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Dr. Bob is Robert Hsiung, MD,
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Posted by floatingbridge on August 16, 2009, at 22:08:40
In reply to Re: Scott-quick question on lithium » floatingbridge, posted by Maxime on August 16, 2009, at 21:57:35
Hi Maxime,
I will float this by my pdoc tomorrow. Right now I'm beginning to feel a little sad trying to figure out what's wrong with me. It's been a life-long question. Bipolar something.... Sigh. It's changed throughout the years, started early and is only getting worse. Sounds like many of us here.
Thanks for your help,
fb
Posted by alchemy on August 16, 2009, at 22:58:18
In reply to Re: Scott-quick question on lithium » floatingbridge, posted by Maxime on August 16, 2009, at 21:57:35
> Fb, I have heard of so many people doing well on low doses of lithium for mixed states and depression. I really think it's something you should try. It may be the med for you!
>
I didn't know it had much of an effect on depression. I'm kind of a Bipolar II with agitated depression and swings. (I wish I new what mania felt like).
I still need something to help my wellbutrin-lamictal-celexa-xanax combo. I stil have a little cycling and my status-quo is depressed,
One of my main issues is RESTLESS BUT DON'T WANT TO DO ANYTHING/LACK OF MOTIVATION. Ideas on that? Adderall rocked for the 1st week then I really started to cycle.
Do these small doses often affect your weight?
Posted by morganator on August 16, 2009, at 23:37:10
In reply to Re: Scott-quick question on lithium-Good to hear, posted by alchemy on August 16, 2009, at 22:58:18
I'm not Scott and I hope you don't take this the wrong way. I'm just curious to know if you have tried alternative ways to being better for yourself. For example, exercise, therapy, building relationships/friendships, working on your ability to form and build strong friendships/relationships, meditation, yoga, bikram yoga. I know being really depressed and agitated and anxious makes it harder to do positive things for ourselvs. I am in that position right now. If it were not for the condition of my wrecked body, I probably would not be on this board right now. Don't get me wrong, I really appreciate psycho babble and what it has to offer.
If I were you I would add on a low dose of Lithium. Why Not? I mean, some life extensionists are taking it now.
I don't think lithium will do much for motivation.
How much xanax do you take? Xanax is not going to help your motivation. You are better off dumping xanax if you can, unless you just take it PRN.Sorry for the mini rant, I just think that motivation has to come from within, not from medication. There may be underlying reasons for lack of motivation that need to be addressed.
Posted by SLS on August 17, 2009, at 6:12:06
In reply to Re: Scott-quick question on lithium » floatingbridge, posted by morganator on August 16, 2009, at 21:10:53
Re: lithium
> I am hoping that at these low doses, I will get the benefits and avoid the potential kidney and thyroid issues.
One of my doctors told me that the evolution of kidney and thyroid abnormalities is NOT dosage dependent. I haven't done any research to corroborate this.
- Scott
Posted by SLS on August 17, 2009, at 6:33:18
In reply to Re: Scott-quick question on lithium-Good to hear, posted by morganator on August 16, 2009, at 23:37:10
Hi Morgan.
I can attest to the destructive power that depression has over motivation. When I have had brief antidepressant responses, I had no problems initiating activities. In fact, a few weeks ago, when I experienced a moderate response to the addition of lithium, I was already beginning to plan a trip down to the Florida keys. Man, it felt so good to be driving with the roof open with sunshine all around me. I couldn't wait to pack.
Motivation/Interest/Energy are lost to this illness. Just how much PUSHING should one person expect of another when the other person is severely depressed? Without medication, my depressive state does not allow me enough motivation to stop staring at the wall and fix my gaze on the TV. Forget about picking up the remote to change channels.
I think it helps to think of the various types and severities of depressions in terms of thresholds of functionality. I am right at the threshold of going back to the gym. These past few days, I have PUSHED myself out the door in order to walk a mile. I think if I PUSH myself, I can get in the car and drive to the gym. Once I'm there, I am hoping that momentum will allow me to begin exercising. If I were feeling any worse than I am right now, though, I would be below the threshold of being able to accomplish this.
