Lithium Beats Newer Meds for Bipolar Disorder

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I’ve been on Lithium since 1986, (except for a disastrous period between 2001 – 2008) so this comes as no surprise for me. I am now on 600 mg Lithium Carbonate ER per day and 100 mg Seroquel daily. My mood is stable, my symptoms are totally under control. I don’t feel flat, I still feel things, still have sadness and happiness. I have been stable for one and a half years, a record for me, as I used to cycle at least a couple of times a year. This is attributable to Lithium of course, but also to the fact that I am no longer on an SSRI (Zoloft), which causes people who have bipolar disorder to cycle and have mixed phases, which is exactly what I was experiencing. Mixed phases, hmm, the best way to describe them is you experience mania and depression symptoms at the same time, also with a huge amount of anxiety. Not fun! So not being on Zoloft and yes being on Lithium has been the best thing for me as far as mood stability is concerned. I admit, the scary depth of feelings led me to be more creative as in writing poems, stories, etc. But I gladly give that up for relative peace of mind. I don’t care if I never write “creative” poems that have much too much emotion in them (mostly sadness and anxiety,) I choose to be stable mood wise, I’d rather not visit those dark, frightening dungeons where bipolar monsters live.

PS

Lithium can affect your kidneys, so regular tests are needed to ascertain that the kidneys are woking well. Also, it can affect your thyroid, cause hypothyroid, so again testing is needed to make sure that your thyroid is fine. My thyroid stopped working a few years ago, we thought it was because of the lithium, but it is in fact Hashimoto’s thyroiditis, which is an autoimmune disease, whereby your own immune system basically kills your thyroid, so now I take Synthroid, synthetic thyroid hormone, to replace what my thyroid no longer makes.

http://www.webmd.com/bipolar-disorder/news/20160512/lithium-beats-newer-meds-for-bipolar-disorder-study-finds

Lower rates of self-harm, accidental injury seen

By Dennis Thompson

THURSDAY, May 12, 2016 (HealthDay News) — Lithium outperforms newer mood stabilizers in the treatment of bipolar disorder, a new study has found.

Patients taking lithium had lower rates of self-harm and unintentional injury compared to those taking other bipolar drugs, such as valproate (Depacon, Depakote), olanzapine (Zyprexa) or quetiapine (Seroquel), said lead researcher Joseph Hayes. He is a fellow of psychiatry at University College London.

“This is important because people with bipolar disorder are 15 times more likely to die by suicide and six times more likely to die by accidental injury than the general population,”¬†Hayes explained.

People taking one of the alternative mood stabilizers were 40 percent more likely to harm themselves compared to patients on lithium, Hayes and his colleagues found.

And people on valproate or quetiapine were 32 percent to 34 percent more likely to fall victim to unintentional injury, most likely while experiencing a manic episode, the researchers said.

“Lithium still is the gold standard for the treatment of bipolar. We really haven’t had a medication that surpasses lithium, as far as we know,” said Dr. Raphael Braga. He is physician-in-charge of the Center for Treatment and Research of Bipolar Disorder at Zucker Hillside Hospital in Glen Oaks, N.Y., and was not involved with the study.

Hayes noted that lithium has been used for more than half a century to treat bipolar disorder, but it’s still not clear how the drug stabilizes a person’s mood.

Bipolar disorder, which used to be called manic depression, is characterized by extreme mood swings ranging from emotional highs to depressive lows.

The researchers undertook their study following evidence reviews and studies that suggested lithium might be better than newer medications at preventing suicide and self-harm.

These studies have contended that lithium achieves these results by reducing symptoms such as depression, aggression, risk-taking and impulsive behavior, according to background notes in the study.

Lithium can be hard on the body, the study authors said, increasing a person’s risk of kidney and thyroid disease, but even that may have a positive side in bipolar patients. Because patients must be closely monitored for side effects, they are in more frequent contact with doctors who can pick up on emotional problems that lead to suicide, the researchers contend.

To compare lithium against newer medications, Hayes and his colleagues collected medical data on nearly 6,700 people diagnosed as bipolar and prescribed only one of the drugs — lithium, valproate, olanzapine or quetiapine.

The investigators found that people on lithium were less likely to harm themselves, either intentionally or by accident.

The suicide rate was lower in the lithium group, but too few suicides occurred to allow accurate risk estimates, the study authors said.

The findings were published online May 11 in the journal JAMA Psychiatry.

