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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Roslynn on May 29, 2021, at 9:37:24
Hi everyone, I am having to reduce and eventually stop lithium due to kidney problems.Has anyone done this before and how fast was your reduction? What did you substitute for the lithium?
I'm also finding that once I reduce a dose I continue to feel worse and worse even though it seems it would level off after each reduction, if that makes sense.
Thank you for any help.Roslynn
Posted by Roslynn on May 29, 2021, at 10:46:25
In reply to coming off lithium?, posted by Roslynn on May 29, 2021, at 9:37:24
I just wanted to clarify, I reduced the dose from 675 to 450 about two months ago and I'm feeling worse and worse each week rather than having my mood level off. I only expected one drop in my mood.
Also,, I am taking lithium as an augment to my depression meds, I don't have bipolar.
Thank you,
Roslynn
Posted by Christ_empowered on May 29, 2021, at 15:17:29
In reply to Re: coming off lithium?, posted by Roslynn on May 29, 2021, at 10:46:25
hi there. so sorry about your situation :-(
ok, so -no personal experience- . really helpful, I know. lol. however...
i skimmed over a bit of info on lithium discontinuation while searching for info on neuroleptic/tranquilizer discontinuation. fun fact: just like (it seems...) all psych drugs, ever, stopping lithium carries with it a definite discontinuation syndrome, which does not necessarily mean that an underlying condition is getting worse or anything.
ok. it does seem that a lot of lithium's actions seem to overlap with the neuroleptics, just...it carries a different adverse effect profile. personally, i've found sedatives (gabantin/neurontin, in my case) helpful when reducing the dosage of my "atypical antipsychotic."
would your prescribing doctor consider providing some flavor sedative? i'd personally try to steer clear of any "atypical" antipsychotics, at least right now (honestly, in general, but that's me...). th elast thing anyone would want is to deal with NMS or akathisia on top of lithium discontinuation.
maybe...neurontin, lyrica, even a short(ish) term benzodiazepine (good ole valium, even) ?
ok. hope this helps a bit.
Posted by Roslynn on May 30, 2021, at 14:25:28
In reply to Re: coming off lithium?, posted by Christ_empowered on May 29, 2021, at 15:17:29
Thank you. I'm actually already on a benzo which my doc tries to keep at a reasonable amount.
He's thinking of switching me to Latuda I think...
Thanks for your thoughts:)
Posted by SLS on May 30, 2021, at 21:42:21
In reply to Re: coming off lithium? » Christ_empowered, posted by Roslynn on May 30, 2021, at 14:25:28
Hi, Rosalynn.
Are you bipolar? Is depression your problem right now? Has anxiety appeared that wasn't there prior to your reducing the lithium dosage?
If you haven't tried Lamictal (lamotrigine) yet, it is worth a try. Latuda is good for bipolar depression, too. I am not crazy about taking an antipsychotic if another class of drug would work equally well. I suspect Lamictal might increase activity in the nucleus accumbens. That is the structure of the brain currently thought to be the center of reward (instead of punishment). Other neural pathways are networked to activate this structure, and other regions participate in making you "feel good".
What other drugs are you taking? If you do choose Lamictal, just follow the starter pack. The dosage has to be increased gruadually. I think it take 4 weeks to reach 200 mg/day. This is usually the minimum effective dosage for bipolar depression. I need 300 mg/day. I also take 300 mg/day of lithium in the hopes that it will prevent Alzheimer's Dementia. When I first added lithium to Parnate, I felt a mild improvement in depression within a few hours. If I go higher in dosage, I become increasingly depressed and flat. If you are urgently depressed - suicidal - perhaps it makes sense to take Zyprexa for a few days, or longer. If your doctor wants you to start Latuda tomorrow, then taking Zypexa might complicate things. If you feel it's appropriate, ask your doctor about what alternatives there are for immediate relief.
Take it one step at a time. Maybe you should work on making a flow-chart with your doctor as to what drugs and drug combinations to take and in what order.
Is there anything you can do to minimize kidney dysfunction? Cranberry juice? I really don't know.
