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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by BarbaraCat on January 19, 2003, at 12:04:50
Can anyone provide info on how lithium works? I can no longer take it because of the damage it's doing to my hypothyroid condition. TSH has become dangerously high in the the 1 year I've been on it. I'm BP-II, mixed states (for want of a better diagnosis) and although I'm taking Lamictal, I'm missing lithium very much and am constantly fending off the ever-threatening mixed-states hell. Staying on lithium is not an option because extra thyroid medication isn't helping unless I'm off it.
I know about the other mood stabilizers and will discuss them with my pdoc this week, but would appreciate any bio-chemical theories on how lithium works so I can do my own further research. Thanks much. BarbaraCat
Posted by Ritch on January 19, 2003, at 13:23:21
In reply to Lithium - need info on how it works, posted by BarbaraCat on January 19, 2003, at 12:04:50
> Can anyone provide info on how lithium works? I can no longer take it because of the damage it's doing to my hypothyroid condition. TSH has become dangerously high in the the 1 year I've been on it. I'm BP-II, mixed states (for want of a better diagnosis) and although I'm taking Lamictal, I'm missing lithium very much and am constantly fending off the ever-threatening mixed-states hell. Staying on lithium is not an option because extra thyroid medication isn't helping unless I'm off it.
>
> I know about the other mood stabilizers and will discuss them with my pdoc this week, but would appreciate any bio-chemical theories on how lithium works so I can do my own further research. Thanks much. BarbaraCatHi, here's a few links I came up with. hope this helps:
http://archpsyc.ama-assn.org/issues/v57n1/ffull/ylt0100-2.html
http://www.clinicaltrials.gov/ct/gui/show/NCT00026585?order=23
http://www.chinspirations.com/mhsourcepage/moleculartargets.html
Posted by BarbaraCat on January 19, 2003, at 13:59:49
In reply to Re: Lithium - need info on how it works » BarbaraCat, posted by Ritch on January 19, 2003, at 13:23:21
Thanks Mitch,
I can tell I'm teetering on the edge. That's just the info I'm looking for but brain is too disorganized and can't focus long enough to read it! Hanging in there anyway. BCat
Posted by Jumpy on January 19, 2003, at 14:46:24
In reply to Lithium - need info on how it works, posted by BarbaraCat on January 19, 2003, at 12:04:50
Of course, no one truly knows how lithium works .... heck, no one knows the cause of mood disorders period. But many years ago, doctors used to talk about lithium affecting the "second messanger" system (the chemical cascade that occurs just after the neurotransmitter binds to the receptor in the the cell membrane and cytoplasm). Lithium blocks inositol triphosphate from being "dephosphoralated" to inositol biphosphate (if I remember correctly). Some how this is suppose to slow neural activity and calm mania.
It definately slows the thyroid gland down ... and its production of thyroid hormone become subtherapeutic for some patients.
Hope your feeling better soon.
Jumpy
PS Sorry to hear that thyroid hormones haven't worked for you. Frankly, I have never heard of this happening before. When a patient becomes hypothyroid from lithium, thyroid medications I though always corrected the problem. Well, I guess there are exceptions to every rule.
Posted by Ritch on January 19, 2003, at 14:51:06
In reply to Re: Lithium - need info on how it works » Ritch, posted by BarbaraCat on January 19, 2003, at 13:59:49
> Thanks Mitch,
> I can tell I'm teetering on the edge. That's just the info I'm looking for but brain is too disorganized and can't focus long enough to read it! Hanging in there anyway. BCatBarb, has your pdoc got some kind of plan to place you on a different antimanic? You might consider "idling" along on maybe just 300mg of lithium until you can get your meds changed. Geez, I could skip a nighttime dose of lithium in the past and my thoughts were just like a pinball machine the next morning-couldn't focus on diddly. Be careful.
