggles on November 8, 2005, at 20:12:03
thanx for the concern. more info: i live on the gold coast in australia, its a tropical environment with alot of humidity. I think that may explain my sweating, if i were peeing more than usual on top of the sweating i may be a bit more alarmed but theres been no increase there. I also drink 2.5+ litres of water a day.
Posted by Squiggles on November 8, 2005, at 20:43:15
In reply to Re: ANY info on Lithium: Day 2 Li » Squiggles, posted by BorderlinePersona on November 8, 2005, at 20:17:38
Borderline,
If you check the keywords
lithium
sodium
sweating
urinationyou will find many sites indicating the
danger of sweating too much for whatever
reason -- if not dangerous, it will at least
raise your lithium level, esp. if you
are not voiding.Here is a similar example to the topic:
http://www.bipolarworld.net/Phelps
"Q: Relationship of Lithium, Salt & Loss of Body Fluids
Dear Dr. Phelps,I suffer from Bipolar I and I have been taking lithium for the past year. In addition to lithium, I control my symptoms through diet and lots of exercise, mostly walking, biking and swimming. Given the hot summer months, I am sweating more than ever and I would like you to explain the relationship of lithium and salt and the loss of body fluids. I always drink tons of water after exercise and I eat pickles to replenish my salt levels, because that's what it says to do on my medication instructions. But I'd like to know how it works.
Thanks for helping bipolar patients everywhere.
Nancy
Dear Nancy --
I love it when people "want to know how it works". There's a pretty simple explanation which also helps understand why anything that makes you lose water can raise your lithium level, and it's useful to know, because of another way of becoming dehydrated, namely when you're sick, as you'll see below.Lithium is an "element", as you may recall from high school chemistry. You might even remember that it is closely related to sodium, the "main ingredient" in table salt (and in the brine used to pickle cucumbers, making those pickles you eat). Sorry, the chemists in the crowd are going to choke. I don't think this is too tough. If you had trouble in high school chemistry, don't worry, this is super-simple. Table salt is sodium chloride, remember. That's useful, because the lithium you take is lithium chloride. They're that similar to one another (as you can see on the periodic table of elements, even, where they're next door neighbors: Li and Na).
They're so similar, in fact, that your kidney handles them both in the same way. When your kidney is hanging on to sodium, which is one of its jobs, it hangs on to lithium at the same time. Your kidney filters your blood and the "pulls back" into your system all the things that it filtered out that you want to keep, letting the rest go into your urine. That's how it gets rid of the things its supposed to get rid of. It can even get rid of sodium, if you've got too much, such as when you eat a pizza or chips. It just doesn't re-absorb some of the sodium, letting it go on downstream in the urine. It will lose some of your lithium in this way also, though we don't usually worry about losing a little in this fashion.
The opposite is the problem, when your kidney is holding on to sodium. There's just one more step needed to understand why this works as it does. Sodium, as in table salt, pulls water toward it (remember about "osmosis"?). So when your body wants to hang on to water, it does so by hanging on to sodium. This also ends up stimulating your thirst, so you'll go get something to drink! Ah, but there's the problem: when your body hangs on to sodium, it also hangs on to lithium. If you become very dehydrated, it will hang on to a lot of sodium, and thus a lot of lithium, that it would usually be letting go into the urine.
So while 900 mg or 1200 mg of lithium might give you a blood level of 0.8, if you get dehydrated you can get up to 1.0 or even a bit higher. Side effects like tremor are common as your blood level goes up. So, as you can see, one of the ways to treat a tremor that just comes on once in a while is to have people drink more water: the body will conclude that it doesn't have to hold on to as much sodium, and let go of some lithium in the process, lowering the blood level just a bit, and the tremor can diminish or even stop.
The other main way to lose a lot of water is diarrhea, or vomiting. If you get the "flu" for example, and can't keep fluids down without throwing up (yecch, I hate that); and especially if you have diarrhea at the same time; then you can become very dehydrated, probably much more than you would from sweating or exercise. Some psychiatrists recommend that you stop taking lithium at that point, until you can keep fluids on board. (When in doubt, call her or him and ask). Because if you get a high blood level of lithium, that itself can make you sick and cause nausea and diarrhea, which as you can see could lead to a "loop" in which your blood level goes up and you get sicker and can't keep fluids on board so your lithium level goes up further, and so on. If you're still taking lithium during that loop, that's when you can get far too high a lithium level (beyond 1.5) and get really sick.
