Fatigue from Lithium--need advice/shared experience

Hi, I'm new here. I've been on several meds through out the years--some have worked better than others, but eventually they do lose their efficacy. Long story short, I ended up in the hospital twice within these last 5 months for a severe suicidal depressed episode. Docs tried several meds to no avail. since my old ones stopped working. Finally, the doc at the last hospital i went to, (which was waaaay better than the previous one), told me she didn't believe that bipolars should be on anti-depressants because it keeps them "looping" in addition to other issues. She took me off all the meds they put me on and convinced me to go on Lithium-- which i was very reluctant about due to the side effects i knew a bit about. She insisted it was fast acting and she wasn't kidding. Within days, once i was put on lithium, the constant crying spells, anxiety, suicidal ideation and depression began to lift. I was shocked at how quickly it worked considering i've been used to waiting weeks for some anti-depressant to kick in.

I was obviously relieved, but now that i've been home for the past few weeks, I'm finding that i'm constantly fatigued. I feel as in a state of limbo/dazed...too tired to do anything, but not tired enough to sleep it away. I eventually end up taking naps and feeling cranky/whiny from being in this fatigued state. I even drink strong espresso to "snap out of it" or energy drinks which does for a short time, but here i am back on my couch too physically tired to get anything done.

Yesterday i just broke down crying because here i thought i finally found something that stabilized me, but what good is it if i'm always too tired to "live" my life and do the things i need to do. Sure i'm glad i don't want to kill myself anymore, but I just hate these trade offs. I had all these plans after leaving the hospital---exercising, finding a network of people (like a bipolar support group), re-joining the human race and building a social life so i wouldn't be so isolated....but now, it just seems like such an effort to running simple errands outside the home---let alone all the daily tasks and in home projects/art work i started working on. I've only worked on this stuff in spurts, then get tired and have to stop. PMS week and the duration of my menstrual cycle only makes it worse. But that's a whole other story that i'm still trying to figure out.

My current Lithium dose is 900mgs plus my new doc just put me on lamictal 25mgs. My question is to those out there who do take Lithium. Do you feel this side effect as well? If so, does this fatigue side effect go away with time or is it a standard side effect that continues? Would a lower dose improve this side effect? Can you offer any advice about what i could do to counteract this constant fatigue? Another additional medication perhaps? Some kind of supplement? One thing that has changed re: my meds is that the doc at the hospital put me on somewhat high doses of topamax since it's an appetite suppressant due to my concern about weight gain. (In my past i gained an enormous amount of weight of depakote and worked hard to lose the weight) My current doc wanted me to come off topomax due to the cognitive side effects, which i agreed with due to some research i did of this medication as well as hearing about personal accounts. I wonder if the topomax at high doses also boosts your energy which is why i didn't feel the fatigue i feel now. He switched me off topamax and replaced it with lamictal about a week ago. I don't remember feeling so tired like i do know since he took me off topomax. Not sure. I've been on lamictal before so it's not new to me, nor did i feel any fatigue effects from it in the past. I've also been experiencing the tremors pretty severely (both hands and legs even) from the Lithium, but that seemed so get a lot better. Good thing i'm not a brain surgeon huh?

I'm just so bummed out since i've always had such a high tolerance for meds that make you tired. I'm also worried about weight gain, acne (since i'm already prone), thyroid issues (which are coming up in my blood work) etc. Right now the one side effect that is presenting itself and interfering with my quality of life is the fatigue, which, in turn, is "psyching me out" or causing me to feel unmotivated which is one of the depressive symptoms i hate most. I fear that this constant lethargic fatigue will trigger me into a depressed episode. Any advice, info. or shared experience would be greatly appreciated.

Lithium is the one med I have avoided, but one doctor kept trying to convince me to go on it. It is the "original" drug for bipolar. I've heard it can cause tiredness and the other symptoms you mentioned. You might also look it up on the Internet to see what it says.

I'd definitely mention your tiredness to your doc to see if anything can be done to help or if generally it gets less problematic after awhile.

I used to sleep at least 10 hrs a night on lithium. The tiredness was worst for the first 3 months and improved after that. The acne is zinc responsive so if you do get it just take zinc supplements. I put on lots of weight on lithium mainly due to increasd thirst. But also cos I are more and got hypothyroid. Off lithium now and on abilify and it works really well, is weight neutral. I'm also on an anti depressant.

