![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 35. This is the beginning of the thread.
Posted by chloe on September 29, 2001, at 10:14:44
I am taking 600 mgs Li ER (along with a tad of Celexa, 500 mgs neurontin and 7 mgs diazapam) but don't really have any of the "classic" annoying side effects of Li. But I do have this edgy, jittery feeling inside all the time. When I lie in bed, I just hear my heart pounding away. I feel terribly over caffineated, though that is NOT the cause, since I have almost cut out caffeine :(.
Can anyone tell me if they exerience this inner *activation*? I hate feeling all jazzed up. Is there any way that this could diminish as my neurons get used to the Li? Or is this a permanent feature of this med? All the searching I have done, does not mention an inner shakiness. Just a hand tremor. And surprisingly, I have not developed that.
The other disappointing thing, is that I thought my mood and irritability had improved over the 10 days I have been on Li. But last night, I had two very abusive rage outbursts, at rather minor triggers. My pdoc assured me that Li is very good for "rage" etc. But now I am quite disillusioned.
If anyone has any insight or experience to why I feel so "jittery" inside and short fused, please respond. I would so appreciate some insight to help me get through this weekend.
Ever grateful,
Chloe
Posted by lou pilder on September 29, 2001, at 10:26:46
In reply to Is the LITHIUM causing this?, posted by chloe on September 29, 2001, at 10:14:44
> I am taking 600 mgs Li ER (along with a tad of Celexa, 500 mgs neurontin and 7 mgs diazapam) but don't really have any of the "classic" annoying side effects of Li. But I do have this edgy, jittery feeling inside all the time. When I lie in bed, I just hear my heart pounding away. I feel terribly over caffineated, though that is NOT the cause, since I have almost cut out caffeine :(.
>
> Can anyone tell me if they exerience this inner *activation*? I hate feeling all jazzed up. Is there any way that this could diminish as my neurons get used to the Li? Or is this a permanent feature of this med? All the searching I have done, does not mention an inner shakiness. Just a hand tremor. And surprisingly, I have not developed that.
>
> The other disappointing thing, is that I thought my mood and irritability had improved over the 10 days I have been on Li. But last night, I had two very abusive rage outbursts, at rather minor triggers. My pdoc assured me that Li is very good for "rage" etc. But now I am quite disillusioned.
>
> If anyone has any insight or experience to why I feel so "jittery" inside and short fused, please respond. I would so appreciate some insight to help me get through this weekend.
>
> Ever grateful,
> Chloe
Dea Chloe; I think that you need to understand that the benzodiazepine that you are taking that ends in "pam" is most probably the culprit in what you describe. In order to ascertaine this, however, more info is needed . Please feel free to email me at [email protected] for this can become quite serious if you do not understand this drug quickly.
Lou Pilder
Posted by SLS on September 29, 2001, at 11:00:21
In reply to Is the LITHIUM causing this?, posted by chloe on September 29, 2001, at 10:14:44
> I am taking 600 mgs Li ER (along with a tad of Celexa, 500 mgs neurontin and 7 mgs diazapam) but don't really have any of the "classic" annoying side effects of Li. But I do have this edgy, jittery feeling inside all the time. When I lie in bed, I just hear my heart pounding away. I feel terribly over caffineated, though that is NOT the cause, since I have almost cut out caffeine :(.
>
> Can anyone tell me if they exerience this inner *activation*? I hate feeling all jazzed up. Is there any way that this could diminish as my neurons get used to the Li? Or is this a permanent feature of this med? All the searching I have done, does not mention an inner shakiness. Just a hand tremor. And surprisingly, I have not developed that.
>
> The other disappointing thing, is that I thought my mood and irritability had improved over the 10 days I have been on Li. But last night, I had two very abusive rage outbursts, at rather minor triggers. My pdoc assured me that Li is very good for "rage" etc. But now I am quite disillusioned.
>
> If anyone has any insight or experience to why I feel so "jittery" inside and short fused, please respond. I would so appreciate some insight to help me get through this weekend.
>
> Ever grateful,
> Chloe
Hi Chloe.I can't be sure what the "jittery" feelings involve. I really don't feel that I have had enough personal experience with lithium to comment on it.
Anger and rage often appear as depression just begins to lift. It is sort of the reverse of what some peope experience when depression is just beginning to emerge, or during the first two days of PMS. It might actually be a good sign.
Depending on how you are taking the Neurontin and diazepam, you might be setting yourself up for a sort of daily benzodiazepine withdrawal. This could explain both the jitteriness/anxiety and the anger/rage.
I wish I could give you something more definitive. I'm sure someone else can.
Good luck.
Ever caring,
Scott
Posted by Mitch on September 29, 2001, at 12:00:13
In reply to Is the LITHIUM causing this?, posted by chloe on September 29, 2001, at 10:14:44
> I am taking 600 mgs Li ER (along with a tad of Celexa, 500 mgs neurontin and 7 mgs diazapam) but don't really have any of the "classic" annoying side effects of Li. But I do have this edgy, jittery feeling inside all the time. When I lie in bed, I just hear my heart pounding away. I feel terribly over caffineated, though that is NOT the cause, since I have almost cut out caffeine :(.
>
> Can anyone tell me if they exerience this inner *activation*? I hate feeling all jazzed up. Is there any way that this could diminish as my neurons get used to the Li? Or is this a permanent feature of this med? All the searching I have done, does not mention an inner shakiness. Just a hand tremor. And surprisingly, I have not developed that.
>
> The other disappointing thing, is that I thought my mood and irritability had improved over the 10 days I have been on Li. But last night, I had two very abusive rage outbursts, at rather minor triggers. My pdoc assured me that Li is very good for "rage" etc. But now I am quite disillusioned.
>
> If anyone has any insight or experience to why I feel so "jittery" inside and short fused, please respond. I would so appreciate some insight to help me get through this weekend.
>
> Ever grateful,
> ChloeHi Chloe,
So, your pdoc has upped your lithium from 300mg to 600mg day? You must have had some positive response. I wonder if you are just going through a little jag (for a few days) as a response to the increased dosage. You seemed to have that problem when you first started it and then you seemed to level out ok. As far as angry outbursts go, I notice that when my depression lifts I start to care about stuff that I previously didn't appear to have any interest in and it can take people by surprise and you can get into a shouting match-because they think you are not paying any attention to it. I think you can get through this ok. I would suggest talking to your doc about hanging around at 600mg/day for a while (a few weeks) before any more increases (if any) so you can adjust to it a little better.
