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Lithium March 13, 2010

Posted by Crazy Mermaid in mental illness, Mental Illness and Medication, Psychiatrists, Weight Gain and Mental Illness.
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Lithium Carbonate has many different uses, both in the industrial fields of glass-making and cement as well as in the pharmaceutical field. .  Used as a mood stabilizer, it treats the symptoms of depression and mania in bipolar disorder.

But from the pharmaceutical standpoint, there’s one giant problem with lithium carbonate: it’s almost free. There’s no money in it.  Because it couldn’t be patented (it’s a naturally occurring element), its use started in the 1870’s but died out, completely disappearing until 1949, when it was rediscovered by an Australian psychiatrist named John Cade. He got the idea to use lithium salts on mentally ill manic patients from an experiment he did on mice.  He tried it out, and it worked.  At that point, lithium carbonate (lithium salt) became the first drug used to successfully treat mental illness (again).

Unfortunately, many people died because the wrong dose was administered, or because a different type of lithium was substituted for lithium carbonate.  But through research, the right dosages were found, and we learned not to substitute one kind of lithium for another. It’s still tricky to prescribe the right dosage, though, because every patient reacts differently.

Because lithium has many unpleasant side effects, many people who were (and are) prescribed it refuse to take it.  They believe that their quality of life without medication is better than their quality of life with it, so they either stop taking it entirely, or they never start. They determine that they would rather suffer with depression or schizophrenia than lose the ability to walk or grasp anything, because by far the biggest side effect is something called ataxia.

Boiled down to brass tacks, ataxia is a lack of physical coordination.  It means that you can barely walk, and when you do you walk so stiffly and with such a shuffle that not only is it difficult to cover any ground, but anyone watching thinks you have a disease like Parkinson’s. It means that swimming or any sport is out of the question, since you drag your legs behind you like a beached whale. It means that you can’t peel a banana because you can’t grasp and hold on to objects. Many everyday tasks that we all take for granted, like opening lids and brushing our teeth, become difficult or impossible.

Running a close second behind ataxia is the tremors.  Tremors mean that your hands shake.  You can’t write because your hand shakes too bad, and you can’t use the computer because your hand shakes too much to touch the individual letters on the keyboard. Hands become almost useless when they’re shaking that bad.

Weight gain is one of the more famous side effects of not only lithium but almost every other drug associated with controlling mental illness symptoms.  Not only does your appetite increase, but the drugs also slow down your metabolism, which means that you’re hit with a double whammy, so it’s almost impossible not to gain weight on lithium. Some people gain 100 lbs, others gain 20 or 30 lbs, but almost everyone gains weight.

Those three side effects were by far the worst that I had that were lithium-related, but there were others that I fortunately didn’t experience, like alopecia (the loss of all of your hair), polyuria (loss of bladder control), and a host of others that I won’t go into here.  As if all of that isn’t enough of a problem, those side effects don’t always go away once the dosage is decreased.

Having said all of this, it’s important to note several important facts. Fact one: When mental illness is initially diagnosed, lithium is typically prescribed at a higher dose and then the dosage is backed off. Fact two: There are second generation drugs like Geodon that take the place of lithium nowadays, so sometimes lithium is never even given to a patient. Fact three: Most importantly, life with my mental illness more or less under control is so much better than life without it.

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Mental Illness and Weight Gain January 14, 2010

Posted by Crazy Mermaid in Hearing Voices, mental illness, Weight Gain and Mental Illness.
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4 comments

Fat Fat Fat

Getting enough meds in me to keep sane and yet relatively un-blimpo is quite a balancing act.

Most mood stabilizers and antipsychotics are well-known weight gain drugs.  The “big names” like Lithium, Lamictal, Risperdol, and Seroquel are all famous weight gainers.  I was on three out of four.

Because I was on major quantities of Lithium (900 mg) while at the hospital for my three week “vacation”,  Dr. K, my new (at the time) psychiatrist,  went to work on the weight gaining aspect of my medications immediately after I left the hospital, weaning me off the massive quantities of Lithium and onto Geodon, the only anti-psychotic that doesn’t cause weight gain.  The process took months to accomplish.  Because I had to be relatively stable in order to accomplish the switch, the process took longer than it “should” have, having to arrange itself around my various “falling-down” eposides.  Saying the progress was not uniform is an understatement. There would be forward progress,  then an incident that caused back-peddling, then forward progress, then backpeddling. Back and forth for months and months, until finally, *we got entirely on the Geodon. All was well for several months.

