![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 3 to 27 of 36. Go back in thread:
Posted by BarbaraCat on May 22, 2002, at 17:17:41
In reply to Re: Lithium - one kind better than another?, posted by Squiggles on May 22, 2002, at 16:52:25
Squiggles,
When you say 'smoother', does that mean you have uncomfortable reactions to lithium? I've never noticed any side effects at all, other than I feel better.> Well,
>
> I hope i'm not wasting bandwidth - I take
> lithium carbonate; i once asked for the extended
> release - thought it might be smoother; but
> unfortunately it is not available in Canada,
> at least in Quebec, where I live. Good question;
>
> Squiggles
Posted by johnj on May 22, 2002, at 17:19:33
In reply to Lithium - one kind better than another?, posted by BarbaraCat on May 22, 2002, at 16:02:52
I originally took 600 mg of li carbonate and then went to lithobid(more expensive by the way). I didn't notice it at the time since the lithium just helped me to stay more focused and not have the 4 o'clock cloudiness anymore. But after a few years my pdoc switched me to lithobid. At the time it didn't matter since my insurance was the same. I tried to swithch back twice and just felt strange. I have no explanation on why switching back caused some cloudiness again. If you are feeling fine I don't know why a switch would be helpful. Hope this helps.
johnj
Posted by BarbaraCat on May 22, 2002, at 17:41:07
In reply to Re: Lithium - for me, yes, posted by johnj on May 22, 2002, at 17:19:33
John,
Is Lithobid extended release? The reason I'm trawling is I'm going to see my pdoc tomorrow (my once every 8 weeks whether I need it or not visit). My levels have been below the therapeutic window and he'll probably suggest I take more. I want to minimize side effects and take the 'best' form of it that I can.> I originally took 600 mg of li carbonate and then went to lithobid(more expensive by the way). I didn't notice it at the time since the lithium just helped me to stay more focused and not have the 4 o'clock cloudiness anymore. But after a few years my pdoc switched me to lithobid. At the time it didn't matter since my insurance was the same. I tried to swithch back twice and just felt strange. I have no explanation on why switching back caused some cloudiness again. If you are feeling fine I don't know why a switch would be helpful. Hope this helps.
> johnj
Posted by Squiggles on May 22, 2002, at 17:57:05
In reply to Re: Lithium - one kind better than another? » Squiggles, posted by BarbaraCat on May 22, 2002, at 17:17:41
Hi again,
By smoother, I suppose I mean that I won't
get diarrhea so often.I'm in the middle of an experiment now - regarding
some symptoms - i hope to be able to stand the
Synthroid speediness to keep going till Sun. to
let you guys know - i am testing for peripheral
neuropathy which and edema which I suspect li
is responsible for.......take care
Squiggles
Posted by Chloe on May 22, 2002, at 18:54:57
In reply to Lithium - one kind better than another?, posted by BarbaraCat on May 22, 2002, at 16:02:52
> I currently take plain old vanilla lithium, generic for Lithonate. It helps tremendously along with Remeron. I'm curious about the different forms of lithium, such as Lithobid(R) for extended release, lithium orotate vs. carbonate, liquid lithium, etc. Has anyone out there found one to work better than another?
Hi Barbara,
Here is what I know about the extended release lithiums: (Also, check the archives, Mitch and I have had many discussions about lithium...)
Lithobid-300 mg pink enteric coated pill that by-passes the stomach. This way there is less or no nausea/diarrhea. The formula also seems to have a little sodium chloride added to it, so if your dietary salt levels changes, it has little effect on Li blood levels.
Personally, I find lithobid more like a "drug" than lithium. I tend to have very few side effects except some dry mouth. NO hand tremor, diarrhea. No low blood sugar shaky feeling that happens late afternoon. No polyuria to speak of. This formula for me is very easy to tolerate if my level stays below 0.6. That seems to be my li limit, FWIW.Eskilith CR-450 mg hard pack yellow scored pills that dissolve slowly in the stomach and small intestine. I find this one equally good in keeping level from crashing at the end of the day, and keeping tremor at bay. But this brand, to me, feels more like the immediate release lithium. I notice a little polyuria and just know I am taking lithium. I rather prefer this one at the moment. I like the feeling that lithium gives me. I also like the fact that I can cut this pill in half and not destroy the extended release quality. Eskilith CR is good if you are taking 900mg/day, because you can take 450 bid.
