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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by ronaldo on November 2, 2006, at 3:24:26
What is the average maintenence dose for Lithium users? And what is the average blood serum level? Mine is 0.8 mMol/litre and I take 900 mg of Priadel (Lithium Bicarbonate)- a controlled release formulation. 0.8 is within the therapeutic window.
Some people are only taking half of what I take, ie about 400 mg Lithium and do well despite their blood serum being below the therapeutic level. How does this work? Has the therapeutic window been shifted? Are they taking something else, say an AP or an AD which means they can get by with a smaller dose of Lithium? Did they start on a bigger dosage of Lithium and then reduce it later? I would really like to know. I am also taking Olanzapine at 10 mg - recently increased from 5 mg. I would like to lower my Lithium dose but don't want to become ill again.
If you are bipolar and you take Lithium, or you used to take Lithium, I would be really grateful to hear your story. Please help.
....ronaldo
Posted by tensor on November 2, 2006, at 4:42:15
In reply to Bipolars: Lithium levels, dosage and adjuncts., posted by ronaldo on November 2, 2006, at 3:24:26
Hi ronaldo,
i took lithium in the past as an AD augmentor, i reached 1200mg with a blood level at 0.7mmol/L which is in the higher end of the range for unipolar depression, it didn't help though. I've heard stories where people responding to levels as low as 0.2mmol/L. In your case 0.8mmol/L is in the lower end. Don't focus too much at the dosage, it's the blood level that counts, many people take 1500mg with blood levels at 1.2 or more.
Everyone responds differently, if you respond to 900mg/0.8mmol/L that's a good thing. If you don't have other complications, don't reduce dosage; if it ain't broken, don't fix it./Mattias
Posted by ronaldo on November 2, 2006, at 5:52:05
In reply to Re: Bipolars: Lithium levels, dosage and adjuncts. » ronaldo, posted by tensor on November 2, 2006, at 4:42:15
Hi Mattias,
Thanks for your reply.
You said >if it aint broken, don't fix it.<
I know what you mean. But I feel that I have been too compliant with the pdocs in the past and I have sold myself short. I only joined this board just over a month ago. I only recently learned about side effects such as flat affect and avolition (general lack of desire, motivation, and persistence).
In the past I have regarded these evils as simply unavoidable. Now it seems to me they can be 'medicated out'. The medication responsible for these s/e's can be stopped and replaced with something more suitable. There are so many different medications in the market place today. Too many for one patient to try them all even just for one illness like BPD. This is the beauty of a board like this. Patients can share their experiences with each other and it is possible to learn what a certain drug is like without having to take it oneself. Obviously first hand experience is the best.
I would just like to know how other Bipolars have dealt with the s/e's of flat affect and avolition. These two are a nasty pair and I would like to get rid of them. The question is how?
......Alan
Posted by Squiggles on November 2, 2006, at 8:16:38
In reply to Bipolars: Lithium levels, dosage and adjuncts., posted by ronaldo on November 2, 2006, at 3:24:26
I am prescribed 300mg lithium carbonate
3 x per day. I have been on this dose
for more than 20 years now.
When initiated the first year
I was started slowly and raised within a
year (if my memory serves me well).
With that I take 1.50 mg Klonopin.I also take Synthroid for lithium-induced
hypothyroidism - 0.112.I have asked if i could take a smaller dose
of lithium, but my blood levels being
consistently 0.8-1.2, my dr. does not think
it is a good idea to lower it.You may not have seen my post on a counterfeit
lithium batch i took last year -- within 6
months i reached mixed states - a very dangerous
fall. I was able to raise myself out of it by
switching pharmacies and getting the "good" stuff.
I think that is proof that I am bipolar, if there was ever any doubt in my dr.'s mind or mine, or anyone else's.Squiggles
Posted by ronaldo on November 2, 2006, at 9:05:09
In reply to Re: Bipolars: Lithium levels, dosage and adjuncts. » ronaldo, posted by Squiggles on November 2, 2006, at 8:16:38
> I am prescribed 300mg lithium carbonate
> 3 x per day. I have been on this dose
> for more than 20 years now.
> When initiated the first year
> I was started slowly and raised within a
> year (if my memory serves me well).
> With that I take 1.50 mg Klonopin.
>
> I also take Synthroid for lithium-induced
> hypothyroidism - 0.112.
>
> I have asked if i could take a smaller dose
> of lithium, but my blood levels being
> consistently 0.8-1.2, my dr. does not think
> it is a good idea to lower it.
>
> You may not have seen my post on a counterfeit
> lithium batch i took last year -- within 6
> months i reached mixed states - a very dangerous
> fall. I was able to raise myself out of it by
> switching pharmacies and getting the "good" stuff.
