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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by fattoush on November 27, 2009, at 11:08:14
Scott tells me that it may not be such a good idea to be on Lithium if my main complaint is depression. I really got scared. I am a bipolar II, who was only diagnosed so when she flipped - and only a few years into - anti-depressants. I can be just agitated anxious manic, I can be compulsive manic, never psychotic.
Here's my main serious issue. I am very sensitive to medicines and, on top of it all, get migraine. I have tried practically everything, and of course the obvious, including Depakote. Lithium saved me from suicide at least 3 times.
I am asking for a poll. Yes or no, can it work as monotherapy for depression? I take onle 450 mgs and notice a difference. I'd be better at a higher dose but get very tired and short of breath. Scott, I sincerely appreciate your wise input.
Posted by SLS on November 27, 2009, at 11:46:12
In reply to Lithium Monotherapy for Depression, posted by fattoush on November 27, 2009, at 11:08:14
Hi.
I must be confused. Lithium monotherapy can exert an antidepressant effect when treating bipolar disorder. However, it is usually more effective for bipolar I than bipolar II. It may be that lithium has an anti-suicide effect that manifests separately from a true antidepressant effect. Depakote, on the other hand, seems to be more effective for bipolar II.
If you find that lithium provides some benefit, I would not discourage you from taking it. However, I would encourage you to work with your doctor to optimize the dosage of lithium, which seems rather low, especially if it must act as an antimanic treatment. Do you think that the fatigue and breathlessness might have been only a temporary effect?
Migraine is often comorbid with bipolar disorder and major depression. Perhaps the migraines will subside to some degree once the depression is treated successfully.
How did your doctor determine that you are bipolar II and not bipolar I?
- Scott
Posted by willyeee on November 28, 2009, at 0:49:01
In reply to Re: Lithium Monotherapy for Depression » fattoush, posted by SLS on November 27, 2009, at 11:46:12
Scott i find the whole bipolar spectrum of now,1,2, etc a bit much.
Seems when a patient doesent respond to a med,or has other complaints they create a new class.
The classes of bipolar dont seem to hold any scieance either,just kinda like oh u behave xxx well u bipolar xxxx,just seems odd to me.
Posted by fattoush on November 28, 2009, at 0:55:58
In reply to Re: Lithium Monotherapy for Depression, posted by willyeee on November 28, 2009, at 0:49:01
> Scott i find the whole bipolar spectrum of now,1,2, etc a bit much.
>
> Seems when a patient doesent respond to a med,or has other complaints they create a new class.
>
> The classes of bipolar dont seem to hold any scieance either,just kinda like oh u behave xxx well u bipolar xxxx,just seems odd to me.I just think that it's a young branch of the neurology/ psycholanalysis, even early psychiatry days. If doctors were more candid, flexible, paid more attention to what patients said rather than what pharmaceuticals told them, we'd be in better shape.
Posted by SLS on November 28, 2009, at 14:48:43
In reply to Re: Lithium Monotherapy for Depression, posted by willyeee on November 28, 2009, at 0:49:01
You are right. There has been very little prospective scientific investigation into the validity of a classification scheme of bipolar disorder subtypes.
I think the research and writings of Hagop S. Akiskal, MD are relevant. He is a proponent of the use of a spectrum to understand the various presentations of bipolar disorder. At the very least, I think the bipolar I/II dichotomy is valid as each responds to a different set of treatments.
- Scott
Posted by SLS on November 30, 2009, at 7:45:08
In reply to Re: Lithium Monotherapy for Depression, posted by SLS on November 28, 2009, at 14:48:43
> I think the bipolar I/II dichotomy is valid as each responds to a different set of treatments.
Some of the more current literature calls into question whether there is such a large difference in the way bipolar I and bipolar II respond to lithium. Perhaps there isn't as large a difference in the way the two subtypes respond to medication as was initially reported.
- Scott
----------------------------------------------------Lithium Maintenance Treatment of Depression and Mania in Bipolar I and Bipolar II Disorders
Leonardo Tondo, M.D., Ross J. Baldessarini, M.D., John Hennen, Ph.D., and Gianfranco Floris, M.D.OBJECTIVE: Effects of long-term lithium treatment for depressive and manic phases of type I and type II bipolar disorders were compared. METHOD: Clinical research records of 317 patients with DSM-IV-defined bipolar disorder (188 with type I and 129 with type II) were analyzed for frequency and duration of affective episodes and hospitalizations before (mean=8.38 years) versus during (mean=6.35 years) lithium maintenance treatment. Treatment effects were also assessed by survival analysis of interepisode intervals and by multivariate regression testing for factors associated with response to treatment. RESULTS: Bipolar I and bipolar II patients were ill before treatment a similar percentage of time, but the subtype distinction was supported descriptively. Lithium had superior benefits in type II patients, with significantly greater reduction of episodes per year and of the percentage of time ill. Reduction of depressive morbidity was similarly strong in both diagnostic types. During treatment, bipolar II patients had 5.9-fold longer interepisode intervals and were twice as likely as type I patients to have no new episodes. Starting lithium maintenance earlier predicted greater improvement. CONCLUSIONS: Lithium maintenance yielded striking long-term reductions of depressive as well as manic morbidity in both bipolar disorder subtypes, with greater overall benefits in type II patients and with earlier treatment
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