Question for CamW

Hi Cam,
How are things? I am up to 4 (300mg) tabs of lithotab a day, just started to have edema while on this amount, do you know if this will subside in time? I know you are not suppose to alter your sodium intake while on lithium, but is there anything I can do to eliminate this "bad" side effect"?? It actually makes me feel tired carrying this extra water weight around. I hope it does subside cause the positive side has helped me "chill" out, better than depakote has. Please let me know anything about side effects, other than what the pharmacist inserts with your "pick up". Thanks!!!
"darkeyes"

Darkeyes - There are a couple of things that can cause edema when taking lithium. Edema is not a common side effect but I have seen it in my practice. The least common cause is hypotension, which is a drop in blood pressure (which is why your doctor will periodically assess your cardiovascular function). The more common cause is just a transient increase in fluid retension, which resolves by itself in a day or two. If it lasts longer than this contact your doctor. Sometimes, if edema persists, the doc will put you on a diuretic (water pill). Thiazides ( like Hydrodiuril™ - hydrochlorthiazide 25mg to 50mg) or Moduret™ (amiloride) 5mg to 10mg, are given. The thiazides are tricky to dose, and may require a downward adjustment of the lithium dose and can occasionally cause hypokalemia (decreased potassium blood levels), therefore I recommend amiloride. Lately, some docs in our area have used Aldactone™ (spironolactone) with some success or Lasix™ (furosemide - but also have to watch for hypokalemia. If I had my druthers, I'd opt for the Aldactone. All that being said, more often than not the edema is transient and will go away fairly quickly.

As for side effects of lithium, I will give my spiel that I use during lectures and presentations:

DOSE RELATED SIDE EFFECTS (which are worse in the first few weeks of lithium therapy, and are usually bothersome, but not severe) (percentages given for incidence of these side effects are as follows: [low blood levels = 0.7mEq/l; higher blood levels >0.85mEq/l]):

1) polydipsia (excessive thirst): 60%; 70% (25% may experience this for up to 2 years.

2) fine motor tremor: 15%; 45% (eliminate caffeine, but if still present ß-blockers can be used to stop it - eg. Inderal™ - propranolol 40mg to 80mg/day; or Lopressor™ - metoprolol 50mg to 100mg/day).

3) polyuria (pee like a racehorse): 25%; 25%

4) diarrhea and othe G.I effects: 6%; 20% (dividing the dose to twice daily or switching to long acting formulations can stop this if it persists).

5) muscle weakness: 30% (but this usually disappears soon after initiating treatment).

6) cognitive impairment (rare - manifested as confusion, mental slowness, poor concentration, and memory problems; which are difficult to distinguish from symptoms of depression - a lowering of dose usually resolves this).

7) lithium toxicity: a sign that blood levels are too high (>1.0mEq/l) and if the following symptoms become present you should contact your doctor immediately - worsening tremor, slurred speech, muscle weakness, muscle twitching, and difficulty walking).

NON-DOSE RELATED SIDE EFFECTS (rarer):

1) nephrogenic diabetes incipidus: manifested by >3 litres of urine per day, with some sugar being spilled into the urine. It is usually a progression of polydipsia and polyuria and is caused by decreased water absorption from the distal tubules and collecting ducts of the kidneys. This is the reason that you doc may periodical test your kidney function.

2) diffuse nontender goiter: this type of hyperthyroidism occurs in about 5% of those taking lithium and usually occurs within the first few months of treatment.

3) hypothyroidism: the opposite of hyperthroidism also occurs in about 5% of those taking lithium and is due to lithium inhibiting TSH (thyroid stimulating hormone).

4) weight gain: typically, people taking lithium gain about 8 lbs while on lithium therapy, but about 20% will gain 44 lbs.

5) aggrevation of psoriasis and acne: a fairly rare side effect.

6) alopecia (hair loss): an even rarer side effect (and is usually secondary to hypothyroidism, but I have seen it happen. It can be reverse, in many cases, by supplementing with zinc and selenium.

