How much difference should I feel?

[horselover65]

I've been on lithium a while now and I don't notice any difference. In fact, it seems that some things are actually worse. I'm cycling more rapidly and have lot more out-of-body type feelings, anxiety, anger and am hyper-sensitive. It is true that there are a LOT of stressors in my life. Unfortunately, my husband swings from helpful to indifferent with no warning. And, one of my grandparents who was already having health problems appears to have suffered a stroke or something. They're not sure. I'm scared about it, but also furious. They did a CT scan but no MRI, which is ridiculous. She's 1000 miles away, so my hands are tied. Anyway, the psychiatrist said we could up the lithium if needed and I imagine we will. I wonder if the low-grade nausea is going to get worse, though. I also wonder why I have to go up in 300mg increments. Why couldn't we go up just 100mg? Is it just my psychiatrist that does it this way? My level was low-normal (like I have a clue what that means), so we have room to manuver. Any info would be appreciated. I am not blaming the lithium for my deterioration, btw (although my husband probably will). Things have been getting worse and worse pretty rapidly. Wanted to make that clear...

[horselover65]

Thx monkeyc. I'm nothing if not hanging. I imagine it shouldn't take too long for something to happen. I made it all these years, so a little longer should not be too awful. Things have calmed down a little, but I'm now waiting on a phone call. Seems something is going on with my grandparents. Waiting to hear is driving me up the wall. The stress and worry keep building the longer I sit here. I'm WILLING the phone to ring!

[monkeyc]

Thats a good sign, I get fine motor tremors when my dosage plays up - another short term side effect.

.66 is low so a boost to get you to 0.7 and up is better - they say about 0.85 is a good place to be which is what they will try I assume.

hang in there - it does work trust me.

[horselover65]

My lithium level was .66. We increased to 1200mg a day starting last night. I could tell it went up because I felt tingling in my lips this morning which also happened when I first started taking lithium. If it's like last time, within a couple of days I won't feel it any more.

[horselover65]

I feel the need to apologize because I know this is not a good answer. I don't know how I will deal with the worry. I have been like this since childhood, so I am sorry if I don't know how to change that. I really don't have a clue. Almost anyone who has known me through the years would say I am the most stressed-out person they know. I can get stressed over choosing a type of toilet paper. Anything that is new or different freaks me out. On a really good day, I can roll with the punches. But 95% of the time I end up frantic over the stupidest thing. There are little stores and gas stations locally that I have never been in because they didn't look right or I couldn't figure out where I should park. Perfectly normal little businesses, but something about them seemed off to me. Irrational. I have to fly way more than I'd like. I hate everything about it. I am especially upset by takeoff. Finally started taking the Xanax for that. I was on a plane that got caught in a storm when I was about 16. I woke up and folks were puking. We'd been diverted. Scared me so bad that it took about 20 years for me to sleep on a plane again - and that was on a loooong trans-Pacific flight. There's no point here except that I have issues with stress, fear, anxiety, worry - and always have had them. The older I get, the more things happen to reinforce those issues and make new ones.

Either I am hallucinating or it is snowing. It's not supposed to be snowing today.

[horselover65]

Thx monkeyc. I'll come right in time. I don't have valium only xanax. I'm actually starting to go downhill now, so that would probably put me to sleep and I have to finish this lovely cleaning. I'm back to crying now. Not sure it's an improvement.

Don't think the psychiatrist is in today because they normally close Fridays. If he's there, he should return my message from Wednesday. He'll probably tell me to up the lithium and schedule an appointment. I'd hoped to have a therapist by now, so maybe he will recommend one. I can't go to the hospital. They won't do anything and they'll charge the earth for it. I guess I could beep the doc, but don't know what to say really. He'd probably tell me to take Zyprexa. I went from an hour or two of sleep for a couple of weeks to one normal night of sleep, then about 10 hours. So, up all night and not sure what state I'm in. Not really sleepy. Sad. Agitated. Mad. But at least I'm not shaking all over like I was earlier...

I don't know if I'm paranoid. I think he is so ruled by inertia and fear of confrontation that he might be secretly relieved if I died. He has waffled about getting counselling and now apparently can't stand the idea of being supportive if that means he actually has to do something. I can't help it. I'm still furious with him. Just sad at the same time now. Resigned to the b.s. at least for today. Ready to fight if he looks at me wrong, but that yucky fight where I'll burst into tears and hate myself for it.

[monkeyc]

You do realise there is some paranoia creeping in here ok?