Mitch
Posted by chloe on September 29, 2001, at 16:45:40
In reply to Re: Is the LITHIUM causing this? » chloe, posted by SLS on September 29, 2001, at 11:00:21
> Anger and rage often appear as depression just begins to lift. It is sort of the reverse of what some peope experience when depression is just beginning to emerge, or during the first two days of PMS. It might actually be a good sign.
>
> Depending on how you are taking the Neurontin and diazepam, you might be setting yourself up for a sort of daily benzodiazepine withdrawal. This could explain both the jitteriness/anxiety and the anger/rage.Wow, Scott,
You might have nailed it. I feel my depression lifting, but it is making me very agitated. I am thinking about *my issues* now, and am not just focused on how depressed or suicidal, etc. I can be. In a way, it's easier to focus on gloom and doom than to have to deal with what life has handed me. Boy my depression is better, but I am still kinda grumpy and edgy...The smallest things annoy the hell out of me. But I am not suicidal, so I guess that's an improvement. I do hope I get more mellow and perhaps *happier* with time.However, I do know that the Li is causing some physiologic energizing or something. I just feel so caffineated without the caffeine. I wish I know the mechanism of Li...Perhaps this feeling is the AD effect of Li...
In terms of the benzo's I take 2 mgs am and 5 mgs pm. I thought diazapam had such a long half life that BID was ok. In terms of neurontin, I take that every 6 hours or I get (more!) edgy and shaky. I don't know how I will ever withdrawal off on Neuontin. Hope I never have to. I can feel the minute 6 hours is up!
Thanks for your thoughtful response. If you have any insight on benzo withdrawal, I would be interested.
Chloe
Posted by Sunnely on September 29, 2001, at 17:12:53
In reply to Is the LITHIUM causing this?, posted by chloe on September 29, 2001, at 10:14:44
> I am taking 600 mgs Li ER (along with a tad of Celexa, 500 mgs neurontin and 7 mgs diazapam) but don't really have any of the "classic" annoying side effects of Li. But I do have this edgy, jittery feeling inside all the time. When I lie in bed, I just hear my heart pounding away. I feel terribly over caffineated, though that is NOT the cause, since I have almost cut out caffeine :(.
>
> Can anyone tell me if they exerience this inner *activation*? I hate feeling all jazzed up. Is there any way that this could diminish as my neurons get used to the Li? Or is this a permanent feature of this med? All the searching I have done, does not mention an inner shakiness. Just a hand tremor. And surprisingly, I have not developed that.
>
> The other disappointing thing, is that I thought my mood and irritability had improved over the 10 days I have been on Li. But last night, I had two very abusive rage outbursts, at rather minor triggers. My pdoc assured me that Li is very good for "rage" etc. But now I am quite disillusioned.
>
> If anyone has any insight or experience to why I feel so "jittery" inside and short fused, please respond. I would so appreciate some insight to help me get through this weekend.
>
> Ever grateful,
> Chloe***************
I'm not sure but could this be akathisia? Akathisia is a form of extrapyramidal symptom (EPS) manifested by subjective (eg. "edgy," "jittery," "all jazzed up," etc.) and objective (e.g., restlessness, pacing, etc.) symptoms. This is usually seen with the use of antipsychotics (ie., dopamine blockers) and sometimes with antidepressants (e.g., SSRIs). Akathisia has also been reported with anti-nausea/vomiting drugs such as Compazine and Reglan; some of the calcium-channel blockers for high blood pressure (e.g., Cardizem, Calan); even with buspirone (BuSpar).
Akathisia has also been reported with the use of lithium. The exact mechanism as to how lithium causes this problem is unclear. However, in animal (rat) study, lithium decreases the amount of dopamine in the brain. This may have similar effect in humans. It is also postulated that lithium may have physostigmine-like effect, thereby acting as a cholinesterase inhibitor and increasing brain cholinergic activity leading to EPS such as akathisia. (Drugs for Alzheimer's disease such as Aricept, Exelon, Cognex, Reminyl, have cholinesterase-inhibiting effect leading to increase in cholinergic effect and delaying the progression of the illness. One of their potential side effects is EPS.)
SSRIs by themselves such as Prozac, Zoloft, Paxil, Luvox, and Celexa have been reported to induce akathisia. The exact mechanism is unclear. It is postulated that the enhanced serotonin effect of SSRIs mediate inhibition of dopamine in the brain leading to EPS such as akathisia.
Have you had a lithium level lately, at least since you cut down your caffeine intake? Reason I asked this is because excessive caffeine intake can lower the blood level of lithium. If you cut down your caffeine intake, your lithium blood level may rise which could lead to increase side effects --- > ?akathisia. It will be worth it to check to lithium level if this has not been done, yet since you cut down your caffeine intake.
Is the outburst of rage related to the akathisia due to lithium and Celexa? Not sure. However, there have been case reports of increased agitation, outburts and even suicidal attempts related to drug-induced akathisia.
Diazepam and Neurontin are not known to cause akathisia. In fact, benzodiazepines such as diazepam tends to alleviate akathisia. Neurontin may also have calming effect due to its indirect GABA action. OTOH, benzodiazepines have also been reported to cause "disinhibition syndrome" characterized by increased irritability and paradoxical rage. Can't say for sure if this is the case with you.
In sum, you probably experiencing akathisia and probably due to combined use of lithium and an SSRI (Celexa). A very long shot is a "disinhibiting effect" of diazepam.
Posted by chloe on September 29, 2001, at 17:16:27
In reply to Re: Is the LITHIUM causing this? » chloe, posted by Mitch on September 29, 2001, at 12:00:13
Mitch,
I do seem to be having a positive response to Li. But it's very uncomfortable. I am thinking and feeling things that I haven't felt for months. About doing projects, or increasing my work load, traveling for the holidays. This is all very unsettling. But you say this is a good thing? Ugh...I just feel so fragile and unsure.Anyway, back to meds. The side effects of Lithium have been so easy to take, I can't believe I turned this stuff down so long. BUT, I know that the ER formula is what is making it tolerable. The long action and enteric coating of the pill make it so I don't have the nausea/diarrhea or the low blood sugar attacks and awful hand tremor that I experienced when I took it over 10 years ago in regular form.
The only draw back I can see is this inner disquiet. The caffineated feeling...And I am worried this may not go away. I just wonder if the disquiet make me get pissed off so fast. Or the disquiet is irrelevent, and I am just extra volitle as my mood improves...It's so hard to be patient and wait it out. A part of me wants to stop the Li.But your words are reassuring. (I have a terrible sense of history!) Because I forgot that I had a bit of anxiety when I started at 300. So it's only natural that after being at 600 mgs, I could feel anxiety again. Thanks for the reminder!
