A new dose & a vacation

January 6, 2010

Two weeks ago, I tried upping my lithium again, to a lower dose than before (450mg +2x300mg = 1050mg), then  I was out of my country for over a week on a family trip.  I think it was the lithium, but I had no serious mood problems on my trip!  However, I also had very few triggering (stressful) events….  I’m a bit apprehensive to start work again, since it seems to largely consist of stress.  I will try to practice observing it rather than reacting to it.

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More lithium, please

November 29, 2009

After a month on lithium, I’ll be emailing my psychiatrist today to tell him about my symptoms and see if he thinks I should increase my dose to 1250mg.

My symptoms have been a whole lot of anxiety, irritability, obsessiveness, and not being able to sleep much in the morning.  And occasional rage.  Sounds mostly like anxiety, but has enough of mixed state in there that more lithium might help.

I’m fed up.  There’s no one person or thing to be angry at, but I just feel angry that several months of acceptance, drugs, DBT (Dialectical Behavioral Therapy) classes, Bipolar informational classes, talking to co-workers and family….  none of it seems to have been effective.

It’s hard to keep going.  I’m in no danger of suicide, just in danger of losing the will to do anything but acquiesce to the couch.

Things that will make me happy include reaching out to distant friends, going outside, and doing interesting activities, but this all seems just beyond my grasp.

I feel haunted by something my doctor said at our last visit: “I can medicate you, but I can’t medicate your life”.  I hope just a little more lithium will help me make changes in my life.

Starting Lithium

October 29, 2009

The initial symptoms of Lithium are comparable to those of Depakote — with the big caveat that YOUR MILEAGE MAY VARY.

I’m feeling shaky and jittery and electrified as though I’m manic, but I’m pretty sure that it’s the Lithium.  The brain fog of my depression the last week seems intensified.  I’m also sleepy all the time, but that may be in large part to the Seroquel I’m taking to calm down the jitters.  My focus at work is shot to hell.  Hopefully next week will be better!

All this is affecting my work performance — I need to tell my new boss about my illness soon before she questions my dedication or judgment.  More to come on “coming out” about bipolar in the workplace.

These side effects made me think I should go off of Depakote (1000mg/day) and try Lithium:

  • itchy face
  • extremely sensitive scalp
  • more hair in the hairbrush than usual
  • my latest period lasted less than 2 days
  • weight gain (not that I expect it to be better with Lithium!)

The psychiatrist agreed (in his typical terse one-sentence-fragment-email), and I’ve been dialing off the Depakote and will be entirely unmedicated by the start of my work week.

I was initially excited about the manic boost I’ve been getting by going off the med….   I was able to start a blog, write over a dozen queued blog posts, clean the kitchen, and make pizza.  Then it escalated, and my thoughts were racing and I was panicking, and I couldn’t get to sleep last night. I had to take a third of a Seroquel today in order to function.

A long talk with my partner made me reassess everything, including starting Lithium.  My serious manic & depressive episodes are in the fairly distant past now, and I’ve only had hypomania and minor depression this year.

The serious stuff has been the anxiety and the mixed states (rages, dysphoria, etc), and I really want to primarily treat that.  If I can do so without going on a hardcore bipolar drug, that would be awesome.

Stay tuned for manic fun or manic horror!

Who knows what medications lurk in the pockets of co-workers?

Meds 4 Life

October 11, 2009

Can I stop taking drugs if I feel better?

Here’s an abrupt answer from WebMD:

Anyone who has experienced two to three episodes of bipolar disorder is considered a long-term — if not lifetime — bipolar patient. That person should have maintenance therapy. Once your doctor has helped stabilize the moods of the acute phase of the disorder (either a manic or depressive episode), drug therapy is continued indefinitely — often at lower doses.

People with bipolar disorder may take lifelong lithium as maintenance therapy to prevent relapses. When lithium treatment stops, relapses can occur within six months in 90% of patients. Moreover, subsequent lithium treatment and other treatments are less likely to be effective.

WebMD doesn’t cite their sources, so take this with a grain of sodium.

What about if a woman with bipolar wants to get pregnant?  Or don’t I even want to know?

Depakote vs Lithium

October 10, 2009

Lithium has been used for over half a century to treat mood disorders -- yet it's still imperfect, and its mechanism isn't entirely certain.

Lithium has been used for over half a century to treat mood disorders -- yet its mechanism isn't entirely known to neurologists.

Fierce online debates about Batman vs Wolverine contain a lot more reliable detail than those about Lithium vs Depakote.  These are the two “biggies” that psychiatrists prescribe for Bipolar, yet they’re really hard to compare,  even for professionals.

Both Depakote and Lithium…

  • Treat mania
  • Treat depression, to a lesser extent
  • Often cause weight gain
  • Are semi-mysteries
  • Are maintenance drugs
  • Require blood level tests to prevent poisoning

Their differences sort of balance out too:

  • Lithium has a stigma, but a solid 50-yr history; Depakote has no stigma, but less extensive time in use
  • Depakote is thought to be effective when Lithium isn’t (eg, for rapid-cycling); but Depakote more often needs to be taken with additional medication

…And perhaps it’s telling that I can’t think of any other certain differences that one could weigh when trying to decide between the two drugs.

Trustworthy details are scarce….  I searched on PubMed for recent studies that mention both Lithium and Depakote — please follow the links to the briefs and draw your own conclusions!

  • Nov 2008, NIMH, Bethesda — Trouble with affective processing and attention is linked with medication (Lithium & Depakote) rather than the disorder itself; yet the attention problem is exacerbated in medicated people diagnosed with type II rather than type I
  • Sep 2008, University of Texas, San Antonio — A finding that Depakote compares well to Lithium in acute mania remission rates
  • Jan 2008, McMaster University — Lithium can affect the hippocampus by increasing its volume, which sounds scary; if I understood the brief correctly, Depakote doesn’t do this. (I also found a cryptic brief that may imply that this very thing is a benefit of Lithium!)
  • Nov 2007, UCLA — An inconclusive study that shows similar effectiveness of Lithium, Depakote, and Carbemazapine (Carbatrol, Epitol, Equetro, Tegretol) on sucidal behavior
  • Jun 2007, Ankara University — Verbal memory impairment found in people with Bipolar is the same whether they’re being treated with Lithium or Depakote; either the impairment is a symptom of the disorder, or an equal side effect of both drugs
  • Jun 2006, Harvard — Depakote may cause a small but significant percentage of women to exhibit symptoms of hyperandrogenism (stuff like hair loss and cessation of periods – basically, becoming a bit more man-like)
  • Nov 2005, Case Western Reserve — Depakote is not necessarily more effective than Lithium for rapid cycling