lithium

If you are on lithium do you need to go to the doc and get checked out every so often?  I am debating on telling my doc to put me on lithium to try and help the depression side.

[ILADVOCATE]

You need a monthly bloodtest. That's a required follow up. Lithium is of course a mood stabilizer that works well on mania and depression both. Besides the bloodtests if this is your first time taking it your psychiatrist will probably have you get a general physical exam first. I know that happenned with me and is generally reccomended.

[Venora Moonwind]

Also you need to keep an eye on your thyroid as lithium can destroy it. I am pretty sure that is what happened to my thyroid.  Your TSH levesl should be between 1.0 and 3.4.Alot of docs dont know this Just ask for a full panel thyroid blood test.
Love Venora

[monkeyc]

Lithium cannot destroy your thyroid unless you have a damaged one already or an undiagosed thyroid problem already.  The only way this can happen is if your doctors do not do proper testing before prescribing - this is in the guidelines for the drug and the same goes for kidney failure which is another one - you can also get a damaged thyroid from inapprpriate dosage monitoring and toxicity.

Lithium has been taken for over 30 years by many many patients without incident.

As to the OP if you do a search on the forum you will see a comprehensive post I wrote on lithium not long ago that explains a lot about this drug, its dosage, myths and other information.

[Jester2005]

my pdoc hasn't sent me for bloodwork and I started Lithium at the end of NOV.
should I be worried? I see him tmr; should I demand bloodwork be done?

[2009toads]

I really find  your posts balanced and informative.  I tried to search for your comprehensive post on lithium....not able to find it...any suggestions?

Thanks

[ILADVOCATE]

I would say any responsible provider would have you get a standard bloodtest before you start Lithium to check things out. And once you start Lithium you have to get bloodtests for Lithium level once a month. That's a given. I'm sure your psychiatrist will have that done but if not, as can happen on occasion, they are not being responsible. It really isn't a big deal and you get used to it. But don't "demand" it. Just say it makes common sense and you'd appreciate it. I doubt considering that since its part of standard psychiatric practice that they'd disagree.

[jimgreg]

hey..lithiem is a good med for bipolar..i was on the300mgs twice aday  for it..you have to be checked every 3 monthes or even sooner..to avoid toxic..i was fine on it till i went on the 900mgs..then in 1 month my body went toxic!!  but if you go every 3 monthes to get ur blood drawled you will be fine..everyone is difft to these meds..i found that out for myself..you cant  not take something though!! so go with the lithiem..its been out there for alot of years..they have studied this med alot..i was stable at .6  then i stared getting alittle manic..witch i found out was normal cuz the metabolism of the med..so i went to fast..and this was over almost 4 month period..i never overdosed on it..i took what i was to take..my body just build it up too fast........im on nothing now....i was on serquil it worked very well when on it..then had my heart race so had to stop it..but the lithiem was the best one that i got on..and settled me right down..SO JUST AS LONG AS YOU GET THE BLOOD WORK DONE EVERY 3 MONTHES YOU WILL BE FINE..TRUST ME ON THIS..THERE ARE ALOT OF PEOPLE ON THIS SITE THAT ARE ON LITHIEM..THEY CAN ANSWER ANYTHNG YOU NEED..ALOT OF PEOPLE CAN GET ON THE 450MGS AND DO GOOD..THE TOXIC LEVELS AFTER 1.2-1.5  I WAS   3  THEN SERVE  TOXIC..............MY DOCTER ADVISED ME  THAT I COULD HAVE PROBLEMS ON THIS MED...I SAID LETS TRY IT..SO I DID..I ONLY HAVE 1 KIDNEY BUT ITS WORKING AT 79  THATS REAL GOOD OUTPUT FOR JUST ONE KIDNY..YOU WILL DO GREAT.......SO GO FOR IT  AND GET BETTER....THANKS MAN JAMES

[jimgreg]

i forgot..like there saying on here get checked out before you start it..cuz if you have a low count on ur thyroid ..and kidney funshion...cuz you excreet most threw the kidneys..so good luck man....................james

[GeorgiaAnnie]

docs like it.

[monkeyc]

Yes because its cheap, known, safe and has well understood side effects.

A read of side effects of some of the Anti Psychotics might be instructive sometimes...

