Tell me about your experiences with Lithium.

In My Humble Opinion
21

I personally would not take lithium without having those tests done first, to be certain my body could handle the shock. My cousin died when starting lithium, her body just shut down. She had a nervous breakdown and ended up in a mental facililty in Virginia, where it was decided that lithium would help put her to rights. The last her family heard from her in a phone call was that she was feeling hope again, thinking that she would be able to live normally soon. This was about ten years ago. I didn’t want to post that earlier and panic you, but I guess my words didn’t convey the importance of getting multiple tests before starting lithium.

Any responsible psychiatrist will make sure the patient won’t have problems on the medicine and will send them to get tested depending on the medicine. At the least they should ask about your family medical history and your medical history. Psychologists can’t prescribe meds, psychiatrists can, they studied more. The one I had in High School even diagnosed an ear infection once and gave me meds for that, though that is unusual. He’s retired now, he was a very good doctor.

Get a second opinion. Talk to your counselor, and explain that you want something that will even the moods out, but you do want to feel. See if your counselor can/will help advocate (or at least advise you how to say things to get your point across) with your next psychiatrist to get the right medicine for you.

22

I’m bipolar, and I take lithium and Lamictal. For me, lithium was like a revelation. I feel normal again, like I did before my early 20s, when I started going through cycles of abnormally high and low moods. I do not feel emotionally blunted in any way.

What I have learned from speaking to many other bipolar people–often, when they talk of hating lithium because they feel “flat,” what they mean is, they miss the highs of mania. Mania usually feels really good. If I could guarantee that I could stay hypomanic forever, I’d quit my meds in a split second. But I had some really bad mania experiences, and my depressions are worse than my manias, and so there’s less temptation for me to quit my meds.

To get a little personal here–you have been pretty candid on this board about your sex life. Hypersexuality is a symptom of mania. If you take an antimanic agent like lithium, it’s likely your sex drive will diminish. You might not like that, and it might be a temptation for you to quit lithium and/or other antimanics.

Before lithium, my illness had gotten so bad that I couldn’t hold a job or do anything productive. Now that I’m on it, I’m rebuilding a normal life. Shrinks tried giving me lots of other drugs because lithium is no longer a popular one to use. Nothing else worked.

There are certainly some real concerns with lithium. First, I have learned never, ever to get psychiatric meds or a psychiatric diagnosis from a non-psychiatrist. Then, when you get a diagnosis, get a second and a third opinion. Consult a psychologist too–they usually have a different perspective. Also, if you are seeing a psychiatrist who doesn’t listen to you, doesn’t take enough time with you, doesn’t seem to care about you or remember you, or who just generally makes you uncomfortable–find someone else. I’ve changed around enough to know it is hard to find a good shrink, but they’re worth looking for.

Second, start reading. This is a profoundly life-altering thing. You need to know about the illness. You need to know about the different treatments. You need to walk into your doctor’s office with ideas and opinions about treatment. You will need this knowledge to help you know who are the good shrinks and who are the duds.

Third, once you feel reasonably confident that a bipolar diagnosis is right, make sure the doctors do the proper blood tests (kidney function is the biggie). If you keep taking it, be diligent about getting regular blood tests. Chronic lithium toxicity is not as common as it once was, because people are maintained on much lower doses now than in the past. But the risk is there.

Lithium’s effects are felt within the first few days. Either it works for you, or it doesn’t. There is not the same lengthy adjustment period that happens with antidepressants. Lithium took me from the highest mania to normal in a day and a half. There might be fiddling with the dosage needed, but that happens in a much more compressed time frame than with other medications. Trying lithium is not likely to be a long, painful process, as with many other psychotropic medications.

If you are willing to be diligent and responsible, the physical health risks with lithium are relatively low. Many of the studies that discuss the risks of lithium are long out of date because people are not, on average, given doses as high as were given in the past. Current studies show risks are much lower than previously thought.

My only complaint: I have lithium-induced hypothyroidism. I take Synthroid for it. I have not had any problem losing weight when I have made a reasonable effort toward diet and exercise. I know a few other people on lithium, and they have never had weight problems with it at all.

