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Dr. Bob is Robert Hsiung, MD,
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Posted by ruby on July 16, 2010, at 14:18:23
Anyone on both of these? At what dosages? After an upswing and a crash my pdoc is suggesting I add 150mg of lithium to 5mg of Abilify. Gotta say the lithium makes me nervous.
Posted by Christ_empowered on July 16, 2010, at 19:31:13
In reply to Abilify and Lithium, posted by ruby on July 16, 2010, at 14:18:23
Hey. Although docs combine neuroleptics and lithium all the time, problems can happen. EPS is more likely. TD is, I believe, more likely. Some antipsychotics (like Haldol) should never be combined with lithium b/c of the potential for brain damage.
Personally, I'd just ramp up the Abilify to a full 10mgs/day, but that's just me. Ask your doc about other options if you don't think this is a good combo; at the end of the day, its your brain that's going to be affected.
Posted by Ruby on July 17, 2010, at 8:37:01
In reply to I'd be nervous, too, posted by Christ_empowered on July 16, 2010, at 19:31:13
Thanks,CE. I think I've pretty much decided not to do the lithium--and not in small part because I lost a kidney last year and am feeling very overprotective of the one that I still have! My upswing was just 2 days followed by the crash, and this coincident with having gone off abilify (because of the weight gain issue) and coincident with adding some supplements, one of which has 800mcg of chromium which is known to cause mood swings.
SO all this to say, I think going back on the abilify is all I need. I was good on it except for the weight gain. Plus I simply don't want the lithium.
Posted by Emily Elizabeth on July 17, 2010, at 9:56:07
In reply to Re: I'd be nervous, too, posted by Ruby on July 17, 2010, at 8:37:01
Posted by Christ_empowered on July 17, 2010, at 12:21:23
In reply to Abilify and Lithium, posted by ruby on July 16, 2010, at 14:18:23
Sorry if my post frightened you. I just personally think that neuroleptic+lithium combos are kind of...well, frightening, given the potential risks.
So, how are you feeling now?
Posted by Ruby on July 17, 2010, at 12:28:49
In reply to are you OK now?, posted by Christ_empowered on July 17, 2010, at 12:21:23
Thanks, CE. I wasn't frightened by your post--mostly you confirmed the concerns I already had. I'm taking the weekend to think and pray it through. Probably will see my pdoc sometime next week. She's been great at texting me to see that I'm doing okay. I'm some better but still fragile. I get so frustrated sometimes when I can't do what I want because it is simply to taxing when I'm feeling as I do now. For some reason the downswing seems to have triggered my PTSD so I'm feeling acutely sensitive to noise and chaos. I think I need to lay low this weekend so that 1) I can go back to work on Monday where I have an extremely taxing week ahead of me and 2) I have clarity in my mind and spirit about the lithium.
Thanks for asking how I'm doing.
Posted by ed_uk2010 on July 17, 2010, at 12:45:31
In reply to Abilify and Lithium, posted by ruby on July 16, 2010, at 14:18:23
> Anyone on both of these? At what dosages? After an upswing and a crash my pdoc is suggesting I add 150mg of lithium to 5mg of Abilify. Gotta say the lithium makes me nervous.
Optimal efficacy is more likely to occur at 10mg Abilify than 5mg. Just something to consider.
150mg lithium is a very small dose. It sounds like your pdoc is being cautious. I wouldn't expect any serious reactions to occur at such as dose.
Posted by Ruby on July 17, 2010, at 12:52:10
In reply to Re: Abilify and Lithium, posted by ed_uk2010 on July 17, 2010, at 12:45:31
Yes, they are very small doses. I'm quite sensitive to meds and tend to be on smallish doses of them. We're also hesitant to go higher on the abilify because I have weight gain with it--50 pounds added on so far and still gaining. Ugh.
I know lots of folks do well on complex "cocktails" of meds, but I'm always hesitant to add something new.
Right now I'm on abilify 5mg, synthroid 125mcg, nuvigil 150mg, clonapin .5 3x/day, trazodone 200mg, and nortriptylene 100mg. And NAC--2400mgs.
Posted by ed_uk2010 on July 17, 2010, at 13:20:30
In reply to Re: Abilify and Lithium » ed_uk2010, posted by Ruby on July 17, 2010, at 12:52:10
>Right now I'm on abilify 5mg, synthroid 125mcg, nuvigil 150mg, clonapin .5 3x/day, trazodone 200mg, and nortriptylene 100mg.
Interesting combination. Do you think it's possible that some of your meds are 'cancelling out' the benefits of your other meds?
For example, trazodone might cause fatigue and reduce the effects of Nuvigil. There are also other potential problems.