Lithium Citrate-a pink syrupy liquid that is mainly used for the elderly, those who have trouble swallowing pills or for patients taking less than three hundred milligrams per day. It is NOT extended release, and is absorbed quickly throw the stomach lining.
Lithobid and Eskilith CR are the only two extended release formulas that are available in the US. There is a big difference in price. About $20 for a month's supply at 900 mgs/day. If you are not extremely sensitive to meds, you may not need to try one of these name brands. You could just space out your dosing to TID perhaps.
But I highly recommend them. When one is BP2 stability of blood levels will increase the chances of having stability of mood, IMHO.Ask you pdoc. See what his take is, and let us know, Ok?
Hope this helps,
Chloe
Posted by johnj on May 22, 2002, at 19:23:58
In reply to Re: Lithium - for me, yes » johnj, posted by BarbaraCat on May 22, 2002, at 17:41:07
BCAT:
yes, the lithobid is extended release. And for some reason I tolerate it better now. I take 300 mg in the morning and another 300 mg at night. I am knocking at the theraputic window, actually slightly below I believe. I think I am around 0.4, but of course that varies per individual. Hope it goes well. BTW I did try to go up to 900 mg total and it didn't work for me. I have even tried to lower it to 300 mg and I ended up going back to 600 mg. I am also super med sensitive. Take care and keep us informed.
Johnj
Posted by Squiggles on May 22, 2002, at 19:29:04
In reply to Re:The low down on Lithiums » BarbaraCat, posted by Chloe on May 22, 2002, at 18:54:57
This is wonderful information Chloe;
I will ask my husband if I can print it
and maybe next time when i go for my
prescription renewal, I can suggest it -
by then who know Quebec may have it.Really appreciate the work you put into
this suggestion.Squiggles
Posted by Chloe on May 22, 2002, at 19:58:52
In reply to Re:The low down on Lithiums, posted by Squiggles on May 22, 2002, at 19:29:04
> This is wonderful information Chloe;
> I will ask my husband if I can print it
> and maybe next time when i go for my
> prescription renewal, I can suggest it -
> by then who know Quebec may have it.I *think* I remember corresponding with someone on PB from Canada who was able to get Lithium ER. I am not sure what province he was from. I do hope you can find li ER. Could it be under another brand name in Canada?
> Really appreciate the work you put into
> this suggestion.Thank you Squiggles! I so appreciate you taking the time to tell me. It means a lot. :)
Chloe
Posted by BarbaraCat on May 23, 2002, at 0:20:38
In reply to Re:The low down on Lithiums » BarbaraCat, posted by Chloe on May 22, 2002, at 18:54:57
Chloe,
Wow, what a great post! I'm going to take this to my pdoc tomorrow, but I doubt very much he has even a fraction of your knowledge on this subject. THANKS!
Posted by Chloe on May 23, 2002, at 19:10:53
In reply to Re:The low down on Lithiums - great info! » Chloe, posted by BarbaraCat on May 23, 2002, at 0:20:38
Posted by BarbaraCat on May 23, 2002, at 21:14:12
In reply to Re:good luck at pdoc appt! (nm) » BarbaraCat, posted by Chloe on May 23, 2002, at 19:10:53
Well, I'm still taking the generic for Lithonate, which I guess is plain ol' lithium carbonate. Big Brother HMO's don't encourage any new-fangled meds, I guess.
I expressed concern about raising the levels from my current 600mg per day any higher because I don't want to incur any renal damage or otherwise. He suggested taking a full dose at one time, preferably at night. Apparently some new data has shown that taking the full dose at once rather than spreading it out avoids alot of the tremors, renal damage and otherwise. I don't quite get it, but was loath to waste any more of my allotted 20 minutes every 2 months appointment time by asking silly time consuming questions. So, I ask you, my friends - anyone have any data on combined dosing for lithium?
Posted by Squiggles on May 24, 2002, at 12:08:52
In reply to Lithium appointment - combined doses?, posted by BarbaraCat on May 23, 2002, at 21:14:12
Hi Barbara,
I have read many articles from medical journals,
and from doctors's sites about this. It is almost
a legendary advice to do that now. But I am very
sceptical about it - not that I have knowledge
to the contrary (I did read an article on PubMED
saying this is nonsense. It is not coincidence
that those who advise also advise "if there is
tolerance for taking all 900mg at night". I
just don't get it myself, because I think I would
get quite a punch from such a huge dose altogether.Perphaps it does protect the kidneys, but does
it have other adverse effects, would by my question.IHMO I would not do it.