Best of luck. Feel free to ask me further questions if you like. I am willing to get more personal if you are interested.

23

I should add–many doctors try lithium in patients who they suspect are bipolar because it’s the closest thing they have to a physical test for bipolarity. The wisdom is, “If the patient responds to lithium, they’re bipolar.” This is actually correct the vast majority of the time. That’s why I lean toward thinking, find a psychiatrist you feel comfortable with, and then try a course of lithium. If it doesn’t change anything at all, they’ll probably try one or two other mood stabilizers. If those don’t change anything at all, the doctors will likely cross bipolar off the list and go back to the drawing board. In your shoes, I’d want to do it for that reason alone.

24

Also–stop reading information off the Internet. Start by getting some real books from a real library where you can have some confidence in the source of the information. Once you have a good basic grasp of the symptoms of the disease and the basics of treatment, then start looking beyond the basic books.

Books I recommend:
Taming Bipolar Disorder by Oliwenstein. This is put out by Psychology Today and has good basic information in an easy to read style.

Bipolar Disorder: A Guide for Patients and Families by Mondimore. I think the clinical examples in here are excellent. They go beyond the very classic examples of Type I, cyclothymia, etc.

Surviving Manic Depression by Torrey and Knable. This too is a good all-around book of general information, but it’s more in-depth and slightly more scholarly in bent.

I understand that reading is probably very hard for you, concentration-wise. It certainly was for me at times. Force yourself to do it anyway, even if it’s just a little at a time. Start with the Psychology Today book if that’s the case. It’s got a very simple, basic style.

Getting freaked out by things you read on websites when you don’t have any idea about the reputability of the source is counterproductive.

25

I don’t think your current doctor would hold it against you if you told her you needed a second opinion. If you had some type of skin problem that she didn’t deal with in her office very much or wasn’t part of her specialty - she would probably send you to a dermatologist. Your case shouldn’t be that much different - only to a psychiatrist instead. I really think you need to talk to someone that has more experience with it. You need a bigger support team than a regular doc usually has at their disposal.

A psychiatrist would be able to pinpoint your diagnosis for you. You may have one of the “hybrid” types of bipolar - that they sometimes consider personality disorders in their catagories.

I also strongly second what Q.N. said about reading real books not only things on the internet. (I strongly agree with pretty much all of Q.N.'s post(s) ) Unless it is something like WebMD or Mayo Clinic that are certifiable. I’ve also read, and recommend “Bipolar Disorder: A Guide for Patients and Families” by Mondimore. It would be helpful for your S.O. or any family as well.

I am bi-polar and have been taking lithium since day 1 of my diagnosis 14 years ago. Other than anti-depressants for fall and winter - I haven’t taken any of the other meds usually prescribed for it (maybe short term in the hospital). I am lucky it has continued to work for me. Sometimes I would have a slight hand tremor if I was on a higher dose, not really noticible to anyone else but me. It makes your nails grow fast :0) I was relieved to be told I had bi-polar, because then all the crap I had been going through actually had a name ! I am a rapid cycler - which is pretty much mood swings that can go back and forth between manic and depressive (and everything in between) many times throughout the day. Sometimes within hours. My longer manic phases have almost always occured in the spring.

The symptoms you described to your doctor sound like a good deal of the questions that they would ask you on a test to see if you had it. So, I don’t think she’s wrong in her diagnosis. I just thing you should have a better treatment plan, than just throwing some lithium at you. Although, it is usually the drug that has the least side effects and works for a good deal of people that try it.

Not everyone has hallucinations, or psychosis. They have to give you all of the bad cases - so they can cover there ass, and not have someone sue them for not disclosing that bad things could happen.

I almost forgot the main reason I came in here to post: what Q.N. said about the hypersexuality. That is one of my main issues. I was hospitalized once because it was so out of control. And when I have read previous posts of yours - you kinda reminded me of myself. I just thought it was nice to see other women on here with high sex drives. But when I saw that it was your OP a few little bells went off. So, no matter what meds you might end up on, make sure to ask about sexual side effects.