Posted by BarbaraCat on January 19, 2003, at 16:45:04
In reply to Re: Lithium - need info on how it works » BarbaraCat, posted by Jumpy on January 19, 2003, at 14:46:24
Mitch,
The timing of your post was uncanny. In a state of desperation, I gave in and took 300mg of lithium a few hours ago. Within 2 hours I felt about 80% better. Ping-ponging describes it perfectly. Can't get anything done in that state and then paralyzing agitated depression sets in. I want to do my homework before starting on a new med - something that works as well as lithium without further clobbering my thyroid. My pdoc is not an expert on such matters.Jumpy,
I've read conflicting accounts about the lithium/inositol metabolism theory. Some studies seem to be favor of taking the myo-inositol form for helping with bipolar via improved second messenger communication. I'm throroughly confused. I was taking myo-inositol powder at about 8-12 grams per day a while back and it seemed to help in general, but not this time. After being off lithium for about a week and ramping up with myo-inositol, all I got was mongo diarrea.I've been hypothyroid for almost 20 years and it's been controlled just fine using various forms of T3/T4 until just recently. I've been on lithium 11 months and until 3 months ago TSH has been between 1 and 2.0. Then levels started rising pretty rapidly - up from 2 to 15 in just 8 weeks and even with increased thyroid med I'm feeling very hypo. No tenderness, no goiter or swelling, just freezing, tired and depressed, along with mixed states agitation from quitting lithium. I haven't even been on that high a dose of lithium, just 600mg per day, but it's the only suspect thus far and I'm really concerned that it's further damaging my thyroid function. - Barbara
> Of course, no one truly knows how lithium works .... heck, no one knows the cause of mood disorders period. But many years ago, doctors used to talk about lithium affecting the "second messanger" system (the chemical cascade that occurs just after the neurotransmitter binds to the receptor in the the cell membrane and cytoplasm). Lithium blocks inositol triphosphate from being "dephosphoralated" to inositol biphosphate (if I remember correctly). Some how this is suppose to slow neural activity and calm mania.
>
> It definately slows the thyroid gland down ... and its production of thyroid hormone become subtherapeutic for some patients.
>
> Hope your feeling better soon.
>
> Jumpy
>
> PS Sorry to hear that thyroid hormones haven't worked for you. Frankly, I have never heard of this happening before. When a patient becomes hypothyroid from lithium, thyroid medications I though always corrected the problem. Well, I guess there are exceptions to every rule.
Posted by Jumpy on January 19, 2003, at 17:17:50
In reply to Rich and Jumpy:Lithium how it works, posted by BarbaraCat on January 19, 2003, at 16:45:04
B-Cat,
Does lithium destroy or just slow down the thyroid? I think it just slows it down without permenant damage. Once again, it has been along time still I studied that stuff ... so I could be totally wrong.
J
Hope your better soon!
Posted by BarbaraCat on January 19, 2003, at 17:34:27
In reply to Re: Rich and Jumpy:Lithium how it works » BarbaraCat, posted by Jumpy on January 19, 2003, at 17:17:50
I was doing a search the other day and came across some research findings that long-term use permanently damaged the ability of iodine intercellular transport, or something like that. But only in people who already had compromised thyroid function. With normal function, it seemed to only slow it down and thyroxine supplementation did the trick. Didn't keep the link but it scared me into quitting the stuff. B-Cat,
>
> Does lithium destroy or just slow down the thyroid? I think it just slows it down without permenant damage. Once again, it has been along time still I studied that stuff ... so I could be totally wrong.
>
> J
>
> Hope your better soon!
Posted by Jumpy on January 19, 2003, at 19:18:04
In reply to Re: Lithium how it works » Jumpy, posted by BarbaraCat on January 19, 2003, at 17:34:27
Interesting .... hopefully depakote, tegretol, trileptal, verapamil, neurontin, topamax (but you might have mentioned this didn't work), or fish oil might help. Keep us updated.
