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Re: My Disappointment here + My early years Lamdage22

Posted by SLS on September 2, 2021, at 15:46:37

In reply to Re: My Disappointment here + My early years, posted by Lamdage22 on September 2, 2021, at 1:02:22

Hi, Lamdage.

> It sounds solid. I like that you have mood stabilization in there as well.

> > 1. Nardil: 90 mg/day -> 75 mg/day
> >
> > 2. nortriptyline: 100 mg/day -> 75 mg/day
> >
> > 3. Lamictal: 300 mg/day Unchanged
> >
> > 4. lithium: 300 mg/day Unchanged

I would like to describe my experience with lithium. I have Bipolar Disorder, but it presents only as depression. I have had a handful of manic reactions to antidepressants, but I never had mania as a part of my untreated illness.

The facts about lithium include the observations that it displays a bimodal effect at different dosages. The bimodal distribution is observed in both clinical and neuronal activity. Low dosages of lithium (300 mg/day for me) can improve depression significantly. Monitoring blood levels in this scenario is not necessary. Just titrate it looking for clinical improvement. However, mania cannot be treated effectively at these low dosages. In this case, blood levels are the guideline to dosing, and usually follows a dosage range of 900-1500 mg/day. However, with me as an anecdotal example, if I go above 300 mg/day, my clinical improvement disappears, and I relapse into depression and also experience the common side effects, including amotivation, apathy, and flat affect. Therefore, I display a bimodal dose-response curve. There are studies reporting this exact bimodal effect on clinical symptoms of subjects with Major Depressive Disorder.

The second finding that I came across accidentally is that lithium has a bimodal effect on glutamate activity. At low dosages, it increases activity, whereas higher dosages reduce activity. There is some speculation that glutamate activity is associated with mood states. Glutamate is the most pervasive excitatory neurotransmitter. Too much glutamate is thought by some to be a contributing cause of mania. Conversely, too little activity might contribute to the depressive state.

If you have never experienced mania, and you feel that the worst thing that can happen is that you feel worse for a few days instead of better, give some thought to trying low-dosage lithium. Many years ago, Harvard (Fava and Nierenberg, I think) was working with Prozac (fluoxetine) + low-dosage lithium in treating treatment-resistant depression. They found that 300-600 mg/day of lithium combined with 60 mg/day of Prozac worked better than either drug alone. However, they attributed most of the synergistic effect to Prozac.


- Scott


Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.

 

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