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I am presently a depressed bipolar 1. Last wk a Lithuim

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increase of 150mg p/d. This...
i am presently a depressed bipolar 1. Last wk a Lithuim increase of 150mg p/d. This 800 mg p/d made me toxic 3 mnths back.
Dr says antidepressants will make me manic ? Are their any alternatives for me ?
Woman age 52.
Submitted: 8 years ago.Category: Health
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Answered in 2 hours by:
6/11/2010
Health Professional: Devra K, Nurse replied 8 years ago
Devra K
Devra K, Nurse
Category: Health
Satisfied Customers: 75
Experience: Rn for 24 years with Med/Surg, ICU, Behavioral Health experience and MORE
Verified

Hello my name is***** am a Registered Nurse (BSN) with 24 years experience in Med/Surg, ICU, Neurosurgery and Behavioral Health and I would be happy to help you today.

I need to ask you some questions first.

Does the doctor who prescribed your lithium know you are taking St. John's Wort?

When was your last lithium level drawn and what were the results?

Thank you for the additional information.

Devra

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Customer reply replied 8 years ago
Devra K
This is the second and last time that I shall attempt to supply additional information.

Then I would just like a refund, please.

NO...My Psychiatrist does not yet know about me taking the St John's Wort for the last month as it is classified as a low mania risk herb.

YES... my lithium level was drawn after my lithium was reduced for 7 days by 150mg per day from 800mg to 650mg 12 April 2010 being .75. Last level done.
At 800 mg per day the two previous readings were .9 and 1.1 a month apart respectively.

I am seeing the DR on 6 July '10 when another level will be done if it falls within 12 hours of my last lithium dose.

Kind regards
Lynne

Health Professional: Devra K, Nurse replied 8 years ago

Dear Lynne,

This is the first I have seen a reply from you, I apologize for any inconvenience. Your deposit will not be released unless you accept my answer.

Lithium is the gold standard for treating Bipolar disorder. The therapeutic level for lithium is .8 to 1.2 depending on the lab that runs your tests. You may be more sensitive to lithium and your levels bear a close watch to keep you at a therapeutic level without toxicity. It is possible for the doctor to have you alternate 650 mg with 800 mg to keep you at a therapeutic level but not toxic.

You have stated that you have signs and symptoms of depression, yet the doctor is concerned that an antidepressant may make you manic. While that is possible, I believe that you are well educated about your illness and savvy enough to be on the look out for how mania presents itself in your case. A trial of a low dose antidepressant to me would certainly not be out of the realm of possibility. However, St John's wort can take up to a month to see results in cases of mild to moderate depression and perhaps in your case, it may take a little longer. Since you are not seeing your doctor for another few weeks, my suggestion would be to continue the St John's wort, monitoring yourself for signs of a lessening in your depression. When you see your doctor next month and you are still feeling depressed, you can tell him that you tried St John's without effect and that you would like to try a low dose antidepressant. And like the lithium, you can try taking the antidepressant on alternate days to prevent mania.

It would be helpful that you advise the people around you to watch for signs of mania, should you doctor agree to a trial, just in case you do not pick up on the first subtle signs. You are probably aware that although you are being treated, an exacerbation of bipolar is possible despite the best of intentions on your part and the use of lithium. It is just the nature of the disease.

I wish you the best of luck with this issue. Finding a good balance in your mood may take some time but I think anything is worth a try for you to feel good.

Sincerely,

Devra

If you have found my answer helpful, please click Accept.

If you have any questions, please ask as your question remains open until you are satisfied.

Feedback is appreciated.

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Customer reply replied 8 years ago
Thank you Devra for your polite and cautious feedback.
I would appreciate a more definitive answer with names of anti-depressants which have been successfully used on Bipolar 1 patients suffering from depression. I HAVE NEVER TAKEN AN ANTIDEPRESSANT. Maybe I am naive in thinking the States has progressed further in this field than South Africa.
Some additional personal info will possibly give you greater understanding of my hesitance to accept general suggestions and opinions.

I have had severe adverse reactions to sulpuride, sodium valproate, tegretol, risperdal etc. My Dr plans to put me on ANOTHER mood stabiliser ? if the increased. Lithium does not alleviate the depression !!!

I understand there are no guarantees with antidepressants for me either.

Dainippon Sumitoma Pharma America INC in NJ are presently doing research / trials on lurasidone to compliment Li in Bipolar 1 patients. I volunteered to help myself and others like me but their consent form makes your Medical Aid or you responsible for costs if things go wrong. My history of adverse reactions prohibits me from taking this risk.
Look forward to hearing from. Please be kind enough to pass this on to an MD if it is beyond your field of expertise.
Kind Regards
Lynne
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