[Venora Moonwind]

http://www.medscape.com/medline/abstract/10866336?src=emed_ckb_ref_0
check out this article. Lithium does affect the thyroid.
Love Venora

[ILADVOCATE]

Right but it doesn't mean it will happen. It just one of the things they test for. The bloodtest for Lithium is monitoring a large number of things. I know because when I got a bloodtest for Lithium every three months I had to get a fuller bloodtest than just for Lithium level. All of the things they are monitoring for if caught in time are reversible and none are typical long side effects nor are they inevitable. They are rare. But they are a very good reason to get the blood tests regularly to make sure everything is in balance.

[bernie40]

Hi,  I started on lithium just before Christmas.  I had my blood checked prior to starting the medication and then again 3 weeks after starting it to check the levels.  So far so good.  My doctor checks for the lithium level and the T levels (I'm assuming this is the thyroid but could be wrong).  I am due another test in a couple of weeks time.

I don't mind blood tests so it really isn't a problem to me, plus if this is going to help make me feel better then I'd gladly have a blood test on a weekly basis let alone a monthly one!

It is important to be aware of possible side effects but I would stress that the side effects are rare and as ILADVOCATE and monkeyc have stated, this drug has been around for a long time and there is little they don't know about it.  

[monkeyc]

Lithium affects the thyroid like it affects the kidneys - its a salt.

It cannot destroy the thryroid however in normal safe usage unless a pre-existing condition is there or levels are not monitored.

I understand where you are coming from but blanket statements bother me deeply - the risk of thryoid damage from all that I can find and read is very small especially when compared to things like Tardive Dykensia in Atypicals which has a much higher risk.

Lithium requires management and patient compliance, its not a take and forget drug but there is literally no better mood stabiliser on the market for effectiveness in both phases.

[2009toads]

I started Lithium before Christmas, and have been titrating up the dosage to 1000 mg/day.  My question to the group is do you find it OK to take the dosage all in one go or do you spread it out over the day?  I find if I can do it once a day I am more likely to remember taking it.

I had a hard time accepting Lithium as an option....now that I am feeling better I am not sure why I was so resitant to taking it....maybe I was buying in to societal perceptions/attitudes?  

[bernie40]

I was just like you and very resistant to starting the Lithium and it was all due to the horror stories I'd read.  On reflection I realised that it wasn't the whole story and after coming on here and doing some research I realised it wasn't as awful as I'd heard.

I'm also upping the dose slowly.  I'm supposed to be going up to 600mg from 400mg but I'm holding back at the moment.  I don't know why, I think its a control issue :-s

I take mine in the evening and will probably continue to do that.  My psych advised taking it at night rather than in the morning.

[monkeyc]

With a dose of 1000mg the normal process is splitting - most doctors prefer to split a smaller dose in the AM and a larger dose PM because it can cause sedation in some people - I take 500 morning and 750 night for example.

This also ensures a level is maintained across 24hours.

The major reason people hesitate with Lithium is all the FUD and Lies on the internet - you just have to ask yourself the basic question - if this drug was so terrible then why is it still being used as the number one first line treatment world wide and has been for 50years now and how have so many patients survived decades on it.

[jst4shanell]

Oh Lithium, sigh.  Lithium has saved my life and almost taken it away.  Things to be cautious of with Lithium is big changes in your body chemistry.  Surgeries, diet changes, things of that nature.  I recently wad hospitalized with Lithium toxicity.  As painful as it was to endure that I can't wait to get back on it.  I hope my pdoc decides to do it.  It is the only medication I truly responded to.  It really is a great drug and coming from both sides I would still recommend it to anyone.

[LeftCoastChick]

I agree with jst4, it's a great drug for many - and I was personally sad to have to be taken off the medication, it worked so well for the depression.  I didn't have toxicity, as I had my levels checked frequently, but I found out that having a more of a predisposition to Diabetes2, it  caused issues with my kidneys. I found out after some pretty thorough tests that I was actually Diabetic Type 2,not at risk any more. It was nothing my pdoc did wrong, all the right tests were done. That being said, Tylenol can be quite toxic if used frequently and taking a higher dose of B Vitamins can effect you as well. They key is watching how you feel, questioning your health care providers and asking for testing.
I've switched over to another drug, which has a different set of risks, but I'm willing to take the med, because I don't want to relapse again. When it comes down to it, breathing has risks to :)

[monkeyc]

Tylenol will kill you if used incorrectly.   Paracetemol in overdose can destroy the liver, its a very painful death as well and suprisingly common as a suicide method - I believe that doses above 4 grams of Paracetemol can be fatal - for adults 12-24 tablets in fact.