But about 6 months into the “complete” Geodon  regimen, I heard what we called “break-through voices”, which means in layman’s language that the Geodon failed to work.  So Geodon was out.  And Lithium, though very effective for voices, has too many terrible side effects, so we didn’t want to return to that, although there was no doubt that it would have gotten rid of the voices. That left some brand new drugs with fewer side effects, but those newer drugs had price tags in the $500 a month and up range (all out-of-pocket), so my husband and I decided that they were out for financial reasons.  That left Risperdol, which was an older, effective, but weight-gaining, drug.

So I was weaned off the Geodon and onto the Risperdol, which took  time. You don’t just suddenly stop taking one drug and get the effects out of your body immediately or start taking one drug and get it up to full strength immediately.  Most mental illness drugs don’t work like that.  It took several months for the Risperdol to build up enough in my system so that we could begin reducing the level of Geodon. Again, there would be backsliding while the switch was being made.  Finally, over a period of months, I was weaned entirely off the Geodon and entirely onto the Risperdol. Then it was a matter of finding out whether the Risperdol was going to work.  That was a matter of watching and waiting. Or in my case listening.

For months, the Risperdol worked just fine.  It worked so well, in fact, that we were able to reduce my dose from 1 mg down to .5 mg, and then to .25 mg, with the intent of eliminating the drug altogether in the relatively near future.   But before that could be accomplished, I had a little “bump in the road” incident a few months ago. So instead of discontinuing the drug as planned, we raised it back up to .5 mg. That was supposed to be a temporary thing.

Before we could lower the dose back to .25 mg, I had a major setback about a month ago.  Suffice it to say that the voices came back so strongly that it was back to the Haldol  (the nastiest drug in the universe)  as we contemplated a return to the mental hospital. That’s how bad the symptoms were.  (Note: There was a major trigger to the incident, so it wasn’t that the drug was failing. It was that the trigger was too strong).  But as Dr. K and I talked it over, we decided that instead of continuing on Haldol (which I despise) or hospitalization, we would triple my dose of Risperdol and see if that worked before trying hospitalization or more Haldol.   So I went from .5 mg to 1.5 mg virtually overnight.  As it built up in my system the past four weeks, the voices have gotten quieter and quieter, finally tapering off entirely about a week or so ago.  That’s all to the good. But there’s a down side to the Risperdol:  Weight gain.

Until my Risperdol was tripled, I had come to relative terms with my appetite, despite the fact that I was on all of those other weight-gaining meds, including Seroquel, Lamictal, and a smaller dose of Risperdol.   I was taking Welbutrin in an effort to combat some of those pesky appetite-increasing side effects, and it was working fairly well.  But then the triple dose of Risperdol kicked in, and I gained about 4 lb in about 4 weeks. Not good.  I saw Dr. K yesterday, and I told him how out of control my appetite is. I can’t stop thinking about food food food. When’s my next meal? How much can I eat? How many calories have I had already? And on and on and on every second of every minute of every day.  He was concerned, as am I.  Concerned enough that we brainstormed solutions.  I talked about how well phen/fen worked for me back in the mid 1990’s.  He doesn’t like SSRI’s for me because they might flip me to mania, so we settled on Topamax, at least for now. So now, we’ve added Topamax to the mix in an effort to get the weight gain under control.

Dr. K’s not thrilled about adding another drug to the mix (this will be #5), and yet we’re caught between a rock and a hard place. Trying to reduce the Risperdol and/or the other meds invites a return of the voices in full force.  Leaving the drug levels as is tips the scales to diabetes and all of the problems it entails.  So it all comes down to this: which is the lesser of two evils:  Voices or substantial weight gain?

In the end, we decided that adding that 5th  med is better than risking diabetes. So that’s the way we’re going.  The caveat is that instead of seeing me in 6 to 8 weeks, he’s seeing me in 2 weeks.  We’ll see how we do.

* I use the term “we” because Dr. K and I work together as a team. It’s not just “I” or “Him”. It’s “us” and “we”.  It’s been that way from the very beginning almost 2 years ago. I consider myself very, very fortunate.