lithium

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As the days get shorter… :((.

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As the days get shorter, unfortunately, my face gets longer. My mood gets choppy…
(A note: Please don’t think I am whining, I am not. At times it feels like the rug being pulled out from under my life, at times, and this is the worst, it feels like my heart is breaking into a million, jagged pieces, and at times it feels like I am living in pitch darkness. None of it is good, and I have lived with this, on and off, for twenty eight years. So please believe me when I tell you, I am not whining or needlessly caterwauling. I am not.)
Getting hard again. Sadness creeping in. Emotions too close to the surface. Crying a lot again. Missing my friends. Missing my precious son. Memories creeping in. Ammi, Farooq, Mamoon, Ammi Khala, Khalid Mamoon, all gone, lost to me. Tears on the brink of falling, hurriedly wiped away. Life is never easy, but it gets much more difficult when bipolar strikes. God, I thought I might escape it this year, with the increased dose of medication. Haha, no such luck. But I go on. I cook, I bake, I even model (!!), I read, I go see plays, I talk to and even laugh with my friends and family. But the heaviness in my heart remains. No one knows. I don’t think anyone suspects. I put on a good show :)). Of course I do. There is nothing else I can do. Uneasy feelings or not, life must go on. I must go on, although thoughts of not going on cross my mind. But I shoo them away, I have a son and nephews and nieces for god’s sake. I would never do anything that would even hurt one little hair on their precious heads. Of course I go on. I summon the strength with which I was lucky enough to have been born. I remember the love my grandmother, and my mother and my aunts and uncles gave me from the day I was born. That is the love that sees me through. I have their faces and their hearts imprinted on my heart. My Amma, my Ammi, my Farooq, my Mamoon, my Ammi Khala, my Khalid Mamoon. All full of love and caring and such steely strength. We are descended from a great Sufi saint named Baba Farid! He preached love, nonviolence, meditation, and living simply, and he practiced it. I am his great, great, great, … grand daughter. I have read his poetry and it’s very sweet and sounds a lot like Buddhism. One of his poems says that he thought he was the only one in pain, but when he climbed on the roof of his house, he saw every house was on fire! Another poem says not to strike someone who hits you, but kiss his feet and go home! Even one step beyond ” turn the other cheek”… He is still worshipped in Pakistan and India, by Moslems, Hindus and Sikhs! What does this have to do with bipolar disorder? Well, in times when I feel weak, I draw my strength from the love my family gave me and the teachings of my ancestors. It’s about having the strength to hang on with the tips of your fingers when the mountain you’ve been scaling, starts to crumble in a landslide. Of course I am going to call my doctor and increase the Seroquel dose or the lithium dose, and then I will be as right as rain again. These medications are a godsend and a blessing for me. Without these, I would be nowhere, so I am very fortunate that we have them and that they work for me. So, as usual, when the days get shorter, my mood goes awry. Seems that I can’t avoid it. But, and this is a big but, I can control the severity of the swing and quickly squash the phase by staying on higher doses of medication all year, and then increasing one or both as soon as I feel bad. That is indeed a great blessing and something for which to be very thankful!

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Something I just learned!

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First of all I’d like to say that I have been feeling fine, no major mood upheaval to report since late June/early July. That is a blessing and I am enjoying my normal mood and being able to handle what life throws my way in an able and normal way. I have been in a play for which I have had to memorize lines and perform in front of an audience, and that has gone extremely well. We have been getting standing ovations from the audience and our director is very pleased. So that is the good news. 

I had an appointment with my doctor today. Something he told me pretty much blew me away. He said I had to stop taking Zoloft, a medication I have been on since its approval by the FDA in 1991. He had said this to me in the past, saying it makes people with bipolar disorder cycle. This time he was pretty adamant that I should come off it. I asked him to explain further and he said that taking Zoloft is fine when things are going well, but when there is upheaval in your life, then it makes you cycle. It can either throw you in a manic phase or into a depression. He said that the mini manicky cycle I had gone through in June and July and the slight depression in the middle of August were directly caused by taking Zoloft. I am flabbergasted! I have always been told that you take Lithium for mania and anti-depressants for depression. Now my doctor is telling me that SSRI’s (selective SEROTONIN reuptake inhibitors) make people who have BPD cycle more and that we cannot take SSRI’s and should only be on lithium! I asked him what I do when a depression comes sauntering into my life, and he said I can take other anti-depressants or mood stabilizers. He mentioned Abilify, which I can’t take because it gives me severe Parkinson’s like symptoms and makes me feel about a 100 years old. He mentioned Welbutryn, but I can’t take that because it makes me feel like I am literally going to explode from anxiety… so, hmmmmm, depression… I don’t know what I’m going to do. Cry a lot and feel bad a lot? Apparently what happens with SSRI’s is the number of Serotonin receptors is down regulated. Also, the number of synapses is reduced. This is what causes people with BPD to cycle. These changes in neurons are reversible but it takes about a year for neurons to go back to pre SSRI configuration. So for a year… he did tell me about a medicine called Brintellix, which is an SSRI but doesn’t do either of the things I mentioned above therefore does not make people cycle. However he said that would not be his first choice. But I think it would be mine out of the three he offered as alternatives to Zoloft. Well let’s see how this goes. Every time I get a new psychiatrists, things change, and not necessarily for the better. My mental health is of course affected by changes in these psychoactive drugs.

