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Lithium

lithium

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#1 metabrain

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Posted 10 August 2014 - 08:53 PM


Hi all,

 

I am considering trying Lithium Orotate for Bipolar 2 and was wondering if anyone had any experience with it. I have some questions

 

Is Lithium Orotate much different to Carbonate?

What side effects did you experience?

How did it make you feel?

Could you still experience enjoyment of things?

How was your memory?

Did it cause you to gain weight?

Did it cause sexual dysfunction?

Any other experiences on it?

 



#2 medicineman

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Posted 10 August 2014 - 09:19 PM

I think you should stick to carbonate if you are bipolar. we know the pharmacokinetics, mechanism, effective doses, long-term effects, etc

I take lithium orotate, 20mg nightly. I get better sleep and wake up more refreshed and generally less depressed. Mornings aren't as bad, and sleep is easier at night. my aim is neuroprotection

Edited by medicineman, 10 August 2014 - 09:22 PM.


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#3 Tom_

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Posted 11 August 2014 - 03:31 PM

Lithium orotate is not an evidenced based treatment. There is no evidence it works for depression or Bi-Polar disorder.

 

You would be much better off sticking with atypical antipsychotics and mood stabilizers. Most people manage to find a drug or combination that together work well and don't cause intolerable side effects.


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#4 metabrain

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Posted 11 August 2014 - 05:36 PM

I have tried a lot of mood stabilisers, nothing seems to work for me and I was worried that Lithium Carbonate would just give me renal failure after a decade of use.



#5 Tom_

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Posted 11 August 2014 - 10:16 PM

Renal failure with Lithium Carbonate is rare except in overdose. People on Lithium are monitiored carefully to ensure Lithium levels don't increase beyond theraputic levels and cause damage. If you are one of the few unlucky ones who end up with unacceptable medical problems from taking it, they will remove it before it causes serious problems.

 

Lithium Orotate, while not studied is likely to carry a very similar side effect profile.

However if you are keen to avoid Lithium often a combination of mood stabilizers can work, if monotherapies have failed. Don't fall into the trap of rejecting other treatments either. Psychotherapy (in particular CBT), psychoeducation, exercise, mindfulness and maintaining good sleep hygeine (plus light therapy if you have a seasonal component) are all possible treatments that while generally in Bi-polar need to be supplemented with medication can work wonders.

Do you have any other comorbid diagnoses?

What medications have you tried, at what doses and in what combinations? What did they do for you?

Is the diagnosis of Bi-polar very certain? Is it possible that it is actually a depressive disorder or a cluster b/c personality disorder? This is a very common reason for poor response to medication - comorbidity or an incorrect diagnosis.

 

Have you ever had a well defined and clear hypomanic episode?

Can you tell me more about your symptoms when you are depressed, eythumic (normal) and when you are hypomanic. Do you have mixed episodes?

 

Have you had a bad psychiatric reaction to antidepressants.

 

 


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#6 metabrain

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Posted 12 August 2014 - 07:46 PM

I have one or two hypomanic episodes per year on average, I am mostly depressed with low energy.I don't do any form of drugs and drink only every once in a while.

 

I have checked my Thyroid, I sleep 8 hours a night just fine. I have had 4 blood works done which showed I am in excellent shape. I am 5'6 32 inch waist so no problems there. I work out every day with weights and walking.

 

My current Psychiatrist is not sure of my DX he thinks I might be Aspergers as I have poor social skills but I have don't agree since a lot of the diagnosis just doesn't fit.  I have lot's of interests, I don't have strange obsessions, I have no problems recognising emotions. I get all the symptoms of hypomania when manic. I have had lots of sexual partners when hypomanic. I do have problems socialising but I think its because I grew up in an abusive household where I couldn't have friends over, my low energy levels meant I spent a lot of time in bed too and didn't get out much. I have been depressed for a long time. I think I have social phobia. When I meet people it takes me a while to open up and chat to them.

 

The psychiatrist who DXd me Bipolar 2 interviewed me over many years where as my current Psychiatrist interviewed me once. I know Bipolar 2 can look like Aspergers such as when a Bipolar person is feeling low they don't converse much. I have only met one other person with Bipolar and it was like looking in a mirror.

 

Medications

 

I have tried over 17 different medications. SSRI and SNRI medications as well as one mood Stabiliser Lamictal.

 

Sertraline worked the best for me but gave me sexual side effects and serious weight gain which made me and my girlfriend break up at one stage.

 

Topomax gave me serious amnesia and I couldn't think straight, the effect was so bad I was sent for an MRI as a doctor thought I had a mild stroke. I refused to take SSRI or SNRI medication after that.

 

The other anti depressants side effects varied such as the inability to enjoy things, nausea etc which I just couldn't stand.

 

Lamictal worked very well for my depression but I was allergic to it so I had to come off it.

 

I responded really well to Piracetam for about 6 months until it stopped working, even after giving it a break it never worked again.

 

Alternative Treatments

 

I am experimenting with alternative treatments at the moment but the experiments are expensive,  in my home country prescription medication is free so I am reconsidering.

 

I am currently taking Magnesium Citrate which is the only thing keeping me alive, it isn't enough though.

I have tried NAC which worked really well but killed my sex drive and I didn't enjoy anything like music, movies etc on it.

