Lithium question

Good morning all. I have been trolling the boards here for a really long time, finally decided to join the conversation.

I was Dx bipolar 2 about 8 years ago, and have had crummy luck with pdocs and therapists. Worse luck with meds ... Have been down the list, every category, and nothing has helped, most things have made me much worse. I also have chronic daily migraine, which complicates meds and dealing with emotional flips. The only major med I have not tried is lithium. My husband, who has been unconvinced of the diagnosis for years, has started going with me to a new pdoc. He agrees with the doc that I need something to help, and encouraged me to try the lithium. It could help the migraine, too, and my neuro is on board as well.

So I am on 600mg, started 3 days ago. See a definite increase in water retention and needing to go to the bathroom. Last night, despite my normal sleeping aids and nothing bad on my mind, I woke at 1:00am and was unable to get to sleep. I can't say this is terribly unusual.

Wondering what you all think of lithium ... The good, the bad, and the ugly. Pretty nervous, having had nasty responses to so many other well-respected meds.

Thanks!
T

Lithium saved my life. It is that simple. What it does for anyone else is particular to that person but my experience is overall positive. What it dealt with for me was chronic irritability, in-patience and impulsiveness - along with stopping me from being chronically and, at times acutely suicidal. I have not attempted suicide since commencing Lithium nearly three years ago and I had attempted several times before.

My Bipolar doesn't just disappear though, it is just these symptoms that Lithium addresses for me. There are negative to taking Lithium, like needing to drink more hence go to the bathroom more, and weight gain and hand tremors but I am willing to put up with those as the positive effects are so dramatic. I am off Lithium completely at the moment as I am having ECT and I am really noticing a dramatic increase in my in-patience, irritability, impulsiveness and suicidal urges. The ECT is dealing with the depression but not the other symptoms. Sorry for going on a bit. I hope this info helps.

I love Lithium for mood stability and augmenting my anti-depressant! I haven't had any side effects either.

Well....I think it has helped me but I have to deal with acne, drinking and peeing a lot and sometimes gut issues. But my pdoc gave me gel for acne and its helping and I will deal with the thirst. The gut issues are not fun but its not very often and I can take med if it gets too bad.

I was on 1800mg and got Lithium Toxicity which was a complete nightmare, although I know not everyone would get that at that does, it just built up over time.

It is unlikely that Lithium would help with the migraines. Nor would it hurt - it is just unlikely to help. What are you taking for migraine prevention right now?

Your story is rather sad and rather representative - Lithium is the last medication to try whereas it really should be the first to try (and, if necessary, discard, but at least try first) since it remains the gold standard of bipolar treatment. There is no money in Lithium, for one, and, many pdocs prefer to prescribe newer drugs that they keep reading about. Probably that explains why you are going to try it a whole 8 years after being diagnosed.

It was hands down thee single worst thing I've ever put inside my body.


On the upside, it was sO terrible that it inadvertently caused me to quit my meds altogether, and I've been doing much better without.


So even though it was bad for me, it helped accomplish something good. 😁


Ps. The severity of my side effects are pretty uncommon, so don't let my story scare you off.


Pps. Please make sure your pdoc does regular blood work, to avoid kidney and thyroid damage.

Wow, thanks everyone! My first question, amd you have made me feel a lot better

My pdoc has labs scheduled for two weeks from now, and made sure my thyroid was stable (I have been hypo for 13 years) before I started the lithium. He wanted me to start slowly since I tend to have adverse reactions, tho he said that lithium is very different than other meds. One reason I refused to take it in the past was my NPP ... She was obviously not competent, and I didn't trust that she would know how to read labs correctly.

My only migraine preventative right now is buspirone ... Last ditch effort after everything else failed completely. It helps my anxiety, which is a major trigger. I take 50mg benadryl when it turns really ugly, which weirdly is more effective than anything. Self-prescribed after research. Neuro threatened to not see me anymore, as she felt that much of my trouble was psych related. I was angry at her, but she is right

Also have fibromyalgia. Untreated, as both meds I tried (Lyrica and Nortryptilene) flipped me into mixed state insanity. Lots of meds do that, and bring up the suicidal thoughts. Scary.

Ok. I tend to go on! Sorry!
T

Try the herb called Feverfew for migraine prevention. It may help a bit, and at any rate won't hurt - won't send you into a mixed state, induce suicidality, etc. You can get it in capsule form on Amazon.

The first week or two on Lithium can be rough. Even at 600mg I was having severe nausea. That subsided after a couple weeks. One thing you need to do is make sure your intake of water is solid. It can cause very serious kidney problems. This is especially true if you plan to undertake any strenuous activities. Keep yourself a water bottle and drink up. Also, make sure your doctor checks your kidneys/thyroid and lithium levels. No skimping on this either.