I do need to talk to my pdoc on Monday about the agitation. But I don't think she will increase in the dose. Her target was 600mgs. And I think 600 mgs is more than enough.
Thanks for keeping me centered, Mitch!
Chloe
Posted by chloe on September 29, 2001, at 17:42:34
In reply to Re: Is the LITHIUM causing this? » chloe, posted by Sunnely on September 29, 2001, at 17:12:53
Sunnely,
I have not had a level yet, as I have only been on Li for 10 days. I was pretty depressed before I started the Li, and did not experience rage attacks like I did last night.I have had trouble with Celexa and agitation. I was only able to tolerate 2 mgs before I started the Li. But I had to decrease the Celexa to 1 mg when I added Li due to feeling to speedy, edgy and clenchy with my mouth. Perhaps I need to ditch the Celexa all together. But I do think it gives me the slightest bit of feeling positive and "up."
In terms of akathisia, I have had it before when taking the traditional ap's in the past. I would say that the feeling is similar, but not so much in my limbs that I have to be walking around all the time. It's more in my chest. A thumping and beating that is loud and makes me feel nervous. So nervous that I feel like I should be doing something all the time. It is also interfering with my sleep.
Is there anyway to manage this disquiet? This is not the typical use for propanolol is it? That is for shaking hands, not shaking insides, right?
Thanks so much for your information.
Chloe>
> I'm not sure but could this be akathisia? Akathisia is a form of extrapyramidal symptom (EPS) manifested by subjective (eg. "edgy," "jittery," "all jazzed up," etc.) and objective (e.g., restlessness, pacing, etc.) symptoms. This is usually seen with the use of antipsychotics (ie., dopamine blockers) and sometimes with antidepressants (e.g., SSRIs). Akathisia has also been reported with anti-nausea/vomiting drugs such as Compazine and Reglan; some of the calcium-channel blockers for high blood pressure (e.g., Cardizem, Calan); even with buspirone (BuSpar).
>
> Akathisia has also been reported with the use of lithium. The exact mechanism as to how lithium causes this problem is unclear. However, in animal (rat) study, lithium decreases the amount of dopamine in the brain. This may have similar effect in humans. It is also postulated that lithium may have physostigmine-like effect, thereby acting as a cholinesterase inhibitor and increasing brain cholinergic activity leading to EPS such as akathisia. (Drugs for Alzheimer's disease such as Aricept, Exelon, Cognex, Reminyl, have cholinesterase-inhibiting effect leading to increase in cholinergic effect and delaying the progression of the illness. One of their potential side effects is EPS.)
>
> SSRIs by themselves such as Prozac, Zoloft, Paxil, Luvox, and Celexa have been reported to induce akathisia. The exact mechanism is unclear. It is postulated that the enhanced serotonin effect of SSRIs mediate inhibition of dopamine in the brain leading to EPS such as akathisia.
>
> Have you had a lithium level lately, at least since you cut down your caffeine intake? Reason I asked this is because excessive caffeine intake can lower the blood level of lithium. If you cut down your caffeine intake, your lithium blood level may rise which could lead to increase side effects --- > ?akathisia. It will be worth it to check to lithium level if this has not been done, yet since you cut down your caffeine intake.
>
> Is the outburst of rage related to the akathisia due to lithium and Celexa? Not sure. However, there have been case reports of increased agitation, outburts and even suicidal attempts related to drug-induced akathisia.
>
> Diazepam and Neurontin are not known to cause akathisia. In fact, benzodiazepines such as diazepam tends to alleviate akathisia. Neurontin may also have calming effect due to its indirect GABA action. OTOH, benzodiazepines have also been reported to cause "disinhibition syndrome" characterized by increased irritability and paradoxical rage. Can't say for sure if this is the case with you.
>
> In sum, you probably experiencing akathisia and probably due to combined use of lithium and an SSRI (Celexa). A very long shot is a "disinhibiting effect" of diazepam.
Posted by Sunnely on September 29, 2001, at 20:04:42
In reply to Re: Is the LITHIUM causing this? » Sunnely, posted by chloe on September 29, 2001, at 17:42:34
> Sunnely,
> I have not had a level yet, as I have only been on Li for 10 days. I was pretty depressed before I started the Li, and did not experience rage attacks like I did last night.
>
> I have had trouble with Celexa and agitation. I was only able to tolerate 2 mgs before I started the Li. But I had to decrease the Celexa to 1 mg when I added Li due to feeling to speedy, edgy and clenchy with my mouth. Perhaps I need to ditch the Celexa all together. But I do think it gives me the slightest bit of feeling positive and "up."
>
> In terms of akathisia, I have had it before when taking the traditional ap's in the past. I would say that the feeling is similar, but not so much in my limbs that I have to be walking around all the time. It's more in my chest. A thumping and beating that is loud and makes me feel nervous. So nervous that I feel like I should be doing something all the time. It is also interfering with my sleep.
>
> Is there anyway to manage this disquiet? This is not the typical use for propanolol is it? That is for shaking hands, not shaking insides, right?
>
> Thanks so much for your information.
> Chloe*****************
Lithium has a half-life of approximately 24 hours (in healthy adults). Blood levels should be checked approximately 5-7 days after start of the medication or an increase/decrease in dose. Once, lithium levels have stabilized, lithium level can be checked every 3-6 months. It should also be checked as needed especially when another drug that interferes with lithium elimination is added (e.g., Ibuprofen and other NSAIDs, diuretics, certain antibiotics, excess caffeine intake or the opposite, stopping use of caffeine). It should also be checked ASAP if you develop flu-like symptoms with vomiting/dairrhea or dehydration. In short, you are due for one, especially if you had cut down your caffeine intake.
There is such a thing as "subjective akathisia" which is the typical subjective experience of akathisia in the absence of restless movements (objective symptoms).
It appears that you have high risk for developing akathisia because of past experience. You also seems ultra sensitive to Celexa since even 1-2 mg/day causes you to become "speedy, edgy" (?akathisia).
With regard to EPS, perhaps akathisia is the most common and most distressing. After TD (tardive dyskinesia), it is probably the most difficult to treat. The only reliable treatment for akathisia is withdrawal of the offending drug. Among the pharmacological agents, propranolol, a beta blocker, appears to be the most encouraging. It appears to be effective in 80% of cases (better than the anticholinergic drugs such as Cogentin, Artane, etc.). It can be rapidly effective, often within hours of the first dose. It is not prone to abuse. OTOH, a couple of problems with the use of propranolol are: 1. can cause a drop in blood pressure, 2. slows down the heart beat, 3. may cause asthma attack, 4. may worsen depression and diabetes. If combined with lithium, may cause further slowing of the heart beat and potential for heart block.