- Scott
Posted by linkadge on May 31, 2021, at 13:24:35
In reply to coming off lithium?, posted by Roslynn on May 29, 2021, at 9:37:24
Hi Roslynn,
I assume you've consulted with your doctor regarding this. My mother had some kidney impairment from lithium, but the psychiatrist said that (given her age) the impairment was not bad enough to warrant a complete discontinuation.
Do you need to come off it all? Could you continue to take a lower dose (i.e. 300mg)? For additional mood stabilization, you could first look to valproate, tegretol or lamictal. If neither of these are suitable, you could look to antipsychotics.
Linkadge
Posted by Roslynn on June 1, 2021, at 14:21:16
In reply to Re: coming off lithium? » Roslynn, posted by SLS on May 30, 2021, at 21:42:21
> Hi, Rosalynn.
>Hi Scott! Thank you for your reply.
> Are you bipolar? Is depression your problem right now? Has anxiety appeared that wasn't there prior to your reducing the lithium dosage?
I am not bipolar but my father has severe bipolar I. I have major depression plus OCD. Yes, I'm having more anxiety since reducing the lithium.
>
> If you haven't tried Lamictal (lamotrigine) yet, it is worth a try. Latuda is good for bipolar depression, too. I am not crazy about taking an antipsychotic if another class of drug would work equally well. I suspect Lamictal might increase activity in the nucleus accumbens. That is the structure of the brain currently thought to be the center of reward (instead of punishment). Other neural pathways are networked to activate this structure, and other regions participate in making you "feel good".Lamictal gave me some cognitive problems at one time but I could try it again considering my meds are different now.
>
> What other drugs are you taking? If you do choose Lamictal, just follow the starter pack. The dosage has to be increased gruadually. I think it take 4 weeks to reach 200 mg/day. This is usually the minimum effective dosage for bipolar depression. I need 300 mg/day. I also take 300 mg/day of lithium in the hopes that it will prevent Alzheimer's Dementia. When I first added lithium to Parnate, I felt a mild improvement in depression within a few hours. If I go higher in dosage, I become increasingly depressed and flat. If you are urgently depressed - suicidal - perhaps it makes sense to take Zyprexa for a few days, or longer. If your doctor wants you to start Latuda tomorrow, then taking Zypexa might complicate things. If you feel it's appropriate, ask your doctor about what alternatives there are for immediate relief.
>
> Take it one step at a time. Maybe you should work on making a flow-chart with your doctor as to what drugs and drug combinations to take and in what order.Good suggestion.
My other meds are Luvox 50mg, ativan, seroquel 100mg (can't increase or I get fuzzy thinking), lithium 450mg (down from highest dose of 675mg, andritalin 10mg.
>
> Is there anything you can do to minimize kidney dysfunction? Cranberry juice? I really don't know.
>
I've been trying to drink a lot of water but there is not much more I can do.Thank you for your suggestions, they are all very helpful:)
>
Roslynn
>
Posted by Roslynn on June 1, 2021, at 14:27:52
In reply to Re: coming off lithium? » Roslynn, posted by linkadge on May 31, 2021, at 13:24:35
Hi Linkadge,
>Apparently my kidneys/creatinine are still bad enough at the lower current dose of 450 (down from 675) that he wants me to reduce it even further. I am hoping he will let me try the 300 mg for a while.
> Do you need to come off it all? Could you continue to take a lower dose (i.e. 300mg)? For additional mood stabilization, you could first look to valproate, tegretol or lamictal. If neither of these are suitable, you could look to antipsychotics.
>
> Linkadge
>Thank you for the suggestions on mood stabilizers :).
Best,
Roslynn
>
>
>
>
Posted by stargazer2 on June 13, 2021, at 21:37:46
In reply to Re: coming off lithium?, posted by Roslynn on May 29, 2021, at 10:46:25
Heres a good one. 2 doctors I have recently consulted both said lithium is fine to take with renal impairment. I knew Lithium can cause Renal problems so why don't 2 doctors at Yale know this? Ill tell you why, no one cares at all about patient care. Im in the middle of a bad medical situation and don't trust one doctor anymore except those that I have a good relationship with but any new doctor I meet is suspect for not caring or having my best interests in mind. Anyone else feel this way about doctors of any specialty?
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