> I think that is proof that I am bipolar, if there was ever any doubt in my dr.'s mind or mine, or anyone else's.
>
> Squiggles
>Hi Squiggles,
Thanks for your reply. Do you take a controlled or sustained or extended release form of Lithium? I was surprised to hear that you split your dose in three. Have you always done so? Which lithium brand do you take? I take all my lithium in one dose, 900 mg, at 9.30 pm with my olanzapine 10 mg. That's all I take. Never had thyroid problems luckily.
Do you, or have you ever suffered from flat affect or avolition or anhedonia? (avolition = a psychological state characterized by general lack of desire, motivation, and persistence) social withdrawal? apathy? I have got the whole lot and the purpose of this thread (for me) is to try and find a way out of this depression-like situation.
If anyone has been through this and found a way out of it then I would dearly like to know how they managed it.
....Alan
Posted by Squiggles on November 2, 2006, at 9:31:15
In reply to Re: Bipolars: Lithium levels, dosage and adjuncts. » Squiggles, posted by ronaldo on November 2, 2006, at 9:05:09
...
> Hi Squiggles,
>
> Thanks for your reply. Do you take a controlled or sustained or extended release form of Lithium?No, just regular.
I was surprised to hear that you split your dose in three. Have you always done so?
Yes. The theory that taking it all at once supports the kidneys from glomuronephritis is now obsolete. (see Goodwin and Jamison, "Manic-Depressive Illness" Oxford U. Press);
I have scheduled my drug intake on a regular basis. My experience is that changing that can actually bring on drug-loading side effects. Also, lithium at 900mg in one dose may effect the heart and gut adversely.Which lithium brand do you take?
Carbolith ICNP
I take all my lithium in one dose, 900 mg, at 9.30 pm with my olanzapine 10 mg. That's all I take. Never had thyroid problems luckily.Well, if it agrees with you -- that's good;
My thyroid dose at 0.112mg is at least 10 yrs.
old so it has not been a degenerative thyroid
condition.
>
> Do you, or have you ever suffered from flat affect or avolition or anhedonia? (avolition = a psychological state characterized by general lack of desire, motivation, and persistence) social withdrawal? apathy?I have heard so many people say that about
lithium. No, I have not. Perhaps I was just
way to "vivacious" before, lol :-) No kidding,
it could be the dose.Psychologically, i find lithium just fine -- i just don't like the physical side effects.
I have got the whole lot and the purpose of this thread (for me) is to try and find a way out of this depression-like situation.
>
> If anyone has been through this and found a way out of it then I would dearly like to know how they managed it.
>
If lithium is not treating your depression, then
you better check the dose, the dx, and the possibility of asking for an adjunct. It's possible you have depression. I am sorry to sound so negative about diagnosis, but in psychopharmacology it does seem to be a situation of matching the numbers.Good luck.
Squiggles
Posted by ed_uk on November 2, 2006, at 14:56:27
In reply to Bipolars: Lithium levels, dosage and adjuncts., posted by ronaldo on November 2, 2006, at 3:24:26
Hi Ronaldo
>0.8 mMol/litre
0.6-0.8 is commonly thought to be appropriate in the maintenance treatment of bipolar disorder. Lower levels eg. 0.4 are sometimes adequate when lithium is used to 'augment' an antidepressant in the treatment of unipolar depression ie. when lithium is not being used an an anti-manic.
Ed
Posted by ed_uk on November 2, 2006, at 15:13:04
In reply to Re: Bipolars: Lithium levels, dosage and adjuncts. » Squiggles, posted by ronaldo on November 2, 2006, at 9:05:09
I would consider lamotrigine as a possible treatment. Perhaps, if lamotrigine was helpful, you might be able to reduce your lithium dose? I wouldn't recommend making any abrupt changes to your medication. Lamotrigine is a drug which needs to be introduced gradually - the initial dose is very low......increasing to a therapeutic level over several weeks. After a few weeks on lamotrigine, you might feel able to reduce your lithium dose slightly eg. to 800mg/day.
On the other hand, it's early days on Zyprexa 10mg. Perhaps it would be best not to make any changes to your medication until you've fully stabilised on Zyprexa, which might take a couple of months.
Regards
Ed
Posted by Squiggles on November 2, 2006, at 15:23:08
In reply to Your meds » ronaldo, posted by ed_uk on November 2, 2006, at 15:13:04
> I would consider lamotrigine as a possible treatment. Perhaps, if lamotrigine was helpful, you might be able to reduce your lithium dose? I wouldn't recommend making any abrupt changes to your medication. Lamotrigine is a drug which needs to be introduced gradually - the initial dose is very low......increasing to a therapeutic level over several weeks. After a few weeks on lamotrigine, you might feel able to reduce your lithium dose slightly eg. to 800mg/day.