Squiggles
Posted by Squiggles on May 24, 2002, at 12:13:03
In reply to Re: Lithium appointment - combined doses?, posted by Squiggles on May 24, 2002, at 12:08:52
P.S.
the person to consult on this might be
Dr. David Marples, who is an expert on
lithium induced kidney diseases:
http://diabetesinsipidus.maxinter.net/about.htmSquiggles
Posted by Squiggles on May 24, 2002, at 12:41:04
In reply to Re: Lithium - combined doses? Dr. Marples, posted by Squiggles on May 24, 2002, at 12:13:03
http://www.ndif.org/FAQ/faq-ov3.html
Dr. Bichet is right here in my home town
(but not at McGill); so he would be a good
source of info. on this. I wonder if my
doctor is aware of the danger of lithium
induced nephrogenic disorders - I am so
insecure about the medical profession - it's
pathological I hope.Squiggles
Posted by Chloe on May 24, 2002, at 17:54:00
In reply to Lithium appointment - combined doses?, posted by BarbaraCat on May 23, 2002, at 21:14:12
> Well, I'm still taking the generic for Lithonate, which I guess is plain ol' lithium carbonate. Big Brother HMO's don't encourage any new-fangled meds, I guess.
>
> I expressed concern about raising the levels from my current 600mg per day any higher because I don't want to incur any renal damage or otherwise. He suggested taking a full dose at one time, preferably at night. Apparently some new data has shown that taking the full dose at once rather than spreading it out avoids alot of the tremors, renal damage and otherwise. I don't quite get it, but was loath to waste any more of my allotted 20 minutes every 2 months appointment time by asking silly time consuming questions. So, I ask you, my friends - anyone have any data on combined dosing for lithium?
Hi Barbara,
Well, I guess you pdoc had other lithium ideas... I have never heard of taking all the lithium in one dose. I suppose it would not hurt, as (Mitch informed me :)) Lithium does have over a 24 hour half-life. So spreading it out is not essential.My concern, is the stress the body must endure taking all the lithium at one time. Common sense tells me my kideys would be more traumatized by a huge bolus of lithium in one shot, than smaller amounts throughout the day. But I am no scientist! More like a guinnea pig!
I also know, from personal experience, that when I raised my lithobid to 300 mgs am/600 mgs pm, I began waking up in the morning with a red rash on my face. It seemed to fade as the day went on. I reported this to the pdoc, and she said take the lithobid TID, 300 am 300 eve 300 bedtime, and my mysterious morning rash went away! But 900 mgs was really too much for me to tolerate. I do better at lower li level. More is not always better in my humble opinion...
If you do combine the doses, do let us know it you notice any difference or change. I am glad you are staying at the current dose. I don't always think the blood level (within reason) is as important as how you FEEL when you are BP2.
Yours,
Chloe
Posted by Ritch on May 24, 2002, at 23:31:50
In reply to Re: Lithium appointment - combined doses? » BarbaraCat, posted by Chloe on May 24, 2002, at 17:54:00
> > Well, I'm still taking the generic for Lithonate, which I guess is plain ol' lithium carbonate. Big Brother HMO's don't encourage any new-fangled meds, I guess.
> >
> > I expressed concern about raising the levels from my current 600mg per day any higher because I don't want to incur any renal damage or otherwise. He suggested taking a full dose at one time, preferably at night. Apparently some new data has shown that taking the full dose at once rather than spreading it out avoids alot of the tremors, renal damage and otherwise. I don't quite get it, but was loath to waste any more of my allotted 20 minutes every 2 months appointment time by asking silly time consuming questions. So, I ask you, my friends - anyone have any data on combined dosing for lithium?
>
>
> Hi Barbara,
> Well, I guess you pdoc had other lithium ideas... I have never heard of taking all the lithium in one dose. I suppose it would not hurt, as (Mitch informed me :)) Lithium does have over a 24 hour half-life. So spreading it out is not essential.
>
> My concern, is the stress the body must endure taking all the lithium at one time. Common sense tells me my kideys would be more traumatized by a huge bolus of lithium in one shot, than smaller amounts throughout the day. But I am no scientist! More like a guinnea pig!
