I'm on Lithium, Risperdal, Cymbalta, Concerta, and Klonopin.....I've developed incredibly bad ringing in the ears. (tinnitus)I don't see my doctor for another week. Any ideas if it could be from one of these meds. It kept me up half the night last night!
yes its one of a side effect..of the meds but witch one?? now im on lithiem ive never experinced any of that..i use to be on klonopin and that wouldnt do it..WHY DONT YOU GO TO THE E.R. THEY WILL GET IN TOUCH WITH UR DOCKTER..GOOD LUCK
Lithium has a variety of severe side effects. Has your psychiatrist considered updating it to Lamictal? That is much safer and has far less side effects including not causing cognitive blunting, weight gain and not needing blood draws as well as the risk of long term kidney damager. And as for Rispedal that has a fair amount of side effects too and Abilify is better with that. Of course with any antipsychotic there is the ever present risk of tardive dyskinesia as I am well aware of being that I have it in its extreme forms. And there are new antipsychotics in study such as the glutamate antagonists which can't create tardive dyskinesia, diabetes, movement disorders or weight gain. I am on glycine a phase II study antipsychotic, under the care of a psychopharmocologist and have made a full recovery and the study is likely to be published soon in a psychiatric journal. Cymbalta is a standard anti-depressent an SSRI such as Prozac or Luvox. Klonopin which I personally take is an anti-anxiety mediacation (benzodiazepene) and at reasonably dosages unless a person builds up a tolerance is relatively safe. Concerta appears to have a fair amount of side effects some dangerous especially in combination with the other medications. Ask your psychiatrist if you need all of these medications. I would assume you are diagnosed with bipolar with psychotic features (Risperdal is of course an anti-psychotic) and they added an anti-depressent because there were still issues with depression. Klonopin could be for anxiety or as a side effect pill for the Risperal. Concerta is for adhd. Have they confirmed that you absolutely need that? That sounds like the main offender here. Do not make any changes on your own of course but have them do a medication review. Sometimes polypharmacy can be hazardous if not done properly. I should know because when I had two antipsychotics prescribed at once that is how I developed tardive dyskinesia in the first place. I'm sure they could make dosage adjustments and see what happenend from there and perhaps eventually titrate you off the Concerta as that may be the medication that is causing the severe side effects. Speak to them about it and let them know what's going on.
First things first. Lithium has less severe side effects than Lamictal in fact Lamotrigine prescribing information has a black box warning about life threatening skin reactions, including Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis and its side effects also include (Commonly) headaches, dizziness and insomnia. with others including acne and skin irritation, vivid dreams or nightmares, night sweats, body aches and cramps, muscle aches, dry mouth, fatigue, memory and cognitive problems, irritability, weight changes, hair loss, changes in libido, frequent urination, nausea, and so on and on.
Lithium does not cause cognitive blunting (its a non psychoactive drug) and yes it has a long list of side effects - its been around since 1849 and in use for mental illness treatment since 1949 but when you did into the side effects the incidence of severe ones is very small - the most common side effects for lithium are bringing on incipient thyroid problems, dry mouth, increased thirst and muscle tremors. Lithium is one of the single best understood and safest treatments around - however it requires blood tests to monitor MMOL levels so that may be a pain for some people.
Lithium is not as common as it was because its Generic and thus cheap and the doctors do not push it anymore - Oh and weight gain pretty much all AD and AP drugs have that as a side effect as well.
SSRI drugs come with massive warnings for Bipolar patients - any Bipolar taking them requires careful supervision from a doctor as they have the ability to cause mixed episodes which are no fun at all - SNRI drugs are safer (wellbutrin).
Concerta is Ritalin and not something a bipolar should be taking - it has serious side effects and is over prescribed and not something I would take..
