Bipolar meds & blood tests (or other tests)

I want to start a conversation on regular blood testing, while people are taking various types of bipolar medications.

I know that some bipolar medications (Lithium, Depakote, Carbamazepine, etc) require regular, or at least frequent initial, blood levels to be taken in order to ensure therapeutic doses and prevent toxicity. There are also other recommended blood tests when on these medications, such as to monitor kidney and thyroid functioning, sodium levels, and blood cell counts, just to name some. I know that my doctors are also concerned about how these and other bipolar medications (i.e. antipsychotics) affect my cholesterol, triglycerides, glucose levels, (heart, in general), etc.

Question 1: For anyone who has taken carbamazepine (Tegretol) for extended periods, how often did your psychiatrist (or other doctor) order carbamazepine levels (in the beginning and then later down the line)?

Question 2: How often do you get comprehensive metabolic panel, lipid panel, hemoglobin, TSH/T4/T3 (thyroid) blood tests done? And who orders them? If someone other than your psychiatrist, are the results shared with your psychiatrist?

Question 3: Have (or do) you get other types of testing done that in some way relates to your bipolar medications? For example, EKG, MRI, etc? If so, how often and who orders them?

If you wonder if/when you should have any of the above tests done, it might be good to discuss with your psychiatrist and general practitioner.

Quote:

Originally Posted by BirdDancer I want to start a conversation on regular blood testing, while people are taking various types of bipolar medications. I know that some bipolar medications (Lithium, Depakote, Carbamazepine, etc) require regular, or at least frequent initial, blood levels to be taken in order to ensure therapeutic doses and prevent toxicity. There are also other recommended blood tests when on these medications, such as to monitor kidney and thyroid functioning, sodium levels, and blood cell counts, just to name some. I know that my doctors are also concerned about how these and other bipolar medications (i.e. antipsychotics) affect my cholesterol, triglycerides, glucose levels, (heart, in general), etc. Question 1: For anyone who has taken carbamazepine (Tegretol) for extended periods, how often did your psychiatrist (or other doctor) order carbamazepine levels (in the beginning and then later down the line)? Hi Birdie, I'm not on those meds, so I hope it's okay to reply to the rest of your post. Question 2: How often do you get comprehensive metabolic panel, lipid panel, hemoglobin, TSH/T4/T3 (thyroid) blood tests done? And who orders them? If someone other than your psychiatrist, are the results shared with your psychiatrist? I get all of the above done right about every six months. If my GP orders them they are shared with my pdoc. And vice-versa. In fact, I am due this month for all the blood work. My pdoc will be ordering it. Question 3: Have (or do) you get other types of testing done that in some way relates to your bipolar medications? For example, EKG, MRI, etc? If so, how often and who orders them? Nope! They seem to like to wait until some serious health problem appears, rather than using preventative medicine. For example, I've heard all sorts of this and that about the atypical AP's causing dangerous cardiac problems in some people. Even though I have a history of major cardiac disease in my family, no MD listens to me when I mention having an EKG...they basically blow me off. I've thought about truly assertive about an EKG, though. I believe it's something that needs to be done after having been on AP's for so very many years. Some years ago I was seeing an especially thorough and responsible pdoc; she ordered an MRI (brain). I have never had any other MD of any kind send me for tests having to do with my meds other than blood work. If you wonder if/when you should have any of the above tests done, it might be good to discuss with your psychiatrist and general practitioner. Yes - and be persistent!

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[QUOTE=BirdDancer;6760654]
Question 1: For anyone who has taken carbamazepine (Tegretol) for extended periods, how often did your psychiatrist (or other doctor) order carbamazepine levels (in the beginning and then later down the line)?
That's one med I've never taken.



Question 2: How often do you get comprehensive metabolic panel, lipid panel, hemoglobin, TSH/T4/T3 (thyroid) blood tests done?
Because I'm on clozapine I get a CBC with diff monthly. No test no refills. That's handled by my pdoc. I get a CMP, lipids, and thyroid every 6 months and that is handled by my family doctor.

And who orders them? If someone other than your psychiatrist, are the results shared with your psychiatrist?
Yes, the labs from my family dr go automatically to my pdoc. My pdoc labs don't go to my family dr but I don't think that's a big deal; a monthly lab panel is a lot to have to read when he won't be making any decisions about the treatment.