>
> I also know, from personal experience, that when I raised my lithobid to 300 mgs am/600 mgs pm, I began waking up in the morning with a red rash on my face. It seemed to fade as the day went on. I reported this to the pdoc, and she said take the lithobid TID, 300 am 300 eve 300 bedtime, and my mysterious morning rash went away! But 900 mgs was really too much for me to tolerate. I do better at lower li level. More is not always better in my humble opinion...
>
> If you do combine the doses, do let us know it you notice any difference or change. I am glad you are staying at the current dose. I don't always think the blood level (within reason) is as important as how you FEEL when you are BP2.
>
> Yours,
> Chloe
Hi Chloe..Barb,I just *read* stuff a long time ago about combining all of the Li dose at bedtime was a preferred way of doing it. It is supposed to reduce the overall burden on your kidneys' elimination of the lithium. All I can say in personal experience is after 20 years I did *happen* to get a thyroid tumor, and also *happened* to have elevated serum calcium levels (which *can* be indicative of kidney problems). I got CAT-scans done of my kidneys and they were OK. The associated? transient hypercalcemia problem still remains unexplained and is no longer a concern (I have normal serum calcium levels). My advice is to be sure to routinely check your kidney function, TSH, and serum calcium (and other electrolytes) while you are undergoing lithium therapy.
Mitch
Posted by Chloe on May 25, 2002, at 10:59:07
In reply to Re: Lithium appointment - combined doses? » Chloe, posted by Ritch on May 24, 2002, at 23:31:50
Hey Mitch,
When you were taking li, did you take all your dose at bedtime? I ask because I wonder if your unfortunate kidney and thyroid problems were related to once a day dosing, or simply indicative of lithium therapy in general?The potential side effects of these meds can be so frightening. I guess as patients, we really have to advocate for ourselves, and make sure our labs and any "unusual" symptoms are monitored closely...
BTW, I wish I could bump up my Li just a bit. I feel very depressed, and lifeless. Increasing the celexa by a few drops was a complete mistake. I have been in a dysphoric rage for two days straight, unable to sleep...And I only increased it by 0.1 mgs, to 1.6. Perhaps something else is going on, because a few drops a celexa can't be that powerful. But I am ready to swing back into depression. I hate feeling like I am going to kill someone for no reason. So I am steering clear of people for the moment.
Anyway, a bit more li might smooth things out, enhance my mood, but I am finally getting rid of some of my scalp pain (thanks to FSO). So I am scared to tinker.
Hope you are hanging in there...
Chloe
Posted by BarbaraCat on May 25, 2002, at 15:08:59
In reply to Lithium appointment - combined doses?, posted by BarbaraCat on May 23, 2002, at 21:14:12
I combined my two daily 300mg into 1 600mg dose two nights ago. I woke up feeling shakey, trembly, nauseous, and peed like a racehorse all day. Actually thought I was coming down with something, I felt so crummy. It was my BDay and a beach hike was planned by Hubby, so I really had to force myself out and about.
I noticed some interesting visual effects while I was there. We hiked out to a promontory where I sat blissfully transfixed by the light sparkling on the ocean. The surf booming on the rocks was echoing inside my head. It was very trippy. After that I began to notice that the quality of light was just - different. Colors more bright, scalp was tingling. I still felt physically a bit sick but OK. Overall, it was like a mild dose of psilocybin. The moderately concentrated Li dose is all I can attribute the above to. Be VERY interested if anyone else has had a similar reaction. - Barbara
Posted by Ritch on May 25, 2002, at 19:00:49
In reply to Re: Lithium appointment - combined doses? » Ritch, posted by Chloe on May 25, 2002, at 10:59:07
> Hey Mitch,
> When you were taking li, did you take all your dose at bedtime? I ask because I wonder if your unfortunate kidney and thyroid problems were related to once a day dosing, or simply indicative of lithium therapy in general?
>
> The potential side effects of these meds can be so frightening. I guess as patients, we really have to advocate for ourselves, and make sure our labs and any "unusual" symptoms are monitored closely...
>
> BTW, I wish I could bump up my Li just a bit. I feel very depressed, and lifeless. Increasing the celexa by a few drops was a complete mistake. I have been in a dysphoric rage for two days straight, unable to sleep...And I only increased it by 0.1 mgs, to 1.6. Perhaps something else is going on, because a few drops a celexa can't be that powerful. But I am ready to swing back into depression. I hate feeling like I am going to kill someone for no reason. So I am steering clear of people for the moment.
>
> Anyway, a bit more li might smooth things out, enhance my mood, but I am finally getting rid of some of my scalp pain (thanks to FSO). So I am scared to tinker.