However, don't everybody start worrying they're going to end up really sick from taking their lithium, please. I don't think I've ever seen somebody get such a high lithium level from exercise in the sun that they ended up in the emergency room with severe symptoms from this. It could happen, and if you're a serious athlete you definitely have to be careful to stay hydrated. But the main way people end up with too high a lithium level is when they keep taking lithium after they've already had their level get too high for some reason. If something changes your kidney function, for example, such as a new blood pressure medication (most of them shift lithium levels) or a medication for pain (the "non-steroidal anti-inflammatories, or NSAIDS, such as ibuprofen (Motrin), naprosyn (Naproxen), and others can also significantly shift lithium levels), you need to know what has happened to your lithium level. This is by far the most common basis for getting "lithium toxicity".
Thanks for your question.
Dr. Phelps"
Published September, 2005
-------------
hope that helps;
Squiggles
Posted by BorderlinePersona on November 10, 2005, at 0:06:33
In reply to Re: ANY info on Lithium: Day 2 Li, posted by Squiggles on November 8, 2005, at 20:43:15
Wow, i awoke today feeling more relaxed than i have been in a very long time. this feeling has stuck around the entire day. its great. my only doubt is the fact that this early in treatment, lithium couldnt be the cause yet, could it!?
150mg Efexor Xr + 500mg Lithicarb... ive read alot about its success in treatment resistant depression and bipolar. It also just feels right.
blah blah blah... :)
Posted by Squiggles on November 10, 2005, at 8:09:16
In reply to Re: ANY info on Lithium: Day 3 Lithium, posted by BorderlinePersona on November 10, 2005, at 0:06:33
I'd find it surprising too-- whether lithium/and/or
effexor, esp. with the lithium at that tiny dose.
But -- if it keeps up, why look a gift horse
in the mouth?Squiggles
Posted by Emily Elizabeth on November 10, 2005, at 9:16:17
In reply to Re: ANY info on Lithium: Day 3 Lithium, posted by BorderlinePersona on November 10, 2005, at 0:06:33
I think it is possible that what you are feeling is the Li. It only takes 4 days to stabilize the blood level of Li, so it is possible that you are at (or close to) where you'd be feeling its therapeutic effects.
As an augmenting agent, you can get away with a much lower dose of Li. Pdoc says that blood levels of .4-.6 are sufficient for augmenting (higher is needed for bipolar).
My pdoc also says that if you are having success with it, it is likely that you will continue to do so (unlike some of the others like SSRI's which can stop working after a while).
I've got my fingers crossed for you!
Best,
EE
Posted by ed_uk on November 10, 2005, at 13:54:30
In reply to Re: ANY info on Lithium: Day 3 Lithium, posted by BorderlinePersona on November 10, 2005, at 0:06:33
Hi,
>Wow, i awoke today feeling more relaxed than i have been in a very long time. this feeling has stuck around the entire day. its great. my only doubt is the fact that this early in treatment, lithium couldnt be the cause yet, could it!?
Yes! It could. For some people, lithium can work quickly, and at a low dose.
Ed
Posted by BorderlinePersona on November 11, 2005, at 19:30:31
In reply to Re: ANY info on Lithium: Day 3 Lithium » BorderlinePersona, posted by ed_uk on November 10, 2005, at 13:54:30
so its day 5. ive had some wierd nightmares and waking up suddenly startled if someone wakes me up. im a bit bland today so i dont know what to say except i guess lithium is going well. i must admit im talking a bit more and seem to be a little more outgoing.
woo hoo for lithium
Posted by katekite on November 11, 2005, at 22:21:56
In reply to Re: ANY info on Lithium: Day 5 Lithium, posted by BorderlinePersona on November 11, 2005, at 19:30:31
Hi,
Thanks for posting this way, updating. I would love to keep hearing how it is going.
I have thought a bunch of times about trying lithium in a low dose for anxiety, my doc always puts me off about it (my thyroid is already screwed up so he is cautious about things that could affect it).
But calm sounds pretty nice!
Kate
Posted by BorderlinePersona on November 14, 2005, at 1:21:04
In reply to Re: ANY info on Lithium: Day 5 Lithium, posted by katekite on November 11, 2005, at 22:21:56
I had my blood test today for lithium levels and to check my blood count, liver and thyroid function. Will know the results sometime next week. so far i give a thumbs up to lithium for mood stabilizing. I feel as if a large load of anger has been lifted from my shoulders. Side effects were minimal and short lasting. Slight nausia for the first few days, a dazed feeling (that on the third day turned into an intense relaxation feeling that leveled out by day 5) some confusion and sometimes forgeting what im doing. i feel energised and dont sleep as much during the day either.
:) pleased with lithium.,
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