I respond well to Vitamin B12

Zinc works also for my depression but increase my libido

Inositol worked but killed my sex drive

 

I am just afraid of Lithium tbh I have seen so many people get renal failure from it and I know exercise can increase its potency, it just seems so dangerous. I don't want to end up worse off.

 



#7 Tom_

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Posted 12 August 2014 - 10:33 PM

Topiramate (topimax) is not an SSRI. Its actually an anti-epileptic occasionally used for bi-polar disorder, although why you were put on it after having only tried one other mood stabilizer is beyond me. From what you have said, your medical treatment has been utterly disgusting.

Its best that people with bi-polar avoid antidepressants in general. You shouldn't have been tried on an SSRI until mood stabilizers had been tried and failed.

It seems clear to me that there are plenty of alternative medications for you to try.

 

Quetiapine would be my first choice. Its the first line choice for Bi-polar 2 in depression and also effective and preventing mania. It does commonly cause weight gain but this can almost always be managed by good diet and exercise (which you do anyway). Its other major side effect is sedation, which means its best taken at night. The first few weeks can leave you feeling very tried but it almost always wares off within a few weeks. Starting with 50mg xl and working up to a minimum dose of 300mg xl you can expect improvements within 4-6 weeks. I am on 350mg xl (alongside a very rarely prescribed antidepressant) and it has worked wonders for me. It has made be put on 4 kg but I eat total crap and do no exercise. its also returned to me my ability to get a reasonable erection.

 

Another option that tends to be more effective for mania but can be used for bi-polar depression is Aripiprazole. Its much less likely to cause weight gain and if it does cause sedation it tends to be very mild. A starting dose of 5mg with an aim for 10-15 is good. Results can be expected within 4-6 weeks.

 

There are a list of atypical antipsychotics which can be tried for bi-polar and they all have different side effect profiles. If neither of these two work for you, there is a good chance another will.

 

If you suffer anxiety particularly severely pregabalin is an option, it also shows preliminary evidence in managing bi-polar disorder. Combined with an atypical antipsychotic it could work well.

 

There are a number of other anti-convulsants you can try, in particular valoprate and Carbamazepine. These are approved treatments for bi-polar and should have been tried already.

 

I strongly recommend Quetiapine, there is a very strong evidence base for it.

 

If antidepressants to become nessary, then Bupropion alongside a mood stabilizer is your best bet.


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#8 metabrain

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Posted 14 August 2014 - 09:33 PM

Yes we have socialised medicine where I am from which is why I have been going around in circles, going private just isn't an option as I can't afford it.

I was looking at Quetiapine and Gabapentin and both seem like medications I could try. It's really hard to know what to pick. My next appointment is 1 month time so hopefully I can get time off work. In the mean time I will keep trying alternative supplements.



#9 drg

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Posted 19 August 2014 - 07:31 AM

https://www.google.c...On53Z208f-M5UCQ

good info on treating bipolar

you gotta reconsider lithium, it is the best mood stabiliser. If you get regular blood tests you won't get kidney damage

#10 Tom_

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Posted 19 August 2014 - 02:37 PM

Lithium is clearly not needed at the moment, although it remains a perfectly good possibility.

 

The first drug that should be tried in bi-polar depression is Quetiapine and it is utterly disgusting you haven't been put on it. Its recommended as such in nearly all treatment guidelines. I strongly urge you to seek the opinion of another psychiatrist. If you live in northern island (and as such are under the NHS) then you have this right. If you live in the ROI then I don't know for sure but suspect this is still the same.

 

Having briefly read about ROI mental health service, I can see they use the same multidisciplinary approach as the NHS and as such you should be entitled to a case manager and quality psychotherapy (which you should take advantage of). Psycho-education, Cognitive Behavioral therapy and potentially more dynamic therapy as well as any rehabilitative services you may or may not need will make as much of a difference as meds if not more.

 

Gabapentin is a bad idea, it hasn't been shown to be of any use in bi-polar depression or mania in any of its large scale studies and as such should only be used as a last line treatment.

 

The main stay of your pharmacological treatment should be with atypical antipsychotics. (Quetiapine or Aripiprazole). If manic episodes are still a problem anticonvulsants may be of use. In general apart from lamotrigine (which you didn't tolerate well (although a slower titration period could be tried later)) anticonvulsants are only useful for treating mania and stopping manic/depressive episodes from happening, not actually treating them - so there is no need for you to take them.

 

I recommend you stop the alternative medical stuff. there is little evidence to no evidence and it could make the situation worse. Change one medication at a time.

 

You may even be able to get your G.P to prescribe you the Quetiapine at a lower dose - either with a complaint of insomnia (and say you don't want to take benzo's) or directly as a mood stabilizer, although I doubt they would want to increase your dose beyond 100-150mg. Remember if possible get the long release version.

 

The reason all of your meds haven't been working is because you have been prescribed the exactly wrong medications (bar the lamotragine). Its like prescribing Paracetamol for an ear infection...it just doesn't make any sense, you clearly need antibiotics.


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#11 metabrain

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Posted 24 August 2014 - 06:00 PM

Quetiapine is something I was looking at, seems to have very few side effects. I have a very poor memory now which is causing me great concern though but I will see how I am. I will be visiting a new Psychiatrist on Tuesday and hopefully she can give me something worth while.







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