![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 59. This is the beginning of the thread.
Posted by MoparFan91 on February 22, 2005, at 19:39:13
I found a while ago that not all (Hypo)mania is of the euphoric/happy kind, which some call White Mania. Some mania can involve anger/agitation, rudeness, and rage. Some refer to this kind of (Hypo)mania as Black Mania.
In my experience, I have the following symptoms during dysphoric (hypo)manic episodes:
Being rude to people and acting smart towards others
Shouting of foul language and namecalling
Honking the horn a lot while driving as others seem slow
Irritability
Being bossy
Snapping at people and going off on others
Sometimes road rage
Super agitated
Noises seem amplified
Irrational anger and being mad as a hornet
Being very argumentative and thinking "It's MY way or NO way!"Dyphoric Mania is much different from Mixed States. One involves anger towards 'others' & an attitude, and the other involves anger towards 'yourself' along with severe depression. Some people say that Dysphoric Mania is the same as Mixed States, but they are very distinct in my experience.
I usually have the Dysphoric Manic states when on antidepressants. I got way agitated and angry on Zoloft, and Lexapro made me all wound up and excited/euphoric at first which progressed to anger and dysphoria. Paxil made me express way too much anger inappropiately, and on it, I stirred up trouble at different places. Thankfully, I rarely have these episodes when unmedicated, but I have a lot mixed states instead. Wellbutrin worsened the mixed state.
So, what are your own symptoms when having a dysphoric manic episode? What things do you usually do during these states?
Posted by Phillipa on February 22, 2005, at 20:07:38
In reply to Dysphoric Mania, posted by MoparFan91 on February 22, 2005, at 19:39:13
I seem to exhibit a lot of your symptoms. Maybe it's time for a new DX. Fondly, Phillipa
Posted by CareBear04 on February 22, 2005, at 20:14:00
In reply to Dysphoric Mania, posted by MoparFan91 on February 22, 2005, at 19:39:13
interesting... i'll just share some experiences and maybe you can categorize them since i missed some of the finer points of your distinctions.
i used to have purely "white" manias-- high energy, euphoric, magnetic, energizer bunny states that lasted months. i'd get so much done and feel so great, and people would inquire whether i was on amphetamines or wonder how i got everything done and didn't sleep.
when i had my first really serious depressive episode and was put on lexapro, it put me in a really bad place. the depression was blacker than ever, but while it had been the lethargic sort before, it became super-agitated akathisia like depression. this was nyc, and i used to go up to the roofs of high buildings with strong urges to throw myself off, partly from depression, and partly just because i felt so much agitation that i couldn't get away from myself. i had psychotic symptoms-- paranoid delusions that my room was bugged and people on the street would shoot me; visual hallucinations of blood and body parts; auditory hallucinations telling me to hurt myself. was this a dysphoric mania or a mixed state or an agitated depression? antidepressants in general tend to do bad things to me, especially without a strong mood stabilizer. the SSRIs are the worst, like for you.
finally, i've recently had high energy states where i've felt cabin fever and had to keep moving and cleaning and doing. i couldn't sit still but wasn't doing anything that productive. it wasn't a white mania; i was definitely irritable, which isn't like me. i couldn't sleep, but unlike mania, where i don't feel the need to sleep, this was like depression where i wanted to sleep but couldn't. my energy level was high, but it was too much for my mood to handle in a way. is this dysphoric mania?
these are some of the states i've had. thoughts?
Posted by Phillipa on February 22, 2005, at 20:21:06
In reply to Re: Dysphoric Mania » MoparFan91, posted by CareBear04 on February 22, 2005, at 20:14:00
I don't know, but I have cabin fever as well. I can't stay in this house during the day. I don't want to clean etc, the only thing I can think to do is walk, so I walk the beach and check my watch to see when I can go home. Then after I take my meds at night I just want to sleep and not get up the next day. I say is that all there is? Fondly, Phillipa
Posted by MoparFan91 on February 22, 2005, at 20:31:36
In reply to Re: Dysphoric Mania » MoparFan91, posted by Phillipa on February 22, 2005, at 20:07:38
> I seem to exhibit a lot of your symptoms. Maybe it's time for a new DX. Fondly, Phillipa
I'm diagonosed Bipolar II. Unmedicated, I'm usually stuck in depression and have mixed states a good bit, but I occasionally have hypomanic periods where I get alot done. I go manic on antidepressants even on mood stabilizers. When I took Lexapro and Zoloft, my mood stabilizer was 100mg of Topamax (yeah, this was barely at a therapeutic level).
