anyone been on lithium?

[Louise13]

At the moment I am on an antidepressant {venlafaxine} diazapam and antipsychotic [aripriprizole] psychiatrist wants to add lithium as been having manic symptoms. has anyone been on this combination or similar or just on lithium on its own? any advice,opinions or info would be appreciated.

[Naomi_at_app Volunteer]

Hi Louise13

How are you finding your combination of meds at the moment? I used venlafaxine after my second baby - it was our 4th try antidepressant (!) - and was the right one for me, making a clear difference in around 3-4 weeks. But as you know, unfortunately we are all so unique in our biochemical make-up that what works for one person may not be the best combination for another.

I haven't personally taken lithium but I do know that its evidence base is very good for good long-term maintenance of symptoms such as mania/hypomania and depression. Nowadays, much lower doses are used for treatment and so side-effects tend to be diminished. You will need to have regular blood tests to monitor what works best for you in terms of therapeutic levels.

I know another member of APP who has used lithium successfully for many years, and swears by it (!) so I'll ask her to comment in the next few days if possible.

I'll pop back in a sec with a web link

Naomi x

[Naomi_at_app Volunteer]

Hi Louise13

Just to give you the medication choices link again - I know you may not have had time to look at this in your last week of pregnancy as baby came along early. I had a quick look, and lithium, aripiprazole and venlafaxine are all covered.

choiceandmedication.org/ncmh/

The MBU where you are may also have access to a specialist pharmacist from the local general hospital. Pharmacists in some areas are starting to take a more leading role in visiting people on psychiatric wards and talking about meds.

It might be really helpful to talk through your options and potential medication interactions with the psychiatrist and specialist pharmacist together. You could ask any of the nurses on the ward, or your psychiatrist, to find out if this might be available?

How did things go with the home leave?

N xx

[sarah_at_app APP]

Hi Louise13,

I do agree that finding the right medication or combination of medications can be trial and error as we are all do different.

I started taking Lithium about 18 months after the start of my PP episode. I became severely depressed when I tried to do too many things too soon after being unwell. I tried to go back to work and immediately realised I wasn`t well enough. I then became very depressed and felt I`d let everyone down as I couldn`t work and I`d just got married and was saving for a house.

I had moved to a new area and was seen by a new Consultant who started me on anti depressants. I don`t remember the name of the anti depressants. I kept going back to see the Consultant with no improvement and my Consultant kept increasing them. Then I came out out the very severe depression and went to the opposite extreme and became manic.

My moods were rapid cycling from extremely depressed to extremely high. This was so damaging and went on for about a year, going from one extreme to the other.

I eventually got an appointment with a Professor who knew what he was an expert in PP and Biplolar.

My son was nearly two by this time. I was then started on Lithium and within weeks I stabilised. It worked well for me and I see it as a miracle drug because it gave me my life back and I could function again!

I was soon able to return to work and I have remained well on Lithium for 16 years. Many times I have considered coming off it but I don`t want to risk being ill again and the side effects are minimal.

I have a blood test every three months to monitor the Lithium levels. I`ve been on the same dose for many years as this is right for me. The Lithium levels have to be within a certain range to work and having blood tests regularly can motnitor the levels.

I`m lucky that Lithium works for me and I can live my life.

Good luck and hope the treatment you have works well for you. If there`s anything you want to ask me, feel free.

Take care,

Sarah x

[sarah_at_app APP]

Sorry, just to correct a mistake. It should say I eventually got an appointment with a Professor who was an expert in PP and Bipolar. Was going to say a Professor who knew what he was talking about but thought it may sound unprofessional!!

Sarah x

[Lilybeth Volunteer]

Hi Louise 13,

Sorry I can't help you as I don't remember if I was given Lithium. I do recall taking Imipramine at some stage but my first psychosis was more than thirty years ago so I think medication has improved since.

Hope your 'time out' is going well.

[openeyes]

My episode of Pueperal psychosis was 15 years ago. I was treated with a combination of ECT, haloperidol and lithium. After discharge I became depressed and continued with the lithium with seroxat added. There are lots of things I would not recommend about this treatment regime but lithium was the best part as I stayed well after the severe acute episode. I do remember experiencing some emotional blunting and when I stopped the lithium 18 months later at Dr instruction the world seemed to come to life again.

7 years later I than had another mixed state episode and was treated with valporate and olanzipine. After discharge I wanted to stop the olanzipine because of weight gain but found the valporate was not effective to stabilise my mood on its own. I was very resistant to taking lithium in part due to fears about long term side effects and in part because I found it hard to accept the diagnosis of bipolar I had been given and thought I could beat it on my own.

After 5 years of yo yoing around where I mainly suffered the lows and self managed the highs with olanzipine I saw a professor for a second opinion as I was very depressed and had been advised to take an antipsychotic and antidepressant and did not like this plan.