One caveat that I try to employ for myself is to not judge another person's experience of depression against mine. Just because I can get out of bed in the morning and cook myself breakfast does not mean that others must be able to do it as well if they would only PUSH themselves hard enough.
I am tired of PUSHING.
- Scott
Posted by SLS on August 17, 2009, at 6:40:00
In reply to Re: Scott-quick question on lithium » SLS, posted by floatingbridge on August 16, 2009, at 20:47:33
> Thanks Scott and Maxime,
>
> Have either of you (or anyone) heard of lithium used as a mood stabilizer for someone like, well, like me.Topamax.
If you start low and go very slow, you can probably avoid all of the cognitive side effects that people complain about.
25mg x 1 week
50mg x 1 week
75mg x 1 week
100mg x 2-4 weeks - Evaluate for need to increase the dosage.
- Scott
Posted by zana on August 17, 2009, at 9:05:22
In reply to Re: Scott-quick question on lithium » floatingbridge, posted by SLS on August 17, 2009, at 6:40:00
Dear FB,
I have unipolar depression but took lithium as an augementer and had a terrible time on it. It made me a zombie and made my hair fall out. We're all different and it is considered the gold standard of mood stabilizers. I think you have to talk it over with your PD.
I wanted to say that I too am tormented by a lack of motivation and it is terrible. I have a faint hope that it is in part an artifact of the APs I'm taking but I really think it is part of my depression and I too am tired of pushing all the time and trying to have a "good" time. I just made plans to take my first vacation in many years and my primary feeling is I don't want to go. I just can't imagine what I'll do to have fun and I don't really want to leave my home our my stuff our my dog. How sad. Nothing in the whole world calls to me. The lack of motivation, the deadness is the worst loss for me.
Zana
Posted by floatingbridge on August 17, 2009, at 11:42:19
In reply to Re: Scott-quick question on lithium, posted by zana on August 17, 2009, at 9:05:22
Just thanks! A lot!
fb
Posted by alchemy on August 17, 2009, at 18:05:10
In reply to Re: Scott-quick question on lithium-Good to hear » morganator, posted by SLS on August 17, 2009, at 6:33:18
> I can attest to the destructive power that depression has over motivation. When I have had brief antidepressant responses, I had no problems initiating activities....
> Motivation/Interest/Energy are lost to this illness. Just how much PUSHING should one person expect of another when the other person is severely depressed? ...
>
> I think it helps to think of the various types and severities of depressions in terms of thresholds of functionality...
> I am tired of PUSHING.
>
"Pushing" is a good way to say it. I have said "make myself". And making myself do things can be depressing as well. At times I have made myself get on the treadmill & it makes me feel worse because of how miserable I am when jogging/walking. I am semi-functional but even today the strain of "pushing", getting out & still being depressed made me think of looking up how many pills to end life. 25 years with little progress sure takes a toll.
I am tired of pushing and dealing with this brain. Trying to make it through the day, but then it begins again.Scott, does the lithium still help you? What is your diagnosis?
Posted by morganator on August 17, 2009, at 18:32:26
In reply to Re: Scott-quick question on lithium-Good to hear » SLS, posted by alchemy on August 17, 2009, at 18:05:10
Sorry if I jumped to any conclusions. From your first post it sounded like you were not that depressed. It appeared as if the medications were treating your depression and you just needed a medication for motivation.
Posted by SLS on August 17, 2009, at 18:52:54
In reply to Re: Scott-quick question on lithium-Good to hear » SLS, posted by alchemy on August 17, 2009, at 18:05:10
> > I can attest to the destructive power that depression has over motivation. When I have had brief antidepressant responses, I had no problems initiating activities....
> > Motivation/Interest/Energy are lost to this illness. Just how much PUSHING should one person expect of another when the other person is severely depressed? ...
> >
> > I think it helps to think of the various types and severities of depressions in terms of thresholds of functionality...
> > I am tired of PUSHING.
> >
> "Pushing" is a good way to say it. I have said "make myself". And making myself do things can be depressing as well. At times I have made myself get on the treadmill & it makes me feel worse because of how miserable I am when jogging/walking. I am semi-functional but even today the strain of "pushing", getting out & still being depressed made me think of looking up how many pills to end life. 25 years with little progress sure takes a toll.