J
> I was doing a search the other day and came across some research findings that long-term use permanently damaged the ability of iodine intercellular transport, or something like that. But only in people who already had compromised thyroid function. With normal function, it seemed to only slow it down and thyroxine supplementation did the trick. Didn't keep the link but it scared me into quitting the stuff. B-Cat,
Posted by Ritch on January 19, 2003, at 21:59:01
In reply to Rich and Jumpy:Lithium how it works, posted by BarbaraCat on January 19, 2003, at 16:45:04
> Mitch,
> The timing of your post was uncanny. In a state of desperation, I gave in and took 300mg of lithium a few hours ago. Within 2 hours I felt about 80% better. Ping-ponging describes it perfectly. Can't get anything done in that state and then paralyzing agitated depression sets in. I want to do my homework before starting on a new med - something that works as well as lithium without further clobbering my thyroid. My pdoc is not an expert on such matters.Barb, have you done that Hashimoto's thyroiditis antibody test that Pfinstegg mentioned? I want to get that done myself ASAP. Just a suggestion, but whether or not you continue on Li 300mg as a temporary maintenance dosage, have you talked with your doctor about upping your thyroid supplementation to get your TSH back into normal range? I would strongly suggest doing so--don't let this thing spiral out of control.....
Posted by BarbaraCat on January 20, 2003, at 2:03:42
In reply to Re: Rich and Jumpy:Lithium how it works » BarbaraCat, posted by Ritch on January 19, 2003, at 21:59:01
Thanks Mitch. I agree. I have an appt with my doc this week and am going to INSIST on getting my antibodies tested, even if it costs the HMO a few more bucks, which sorry, I don't give a rip about. As well as my free T3 and T4 and any other dang test that might give somebody a clue as to why I'm feeling so awful. TSH levels never tell the whole story but Duh! no one on my health care team seems to realize this except me. I am so SICK of paying so much money for health insurance, doing my own research and then having to badger my doctors into getting necessary tests that I suggest to THEM! And how about some other hormonal tests since they're already drawing my blood? Who is the Doctor here anyway??
I'm also going to politely suggest that my pdoc and my doc start having a rudimentary conversation with each other about me, their co-morbid patient who expects them to occasionally glance at each other's charts about me. They're colleagues, for Pete's sake.
My doc didn't even know I was taking lithium until I mentioned it (the same HMO, the same records) and even then I had to remind him that well, gee, perhaps there's a thyroid/lithium connection? I've had it with this mis-managed care medical travesty!! I've been a very nice little patient so far but they're going to experience the wrath of BarbaraCat who is one fed up chick! Sorry to rant but this shit is getting out of hand, few of us are getting the care we need, and I for one want some help!!!!!!!!!!!
> > Mitch,
> > The timing of your post was uncanny. In a state of desperation, I gave in and took 300mg of lithium a few hours ago. Within 2 hours I felt about 80% better. Ping-ponging describes it perfectly. Can't get anything done in that state and then paralyzing agitated depression sets in. I want to do my homework before starting on a new med - something that works as well as lithium without further clobbering my thyroid. My pdoc is not an expert on such matters.
>
> Barb, have you done that Hashimoto's thyroiditis antibody test that Pfinstegg mentioned? I want to get that done myself ASAP. Just a suggestion, but whether or not you continue on Li 300mg as a temporary maintenance dosage, have you talked with your doctor about upping your thyroid supplementation to get your TSH back into normal range? I would strongly suggest doing so--don't let this thing spiral out of control.....
>
Posted by Pfinstegg on January 20, 2003, at 8:53:30
In reply to Re: Rich and Jumpy:Lithium how it works » Ritch, posted by BarbaraCat on January 20, 2003, at 2:03:42
It's just amazing how we have to tell our docs what to do for us these days, isn't it? I had the same experience, and even though I had a major depression, and almost no energy or motivation, I had to get very tough and insist on all the things which have eventually gotten me into remission.
I agree that it's important to insist on T3 and T4 values as well as TSH- it helps to know what your ratio of synthroid and cytomel replacement should be. But I,too have to fight each time to get more than a TSH done! Lithium seems to be such an important mood stabilizer for you that it would be great if your docs could work hard on your thyroid, so that the replacement doses would be effective.
