I'm new here. Well, I'll start with a bit of a background. I have bipolar (been told type 2 and one psych said type 1, I'm going to go with type 2), ocd and social anxiety. I've probably seen 20 psychiatrists in 5 years so that's quite a lot in such a short time frame. I stopped seeing so many because they always made my health go downhill more so by putting me on medications that made me worse, a lot of the times much worse.
I probably am treatment resistant in a way though and I do know for sure that I am very sensitive to medications. One medication (lexapro) almost literally killed me by giving me severe akathisia for six months after I only took two tablets of it. It almost literally killed me because I really wanted to kill myself from the severe torture of what severe akathisia does to the nervous system. Anyone who knows about severe akathisia will understand what I'm talking about. I only ever slept a few minutes every few nights for those six months except when I was thankfully given stilnox - a godsend at the time to finally sleep more than a few minutes until it pooped out on me.
Anyway, the new psychiatrist I'm seeing (well actually I need to type that I'm seeing two right now, I wanted a spare one incase I wasn't happy with the new one!) Infact I was even going to see three at the same time just in case. Well the first new psychiatrist I saw did what I asked and put me on lithium. I wasn't expecting she would use such low doses though. I was put on 250mg for two weeks and I've now been on 500mg for two weeks.
I'm not even sure that I will go up from that because the new psychiatrist is so softly spoken and has a bit of an accent that I don't know what's going to happen with the lithium dosage. The second new psychiatrist I saw (spare one just in case) said she still wanted me to just keep taking 500mg and never mentioned it ever going higher. I could understand what she was saying. However, I didn't tell this second psychiatrist that I'm sensitive to medications but for the first psychiatrist I gave her a very long list of all the bad side effects I've had over the years to various meds.
I'm going to keep seeing the first new psychiatrist. I know it seems like I should keep seeing the second psychiatrist because I can understand her much better (my anxiety though makes it hard to listen to her consistently) but the problem with her is that she won't allow my mum to come into the sessions with me, and with my anxiety in general and my social anxiety I find it hard to concentrate and I want my mum with me for comfort reasons and also to debrief after the session to see what the psychiatrist has said because a lot of the times I just can't take much of it in because of my high anxiety levels. My mum said she can understand the first psychiatrist I saw, that's good but I can't but I'm just so sick of seeing new psychiatrists. I'm hoping when a medication starts working for me that I'll be able to concentrate a lot better and then start undertanding the first new psychiatrist properly.
As for my questions. Is anyone just on 500mg of lithium for a maintenance dose or otherwise? I can't imagine that it can be a maintenance dose being so low a dose. I did catch the first psychiatrist say that because I'm depressed that I should start at a low dose of lithium otherwise it would make me more depressed to begin with. I did very clearly hear that part. Has anyone else been told that lithium at standard starting doses causes worsening depression to start off with if they are starting the initial standard doses when depressed? By the way no-one has taken my blood levels yet (it has never been ordered) and I'm still depressed and anxious and the two psychiatrists know that I'm depressed and anxious still.
I understand with my sensitivities to medications that the first psychiatrist wanted to start with a low dose. But it just seems too low and staying too low. I'm running out of patience so that's why I'm wanting to know if other people have been through the same thing of waiting so long for lithium to get up to strength?
Thank you so much to anyone who helps with my questions.
Last edited by Lightbeing82; 03-13-2011 at 03:11 AM.
Well welcome to the boards and hope we can off some advice that will help you.
I've had BP for 22 years and have gone through many cycles of Lithium. I use it for a while every couple of years because it works really well for me, unfortunately I have some conflicting medical conditions that do not allow me to take if for too long at one time.
First off, and let me say I'm not being judgemental here, but the idea of seeing multiple pdocs at one time, is never a good one. You will literally drive yourself nuts trying to listen to all of them, believe in all of the, trust them, and know that they have your best mental/medical health in mind. And to have a good relationship with you pdoc (which is key) you have to be able to do all of these things. You really need to get it down to 1 pdoc and stay with that pdoc. I've had the same pdoc for 6 yrs and trust him with my life, and it has come down to that a time or two.
Second, 500mg is not necesarrily a low dose of Lithium, it all depends on the body chemistry and what works for you. Are you getting benefit from this dose, is it controlling the BP symptoms? If so, then why worry about going up? When dealing with BP meds you can't always go with the literature saying what the proper dose should be. These meds depend on how the patient responds to them, what other meds your taking at the same time, things like that etc. I've been on doses as low as 100mg, that helped me greatly, and doses as high as 1200mg. My "good" dose that seems to agree with my medical condition and gives me releif from the BP symptoms is 600mg.
So, this is where you just have to have trust in your pdoc, listen to your body and be aware of whether the symptoms are being releived, and overall how you feel. As you've said you are sensitive to meds, so I'm sure your pdoc isn't in any hurry to start you on 900 - 1200mgs of Lithium....they don't want you to have any bad reactions.
Well hope I haven't sounded to preachy, I'm really glad you've come here, it helps so much to talk to other folks who deal with the same thing you have to deal with everyday. Please come back, talk to us, let us know how it's going. And anytime you need to rant or rave, we're hear. )
Thank you so much for your response. This is the first time I have seen two psychiatrists at once. The reason why I have seen so many in the past has had to do with going to community mental health centres and you don't get to see the same psychiatrist.