Adding a beta blocker (propranolol) may alleviate the akathisia but may also pose some problems as indicated above. Instead of adding an extra medication, why not stop one of the potential drug offenders (Celexa) and see how it goes. If antidepressant is necessary, consider a trial of Wellbutrin. It is free of serotonergic effect, hopefully avoiding the same problem you encountered with Celexa. Furthermore, theoretically, Wellbutrin's dopamine-enhancing effect may even alleviate the akathisia.
Posted by Mitch on September 30, 2001, at 1:27:23
In reply to Re: LITHIUM helping depression... » Mitch, posted by chloe on September 29, 2001, at 17:16:27
>
> I do need to talk to my pdoc on Monday about the agitation. But I don't think she will increase in the dose. Her target was 600mgs. And I think 600 mgs is more than enough.
> Thanks for keeping me centered, Mitch!
> ChloeOh, there is something I just thought about after reading your last post-cycle frequency. I have three week cycles-I can't really tell whether something is doing me good or ill unless I hold everything constant through at least one full cycle to be able to tell if it was the med or just my own cycling. You may be in an agitative or mild mixed-state part of your cycle.
just an idea,
Mitch
Posted by chloe on September 30, 2001, at 19:59:52
In reply to Re: LITHIUM helping depression..., posted by Mitch on September 30, 2001, at 1:27:23
Posted by SLS on October 1, 2001, at 8:11:46
In reply to Re: Is the LITHIUM causing this? » chloe, posted by Sunnely on September 29, 2001, at 17:12:53
> SSRIs by themselves such as Prozac, Zoloft, Paxil, Luvox, and Celexa have been reported to induce akathisia. The exact mechanism is unclear. It is postulated that the enhanced serotonin effect of SSRIs mediate inhibition of dopamine in the brain leading to EPS such as akathisia.
Hi Sunnely.By what mechanisms does lithium exert its pro-serotonergic effects?
Thanks.
- Scott
Posted by Sunnely on October 1, 2001, at 19:14:18
In reply to Re: Is the LITHIUM causing this?, posted by SLS on October 1, 2001, at 8:11:46
> Hi Sunnely.
>
> By what mechanisms does lithium exert its pro-serotonergic effects?
>
> Thanks.
>
>
> - ScottHi Scott,
Exactly, I don't know. It appears that lithium enhances tryptophan uptake and has various other indirect effects on serotonin metabolism.
Here's an excerpt from a book explaining lithium's pro-serotonergic effect.
Many studies have shown that lithium affects the synthesis, turnover, release, and uptake of the monoamine neurotransmitter 5-hydroxytryptamine (serotonin; 5-HT). Furthermore, it enhances the effects of serotonergic antidepressant drugs, particularly in cases of tricyclic-resistant depression. Although the number (Bmax) and function of 5-HT2A receptors are modulated by several antidepressant therapies, lithium's effects on this serotonin receptor subtype is not straightforward. The 5-HT2 family of serotonin receptors is of particular interest because it activates, through a guanine nucleotide binding protein (G protein) linkage, the hydrolysis of phospholipase C (PLC), which activates the diacyglycerol (DAG) and inositol 1,4,5-triphosphate (IP3) second-messenger systems. Lithium's involvement in modulating 5-HT2A receptor function is probably not a simple matter of it altering receptor number or affinity, because many investigations have failed to show a consistent effect. The functional consequences of lithium on 5-HT2A receptor activity, as measured by behavioral responses, are equally ambiguous.
Reference: Bipolar Medications: Mechanisms of Action, 2000. Edited by Husseini K. Manji, MD, Charles L. Bowden, MD, and Robert H. Belmaker, MD. American Psychiatric Press, Inc., Washington, DC.
Posted by chloe on October 1, 2001, at 20:04:46
In reply to Re: Is the LITHIUM causing this? » SLS, posted by Sunnely on October 1, 2001, at 19:14:18
> >Many studies have shown that lithium affects the synthesis, turnover, release, and uptake of the monoamine neurotransmitter 5-hydroxytryptamine (serotonin; 5-HT)
Hi Sunnely.
Your post was extremely informative. But do you have any experience or knowledge of how effective Li is as an AD? I have discontinued the Celexa, and after two days, feel so much calmer and quieter inside. But of course I am a little worried that I will not feel too well without a traditional AD. I only seem to respond to SSRIs. Things like tricyclics, remeron and serzone were not of much use to me. And wellbutrin causes awful night sweats, the drenching kind.
I guess my question is, are there some folks (with treatment resistant depression, BP 2, BPD) who get AD effect from Li without a traditional AD on board? I know everyone is different, but does any one have any experience with this?
Thanks
Chloe
Posted by Sunnely on October 1, 2001, at 22:48:14
In reply to Re: LITHIUM, as the sole AD?, posted by chloe on October 1, 2001, at 20:04:46
> > >Many studies have shown that lithium affects the synthesis, turnover, release, and uptake of the monoamine neurotransmitter 5-hydroxytryptamine (serotonin; 5-HT)
>
> Hi Sunnely.
>
> Your post was extremely informative. But do you have any experience or knowledge of how effective Li is as an AD? I have discontinued the Celexa, and after two days, feel so much calmer and quieter inside. But of course I am a little worried that I will not feel too well without a traditional AD. I only seem to respond to SSRIs. Things like tricyclics, remeron and serzone were not of much use to me. And wellbutrin causes awful night sweats, the drenching kind.
>
> I guess my question is, are there some folks (with treatment resistant depression, BP 2, BPD) who get AD effect from Li without a traditional AD on board? I know everyone is different, but does any one have any experience with this?
>
> Thanks
> Chloe******************************
Hi Chloe,
The answer to your question will most likely depend on what exactly is your diagnosis. If you are treatment-resistant depression (unipolar depression), then the use of an antidepressant (most probably with an adjunctive treatment such as lithium), is beneficial in a number of cases. However, if you belong to the bipolar disorder spectrum (e.g., Bipolar I, Bipolar II), the use of a mood stabilizer (or combination of mood stabilizers) without antidepressant is more beneficial than with antidepressants.
Antidepressants may be necessary in acute bipolar depression, but it is recommended that they be tapered and discontinued once the response has been established over 1-3 months. For those patients who relapse into depression, it is appropriate that they be maintained on antidepressants for a longer period of time.