Ok youre on a mood stabiliser (lithium), An anti psychotic (Risperdal), And anti depressant (Cymbalta) and an ani anxiety (Klonopin) and good old Ritalin. Im sort of confused as to the mix myself, I am assuming he is low dosing you on the Lithium and Risperdal and using the Cymbalta to balance mood states (common in the US it seems to give an MS and an AD - in Australia its never done in maintenance phases) and the anti anxiety makes some sense but Ritalin?
My advice. Speak to your pharmacist and then get advice from another doctor - second opinion does not hurt and if you are not seeing a psychiatrist then you need to be.
Ahh bingo. Yes it can indeed. I didnt think of that because tinnitus is not a side effect of lithium normally it is however present in cases of toxicity..
These are the signs of Lithium Toxicity :
Early signs of lithium toxicity include diarrhea, vomiting, drowsiness, muscular weakness, and lack of coordination.
More severe symptoms include ataxia (failure or irregularity of muscle action), giddiness, tinnitus (ringing in the ears), blurred vision, and a large output of dilute urine.
If you have multiple signs on this list then you need to increase your fluid intake and go to hospital - toxicity is no joke at all as it can lead to renal failure and liver damage among other things. It should be very hard to reach toxic levels if you are being properly monitored and following the correct regimen including increase fluids (at least 2 litres of water per day) but some drugs can cause toxicity to come on because they affect kidney output or interact with lithium.
This is avoidable in most cases if your pharmacist is aware of the drug but on lithium (and all of these classes of drugs) you need to always inform a pharmacist or doctor when he is prescribing.
Mind you im also not convinced an SSRI reaction could not cause ringing in the ears, especially if you also feel ill at ease and hyper.
I respect what you are saying and if Lithium works for you then by all means stay on it. But I was speaking from personal experience and from what providers have said. Lithium does indeed cause cognitive blunting. Not everyone experiences it but its common. My psychiatrist has said Lamictal is the only common used mood stabilizer that doesn't. As for the rash which is Stephen's Johnson Syndrome the chances of a person getting it are one in a thousand. Basically if you take Lamictal if you get a rash you call your provider and they will see what it is and then discontinue it if found but if you don't you are out of the woods. Its safe and effective and doesn't require blood draws and can't cause weight gain either. Also many providers will stop using Lithium in a consumer after ten years because there is the risk of kidney failure long term especially if not properly titrated. Please understand I obtain information from psychopharmocologists, including researchers and up to date medical websites. I wouldn't second guess a provider and I don't put myself in that place but some are less than forecoming about side effects. I do let people know about the specific rates of tardive dyskinesia but I always in every post tell people to stay in treatment and not make changes without asking their provider or if unsatisfied switch to a trained psychopharmocologist. You were correct about Wellbutrin but I had a friend and she's a social worker by the way, become wild manic recently and it turned out it was because of Pristiq. I warned her about the dangers of tardive from Abilify and since she had no psychosis (if a person does, they need an antipsychotic) her provider is voluntarily changing her to Lamictal and Wellbutrin. Thorazine and Dilantin have been around a long time too. One is an outdated antipsychotic that like other typicals has a high rate of tardive (5% per person per year) and the other can cause liver failure as it did in someone I know. You identified correctly the signs of Lithium toxicity. You may doing well on Lithium but someone else may not be and Lamictal is a good option. Its officially approved as a first line mood stabilizer and I've been on it before. Cost should never be a concern. I appeal to have the drug companies cover what I need and to obtain the benefits I deserve and get the best of treatment and I would be willing as a consumer advocate to help others do the same.
Whilst I understand what you are saying the reality is that brain fog or mental blunting are not listed as a side effect of lithium in any study and nor are they listed in the Australian Prescriber database (which i can access) and in the advisories for Lithium I can find - that of course does not mean you did not suffer from it or other people have not suffered from it as each and every one of use is different but then again most of us are also taking other drugs as well so it becomes hard to pick an interaction from a side effect.
Every person is different but the reality is that so often the very first thing I see when people mention lithium is oh you should change to X with X being flavour of the day and it deeply irritates me - if Lithium does not work for you then thats fine, change, if it does then it is cheap and effective and well understood and god knows for the cost per dose of some of the newer MS drugs the dollars mount up.
