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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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Therapy and Weight Loss October 26, 2009

Posted by Crazy Mermaid in Therapy.
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I never would have voluntarily entered counseling in a million years.

However, my release from the mental hospital was conditioned by a contract I had to sign before the hospital would release me. The Least Restrictive Treatment (LRT) contract between the State of Washington and me required me to attend weekly therapy sessions with a Licensed Mental Health Counselor. Michelle, my caseworker at Fairfax, selected my therapist, Beth, and made arrangements for my first therapy visit to occur three hours after my release from the hospital.

Walking through the door of my new counseling office, I was very wary of the arrangement. Still psychotic, I didn’t believe that I belonged in therapy. Therapy was for screwed up people, and I clearly wasn’t one of those. I was perfectly well. But rather than return to Fairfax, I resigned myself to going through the motions of therapy.

It turns out that my therapy has had and continues to have surprising benefits. Who knew that my lifelong battle with my weight and food started at a very early age, and is the root of my personal battle of the bulge?

My battle with food is getting more interesting the more therapy I have. The therapy allows me to put my food battle in perspective, something that has eluded me for the past 50 years of my life. It never dawned on me before I started counseling that I could put a pattern to my personal battle of the bulge.

Talking with my therapist continues to be valuable.  With the increasing trust in my therapist comes knowledge. The little girl in me is starting to understand that everyone has food calorie limits that aren’t dictated by others. Regardless of whether I felt starved as a little girl, there were always caloric ceilings to adhere to or I gained weight. The laws of physics apply to everyone, including the little girl in me. As adults, we’re free to live on our own, with rules and regulations acquired independently.  But certain things never go away. No matter what the circumstances, there is a limit to the number of calories we can ingest each day before gaining weight. In my case,  1950 calories a day is what  my body needs in order to perform at the optimum level. Any less and I lose weight, and any more and I gain weight.

Recently my therapist has been guiding me through some exceptionally difficult therapy. With that difficult therapy has come an ever-expanding girth.   In the three months of exploration of certain things in my life, my stomach has expanded about 3 inches because of the enormous number of calories I have been taking in. One of my ‘go-to” comfort foods is dark chocolate. During my intense therapy sessions, I have been allowing the little girl in me to eat as much and whatever she wanted, understanding that it was part of the therapy process. Chocolate chips are my comfort food, and I need to have unlimited access to them in order to get better.  I understood on an intellectual level that my body had daily calorie limits.  But the little girl inside me has been fighting those caloric limits as if they were imposed by people rather than the laws of physics.

I’m finally reaching a landmark in my therapy, where I am beginning to internalize the fact that caloric limitations area caused by the laws of physics. They aren’t administered by others. With concept comes a new approach to food. I’m not saying I’m skinny or even that I’ve started to lose weight. I’m simply coming to terms with the laws of physics. That, after 50 years, is a major accomplishment.