Posted by Ruby on July 17, 2010, at 14:15:53
In reply to Re: Abilify and Lithium, posted by ed_uk2010 on July 17, 2010, at 13:20:30
Hi Ed:
Interesting thought. I'm on that dosage of trazodone b/c I have pretty severe insomnia--practically need to be hit on the head to go to sleep. Pdoc's been afraid to up my nuvigil b/c it might increase my anxiety--which is why i take the clonapin(sp?). the nortriptylene has been there since I had ECT treatments last September...and it seems to help me fall asleep...though we started to talk about lowering it right before this latest incident.
When I was in the hospital, one of the things they did was "clean up" my meds to make a simpler cocktail. The nortrip and the traz make me groggy in the morning...which is why we introduced the nuvigil...which has been a real boost. I was having real trouble focusing and reading (not good for an academic) and it has helped tremendously.
Anyway, I am interested in hearing your thoughts about how this cocktail might not be the best combo. I have a really good pdoc, I think. She is very attentive and concerned...but perhaps we've gotten too close in and aren't seeing the forest for the trees.
We do try to adjust the meds between my academic terms so I'm not dealing with that while I'm teaching...
Thanks again. If you have more to say, I'm insterested.
Posted by ed_uk2010 on July 17, 2010, at 14:43:50
In reply to Re: Abilify and Lithium » ed_uk2010, posted by Ruby on July 17, 2010, at 14:15:53
Hi Ruby,
>Interesting thought. I'm on that dosage of trazodone b/c I have pretty severe insomnia--practically need to be hit on the head to go to sleep.
The problem with using trazodone for sleep induction is that it lasts far too long, potentially making you feel tired all day (which really defeats the point). Short-acting drugs such as ramelteon (Rozerem) and eszopiclone (Lunesta) are much less problematic in this respect. Lunesta is best taken intermittently due to the risk of dependence.
Clonazepam (Klonopin) can sometimes aggravate depression. Have you noticed this at all? I assume your anxiety and depression do not response well to SSRIs such as Lexapro?
>The nortrip and the traz make me groggy in the morning..
Desipramine can sometimes be an effective and non-sedating alternative to nortriptyline. Desipramine can be taken in the morning.
Posted by Ruby on July 17, 2010, at 16:44:23
In reply to Re: Abilify and Lithium, posted by ed_uk2010 on July 17, 2010, at 14:43:50
Hi Ed--
Thanks for your thoughts; they are certainly ones I will bring up with my pdoc.
> The problem with using trazodone for sleep induction is that it lasts far too long, potentially making you feel tired all day (which really defeats the point).
I've been on traz for 8 years now; for 7 of those years I only needed 50mg of it to give me a good night sleep and wake up feeling refreshed. Since I was in the hospital and since the ECT, I've needed much more traz to make me sleep. But you are right, I do feel fatigued all day and have a terrible time getting out of the door in the morning.
Short-acting drugs such as ramelteon (Rozerem) and eszopiclone (Lunesta) are much less problematic in this respect. Lunesta is best taken intermittently due to the risk of dependence.
I've not heard of ramelteon, though I have heard of lunesta. My insomnia is hard, tried and true since I was a child, so I'm not sure the lunesta would work for me.
>
> Clonazepam (Klonopin) can sometimes aggravate depression. Have you noticed this at all?I've not noticed this at all; it really takes the edge off of my anxiety and even at .5mg works to get me through difficult parts of the day--more than once its gotten me through a stressful meeting when I thought I might jump out of my skin.
I assume your anxiety and depression do not response well to SSRIs such as Lexapro?
I've been on all kinds of meds--and you are right the SSRIs just don't work for me. Was on Lamictal for a long time, it worked wonderfully, but I kept getting a rash (not THE rash but a rash) and finally my pdoc decided she didn't want me getting rashes and not knowing when a rash might be the bad one. Can't remember all the meds they've tried with me...wellbutrin was awful, as was seroquel....my depression has been called treatment resistant, bipolar 2 with anxiety disorder and PTSD.
>
> Desipramine can sometimes be an effective and non-sedating alternative to nortriptyline. Desipramine can be taken in the morning.
>
Haven't heard of this one either, so will bring it up to the pdoc and see what she has to say.Lots to think about here. And all because of "little" upswing/downswing which might have been the result of a supplement I took that have chromium in it.
Thanks again for your thoughts and help. I'm sure we'll get things straightened out.
Ruby
Posted by ed_uk2010 on July 18, 2010, at 11:43:45
In reply to Re: Abilify and Lithium, posted by Ruby on July 17, 2010, at 16:44:23
Hi Ruby,
>My insomnia is hard, tried and true since I was a child, so I'm not sure the Lunesta would work for me.