FYI, the trend in the US among bipolar researchers and some practitioners has been to limit antidepressant use. This view has also tended to be supported by bipolar specialists in some parts of Europe, especially in the more Mediterranean countries, while some bipolar researchers in the US and many researchers in other parts of Europe, particular in the UK and some in Germany, feel less concerned about the drawbacks of antidepressant use in bipolar disorder and are more concerned that bipolar depression will go untreated.
The risks of long-term use of antidepressants in bipolar depression is acute manic switch or rapid cylcing. In a review done by Goodwin and Jamison, the early literature on tricyclic antidepressants (TCAs) generally suggests a rather high rate of switches to acute mania (in the 30% - 60% range) with those agents. Monoamine oxidase inhibitors (MAOIs) do not have a lower mania switch rate, though they appear to be more effective than TCAs in bipolar depression. Recent clinical studies suggest that the acute manic or hypomanic switch rate with SSRIs in bipolar I and II is not minor - being 15% -27%, even despite concurrent mood stabilizer treatment.
A number of bipolar disorder experts recommend "aggressive" use of mood stabilizers and brief trials of antidepressants. By "aggressive" use of mood stabilizers they mean routine polypharmacy (multiple mood stabilizers) with two or three mood-stabilizing agents. Since FDA-indicated agents for mania are few, this approach entails frequently using other drugs with mood stabilizing effects that may not be FDA-indicated for mania, such atypical antipsychotics and novel anticonvulsants.
Bottom line is, in your case, whether to use an antidepressant or not will depend on what exactly your diagnosis is. Some patients initially diagnosed with unipolar depression turn out to be bipolar disorder. Natural history studies largely indicate that untreated bipolar depressive episodes are briefer (mean 3-6 months) than unipolar depressive episodes (mean 6-12 months). Recent data also link a higher likelihood of lithium response for depression to very brief, recent depressive episodes. Post partum depressive episodes are also more frequent in bipolar disoder than unipolar depression. Recently, the antidepressant "wear off" phenomenon or "pooping out" (in which patients exhibit acute, but not prophylactic, response to antidepressants) has been linked to bipolar disorder. Lastly, lack of response to three or more adequate antidepressant treatment trials has long been considered a reason for reassessment of the unipolar depression.
If your diagnosis is bipolar II, "aggresive" use of mood stabilizers and limited use of antidepressant (only if absolutely necessary) is probably the best treatment approach. Since lamotrigine (Lamictal) appears to be beneficial in patients with bipolar depression, the combined use of lithium and lamotrigine (without antidepressant) may not be a bad idea in your case.
Posted by SLS on October 2, 2001, at 13:59:44
In reply to Re: Is the LITHIUM causing this? » SLS, posted by Sunnely on October 1, 2001, at 19:14:18
Thanks again, Sunnely.
Manji was at the NIMH during my time there. He was considered by my immediate research clinician to be brilliant. He and Robert Post made a good team. They were really into PKC at the time - 1992.
Who would have thought that a simple monovalent ion could have such diverse and profound effects?
- Scott
> > Hi Sunnely.
> >
> > By what mechanisms does lithium exert its pro-serotonergic effects?
> >
> > Thanks.
> >
> >
> > - Scott
>
> Hi Scott,
>
> Exactly, I don't know. It appears that lithium enhances tryptophan uptake and has various other indirect effects on serotonin metabolism.
>
> Here's an excerpt from a book explaining lithium's pro-serotonergic effect.
>
> Many studies have shown that lithium affects the synthesis, turnover, release, and uptake of the monoamine neurotransmitter 5-hydroxytryptamine (serotonin; 5-HT). Furthermore, it enhances the effects of serotonergic antidepressant drugs, particularly in cases of tricyclic-resistant depression. Although the number (Bmax) and function of 5-HT2A receptors are modulated by several antidepressant therapies, lithium's effects on this serotonin receptor subtype is not straightforward. The 5-HT2 family of serotonin receptors is of particular interest because it activates, through a guanine nucleotide binding protein (G protein) linkage, the hydrolysis of phospholipase C (PLC), which activates the diacyglycerol (DAG) and inositol 1,4,5-triphosphate (IP3) second-messenger systems. Lithium's involvement in modulating 5-HT2A receptor function is probably not a simple matter of it altering receptor number or affinity, because many investigations have failed to show a consistent effect. The functional consequences of lithium on 5-HT2A receptor activity, as measured by behavioral responses, are equally ambiguous.
>
> Reference: Bipolar Medications: Mechanisms of Action, 2000. Edited by Husseini K. Manji, MD, Charles L. Bowden, MD, and Robert H. Belmaker, MD. American Psychiatric Press, Inc., Washington, DC.
Posted by susan C on October 3, 2001, at 19:00:51
In reply to Re: LITHIUM, as the sole AD? » chloe, posted by Sunnely on October 1, 2001, at 22:48:14
> > > >Many studies have shown that lithium affects the synthesis, turnover, release, and uptake of the monoamine neurotransmitter 5-hydroxytryptamine (serotonin; 5-HT)
> >
> > Hi Sunnely.
> >
> > Your post was extremely informative. But do you have any experience or knowledge of how effective Li is as an AD? I have discontinued the Celexa, and after two days, feel so much calmer and quieter inside. But of course I am a little worried that I will not feel too well without a traditional AD. I only seem to respond to SSRIs. Things like tricyclics, remeron and serzone were not of much use to me. And wellbutrin causes awful night sweats, the drenching kind.
> >
> > I guess my question is, are there some folks (with treatment resistant depression, BP 2, BPD) who get AD effect from Li without a traditional AD on board? I know everyone is different, but does any one have any experience with this?
> >
> > Thanks
> > Chloe
>
> ******************************
>
> Hi Chloe,
>
> The answer to your question will most likely depend on what exactly is your diagnosis. If you are treatment-resistant depression (unipolar depression), then the use of an antidepressant (most probably with an adjunctive treatment such as lithium), is beneficial in a number of cases. However, if you belong to the bipolar disorder spectrum (e.g., Bipolar I, Bipolar II), the use of a mood stabilizer (or combination of mood stabilizers) without antidepressant is more beneficial than with antidepressants.
>
> Antidepressants may be necessary in acute bipolar depression, but it is recommended that they be tapered and discontinued once the response has been established over 1-3 months. For those patients who relapse into depression, it is appropriate that they be maintained on antidepressants for a longer period of time.