When I was at the hospital the other day my psychologist was talking to me about a family she is counselling whse 16 year old daughter is in intensive care dying from a paracetemol overdose - she hurt her leg at sport and took 12 tablets in an hour.

People worry about esoteric drugs and forget the every day ones in the medicine cupboard can be most dangerous.

[cowgirlnerd]

Drug overdose - as a suicide attempt or accidental  (my overdose was suicide attempt), is PAINFUL...like Monkey said.  It's not a pleasant thing and is extremely EXTREMELY painful.  

If there are any chances of overdosing - get help right away.  Don't try to figure that out alone.  I had stock piled pain killers, muscle relaxers, etc., and started taking them first to fight a migraine and just kept taking everything I had in the cabinet.  

Good luck!

[cowgirlnerd]

Oops - I just read back over the post and realized that was a "non-related" comment....but it does hurt!  :)

[maggie1of4]

Monkeyc, where did you get your informatiaion about lithium not causing thyroid damage unless there is already damage?  While I was in an outpatient research study at NIMH, mine was monitored closely.  It was normal in the beginning.  It then became hyperactive, which they told me was the opposite of what they would expect, as sometimes lithium causes hypoactive thyroid functioning.  They said in time it might "burn itself out" in which case I would need to take thyroid, which in fact is what happened.  I don't consider this a big problem, but 2009toads, I don't know where monkeyc is getting all his information.  I don't know that I would consider it balanced and informed.

[maggie1of4]

I don't mean to slight the research you've done.  You must have read a lot.  I do think there may be notable exceptions to some of the blanket statements you make.  Even if you think they are anecdotal at this point, this information needs to be gathered in a comprehensive way so that the true picture of long-term use becomes clear.  Yes, lithium has been used for 30 years, but it took me 30 years to get to this point with my kidney problem.  Who's following that now --who's paying attention?  Who is updating such statistics?

[monkeyc]

1 person is anecdotal evidence - If you can point me to a study that shows that Lithium conclusively damages peoples thyroids then I will read it and be more than happy to modify an opinion if the science backs it up.

There are always exceptions which is what I said if you read but if lithium was so damaging to even a significant percentage of patients thyroids then its fairly safe to assume that this information would be everywhere - the studies would show it for one - as lithium is the fav target of the internet drug consipracy theorists there is no way you could hide massive damage to large patient populations like that and in a drug that has been in use for 50 years..

Sorry but happy to read the evidence if you can show that Lithium damages a larger than negligible percentage of patients thryroids.  

You know this amazes me - the symptoms lists for drugs often list things which are 1 in 100000 occurences and lithium has a list of collected side effects that are as long as your arm and yet this thyroid destruction is not a documented one in most reputable place - there are plenty of other ones which are just as scary but this one misses out for some reason?  More people it seem go toxic than get this happening and of course in toxicity all bets are off anyway.

Otherwise I personally consider calling my comments unbalanced and uninformed personal attacks and will mark them as such - personal attacks are not welcome here now acceptable.

[jst4shanell]

I completely agree with moonkeyc.  I was also informed that Lithium does not permanentaly damage the thyroid.  It can of course alter it but it's not permanent.  I'm sure there are exceptions to the rule.

[2009toads]

This is a really informative and interesting discussion happening here.  I feel fortunate to have found this group.   Before I had no one to really talk to about this except my doctor and of course my wife! :)

For some reason the valproic acid that had been working relatively well for about 6 years just was not doing it and I have had some severe swings for the last year.

My doctor suggested Lithium a few times over the years and I was always resistant because of the possible severe side effects.  I think the bigger reason is that I associated lithium with really "crazy" people....like Jack Nicholson in One Flew Over the Cuckoo's Nest

Now that I have been on it for over a month things are starting to level.  Still had one weekend of depression but overall things are better.  The only side effect I am having right now is the need to drink copius amounts of water....which I can definitely live with.

[RoadBum]

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