Seriously I know where you are coming from on this, both the husband and the grandparents - I wished many times for my mother to be able to have more years BUT ultimately there is a simple reality that is VERY hard for us special people to swallow - all the worrying in the world cannot change it - it just makes us very sick.

Im worried about whats going on for you right now, and please if it gets worse seek some help ok, go to the hospital - I think you need something on top of the lithium - maybe some valium even to take the edge off this feeling.

[horselover65]

Thanks ya'll.

monkeyc - he may have said what the level was, but I don't remember. It was a message, but I didn't call him back until hours later when I had to leave him a message. I'll probably hear from him tomorrow or Monday. I take 900mg of the extended-release nightly.

The plan was to try to get the lithium level right BEFORE adding anything to it. I don't know if that's such a good plan any more. Guess I need to see the doc because things are getting bad.

You're right. I have gotten zero support lately. There have been a few days here and there where I felt like my husband was getting it. That hasn't lasted and I can't wait until he gets on a plane and gets out of here because I can't stand the sight of him right now. It's especially upsetting because he knows I'm a stress monster and that I'm falling apart over my grandparents. He's in his own little world, though. It seems almost like he is trying to provoke me. I just want him to go. I had looked forward to us having time together and it's been a disaster. He's so passive aggressive. Lately, I think he secretly wants me to kill myself. I think he does stuff on purpose that drives me crazy.  

I really don't know how anyone handles people aging and having health problems, etc. I think it's not only concern about them individually, but I am terrified of what will happen if my grandmother dies. She was always the stronger one. My grandfather is a great guy, but he can't much handle being alone. I've been sitting here thinking how it's ironic that I don't much care whether I live or die, but odds are that I could live another 40 years. They're not ready to go, but they will anyway. I wish I could give them my time.

[bernie40]

I'm so glad monkeyc has answered this post.  I started my lithium about a fortnight ago on 400mg.  I'm not expecting to see any "help" from it for a fair while yet, certainly not until I'm up to the correct level.  I do take depakote alongside my lithium at present but i'm weaning off this as my lithium is increased.

Monkeyc is right in that stressors will still come along and "blindside" you.

I've written more to you privately so I won't repeat myself or monkeyc further :-)

Take care.

[monkeyc]

From the point of view of 2 years on Lithium it depends on what you mean by feel.

First things first - stressors are not something that a drug can control, part of Bipolar is educating yourself to manage stress and triggers to ensure that you can control things - A mood stabiliser will work to blunt the highs and smooth the lows but it cannot prevent them - you can and will get hypomanic and depressed on any Mood Stabiliser and Lithium is no different.

It sounds to me like there are 2 things here you have going on.

1. is a lack of family support and high external stressors - these can happen (read my journals for oct/nov if you like) and they can blindside you - the lack of consistent support is a real problem for bipolars as we crave routine and consistency - surprises are a bad thing to us and they have the capacity to wipe us out.

2. Your psychiatrist seems to not be giving you the right information - for one thing you do not know what a Lithium level is which is a big worry; this should have been discussed with you as titration is vital on lithium - you do not say what you are taking per day and if its split morning/night - for example I take 1250mg a day and its split 500 day/750 nocte on 250mg Lithcarb - my levels run steady at 0.8 to 0.85 mmol every time.

Lithium is a salt and it requires a consistent level to work - the common quoted theraputic range is 0.7 to 1.2 mmol (mili mols per litre of blood) and toxicity is 1.5 and up - realistically 1.2 is so close to toxic that a pdoc would be a mad man to want someone at that and no one really goes above 1.0 and even then some people can be toxic.

What does all this mean - a level of 0.8 to 0.9 is best and the way to reach that is to increase the dosage and test.  The reason for the 300mg is because it seems the US commonest LithCarb tab is 300mg though there is a 150mg available and a slow release version as well as a liquid - the slow release is supposed to help lessen some side effects - generally doctors do not like splitting pills for drug such as this as it messes up dosing and really 300mg is one pill.

Each person's dosage will be different as each person has a different system - this is a drug which is dependant on hydration, kidney function, thyroid health and a host of other individual things.

The good thing is its cheap and effective and despite the FUD its safe.

Everyone wants to blame the drugs ultimately - however right now you need some support and I do not see you getting it.  Have you talked to your psychiatrist about an adjunct drug you can add to this to help you a bit?  Anxiety and Anger and Hyper Sensitivity are bipolar depression symptoms (This is not the same as unipolar depression or classical depression) btw.