As to mental blunting and Lamictal - memory and cognitive problems are listed as side effects of Lamotrigine and that's mental blunting. In other words its just the same as all of the drugs and in reality if you study how they work the Atypicals can all cause it to happen by the nature of their mechanism. That doesnt mean that you will get it or the next person - remember some of these symptoms only affect 1 in 100'000 people.
Lithium has been taken 25 years by some patients, titration is a risk and increased risk of renal failure exists but its not unusual for patients to take it long term either - lithium is however unusual in that it is a salt and it can build up in the body - the major risks of lithium are thryoid based and thats why it needs monitoring - in reality its not the best drug for the whole of your life but it is very effective as a first line drug and for usage up to 10 years safely - it is still used in AU, NZ and UK as the first line drug of choice to stabilise Bipolars because its reasonably fast acting, non psychoative, works on both mania and depression, is inexpensive and easy to take with fairly well known side effects. Its not uncommon to move to Lamictal after that and there's nothing wrong with Lamictal - its probably where I will end up shortly according to my psychiatrist and it does not worry me.
Sadly SNRI's can still bring on mania but they are proving safer than SSRI's in incidence of Mania and more seriously mixed episodes which are the dangerous states and SSRI's are very good at provoking them.
I agree cost should never be a concern but sadly we all live in the real world - In Australia this is not such an issue as we have a subsidised prescription system and a pretty much free health care system but in countries such as the USA cost is a major factor - I have friends who struggle to pay for all the drugs they need as they cannot work and medicaid is a mess - the reality is that Drug Companies have a vested interest in making sure drugs are not cheap nor free - they are a profit making business and especially in the USA where your medical system is a profit making or dare I say profit gouging business, sadly ours is heading the same way in the future.
Less people think we are disagreeing here we're not - Lithium or Lamictal is not the point - what is the point is a patient should be educated about their drugs, asking informed questions and making sure they understand what is going on in their treatment - your right as a patient are vital and you should always be making sure they are being treated with respect. Trust is a key cornerstone to effective treatment and you have to be able to trust your doctors and to do that you need to educate yourself on the drugs you are taking and the side effects and interactions.
And ILADVOCATE is right - if one drug works for me it might not work for you - you owe it to yourself to get the right treatment for you as we all do.
I agree with what you are saying and if Lamictal has caused cognitive confusion and it was noted then I should be aware of it. Lithium can however, can cause that as a side effect. If people don't get it then of course its nothing to worry about. But they should know that it can occur. I'll post this link which comes from a clinical website that is factual that notes cognitive effects as a side effect:
Please leave the link up. It just discusses the medication and how it works and how it helps as well. It does not advise against taking it. And you are correct. All antipsychotics in current practice can cause cognitive confusion. Abilify is the least likely to but its a possibility. But the glutaminergic agents don't. I know that when I take glycine it actually increases my ability to concentrate and understand things and relate to people. This is part of a confirmed study. And it can knock out a manic episode cold or even better help me convert the manic energy to doing something positive such as advocacy. But its not a mood stabilizer. Its an antipyschotic and I need a mood stabilizer with it. But I've been posting about it because I want people to find out about these new anti-psychotics in study now rather than years later when they are released because if we advocate to have them fast tracked as I am doing then we all have them available to us and make a fuller recovery and not be at risk of tardive dyskinesia and diabetes, weight gain or cognitive confusion. If you could picture a medication that would actually clear up symptoms without decreasing any aspect of who you were before and return you completely to the real world. That's what its like. And I want everyone to be there as well. So we have to keep ourselves up to date. Here's a link that updates itself:
And I'll update people as there are more forums and presentations by mental health research and advocacy organizations about new treatments in study such as the last one where I provided testimony at the request of the director of psychiatry at the hospital that developed Clozaril. Because the recovery they had first identified in Clozaril without any of the severe side effects is the recovery you'll find from these new treatments and psychiatric journals will confirm that if you go to PubMed.