>
> FYI, the trend in the US among bipolar researchers and some practitioners has been to limit antidepressant use. This view has also tended to be supported by bipolar specialists in some parts of Europe, especially in the more Mediterranean countries, while some bipolar researchers in the US and many researchers in other parts of Europe, particular in the UK and some in Germany, feel less concerned about the drawbacks of antidepressant use in bipolar disorder and are more concerned that bipolar depression will go untreated.
>
> The risks of long-term use of antidepressants in bipolar depression is acute manic switch or rapid cylcing. In a review done by Goodwin and Jamison, the early literature on tricyclic antidepressants (TCAs) generally suggests a rather high rate of switches to acute mania (in the 30% - 60% range) with those agents. Monoamine oxidase inhibitors (MAOIs) do not have a lower mania switch rate, though they appear to be more effective than TCAs in bipolar depression. Recent clinical studies suggest that the acute manic or hypomanic switch rate with SSRIs in bipolar I and II is not minor - being 15% -27%, even despite concurrent mood stabilizer treatment.
>
> A number of bipolar disorder experts recommend "aggressive" use of mood stabilizers and brief trials of antidepressants. By "aggressive" use of mood stabilizers they mean routine polypharmacy (multiple mood stabilizers) with two or three mood-stabilizing agents. Since FDA-indicated agents for mania are few, this approach entails frequently using other drugs with mood stabilizing effects that may not be FDA-indicated for mania, such atypical antipsychotics and novel anticonvulsants.
>
> Bottom line is, in your case, whether to use an antidepressant or not will depend on what exactly your diagnosis is. Some patients initially diagnosed with unipolar depression turn out to be bipolar disorder. Natural history studies largely indicate that untreated bipolar depressive episodes are briefer (mean 3-6 months) than unipolar depressive episodes (mean 6-12 months). Recent data also link a higher likelihood of lithium response for depression to very brief, recent depressive episodes. Post partum depressive episodes are also more frequent in bipolar disoder than unipolar depression. Recently, the antidepressant "wear off" phenomenon or "pooping out" (in which patients exhibit acute, but not prophylactic, response to antidepressants) has been linked to bipolar disorder. Lastly, lack of response to three or more adequate antidepressant treatment trials has long been considered a reason for reassessment of the unipolar depression.
>
> If your diagnosis is bipolar II, "aggresive" use of mood stabilizers and limited use of antidepressant (only if absolutely necessary) is probably the best treatment approach. Since lamotrigine (Lamictal) appears to be beneficial in patients with bipolar depression, the combined use of lithium and lamotrigine (without antidepressant) may not be a bad idea in your case.Hi all
Maybe, just maybe, I am beginning to understand some of what is being said here on this board. The final section of your post is exactly what a 'world famous researcher' diagnosed and recommended for bipolar 2, rapid cycling. If my insurance had not been part of a negotiated coverage, off the street, that advice would have been $400. Again, I am impressed, in general, and in you, Sunnely, Thank you.
Unfortunately I did not respond well to lamitical.
but, 'that's (not) all folks'Susan C (often self-referred to as mouse)
Posted by Chloe on October 3, 2001, at 22:06:45
In reply to Re: LITHIUM, as the sole AD? » chloe, posted by Sunnely on October 1, 2001, at 22:48:14
Thank you Sunnely,
As usually, your post was most informative.
Now several days of being off of celexa, I am "crashing." My pdoc seems to think that Li alone can be my antidepressant/mood stabilizer. I hope she is right, but I am not optimistic.It is not completely clear what my diagnosis it. I have had major depression since puberty and am now 35. When i was younger, it seemed more unipolar with psychotic features, and treated wtih tricyclics, ssris, traditional aps, stimulants, depakote.
Now, I seem to be much more agitated and meds like SSRI's can zap me into a mixed or hypomanic state. I have had hypomanic reactions to a few drugs, one being Geodon (along with EPS) So, I guess treating me is more complicated now. It's also a terrible shame that I can't take the AP's, new or old anymore due to EPS and TD.I have been on every mood stabilizer it seems. Even Lamictal. That was extremely energizing to me. For the two weeks I was on it, I felt like sleep was optional. I really wasn't fond of that one, though it does have powerful AD properties.
Hum, I said all that to say that I am sticking with the lithium and hopefully will be able to find some AD that I can add to the mix that won't send me into the stratosphere. What ever it is, it seems I will only need a little bit...
One last thing, I thought this internal buzz and pulsing was from the Celexa. But I am finding it's still with me. I don't feel like I have to be moving, but it does give me an anxious feeling. Like I am "alive" inside. This is quite annoying, and I wish it would resolve. But somehow, I think it's here to stay. Will I ever feel calm and NOT depressed???
Thanks for listening
chloe
Posted by SLS on October 3, 2001, at 23:38:40
In reply to Re: LITHIUM, as the sole AD? » Sunnely, posted by Chloe on October 3, 2001, at 22:06:45
> Thank you Sunnely,
> As usually, your post was most informative.
> Now several days of being off of celexa, I am "crashing." My pdoc seems to think that Li alone can be my antidepressant/mood stabilizer. I hope she is right, but I am not optimistic.
>
> It is not completely clear what my diagnosis it. I have had major depression since puberty and am now 35. When i was younger, it seemed more unipolar with psychotic features, and treated wtih tricyclics, ssris, traditional aps, stimulants, depakote.
>
> Now, I seem to be much more agitated and meds like SSRI's can zap me into a mixed or hypomanic state. I have had hypomanic reactions to a few drugs, one being Geodon (along with EPS) So, I guess treating me is more complicated now. It's also a terrible shame that I can't take the AP's, new or old anymore due to EPS and TD.
>
> I have been on every mood stabilizer it seems. Even Lamictal. That was extremely energizing to me. For the two weeks I was on it, I felt like sleep was optional. I really wasn't fond of that one, though it does have powerful AD properties.
>
> Hum, I said all that to say that I am sticking with the lithium and hopefully will be able to find some AD that I can add to the mix that won't send me into the stratosphere. What ever it is, it seems I will only need a little bit...
>
> One last thing, I thought this internal buzz and pulsing was from the Celexa. But I am finding it's still with me. I don't feel like I have to be moving, but it does give me an anxious feeling. Like I am "alive" inside. This is quite annoying, and I wish it would resolve. But somehow, I think it's here to stay. Will I ever feel calm and NOT depressed???
>
> Thanks for listening
> chloe
Hi Chloe.I just wanted to let you know that I'm listening too.
Have you ever tried Buspar?