I totally understand how you feel a little broad sided right now. It is alot to digest all at once. I hope some of this will help. You’ve made it this far without taking it, so waiting for a second opinion shouldn’t hurt you. Like you said you aren’t suicidal or anything. Good luck, and keep us posted.

26

I am bi-polar, and after many years of being misdiagnosed as having clinical depression and anxiety disorder, taking lithium (in combination with other meds) really made many of my simptoms fade away. That said, I’ve rarely heard of anyone taking just lithium anymore, and a doctor that is not willing to discuss side effects, etc is not one that I would recomend.
As to internet sources of information I find Crazymeds.org to be a wonderfully candid and amazingly thorough source of free information. It is better than many books I’ve read on the subject. I’m actually curious on other dopers thoughts on that website.

27

Absolutely, get a second oppinion. My sister had some bad issues with depression, including at least one suicide attempt. After being put in a hospital, she got a Dr. who prescribed lithium, saying it was clear to him that she was bi-polar.

The drugs were not helping, which she told him, but he kept telling her she was in denial and upping the dosage. He damn near killed her.

When my mother finaly drug her to a new Dr. who did blood tests, she was at toxic levels of lithium and her thyroid had been destroyed. Suprise, suprise, she is not bi-polar. She does, however, have a tendancy to clinical depression, which was exacerbated by living with an alcoholic for 10 years.

I think bi-poler seems to be the fashionable diagnosis right now, like ADD was before it.

28

Ye gods.

Q.N. Jones, thank you for your informative posts - and you’re right - I do have a high sex drive. It’s been that way since I hit puberty, but I suppose I could have been bi-polar since then.

The places I’ve been reading about bi-polar disorder have mainly been WebMD and the Mayo site, as well as some others that I’ve been taking with a heavy grain of salt. However, I will definitely be following up on the suggestion to head to my local library and check out those books.

When I’m happy, I’m happy, but I don’t know if I’d describe them as “highs” really, after reading about what they were. And my lows? Besides being few and far between, I’m not suicidal, hell… I’m not even that “depressed”. I don’t linger on thoughts of death, I don’t feel angry or irritable, I don’t shout at people or start petty arguments, I don’t get blue over seemingly nothing. I described myself as emotional earlier, and when I mentioned that to my husband, he told me a better word to use would be “sensitive”: I cry over sad movies, or a particularly sad news story, or if I feel homesick, or someone I care about is in some kind of pain. I think he’s right.

I don’t do the self-diagnosis thing, but the information I’m reading just doesn’t add up. It doesn’t worry me that I may, all said and done, really be bi-polar. That’s okay. I would like to try some things out before taking something as (potentially) dangerous as Lithium. I’d like to try dietary changes, counselling, whatever a specialist is willing to suggest. And if in the end I must take Lithium, so be it.

The thing that really gets me is that my number one complaint has always been, “I can’t get a good night’s sleep. I am unable to focus or concentrate when I am awake. I’m tired all the time.” And not once has any doctor suggested techniques to help me sleep, or even a sleep med to see if that helped. Cripes, when I was going over my pre-surgery stuff with one of the hospital nurses, she noted some of my symptoms, and she immediately asked me if I’d ever taken part in a sleep study, and if I hadn’t, I should. She’s the first one to ever suggest my problems may have all been due to a lack of good sleep.

Before the bi-polar diagnosis, I was labelled with ADD. Those meds didn’t help much, and I stopped taking them. Now I’m bi-polar. I do have to seriously wonder if this is just the diagnosis du jour. If I could just get a good night’s sleep…

I want to thank everyone who had advice in this thread, because it is all useful. I appreciate those of you with bi-polar disorder explaining things to me especially. I’ve learned an awful lot since coming home from the doctor Friday afternoon - and it’s not all bad. I have you guys to thank for that. :slight_smile:

29

LIAR!

looks sheepish

I was on barbituates as a teenager. My humblest apologies to the doctors that did, once upon a time, try to help me out. They were bad news, too. I was taking them back when I was taking my ADD meds, and when I mentioned I stopped taking those, I completely forget about the 'bituates. ("*bitch-*uates" I hated those things!) I stopped taking them all at the same time.

30

“Barbituates”? Barbiturates. I think?