>
> On the other hand, it's early days on Zyprexa 10mg. Perhaps it would be best not to make any changes to your medication until you've fully stabilised on Zyprexa, which might take a couple of months.
>
> Regards
>
> Ed
There are a number of reasons why I must not
get off lithium and onto another drug:1. My doctor refuses to lower my lithium
dose - i have asked numerous times; and
to tell the truth, when i tried to lower it
myself, i did not feel well at all;2. There is no reason to switch from lithium
to something else; my kidneys are fine, my
thyroid is stable, my psychological state is
good, and my heart is fine. My only real
problem is the typical side effects of lithium
(which is a problem with every drug) and the
diarrhea, which may or may not be due to
lithium.3. Switching to another drug after so many
years would require the possibility of withdrawing from clonazepam (out of the question), adjusting
the thyroxine - very tricky;4. It is not known how the withdrawals and the introduction of a new drug would react on my body after so many years.
5. If it does not work out, it is not known if the damage done could be reversable.
AFTER SO MANY YEARS OF STABILITY AND PSYCHOLOGICAL GOOD HEALTH (which others would envy on the armamatorium of current psychiatric drugs) WHY SHOULD I CHANGE TO SOMETHING EXPERIMENTAL AND CONTRARY TO MY AND MY DR.'s ADVICE?
Squiggles
Posted by ronaldo on November 2, 2006, at 16:11:16
In reply to Re: Your meds » ed_uk, posted by Squiggles on November 2, 2006, at 15:23:08
> > I would consider lamotrigine as a possible treatment. Perhaps, if lamotrigine was helpful, you might be able to reduce your lithium dose? I wouldn't recommend making any abrupt changes to your medication. Lamotrigine is a drug which needs to be introduced gradually - the initial dose is very low......increasing to a therapeutic level over several weeks. After a few weeks on lamotrigine, you might feel able to reduce your lithium dose slightly eg. to 800mg/day.
> >
> > On the other hand, it's early days on Zyprexa 10mg. Perhaps it would be best not to make any changes to your medication until you've fully stabilised on Zyprexa, which might take a couple of months.
> >
> > Regards
> >
> > Ed
>
>
> There are a number of reasons why I must not
> get off lithium and onto another drug:
>
> 1. My doctor refuses to lower my lithium
> dose - i have asked numerous times; and
> to tell the truth, when i tried to lower it
> myself, i did not feel well at all;
>
> 2. There is no reason to switch from lithium
> to something else; my kidneys are fine, my
> thyroid is stable, my psychological state is
> good, and my heart is fine. My only real
> problem is the typical side effects of lithium
> (which is a problem with every drug) and the
> diarrhea, which may or may not be due to
> lithium.
>
> 3. Switching to another drug after so many
> years would require the possibility of withdrawing from clonazepam (out of the question), adjusting
> the thyroxine - very tricky;
>
> 4. It is not known how the withdrawals and the introduction of a new drug would react on my body after so many years.
>
> 5. If it does not work out, it is not known if the damage done could be reversable.
>
> AFTER SO MANY YEARS OF STABILITY AND PSYCHOLOGICAL GOOD HEALTH (which others would envy on the armamatorium of current psychiatric drugs) WHY SHOULD I CHANGE TO SOMETHING EXPERIMENTAL AND CONTRARY TO MY AND MY DR.'s ADVICE?
>
> Squiggles
Hi SquigglesThanks for your arguments for the status quo - I will bear them in mind. I always keep the saying 'out of the saucepan into the fire' in the back of my mind. Ten mg of Zyprexa seems to be working for me, it feels more positive than when I was on the 5 mg. I feel as if I was not getting the full benefit of the drug at just 5 mg. If 10 mg Zyprexa continues to treat me this well, and maybe even better with the lapse of time, I will leave my meds alone - at least for a few months. At present I am living from day to day not knowing what the next day will bring and not knowing whether I will get a decent night's sleep. If I sleep well then the next day is most likely going to be good. I have had a good day today after a good night's sleep last night. I thank the 10 mg Zyprexa for that.
Like you I have been on Lithium for about 25 years altogether. I did come off it temporarily in 1987, after 11 years on it, without any difficulty but my wife persuaded me to go back on it after I blew my top about a work related matter. One thing I have learnt since joining psychobabble is that you have to give the drugs time to settle into your system. I think I was too hasty with my conversion to Seroquel, never mind the Zyprexa seems to be working.
Unlike you I have not been well settled psychologically on the 900 mg Lithium. I suffer flat affect, avolition, social withdrawal, and apathy. After the 10 mg Zyprexa has settled in I would like to address these negative symptoms ie if they have not already been addressed by zuper Zyprexa.
I'm glad Lithium at 900 mg split into three daily doses works so well for you. I agree it would be madness to mess with something that works so well.