>
> Hope you are hanging in there...
> ChloeHi Chloe,
When I first started lithium back in 1979, the doctor *told* me to take all of it at once midday (3x 300mg tabs). It was those green Lithane tabs that dissolve in your mouth half of the time before you can swallow them, yuck! He was wanting to see how I would react to a strong punch of it at once. I handled it OK, but it didn't take long before it started giving me diarrhea (at all times of the day). Then, I went to Lithobid 300mg tabs after that. I would take two at bedtime (600mg), and then take one midday (300mg with lunch). I was on that for a couple of years and then they wanted to boost the dose upupup. I was up to 1800mg/day (600mg 3x daily), then went downdowndown to 600mg (two 300mg lithobid tabs that I took 12 hrs apart). We found that 600mg seemed to be about as good as any other higher dose. Then I went down to 450mg (Eskalith CR), and then finally to just 300mg of (Eskalith IR capsules) at bedtime. The first thing that happened to me before I got off lithium and on anticonvulsants was the hypercalcemia. It wasn't (serum calcium) that high-I think my blood level was around 11.0. The top of "normal" I think is right around 10 or 10.5. The doctor immediately thought it was my *para*thyroid glands that were involved (they regulate calcium in your body). That checked OK, then he thought it might be my kidneys-well that checked OK, too. Did another serum calcium and it was within normal range. ???? Anyhow, I switched from lithium to depakote later that year (and my depression got worse!, but the depakote worked better for everything else the lithium seemed to help-grouchiness-cycling). The thyroid tumor happened two years later (I had been on depakote for 1 1/2 years by then). I was tinkering about with several other meds just before it (the tumor) happened. I was on some Seroquel just before it got discovered. If you read Seroquel's insert it mentions that it can significantly lower TSH levels (or free T4, whatever-I can't remember now). So lithium may have had nothing to do with the thyroid thing. Also my Mom had thyroid cancer, so there is a genetic link. If you look at monographs of the older drugs (lithium, TCA's, etc.), they REALLY look scary. I think a lot of that is primarily due to the wealth of accumulated experience with the medicine. I would bet that a lot of the *newer* stuff around might look equally scary 10-20 years from now. So... in IMO, I wouldn't worry too much about when and how often you take it. If it *works* better and is more convenient for you to take it all at bedtime-that's what I would do. If it seems that you get more benefit from dividing the dose-I would do that.
So, you are getting tired and grouchy? If you think an increase would help (lithium), just ask your doctor. I think you are at 450mg/day? So, you are thinking about going from 450mg/day of Eskalith CR to 1 1/2 tabs to 675mg/day? You could try that for a while and see if it helps. If not, you can always back it down again. I think I mentioned this to you before-but do you think your diazepam might be worsening your depression? It definitely made mine worse, and it also made me very grouchy (the worst thing about that particular benzo for me was the loss of impulse control-as in punching people). I think you said that clonazepam made you too tired, right? Just floating some ideas about... I am thinking about asking my pdoc about switching from clonazepam to lorazepam sometime. When I took it a long time ago it didn't seem to make me feel depressed and I definitely didn't get grouchy. The main reason I am thinking about switching is that lorazepam is probably more "liver friendly" than the other benzos (and it also works real well for panic).Mitch
Posted by Ritch on May 25, 2002, at 19:06:14
In reply to Tried combining doses - strange!, posted by BarbaraCat on May 25, 2002, at 15:08:59
> I combined my two daily 300mg into 1 600mg dose two nights ago. I woke up feeling shakey, trembly, nauseous, and peed like a racehorse all day. Actually thought I was coming down with something, I felt so crummy. It was my BDay and a beach hike was planned by Hubby, so I really had to force myself out and about.
>
> I noticed some interesting visual effects while I was there. We hiked out to a promontory where I sat blissfully transfixed by the light sparkling on the ocean. The surf booming on the rocks was echoing inside my head. It was very trippy. After that I began to notice that the quality of light was just - different. Colors more bright, scalp was tingling. I still felt physically a bit sick but OK. Overall, it was like a mild dose of psilocybin. The moderately concentrated Li dose is all I can attribute the above to. Be VERY interested if anyone else has had a similar reaction. - BarbaraHi Barb,
Interesting little experience there. I remember when I first took my lithium I felt spacey. My parent's dog was running about through the house and it seemed like the image of the dog was "trailing" around after it. The latest retrial with lithium (as an augmentor) triggered mild scale illusions-everything seemed "smaller".