I don’t know. I can’t focus! :stuck_out_tongue:

31

I’m doing a psych rotation now.

First off, there’s a spectrum of disease:
bipolar I – depressive episodes and manic episodes/mixed episodes. A manic episode by itself can serve alone as a diagnostic clue that one is bipolar I, as pure mania is very rare.
bipolar II – depresive episodes and hypomanic episodes.
cyclothymia – you are never truly depressed by the DSM definition of it and you have hypomania. In the clinics, we see these people less often (although it is probably more common) as cyclothymia rarely imposes itself as much as bipolar disorder.

These are diagnosed only when there is no preexisting substance abuse, general medical condition, or better explanations by other diagnoses. There are modifiers to these as well – rapid cycling, psychotic features, catatonic, postpartum, etc.

The questionaire you took was probably trying to answer the DSM-IV criteria for Bipolar I/II/cyclothymia to reach a reasonable diagnosis, and trying to answer if you have had manic and/or depressive episodes.

To have a true manic episode, you need >1 week of >3 of: distractability, impulsiveness (or high-risk behavior), grandiosity, flight of ideas (racing thoughts), agitation (or increased goal-directed activity), decreased need for sleep, and pressured speech.

For depressive episodes, you need >1 week of >5 of: depressed mood, loss of interests or pleasure, sleep abormalities, feelings of guilt, decreased energy, decreased concentration, feeling lethargic or agitated, change in appetite, or suicidal ideation. One of the 5 must be depressed mood or loss of interests or pleasure.

A mixed episode has features of both over a week.

If a patient is having these, they are bothering the patient, and the patient is receptive to it, it probably isn’t a bad idea to at least consider mood stabilizers. As a future internal medicine doctor, though, I would definitely refer at this point to a psychiatrist, as the pharmacology is quite complicated and should be managed IMHO by a specialist.

Lithium can be a dangerous drug and it does have a low toxicity, but it can be used safely. You just need to keep on top of it. In the end, it is just a salt, and it is rapidly cleared from your body if you have normal physiology. There are also a bunch of other mood stabilizers, which have their own set of toxicities, adverse effects, and other problems. Some may seem less scary than lithium to you, some may seem more.

I would highly recommend a psychiatrist because this is what they do all day long. Different presentations – depression predominant, mania predominant, psychotic features, etc. – warrant different pharmacologic approaches. In addition, psychiatrists can help establish the proper support structure, for instance groups or other therapy. Lastly, a good psychiatrist should be up to date on the most current literature and be able to answer your questions, for instance about non-pharmacologic approaches, etc.

32

Hijack Warning!

Sorry, as a psychologist, I couldn’t let this go. I understand that many people don’t get the whole psychologist/psychiatrist thing, so I am not annoyed, but in the interest of fighting ignorance…psychiatrists don’t study more than psychologists, they study different things. Psychiatrists are MDs, so they spent a lot of time studying anatomy, pathology…you know, medical stuff. :slight_smile: They then complete a residency in psychiatry where they learn the finer points of psychopathology and psychiatric medications.

On the other hand, psychologists are PhDs (well, the doctorate level ones are, and in my state we are the only ones who can call ourselves psychologists). We spent our time (at least 5 years) studying statistics and research design as well as psychopathology and therapy. We then complete an internship and often a post doctoral residency.

33

My apologies, I phrased that very badly. I meant, they study more along the lines of a medical doctor. I wasn’t postive at the time I posted (brain farts) that they were actually MDs. Sorry about that.

34

Boy, am I off.
I saw the thread title and thought it was about the metallic element, which I do have experience with.

For the record, it’s nowhere near as reactive as sodium or potassium. Throw it in water and it is much more benigh, not skittering wildly around. It still breaks down the water, releasing hydrogen, which it ignites, but it stays pretty much in one place and just floats with pretty colored flames.

it’s hard to keep, even in a bottle with dessicant, because it will grab water more readily than moat dessicants and form LiOH.

I was surprised to see copies of old 7-up ads that called 7-up “the lithiated soda”. Scary to think that, back in the early years of the 20th century, you could have been dosing yourself with psychoactive drugs without knowing it. at least it’s better than taking Radithor.