I don't know if this is relevant to you, but I found that the estrogen in Hormone Replacement Therapy is vital in order for me to avoid a crash into an even more crushing depression. Last July I discovered this when I tapered off the HRT. according to the new guidelines for them. At the moment, I take Ogen(a plant based form of estrogen) and Provera (progesterone) twice a week, and that seems to be enough to avoid that crash. My gyn, who is the one doctor I have who is really well-read, and who works together with me to find solutions, understands estrogen's role in some depressions, and so supports this solution. I don't know what age you are, but if peri-menopausal low estrogen is playing any role in your depression, you could find out by getting the levels of those hormones done, and then having a trial of replacement.
Pfinstegg
Posted by Ritch on January 20, 2003, at 9:50:58
In reply to Re: Rich and Jumpy:Lithium how it works » Ritch, posted by BarbaraCat on January 20, 2003, at 2:03:42
Well, that's interesting how the communications can be so poor between doctors. My endo does fax my pdoc results of thyroid exams/tests, but he doesn't want me on any thyroid meds with my TSH below 2.0., and my pdoc doesn't want to futz with it as a result. I had to go to the ER for a stomach flu three years ago and when I listed "bipolar disorder" and "depakote" as one of my meds, they were puzzled, because they had never heard of it being used for bipolar and it had FDA approval for mania for several years! I just changed health plans and now I have to pick a new PCP.... well that's going to be hoot.
> Thanks Mitch. I agree. I have an appt with my doc this week and am going to INSIST on getting my antibodies tested, even if it costs the HMO a few more bucks, which sorry, I don't give a rip about. As well as my free T3 and T4 and any other dang test that might give somebody a clue as to why I'm feeling so awful. TSH levels never tell the whole story but Duh! no one on my health care team seems to realize this except me. I am so SICK of paying so much money for health insurance, doing my own research and then having to badger my doctors into getting necessary tests that I suggest to THEM! And how about some other hormonal tests since they're already drawing my blood? Who is the Doctor here anyway??
>
> I'm also going to politely suggest that my pdoc and my doc start having a rudimentary conversation with each other about me, their co-morbid patient who expects them to occasionally glance at each other's charts about me. They're colleagues, for Pete's sake.
>
> My doc didn't even know I was taking lithium until I mentioned it (the same HMO, the same records) and even then I had to remind him that well, gee, perhaps there's a thyroid/lithium connection? I've had it with this mis-managed care medical travesty!! I've been a very nice little patient so far but they're going to experience the wrath of BarbaraCat who is one fed up chick! Sorry to rant but this shit is getting out of hand, few of us are getting the care we need, and I for one want some help!!!!!!!!!!!
>
Posted by BarbaraCat on January 20, 2003, at 12:06:29
In reply to Re: Rich and Jumpy:Lithium how it works » BarbaraCat, posted by Ritch on January 20, 2003, at 9:50:58
Good luck on getting a decent pcp. It becomes a process of elimination, it seems. A suggestion is, if you have a compounding pharmacy in your area, ask the pharmacist for names of M.D's or O.D's who use their services and if there are any in particular who specialize in your condition. Dr.'s who use compounding pharmacies generally give the matter more thought and consider things more holistically rather than relying on pharm companies treatment opinions. Unfortunately, most managed-care insurers don't cover doctors who insist on a thorough approach.
> Well, that's interesting how the communications can be so poor between doctors. My endo does fax my pdoc results of thyroid exams/tests, but he doesn't want me on any thyroid meds with my TSH below 2.0., and my pdoc doesn't want to futz with it as a result. I had to go to the ER for a stomach flu three years ago and when I listed "bipolar disorder" and "depakote" as one of my meds, they were puzzled, because they had never heard of it being used for bipolar and it had FDA approval for mania for several years! I just changed health plans and now I have to pick a new PCP.... well that's going to be hoot.
>
>
> > Thanks Mitch. I agree. I have an appt with my doc this week and am going to INSIST on getting my antibodies tested, even if it costs the HMO a few more bucks, which sorry, I don't give a rip about. As well as my free T3 and T4 and any other dang test that might give somebody a clue as to why I'm feeling so awful. TSH levels never tell the whole story but Duh! no one on my health care team seems to realize this except me. I am so SICK of paying so much money for health insurance, doing my own research and then having to badger my doctors into getting necessary tests that I suggest to THEM! And how about some other hormonal tests since they're already drawing my blood? Who is the Doctor here anyway??
