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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Ted_Brossnan on May 23, 2007, at 15:19:32
Hello,
I just have got an impression, from what I have read long time ago, that there are several negative things about Lithium. Now I am interested to know more about it. Can anyone summerize what is that that is negative about it? Can regular use lead to irreversible health problems?! How safe is it?! Can it help anxiety or specifically social phobia?! What about the mechanism of action?!
All input is highly appreciated.Ted.
Posted by kaleidoscope on May 23, 2007, at 15:23:49
In reply to Some questions about Lithium., posted by Ted_Brossnan on May 23, 2007, at 15:19:32
Hi Ted
Long time since I've seen you around here! Last I knew you were taking Nardil......and....was it cyproheptadine?
How are you doing?
>Can it help anxiety or specifically social phobia?!
There is no evidence that lithium is effective for social phobia.
Ed_UK - Kaleido is my new name
Posted by Phillipa on May 23, 2007, at 16:55:25
In reply to Some questions about Lithium., posted by Ted_Brossnan on May 23, 2007, at 15:19:32
My ex father-in-law has taken lithium for years for bipolar. The negatives for him are a tremor and weight gain. Other than that it has saved him life as if he goes off it he becomes manic and two weeks later severe depression . So he's 85 now and doing quite well. Good luck. Love Phillipa
Posted by Squiggles on May 23, 2007, at 17:33:16
In reply to Some questions about Lithium., posted by Ted_Brossnan on May 23, 2007, at 15:19:32
Negative things:
- I think about 10% of people taking it
develop hypothyroidism, which is treatable;- weight gain
- thirst
- many report tremors
- water gain
- "narrow therapeutic index"
- skin disorders in some people
- lethargy
- frequent urination and thirst
- not recommended for cardiac patients or those with bad kidney clearance
I highly recommend you look up Dr. Schou's booklet -- Lithium Guide as a popular book.
The good points: at the right dose it feels very normal if any psychiatric drug can.
Squiggles
Posted by linkadge on May 23, 2007, at 18:09:21
In reply to Re: Some questions about Lithium., posted by Squiggles on May 23, 2007, at 17:33:16
I can cause kidney dammage.
Linkadge
Posted by linkadge on May 23, 2007, at 18:09:30
In reply to Re: Some questions about Lithium., posted by Squiggles on May 23, 2007, at 17:33:16
It can cause kidney dammage.
Linkadge
Posted by linkadge on May 23, 2007, at 18:14:41
In reply to Re: Some questions about Lithium., posted by linkadge on May 23, 2007, at 18:09:30
For some people, it may be a factor in the development of parkinsons disease.
Linkadge
Posted by gardenergirl on May 23, 2007, at 22:03:29
In reply to Re: Some questions about Lithium., posted by linkadge on May 23, 2007, at 18:09:21
> I can cause kidney dammage.
>
> LinkadgeHey Link, is that a black box warning? ;)
I just couldn't help but giggle and snort when I read that typo. Some are such happy accidents. :)
gg
Posted by Squiggles on May 24, 2007, at 6:31:57
In reply to Re: Some questions about Lithium., posted by gardenergirl on May 23, 2007, at 22:03:29
I was going to chide him, that in that case
i would stay away from linkadge, but you beat
me to the punch. I hope the problem isn't
a Freudian one :-).Squiggles
Posted by linkadge on May 24, 2007, at 6:36:11
In reply to Re: Some questions about Lithium., posted by gardenergirl on May 23, 2007, at 22:03:29
I know I know. I pressed the button to move back after I hit post, but it was too late.
But, I mean, if you're really desparate for kidney problems, I could probably arrange *something*.
Linkadge
Posted by Squiggles on May 24, 2007, at 10:39:10
In reply to Re: Some questions about Lithium. » gardenergirl, posted by linkadge on May 24, 2007, at 6:36:11
Here is the book by Dr. Mogens Schou on lithium--
sorry i had no time to post it later:1.
