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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Rick on September 19, 1999, at 18:10:52
Sorry for the patheic pun, and I have no intention of suing anyone. But I'm a little curious...
A few months ago I was given Selegiline for Social Phobia (only) after Nardil pooped out. When I showed no progress (of course not, especially at only 10 mg), the psychiatrist tried to potentiate it with Lithium. I took the Lithium (one-half big Eskalith extended-release tablet...don't recall exact mg), and spent the whole night in bed waking up with spastic jerks. He said he had never seen this kind of reaction in 20 years of practice. Needless to say, that was out the door pronto.
I was rather shocked when I read that Lithium is NOT supposed to be administered without first testing for the amount already in the blood. While the psychiatrist gave me many warnings about Lithium, he never did such a test, nor even mentioned that it existed.
Is it fairly common to bypass the blood test when Lithium is used just as an AD potentiator, or was he playing a little loose with the rules?
Rick
Posted by Noa on September 19, 1999, at 18:50:41
In reply to Grounds for Lithi-gation?, posted by Rick on September 19, 1999, at 18:10:52
My pdoc has lithium in the wings for me if my current cocktail doesn't do it, and he already had me do some tests: complete blood chemistries and an EKG. I think this is SOP pre-lithium.
Posted by JohnL on September 20, 1999, at 3:31:28
In reply to Grounds for Lithi-gation?, posted by Rick on September 19, 1999, at 18:10:52
I think the blood tests are mainly to check organ functions, like thyroid and liver. Lithium makes kidneys work overtime. The EKG is important at high doses. My psychiatrist did not indicate the need to do a blood test for augmentation in the 600-900mg range, though I voluntarily did one anyway. It's not a bad idea to check liver, thryoid, and blood counts once or twice a year when taking any of these meds we take. Also, even though psychiatrists are specialists, I don't think they can keep up with every single detail of different combos. For example, I recently tried Lithium. Even at just 300mg it was bad stuff. I forgot where I saw it, but I read something just the other day that said Lamictal + Lithium is a bad combo. Well, I'm on Lamictal. Maybe that explains it. So if I'm going to go back to Lithium, I need to first ween off the Lamictal. My psychiatrist wasn't aware of this though, and I wonder how many are. I had to do a lot of research to stumble onto it.
Back to the blood test though, I don't know if it is standard practice to give a blood test at low augmentation doses, but I wouldn't think it is vitally important. It becomes crucial at high doses. I'm no expert on Lithium, but that is the extend of my knowledge at this time. There are some Lithium vets here who can probably provide better answers.
Posted by Ian on September 20, 1999, at 3:44:19
In reply to Grounds for Lithi-gation?, posted by Rick on September 19, 1999, at 18:10:52
You don't have Lithium in your body normally, I think you must have misinterpreted something about testing before changing Li dosage. Li is a mood stabiliser stopping both extremes of a 'bipolar illness'. It has a narrow therapeutic index i.e the diffence in blood concentrations between it have a beneficial effect and it being toxic are small. In the realms of pyschopharm doesn't sound like your psychiatrist was being to risqué.
Posted by Bob on September 20, 1999, at 9:06:20
In reply to Re: Grounds for Lithi-gation?, posted by Ian on September 20, 1999, at 3:44:19
I had the same sort of experience as Ian. No concern about tests prior to going on lithium, but very close monitoring once I was on it as an augmentor for prozac and then zoloft. Unfortunately for me, all that I could handle was 300 mg ... at 600, I was still in the "safe" range but the side effects (anxiety, shakes, GI upset) were too much to handle at that level.
Posted by Elizabeth on September 24, 1999, at 22:58:02
In reply to Grounds for Lithi-gation?, posted by Rick on September 19, 1999, at 18:10:52
I believe standard procedure is that before you start a patient on lithium, you order the following tests: TSH [thyroid-stimulating hormone] (measure of thyroid function), BUN [blood urea nitrogen], creatinine, electrolytes [ions such as sodium, potassium, chloride, calcium, etc.] (measures of renal function).
You have to have baseline measurements so that you can tell if something has changed after the person started the lithium.
Posted by saint james on September 25, 1999, at 20:06:05
In reply to Re: Grounds for Lithi-gation?, posted by Elizabeth on September 24, 1999, at 22:58:02
> I believe standard procedure is that before you start a patient on lithium, you order the following tests: TSH [thyroid-stimulating hormone] (measure of thyroid function), BUN [blood urea nitrogen], creatinine, electrolytes [ions such as sodium, potassium, chloride, calcium, etc.] (measures of renal function).
>
> You have to have baseline measurements so that you can tell if something has changed after the person started the lithium.You need to add...when taking doses close to the toxic level (which as others have said is close to therputic level used in mania) the level for agumentation is much lower, so tests are not needed.
j
Posted by Elizabeth on September 26, 1999, at 17:39:43
In reply to Re: Grounds for Lithi-gation?, posted by saint james on September 25, 1999, at 20:06:05
> You need to add...when taking doses close to the toxic level (which as others have said is close to therputic level used in mania) the level for agumentation is much lower, so tests are not needed.
The tests are advisable anyway. I have them.
This is the end of the thread.
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