I do agree with him that I have mini cycles, exactly like I had in June/July (manicky) and mid August (just a tad bit depressed.) And both of those happened because of situations in my life. So I think what he is saying is correct. The only issue is how will I control the symptoms of a depressive episode if I can’t go to my trusted Zoloft. Scary. Well here we go into the wild blue yonder. Life without Zoloft. Thank you Zoloft, you have served me well (maybe not quite so well), but now we must part. Lets hope it will all go smoothly and my neurons will up-regulate Serotonin receptors and synapses at record speed :)) Actually I am sitting here smiling at my silliness, but truly hoping this all goes well.

All silliness aside, this should make my mood much more stable, no more “mini” phases, that have quite maxi effects on my life. Without the Zoloft, the cycling through manic, normal, depressed will decrease and the time in normal phase will increase. What a joy that seems, to not have emotional fits from anxiety, mania, and depression. I’m all for it and starting today to make sure that my mood stays normal :))

 

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Impulsivity is a symptom of mania or hypomania!

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One very important reason to take the correct dose of the correct medication is shown below from the article: “Impulsivity and Risk Taking in Bipolar Disorder and Schizophrenia” published in Neuropsychpharmacology in September 2013. Here is the reference if anyone would like to read the whole article: http://www.nature.com/npp/journal/v39/n2/full/npp2013218a.html

Basically what this article is saying is that impulsiveness, which is defined as risky decision making, high risk attitudes, acting without planning, poor inhibition of risky actions, high risk attitudes, and rapid decision making (which basically means making decisions without thinking them through). Please understand that these are symptoms of mania. Once you are in a manic phase, you are going to do this. In a hypomanic phase, you are also going to do this but to a much lesser degree, your actions will not be as risky to your life or health. Please also understand that the only way to stop this from happening is to NOT go into a manic or hypomanic phase. The way to do that is to take the right amounts of the right medication as you doctor had prescribed. And if you feel like your mood is slipping towards mania or depression, to call your doctor and let them know. This is a BIOCHEMICAL disease involving levels or metabolism of neurotransmitters. All these neurotransmitters have certain effects on the brain. When their activity or levels of these neurotransmitters are high, we become impulsive. So, just take the right dose of your medication and head these problems off at the pass, nip them in the bud, stop them before they happen. If you don’t, this disease WILL ruin your life, it will destroy your peace of mind, it will destroy your relationships, it will destroy your friendships, it may even take your life. That is as bluntly as I can put it. I am definitely on the therapeutic dose of lithium and I’m staying on it for the rest of my life, I am not allowing this mood disorder to control my life or take days away from me or most importantly take my family or beloved friends away from me.

Not me, not now, not ever again! I hope you too will make a commitment to your health and sanity and your life, and follow your doctor’s advice to the letter.

Below in quotes are passages from the above mentioned article.

“Impulsiveness is a clinical feature of bipolar disorder. Broadly, impulsivity refers to a predisposition toward unplanned reactions without consideration of consequences and can include risky decision making, self-reported high-risk attitudes, poor response inhibition, and rapid decision making. 

Bipolar disorder is often characterized by impulsive behavior and increased tendency to work toward a reward, often without sufficient planning. Although risky-impulsive behavior is a diagnostic criterion for mania and bipolar patients consistently show abnormalities on self-report measures of impulsivity, they do not consistently show deficits on behavioral tasks that require planning and forethought. These differences may reflect the multi-faceted nature of impulsivity, or the measurement tools used to assess the construct.

Finally, some of the mixed findings in bipolar disorder and schizophrenia regarding impulsivity and risk taking may be attributable to the types of medications patients are taking. The neurochemical basis of impulsivity and risk taking involves dopaminergic, serotonergic, and other neurotransmitter systems, and these systems are affected by antipsychotic (AP) medications. Some studies find a reduction in impulsiveness associated with AP medications, whereas others find no such effect in psychotic samples. Thus, it is important to consider the role of AP medications on measures of impulsivity and risk taking.

This is one of the first studies to examine both self-report and behavioral measures of impulsivity in bipolar disorder and schizophrenia. The study had two goals. The primary goal was to conduct a careful analysis of impulsivity using multiple approaches across three groups: bipolar disorder patients, schizophrenia patients, and healthy controls. The secondary goal was to compare subgroups of bipolar disorder patients who differed in terms of AP medications and history of psychosis on measures of impulsivity and risk taking.”