When I have seen private psychiatrists I usually stick with them for around 6 months to a year, one time I saw one for years and then he claimed he could tell a persons personality by their left and right eyeballs, so he told me what he thought of my families personalities from photos based on their left and right eyeballs. "The right eye says this about them.. and the left eye says this about them.." Bloody hell!! I'm not kidding in the slightest. Needless to say I didn't go back to him. It's such a shame he turned out to have such a strange and ridiculous manner about him because he was the one psychiatrist I had seen the longest. It was such a huge let down and downright shocking. I still to this day want to go back to him and ask.. what the dickens where you on about??
I wish I could say I trust psychiatrists, truth is I don't because when it comes down to it it is always the meds that I ask for from gps that make me feel more stable but unfortunately I end up going off them because it comes down to the side effects. Yet when it comes to what psychiatrists prescribe for me, then it all goes downhill from there. But I am being optomistic though because with lithium it is still early days. It however as yet certainly has had no effect on me positively, infact I have felt more down on it. But the psychiatrist did say this would happen at first but never said for how long. So for four weeks on lithium now my depression has worsened and quite a fair bit too. So I still feel down and getting worse and not better.
I think anyone who finds a psychiatrist who seems to know what they are doing have struck gold. I'll never trust psychiatrists until one actually starts making me feel better instead of worse. For some reason they all love putting me on antidepressants way too soon which make my depression worse, or put me in a mixed state or hypomanic or rapid cycle or suicidal. I don't know why they can be so stupid and put me on antidepressants so soon when I have not yet been put on a therapeutic dose of a mood stabiliser. They all seem like idiots to me and then I always end up being mad at myself for listening to them instead of my better judgement.
I'm not sure I can take anymore of this destabilising when I see a psychiatrist. I always do better without seeing them and only see them when I read about others getting better for seeing one. I don't know how on earth such a thing can happen. They all seem so uneducated about bipolar to me.
Last edited by Lightbeing82; 03-15-2011 at 01:56 AM.
I agree about the whole one doc thing. It's a shame your community mental health center is that way. Mine is smaller - there is one psychiatrist and one nurse practitioner. I see the psychiatrist because my case is a little more complicated because I have severe Bipolar 1.
I was hospitalized 2 weeks ago. I've been on a lot of stuff and had been on Geodon for about 7 months. It was controlling the mania but not helping with depression. I tried several mood stabilizers, but none of them worked.This time around I was finally put on lithium. The doc started me on 300mg once a day at bedtime. When I got out and saw my psychiatrist, he asked me "why did he put you on such a baby dose?". He asked if I wanted to raise it and I said yes, because I'd hate to wait the 4 weeks or more that it takes to see full effect only for it to do nothing because it's too low. So he raised it to 300mg twice a day.
So you dose is a little low, but you're just starting out. His plan is to probably get your lithium blood levels checked in a couple weeks, then adjust it from there. You could ask him about the low dosage and see what he says. Give it a little time at least. If he hasn't checked your lithium levels by 2 months, something is wrong with your doc.
Take the initiative though, ask your doc why the dose is so low. I like my doc because it's like a partnership. He doesn't up anything or lower anything unless I approve of it. He asks me before he does anything...Do I want to try this or that, do I want my dose raised - and he actually wants a response, it's not a rhetorical question. If I say no, he doesn't press me or get upset with me - I usually have a good reason and he respects it. If your doc is good, he will tell you why he does something, and will take your suggestions into consideration.
That doesn't mean he will always take your advice, because the doctors do know more about medicine than we do and have probably seen a lot of patients like you, so sometimes they believe they know best. But do know that they are trying to do what they think is best for you. You should have some say over what happens, and if he is a good doc, he will address your concerns.
To a certain extent, you need to trust your doctor - unless they truly prove themselves to be incompetent. Still, voice your concerns, make sure he knows. That's how you forge a good relationship with a psychiatrist. If you can stick with one doc, that would be best. Having a trusting relationship with your doctor is really important. My psychiatrist trusts me to be truthful and to take meds as prescribed, and I trust him to give me sound advice and to help make decisions that are in my best interest. He earned the trust from me by being competent, caring, and open about everything he did.
Sorry, I ramble. But I hope the lithium works for you, and do know that your dose will probably be increased. And pick a doc and stick with 'em if at all possible! It's important!
Thank you so much for your response and good advice. I'm surprised you weren't put on lithium sooner considering that you have severe bipolar 1. It seems to me that it should have been the first choice for you really. I really hope the lithium works for you too!
You'd think, but some doctors don't like it because of the blood tests and some of its possible medical side effects. It's also hard on your liver if I remember right.
I went through Depakote first, then Geodon, then Abilify, then Seroquel, then Trilafon, then back to Geodon. I'm currently on the maximum dosage of Geodon - 80mg 2x a day. I think my docs just haven't wanted to add too much on top of that.
My psychiatrist apparently thought I'd already been on lithium before. He was surprised to learn I hadn't been. He gave me a lot of warning about things to watch for medically, though.
Sorry you're having a hard time getting better. I'm severe mixed Bipolar. I take 1350 mg Lithium. It doesn't work actually. So I was given 1000 mg Depakote as well as 300mg Seroquel. I felt great then all of a sudden I gained 30 lbs...pdr thought it was the depekote and seroquel so I was weaned off and sent for bloodwork...they found a hypothyroidism which was most likely caused by the lithium. I now have a skin disorder, am 3 sizes larger, always nauseous, feel like something its in my throat, constant headaches thanks to the med that its supposed to stabilize my mood but doesn't. So higher dose isn't necessarily better.
Also people who are Bipolar shouldn't take antidepressants, they do the opposite of what theye do to people of regular depression. So your more likely to feel sad, mad, suicidal, swings etc...
I hope you get the care you need and I agree that it is best to stock with 1 dr at a time. Its do hard to get good care and to get better! Good luck!