The glycine stuff is very interesting, I have been reading what I can find on it since you first mentioned it and it looks like a wonderfully effective drug. Please keep us posted on this one - I agree that the need to fast track these is vital if they are effective.
Im glad you are out there working as an advocate for people like us, there are not enough voices speaking out at times and its vital that we all do it as much as we can.
Interesting information on Lithium - it was not something I had previously seen listed anywhere - Lithium can cause headaches and I would be willing to believe it can cause brain fog as well in some people - the problem with Lithium is also one of the good things about it - its a salt and that can mean good and bad things in terms of buildup and effectiveness depending on your body's ability to deal with it. It doesnt work for everyone but sadly nor does any drug - right now im disconnected and brain fogged from Remeron and hating taking it for example.
Thanks for your comments. I'll post the link to the official glycine study.
And mine will go up when its published. Right now its studied as an adjunct for schizophrenia. There have been no studies with it as a primary anti-psychotic so mine will be the first. But this is a glutaminergic agent that is in Phase II FDA study as a primary:
Glycine would not be used for straight bipolar but it could be helpful for bipolar with psychotic features. And certainly for schizoaffective. Its widely available online from the company. That's how I obtain it. But I am not going to post a link because I would not want anyone to take it not under a psychiatrist's care. But if people do have a schizoaffective, schizophrenia or bipolar with psychotic features and print out the study for their psychiatrist and they warrant using it as an adjunct, at that point and only then would I send information on how to obtain it. I've gone onto other sites where people were using it (and obtaining good results) not under a psychiatrist's care (before I signed up) and told them they had to take it in that manner. If its advertised as a "natural remedy" or "compound" its not. And the pills are available at any health food store and should not be taken as they are useless. Only the specific pure powdered form should. But I will not post any further specifics until the study on me is finalized and published and then I will post that link. Its under standard APA guidelines and will be in one of their publications. My psychopharmocologist just asked me not to put his name online but said I could post the information and I update him of my postings and he approves them.
I think you should try to cut down on your medications; the smallest dose with the best effect is the goal.
I think people nowadays are on these "cocktails" that I think are highly toxic. You should see another doctor as a good one would not have you on two antipsychotic medications.
Just a warning note to everyone - No one should cut down on their medications on their own bat EVER.
Only a doctor can lower medication doses and many medications can cause serious side effects and manic and even mixed episodes if withdrawn too fast or at an insufficient dosage is applied - you risk falling out of the theraputic range at best.
A doctor is the only person who can assess your meds and lower them, generally a psychiatrist is the best reccomended to do so.
And as much as we might like it none of us online are walking in another person's shoes - the cocktails we take are dependant on us - I do think that in this case a second opinion is needed - there is also no indication if the doctor is a pdoc or not which is also important. However there are valid reasons for multiple meds.
BTW there is only 1 AP med in this cocktail - Lithium is a Mood Stabiliser not and AP and Klonopin is an anti convulsant also used for anxiety. The other 2 ad an AD and Ritalin. The ritalin is in fact the odd one out in this cocktail from where I sit - the others can all have legitimate uses in a cocktail to balance a patient - we also do not know what phase the poster is in - if he is just coming out of an acute phase then an MS and AP are not unusual.