Overall, Lithium has the most documented efficacy of any “mood stabilizer” on the market. It has been around for a very long time, but they do not like to use it because of the long-term issues associated. A significant amount of people who have taken lithium long term ended up with thyroid problems. Thyroid issues themselves cause mood instability. However, if you have tried everything else and you do not feel better. Have a go for it! Also, to be honest, it even works in unipolar for some patients as an augment. I wouldn’t be to hung-up on the diagnosis. The fact is you need relief.

Another thing - now that you are going to be on Lithium, you can take a low dose of Elavil for migraine prevention. It is a fairly effective drug, and, it is very old=well studied, with a benign side effects profile at a low dose.

I take both Elavil and feverfew. I would not boast having no migraines, but I have fewer than I used to. Maybe once a week or sometimes even once every two weeks. I consider it worthwhile to take the herb and Elavil.

The "mega" drugs for migraine prevention, Depakote and Topamax, both harmed me in very significant ways, while Elavil pretty much is innocuous and even helps with sleep.

Since Elavil is so old, it is not on the radar of many pdocs and neurologists, because it is not studied anymore, not pushed, etc. So you need to be proactive - ask for it. It is also very cheap in case you do not have insurance.

PS Elavil is an AD at high doses, but even at low doses it can push a bipolar patient into mania, which is why it is not advised unless it is accompanied by Lithium, or, another MS.

It made me sleep! I slept to much with it myself. I won't use it, it was hard on my system. Everyone is different, it might work for you.

I started out on lithium when I was first diagnosed 14 years ago. I put up eith the side effevts for about 18 months before going off it and all my other meds. Long story there.....

Time warp foward 13 years and im back on medication. This time rather than lithium im taking its newer version lomotrigine. Have only been on three months after being hospitalized but the effectiveness of the drug compared to everthing else ive tried in the last 18 months cannot be understated. It works.
As far as I know it has less side effects than lithium (certainly has for me) so I'm definitely sold on mood stabilizers. But everyone is different. ...I hope you can find the right combo for you.

Hugs

The first mood stabilizer I was on was lamotrigine ... Took for over two years, then realized it was causing more suicidal thinking than I had ever had without it. Many meds do that to me ... Lyrica, nortriptilene, Lexapro, topamax. That is one reason I was so hesitant with lithium.

I have never tried feverfew, but have heard both it and butterbur can be quite helpful. The Elavil is a good tip, thanks! My neuro recently sent me to a migraine specialist several hours away. She was great, had a couple med ideas we are working through, but main recomendation was MBSR. It has helped!

They don't prescribe lithium the same reason they don't prescribe Haldol first for psychosis, despite it being the most effective anti-psychotic: because it's very dangerous. The long-term risks of lithium can be catastrophic, even when levels are monitored. I know several people in my bipolar support group who've ended up in kidney failure from long-term lithium. If anything, I feel doctors remain too loose in prescribing lithium (Depakote also).

Haldol+Cogentin is less dangerous than modern atypical AP's, but, again, there is no money in it. Modern AP's give the benefit of fewer neurological side effects, including tardive dyskinesia, compared to older ones, but on the negative side is the weight gain and the metabolic syndrome. Those side effects - the weight gain and the metabolic syndrome - are often persistent, and yet not disclosed in drug leaflets as tardive, unlike TD. Cogentin works to reduce the neurological side effects, but there is no standard treatment to outweigh (no pun intended) the weight gain produced by many later AP's. In other words, there is no antidote to modern AP's - topamax is used sometime, but it gives its own side effects. So given the metabolic side effects of modern antipsychotics, including the risk of developing diabetes, it is hard to say that Haldol is necessarily more dangerous. Plus, many people can manage on Haldon PRN, which is vastly safer than regular intake.

Alright, now for a side effect ... Is it the lithium making me have this nasty mettallicy sour mouth? New for me in last couple days, now constant! Yuck!

I'm supposed to be given a script for lithium soon (I'll be new to it as well we're in the same boat!) Anyway the pdoc told me that that could happen and said putting tooth paste on your tongue would deal with it. Idk how that would feel tho but it's worth a try!

I never found a cure for the taste of batteries in my mouth, it lasted the entire time I was on it. Nothing helped me in those 7 months, it was truly disgusting!


Good luck, I hope mints, gum or toothpaste are more effective for you.

It broke my thyroid for life after 1 year of being on it. Will be on thyroxine sodium for life now.

I do remember a nasty taste, but it wasn't exactly metallic. Are you on Lunesta for sleep? That's some serious metal mouth.