I took Lexapro again later on but with Depakote. On this combo, I was having hypomanic periods at work where I'd be really hyper, acting out of character, laughing, and working at a super-fast pace. One of the people who I work with even asked me if I was taking Speed. When I came back from my break one time, I came back to the work area walking so fast, and the coworker said, "Are you on Speed? Looks like you're on Speed or something". My department manager thought I was just really hyper. I told them I was having a caffeine/sugar rush. I had drunk a coke during my break. That was funny. Another day, on this same combo of drugs, I had another hypomanic experience where I pulled a stunt at work. Some ladies were demo-ing soy milk, and I sampled it. I joked around and said, "THIS STUFF IS NASTY!!!", and I was laughing all over the place. Customers noticed how I was acting. I told many other employees about how nasty it was as well in a laughing tone of voice. This was kinda out of character. In reality, I love soy milk.
Posted by MoparFan91 on February 22, 2005, at 21:05:21
In reply to Re: Dysphoric Mania » MoparFan91, posted by CareBear04 on February 22, 2005, at 20:14:00
> interesting... i'll just share some experiences and maybe you can categorize them since i missed some of the finer points of your distinctions.
>According to my experience, my mixed states present the following symptoms:
Self-hatred
Self-rage and damaging my own belongs
Wailing/Crying
Loneliness
Extremely agitated and wanting to jump out of my skin
Self-injury and cutting
Things and people occasionally having a nightmarish quality to them
Being anxiety-ridden, tense, and scared
Suicidal impulses
Certain kinds of music (whether from my stereo or in my head) makes me go crazy and bang my head on the table or wall
Paranoia or thinking that others are against me
Feelings that no one likes me
Feeling removed from everyone and lost in a bad world
Mental torturing with bad, scary thoughts in part due to the OCDI have problems with OCD along with the Bipolar, and when OCD symptoms happen during a mixed state, it can turn real ugly real fast. It's like my mind is 'sticking' and 'locking on' to certain bad thoughts, and they push me down further in the abyss and make me more anxious/agitated. It's next to impossible to get out of this state because of this.
> i used to have purely "white" manias-- high energy, euphoric, magnetic, energizer bunny states that lasted months. i'd get so much done and feel so great, and people would inquire whether i was on amphetamines or wonder how i got everything done and didn't sleep.
>I tend to get hypomanias where I feel boundless energy, elated, and laugh at about even the silliest things. I put a funny twist on everything. It's like feeling a little high (on some nitrous acid, or 'laughing gas'). I talk and talk and talk. I've acted obnoxious at times in this state.
> when i had my first really serious depressive episode and was put on lexapro, it put me in a really bad place. the depression was blacker than ever, but while it had been the lethargic sort before, it became super-agitated akathisia like depression. this was nyc, and i used to go up to the roofs of high buildings with strong urges to throw myself off, partly from depression, and partly just because i felt so much agitation that i couldn't get away from myself. i had psychotic symptoms-- paranoid delusions that my room was bugged and people on the street would shoot me; visual hallucinations of blood and body parts; auditory hallucinations telling me to hurt myself. was this a dysphoric mania or a mixed state or an agitated depression? antidepressants in general tend to do bad things to me, especially without a strong mood stabilizer. the SSRIs are the worst, like for you.
>I'm sorry to hear what you went through. It's a really bad feeling. I hope you're doing better.
What you had above was definitely a mixed state. A mixed can feel like a form of akathisia to me. It's like wounded in a cage trying to get out but can't.