"Lithium Treatment of Mood Disorders: A Practical Guide"
Lithium Treatment of Mood Disorders: A Practical Guide by Mogens Schou (Paperback - April 30, 2004)
Buy new: $26.50 12 Used & new from $23.85
Usually ships in 1 to 2 weeks
Eligible for FREE Super Saver Shipping.
Other Editions: Hardcover, Paperback
2.
Lithium Treatment of Manic-Depressive Illness
Lithium Treatment of Manic-Depressive Illness by Mogens Schou (Paperback - 1980)
Currently unavailable
3.
Lithium- Behandlung der manisch-depressiven Krankheit. Informationen für Arzt, Patient und Angehörige.
Lithium- Behandlung der manisch-depressiven Krankheit. Informationen für Arzt, Patient und Angehörige. by Mogens Schou, Jochen Albrecht, R. Drochner, and Bruno Müller-Oerlinghausen (Paperback - May 1, 2001)
Currently unavailable
Posted by Justherself54 on May 24, 2007, at 18:26:43
In reply to Re: Some questions about Lithium., posted by Squiggles on May 24, 2007, at 10:39:10
I had to stop lithium as I couldn't tolerate the tremors in my hands..was so bad it would send the computer mouse flying! But I can't tolerate mood stabs at the best of times..everyone is different so the negative stories usually have as many positive ones..sometimes you feel like you're playing in a crap shoot..might get lucky with a new med or might "crap" out..good to do some research..
Posted by Squiggles on May 24, 2007, at 20:15:24
In reply to Re: Some questions about Lithium., posted by Justherself54 on May 24, 2007, at 18:26:43
> I had to stop lithium as I couldn't tolerate the tremors in my hands..was so bad it would send the computer mouse flying! But I can't tolerate mood stabs at the best of times..everyone is different so the negative stories usually have as many positive ones..sometimes you feel like you're playing in a crap shoot..might get lucky with a new med or might "crap" out..good to do some research..
I've never had tremor with lithium. I don't know what causes it in some people. I really should do some research on that-- it may be the dose or just not the right drug for your condition. I know that when I took imipramine for depression, i got very sick. Some articles i have read point to a connection of imipramine and manic-depression, i.e. that imipramine can cause mania upon withdrawal. I don't really know. Lithium made me feel better than I was before any drug or drug-free state. I have had some close calls with toxicity though-- you have to watch the conditions under which you take it.
Squiggles
Posted by Squiggles on May 24, 2007, at 20:43:53
In reply to Re: Some questions about Lithium., posted by Squiggles on May 24, 2007, at 20:15:24
Just browsing through the net, i see that
tremor with lithium can be- too high a dose (lowering it would be the sensible thing to do)
- extrapyramidal (sounds dangerous--Propanol and other Beta blockers are recommended, which i think is downright dangerous--eyes wide shut)
- taking it with caffeine (the suggestion to eliminate caffeine shows ignorance about the effect of caffeine on lithium--which is to lower the lithium in the blood).
- taking it for a very long time (any drug which you take into your old age should be reassessed as seniors tend to lose renal clearance and their metabolism of all drugs slows down)- perhaps lower the dose as the person gets older;
------
I would choose the first possibility, and if the lithium dose is not enough maybe add another fraction of a drug;
Squiggles
Posted by linkadge on May 25, 2007, at 6:39:35
In reply to Re: Some questions about Lithium., posted by Squiggles on May 24, 2007, at 20:43:53
It can also be a mild parkinsonian like effect. Similar to what is produced by antipsychotics.
Lithium does have antidopaminergic effects (indirect), and may affect motion in this manner.
Twitching is a little different and may be due to the proconvulsant effects of lithium.
Linkadge
Posted by Squiggles on May 25, 2007, at 7:48:05
In reply to Re: Some questions about Lithium., posted by linkadge on May 25, 2007, at 6:39:35
I think that assertion may be false.
