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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by jerseygal1 on September 20, 2011, at 15:18:15
Saw my pdoc today and it looks like we are going to try another strategy. Zyprexa didn't work for me so he recommended trying lithium to try to get a positive response. I also take 100 mg. pristig, 30 mg. remeron, 2 mg. klonopin, and was taking 10 mg. zyprexa. We're going to taper the zyprexa as I begin the lithium. Does anyone have any experience with lithium they can share? Oh, my diagnosis is depression/anxiety but the doctor said I may have something they call dysphoric bipolar II.
Posted by floatingbridge on September 20, 2011, at 15:28:36
In reply to Lithium - Anyone use to augment antidepressant?, posted by jerseygal1 on September 20, 2011, at 15:18:15
Hey JG. I did. But there was so much going on for me to tell. It was completely tolerable for me, and I would take it again if my pdoc recommended it. It's in the wings as a possible add-on.
Did your doc mention dosage?
How are you with the idea?
Posted by atypical on September 20, 2011, at 15:28:46
In reply to Lithium - Anyone use to augment antidepressant?, posted by jerseygal1 on September 20, 2011, at 15:18:15
Augmenting an SSRI or SNRI is a very common strategy and has been fairly well studied with a decent success rate. It might help you. You would need to be on a high enough dose of Lithium so that you have blood levels of at least 0.6, which, for most people is about 600-900 mg. Lithium had helped me some, I believe. I still take it now.
Atypical
> Saw my pdoc today and it looks like we are going to try another strategy. Zyprexa didn't work for me so he recommended trying lithium to try to get a positive response. I also take 100 mg. pristig, 30 mg. remeron, 2 mg. klonopin, and was taking 10 mg. zyprexa. We're going to taper the zyprexa as I begin the lithium. Does anyone have any experience with lithium they can share? Oh, my diagnosis is depression/anxiety but the doctor said I may have something they call dysphoric bipolar II.
>
Posted by jerseygal1 on September 20, 2011, at 15:43:20
In reply to Lithium - Anyone use to augment antidepressant?, posted by jerseygal1 on September 20, 2011, at 15:18:15
FB, I am completely fine with it - I'll try anything at this point to get me well again. The dose I'll be taking is 900 mg. I'm starting with 300 mg. tonight, 600 mg. tomorrow, and then 900 mg. Then the wonderful blood test after 1 week. I really don't mind getting blood work. It's just a pain because you have to go to these labs now like LabCorp or Quest and can't just have it done at the doctor's office.
Posted by floatingbridge on September 20, 2011, at 15:50:36
In reply to Re: Lithium - Anyone use to augment antidepressant?, posted by jerseygal1 on September 20, 2011, at 15:43:20
> FB, I am completely fine with it - I'll try anything at this point to get me well again. The dose I'll be taking is 900 mg. I'm starting with 300 mg. tonight, 600 mg. tomorrow, and then 900 mg. Then the wonderful blood test after 1 week. I really don't mind getting blood work. It's just a pain because you have to go to these labs now like LabCorp or Quest and can't just have it done at the doctor's office.
I am fortunate there is a lab on my daily route not far. The labs are important. I expect you'll grow accustomed to them. But yeah, an extra to-do stop. I'm glad to read Atypical's positive post. I don't mind the idea of lithium, either.
I imagine then, your doc might be keeping you in the range Atypical mentions?
More finger crossing for you. Update us?
Posted by SLS on September 20, 2011, at 17:02:07
In reply to Re: Lithium - Anyone use to augment antidepressant?, posted by atypical on September 20, 2011, at 15:28:46
> You would need to be on a high enough dose of Lithium so that you have blood levels of at least 0.6, which, for most people is about 600-900 mg.