Even on mood stabilizers, I became (hypo)manic on them. Eventually, I got to mood cycling faster and more fiercely on them, though the depression was better overall.
> finally, i've recently had high energy states where i've felt cabin fever and had to keep moving and cleaning and doing. i couldn't sit still but wasn't doing anything that productive. it wasn't a white mania; i was definitely irritable, which isn't like me. i couldn't sleep, but unlike mania, where i don't feel the need to sleep, this was like depression where i wanted to sleep but couldn't. my energy level was high, but it was too much for my mood to handle in a way. is this dysphoric mania?
>This is more like Dysphoric HypoMania to me. Irritability is a main component.
> these are some of the states i've had. thoughts?
Your agitated depression experience sounded very similar to what I went through before. Many times, I've felt like driving off a bridge in these states. Mixed States are more like impulsive depression or depression on Speed.
Posted by barbaracat on March 21, 2005, at 18:40:37
In reply to Re: Dysphoric Mania, posted by MoparFan91 on February 22, 2005, at 21:05:21
Interesting thread - I've always wondered how others experience this strange condition. My mixed states are similar to yours. Very nightmarish, anguished sorrow. I refer to them as Edgar Allen Poe lost in a graveyard on bad acid. Been having them for the last 30 years, used to be one every few years or so which, for no other term, always called my 'black depressions' to distinguish them from the milder 'sludgey depressions'. I only knew that these other kinds were quite different from anything I'd read or hear about and no one seemed to know what I was talking about. Not depressed but not your classic constant schizoprehnic either.
As I got older and neared menopause they picked up in intensity and frequency and for about a year I was in a continuous mixed/panic state that landed me in the hospital. No one connected bipolar at this time and I was taking high doses of Zoloft. Hah! If I only knew what I know today!
Mixed states are always agitated, wailing, ultra sensitive affairs. Dank, lonely, haunted. Existential angst at the control of an insane god. So alone in it because I'm afraid I'll infect others with my morbidity. I worry constantly that my loved ones will die, have OCD like ruminations about coming home and seeing my cats lying smashed in the road, my husband getting into a fatal car wreck on his way to the local supermarket. Visions of loss, the pain and anxiety of immanent loss. Unfortunately these things come true sometimes. My mother was killed by a car while out walking while I was in the midst of one of these things.
I hear lobsters screaming in the supermarkets, road kill can undo me, I'm devastated by world news, ecological distasters, scenes of clear cuts near my house. Everything painful is amplified and sometimes I can't stop crying, in stores, on the streets. It's like all my soothing filters have vanished and there's no one, no one who can understand or help me. Even meds abandon me. Benzos become like speed. Handfulls of Ambien do nothing for my insomnia. The ONLY things that help somewhat are alcohol (which I've learned the hard way does NOT help) and opiods. Taking a hydrocodone will bring me down as long as it lasts and then it's back to the same.
My journal at this time is my only friend and my therapist. My writings during these raving times are some of my best but I don't remember writing those things.
I feel and look weird and wired. I think people sense that I'm 'different' and keep their distance - which I feel acutely as rejection. At times I tune into an extremely psychic wavelength, and very accurately so, but have made the mistake of telling others unsolicited psychic advice who then permanently place me in the 'wacko' or even 'demonic' category. Well, it does feel demonic. There's an evil aura about it. The worst part is that I cannot feel any connection to the Light or to Spirit. It is ultimate aloneness.
Something electrical sensitivey occurs at this time, I can't explain it any other way. I feel currents of electricity, feel as though my sensors/antennas pick up fields of information that is extremely disturbing, but real, by God. Stuck on 'Fear Factor'. The difficulty is that these awful things ARE happening in the world so it's not hallucinations or paranoia. It's just that the normal buffering layer isn't there and I'm left a raw quivering nerve who doesn't sleep, paces, wails, is irritable and says anything and everything that my urgency senses is important. I've lost quite a few friends during these times.