Mitch
Posted by Chloe on May 25, 2002, at 21:50:31
In reply to Re: Lithium appointment - combined doses? » Chloe, posted by Ritch on May 25, 2002, at 19:00:49
>
>> Hi Chloe,
>
>> When I first started lithium back in 1979, the doctor *told* me to take all of it at once midday (3x 300mg tabs). It was those green Lithane tabs that dissolve in your mouth half of the time before you can swallow them, yuck! He was wanting to see how I would react to a strong punch of it at once. I handled it OK, but it didn't take long before it started giving me diarrhea (at all times of the day). Then, I went to Lithobid 300mg tabs after that. I would take two at bedtime (600mg), and then take one midday (300mg with lunch). I was on that for a couple of years and then they wanted to boost the dose upupup. I was up to 1800mg/day (600mg 3x daily), then went downdowndown to 600mg (two 300mg lithobid tabs that I took 12 hrs apart). We found that 600mg seemed to be about as good as any other higher dose. Then I went down to 450mg (Eskalith CR), and then finally to just 300mg of (Eskalith IR capsules) at bedtime. The first thing that happened to me before I got off lithium and on anticonvulsants was the hypercalcemia. It wasn't (serum calcium) that high-I think my blood level was around 11.0. The top of "normal" I think is right around 10 or 10.5. The doctor immediately thought it was my *para*thyroid glands that were involved (they regulate calcium in your body). That checked OK, then he thought it might be my kidneys-well that checked OK, too. Did another serum calcium and it was within normal range. ???? Anyhow, I switched from lithium to depakote later that year (and my depression got worse!, but the depakote worked better for everything else the lithium seemed to help-grouchiness-cycling). The thyroid tumor happened two years later (I had been on depakote for 1 1/2 years by then). I was tinkering about with several other meds just before it (the tumor) happened. I was on some Seroquel just before it got discovered. If you read Seroquel's insert it mentions that it can significantly lower TSH levels (or free T4, whatever-I can't remember now). So lithium may have had nothing to do with the thyroid thing. Also my Mom had thyroid cancer, so there is a genetic link. If you look at monographs of the older drugs (lithium, TCA's, etc.), they REALLY look scary. I think a lot of that is primarily due to the wealth of accumulated experience with the medicine. I would bet that a lot of the *newer* stuff around might look equally scary 10-20 years from now. So... in IMO, I wouldn't worry too much about when and how often you take it. If it *works* better and is more convenient for you to take it all at bedtime-that's what I would do. If it seems that you get more benefit from dividing the dose-I would do that.Very interesting, Mitch. I guess the switch was a to Depakote was a good thing. Easier on your gut, kidneys, thyroid and it works better for you!
> >So, you are getting tired and grouchy? If you think an increase would help (lithium), just ask your doctor. I think you are at 450mg/day? So, you are thinking about going from 450mg/day of Eskalith CR to 1 1/2 tabs to 675mg/day? You could try that for a while and see if it helps. If not, you can always back it down again. I think I mentioned this to you before-but do you think your diazepam might be worsening your depression? It definitely made mine worse, and it also made me very grouchy (the worst thing about that particular benzo for me was the loss of impulse control-as in punching people). I think you said that clonazepam made you too tired, right? Just floating some ideas about... I am thinking about asking my pdoc about switching from clonazepam to lorazepam sometime. When I took it a long time ago it didn't seem to make me feel depressed and I definitely didn't get grouchy. The main reason I am thinking about switching is that lorazepam is probably more "liver friendly" than the other benzos (and it also works real well for panic).Mitch, are you having probs with panic attacks now? Ativan clearly does kick in faster, and I think you can take it sublingually. But you will have gaps or have to carry it with you and take it more often...Or is this mainly to protect liver?...
Aren't our livers beyond repair after decades of these meds? Mine must be! Sorry, gallows humor :(I am only at 225 mgs of Li CR (600 neurontin, 250 depakote, 10 valium) at the moment. I am finally getting some relief from neuropathy and dryness, and everytime I adjust a dose of li or neurontin, I get an awful burn for about a week. It really takes a toll on me...I fear all the my *remaining* hair is going to come out, since I can hardly brush it, and it just sheds and sheds...I am sure my pdoc would go for it, but I am going to wait a few more days...And for grouchiness, she often wants to increase valium. I do NOT think this is a solution...But she thinks 10 mgs is a low dose. I think it's adequate+ and occassional 2.5 mg prn.
