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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by rjlockhart37 on January 4, 2023, at 14:53:03
i've been having defiantly disturbance in thought process, so my doctor has increased lithium to 1200mg daily. We're bumping up and if it's needed 1800mg
'
Never been on lithium at high dose, but it's needed right now. I've been going through hell, these past weeks
Posted by SLS on January 4, 2023, at 17:05:30
In reply to lithium, posted by rjlockhart37 on January 4, 2023, at 14:53:03
> i've been having defiantly disturbance in thought process, so my doctor has increased lithium to 1200mg daily. We're bumping up and if it's needed 1800mg
> '
> Never been on lithium at high dose, but it's needed right now. I've been going through hell, these past weeks
What's going on? What are you experiencing?
- Scott
Posted by rjlockhart37 on January 5, 2023, at 21:24:41
In reply to Re: lithium » rjlockhart37, posted by SLS on January 4, 2023, at 17:05:30
i've been having some hypomanic episodes, yet the other part, its hard to explain but just 'disturbance' in thought processes. They will derail and its just .... can't explain entirely but its been platuing, the lithium was increased to 1200 day. We'll see what happens and if it works to treat it
Posted by rjlockhart37 on January 5, 2023, at 21:36:30
In reply to Re: lithium, posted by rjlockhart37 on January 5, 2023, at 21:24:41
but for right now im seeming to be ok
Posted by SLS on January 6, 2023, at 7:27:04
In reply to Re: lithium, posted by rjlockhart37 on January 5, 2023, at 21:36:30
Hi.
> but for right now im seeming to be ok
That's good. Every okay moment is a blessing.
Is hypomania your priority concern right now? Is your hypomania euphoric or dysphoric?
For a dysphoric hypomania, I have seen topiramate (Topamax) 200-400 mg/day worked wonders for a case of dysphoric / irritable hypomania. She might have been diagnosed as having Bipolar Disorder / Mixed state. I never asked her, but the symptomatology that she displayed was one of high-energy and anger. My guess is that topiramate is most effective when treating dysphoria or mixed-states in Bipolar Disorder. Its utility might be limited to a narrow spectrum of a Bipolar presentations.
If true hypomania is part of your condition, you have several choices that come to mind:1. High-Dosage Lithium: 900-1500 mg/day.
2. Moderate Dosage Atypical Antipsychotic: Years ago, I would have recommended olanzapine (Zyprexa) if you tolerated it. However, olanzapine practically guarantees an insatiable appetite and a large increase in body weight. I think 10-20 mg/day would be appropriate. Since then, many more atypical antipsychotics have become available for which a large weight gain is not as much of a problem. If you never tried asenapine (Saphris), I would consider placing it towards the top of your list. It might reduce your hypomania and avoid or reduce depression. While taking asenapine, I experienced a significant antidepressant effect that lasted for about a week. For me, experiencing such an improvement is unusual. https://reference.medscape.com/drug/saphris-asenapine-999301. One drug that I am not sufficiently familiar with is lumateperone (Caplyta). Lumateperone might be a better choice for treating Bipolar Depression than is lurasidone (Latuda).
3. Moderate Dosage Anti-convulsant: Oxcarbazepine (Trileptal) would be my choice. It is a cousin of carbamazepine (Tegretol) for which agranulocytosis is not a side-effect. The only significant side effect of oxcarbazepine that I am aware of is hyponatremia (low sodium). https://pubmed.ncbi.nlm.nih.gov/19007842/ Other anticonvulants worth looking at are topiramate (Topamax), valproate (Depakote), lamotrigine (Lamictal). I don't have enough of a feel for the others to be able to comment on them.
4. Something suggested by others.
- Scott
Posted by rjlockhart37 on January 13, 2023, at 15:53:02
In reply to Re: lithium » rjlockhart37, posted by SLS on January 6, 2023, at 7:27:04
i just took 900mg right now during a dyphoric emergency. I notice ... it takes 900mg to notice an antidepressant effect, i can notice a mild improvement in mood, but its not a peppy yay improvement. It seems to have a potent effect on serotonin, i never knew lithium increased serotonin but it does and that's contributed to its antidepressant effect.
