Medication levels

I've noticed that I am taking much higher doses of my meds than most of you I have seen listed, for all of the meds I take. You can see them listed below, the only difference is my Klonapin is now 1.5 mg. My Lithium level is 1.4 which my doc says is necessary for me, but is it really? What are your thoughts on all of this?

meds are different for everybody..some people are more med tolerant. I know I don't need as much meds......I only take .05 klonopin as needed but I know some people take higher doses several times a day. your abilify and lamictal look like normal doses but I don't know anything about lithium. I know most people only take 50mg of Topamax but I take 400.....so you never know..

your Abilify is a pretty high dose too

My pdoc likes a light touch with the meds. I'm just on a lot of them.

I wanted to deal with my issues through therapy. I'm on a low dose of lamictal because my former pdoc doesn't feel comfortable with a higher dose. My viibryd is low so that it can be adjusted when depressed. I don't do well with Med changes.

I think it's different for everyone. When I was on Lithium my level was around 1.0, then I found out after being in the ICU for a week after about a month of being horribly sick, shaky, no balance, memory loss and a lot more I had Lithium Toxicity and my levels were 4.6. Had to get dialysis because my kidneys were shutting down and I had a seizure. Only a few brief recollections after being brought to the Emergency room via ambulance, other than that nearly all of the 7 days in the ICU I have no memory of. I was on 1800 mg at the time. Of course I'm sure there are people that do just fine on that dosage, and I'm sure there have been people that have gotten toxic off much lower levels than I had.

I'm not on super high doses of meds (6 mg Abilify, 400 mg Seroquel, 1 mg Risperidone) but it's a little strange that I'm on 3 APs. Even my pdoc thinks it's strange and is a little concerned about increased side effects, but for now she's keeping me on it because it seems to be working.

Me too. I take three -- Abilify (15 mg), Seroquel (150 mg) and Lamictal (100 mg). I'm very sensitive to medications.

And by the way, a good friend of mine was on lithium for 30 years, and now her kidneys are shot. She's in line for a kidney transplant. She says it's because of the lithium. Just saying what she told me, but it'd be worth a discussion with one's pdoc if taking lithium.

The funny thing about Psych meds ..Everyones body processes them differently ..

One thing I will say and I have seen it over and over .. Patient X is started on medication A and then still having trouble so med B is added .. still having trouble lets add med C and increase A and B again .(on and on). You get the picture ...Sometimes meds just get upped and upped and added onto that. I see a lot of cases where people are just on so many meds and over medicated.

I think everyone thats on numerous meds need to sit down with there Pdoc occasionally and just review all the meds and doses .. Things can just be over looked and its not done on purpose of course ..

Just my opinion of course

My pdoc has 30 years experience. I asked him about this once and he told me that some of his patients are like me and only need a small amount of medication, and some have much more severe symptoms which require more meds and higher dosages.

I know...this actually scares me and I think about it a lot. My pdoc and I have discussed it and lithium keeps me pretty sane most of the time, seemingly more so than any other drug. The benefits out weigh the risks (or at least I pray they do because I often doubt this). She keeps my levels high.

This is what I am afraid of. But, at the same time, my pdoc was weaning me off of some of the drugs. She took me off of Saphris and dropped me from 400 mg to 150 mg of Lamictal overnight. It proved to be the wrong decision. However, she has, 50 mg at a time, gotten me back up to 400 mg of Lamictal and it still isn't working. This shows that I do indeed need the Lamictal and, I have a feeling she will put me back on saphris which I dread. I don't like being on so many meds in so high quantities. She does know this and it's the reason she was trying to wean me off of some of my meds. I just hope it's not like this the rest of my life.

My pdoc and I have discussed me being on 3 APs. If anything, she's just as worried about it as me but we both agree that since we happened on this combination I've had a greater quality of life than I imagined, so for 6 months I'm staying on it. Then we're probably going to d/c the risperidone and see what happens.