> >
> > I'm also going to politely suggest that my pdoc and my doc start having a rudimentary conversation with each other about me, their co-morbid patient who expects them to occasionally glance at each other's charts about me. They're colleagues, for Pete's sake.
> >
> > My doc didn't even know I was taking lithium until I mentioned it (the same HMO, the same records) and even then I had to remind him that well, gee, perhaps there's a thyroid/lithium connection? I've had it with this mis-managed care medical travesty!! I've been a very nice little patient so far but they're going to experience the wrath of BarbaraCat who is one fed up chick! Sorry to rant but this shit is getting out of hand, few of us are getting the care we need, and I for one want some help!!!!!!!!!!!
> >
>
Posted by BarbaraCat on January 20, 2003, at 12:23:09
In reply to Re: Lithium how it works » BarbaraCat, posted by Pfinstegg on January 20, 2003, at 8:53:30
Absolutely agree with your views on importance of HRT. I'm 51 and have been on plant based estrogen and progesterone for about 3 years. Things were getting very tense when I hit peri-menopause and the hormones helped. I shudder to think where I'd be without them. I also know that estrogens have a definite effect on thyroid function. However, no one will do any testing to determine what these levels are in me, so I'm sure there's a relation there as well.
One thing you might want to consider is taking Prometrium rather than Provera. Provera is a synthetic progesterone and has been implicated in bad side effects, one of which is depression. Prometrium is micronized plant based progesterone, virtually identical to our own and easier on the liver. Its a standard pharmacy item, but you might have to 'educate' your doctor about it and insist on it since it's not usually on their list of formulary drugs. I remember reading that Ogen is plant based estriol, rather than conjugated equine hormones. All those recent negative test results on breast cancer, etc. were done using conjugated horse estrogens like Prempro and Premarin rather than plant based. And now all these women are panicking and throwing out all their hormone babies with the bathwater. Shudder.
> It's just amazing how we have to tell our docs what to do for us these days, isn't it? I had the same experience, and even though I had a major depression, and almost no energy or motivation, I had to get very tough and insist on all the things which have eventually gotten me into remission.
>
> I agree that it's important to insist on T3 and T4 values as well as TSH- it helps to know what your ratio of synthroid and cytomel replacement should be. But I,too have to fight each time to get more than a TSH done! Lithium seems to be such an important mood stabilizer for you that it would be great if your docs could work hard on your thyroid, so that the replacement doses would be effective.
>
> I don't know if this is relevant to you, but I found that the estrogen in Hormone Replacement Therapy is vital in order for me to avoid a crash into an even more crushing depression. Last July I discovered this when I tapered off the HRT. according to the new guidelines for them. At the moment, I take Ogen(a plant based form of estrogen) and Provera (progesterone) twice a week, and that seems to be enough to avoid that crash. My gyn, who is the one doctor I have who is really well-read, and who works together with me to find solutions, understands estrogen's role in some depressions, and so supports this solution. I don't know what age you are, but if peri-menopausal low estrogen is playing any role in your depression, you could find out by getting the levels of those hormones done, and then having a trial of replacement.
>
> Pfinstegg
Posted by Ritch on January 20, 2003, at 13:52:25
In reply to Re: Rich and Jumpy:Lithium how it works » Ritch, posted by BarbaraCat on January 20, 2003, at 12:06:29
Thanks for the advice. I hadn't thought of that one. The angle I was fixing to take had to do with whether the PCP deals a lot with patients with epilepsy (since I take 3 AED's). I am looking to try to get a neurology referral and attempt to eliminate possible epilepsy. Also, you guys talking about Hashimoto's thyroiditis, has got me wanting that antibody test. I wonder if it only shows an active problem, or whether it has *ever* happened?
