Therapeutic Range??

I use to take lexapro and clonazepam for the last 6 years. Pdoc said I should've never been on the lexapro because it was making me rapid cyscle, Now I take 25 mg of Lamictal (can't go up because pdoc is saying that it's making me manic), 50 mg of Seroquel, 900mg of Lithium and 1 mg of clonazapam. I actually use to have to take 3 mg of clonaz but I think the seroquel is making me not need it as much. Anyway, someone made a comment that those levels are so low that there not in "therapeutic range". What does that mean exactly? I'm trying to stay on as low a dose of each as possible.

[hell1971]

Hi a theraputic level is the level that the drug needs to be in your system for it to have any beneficial properties. This is why for lithium you have the blood test to check the levels, I beleive drug levels vary per person but the range is normally 750 to a max of 2000mg of lithium, im on 1000mg. You should get your doctor to explain it for each drug so you know why each drug at each level is used, this is why they use a combo.

[beatfreak]

Thank you. I totally agree about it being different for everyone. I know that person wasn't trying to **** me off but when I asked for any warning signals of toxicity (about the lithium) she started saying that NONE of my meds are even close to a therapeutic level. It kind of pissed me off! I just thought that was a pretty strong statement to make to someone, not being a doctor. But your right my pdoc knows what she's doing and I just need to trust her. To be completely honest I'm feeling extremely manic, jumpy, AND IRRITABLE!!!!!!!!! I'm letting stuff get tot me that usually doesnt, and like I said I don't think she was trying to be mean.

[jst4shanell]

900mg of Lithium is therapeutic level.  3mg of Clonazepam is max.  Whoever you were talking to was misinformed.  The reason I say this is because all the meds work together as a combination.  They do not need to be at therapeutic level to get the benefits.  Hope this helps  :)

[freebird227]

I agree with you, the comment was rather codescending but you gave them the info and open the door. Next time be careful who you confide in. This person could be absolutely correct but if you have concerns ask your pdoc. I too could only tolorate 25mg. of lamictal I became elevated in my mood and develpoed a puffy place in my mouth, so I had to come off. I made me feel so much better I begged my pdoc to let me re introduce the med again and see if I got different results ( insanity ) I didn't.50mg of seroquil I assume is at bed time, because that is a low dose. I take 125 @bed time.Back to the lamictal 25mg. is usuall a intro dose .900 mg of lithium is on the low side but acceptable I use to take 900 up to 1200. You said " feeling manic jumpy and irritable Could be the lamictal ( how long have you been on it?)How long since you went from 3mg to 1 mg of clonazapan It would not hurt you to take a 1mg to take the edge off but Always call your doctor first.If it's close to bed time skipp it and wait on the seroquel I don't blame you for wanting to keep your meds down. I do the same  Best wishes ! ! ! (*~*)

[beatfreak]

Thank you that helps tremendously! That would make sense that all the meds are working together. Thank you! it really had me worked up....it's been a very long day:()

[freebird227]

One more thing.. There are a lot of really smart people on this forum who have educated themselves either professionally or through their own research and experience. Sometimes we only need to ask for clariafication. No one on here is intendinng to cause you to feel bad . Kep posting ,all will be well( no pun intended )

[beatfreak]

Girl you know it! I took a 1mg about an hour ago . My anxiety has just been through the roof lately. Well when I started the lamictal I was  and had been for a while, extremely depressed but then I was starting to feel manic, but that was only 2 days into it and my doc said it was too early to be the Lami. she said I was just going into a manic phase  and thats when she started the lithium but now I've been on it for 3 1/2 weeks and I'm sure that's it. The lithium was suppose to level me out but as I said earlier, I just got bumped up to 9 because at 6 my level was .3 and that's obviously too low. This is literally my second day of taking 900 so I'm just gonna have to wait and see. I know what you mean about all the people on the forum, I think that most of us, when we find out whats going on, we educate ourselves. I've been researching bipolar and anxiety for 10 years now. But I definitely would never think I knew enough to tell someone that what their doc prescribed them is too low of a dose to be effective. But I know she wasn't trying to be mean. Thank you for your comment, it's very much appreciated.

[jimgreg]

i dont see how you could back off the klonopin without withdrawing?? even though ur pdoc is aware  of the meds ur on!! i was also on lexapro and klonopin for about 4 yrs..and i went manic on it several times..so had to come off the lexapro..till this day i cant take any ssri..without being on a mood stabilizer..all people are difft..i was on lithem 600,s for 3 monthes..with serum level at .6..then i wanted to get to therapeutic as close as i could went to 900 mgs aday..with in 1 month went TOXIC  1.2 is toxic  i was ( 7)!!...so now im on nothing except the xanax..waiting to see my 1st pdoc the 23rd of march..dont think im going o be able to waite on that appt..might have to fo inpatient..the lithem did me great til that happend..and belive this ort not.if my gpdoc said i,ll put you back on it just 600 mgs aday I WOULD DO IT..IM NOT REAL MANIC AS SOME OF YOU ARE..BUT IT REALLY HELPOED WITH THER DEPPRESHION..so yes everyone's difft..ive learned that on here alot..i been on here since aug 08..its a great place to learn and make friends.....good luck man...james

[jst4shanell]

Hang in there.  Sometimes, just a small adjustment to your meds can make a world of a difference.  

[jst4shanell]

Oh, I forgot.  Clonazepam is a serious medication with very heavy withdrawl (withdrawal) symptoms if not weened off of properly.  I take 3 mg a day.  I have tried weening myself off.  My pdoc told me to take away .5mg a month until you are where you want to be.  It might be why you are feeling so crummy?

[bernie40]

Hi,  With regard to lithium it is considered that the levels in your blood need to be around 0.7 for them to be within the therepautic level.  I am finding that I am doing well with only a level of 0.2 (I'm on even less lithium than you) but I take it alongside another MS, depakote.

When someone is acknowledging that you are on lower doses that are not considered therapeutic this is not a criticizm of you.  It was an observation based on what levels/doses are the average.  For instance, on average a person will take a dose of 1000mg minimum of depakote, however I only need 500mg so I am on what is considered a low dose.  Now that I am on lithium I have reduced that even further to 250mg.

My psych will insist that I need to up my lithium dose based purely on her text book telling her that my blood level is far too low to be considered therapeutic!  I shall be fighting my corner on this one as I actually feel better than I have done in a long while.  

Going back to side effects and toxicity - make sure you read the patient information leaflet, I understand that the signs are quite obvious if you are heading down that road.  I'd also say that if you are unsure about whether or not you are experiencing something untoward then nip into the ER or your Dr's office - that's what I'd do :)

Good luck and I hope the increase begins to work for you.

[beatfreak]

yeah I tried to back off the klonipin (klonopin) but I was still having bad panic attacks so I am taking between .5 to 1mg daily. My pdoc actually just said the same thing (that I would not be able to quit it just yet. That really could be why Im feeling so crummy. I guess I'm just still adjusting to all the new meds. I've been happy, but jumpy, irritable, shaky and all the rest. I guess I should quit trying to "rough it" without the klonipin (klonopin) and just take it when I need it atleast until I'm use to all these other meds.

[beatfreak]

I am so embarrassed. I was totally reading her message the wrong way. It kind of freaked me out I guess because of the mood I was in. Now that I read it in a different frame of mind I can tell she definitely wasn't trying to be hurtful. Like I said I've just been jumpy and irritable BAD lately. Sorry. And thank everyone for the advise about the lith! I feel much better about it now. I hope it starts working soon.