Brian's Take on Lithium

Lithium and I are old acquaintances and, recently, friends. I was diagnosed
with BP 1 in 1989 at the splendidly hormonal age of 17. After much
resistance because of how manic I was, I finally decided I was really,
really sick because of hallucinations, sleeplessness, and a general feeling
of "OHSHITOSHITOHSIT!!!!! things are most definitely NOT okay" some 9 weeks
or so after my general fractioned made the call.

In 1990, the only meds in use for bipolar disorder were Lithium and
Tegretol. Carbamazepine was used for folks who were treatment refractory to
Lithium, meaning that Lithium did not do the job. I have heard that some
65% or so of folks with bipolar disorder are responsive to Lithium and that
those of us who are probably are genetically so inclined. Lithium was a
wonder drug for me because of the simple fact that I had no manic or
depressive episodes at all during the period from January 1990 until when I
quit Lithium without anyone's knowledge in June 1995. Like most folks who
take the standard dose of Lithium typically prescribed back then, I quit
because of the side effects and what I perceived to be a dulling down of my
overall quality of life.

Lithium is a salt, therefore the most noticeable side effect is dry mouth,
excessive thirst and a tendency toward rapid dehydration requiring 2-3x as
much water as any other comparably sized person. This is also known as an
anticholinergic side effect. Other ACH side FX include constipation,
blurred vision, urinary retention, memory impairment & confusional states.
Blurred vision and mild hallucinations are a sign of Lithium toxicity, as
are the confusional states. Constipation is a typical side effect of
Lithium that usually goes away after one gets used to it in 2-4 weeks or so.

Lithium causes tremors in one's hands, around the eyes, mouth, and toes. It
sometimes is so bad that tying shoe laces and threading needles become
difficult. This is an example of an extrapyramidal side effect. Most EPS
are associated with antipsychotics and include shuffling gate (the
"Thorazine Shuffle" as in the Gov't Mule song and on psyche wards), muscle
spasms, tardive dyskinesia (a serious long-term irreversible muscle spasming
condition), stiffness/rigidity and the ever-vexing problem of flat affect.
That's right. Feeling flat is a real side effect of many meds and qualifies
as extrapyramidal. I had the shakes for a few years and while they subsided
some, they never really went away. It made me look rather spastic most of
the time. I also had flat affect for much of that time. Sure, I'd feel
things and emotions, but not as intensely and not at certain hours of the
day. Any time I went on Lithium Holiday for a day or several, the flat
affect would disappear quickly. This made the decision to quit temptingly
easy in the end.

From 1990-1995, I was on 1800-2100 mg of Lithium. I am 6 feet tall and back
then around 210 or so. That dosage gave me a blood level of about 1.1. The
target range has typically been and, in general, still is 0.9-1.2. The range
falls just short of toxicity and seems to be the way all psychiatrists go
about prescribing Lithium in the U.S.

After quitting Lithium in 1995, my pdoc told my mom "prepare yourself, it's
just a matter of time before Brian gets sick again, most likely manic." He
was absolutely right on. I hung in there for about 8 months, but my manic
potential is limitless and it returned with a vengeance. I became floridly
psychotic in a vaulting mania for about 10 weeks, maybe more....my memory
has holes blown through it from the experience. After that 2d
hospitalization and subsequent crash into deep depression, I swore I'd never
quit meds again, ever, because the consequences for me are dire.

In the late summer of 2004, I started rapid-cycling again even though I was
faithfully taking Lamictal and Seroquel. This was the 3d med combo for me.
6 years of Depakote disintegrated into major depression in 2001-2002. A
new, brilliant pdoc helped me find a new treatment. I wasn't willing to go
"backward" in my treatment by taking Lithium. Lamictal & Seroquel gave me
the highest level of functioning I'd ever known, but their
effectiveness--probably the Lamictal's--waned and fizzled altogether by Fall
2004. I went to a Naturopath and tried a wide variety of vitamins along
with fish oil and other stuff. 2 months later and things were actually
worse, though the fish oil did work for a short while. Meanwhile, I tried
adding Lexapro, increasing Lamictal, upping Seroquel and adding Topomax.
The Lexapro made things worse according to my current pdoc who is a research
teacher at Dartmouth Medical School in NH. I fired my previous pdoc because
I felt he was clueless and unhelpful. I asked about Lexapro, he said "that
could work," we tried it, I improved in the immediate term but worsened
significantly in the middle term. I tried the other stuff to no avail.
Topomax made me unable to do anything without forgetting what I was trying
to do.

In late December, I was desperate. The problem was that I didn't know where
to go to. There are new meds like Gabitril, Zonegram, Keppra and others. I
guess I could have tried them. However, it dawned on me that Lithium never
stopped working 10 years ago--I just quit it. Could it still work again? I
phoned the pdoc who helped me in 2001 where he currently works at the
National Institute of Mental Healthy (NIMH). Like I said, the guy is
brilliant. He said "new research and data from Europe show that things are
not as they seemed with Lithium. Folks there are using it at a blood serum
level of 0.4-0.8 with great success, comparable to the higher doses, but
with significantly less side effects. Moreover, after cessation of Lithium
treatment, it has been shown to work again when treatment is resumed."
Previously, the general thinking was that it wouldn't work again if a person
quit it. That's why I was prescribed Depakote in May 1996.

I have a Durable Power Of Attorney document. In it, I detail what is to
happen if I should get sick with bipolar disorder to the extent where I'm
unable to make decisions for myself. I give treatment preferences, among
other things. I wrote that if things get out of control and none of the
newer meds work, that I am to be given Lithium. After talking to my old
pdoc down at NIMH, I decided to take my own advice.

Predictably, my current pdoc wanted to put me on the same dose I used to
take. I refused and asked for half that. Instead of a 1.1, my current
blood serum level is around a 0.63. It's time for me to get a new one.
Here's the clincher: I stopped rapid-cycling almost immediately. I have
not had any major episodes in 7 months. My hands shake only when I am
really dehydrated. I do feel thirsty more of the time than before, but hey!
Lots of water is good! I generally feel about the same as before. I've put
on maybe 10 pounds, mostly because I haven't been as active as before. I
feel things. I am more tired than before, but it is something I must get
used to.

I know people who have been stable on Lithium for 9, 15, 22, even 35 years.
I was stable on it for 6. Every med I've tried since has failed in less
time. If I can have another 6 years of stability, maybe I can have 30 or
more. The side effects of this dosage of Lithium are annoying at times, but
certainly not enough to wreck my life and, as such, are far more preferable
than the hell I've just gone through again that really did wreck my life.
Lithium has put my mind back together again and allowed me the chance to put
my life back together again also.

One last thing that's important here is that I have become a food snob. I
am strict about ingesting things that are all natural and organic whenever
possible. I live in a good place for that as Vermont has no shortage of
places to get organic food. Of all the prescription medications out there
for bipolar disorder, Lithium Carbonate is as simple, basic and natural as
one can get. It is not organic because Lithium is an inorganic salt. It
does, however, comprise numbers 3 and 6 on the Periodic Table of Elements
with Lithium and Carbon, respectively. That's it! No weird sounding
chemical additives. Lithium bubbles up out of the ground in hot springs
the world over. My ptherp has bipolar disorder type-2 and has visited one
of these springs in New Mexico, way before she stabilized on the meds she
now takes. She told me that it "mellowed her out for about a week after
soaking in one of the springs."

There is the entirety of what I know about Lithium. I hope this is
helpful!!


With Balance,
Brian