Posted by BarbaraCat on March 28, 2002, at 1:11:42
In reply to Re: Subtherapeutic doses of lithium? » BarbaraCat, posted by Ritch on March 27, 2002, at 23:44:51
Thanks Mitch. Yes, that does help alot, especially since I'm going to see Pdoc tomorrow. Your 'duking it out with Dad' brought back lovely memories of my relationship with my undiagnosed but obviously Bipolar father. I marvel that I'm still alive.
Where are those bipolars who have the wild and wacky creative genius type manias? The ones I've seen (and am) usually manifest frenzy, rage, or cluttered messy minds and lives. On the other hand, I've often been the last one on the dance floor, ready to still go go go, get more buzzed, reel from delerium long after everyone else is dropping on their feet. Yeah, my malady has shown me some good times indeed. But oy! the payback! - BCat
> Hi Barb,
>
> For the first several years I was on lithium (from the med gitgo), I was always taking blood draws constantly and my pdocs always kept me "well within the range". In my case, what that boiled down to was 900mg/day yielding about .6-.9 mEQ depending on what time of year it was. Well, during this time I was also on high-dose doxepin and at *certain* times of the year I had a lot of breakthrough hypomania and hostility, so my lithium got pushed up even further into the "therapeutic range". I think I hit a max of 1800mg of lithium a day there for a while getting a blood level of 1.2-1.3 mEQ from what I remember. Whoa, talk about dazed and confused! Well, the long and short of it was that it didn't really help any better! I just had more side effects and still acted stupid and broke chairs, duked it out with Dad (who was also bipolar IMO) a time or two, etc. So...we started to back it off slowly. I would drop 300mg/day for a month, take a blood draw, see how I was doing (better/worse/nochange?), and then drop another 300mg for another month. Interestingly, I didn't notice any *worsening* of symptoms until I went below 600mg/day. And that was very slight. With all of the years of playing with lithium my optimum dose is 450mg/day, 300mg/day will get me by, 600mg/day works good, but too many side effects, found that 450mg/day is almost indistinguishable from 600/day as far as desired effects go. What we found out was the DOXEPIN was causing most of the problem. They were giving me that for anxiety probs. with the lithium from the start. Well, once that got reduced all of the way down to 25mg/day, and then eventually dropped and replaced with diazepam, voila! nearly all of the hostility and most of the hypomania vanished (go figure).
>
> Don't get suckered into this "we gotta push it up to a therapeutic dose" crap. They are just guinea-piggin' ya. This therapeutic dose blarney with Lithium and Depakote is just a result of treatment of *acute bipolarI mania* (probably inpatient ER presentation, etc.), period.
>
> hope this helps some,
>
> Mitch
>
>
> > Ah, Mitch, my man. Just the post I wanted to see. I just sent off a question to Geezer which you might have read, but I'm interested in info about subtherapeutic levels of lithium and BPII. My level is .5 and it seems to be doing the trick with the Remeron. My pdoc wants me to push it up but I sure don't want to fix anything that ain't broke. I'd much prefer not to deal with the tremors and renal problems from a higher dose. Any of your thoughts on this would be appreciated. - BCat
> >
> > From what I have read over the years about lithium levels .5-1.5 mEQ is used for "short-term acute control" with .6-1.2 mEQ used for "maintenance". There have been some studies showing that maintenance blood levels all the way down to .3 mEQ are effective for some folks. Usually a min. of .45 is a target. FWIW, I found the "subtherapeutic" blood levels to be "therapeutic" for BPII symptoms.
> > >
> > > Mitch
poster:BarbaraCat
thread:99855
URL: http://www.dr-bob.org/babble/20020327/msgs/100660.html