Lithium has stopped these mixed states better than anything. Didn't have much luck on Seroquel or Zyprexa. Certainly sound like schizoid states that SHOULD be helped by an antipsychotic, but are not. They take away some of the agitation but not the raw sorrow and anguish. It feels so remarkably weird and bizarre and fanstastic. I'm both intrigued, want to know more, and hope to God I never experience one again. - BarbaraCat
>
> According to my experience, my mixed states present the following symptoms:
> Self-hatred
> Self-rage and damaging my own belongs
> Wailing/Crying
> Loneliness
> Extremely agitated and wanting to jump out of my skin
> Self-injury and cutting
> Things and people occasionally having a nightmarish quality to them
> Being anxiety-ridden, tense, and scared
> Suicidal impulses
> Certain kinds of music (whether from my stereo or in my head) makes me go crazy and bang my head on the table or wall
> Paranoia or thinking that others are against me
> Feelings that no one likes me
> Feeling removed from everyone and lost in a bad world
> Mental torturing with bad, scary thoughts in part due to the OCD
>
> I have problems with OCD along with the Bipolar, and when OCD symptoms happen during a mixed state, it can turn real ugly real fast. It's like my mind is 'sticking' and 'locking on' to certain bad thoughts, and they push me down further in the abyss and make me more anxious/agitated. It's next to impossible to get out of this state because of this.
>
> > i used to have purely "white" manias-- high energy, euphoric, magnetic, energizer bunny states that lasted months. i'd get so much done and feel so great, and people would inquire whether i was on amphetamines or wonder how i got everything done and didn't sleep.
> >
>
> I tend to get hypomanias where I feel boundless energy, elated, and laugh at about even the silliest things. I put a funny twist on everything. It's like feeling a little high (on some nitrous acid, or 'laughing gas'). I talk and talk and talk. I've acted obnoxious at times in this state.
>
> > when i had my first really serious depressive episode and was put on lexapro, it put me in a really bad place. the depression was blacker than ever, but while it had been the lethargic sort before, it became super-agitated akathisia like depression. this was nyc, and i used to go up to the roofs of high buildings with strong urges to throw myself off, partly from depression, and partly just because i felt so much agitation that i couldn't get away from myself. i had psychotic symptoms-- paranoid delusions that my room was bugged and people on the street would shoot me; visual hallucinations of blood and body parts; auditory hallucinations telling me to hurt myself. was this a dysphoric mania or a mixed state or an agitated depression? antidepressants in general tend to do bad things to me, especially without a strong mood stabilizer. the SSRIs are the worst, like for you.
> >
>
> I'm sorry to hear what you went through. It's a really bad feeling. I hope you're doing better.
>
> What you had above was definitely a mixed state. A mixed can feel like a form of akathisia to me. It's like wounded in a cage trying to get out but can't.
>
> Even on mood stabilizers, I became (hypo)manic on them. Eventually, I got to mood cycling faster and more fiercely on them, though the depression was better overall.
>
> > finally, i've recently had high energy states where i've felt cabin fever and had to keep moving and cleaning and doing. i couldn't sit still but wasn't doing anything that productive. it wasn't a white mania; i was definitely irritable, which isn't like me. i couldn't sleep, but unlike mania, where i don't feel the need to sleep, this was like depression where i wanted to sleep but couldn't. my energy level was high, but it was too much for my mood to handle in a way. is this dysphoric mania?
> >
>
> This is more like Dysphoric HypoMania to me. Irritability is a main component.
>
> > these are some of the states i've had. thoughts?
>
> Your agitated depression experience sounded very similar to what I went through before. Many times, I've felt like driving off a bridge in these states. Mixed States are more like impulsive depression or depression on Speed.
Posted by ed_uk on March 21, 2005, at 19:19:24
In reply to Re: Dysphoric Mania » MoparFan91, posted by barbaracat on March 21, 2005, at 18:40:37
Barbaracat,
I was deeply affected by your vivid account. Thank you for writing.
Please don't stop the lithium again!
Regards,
Ed.