Question 3: Have (or do) you get other types of testing done that in some way relates to your bipolar medications? For example, EKG, MRI, etc? If so, how often and who orders them?

I get an EKG every few years, whenever my family dr becomes worried about my high pulse rate. But it's always normal so life goes on.

Question 1--I just cannot remember on teh Tegretol--so sorry.

Question 2--I get labs once a year. My lithium level has always been 0.9, every single time. I have never had renal or liver issues, lipid problems, or Hb A1C elevation. So, I may be an outlier.

Question 3: I have never had any other testing done that I can recall.

Interestingly, I am now oredering all my own lab tests, since I am uninsured. The company is called Walk-in Lab.

BethRags, BeyondtheRainbow, and bpcyclist, thanks so much for sharing on this topic and answering the questions!

BethRags, I get general blood tests every 6 months, too. I used to get more blood tests (i.e. Lithium levels), but since I'm off Lithium that has ended. I have seen conflicting doctor opinions about Tegretol level test frequencies. Of course I got them frequently in the very beginning, but it has been years since I had my last Tegretol level. I've been on Tegretol for about 7-8 years. Once I did have a symptom of possible Tegretol mild toxicity, but my psychiatrist just lowered my dose without ordering a blood level. The reduction did do the trick, though. I don't know how old you are (not specifically asking), but if you feel an EKG is a good idea, please do push for one. They're not a hard/long test. I had at least four in the past. I think the first two were related to mania-related heart concerns (if that makes sense). The second two were concerns relating to the medication Geodon. Geodon has the potential to affect the heart. I think maybe other medications might, too, though perhaps rare.

BeyondtheRainbow, I had heard about the need for frequent blood tests for Clozapine. I hope it serves you well. I've heard it can be very effective. My blood test sharing works the same way as yours. I'm glad your EKG results are always normal. Mine are, too. I have had tachycardia, though. I take a beta blocker for that (propranolol).

bpcyclist, you only get a Lithium level once per year? I'm glad your other blood test results are normal. I'm betting your frequent biking helps with that. I need to get my lazy butt doing more exercise. That's great that you can order your own blood tests. Is that something anyone can do? Or are you able because you have a background/degree in a medical field?

Beyond what I wrote just above, I have also had an MRI in the past (actually, several). My psychiatrist once also ordered a PET scan. [I don't know what he was looking for in a PET scan. The MRIs were mostly related to pituitary stuff from the antipsychotic Invega, plus some of below.] I know PET scans for bipolar disorder are not typical. He ordered it during a period when I was have extremely odd symptoms. He referred me to a neurologist for her to better interpret the results. She said there was nothing. I have also had a CT scan and several EEGs because of some symptoms (a catatonia, musical hallucinations, and other weird stuff). Nothing from the CT or first couple EEGs. One EEG (a sleep deprivation EEG) led to a Simple Partial Seizures diagnosis from a neurologist, but then an epileptologist said it wasn't definitive. All of the weird stuff has been long gone since Tegretol XR, but I do still get intermittent classic hypomanic, full manic, mixed, and depressive episodes.

I'll admit that all of the tests became overwhelming at one point.

I agree that they can be overwhelming, BirdDancer. And expensive, if you are paying yourself, as I am.

Yes, ordering our own labs is apparently a thing of the future. You don't need a doctor's order to do it with this company, you actually order your own. There are a few states, cannot remember which ones, but it is on their site, where it is still not permitted.

The company is called Walk-in Lab, walkinlab.com. They do seem to offer significant cost savings compared to Quest or LabCorp, which is interesting. I think they are trying to build a business on the idea that some people would like more of their own helath information and are willing to pay for that. They may be right.

Thanks for sharing about Walk-in Lab, bpcyclist. I had never heard of it until now. I usually go to Quest Diagnostics for blood and urine/other tests since it's only 10 mins from my house. My MRIs, etc. have been through a big radiology group near me, or the general hospital.

Thank you, Birdie, for the encouragement to request (insist?) an EKG. I'm 57, high blood pressure, high lipids, and an elevated A1C. Seems to me that an EKG is not only logical, but necessary.

When I was on Lithium I had levels done and a full blood work up done monthly. This is because I have kidney disease and my thyroid is stuffed. Now that I’m not on Lithium I no longer need bloods done as often.
I have had an ECG done every time I’ve been commenced on a new med. Otherwise annual ECG.

I agree that having an ECG makes perfect sense.