Looking at PubMed articles, i see that
lithium is actually *given* for Alzheimer's
and Parkinson's.There *are* cases where the tremor mimics
Parkinson's, but that is not the same thing.
This poor man at 71 had lithium toxicity-- something which is easily avoidable with frequent blood tests. Lithium requires regular check-up, especially at older ages.
"1: Int Clin Psychopharmacol. 1994 Summer;9(2):127-9. Links
Chronic lithium neurotoxicity presenting as Parkinson's disease.* Lecamwasam D,
* Synek B,
* Moyles K,
* Ghose K.Western Bay Health Tauranga, Auckland, New Zealand.
A 71 year old man who had been on lithium for 9 years for mania presented with an encephalopathic illness which was almost certainly due to lithium intoxication. Having recovered from this acute episode (although he was left with some sequelae) he was recommenced on lithium for his manic symptoms with a careful control of his blood levels. After remaining fairly stable for 8 years he presented with features suggestive of Parkinsonism and was admitted to hospital for investigation. There was no history of taking additional medication such as antidepressants or antipsychotics. He died in hospital and a post-mortem examination confirmed the cause of death as acute myocardial infarction. However histological examination of the brain revealed neurological sequelae of chronic lithium intoxication. There was no evidence of degenerative condition such as Parkinsonism or Alzheimer's disease."
Squiggles
Posted by linkadge on May 25, 2007, at 11:17:44
In reply to Re: Some questions about Lithium. » linkadge, posted by Squiggles on May 25, 2007, at 7:48:05
>I think that assertion may be false.
>Looking at PubMed articles, i see that
>lithium is actually *given* for Alzheimer's
>and Parkinson's.Lithium would not be given to treat Alzheimer's or Parkinsons as it is not an established treatment for either. It does not even lead to symptomatic improvement in Parkinson's or Alzheimers, except in perhaps behavioral control (for agitation etc)
Although there has been some preliminary speculation that lithium may slow certain neurodegenerative deseases, there is no long term data to support its use. Lithium has shown certain neuroprotective properties in short term trials, but I know of none which suggest it actually works to treat or supress the progression of either disease.
>There *are* cases where the tremor mimics
>Parkinson's, but that is not the same thing.
>This poor man at 71 had lithium toxicity-- >something which is easily avoidable with >frequent blood tests. Lithium requires regular >check-up, especially at older ages.Lithium use, as well as SSRI use has been associated with later onset of Parkinsons desease. Although, the counterargument is that mood disorders are a risk factor for Parkinsons and not the treatement.
This being said, lithium is actually antidopaminergic. It interacts with dopaminergic pathways via its effects on 5-ht1b receptors.
While this is not proof that it causes parkonsons, it has been associated with onset of parkionsons in a few studies."1: Int Clin Psychopharmacol. 1994 Summer;9(2):127-9. Links
Chronic lithium neurotoxicity presenting as Parkinson's disease.This is just one case. It doesn't proove anything either way.
Squiggles
Posted by Squiggles on May 25, 2007, at 11:42:32
In reply to Re: Some questions about Lithium., posted by linkadge on May 25, 2007, at 11:17:44
...It does not even lead to symptomatic improvement in Parkinson's or Alzheimers, except in perhaps behavioral control (for agitation etc)
>
You may have a point there. It is experimental,
and behavioral control is a favourite test for many new treatments.
...
>
> >There *are* cases where the tremor mimics
> >Parkinson's, but that is not the same thing.
> >This poor man at 71 had lithium toxicity-- >something which is easily avoidable with >frequent blood tests. Lithium requires regular >check-up, especially at older ages.
>
> Lithium use, as well as SSRI use has been associated with later onset of Parkinsons desease. Although, the counterargument is that mood disorders are a risk factor for Parkinsons and not the treatement.That may be so and the cause may be chronic lithium intoxication. This is something Dr. Schou warned against when he recommended a "lithium holiday". The reason he suggested this is that a blood test cannot show an accurate accumulation rate in the brain, and showing a normal blood level can be deceptive.