> I am tired of pushing and dealing with this brain. Trying to make it through the day, but then it begins again.I wish I could do something to make things easier for you. I lost my magic wand years ago.
> Scott, does the lithium still help you?
Maybe. To my pleasant surprise, I felt better than I should have today. That means that something is tickling the right places. I had an initial robust response when I first started lithium beginning at 300mg. When that disappeared, I increased the dosage to 600mg. Again, I experienced a brief response that disappeared. Unfortunately, I felt somewhat washed out and experienced tremulousness. I then decided to reduce back to 300mg with the intention of staying on it indefinitely. I would say that I perceived a slight improvement over the last few weeks. However, this morning was different. I felt significantly better than I would have normally. I can't help but to feel optimistic again.
> What is your diagnosis?
Bipolar depression with infrequent drug-induced manias. I had been an ultra rapid cycler (8 days down and 3 days up) for a number of years before my first battle with lithium. Lithium stopped the cycling, but left me severely depressed. I subsequently stayed away from lithium for years.
- Scott
Posted by morganator on August 17, 2009, at 19:45:41
In reply to Re: Scott-quick question on lithium-Good to hear » morganator, posted by SLS on August 17, 2009, at 6:33:18
I know depression is a major cause of a lack of motivation, I'm living it right now.
When depression is treated for the most part and there is still a lack of motivation, it is reasonable to think that something else is going on that does not require a "motivation" medication to address the problem. When someone is restless and cannot follow through with things we have to begin to address other possible issues, like self worth, which could be one cause of the depression. I just don't believe in a drug for motivation.
Also, when I hear restless but I don't hear depressed, I think that it is possible for someone to use that restless energy to make themselves simply drive to the gym or walk out there door and take a run. It may not be what they want to do, but at least they have the energy to do it. Then, if they do exercise and stretch, restless energy may turn into a more focused calm energy. Whether this makes someone more motivated to do things or not is dependent on the person of course.
No one can argue against the benefit of exercise for depression and the health of our brains. Exercise is one of the best ways to enhance neurogenesis in the areas of our brains that are damaged by depression. That should be some motivation for all of our depressed brains.
Posted by morganator on August 17, 2009, at 19:52:15
In reply to Re: Scott-quick question on lithium » morganator, posted by SLS on August 17, 2009, at 6:12:06
>One of my doctors told me that the evolution of kidney and thyroid abnormalities is NOT dosage dependent. I haven't done any research to corroborate this.
I have to believe that it is dosage dependent. At least the chance of developing these issues may be increased with higher dosages. There is no argument that higher dosages are more toxic. Isn't the therapeutic limit a dose that is very close to a level of toxicity where kidney damage is much much more likely? Maybe I am misunderstanding this.
Posted by morganator on August 17, 2009, at 20:05:18
In reply to Re: Scott-quick question on lithium » morganator, posted by SLS on August 17, 2009, at 6:12:06
> Re: lithium
>
> > I am hoping that at these low doses, I will get the benefits and avoid the potential kidney and thyroid issues.
>
> One of my doctors told me that the evolution of kidney and thyroid abnormalities is NOT dosage dependent. I haven't done any research to corroborate this.
>
>
> - ScottHere is one doctor that believes a low dose of lithium is less likely to cause kidney problems. I think he said that the risk of thyroid issues are still there.
http://www.psycheducation.com/2007/12/value-of-low-dose-lithium.html
Posted by SLS on August 17, 2009, at 20:12:40
In reply to Re: Scott-quick question on lithium, posted by morganator on August 17, 2009, at 20:05:18
> > Re: lithium
> >
> > > I am hoping that at these low doses, I will get the benefits and avoid the potential kidney and thyroid issues.
> >
> > One of my doctors told me that the evolution of kidney and thyroid abnormalities is NOT dosage dependent. I haven't done any research to corroborate this.
> >
> >
> > - Scott
>
> Here is one doctor that believes a low dose of lithium is less likely to cause kidney problems. I think he said that the risk of thyroid issues are still there.