Yes I can confirm what the above poster is saying because in the past before I was recovered when I would drastically lower mood stabilizers I would become manic and it was dangerous. Don't change medication dosage on your own. Psychiatrists will titrate medications downwards to the lowest dose after a person has stabilized. Generally psychiatrists do not give two antipsychotics at once because of the risk of tardive dyskinesia. Its usually not warranted and its what caused it in me. However, mood stabilizers do not have this effect and giving two mood stabilizers, one as a primary and one as an adjunct is common. However, giving an antipsychotic and a mood stabilizer at the same time is a standard regimen for bipolar with psychotic features or in the initial stabilization phase of mania and does not worsen the risk for tardive at all. Its important to remember that yes of course no medication change should be made without a provider's consent but finding out about new treatments and advocating to get on them is often warranted. I looked up Zofran online, asked about it here, printed out the results and my neurologist agreed to start me on it. And its been a lifesaver (literally) preventing myoclonic (full body) and respiratory spasms from the tardive conditions. Another idea to keep in mind is if you feel you are being underserved by a provider, any provider, not just a psychiatrist get a second opinion or do as I did and if your particular psychiatric disability is hard to treat and you want a provider who is knowledgable about new treatments and lesser used but FDA approved treatments, seek a consult with a trained psychopharmocologist. And like everyone here as for the original person the question is indeed if you are diagnosed with ADD because otherwise the Concerta could have harmful effects and be counterproductive. I would assume that's the case but its important, for anyone to find out what medication is for what particular condition its prescribed for, how it works and what the side effects are. As I've posted an informed consumer always gets the best results and works well with providers.
I never suggested that anyone change their medication without consulting their doctor first. In fact, I suggested finding another doctor.
Monkey, please do not post after I do; I find your posts offensive. I think you are trying to create a reaction by placing your unenlightened comments after mine. Thank you for complying.
I have had bad reactions to both Lithium and Limital. While I was taking Lithium I had to be taken to the hospital because I got so I could not walk. I was not on a very high dosage. Lamital caused a rash on my arm which my Psychiatrist had warned me of and told me if I broke out with a rash to let her know. My Psychiatrist immediately took me off the Lamital. I was told the rash could be deadly. I am now on Depakote to help control my mood swings. I would say it all depends on the individual. I am wondering if anyone can explain "brain fog."
Based on my experiences and some reading most commonly Brain Fog generally is a feeling of slowness, like you are thinking through syrup almost, its kind of like being very tired or perhaps a little drunk, every thought seems to come hard. Some people also feel disconnected like they are outside of their body but that is generally a second side effect.
I get those sorts of things - thinking becomes much harder and you cannot concentrate or focus on a task, It feels slowed down like your brain is not working.
I think the correct name is cognitive impairement but I am not sure.
Yes cognitive impairment is the correct name for "brain fog". That is a common side effect of many medications. I think all the posts discuss which of the mood stabilizers can commonly cause it. Depakoate caused it in me but as with anything for some people its a tolerable medication. Since I was unable to tolerate anything I have been on almost every experimental mood stabilizer. Clonidine was the most recent one I had terrible results with, bringing me into an agitated mixed state (it commonly creates depression) and also creating cognitive confusion, blood pressure drop and over eating with weight gain and lack of sex drive. Additionally the patch application burned my skin. However, it was good for the dystonic spasms from the tardive conditions.which have greatly worsened since then. I am finding now as my psychiatrist supports the Zofran has mood stabilization effects but this effect is new to medical science so I can't confirm it for other people. Its primary usage in me is for tardive dyskinesia, what they are identifying as tardive psychosis and an adjunct antipsychotic. The mistake I made before recovery was to go to a website that discussed natural remedies for bipolar and try them with dangerous results. I would tell everyone that Tyrosine and Taurine are extremely dangerous and must not be tried at all, ever. Tyrosine raised my blood pressure to a dangerous degree and Taurine made me psychotic. Do not self medicate for any reason. However, many psychiatrists will allow a consumer to take fish oil capsules but the anti-cholesterol medication Lovaza is a synthetic form of fish oil is being studied as a mood stabilizer with some good results and will replace natural remedies which due to lack of regulation are an unknown quantity but some are clearly helpful. Anyone who is doing well on standard mood stabilizers and does not have problematical side effects should stay on them but if anyone has concerns, a mood disorders specialist can find experimental or otherwise underutilized treatments. This website is a comprehensive link from a well known psychiatrist who is a mood disorders specialist and should be able to answer many common questions people have:
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