Can't really predict whether or not Lunesta would help. It certainly might do, it's a well proven treatment.
Ramelteon (Rozerem) is probably too mild to use in its own. I wonder whether a combination of Rozerem + 50mg trazodone might be sufficient to help you sleep and feel refreshed in the morning?
>I've been on all kinds of meds--and you are right the SSRIs just don't work for me. Was on Lamictal for a long time, it worked wonderfully, but I kept getting a rash....
What was the rash like? A dermatologist might have been able to diagnose.
Posted by Ruby on July 18, 2010, at 12:37:10
In reply to Re: Abilify and Lithium » Ruby, posted by ed_uk2010 on July 18, 2010, at 11:43:45
Hi:
> Can't really predict whether or not Lunesta would help. It certainly might do, it's a well proven treatment.I guess I was thinking I couldn't use it because I need something every night...and even with the dosages I'm on with the traz and the nortrip, I still have sleepless nights--or nights where I'm fighting the sheets all night, tossing and turning.
>
> Ramelteon (Rozerem) is probably too mild to use in its own. I wonder whether a combination of Rozerem + 50mg trazodone might be sufficient to help you sleep and feel refreshed in the morning?
>
Would love to get back to 50mg of the traz; it worked for so long. Recently when I lowered it to 100mg, my anxiety ratcheted up...so annoying.> >I've been on all kinds of meds--and you are right the SSRIs just don't work for me. Was on Lamictal for a long time, it worked wonderfully, but I kept getting a rash....
>
> What was the rash like? A dermatologist might have been able to diagnose.
>
Yes, I was in the dermatologists office often--biopses turned up four allergic reactions in and among a very bad case of poison ivy and a case of shingles. My first rash was about 4 months after I'd been on the Lamictal--allergic reaction so I came off and we reintroduced it about 5 months later, very slowly and stopping at 100mg. It was great and worked for over 6 years. The most recent rash, almost a year ago, came between the poison ivy and the shingles. It was when I came off of it that I landed in the hospital. Not fun.So how do you know so much about all these meds? Personal experience or research? I do appreciate your help.
Posted by ed_uk2010 on July 18, 2010, at 13:37:03
In reply to Re: Abilify and Lithium, posted by Ruby on July 18, 2010, at 12:37:10
>I guess I was thinking I couldn't use it because I need something every night...and even with the dosages I'm on with the traz and the nortrip, I still have sleepless nights--or nights where I'm fighting the sheets all night, tossing and turning.
Using it every night isn't ideal. Dependence can develop and it may become less effective over time. Nevertheless, some people do take it every night and find that the benefit it maintained. Do you find that clonazepam helps you sleep?
>My first rash was about 4 months after I'd been on the Lamictal--allergic reaction so I came off and we reintroduced it about 5 months later, very slowly and stopping at 100mg.
Do you think the allergic reaction might have been due to something else, and not actually the Lamictal? I would have thought that if you were allergic to Lamictal, the rash would have appeared more quickly.
Posted by Emily Elizabeth on July 19, 2010, at 21:35:42
In reply to Re: Abilify and Lithium » ed_uk2010, posted by Ruby on July 17, 2010, at 12:52:10
Hmmmm.. I just noticed that the long post I worte above didn't come through! Only my subject line posted! Here is basically what i wanted to say...
I have/had severe major depression (not bipolar) that doesn't respond well to traditional antidepressants. I have taken both Lithium and Abilify at the same time. I took 600 mg Lithium and between 5-30 mg Abilify.
The one special thing about Lithium is that it reduces suicidal thoughts. I find it amazing, but research has supported it and I definitely experienced it. If this is something you need, you might consider Lithium.
It this point, I have experienced some remission, so I have dropped the Lithium and reduced Abilify to 5mg (I also take a tiny bit of Welbutrin and I'm trying to get off Lexapro).
So my message is that I wouldn't be too afraid of going down this path if you trust your pdoc and this is what s/he suggests. It has worked for me. I wish you the best!
EE
Posted by Ruby on July 19, 2010, at 22:25:06
In reply to Re: Abilify and Lithium, posted by Emily Elizabeth on July 19, 2010, at 21:35:42
Hi Emily--
Thanks for your longer email--wonder why the first didn't make it through. After being back on Abilify for 4 days now, I am feeling much better. I am so relieved as I was worried about dark days ahead. Don't think I'll need to add the lithium, not now at least...who knows what is down the road. I do have a good and careful doctor and I do need to trust her...but I admit, I freaked a little when she started talking about lithium. Mostly because I feel protective of my one kidney.
Thanks again--and glad to hear that your depression is in remission; you must feel relieved too!
Ruby
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