Posted by barbaracat on March 21, 2005, at 20:15:59
In reply to Re: Dysphoric Mania » barbaracat, posted by ed_uk on March 21, 2005, at 19:19:24
Thanks for the support, Ed. Not a chance of stopping lithium. I've done that 3 times so far and learned that I simply can't live without it. I disinitegrate pretty quickly from yowza hypomania to the weird stuff.
Very strange, these mixed states, or whatever the heck my private circle in hell can be called.
The clue seems to lie somewhere in that hypersensitivity to electricity and picking up certain wavelenghts (sounds so schizoid, I know). Lithium acts on the electrical potential of ion gates in the cells so I have to believe there's a connection. So interesting.
I guess everyone who experiences bipolar dysphoria has their own very unique stories to tell. But it makes me wonder if our symptoms aren't actually very similar, as in we're not as alone in this as we imagine? - Barbara
> Barbaracat,
>
> I was deeply affected by your vivid account. Thank you for writing.
>
> Please don't stop the lithium again!
>
> Regards,
> Ed.
Posted by ed_uk on March 21, 2005, at 20:25:04
In reply to Re: Dysphoric Mania » ed_uk, posted by barbaracat on March 21, 2005, at 20:15:59
Hi B!
> I've done that 3 times so far and learned that I simply can't live without it.
Just out of curiosity, what lithium level is best for you?
Ed.
Posted by barbaracat on March 22, 2005, at 8:20:34
In reply to Re: Dysphoric Mania » barbaracat, posted by ed_uk on March 21, 2005, at 20:25:04
>
> Just out of curiosity, what lithium level is best for you?**I do best on 600mg Li Carbonate. Went up to 750mg and it was fine. 900 and up and I start getting tremors and thirst. I try to keep it down to where I don't put on more weight and don't get a flattened emotional affect. There are times of extra stress when I could and should probably take more, but I try to keep my thyroid levels steady becuase hypothyroidism is quite depressing in it's own right.
It also has to be Li Carbonate. Tried Li Orotate twice, believing the hype and hoping to lessen some of the thyroid problems Li was exacerbating. But no go. It took a little longer with Li Orotate, but I hit a mania anyway. I also take a very small amount of Cymbalta (12 pellelts of SNRI), fish oil and many nutrients, and keep on top of all my other hormones, but it's the lithium that keeps me sane.
Posted by ed_uk on March 22, 2005, at 9:00:48
In reply to Re: Dysphoric Mania » ed_uk, posted by barbaracat on March 22, 2005, at 8:20:34
Hi!
>I do best on 600mg Li Carbonate. Went up to 750mg and it was fine.
That's a fairly low dose- sounds good to me. I get the impression that a quite a lot of people take doses of Li which are too high. Do you agree?
Ed.
Posted by CareBear04 on March 22, 2005, at 11:45:59
In reply to Re: Dysphoric Mania » barbaracat, posted by ed_uk on March 22, 2005, at 9:00:48
it's funny, ed, because i used to think i only responded to high doses of lithium. looking back, 1800mg of lithium is an awful lot for a girl of 100 pounds. right now, i'm on a teeny dose of 450mg, and i feel fine. part of the change has to do with my body's ability to metabolize lithium-- 450mg now brings a much higher level than it used to. but more than that, i think it's just impossible to isolate what the lithium is doing when one takes a cocktail of drugs. i thought it was the lithium keeping me afloat when i was at a high dose, but who knows, maybe it was something altogether different? but overall, the less lithium the better. taking it always makes me remember why i hate it.
Posted by barbaracat on March 22, 2005, at 12:23:38
In reply to Re: Dysphoric Mania » barbaracat, posted by ed_uk on March 22, 2005, at 9:00:48
**Well, my experience with bipolar meds is that I need much less than what the the party-line dictates. At higher doses (1200) of Li I had tremors and flatness of affect, greasy hair and nausea. Gave it 3 weeks and then titrated down until I reached a stable mood without sx at 600mg and have stayed there.