 

 

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Lithium, the miracle drug for people with mood disorders!!!

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Lithium is a naturally occurring element. It is the same element that is used in batteries. But it is a Godsend for people with bipolar d/o. It stabilizes our moods. It stops the swings altogether or at least stops them from being too extreme. In areas where the concentration of lithium in drinking water is high, the incidence of mood disorders is lower!!! It is a calming mineral that helps with mania and, to a lesser degree, with depression. The general dose is 900 mg per day. I was on 300 mg because of the few side effects I had (fine muscle tremors, frequent urination, hair loss, acne, weight gain, GI problems.) But that was not enough to control my mood swings, so I went up to 600 mg/day, and that was better, but my swings were still not controlled. Now I am on 900 mg per day. Even though my right hand shakes a LOT, more of my hair is falling out, and I may get acne now and then, however to be stable mood wise is very, VERY important to me. So I am taking hair skin and nails vitamins, using benzoyl peroxide and living with fine muscle tremors. I am confident that the 900 mg dose of lithium is going to keep me in the normal phase, without swings that are too extreme in either the depressive or manic direction.

Lithium possesses unique anti-suicidal properties that set it apart from other agents. With respect to cognition, studies suggest that lithium may reduce cognitive decline in patients. It is seen to have a protective effect on people’s brains. The neuronal cell death that is seen in people with bipolar disorder is decreased when they are on Li+. As neurons die, venticles in the brain increase, this is also seen to lessen in patients who take Li+!!! It even has been hypothesized that Li+ causes neuronal cell growth, thereby reversing the damage that bipolar d/o inflicts upon its victims. So I am very happy, thrilled in fact, to know that the Li+ I take is not only preventing this disease from having an effect on me, but it is also protecting and regenerating my neurons. :)))))

The molecular mechanism of lithium (Li+) seems to be related to its similarity to sodium (Na++). It is taken up by neurons through the same pump that pumps in Na+ (Yes there are pumps that pump ions, such as calcium (Ca++) potassium (K+), in and pumps that pump ions out of all cells, including neurons. Pretty amazing hunh?) 

Evidence from both in vitro and in vivo studies has demonstrated that lithium exerts multiple effects on neurotransmitter/receptor-mediated signaling, ion transport, signal transduction cascades, hormonal and circadian regulation, and profoundly alters gene expression patterns.

Li+ reduces excitatory (dopamine and glutamate) but increases inhibitory (GABA) neurotransmission; however, these broad effects are underpinned by complex neurotransmitter systems that strive to achieve homeostasis by way of compensatory changes. For example, at an intracellular and molecular level, lithium targets second-messenger systems that further modulate neurotransmission. For instance, the effects of lithium on the adenyl cyclase and phospho-inositide pathways, as well as protein kinase C, may serve to dampen excessive excitatory neurotransmission. All this means is that Li+ affects molecules that are called second messengers (the neurotransmitter being the first messenger) and that normally transmit the signal, well Li+ stops the excitatory signals. Makes sense, as it a cracker jack mania buster!

Li+ also has inhibitory actions on inositol monophosphatase, inositol polyphosphate 1-phosphatase, glycogen synthase kinase-3, fructose 1,6-bisphosphatase, bisphosphate nucleotidase, and phosphoglucomutase enzymes. Some of these enzymes are involved in increasing activity of neurons in response to neurotransmitters, such as dopamine, serotonin, epinephrine, norepinephrine, and GABA. So again, Li+ stops excitatory signals from being passed from one neuron to another, thereby decreasing neuronal activity. This is good, because in mania your brain is working like gangbusters! And it needs to be slowed down. So Li+ does that. 

If your doctor has prescribed Lithium for you, please take it. It is a wonderful medication, which will save your neurons, your brain, your relationships, and maybe even your life.

 

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Thank goodness for Lithium!

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The treatments for bipolar disorder were initially discovered serendipitously. Lithium for example remains one of the most frequently used and effective treatments for bipolar disorder, but lithium has a number of different targets in the brain and so we haven’t learned very much specific information from lithium’s effect. Some of the things that lithium does are now targets for a great deal of research. One of those things is that lithium will decrease the function or change the function of some second messenger systems. And so it will give a way that you could have multiple neurotransmitter systems affected or damped-down by just the one effect of lithium. Another thing that lithium does is that it has very robust neuroprotective and neurotrophic effects. It’s thought that lithium may partly have its effect in the brain by restoring the structure, some of these structural abnormalities that occur in bipolar disorder. For example, the reductions in grey matter volume that exist in the hippocampus and the medial prefrontal cortex, there is now some evidence that suggests lithium can actually reverse those changes. Similarly in those experimental animal models where you’ve got repeated stress causing atrophy in the same structures, lithium has the capability of reversing those atrophic changes. So, one impact of lithium might be on the neuroplasticity of the brain.

http://www.dnalc.org/view/2085-Lithium-how-it-might-protect-the-brain.html