....Alan
Posted by Squiggles on November 2, 2006, at 16:40:33
In reply to Re: Your meds » Squiggles, posted by ronaldo on November 2, 2006, at 16:11:16
> Hi Squiggles
>
> Thanks for your arguments for the status quo - I will bear them in mind. I always keep the saying 'out of the saucepan into the fire' in the back of my mind. Ten mg of Zyprexa seems to be working for me, it feels more positive than when I was on the 5 mg. I feel as if I was not getting the full benefit of the drug at just 5 mg. If 10 mg Zyprexa continues to treat me this well, and maybe even better with the lapse of time, I will leave my meds alone - at least for a few months. At present I am living from day to day not knowing what the next day will bring and not knowing whether I will get a decent night's sleep. If I sleep well then the next day is most likely going to be good. I have had a good day today after a good night's sleep last night. I thank the 10 mg Zyprexa for that.
>
> Like you I have been on Lithium for about 25 years altogether. I did come off it temporarily in 1987, after 11 years on it, without any difficulty but my wife persuaded me to go back on it after I blew my top about a work related matter. One thing I have learnt since joining psychobabble is that you have to give the drugs time to settle into your system. I think I was too hasty with my conversion to Seroquel, never mind the Zyprexa seems to be working.
>
> Unlike you I have not been well settled psychologically on the 900 mg Lithium. I suffer flat affect, avolition, social withdrawal, and apathy. After the 10 mg Zyprexa has settled in I would like to address these negative symptoms ie if they have not already been addressed by zuper Zyprexa.
>
> I'm glad Lithium at 900 mg split into three daily doses works so well for you. I agree it would be madness to mess with something that works so well.
>
>
> ....Alan
>
>Sorry, if I sounded a bit abrasive. It is
frustrating for me to have come to this
point of relative stability after so many
medical misadventures - it's hard to live
normally this way. I am sure you understand.It's very important to get feedback from your
own body and soul that *this* dose is right,
*this* drug combo is OK, etc.Sometimes a drug won't work well, because the
diagnosis is off. I was first put in imipramine
and i was sick as a dog. Lithium was like a
balm.This is why i keep yammering about the need
for psychopharmacologists. I think it's really
hard to get the right approximation and perhaps
it is not appreciated in the medical field, how
difficult it is to work and be under drug experimenation all the time.I'm glad you found a relatively good dose with
Zyprexa -- if you are anxious, maybe a benzo addition? If you are too sleepy, maybe a dose
adjustment -- that's how it goes, i'm afraid.Good luck.
Squiggles
Posted by ed_uk on November 3, 2006, at 15:32:18
In reply to Re: Your meds » ed_uk, posted by Squiggles on November 2, 2006, at 15:23:08
>AFTER SO MANY YEARS OF STABILITY AND PSYCHOLOGICAL GOOD HEALTH WHY SHOULD I CHANGE TO SOMETHING EXPERIMENTAL AND CONTRARY TO MY AND MY DR.'s ADVICE?
Huh? My post was to Ronaldo, not you.
Ed
Posted by Squiggles on November 3, 2006, at 15:53:17
In reply to Re: Your meds » Squiggles, posted by ed_uk on November 3, 2006, at 15:32:18
> >AFTER SO MANY YEARS OF STABILITY AND PSYCHOLOGICAL GOOD HEALTH WHY SHOULD I CHANGE TO SOMETHING EXPERIMENTAL AND CONTRARY TO MY AND MY DR.'s ADVICE?
>
> Huh? My post was to Ronaldo, not you.
>
> Ed
-----------Sorry Ed,
I read the header as copied and thought the
post was to me:
Posted by ed_uk on November 2, 2006, at 15:13:04"In reply to Re: Bipolars: Lithium levels, dosage and adjuncts. » Squiggles, posted by ronaldo on November 2, 2006, at 9:05:09"
Squiggles
Posted by ed_uk on November 3, 2006, at 16:54:18
In reply to Re: Your meds » ed_uk, posted by Squiggles on November 3, 2006, at 15:53:17
Don't worry about it! :)
Ed
Posted by clint878 on November 3, 2006, at 18:52:13
In reply to Bipolars: Lithium levels, dosage and adjuncts., posted by ronaldo on November 2, 2006, at 3:24:26
Perhaps lamotrigine would be a good choice. It has been shown to be an antidepressant and also improves cognition.
I wonder, however, why you want to get off the lithium but not the Zyprexa. The main problem with lithium (when not dealing with toxicity) is hypothyroidism. Zyprexa, on the other hand, is associated with tardive dyskinesia and diabetes, problems that are much more serious and more difficult to treat. Some studies show that almost 50-60% of antipsychotic users show signs of tardive dyskinesia at some level of severity.
This is the end of the thread.
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