I know.... I too have always avoided Lithium like the plague due to its age and the potential side effects despite how a few docs in the past have lauded its efficacy. I was super reluctant at the hospital to try it. Before then, i tried several meds to no avail and before taking lithium at the hospital, i tried abilify which sent my anxiety level through the roof---ended up having a panic attack from it as a result. The doc said abilify can cause anxiety as a side effect.

Finally, out of desperation for relief, i gave in since nothing else was working...got taken off abilify and took the lithium. All the anxiety vanished and within days the lithium really worked. She told me it would be fast acting and i didn't really believe her. I'm used to taking ssri's with other mood stabilizers and all of them usually take a while to kick in---but i was really shocked to find how fast acting the lithium was and how quickly it stabilized me. I'm not thrilled with the side effects, but i don't want to mess with my current stability given that it's the only med that has worked after all these months of chronic depression.

Yesterday i saw my doc and told him about the fatigue. What he did was up my dosage of lamictal and might lower the lithium dosage after he sees my blood work.

Here's the thing that i didn't mention---at the hospital, since i was so concerned about weight gain, the doc there put me on topomax. When i came home with the lithium and the topomax, i didn't feel any fatigue. I finally figured out last night why i didn't while on topomax. I was on pretty high doses and in addition to it being an appetite suppresant, i discovered it also gives you an energy boost which i didn't realize was one of the side effects. Last week, my doc took me off topomax and replaced it with a starting dose of lamictal. I agreed to going off topomax due to the scary cognitive side effects which i was experiencing and had experienced in the past when on topomax. I think it's a pretty useless mood stabilizer, imo, and i was only taking it to counteract the weight gain thing with lithium...BUT it can really mess with your memory, concentration etc. I did notice short term memory loss and mistakes i kept making when typing, but then i heard horror stories of people on topomax long term and how, not only did it cause cognitive function side effects while on it, but how it continued after getting off it. This wasn't a risk i was not willing to take. Anyway, he told me that the lamictal, at higher dosages can work as the topomax did to counteract the lithium fatigue since it has anti-depressant properties. He also said that side affect will subside in time. I hope he's right. we'll see.

Thanx for sharing your experience. Apart from sleeping 10 hours, did you still feel fatigue and lethargic through out the day? Like you were dragging? or even in a haze? How many mgs were you on? Were you taking anything else together with the lithium? If you read my response to the post above, i was initially on high doses of topomax which is why i didn't feel any fatigue till the doc took my off the topomax. Well i'm glad to know that the fatigue does subside eventually....though 3 months seems like a long time. I'm hoping the increased doses of lamictal will counteract the fatigue like my doc said.

As for the weight gain....i'm so totally dreading that possibility since i gained a ton of weight yrs ago when i was on depakote. I'm confused....you gained water weight? I thought lithium was an appetite stimulant which is what causes the weight gain....i'm also assuming it slows down your metabolism. Did you find that you were eating more or hungrier while on lithium? I don't understand how drinking more water will cause weight gain. Also, you mentioned a hypo-thyroid issue. Did the hypo-thyroid issue happen after being on lithium or before? I ask because lithium is known to cause hypo-thyroidism which i already just developed before going on lithium--but just barely have it. I was put on a low dose of synthroid this fall when the hypo-thyroidism was discovered and i actually gained weight from that low (starting) dose of the synthroid. I thought the opposite was supposed to happen, but certain researchers believe that low doses of synthroid can actually cause weight gain. I ended up putting on 20 lbs in 2 months as soon as i went on synthroid and couldn't figure out why i had gained so much weight so fast----i just attributed to the hypo-thryroidism. But when i read about the low dose thing, i stopped taking synthroid to test their theory and low and behold i started to put off the weight i had gained. Though my thyroid levels were normal again for a while, just recently i found out it just came back again, but i don't know the severity of it yet till i see my doc.

Oh and thanx a lot regarding the advice of taking zinc. I wonder how many mgs i should take. I'm glad abilify is working for you. For me, it caused a lot of anxiety. Damn all these side effects....so sick of playing the detective "trial and error" game. i hope one day they come up with "designer" meds to fit each persons chemistry. Hope this happens in our life time.

thanx again for sharing your experience with lithium.