I'm having a conversation about just this topic with Cache-Monkey on another thread. He felt good at 900mg but his doctor is insisting on increasing until he reaches the 'therapeutic window'. Now that he's having very uncomfortable sx and polyurea, his doc wants him to quit. So unfortunate because this can be a very good med but at near toxic levels is stops being a good med.
New research is showing that the therapeutic level of lithium may be too high and have lowered the bottom end to .4 instead .6. My levels aren't even in the ballpark, but I dug in my heels with my pdoc and luckily, he reluctantly agreed that a non-therpeutic dose seemed to be working. Those levels are based upon the range of a generic male population and I have always been sensitive to many meds. Ten pellets out of a Cymbalta capsule have been working beautifully as an AD for about 5 weeks now, whereas the standard starting dose of 30mg almost sent me into orbit.
The only negative for me with Li has been an exacerbation of my hypothyroidism, but I'm managing that with Synthroid and Cytomel and feeling good. In fact, all my hormones were flatlining and getting them in order with bioidentical sublinqual hormones has made a huge difference.
It's my theory that mood disorders can be helped greatly by rebalancing the endocrine system. But sadly, few mainstream docs know how to correctly test for hormones or what to do about the results. Few people know how important estrogen/progesterone/testosterone is in men and women - they're precursors to the 3 neurohormones, GABA, and involved in thyroxine synthesis.
So yes, from what I've seen on this board and others, I'd have to agree with you that Li doses do not need to be so high. I'm beginning to suspect that most med doses are too high, especially for us tweaky bipolars.
>
> >I do best on 600mg Li Carbonate. Went up to 750mg and it was fine.
>
> That's a fairly low dose- sounds good to me. I get the impression that a quite a lot of people take doses of Li which are too high. Do you agree?
>
> Ed.
Posted by barbaracat on March 22, 2005, at 12:31:01
In reply to Re: Dysphoric Mania » ed_uk, posted by CareBear04 on March 22, 2005, at 11:45:59
Hey, I'm with you CareBear. A handful on this board have reported the same thing with 450mg working just fine. You mentioned your body being able to better metabolize Li. Are you doing anything in particular to bring this about?
I have to think that all this rampant polypharmacy at high doses is confusing the living heck out of our livers and the enzymes needed to break the meds down. One thing I appreciate about Lithium is that it bypasses liver metabolism and is excreted directly in the kidneys - but huge doses put a huge burden on the kidneys and that ain't right. I've opted for less is better in all my meds and haven't suffered any bad consequences. In fact, I've noticed that just a sliver of a benzo will sometimes affect me stronger than the whole pill.
> it's funny, ed, because i used to think i only responded to high doses of lithium. looking back, 1800mg of lithium is an awful lot for a girl of 100 pounds. right now, i'm on a teeny dose of 450mg, and i feel fine. part of the change has to do with my body's ability to metabolize lithium-- 450mg now brings a much higher level than it used to. but more than that, i think it's just impossible to isolate what the lithium is doing when one takes a cocktail of drugs. i thought it was the lithium keeping me afloat when i was at a high dose, but who knows, maybe it was something altogether different? but overall, the less lithium the better. taking it always makes me remember why i hate it.
Posted by CareBear04 on March 22, 2005, at 12:44:45
In reply to Re: Dysphoric Mania » CareBear04, posted by barbaracat on March 22, 2005, at 12:31:01
thanks barbaracat. i don't know if my body is better or less able to metabolize lithium. i think i'm definitely more sensitive to it because a dose like 450mg now is .5, whereas a year ago, it would be like .2. there doesn't appear to be anything wrong with my kidneys, so it's just an unexplained change. once i got over the fear that i needed 1800mg to function, i like the lower dose better.
you mentioned dropping the therapeutic range down to include 0.4. do you happen to know what the therapeutic range used to be? i remember reading in kay jamison's _an unquiet mind_ that the therapeutic doses were much higher then, and that she was often toxic from her prescribed dose. i'm very glad i wasn't treated with lithium during that time, but i'm curious what dose people were prescribed if it made them sick so often?
thanks!