I was treated initially with quetiapine and then with low dose lithium (400mg). I have taken lithium now for over 2 years and literally feel it has given me my life back and I do not know if I would be here without it.

I can experience mild tremor and increased thirst but I have felt entirely myself with only minor mood changes in relation to stress. Mostly I don't know I am taking it. I have been able to start progressing in my career again and having the confidence to express my ideas and who I am. For me the decision was cost benefit analysis and the benefits of a stable mood have far outweighed the costs.

I do not want to take this medication forever as I am relatively young but hope that with a longer period of stability and when it is possible for my circumstances to allow less demands on me that I can try to stop at that point. I would discuss this with my Dr. I know lithium can feel the last line but to me it is the first and this is what the professor who saw me also thought just because its old does not mean its not the best.

I hope this information helps and good luck!

[MelMags]

My story resonates in many others. In brief, Lithium was hard work at the beginnig with nausea, vomitting, and feeling like my personality was being taken away. For the first year to 18 months I felt very little emotion or desire for anything. I couldn't shed tears and felt a little trapped inside myself. I stuck with it because of great support and am now past 2 years taking it and am finally seeing the benefits. I have been advised i will likely have to take it forever - if that is the case, the benefits far outweigh the alternative. I have no intention of ever becoming severely mentally unwell again. Good luck. I hope you have a great doctor or psychiatrist to support you through these decisions.

[twigwidge]

I have been on lithium for 2yrs now since Baby 2 and my first psychotic episode. I am extremely well on it . Was on quetiapine as well ,stopped that ayear ago. I experienced metallic taste and visual symptoms initially , now nothing unless you count difficult weight to shift. ( personally I blame it on the easy availability of toddler's chocolate and alack of will power ) My problem is I'm scared of coming off lithium. I'd like to be medicine free and I'm not planning on any more chidren. However my manic symptoms were pretty florid and I'm unsure whether my consultant thought I might have uderlying bipolar disease. I really dont ever want to experience the depression I had once the psychosis had abated.

[Hannah_at_APP Administrator]

Hi again Louise and others who have commented here.

Yes, I have been on lithium after my PP episode in 2009. I spent 3 months in total in hospital and also had a course of ECT as nothing (medication wise) appeared to be working in "turning that corner". I don't know what, but I was on an antipsychotic and anti-depressant that really didn't work and made me worse in the very early days I think. When I was transferred to a different hospital and then into their MBU, I was started on the ECT and Olanzapine. This initially worked well (aside from the weight gain, but really something had to be done!! Plus I'd stopped eating anyway so was going the opposite way...) After perhaps 6 weeks or so I had a bit of a relapse - very panicky, obsessive, teary, becoming manic, problems sleeping again etc. Lithium was suggested as a bit of a last chance I think.

I can't remember the dose they went to first but on discharge it was 600mg, quite low as I understand it. That was in Jan 2010. I remained on the Olanzapine for just short of a year and the Lithium til June or so last year (2012). It was explained to me whilst in hospital that the lithium, should I accept it as a treatment (and again, I felt I had to really, I desperately wanted to get well) would be a long-term drug, 2-3 years or possibly more. I think this is due to the way it builds up in your body and the recovery required after such an acute episode. Side effects for me (aside from the weight gain, but I'm with twigwidge above about chocolate and will-power, even now!) were the metallic taste, thirst and the annoyance of regular blood tests. I think part of it was almost a "hangover" from being ill, I was always having to have it checked (or so it felt) and I was feeling better. My impatience again I think... But I know the checks are important and Lithium can be really effective with this monitoring, I think Sarah also noted she's on a dose that works for her long-term. The main areas to watch are liver function, thyroid and something else I think.

When my consultant first mentioned reducing and stopping the lithium, I couldn't wait to get going, although I was a bit apprehensive. He wouldn't do this in the end for a few months longer as it was winter and that can be a trigger for depression, which is what my GP thought when I moaned to him (why did the consultant raise my hopes and mention it I thought, but I'm just impatient I suppose!) It happened gradually, with a reduction from 600 to 400 then 200 then 0 and regular monitoring in-between. I have to say in my experience it was quite easy to do, although I think there might be withdrawal issues if it's done too quickly. For me, going from the relatively low dose of 600 to nothing took about 4 months I think. The consultant had wanted to do it slower, but the pace was increased as it went well.

I've not noticed anything different really from being off the lithium, though I think others might say there's a bit more of the "old me". But I think this is also due to the passage of time and recovery, which can be long after PP. I had some blips in my thyroid levels a year or so ago and this has stabilised again after I've stopped lithium. But I would definitely go on lithium again if it were needed, it personally worked well for me and I know it has for others recovering from PP.

Hope this helps and good luck with the rest of your treatment and recovery. All the best.