It's been a wild ride, last night i didnt get sleep for 2 night and it just...a bad time. 900mg seemed to send a rescue to dyphoria and antidepressant effect. That's i can write, im not doing well but ill get better
Posted by rjlockhart37 on January 13, 2023, at 15:57:38
In reply to Re: lithium, posted by rjlockhart37 on January 13, 2023, at 15:53:02
but still even lithium, i may need to be hospitalized, i've had no sleep for 2 days, and absolute hell going through my nerves. Terrible time
Posted by rjlockhart37 on January 14, 2023, at 0:12:06
In reply to Re: lithium, posted by rjlockhart37 on January 13, 2023, at 15:57:38
i'm manic right now, i havent slept in 2-3 days, i took 900mg lithium, it calmed somewhat but my body functionss are stressed, even lithium is not calming down this mania caused by sleep deprivation, increased dopamine levels are up
Posted by rjlockhart37 on January 14, 2023, at 0:18:03
In reply to Re: lithium, posted by rjlockhart37 on January 14, 2023, at 0:12:06
i'll post soon if this hell subsides, or if go inpatient. I havent slept in 2 days, got 2 hour sleep the day before. This is what sleep deprivtion does to you, it makes you manic after days without sleep, then gradually alters perception. My anxiety levels, one word : excruciating. I have never been this stressed from not sleeping. I'll write if this subsides, or if inpatient happens. End of log
Posted by SLS on January 14, 2023, at 16:08:55
In reply to Re: lithium, posted by rjlockhart37 on January 14, 2023, at 0:18:03
A couple of things, RJ.
1. 900 mg/day of lithium usually ends up being the lowest dosage that will produce an anti-manic effect. 1200 mg/day is about average, but many people need 1500 mg/day or higher.
2. You might do better working with the specialists that you would find in an inpatient setting. I think you need to be monitored closely. Is your outpatient doctor a psychiatrist? Who is making treatment decisions? Do you follow your doctor's instructions? Do you do things that you don't want your doctor to know about?
Since you find lithium helpful at 900 mg/day, I encourage you to go higher if your doctors suggest it. Measuring your blood concentration of lithium will help guide dosing. There are so many antipsychotics available, how would you go about choosing one? How would a specialist choose one?
People on Psycho-Babble really like you. Group cyber-hug. Remember this? (((rjlockhart)))
I'm sure you are in everyone's thoughts. Take care of you. You deserve it.
- Scott
Posted by rjlockhart37 on January 22, 2023, at 23:25:50
In reply to Re: lithium » rjlockhart37, posted by SLS on January 14, 2023, at 16:08:55
thanks, im still having some manic episodes, but I've finally gotten sleep. I'll go into depression with low activity, ill just stay on a few websites, and not venture out and just have no brain activity. And then ill surge, or moderately move out of depression slump. Depression slumps can last months, just stay in the same place, bearly move around on websites, or doing things, seeing friends. Just depressed, that's all i can say. Thank you, for online support, it is much appreciated, thank you
Posted by SLS on January 26, 2023, at 13:12:08
In reply to Re: lithium, posted by rjlockhart37 on January 22, 2023, at 23:25:50
Hi, RJ.
> thanks, im still having some manic episodes, but I've finally gotten sleep. I'll go into depression with low activity, ill just stay on a few websites, and not venture out and just have no brain activity. And then ill surge, or moderately move out of depression slump. Depression slumps can last months, just stay in the same place, bearly move around on websites, or doing things, seeing friends. Just depressed, that's all i can say. Thank you, for online support, it is much appreciated, thank you
Have you tried Lamictal 200-300 mg/day. This drug is deemed valuable in bipolar depression. It is for mine. I take 300 mg/day, without which I would not receive an antidepressant response. From your description, you are probably experiencing Bipolar Disorder type II. That would make you an ultra-rapid cycler. Supposedly, lithium, at standard dosages (900-1500 mg/day), is a good treatment for rapid cyclicity and can be combined with any other drug (as far as I know). Right now, I'm using lithium at a very low dosage (300 mg/day). When I increase the dosage of lithium to 450 mg/day, I relapse pretty hard. At 150 mg/day, I receive no benefit at all. That's a very small therapeutic dosage window if you are using lithium for depression only.
- Scott
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