35

It actually had occurred to me as I was writing this up to put “(as meds)” tagged to the end of my title, but I figured I’d leave the door open. Hey, all the information is good stuff! It’s all ignorance fought for me. :cool:

36

I just called my doctor - I was expecting the secretary, but instead the doctor herself answered the phone, which was a happy coincidence. I explained how I felt about the Lithium, and about the diagnosis in general (being careful not to say I wasn’t sure if I believed it, but just that I would love to have more information on it). She was absolutely happy to comply, and gave me the name of a “fabulous” psychologist (and reminded me to check with my insurance first - I don’t know if that’s common practice - this insurance stuff is all new and very Greek to me!). She also chatted with me a little bit about Lithium, and told me that absolutely there were other alternatives for treatment, and she was happy to point me in the direction of someone who could help me with therapy, diet, and possibly other drugs if they were necessary. She also mentioned that she was just going over my paperwork when I called, and my bloodtests had come back and everything was normal, including my thyroid, so that was good to know.

So, though I was quite overwhelmed at first, I’m happy to report that she was very reasonable, helpful, and quite friendly when I asked for alternatives. I just had to speak up a little more, that’s all. I must not have conveyed just how uncomfortable I was on Friday, because she was really reasonable today, and willing to answer any questions I had.

Yay. :slight_smile:

37

[QUOTE=CalMeacham]
Boy, am I off.
I saw the thread title and thought it was about the metallic element, which I do have experience with.

[QUOTE]

So is it relatively easy to produce Lithium Carbonate (the chemical we are talking about here) I was amazed at how incredibly cheap it was.

38

I can’t speak authoritatively, but that does like a pretty simple bit of replacement chemistry. A quick search of chemistry sites shows that you can buy it in bulk at about $300 oer kilogram. That’s reagent-grade stuff. Things that go into people would have better QC, I’d think. (SO DON’T BUY THIS IN BULK FOR MEDICAL USE.) Still, it’s dirt cheap compared to the general run of drugs.

39

One thing you should keep in mind: many of the alternatives to lithium also carry risks similar to those of lithium. Depakote carries risk of liver and pancreas damage. Tegretol can cause serious blood disorders.

Some of the newer mood stabilizers have cleaner side effect profiles, but most of them are, on the whole, not as effective. Lamictal has one very rare side effect, but it has no demonstrated antimanic properties. There is little research to show that Trileptal has serious mood stabilizing effects. Topomax has no scientifically demonstrated antimanic properties. The majority of bipolar patients who take Neurontin report that it has no mood stabilizing effect at all.

It sounds like some part of your concerns about lithium are irrational fears–that you think of lithium as “dangerous” because of the scare stories you’ve heard, and of “lithium alternatives” as being safer and just as good mostly because you don’t know anything about them. That’s OK. Everyone has irrational fears. The trick is to confront them and educate yourself so you can make the best possible decision for your treatment.

I recommend that you get a psychiatrist and a psychologist. Check your insurance, but it will likely pay for both (to some extent). I cannot say enough times: DO NOT TAKE PSYCHIATRIC MEDS THAT ARE PRESCRIBED BY A NON-PSYCHIATRIST. It takes years of work with psychiatric patients to learn the intricacies of effective use of psychiatric meds. It’s an art, to a large degree. And you want a real artist, not someone who just dabbles now and then. I have never met a person who took psychiatric meds from their regular doctor who was happy with the result. And I’ve met a lot of crazies in my time. :wink:

40

Thank you again for your wonderful, informative post, Q.N. Jones. :slight_smile:

You are right, some of my fears regarding Lithium are likely irrational - I haven’t taken it before and I don’t know anyone personally who does, and it’s quite scary for me not to have a basis for comparison, even though everyone will react differently to it. Of course, I still don’t feel comfortable with it. The alternatives my doctor suggested to me were, as mentioned, therapy, diet, that kind of thing, and she assured me that if I was that uncomfortable with Lithium, that drugs could be used more as a “last resort” rather than a first one, if it would make me feel better. If the alternatives don’t work, I’ll go see a phychiatrist and we’ll talk drugs again - Lithium included, and probably at the front of the line.