In terms of the benzos, my pdoc had me first on Ativan, which I felt jazzed up when I took it. No sedative, or antianxiety effect at all. Then we tried Xanax. Really bad reaction to that one. I was living in a tall apartment building in my college city at the time. After one dose of Xanax, I was hanging out the ledge of the windowing thinking it was really funny...If I have fallen it would have been a mortal fall, but I was having so much fun! And I wasn't suicidal.
So, ever since then it's been Valium. And it has always worked well for me. It's vital when I get into pms or psychotic rages (esp. in the absence of AP's). I wish my pdoc would switch me to Klonopin, though. The stigma attached to valium is really hard for me to deal with. I am very uncomfortable about it, but pdoc says, if anyone, ie my GP or GYN has a problem with it, have them call her. So valium it is.
Thanks
Chloe
Posted by Ritch on May 26, 2002, at 0:01:13
In reply to Re: Lithium appointment - combined doses? » Ritch, posted by Chloe on May 25, 2002, at 21:50:31
> Very interesting, Mitch. I guess the switch was a to Depakote was a good thing. Easier on your gut, kidneys, thyroid and it works better for you!
Yes, it is true-Depakote is much easier on my intestines and seems to quell grouchiness like magic. However, I miss the *positive* effects of the lithium. Li settled down agitation and anger without making me so fatigued and tired (which Depakote seems to be so good at). I might get *dazed* from the lithium, but I felt an SSRI-like okeedokee feeling from it that was unique to any antimanic compound I have ever tried (haven't tried Lamictal yet though). Lithium also never generated an anergic depressive blankness that Depakote can induce (while I am depressed). But, that stuff is remarkably effective for hypomanic spells! IOW, it makes for super effective diesel air brakes, but will leave you stranded in the Horse Latitudes if you aren't careful.
>
>
> > >So, you are getting tired and grouchy? If you think an increase would help (lithium), just ask your doctor. I think you are at 450mg/day? So, you are thinking about going from 450mg/day of Eskalith CR to 1 1/2 tabs to 675mg/day? You could try that for a while and see if it helps. If not, you can always back it down again. I think I mentioned this to you before-but do you think your diazepam might be worsening your depression? It definitely made mine worse, and it also made me very grouchy (the worst thing about that particular benzo for me was the loss of impulse control-as in punching people). I think you said that clonazepam made you too tired, right? Just floating some ideas about... I am thinking about asking my pdoc about switching from clonazepam to lorazepam sometime. When I took it a long time ago it didn't seem to make me feel depressed and I definitely didn't get grouchy. The main reason I am thinking about switching is that lorazepam is probably more "liver friendly" than the other benzos (and it also works real well for panic).
>
> Mitch, are you having probs with panic attacks now? Ativan clearly does kick in faster, and I think you can take it sublingually. But you will have gaps or have to carry it with you and take it more often...Or is this mainly to protect liver?...
> Aren't our livers beyond repair after decades of these meds? Mine must be! Sorry, gallows humor :(
Nope, no problems for some time with panic attacks(since I have been on Klonopin!) I have been on Klon. now for several years (albeit at a low dose). If I can flip to lorazepam and get all the benefits with a lower body burden (that sounds so 50's institutional somehow), I think it would be best.
>
> I am only at 225 mgs of Li CR (600 neurontin, 250 depakote, 10 valium) at the moment. I am finally getting some relief from neuropathy and dryness, and everytime I adjust a dose of li or neurontin, I get an awful burn for about a week. It really takes a toll on me...I fear all the my *remaining* hair is going to come out, since I can hardly brush it, and it just sheds and sheds...I am sure my pdoc would go for it, but I am going to wait a few more days...And for grouchiness, she often wants to increase valium. I do NOT think this is a solution...But she thinks 10 mgs is a low dose. I think it's adequate+ and occassional 2.5 mg prn.
Oh well, that doesn't sound quite so desperate now. You are ready for a "little click" up to 300mg/day Li.
I remember one psych. I saw back in 1981 who wanted to add Valium to my lithium/doxepin. I thought it was a bad idea at the time and wanted low-dose chlorpromazine instead (WRONG!-I found out later why). I asked him something like-"So you want me to take maybe 5mg daily?", and he replied "No, I was thinking more like 10mg 3x daily".>
> In terms of the benzos, my pdoc had me first on Ativan, which I felt jazzed up when I took it. No sedative, or antianxiety effect at all. Then we tried Xanax. Really bad reaction to that one. I was living in a tall apartment building in my college city at the time. After one dose of Xanax, I was hanging out the ledge of the windowing thinking it was really funny...If I have fallen it would have been a mortal fall, but I was having so much fun! And I wasn't suicidal.