>
> http://www.psycheducation.com/2007/12/value-of-low-dose-lithium.html
Thanks! That makes me feel more comfortable in taking this drug.
- Scott
Posted by Phillipa on August 17, 2009, at 20:23:45
In reply to Re: Scott-quick question on lithium » Phillipa, posted by floatingbridge on August 16, 2009, at 22:05:11
FB yes remember. Strange they don't open for you just tried no problem for me? So what did pdoc say or tomorrow?
Posted by SLS on August 17, 2009, at 20:26:53
In reply to Re: Scott-quick question on lithium-Good to hear » SLS, posted by morganator on August 17, 2009, at 19:45:41
Hi Morgan.
I agree with much of what you say - just about all of it.
> When depression is treated for the most part and there is still a lack of motivation, it is reasonable to think that something else is going on that does not require a "motivation" medication to address the problem.
That's fair. Unfortunately, anhedonia can be a residual symptom of depression, even after the other symptoms of depression resolve. There is now some evidence that people with anhedonia do not crave reward enough to work for it. This results in reduced motivation to initiate activities. It sucks.
http://www.sciencedaily.com/releases/2009/08/090812181437.htm
- Scott
Posted by floatingbridge on August 17, 2009, at 20:39:47
In reply to Re: Scott-quick question on lithium-Good to hear » morganator, posted by SLS on August 17, 2009, at 20:26:53
Well, could this be addressed with dopamine agonists? Mirapex for someone severely depressed might not make them into a compulsive gambler or sex addict--maybe they'd feel 'normal'?
fb
Posted by morganator on August 17, 2009, at 21:38:42
In reply to Re: Scott-quick question on lithium-Good to hear » morganator, posted by SLS on August 17, 2009, at 20:26:53
I believe it. I am starting to feel that way. I sure hope there has not been any damage to my mind or psyche to the point where I will begin to suffer from this type of anhedonia. Ugh
Posted by morganator on August 17, 2009, at 21:41:38
In reply to anhedonia » SLS, posted by floatingbridge on August 17, 2009, at 20:39:47
> Well, could this be addressed with dopamine agonists? Mirapex for someone severely depressed might not make them into a compulsive gambler or sex addict--maybe they'd feel 'normal'?
>
> fbI am interested in Mirapex(pramipaxole). I'm waiting to see what they do with it after clinical trials. I am wondering if it will be combined with some SSRIs with a longer half life than it currently has. It appears that it may synergize with SSRIs.
Posted by floatingbridge on August 17, 2009, at 22:00:25
In reply to Re: anhedonia, posted by morganator on August 17, 2009, at 21:41:38
Askapatient.com gave it some favorable reviews for depression in addition to other ailments such as RLS.
Posted by morganator on August 17, 2009, at 22:29:53
In reply to Re: anhedonia » morganator, posted by floatingbridge on August 17, 2009, at 22:00:25
Thank you..I may talk to my doctor about it.
Posted by floatingbridge on August 17, 2009, at 22:56:57
In reply to Re: anhedonia, posted by morganator on August 17, 2009, at 22:29:53
> Thank you..I may talk to my doctor about it.
It may be in the cards for me, too--but my pdoc has a habit of mentioning things and then they disappear from the agenda for months.
good luck to you and keep us posted if you do talk about it w/ him or her.
fb
Posted by morganator on August 17, 2009, at 23:03:14
In reply to Re: anhedonia » morganator, posted by floatingbridge on August 17, 2009, at 22:56:57
Thank you, good luck to as well.
Morgan
Posted by trainspotter on August 21, 2009, at 11:05:37
In reply to Re: anhedonia, posted by morganator on August 17, 2009, at 21:41:38
I've tried Pramipexole with Prozac and Paxil. It's said by activating DA receptors post synaptically, it alleviates depression. The presynaptic antagonist sulpiride and Amisulpiride also releases dopamine in low doses. I could not remain with Mirapex- higher dosages of 1mg or more caused great nausea and were expensive. It made OCD worse, though increased motivation and all.
This is the end of the thread.
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