I have been told that my Bipolar is tough to treat (but it was said during postpartum and so it was a double whammy) and I have had 3 severe episodes of mania--more of depression--in my lifetime, all the rest have been less severe. Those are the only things I can think of that would make my symptoms "much more severe." But, I don't think (or at least I should hope) my symptoms are as such. I will ask my doctor about it and let you guys know.

I don't know if it's a question of severity. I think it's more that some people respond really well to meds and some people don't. Someone with "super huge severe" bipolar could do really great on meds, and someone with "less severe" symptoms could not respond to meds at all and need a more holistic approach. And some people need to blend the two.

Things get tricky when you start applying severity or high/low functioning labels. We each live our own life, and since other peoples' realities can be wildly different from ours, how do we really know who is the most severe?

The doctor can help determine severity. When the current meds stop working, they just up the dose until it works again. This in itself does not speak of severity, but IMO it is a factor. But also I do agree with most of what you said.

I don't think so either and I agree entirely. I was responding to Pawn's comment and feeling a little insecure--then and now. I don't always do well on meds and then...I don't know...I am just shoved more pills and take the max I can take of every one of them. Is there something wrong with me? Sometimes I wonder: am I even Bipolar? If not, obviously the meds won't work...and then I'm back to not wanting to take any of them again. It's frustrating.

I took 400 mg of Lamictal for quite a few years, and the same dose of Lithium in the 80s that you have listed. I'm about 6'5 and 310 pounds though, so I always assumed it was something to do with my size.

Hey guys i agree that it is really hard to discern why some people need more drugs than others. I was just quoting what my doc told me when I asked him this.
I think his exact reply was, "well, you are lucky to be so stable on just one medication, I have some patients that are on 4 medications, and they need them because they have very severe symptoms, and can't cope without them." He also said I may need more meds in the future if I have a bad episode.

For awhile I was on a cocktail of meds (5 or 6... some 5 treat the side effects of other meds). I have been lucky to find a pdoc that is willing to listen and let me cope with some symptoms through therapy. If I was medicated to the point where I was symptom free, I would be drugged wayyyy too much.

I think severity of symptoms is only a small part of it. I'm on higher doses of meds to stop depression and paranoia than my fiance was on to bring him out of full-blown manic psychosis. He would be comatose on the combination that just barely allows me to sleep. It's not because I'm sicker, but because I'm med-resistant. It's the inverse of people who react strongly to low doses of everything. I need a really high dose to get it to do anything. I'm definitely not overmedicated even if my doses would make other people feel like zombies; I often write 5k a day on my novels, exercise, and go out and do things. So if you feel good, I wouldn't worry about your meds being higher than what a lot of people take.

What I have a problem with is my insurance telling me the recommended dosage which is lower that my psych script. Then having to decide to pay the lower dosage copay or pay for the recommended at huge ($5-10 pill ) costs. For a 30 day supply I just can't face it. I also convinced my psych to take me off abilify because my copay was going up to $50 month and I can't afford that. I'm just thankful I have any insurance at all or I'd turn to some other non stable coping mechanism and need hospitalization. That's a cheaper option right? Signed ironically over fixated and broke

I would talk to your insurance company. Normally there are override forms for your doc to fill out if your meds or dosage are out of "recommended targets."

I agree, have your pdoc fill out the paperwork to appeal the Insurance companies decision.

I saw my pdoc today and I asked her why I am on so many meds at such high doses. I asked if it was because my symptoms were hard to treat, severity, or something else. She said absolutely severity. I told her this was upsetting because I felt like I was going to suffer this forever and it would be impossible to treat. She said the meds do help and she wouldn't give up on me. She also had a serious convo with me about sui and the rest of my life, telling me some important things to cling to in my lowest moments (she is such a COMPASSIONATE doctor). She put back on Saphris also which I am not crazy about but I do trust her. I'm sure this isn't probably true for everyone who is on high doses of many drugs, I just wanted to share what she said.