I didn't know Lithium caused a lot of fatigue. I just went off Seroquel because it made me feel like a zombie all day.

So my pdoc just started me on lithium. I'm on a starting dose of 300mg and haven't felt the side effects...yet.

I agree with you Supernova001, I'm also sick of all this trial and error with meds. Sometimes I want to say "screw it" and stop taking my meds and just deal with whatever cards I'm dealt.

I would say seroquel makes you waaaaay more tired/zombified. You're on 300mgs, i'm on 900mgs which is why i'm experiencing the fatigue and you're not. You also gotta take into account body weight/height. I'm just 5'2" at 150lbs. But also keep in mind that not everyone will experience the same side effects. Everybody's chemistry is different. Also, i'm told that this side effect subsides with time. Also, your doc can prescribe something to counteract that side effect. He put me on lamictal and is starting to increase it which will give me more of a boost. Also, just read that this guy didn't feel the fatigue effects when his dose was lowered to 600mgs.

That being said...as sucky as the whole trial and error thing is, it's better than the state i was just a month ago. Lithium really worked for me and was fast acting when nothing else was. So, as sick as i am of meds, i'd rather be dealing with this than crying every 5 min with a knife at my wrist. Don't go off your meds because it's a lot easier to "deal" with this stuff with meds than without them. Hang in there. Keep us posted on your updates with lithium. We can compare notes.

Keep an eye on your thyroid as lithium can effect it's functioning (re; fatigue, weight gain, goiter).

Lithium is still the benchmark for treatment of bipolar illness, although I much preferred Lamictal and took a very small dosage (about 15 mg) for a year.

How well you get along is going to depend to a large degree on how much you are
pro-active in your care. It certainly seems as though you intend to be.

I would say that the best things I did to help myself were to do the following:

1. Give up tea, coffee, and anything else containing caffeine or theophylline.
(For those sensitive to it, it makes the illness worse.)

2. Give up alcohol-it makes bipolar illness worse.

3. Changed my diet to eliminate breads (because of the damage exorphins do to
us--and it is contained in gluten--so anything containing gluten might be considered off limits if we're sensitive to it. (It can cause many, many problems.)

4. Added Omega 3 fatty acids to my diet. They are wonderful for me for calming feeling tone and creating a quiet atmosphere. (Lemon juice will do the same thing for some of us. Just squeeze two lemongs in about 8 oz of water and drink it. If you aren't better after 4 hours, repeat the process. That usually works for those of us who use it.)

5. Read some sights online such as http://www.Alkalinefoods.com for insight into
which foods are best to help keep the fluids and tissues of the body in a more alkaline state.

You need to know that all medications leave an acidic ash (or residue) that must be
metabolized. When we take meds every 24 hours, it is sometimes difficult for the kidneys to keep the blood clear of the effects of that residue. That's the primary
reason for altering the diet: to reduce strongly the acidic reaction of medications and foods which are naturally digested as acidic.

It may sound strange that the lemon (which tastes very bitter) is actually
transformed in digestion into one of the most alkaline foods we can ingest; it's
very helpful for tissues and fluids in improving feeling tone.

Good wishes on going pro-active. It will help, I think.

I've also about the lemon juice, i was on Lithium in the 1980's i remember i liked it, but that was years ago, and i don't even remember why they took me off of it as looking back now, i think it was the best med for relaxing i was ever on, i think it may have been i was too relaxed and sleepy like you too. I also have hypothroidism and am on synthroid, believe me gaining a few pounds is worth the trouble by being put on synthroid. you do sound pretty intellegent when it comes to your meds, you must have studied about them.Well keep courageous and do what you are doing to get the meds to work!!!

I taken lithium and found that side effect only lasted a week or two then I was back to my normal self.

Funny you should mention citrus because this week, since the fatigue side effect began, i've been craving and drinking orange juice like crazy. Thank you so much for all that info. I will def. look into it. Right now, i'm feeling incredibly sluggish so being pro-active is currently on the back burner, but the lemon juice thing is interesting. I had all these plans on starting to exercise and eating healthier, but got blind sided by this constant fatigue so exercise is something i'm not feeling too motivated about. I really hope this side effect subsides quickly. I don't drink alcohol so i'm good on that front. Didn't know about the caffeine though. How does that worsen our illness?