For treating MDD as an augmenter to antidepressants, the dosage range you suggest is higher than what one Harvard research team discovered is necessary. They suggest a range between 300mg - 600mg. They found that most people responded to 450mg to receive full benefit. After some experimentation, I found that 300mg was optimal for me. The risks of kidney failure and thyroid damage produced by lithium are dosage-dependant. It is thus important to establish the lowest effective dosage. The Harvard study chose a dosage range rather than a range of blood levels to investigate. At the end of the study, the mean lithium level was about 0.40 mEq/L. My blood level is about 0.25 mEq/L at a dosage of 300mg. Increasing the dosage beyond 300mg was of no added benefit.
- Scott
Posted by SLS on September 20, 2011, at 17:26:21
In reply to Lithium - Anyone use to augment antidepressant?, posted by jerseygal1 on September 20, 2011, at 15:18:15
> the doctor said I may have something they call dysphoric bipolar II.
Are you irritable or prone to episodes of rage?
I posted the dosages of lithium preferred when treating MDD. To treat a bipolar diathesis usually requires higher dosages. Ranges of lithium blood levels suggested are usually stated as being 0.8 - 1.2 mEq/L. It couldn't hurt to try 0.6 mEq/L, which is the lowest value that is found to work to treat bipolar mania. If this does not produce results, and the drug is well tolerated, you can increase the dosage.
Check out Topamax 100mg if you reach a sticking point.
One last thought. I offer the possibility that 300-600mg of lithium might be effective to treat the depressive phase of BP if other antimanic drugs are being used. The advantage here is that it would prevent lithium toxicity. I have no data to support this notion.
- Scott
Posted by Phillipa on September 20, 2011, at 19:55:17
In reply to Re: Lithium - Anyone use to augment antidepressant? » jerseygal1, posted by SLS on September 20, 2011, at 17:26:21
I always thought the lithium was to bring down and halt a mania? And took a couple of weeks? Phillipa
Posted by SLS on September 20, 2011, at 21:13:36
In reply to Re: Lithium - Anyone use to augment antidepressant?, posted by Phillipa on September 20, 2011, at 19:55:17
> I always thought the lithium was to bring down and halt a mania?
Lithium can treat depression as well, whether or not bipolarity is evident.
> And took a couple of weeks?
Yes. Unfortunately, it can take lithium that long to reduce mania. Perhaps this is the nature of a true mood-stabilizer as opposed to drugs that are preponderantly anti-manic. For this reason, it is often a good idea to administer drugs like Depakote or an antipsychotic to be used acutely while waiting for the lithium to begin exerting it therapeutic effects.
- Scott
Posted by Phillipa on September 20, 2011, at 22:05:29
In reply to Re: Lithium - Anyone use to augment antidepressant? » Phillipa, posted by SLS on September 20, 2011, at 21:13:36
Scott thanks I've seen it work well in lower than theraputic doses in alchoholics also just trivia. Phillipa
Posted by Prozac Pro on September 29, 2011, at 13:46:35
In reply to Lithium - Anyone use to augment antidepressant?, posted by jerseygal1 on September 20, 2011, at 15:18:15
> Saw my pdoc today and it looks like we are going to try another strategy. Zyprexa didn't work for me so he recommended trying lithium to try to get a positive response. I also take 100 mg. pristig, 30 mg. remeron, 2 mg. klonopin, and was taking 10 mg. zyprexa. We're going to taper the zyprexa as I begin the lithium. Does anyone have any experience with lithium they can share? Oh, my diagnosis is depression/anxiety but the doctor said I may have something they call dysphoric bipolar II.
>I was a fairly early user of Prozac (1990), and my initial response was akin to that of Peter Kramer's "super-responders." However, I have tried to go off Prozac several times, and on two of those prior occasions, I had major depressive breaks, for which re-introduction of Prozac at higher doses did little. Both times, lithium augmentation pulled me strongly and quickly out of depression.
While I felt some improvement nearly from the first dose, a strong effect kicked-in at 900 mg per day, but my doctor took several weeks to titrate the dose to that level. After wards (1-2 years later), my doc discontinued lithium, and Prozac alone was sufficient to prevent relapse.
I did experience significant weight gain on lithium, but if your depression is serious, that will be the least of your worries. IMHO, lithium is a wonderful drug.
This is the end of the thread.
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