>
> So, ever since then it's been Valium. And it has always worked well for me. It's vital when I get into pms or psychotic rages (esp. in the absence of AP's). I wish my pdoc would switch me to Klonopin, though. The stigma attached to valium is really hard for me to deal with. I am very uncomfortable about it, but pdoc says, if anyone, ie my GP or GYN has a problem with it, have them call her. So valium it is.
Oh, just curious about what your diazepam history was :) I was taking it for nearly a decade. There probably were other factors that made a larger contribution to my impulse control issues that I associate with its use. Forget stigmas, that is the last thing we all need to worry ourselves about!>
> Thanks
> Chloe
Posted by BarbaraCat on May 26, 2002, at 1:05:01
In reply to Re: Lithium appointment - combined doses? » Ritch, posted by Chloe on May 25, 2002, at 21:50:31
Hi Mitch and Chloe,
Following your posts and funny thing, I just started taking lorezapam. Still on Remeron, lithium of course, but Klonopin wasn't doing it for me. Really needed something to settle me down when I ran out of lithium recently due to my mail order pharmacy taking it's sweet time. Klonopin has always mellowed me for about an hour and then I felt like the jitters were just under the surface. So, I'm doing this trial with lorezapam 'just to see'. So far it's much more sedating, and that's exactly what I'm looking for in a benzo. When I need to be active, driving, doing Costco, whatever, Klonopin is fine. But sometimes a girl just wants to chill.
Posted by Ritch on May 26, 2002, at 2:46:16
In reply to Re: Lithium appointment - combined doses? Mitch » Chloe, posted by BarbaraCat on May 26, 2002, at 1:05:01
> Hi Mitch and Chloe,
> Following your posts and funny thing, I just started taking lorezapam. Still on Remeron, lithium of course, but Klonopin wasn't doing it for me. Really needed something to settle me down when I ran out of lithium recently due to my mail order pharmacy taking it's sweet time. Klonopin has always mellowed me for about an hour and then I felt like the jitters were just under the surface. So, I'm doing this trial with lorezapam 'just to see'. So far it's much more sedating, and that's exactly what I'm looking for in a benzo. When I need to be active, driving, doing Costco, whatever, Klonopin is fine. But sometimes a girl just wants to chill.
That's interesting. I originally got samples of Ativan long, long ago (1984). They were 2mg white tabs I think (that's the medium dose size?). I used them on my first airplane ride to prevent panic. They worked marvelously. They were a little potent-however. I don't think I could use them at work, except maybe a small dose for a presentation. They didn't do wonders for my mathematical skills. However, I never felt depressed on them (as diazepam did), or sullen (like clonazepam can do), never got grouchy on them that I can remember.Mitch
Posted by BarbaraCat on May 26, 2002, at 12:06:00
In reply to Re: Lithium appointment - combined doses? Mitch » BarbaraCat, posted by Ritch on May 26, 2002, at 2:46:16
>
> That's interesting. I originally got samples of Ativan long, long ago (1984). They were 2mg white tabs I think (that's the medium dose size?). I used them on my first airplane ride to prevent panic. They worked marvelously. They were a little potent-however. I don't think I could use them at work, except maybe a small dose for a presentation. They didn't do wonders for my mathematical skills. However, I never felt depressed on them (as diazepam did), or sullen (like clonazepam can do), never got grouchy on them that I can remember.
>
> MitchMitch, the ones I got are tiny little white .5 mg (my pdoc is faily conservative). At the 2mg dose you mentioned I'd be zonked. Your 'sullen' description of clonezapam is a good one. So far I believe I like lorezapam the best. A few years ago when I was experiencing fierce panic attacks I was finally given ativan and it did wonders for me, especially with the quick onset. It also has a shorter half life than clonazepam. Remeron on it's own makes it hard enough to shake off morning grogginess and the 12 hours half life of clonezapam was adding to it. Lorezapam is helping getting to sleep and although I still stumble around for awhile in the morning, alertness comes soon and clearer. Of course, all meds have their tolerance point, so we'll see how things go after a month or so. - Barbara
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