Posted by ed_uk on March 22, 2005, at 13:25:17
In reply to Re: Dysphoric Mania » ed_uk, posted by barbaracat on March 22, 2005, at 12:23:38
Hello!
>New research is showing that the therapeutic level of lithium may be too high and have lowered the bottom end to .4 instead .6.
That's interesting, I think it's 'always' been 0.4 in the UK. I just looked in a book from 12 years ago, it was 0.4 then!
> He felt good at 900mg but his doctor is insisting on increasing until he reaches the 'therapeutic window'.
IMHO, every patient has their own individual therapeutic window.
>My levels aren't even in the ballpark, but I dug in my heels with my pdoc and luckily, he reluctantly agreed that a non-therpeutic dose seemed to be working.
What's your level? Maybe 0.3? Just a random guess!
>I'd have to agree with you that Li doses do not need to be so high.
My friend's pdoc wanted him at a minimum of 0.8 for unipolar depression w/ prominent fatigue! This was despite the fact that his depression got worse at 1200mg (0.7), she wanted to increase to 1500mg- he refused! I don't think he'd even be able to get out of bed if he was on 1500mg.
Ed.
Posted by barbaracat on March 22, 2005, at 14:51:11
In reply to Re: Dysphoric Mania » barbaracat, posted by CareBear04 on March 22, 2005, at 12:44:45
i don't know if my body is better or less able to metabolize lithium. i think i'm definitely more sensitive to it because a dose like 450mg now is .5, whereas a year ago, it would be like .2. there doesn't appear to be anything wrong with my kidneys, so it's just an unexplained change. once i got over the fear that i needed 1800mg to function, i like the lower dose better.
**Yes, it feels much better to not be drooling, eh? You know, there are many substances that interact w/lithium such as coffee, fiber (psyllium, flax), ibuprofen, even milk. Maybe something in your diet or med combo has changed - so hard to pinpoint these variables. Very important to get extra salt in the diet, like a good sea salt. I always put a pinch in my water which prevents the bloat I get from drinking alot of water because of lithium making me thirsty.
>
> you mentioned dropping the therapeutic range down to include 0.4. do you happen to know what the therapeutic range used to be? i remember reading in kay jamison's _an unquiet mind_ that the therapeutic doses were much higher then, and that she was often toxic from her prescribed dose.**I believe it was around .8-2.0 or .9-2.0(2.0 and above is now believed to be toxic). People used to regularly be given 1,500-1,800mg. A Babble Bud I'm communicating with's pdoc insists anything under .6 is worthless. I disagree. You have to go by individual results.
Posted by ed_uk on March 22, 2005, at 15:33:54
In reply to Re: Dysphoric Mania » CareBear04, posted by barbaracat on March 22, 2005, at 14:51:11
PS.
In the UK, the usual range is 0.4-1.
Ed.
Posted by barbaracat on March 22, 2005, at 15:44:25
In reply to Lithium: to barbara and carebear, posted by ed_uk on March 22, 2005, at 13:25:17
>
> What's your level? Maybe 0.3? Just a random guess!**You're right on. My levels have consistently been .3 on 600mg.
>
> My friend's pdoc wanted him at a minimum of 0.8 for unipolar depression w/ prominent fatigue! This was despite the fact that his depression got worse at 1200mg (0.7), she wanted to increase to 1500mg- he refused! I don't think he'd even be able to get out of bed if he was on 1500mg.
>
**That's criminal! What on earth would a unipolar depressive be doing on that much lithium?My friend on another thread, Cache Monkey, just got word from his pdoc to stop lithium immediately because of concerns of diabetes incipidus. He was having polyuria and excessive thirst. It's my partial understanding that he was doing ok on 900mg but not in the therapeutic range, so his doc pushed the dose until he felt miserable. Sigh. We just want to get better. Why can't pdocs have patience and monitor the response at a less than 'therapeutic range'? For some people, this range is proving to be toxic. For me, .3 is just fine, but even I was having some concerns from metabolites in my urine that pointed to lithium induced diabetes - which it turns out I don't have. But still, we need to be careful with this stuff and be provided with a long list of the many drugs and foods that interact with it.