>
> This being said, lithium is actually antidopaminergic. It interacts with dopaminergic pathways via its effects on 5-ht1b receptors.
> While this is not proof that it causes parkonsons, it has been associated with onset of parkionsons in a few studies.Are there any ADs or APs that are not antidopaminergic?
>
>
> Squiggles
>
Posted by linkadge on May 25, 2007, at 14:20:52
In reply to Re: Some questions about Lithium., posted by Squiggles on May 25, 2007, at 11:42:32
Its hard to say that antidopaminergic drugs cause parkinsons. They can cause functional parkinsons, but wheather they are inducing the type of dammage (dopaminergic cell loss) which is associated with parkinsons is uncertain.
My personal speculation of why serotonergic antidepressants may lead to future parkinsons is via their indirect effects on melatonin levels.
Supressing melatonin excretion with SSRI's could open the door to a whole host of problems, as melatonin is both a potent antioxidant, and neuroprotectant.
Thats just my own theory though.
Any potent SSRI will have some effect on dopamine neurotranmsission. Roughtly speaking, ehancing serotonin will supress dopamine function in certain areas of the brain.
For depression in parkinsons, wellbutrin, nortryptaline, or others may be more suited, but I am not up on that.
Linkadge
Posted by Squiggles on May 25, 2007, at 14:36:35
In reply to Re: Some questions about Lithium., posted by linkadge on May 25, 2007, at 14:20:52
A bit more research might give you and the
readers here some more confidence. I have
not come across anything like the melatonin
theory.Thanks anyway.
Squiggles
Posted by linkadge on May 25, 2007, at 16:31:09
In reply to Re: Some questions about Lithium. » linkadge, posted by Squiggles on May 25, 2007, at 14:36:35
Raising serotonin levels to high will affect melatonin excretion via stimulation of 5-ht2a. Drugs that block 5-ht2a such as atypicals, mirtazapine, trazodone etc have some ability to block this effect.
SSRI's can cause insomnia by affecting this serotonin melatonin ballance.
As much as it may seem, I'm not totally pulling this stuff out of my...
---------
See:
http://www.gianteagle.com/healthnotes/Drug/Fluoxetine.htm
Administration of fluoxetine for six weeks significantly lowered melatonin levels in people with seasonal affective disorder (SAD) and in healthy persons as well.3 Further study is needed to determine if this might interfere with sleeping or whether melatonin supplementation might be appropriate.
---------------
I have seen similar studies for other SSRI's, so I am assuming this could be a class effect. (Except for fluvoxamine which actually increases melatonin by affecting its metabolism).
Any other q's??Linkadge
Posted by Squiggles on May 25, 2007, at 16:33:40
In reply to Re: Some questions about Lithium., posted by linkadge on May 25, 2007, at 16:31:09
No. But I'm not getting off my lithium,
for many reasons.Squiggles
Posted by linkadge on May 25, 2007, at 16:58:34
In reply to Re: Some questions about Lithium., posted by Squiggles on May 25, 2007, at 16:33:40
You don't need to. I don't know how the risk benifit analysis pans out for any one individual.
Linkadge
Posted by Squiggles on May 25, 2007, at 17:13:01
In reply to Re: Some questions about Lithium., posted by linkadge on May 25, 2007, at 16:58:34
At my age it probably doesn't matter much;
unless i develop kidney failure. I've been on it
at least 20 years - It does tend to stay stable.Also, i had a serendipitous counterfeit lithium crash a couple of yrs. ago, which inadvertently did just what Dr. Schou would have recommended - it gave me a lithium holiday. I could feel my brain cleansing out.
Actually, near the end it was more like a lithium nightmare, lol. I managed to reinstate, by cutting fractions of the stuff in the caps.
So, now it's like i'm a born-again-lithium-user with another 20 yrs. to go at least.:-)Squiggles
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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