Lithium can cause kidney disease and hypothyroidism (underactive thyroid gland), Braga and Hayes said.
Doctors need to carefully weigh benefits versus harm when prescribing lithium to people with kidney or thyroid problems, and “if these are severe, it should be avoided,” Hayes said. “Lithium [also] needs to be reviewed on an individual patient basis before pregnancy.”

Braga said psychiatrists often require patients taking lithium to undergo lab tests every three to six months, to make sure their kidney function hasn’t been compromised.

Even with this, lithium is much cheaper than the other medications in the study, Braga said. Hayes noted a 2008 study that found lithium was nearly $500 cheaper per month compared with olanzapine.

“Lithium is a great drug,” Braga said. “It’s definitely a drug every clinician should think about when prescribing for bipolar disorder.”

What’s a Girl to Do?

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Well, first they come and tell you we don’t know if you have bipolar d/o or unipolar depression, so here take this antidepressant and you’ll be fine. Then you go into a full blown manic phase, with delusions, hallucinations, total insomnia. Then they say “Oops, you have bipolar disorder, you have to take lithium.” So you go on lithium with added antidepressants only when you’re feeling depressed. So mood stabilizers such as Lithium Carbonate all the time and increased dose for manis, antidepressants, in your case selective serotonin reuptake inhibitor (SSRI), for you it’s Zoloft. Then when you get used to this regime, Lithium Carbonate maintenance dose. Lithium Carbonate increased dose for manic episode. Zoloft + Lithium Carbonate for depression, they change the rules. Now no more SSRI antidepressants, ever! SSRI’s increase the likelihood of cycling, meaning going though depressed and manic phases. So done, gone, nada. Now what do you do when you into a depressed phase? Well there are selective norepinephrine reuptake inhibitors (can’t take them, make be burst with anxiety), there are other mood stabilizers such as Abilify or Depakote (can’t take them, bad side effects), there are Amphetamine derivatives such as Adderall (can’t take them, baaaad side effects.) What does that leave? Maybe, seriously, I have to think about MAOI’s. The monoamine oxidase inhibitors. These don’t inhibit the reuptake of neurotransmitter, they actually inhibit the enzyme (monoamine oxidase) that breaks down neurotransmitters, so there are more neurotransmitter molecules available for neurons. This is good! Unfortunately however, you cannot eat anything aged when you are on MAOI’s, which means no wine, cheese, and other yummy foods. I would try these though if a depressive phase was so bad that I couldn’t function. My friend swears by one called Parnate. This class of antidepressants had been shown to alleviate depression in people who may be otherwise drug resistant. Hmmm, maybe, if I go into a severe depression, I’ll ask my psychiatrist to prescribe Parnate or one of the other MAOI’s. I guess that’s what a girl’s supposed to do. Or a boy for that matter.

Wide Arc Mood Swings

Emotions are a double edged sword for people with bipolar d/o. Our intense emotions allow us to feel deeply, be empathetic, be creative. But these intense emotions can also break us.¬†Things like Empty Nest Syndrome are very difficult to deal with, as our emotions get get very intense and painful and difficult to handle for ourselves. Any kind of emotional upheaval is more difficult when you have a mood disorder. We people who have bipolar 1, 11, or major depressive or anxiety disorders have a more difficult time coping with it. We feel so much more deeply, we really do, I’m not making that up. Whether we are happy or sad, we feel off the charts. Our mood swings are more extreme and have a wider arc than someone who doesn’t have a mood disorder.

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Here’s a figure I made. It’s not exact, just illustrative, the normal mood range is a little past the lines labelled “Normal Depression” and “Normal Euphoria.” The Bipolar mood swings however can go beyond even the “Out of Touch with Reality Depression” and “Out of Touch with Reality Mania“!!! That is some depth and intensity of emotion, that is why when people are in a severe depression, they kill themselves, because the depth, the intensity, the very quantity of their sadness is too painful, too intense to bear.

Just something I wanted to share with people who don’t know what it feels like to have a mood disorder.

Mood stabilizers like Lithium Carbonate, Depakote, Abilify keep us in mostly the normal mood range. They are literally heaven sent for us, people with mood d/o’s. I don’t know if I’d be here without my Lithium Carbonate, I don’t think I would actually. Even with it, I still have been going through some extreme mood situations, but they are somewhat attenuated and more easily reversed than if i wasn’t on Lithium. So even though I have Bipolar Disorder Type 1 (the official name) I feel lucky that I also have Lithium Carbonate. Also, my mood lability was also due, in large part, to Zoloft, which I haven’t taken in 3.5 months, and this will also help stabilize my mood. Yaay! Coming off Zoloft has been anything but easy. But that’s a subject for another post.

Best wishes and hugs to you my dear friends.