How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr. Vikas Your Own Question

Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2207
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
4079050
Type Your Mental Health Question Here...
Dr. Vikas is online now
A new question is answered every 9 seconds

I am taking 900 mg of lithium plus 4 mg of ativan and 2.5 mg

Customer Question

I am taking 900 mg of lithium plus 4 mg of ativan and 2.5 mg of abilify. I am having memory problems, but the worst is I take the lithium 3 times per day. The first dose is goood, I take all of them with a 1 mg ativan. The second dose after about an hour I start to feel tired and want to lay down. I finally take the third dose and it makes me very agitated resless and I cry alot in the evenings..Do you think it is the abilify? do you have any suggestions?
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr. Vikas replied 2 years ago.

Hello Madam,

What is the reason behind taking Lithium with 1 mg of Ativan?

Are you also feeling depressed with symptoms such as low mood, crying spells, low energy, lack of motivation etc?

Thanks

Vikas
Customer: replied 2 years ago.
I don't seem to have that in the mornings but I do by mid afternoon and it is getting worse. I did have high anxiety and still do from time to time I guess that is why he left me on the ativan. I am very sensitive to meds and maybe going off of it would be to much. Not sure? I have tried to skip an ativan to see how I would do and I become very irritable.
Expert:  Dr. Vikas replied 2 years ago.
Thanks for your reply.

You are on very low dose of Abilify and I don't think your symptoms are because of Abilify.

Memory impairment is a reported side effect of Lithium therapy and so is dysphoric mood, irritability etc.

Both Lithium and Ativan are very sedating in nature therefore if taken together can cause lethargy, sleepiness, poor concentration, tiredness etc.

But in a patient who is on Lithium therapy, symptoms such as dysphoric mood, crying spells, impaired memory, tiredness may also be because of a current depressive episode or hypothyroidism and both of them should be ruled out by your doctor.

Therefore a logical first step in your case would be to ask your doctor to rule out a current depressive episode and hypothyroidism.

The Lithium dosing could be changed from thrice a day to twice a day if possible and this should help in reducing the tiredness and feeling of lethargy. In my personal view, the dose of Ativan should also be reduced and it can be gradually taper down.

In case, if you are not able to tolerate the anxiety symptoms you can discuss with your doctor about adding Pristiq (Desvenlafaxine) to the current treatment regime.

Assuming that your current symptoms could be because of a depressive episode along with comorbid anxiety, Pristiq can be very useful in controlling anxiety symptoms as well as the other depressive symptoms and you will be able to taper down Ativan which is a habit forming drug and can lead to dependence.

Best wishes,

Vikas


Please feel free to ask if you need clarification/more information. Kindly click the GREEN ACCEPT BUTTON if you are satisfied with the answer. POSITIVE FEEDBACK and BONUS are warmly appreciated


Customer: replied 2 years ago.
I can't take any antidepressants. All of the ones I have tried have made me very depressed. We did blood work about a month ago and everything was fine so I don't think it is the hypothroidism. I only have the crying spells after taking the third dose of lithium. I get very tired after the second dose. I don't go back to see my dr until late next week would I be okay to cut off the 12:30 dose of lithium until then? I agree I need to taper off the ativan but I don't know how that will happen.
Expert:  Dr. Vikas replied 2 years ago.

Antidepressants treat depression, they can't make anyone depressed!

If hypothyroidism has been ruled out, I still think that adding an antidepressant could be very useful in your case in controlling the anxiety symptoms. This will also help in tapering down Ativan because once your anxiety symptoms are under control you won't be needing it any more.

There are several antidepressants available in the market and you should give them a try.

I don't think, cutting the dose of Lithium would be a good idea because you are already on a comparatively low dose of Lithium.

You can also take the help of relaxation technique to control your anxiety symptoms in the mean while.

Relaxation techniques



Best wishes,

Vikas


Please feel free to ask if you need clarification/more information. Kindly click the GREEN ACCEPT BUTTON if you are satisfied with the answer. POSITIVE FEEDBACK and BONUS are warmly appreciated
Customer: replied 2 years ago.
Well I have went throught this for 3 years and I know antidepressants can make you depressed and suicidal. All you have to do is watch tv to know that. I have also had several dr agree so I don't appreciate your comment. You have no idea what I have been through. I am also not pleased with the time to answer my question. Best regards.
Expert:  Dr. Vikas replied 2 years ago.
Thanks for your honest feedback and I do appreciate it a lot.

Also, I would like to say that you are partially correct here because antidepressants can make a person suicidal but does not aggravate depression further. A popular theory regarding how antidepressant make a person suicidal is that a severely depressed person lack energy and motivation to do anything but once he or she start coming out of depression because of antidepressant, he may start thinking about ending his life.

Since I was not able to help you, I am opting out from this question, you need not to accept the answer. As soon as I opt out, it will become an open question.

Best wishes,

Vikas

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
< Last | Next >
  • http://ww2.justanswer.com/uploads/DR/Dr.Keane/2013-8-20_204325_drkeane.64x64.jpg Dr. Keane's Avatar

    Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
  • http://ww2.justanswer.com/uploads/RE/resolutions66/2011-1-17_05728_IMG8202smilingeditedforJustAnswer.64x64.jpg Elliott, LPCC, NCC's Avatar

    Elliott, LPCC, NCC

    Psychotherapist

    Satisfied Customers:

    5024
    35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
  • http://ww2.justanswer.com/uploads/formybunch/2010-12-06_191055_img_0975.jpg Kate McCoy, M.Ed, NBCC, LPC's Avatar

    Kate McCoy, M.Ed, NBCC, LPC

    Therapist

    Satisfied Customers:

    3733
    Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
  • http://ww2.justanswer.com/uploads/DR/DrAkiraOlsen/2012-2-20_746_AkiraADpicmain.64x64.jpg Dr. Olsen's Avatar

    Dr. Olsen

    Psychologist

    Satisfied Customers:

    2336
    PsyD Psychologist
  • http://ww2.justanswer.com/uploads/norriem/2009-5-27_134249_nm.jpg Norman M.'s Avatar

    Norman M.

    Psychotherapist

    Satisfied Customers:

    2193
    UK trained in hypnotherapy, counselling and psychotherapy and have been in private practice. ADHP(NC), DEHP(NC), UKCP Registered and ECP.
  • http://ww2.justanswer.com/uploads/PsychologyProf/2010-07-15_171248_logos060400409.jpg Dr. Michael's Avatar

    Dr. Michael

    Psychologist

    Satisfied Customers:

    2177
    Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
  • http://ww2.justanswer.com/uploads/KURTEMMERLING/2010-07-23_215531_just_ask_picture1.jpg Steven Olsen's Avatar

    Steven Olsen

    Therapist

    Satisfied Customers:

    1727
    More than twenty years of expertise in counseling, psychological diagnosis and education