- Scott
Posted by Mitch on October 3, 2001, at 23:46:47
In reply to Re: LITHIUM, as the sole AD? » Sunnely, posted by Chloe on October 3, 2001, at 22:06:45
> Now, I seem to be much more agitated and meds like SSRI's can zap me into a mixed or hypomanic state. I have had hypomanic reactions to a few drugs, one being Geodon (along with EPS) So, I guess treating me is more complicated now. It's also a terrible shame that I can't take the AP's, new or old anymore due to EPS and TD.
>
> One last thing, I thought this internal buzz and pulsing was from the Celexa. But I am finding it's still with me. I don't feel like I have to be moving, but it does give me an anxious feeling. Like I am "alive" inside. This is quite annoying, and I wish it would resolve. But somehow, I think it's here to stay. Will I ever feel calm and NOT depressed???Hi Chloe,
I am in a similar situation as yourself. I have the best response with SSRI's for non-seasonal (intra-cyclical) bipolar depression and anxiety, but they exacerbate hypomania more than any other AD's. I can't take ANY (conventional or atypical)AP's due to EPS symptoms. My question is: Have you ever had a trial of an MAOI? I feel strongly that I could have a positive response to one. Tranylcypromine is indicated for bipolar depression and there is supposed to be fewer "switch" rates with MAOI's generally than SSRi's as a class. My pdoc is afraid of them and the last pdoc I had (a few years ago) was afraid of them too. Personally, I think I just saw the word "lawsuit" reading backwards in their eyeglasses. I realize the current "thinking" is "aggressive" use of mood stabilizers w/o AD's, but I am also skeptical. I have comorbid anxiety disorders that aren't helped much by without an AD. Have you had a trial of any MAOI's?Mitch
Posted by SLS on October 4, 2001, at 9:47:36
In reply to Re: LITHIUM, as the sole AD? » Chloe, posted by Mitch on October 3, 2001, at 23:46:47
> > Now, I seem to be much more agitated and meds like SSRI's can zap me into a mixed or hypomanic state. I have had hypomanic reactions to a few drugs, one being Geodon (along with EPS) So, I guess treating me is more complicated now. It's also a terrible shame that I can't take the AP's, new or old anymore due to EPS and TD.
> >
> > One last thing, I thought this internal buzz and pulsing was from the Celexa. But I am finding it's still with me. I don't feel like I have to be moving, but it does give me an anxious feeling. Like I am "alive" inside. This is quite annoying, and I wish it would resolve. But somehow, I think it's here to stay. Will I ever feel calm and NOT depressed???
>
> Hi Chloe,
> I am in a similar situation as yourself. I have the best response with SSRI's for non-seasonal (intra-cyclical) bipolar depression and anxiety, but they exacerbate hypomania more than any other AD's. I can't take ANY (conventional or atypical)AP's due to EPS symptoms. My question is: Have you ever had a trial of an MAOI? I feel strongly that I could have a positive response to one. Tranylcypromine is indicated for bipolar depression and there is supposed to be fewer "switch" rates with MAOI's generally than SSRi's as a class. My pdoc is afraid of them and the last pdoc I had (a few years ago) was afraid of them too. Personally, I think I just saw the word "lawsuit" reading backwards in their eyeglasses. I realize the current "thinking" is "aggressive" use of mood stabilizers w/o AD's, but I am also skeptical. I have comorbid anxiety disorders that aren't helped much by without an AD. Have you had a trial of any MAOI's?
>
> Mitch
Hi Mitch.There seems to be a widely held belief that Parnate is the MAOI of choice when treating bipolar depression. I'm really not sure why. I don't know that there is any real evidence to support this practice. It might be that since Parnate is amphetamine-like and often energizing, it would seem the appropriate choice for the anergic depression that bipolar disorder most often presents with. Although Parnate may not really be statistically superior to Nardil, it is usually more forgiving with respect to side effects. If for no other reason, this might be a good reason to choose it first. However, given that you also suffer from a comorbid anxiety disorder, Nardil might end up being the better of the two for you. If you don't respond to Parnate, it certainly makes sense to try Nardil as well. Many people do much better with one than the other.
I don't know if the manic switch rates for Parnate or Nardil are any lower than the SSRIs. Actually, SSRIs were once thought to have a reduced potential to induce mania than both the tricyclics and MAOIs, but I don't know if there have been any studies focusing on this issue. Both Parnate and Nardil have caused me to switch into mania whereas such was not the case with tricyclics, SSRIs, Wellbutrin, and Effexor. If there is any one drug least likely to induce mania, it would be Wellbutrin, which is one reason it is often chosen first when treating bipolar disorder. I think it might also have a greater rate of producing an antidepressant response. I don't recall seeing very many people become manic on Serzone.
I think choosing an MAOI is very sensible for you at this point, but it might be prudent to take at least one mood-stabilizer concurrently to minimize the risk of mania. It might even improve your chances of successfully treating the depression. Historically, I think Depakote has been shown to be the most effective when treating mixed-states. I don't know how Lamictal, Neurontin, Topomax, or Gabitril compare in this regard. Although Lamictal does exert some antidepressant effects upon me, 200mg/day was absolutely useless in preventing a Nardil-induced switch into a dysphoric mania. Depakote 1000mg - 1500mg has been a potent antimanic for me. Lithium has not been.
- Scott
Posted by Mitch on October 4, 2001, at 13:06:02
In reply to Re: LITHIUM, as the sole AD? » Mitch, posted by SLS on October 4, 2001, at 9:47:36
> Hi Mitch.
>
> There seems to be a widely held belief that Parnate is the MAOI of choice when treating bipolar depression. I'm really not sure why. I don't know that there is any real evidence to support this practice. It might be that since Parnate is amphetamine-like and often energizing, it would seem the appropriate choice for the anergic depression that bipolar disorder most often presents with. Although Parnate may not really be statistically superior to Nardil, it is usually more forgiving with respect to side effects. If for no other reason, this might be a good reason to choose it first. However, given that you also suffer from a comorbid anxiety disorder, Nardil might end up being the better of the two for you. If you don't respond to Parnate, it certainly makes sense to try Nardil as well. Many people do much better with one than the other.
>
> I don't know if the manic switch rates for Parnate or Nardil are any lower than the SSRIs. Actually, SSRIs were once thought to have a reduced potential to induce mania than both the tricyclics and MAOIs, but I don't know if there have been any studies focusing on this issue. Both Parnate and Nardil have caused me to switch into mania whereas such was not the case with tricyclics, SSRIs, Wellbutrin, and Effexor. If there is any one drug least likely to induce mania, it would be Wellbutrin, which is one reason it is often chosen first when treating bipolar disorder. I think it might also have a greater rate of producing an antidepressant response. I don't recall seeing very many people become manic on Serzone.