> Good luck on getting a decent pcp. It becomes a process of elimination, it seems. A suggestion is, if you have a compounding pharmacy in your area, ask the pharmacist for names of M.D's or O.D's who use their services and if there are any in particular who specialize in your condition. Dr.'s who use compounding pharmacies generally give the matter more thought and consider things more holistically rather than relying on pharm companies treatment opinions. Unfortunately, most managed-care insurers don't cover doctors who insist on a thorough approach.
>
> > Well, that's interesting how the communications can be so poor between doctors. My endo does fax my pdoc results of thyroid exams/tests, but he doesn't want me on any thyroid meds with my TSH below 2.0., and my pdoc doesn't want to futz with it as a result. I had to go to the ER for a stomach flu three years ago and when I listed "bipolar disorder" and "depakote" as one of my meds, they were puzzled, because they had never heard of it being used for bipolar and it had FDA approval for mania for several years! I just changed health plans and now I have to pick a new PCP.... well that's going to be hoot.
> >
> >
> > > Thanks Mitch. I agree. I have an appt with my doc this week and am going to INSIST on getting my antibodies tested, even if it costs the HMO a few more bucks, which sorry, I don't give a rip about. As well as my free T3 and T4 and any other dang test that might give somebody a clue as to why I'm feeling so awful. TSH levels never tell the whole story but Duh! no one on my health care team seems to realize this except me. I am so SICK of paying so much money for health insurance, doing my own research and then having to badger my doctors into getting necessary tests that I suggest to THEM! And how about some other hormonal tests since they're already drawing my blood? Who is the Doctor here anyway??
> > >
> > > I'm also going to politely suggest that my pdoc and my doc start having a rudimentary conversation with each other about me, their co-morbid patient who expects them to occasionally glance at each other's charts about me. They're colleagues, for Pete's sake.
> > >
> > > My doc didn't even know I was taking lithium until I mentioned it (the same HMO, the same records) and even then I had to remind him that well, gee, perhaps there's a thyroid/lithium connection? I've had it with this mis-managed care medical travesty!! I've been a very nice little patient so far but they're going to experience the wrath of BarbaraCat who is one fed up chick! Sorry to rant but this shit is getting out of hand, few of us are getting the care we need, and I for one want some help!!!!!!!!!!!
> > >
> >
>
>
Posted by Jumpy on January 20, 2003, at 14:47:31
In reply to Re: Rich and Jumpy:Lithium how it works » BarbaraCat, posted by Ritch on January 20, 2003, at 13:52:25
Hey Everyone,
If someone's TSH come back high, yet the Free T4 is normal, it is call subclinical hypothyroidism. You might get an antibody test then, and if positive, you know the T4 will eventually sink below normal over the next few years. Otherwise, I am not sure how it changes the management of the disease. Either way, you are going to treat with thyroid hormones and follow the TSH.
J
Posted by Ritch on January 20, 2003, at 23:49:29
In reply to Re: Getting the antibodies » Ritch, posted by Jumpy on January 20, 2003, at 14:47:31
> Hey Everyone,
>
> If someone's TSH come back high, yet the Free T4 is normal, it is call subclinical hypothyroidism. You might get an antibody test then, and if positive, you know the T4 will eventually sink below normal over the next few years. Otherwise, I am not sure how it changes the management of the disease. Either way, you are going to treat with thyroid hormones and follow the TSH.
>
> JThanks Jumpy,
That is part of the reason I didn't follow through with the pricey neuro I saw (which insurance wouldn't cover much of). It is like..if I have a seizure disorder I am already taking AED's anyhow for bipolar, so if they work "ok", then I don't have to waste any time/money trying to figure out what the "real" problem is (because the meds are "working" for the BP now-and there are no "observable" seizures anyhow). However, if I do discover a "general medical condition" as the precipitant of my mood disorder, then that DOES change how I will be treated in the future by OTHER docs (which directly affects my general well-being in lots of ways). At bottom, every mental illness will turn into a "general medical condition" once the etiology is figured out in the end, IMO.
This is the end of the thread.
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