I really appreciate the information that you posted, thank you so much. My doctor is talking about putting me on Lithium and I want to know as much about it as possible. The side effects of some of the other medications that I am taking and have taken in the past haven't been good.
warm thoughts

Supernova-So the lithium helped with your depression even? What all did the pdocs you saw say about AD's?

After I got out of the hospital my pdoc through the state clinic would not give me an AD,even though I was depressed. Have you ever had problems with sleep? I always have and the doxepin helps with it. She would not let me go back on doxepin and put me on seroquel instead. I then gained weight. So don't want to go there again.

I have been on Lithium for over a year , I have really had no problems. I already drink lots of water daily, If you don't you will feel poorly.

I know many people are very much against Lithium , I personally think for me at least the AP"S have worse side effects, I refuse to ever take them again.

Good Luck

About caffeine: for those who are sensitive to it, caffeine causes (over a long period of use) damage to the frontal lobes of the brain just above and behind the eyes. For the best information on the subject of caffeine, please read the following article on the internet by Ms. Ruth Whalen (whom I've talked to via internet and she is one who is really in the know about caffeine).

http://www.Doctoryourself.com (It should open by just clicking the site quoted
here if you have Google as your search engine. Otherwise, write down the URL
and switch to Google and give the exact URL given here. That will bring you
to Doctor Yourself.)

When the website pops up, go down the left hand side on the index and look down
until you see an article called "Caffeine Allergy" by Ruth Whalen. It's an astounding
account of her experience as a lab technician who has experience in examination of
brain tissue and the effects of caffeine sensitivity on the brain.

Dr. David Williams in his new book Wheat Belly implicates wheat in brain disease of
some types: dementia and others that I don't recall immediately. At any rate, his
work is worth your reading. I've read it and given up the use of grains as a result.
I simply substitute nuts, seeds, green vegetables for the amino acids missing by not
using grains.

Dr. Williams, as I posted earlier, has said that it is nonsense to think that we cannot
live without wheat, rye, or barley (the big three containing gluten). We can very
easily, and I'm working on it myself and losing weight, too. Grains are a big, big
weight gain cause.

And about craving orange juice: it could be that your meds are taking Vitamin C from your system in order to metabolize them adequately. Or you may have some craving for sugar--orange juice is like 90% or higher in sugar.

Many of us use the whole series of Vitamin B complex (B12, B3, B5, B6, etc. every
other day or so to increase better feeling tone while on medications.) You may
need to increase Vitamins A, C, D3, E, Inositol, and others. Please read some
on this subject to learn how to recognize which vitamins may be low when you're
on high doses of meds.

Vitamin C is most important because humans can't manufacture that vitamin. It must come from an outside source, so please make sure you have plenty of that
around. I take about 1,000 mg per day, and that's not at all too much. Some people take 2,000, 3,000 or up to 4 or 5,000 mg. per day. Government recommended daily requirements are much too low--they are designed to give the
minimum necessary to prevent disease, not the amount necessary to give good
health. If you can afford it, always take a pharmaceutical grade vitamin, please, and remember that vitamins can do nothing for us unless they are taken with food.
In addition, vitamins can do nothing for us unless we have the minerals to digest
them! So-ooooo a good regimen of multiple vitamins and multiple minerals daily
will help offset the acidic residue of meds and keep a good feeling tone as much as
they are able.

Omega 3 fatty acids are remarkable for me. They do help so much and have been
identified as beneficial for bipolar illness. In fact, one study indicates that Omega
3 fatty acids may be the first real finding to alleviate bipolar illness' cause. (I
feel sure there are many causes for bipolar illness; it's just that it is known now
that Omega 3 fatty acids do help alleviate some symptoms of bipolar illness.
I use Nordic Omega 3 fatty acids--there are many available, however.)

Good wishes.

I gained weight from drinking more sugary drinks because of the thirst, increased appetite and the hypothyroidism. I was slowed down while on the lithium but it improved with time. I always needed the increased sleep even after being on it for a year. It also slowed down my reaction time, I couldn't coordinate lunging for rock climbing and kept falling! While I was on topomax I turned into a zombie and had significant memory loss. I have also been on an anti depressant the whole time.