>
> I think choosing an MAOI is very sensible for you at this point, but it might be prudent to take at least one mood-stabilizer concurrently to minimize the risk of mania. It might even improve your chances of successfully treating the depression. Historically, I think Depakote has been shown to be the most effective when treating mixed-states. I don't know how Lamictal, Neurontin, Topomax, or Gabitril compare in this regard. Although Lamictal does exert some antidepressant effects upon me, 200mg/day was absolutely useless in preventing a Nardil-induced switch into a dysphoric mania. Depakote 1000mg - 1500mg has been a potent antimanic for me. Lithium has not been.
>
>
> - ScottThanks Scott, for the response. I suppose I would need to clarify some stuff. I am what my pdoc calls "hyperresponsive" to meds. There have been situations where 1.25mg of Celexa (i.e.), triggered a potent hypomanic episode (like smoking grass) for about 2-8hrs after taking it. Another incident that was far more intense was taking 37.5mg of Effexor which also triggered a robust hypomanic episode that was also quite intense and brief (about 5 hrs). But...those type of meds make me more sociable and settle down panic and reduce anxiety generally. I was on Adderall (5mgAM) with no AD's and my cycling STOPPED and my sleep/wake cycles normalized and I had NO depression (poof!), but...I was cool distant quiet unhumorous. Then I got a thyroid tumor! Could you share some insights into this?
Mitch
Posted by Chloe on October 5, 2001, at 20:26:06
In reply to Re: LITHIUM, as the sole AD? » Sunnely, posted by Chloe on October 3, 2001, at 22:06:45
Well, I have realized I cannot survive without an AD. Lithium is not enough. I got so depressed and agitated I had to resort to Seroquel to stop a very desperate spiraling down. (The AP's work so well, but I can't continue on it due to tongue movements. This truly infuriates me.)
I also had a Li level drawn and on 600 mgs I am shocked to find out that I only have a level of 0.4. I have this jazzy feeling all the time, so I thought for sure I was up around 0.8 or so. Could the low level be one of the factors that allowed my mood to get so low and agitated? I wanted to go DOWN on the Li, but with this low level, I am not sure that is wise if I want any mood stabilization out of it.
Also, I was told to add 1 mg of Celexa back in. It's been 12 hours, and I feel so "up" and wired. I have no idea how I am going to sleep. I wish there were a better AD for me, but no way on the MAOI's. Thanks for the thought Mitch. But I would not be safe on such a drug. And my pdoc does not like Buspar. She hasn't seen any success with it. I was wondering if I could keep the Celexa during the day, and add maybe 25 mgs of Serzone at night. Perhaps serzone would have the calming effect that might last into the next day...and not the emotional lability that comes along with the higher doses.
This is all so complicated. And I feel so awful calling my pdoc every few days with the next crisis. I just can't seem to get stabilized.
Does anyone have any thoughts on my li level. Is it too low for mood stabilization?
How about Celexa with a splash of Serzone? Is this a good combo?
Thanks all.
Chloe
Posted by Mitch on October 5, 2001, at 22:04:15
In reply to Re: LITHIUM, crashing, ADs, etc, posted by Chloe on October 5, 2001, at 20:26:06
> Well, I have realized I cannot survive without an AD. Lithium is not enough. I got so depressed and agitated I had to resort to Seroquel to stop a very desperate spiraling down. (The AP's work so well, but I can't continue on it due to tongue movements. This truly infuriates me.)
>
> I also had a Li level drawn and on 600 mgs I am shocked to find out that I only have a level of 0.4. I have this jazzy feeling all the time, so I thought for sure I was up around 0.8 or so. Could the low level be one of the factors that allowed my mood to get so low and agitated? I wanted to go DOWN on the Li, but with this low level, I am not sure that is wise if I want any mood stabilization out of it.
>
> Also, I was told to add 1 mg of Celexa back in. It's been 12 hours, and I feel so "up" and wired. I have no idea how I am going to sleep. I wish there were a better AD for me, but no way on the MAOI's. Thanks for the thought Mitch. But I would not be safe on such a drug. And my pdoc does not like Buspar. She hasn't seen any success with it. I was wondering if I could keep the Celexa during the day, and add maybe 25 mgs of Serzone at night. Perhaps serzone would have the calming effect that might last into the next day...and not the emotional lability that comes along with the higher doses.
>
> This is all so complicated. And I feel so awful calling my pdoc every few days with the next crisis. I just can't seem to get stabilized.
>
> Does anyone have any thoughts on my li level. Is it too low for mood stabilization?
>
> How about Celexa with a splash of Serzone? Is this a good combo?
>
> Thanks all.
> ChloeChloe, I don't know if you caught one of my posts earlier but have you ever tried a smidge of Paxil or Luvox before? I think Celexa may just be too activating an SSRI for you. I found it was more *wirey* in some ways than Zoloft (although I can sleep on the Celexa better).
I don't necessarily think that the serum lithium level is that predictive when it comes to BPII and unipolar depression. I got by on 300mg a day for years-which certainly was less than .4. If I got into a dicey situation at work (lots of stress/anger) I would up to 450mg for a few days and I could tell a difference. I think if you stayed on 600mg/day for a solid month or so and it didn't get much better I would doubt if more of it would help that much for your particular situation.So here's my ideas:
1) Substitute the Celexa with a very low dose of a more sedating SSRi such as Paxil or Luvox to your current lithium/diazepam regimen. (try that first before going to Serzone)2) Ask your doctor about possibly adding some T4 (levothyroxine) thyroid hormone to try to settle down your cycling. I know you mentioned once that you were paranoid about fiddling with that-but they make a wide array or doses and you might try just 25mcgs/day to start and see if it helps. Also they use T4 to *reduce* thyroid nodules and goiters. Also lithium can make some people a little hypothyroid anyways. I wished my pdoc was willing to let me try that.
keep us informed,Mitch
Posted by Cam W. on October 5, 2001, at 22:09:17
In reply to Re: LITHIUM, crashing, ADs, etc, posted by Chloe on October 5, 2001, at 20:26:06
Chloe - I would say that you lithium level being that low could contribute to your agitation, depresssion, and elation. For lithium to work, you need to stay within the therapeutic window (0.8 - 1.2). If your level is lower than 0.8 you are at risk for a relapse; above 1.2 you need to worry about toxicity.
When lithium is used to augment antidepressants, blood level targets are lower (eg. 0.6).
Good luck in getting the level up. - Cam
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