I know that I am missing some rarer side effects, but this is most of what can happen while taking lithium. The list may look scary, but the common side effects are not usually severe (just bothersome) and more people just put up with them (ie. the relief brought on by the lithium far outweighs most of these side effects). The other side effects listed are relatively rare and most people will never experience any of them. The side effects that I listed should not scare you, but should act as guide of things to be aware of.

I hope that this is of some help.

As for me, I am doing fine, at the moment. My legs are giving me a little problem from the car accident and I am taking a fair bit of ibuprofen (which you should avoid while taking lithium - avoid any anti-iflammaroies, except on the advise of your doc, as they can raise lithium levels. Actually Clinoril™ - sulindac is the only anti-inflammatory not to interfere with lithium levels. I am not sure about the new cox-2 inhibitors like Celebrex™ or Vioxx™, though). Perhaps I should see a doctor and have an x-ray of my back and legs (like my wife and massage therapist say, but I am being a typical man about this.

I did go out an buy a new car yesterday; a 2002 PT Cruiser. I really can believe I bought one of these. I thought that only geeks and goofs drove these and since "I" bought one, I am now sure of it <LOL>.

Stay well, and talk to you later. - Cam

Cam,
Thanks, oh by the way that 8lbs.weight gain do most people gain weight? I am trying to get rid of the 18 lbs. I gained while on depakote I really do not need more . I don't think my brother had gained weight 30 yrs ago when he started the lithium, it only happened over the years (middle age), I know it sounds childish to fret over that side effect vs. the benefit of the medication but being predisposed to depression weight gain just contributes to feeling poorly about one's self, you know? Well I guess I will just have to work at it right?
Hope you are feeling a little less pain, you really should get checked out by a doctor soon! I do not know why guys refuse to go to doctors and dentists, my husband is terrible about getting to a doctor it must be a guy thing. Take care of yourself, do not work too hard
Stay well,
"darkeyes"

Darkeyes - No, not everyone gains weight. I was quoting from the literature. Actually, in most of the groups that I have spoken to, maybe 1 in 8 gained any really noticeable weight. I would think that your response would be similar to your brother's (ie. minimal to no weight gain), as I typically see family members respond to lithium in similar ways, in regards to time to repsonse, extent of response, side effects, etc.

Hang in there, you sound much better. If you don't fret about the weight gain until it happens (if ever), I will go get an x-ray. Do we have a deal? Actually, I am not too impressed with my right hand swelling up (rings are really tight), but having no neck pain (which would indicate some brachial nerve plexus inflammation), has me puzzled. Both of my thighs keep seizing up, as well (ie. the muscles kinda knot at times), but I can usually stretch them out. Besides, my massage therapist is working out most of the kinks, but she is torturing me every time she finds a knot (my right side is full of them). I think it is just that I am old and am taking longer to recover. I am on my feet for 12 hours a day at work, and when I am busy I don't really notice my aches and pains too much. It is only when I stop and sit for a while that I seize again. I should probably get working toward my black belt test in karate. I have been putting that off for too long. I always seem to have an excuse. I should just do it and get it over with. My therapist says that I don't finish anything because by not finishing I don't have a chance at failing. I dunno, that's probably sorta true. It's hard to break life long habits.

Take care and keep in touch. - Cam

Hey Cam,
Maybe your therapist has a point, that sort of sounds like what my problem is with never finishing anything so that one does not have to worry about failing or maybe the degree of ADHD my past therpist added to my diagnose of being bipolar is what my problem is all I know lithium is helping me with one area but I still have my problem of focussing and completeing things I distract too easy the only times I did not is when I was using phenterimine for weight loss, I mean it does not take a rocket scientist to see that I may also need cylert, ritalin or something like that to get totally together. My brother had been put on ritalin besides lithium during the times he was on the down side of this disorder, helped stave off excessive fatigue and kept him from "hibernating" the doctor stopped the ritalin when he started to feel overwound. Well we will see where I end up, so far I am doing much better than I have over the past 19 months. Finally!! You got a deal about me not fretting about the weight, it is dumb for me to get worked up over it, I just have to take everything one day at a time, right?
P.S. Your are not getting old, you are getting better! Did you ever hear that expression? I sometimes find it to be true and then there are days where it is a cruel reality, oh well the best thing we can all do is just enjoy it anyway. Stay well. . .
"darkeyes"