Passion, I went into the hospital ONLY for a chronic suicidal depressed episode. (lasting 5 months) I was not at all manic. I was in a manic episode during the summer then crashed from one day to the next into a severe depressed episode. When i crashed into the depression in Sept. i ended up missing 2 therapy appts at the crap clinic i used to go to, so they dropped me out of no where with a letter in the mail. Result: no more meds. I was on effexor, lamictal and topomax at high doses. Luckily i had enough to wean myself off slowly so as to not experience the withdrawal symptoms. I never intended to go off meds or stop receiving care. They have a strict policy at this clinic that if you miss 3 appts, you get dropped. It was the new 20 something yr. old therapist i just started seeing that closed my case. The idiots at this clinic didn't realize that it takes 4-6 weeks to get into another local clinic. By then, i was so crippled by the depression and became house bound that i no longer cared or was in a proper mind frame to find help. I just kept telling myself, when the depression episode passes, i'll go and find a new clinic etc. I was in that state where even making a phone call was insurmountable. Anyway, after a few months of depression hell, i attempted suicide for the first time. Was taken to a local crap hospital, put on wellbutrin, topomax, lamitcal and i can't remember what else. I think it was the lamictal that started to bring me out of it because i consider the other 2 meds useless. Anyway, i believe they released me prematurely because one week later, the depressive symptoms hit me again. I started going to another clinic referred by the hospital, but the dr. there seemed like he just got out of med school and inexperienced. The idiot took me off lamictal because i told him my acne was coming back---he thought it was a rash...i explained i was on lamictal for yrs before this and that it was acne and not a rash. Anyway, as my depression worsened, he kept changing my anti-depressants and i had to keep starting from scratch. I ended up back in the same hole and feeling suicidal again and a friend suggested i leave the county and go to another hospital. Thank god i did because the care there was 10,000 times better.

Sorry for the long story...but to answer your question: Yes, the lithium alone was what lifted the depressive symptoms which i didn't expect since it's often given for manic states even though it's, of course, a mood stabilizer which works for both. I was very surprised when the doc there wanted to take me off anti-depressants and not give me any at all. She even took me off trammadol which i was taking to sleep since it had AD properties. Keep in mind, i've been on AD's with a mood stabilizer for all these yrs. since diagnosed, but she was really against AD's for bipolars and believed it was the reason it keeps us going up and down,(more so than usual) not to mention the potential side effects such as anxiety etc. I've read about the manic-switch prior to this and met another person with bp whose pdoc agreed was of the same mind set as my pdoc at hospital, but i just found it hard to believe that a mood stabilizer alone would lift my depression, but it actually did and my depression was pretty severe.

So far it's been about a month since i was released from the hospital and other than a pms moment, i've had no depression at all. Only thing i'm struggling with is the fatigue side effect which really sucks since it psychologically reminds me of a dep. episode, but this is only physical, not chemical. Hopefully the lamictal that my new pdoc prescribed will counteract this side effect---which is what he said would happen as he ups the dose.

Thankfully i'm no longer in a conveyor belt clinic as i have been for all these yrs. I was able to get a private doc thanx to the doc at the hospital who called in a favor. I live in NJ and if you have both medicare and medicaid like i do, it's virtually impossible to find a private pdoc that will take my insurance. So i'm sooooooooooo very thankful for that. Makes a huge difference. Only challenge now will be to find a therapist which i haven't had much success with since the ones at the clinics in my area were a joke.

p.s. and yes!!!! regarding your question about sleep. I've had erratic sleep patterns as long as i can remember. (no natural rhythm) Lately my sleep patterns seem to be normal so far. I wonder if it was the AD's that caused it. Dunno.... we'll see in time.

Blackpup, i don't know if you're a male or female, but i've been asking this fatigue/lithium question at other forums. I don't know if this is a coincidence, but thus far, (with the exception of christina) females have reported the fatigue side effect whereas males have reported they didn't have this side effect. I wonder if females tend to be more susceptible to this side effect more than males and if so, i wonder why. In my past, i have always been pretty tolerant to sedating meds and have not had the tendency to be sensitive to side effects in general, i guess that's why i'm having such a hard time dealing with this side effect. Like you, at another forum, someone reported that the fatigue side effect subsided within a few months.