Posted by barbaracat on March 22, 2005, at 15:47:30
In reply to Re: Dysphoric Mania, posted by ed_uk on March 22, 2005, at 15:33:54
> In the UK, the usual range is 0.4-1.
>
**Here, it's .5-2 or .6-2, recently dropped to .4-2.
Posted by ed_uk on March 22, 2005, at 15:57:53
In reply to Re: Lithium: to barbara and carebear » ed_uk, posted by barbaracat on March 22, 2005, at 15:44:25
Hi!
>That's criminal! What on earth would a unipolar depressive be doing on that much lithium?
His pdoc appeared to be following the guidelines for the treatment of mania!
>Why can't pdocs have patience and monitor the response at a less than 'therapeutic range'?
I don't know, they seem to work by a 'one size fits all' strategy eg. everyone should be on 20mg Prozac etc.
>0.3
Do you think your 'requirements' have decreased with time as you've been on the Li??
Ed.
Posted by ed_uk on March 22, 2005, at 16:33:10
In reply to Re: Dysphoric Mania » ed_uk, posted by barbaracat on March 22, 2005, at 15:47:30
Hi B!
I thought the 'standard' upper limit was 1.2 in the US?
Here, we usually say >1.5 is toxic and >2.0 requires emergency treatment!
Kind regards,
Ed.
Posted by CareBear04 on March 22, 2005, at 16:50:40
In reply to Re: Dysphoric Mania » barbaracat, posted by ed_uk on March 22, 2005, at 16:33:10
thanks both for your posts.
i'm pretty sure 1.2 is the upper level of therapeutic in the U.S. definitely anything above 1.5 is now treated as toxic. i think my former pdoc fell into the mentality of your friend's dr you described. of course, i told him that i felt better with more lithium-- and i did feel like my thoughts were slower and i was sleeping better, though i was really sluggish-- but he didn't think anything below 0.6 was worth taking. for me, we aimed between 0.8 and 1.2, and 1800mg put me at 1.12. it's funny b/c he's otherwise a very liberal, free-thinking pdoc. he's a psychoanalyst and doesn't even prescribe drugs to most of his patients. but on the matter of lithium, he was very old-school in his belief that more is better and his convinction that lithium, when it works, is elegant and unmatchable. i think i've been brainwashed as well. when i'm on lithium, especially higher levels, i hate it and want to go off. when i'm not on it, i start to feel racy and feel like i need to be back on lithium. what a drug! thanks for your thoughts.
Posted by barbaracat on March 22, 2005, at 17:30:06
In reply to thanks barbaracat and ed! » ed_uk, posted by CareBear04 on March 22, 2005, at 16:50:40
I have some fairly recent lab results that show the range as .5-2.0. I agree that even 1.5 is getting way too high. If I stop lithium I'm a mess. Mixed states, racing thoughts, total fracture. There's a happy medium, however, and it's not 'too much', it's 'just right'.
>
> i'm pretty sure 1.2 is the upper level of therapeutic in the U.S. definitely anything above 1.5 is now treated as toxic. i think my former pdoc fell into the mentality of your friend's dr you described. of course, i told him that i felt better with more lithium-- and i did feel like my thoughts were slower and i was sleeping better, though i was really sluggish-- but he didn't think anything below 0.6 was worth taking. for me, we aimed between 0.8 and 1.2, and 1800mg put me at 1.12. it's funny b/c he's otherwise a very liberal, free-thinking pdoc. he's a psychoanalyst and doesn't even prescribe drugs to most of his patients. but on the matter of lithium, he was very old-school in his belief that more is better and his convinction that lithium, when it works, is elegant and unmatchable. i think i've been brainwashed as well. when i'm on lithium, especially higher levels, i hate it and want to go off. when i'm not on it, i start to feel racy and feel like i need to be back on lithium. what a drug! thanks for your thoughts.
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