Re: topomax---it's a scary medication regarding the memory loss and cognitive blunting. I've heard horror stories from people who were on it long term---that the memory loss and lack of concentration continues even yrs after discontinuing. (and btw, some of these people weren't even mentally ill---they were taking it for migraines). ONe woman even forgot her name! For this reason, my new doc wanted to take me off it immediately. With such a severe side effect, i can't believe it's even on the market.

You are such a great source of info. regarding this stuff. I wish i could have a holograph of you whenever i'm in my kitchen. lol...I know nothing about vitamins or how the body metabolizes the meds etc. I have a lot of homework to do. I had a b12 and vitamin D deficiency show up in my bloodwork this fall and had to get a shot for it. I have lost a lot of hair (thinning) within these 8 or so yrs and have been trying to figure out why. Wondering if it was one of the many meds i've been on or if it's something hormonal.

I don't take any vitamins since i don't know which to take or how many etc. I read somewhere that you have to be careful with that because too high of vitamin mgs can be bad, so since i'm clueless at the amount, i haven't taken any. I do know that omega is great for the brain, but again, which kind to take and how many mgs? How many mgs do you take?

AS for the citrus, i don't think it's the sugar otherwise i'd pig out on edible sweets. I've been used to water and coke zero and never drinking sugary drinks.... i also use equal in my coffee. AT first it was for health reasons, but now i just hate that corn syrupy after taste you get from sweet beverages. As for the orange juice, i only like fresh squeezed and usually drink it when it's mixed with fresh carrot juice. I think my body was craving vitamin c because for me to drink the store bought orange juice that has all that added sugar (which i find gross) must mean i craved the orange juice itself. I also went through a 5 lb bag of tangerines fairly quickly so i think you're right re: the vitamin C.

Re: Nordic Omega 3 fatty acids you take, how many mgs should i take? Is that the brand name? Could i order them online? I don't know if i should take a multi vitamin or individual vitamins? How many mgs etc. Also, which are considered pharmaceutical grade?

Yes, Nordic Omega 3 fatty acids is a tradename. It's available at Vitamin Shoppe,
GNC and probably at many other pharmacies and whole foods stores, as well. I take
about 1,000 mg per day and that's not too much. (Incidentally, omega 3 fatty acids
will improve hair growth if you are getting too many acidic foods in your diet--that
is, ones that are digested as highly acidic, e.g., red meats, wheat, milk products, etc. I lost hair in patches, and it came back quickly after adding Omega 3's to my
diet.) The medication Depakote (Valproic acid) is notorious for causing hair loss.

Wheat also will cause you to lose hair. I can't emphasize how much the new
book by Dr. David Williams called Wheat Belly is in beneficial terms to let us know
how serious it is to use wheat in our diets, particularly if we have a sensitivity to it.
The symptoms he discusses are enough to make one want to toss out all the wheat
in one's home! I've dropped it and feel much, much better. He explains how easily
one may substitute nuts, seeds, green vegetables for amino acids existing in grains.

You're pretty safe if your ask your pharmacist for a pharmaceutical grade multiple
vitamin. He/she can recommend one that is excellent. You probably won't get too
much of any one vitamin if you don't overdo too much the government recommended allowances. You know that they are way too low to be effective in maintaining good health. (They're just the amount needed to prevent illness.)

Vitamin C travels on the same pathway as glucose and when in transit glucose will win out every time leaving you deficient in Vitamin C. That's one reason why it's important to keep the vitamin C level high--that, and it has so many functionally effective uses for the body, almost more so than any other vitamin. About 1,000 mg per day is adequate for me unless I've had a lot of stress, then I may increase it by 500 mg.

Stress is a strong acid builder of the tissues and fluids. Try to keep things cool and calm around you to maintain that slightly alkaline state you want for your fluids, etc. That's what really keeps us healthy in the long run and overcomes the residue of medications.

The following paperback is the most helpful source I've ever used in learning about vitamins, minerals, herbs, etc. for nutrients that are right for us: Vitamins, Minerals, Herbs & More
Choosing The Nutrients That Are Right For You by Pamela Wartian Smith, MD., MPH.

I wish I could get this into a more succinct article. It just seems to go on and on. Sorry about that.
Take care.