Lithium
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- เผยแพร่เมื่อ 14 พ.ค. 2019
- Among the several available treatments for mania associated with the Bipolar Disorder, none offers a greater likelihood of improvement than lithium. This mood stabilizer often provides significant relief as solo therapy, however many affected individuals will ultimately require several drugs for adequate respose.
More widely prescribed in Europe than the United States, lithium needs between 1-3 weeks to become fully effective. The drug offers its benefits within a relatively narrow therapeutic window with toxic reactions associated with excessive serum concentration. To minimize the potential for harm, mandatory routine blood testing must be performed weekly at the onset of therapy and progressively less frequently over time.
People receiving lithium must remain adequately hydrated. Dehydration even from excessive perspiration or exercise may alter the blood concentration of lithium and precipitate a wide array of adverse reactions.
Side effects range from restlessness and sedation to acne, hand tremor, slurred speech and weakness. Among the peculiar problems associated with lithium are hypothyroidism due to decreased production of the hormone and interference with its conversion into the active form - triiodothryonine. This occurs more often in women than men.
Lithium competes with vasopressin in the kidney. This chemical, also known as anti-diuretic hormone, allows the kidney to reabsorb most of its filtered load and prevent dehydration. Lithium regularly increases urine volume which leads to thirst and dry mouth. Of course the resulting dehydration and blood volume contraction raises the serum lithium levels which in turn multiplies the possibility of other adverse reactions.
Acute toxicity focuses on the gastrointestinal system causing nausea, vomiting and diarrhea. Chronic toxicity tends to involve neurologic symptoms and may originate from causes as diverse as loss of appetite, exercise or food poisoning. Suggestive symptoms include impaired walking ability, poor judgment, altered mental state and difficulty concentrating. Hallucinations, seizures and coma may develop if the warning signs are not appreciated.
In spite of the long list of potential problems, lithium may reduce the incidence of suicide by as much as 40% in those suffering from mania. In this regard, no other medication provides anywhere near the benefit. Surprisingly in those communities where moderate levels of lithium are found in municipal water supplies, studies demonstrate a decreased incidence Alzheimer’s disease, less depression and an elevated mood.
Great video. It looks like Lithium is the best treatment for bipolar, yet it is being less and less prescribed in favor of antipsychotics. I think doctors don't want to deal with the monitoring of lithium levels.
More money in the new drugs. No patent on old time lithium.
Big PhRma wants big profits. Lithium is cheap.
@@johna5484 That isn't the reason it isn't being prescribed. Today, prescribers do NOT make money prescribing certain medications. It is even now illegal to receive any financial gifts or otherwise from pharmaceutical companies (thankfully). Instead, as a prescribing practitioner, the reason lithium is not prescribed as much is for a couple of reasons. One, pharmaceutical companies are advertising and pushing the newer medications like antipsychotics for bipolar disorders. Even prescribers fall bait to the advertising, but the reason is because of the second reason, SIDE EFFECTS. The side effects are absolutely significant and even more so than almost all the antipsychotics (second generation antipsychotics). Furthermore, the therapeutic window (0.8-1.2) is so narrow that even going beyond it just a little can be dangerous if not lethal. That means even sweating too much or not drinking enough water or taking something over-the-counter can be deleterious to the patient, who should also never drink alcohol. On that note, I don't know why anyone would consume alcohol to begin with. It is a central nervous system depressant (even one drink). It literally makes you depressed.
Also, just assume you are going to end up with hypothyroidism, which is going to leave you exhausted and further depressed and hopeless.
Additionally, because lithium has a delayed onset of action to reach its full efficacy, it often isn't the first choice in acute mania, but rather maybe used as an adjunct. I am not saying I agree or disagree with this approach. I am just stating why this is happening. Also, you can't use it for mixed mania and rapid cycling. So there is another reason.
These are the reasons why it isn't being used as much. It isn't because of money regarding the prescribers. It is certainly the intention of the pharmaceutical companies to make ridiculous amounts of money off medications, but to blame one side or another is just narrow minded.
Society would rather be put on medications than make significant changes in their life. I know this first-hand as a practitioner no matter the patient and no matter what any non-expert in caring for patients say. Some patients are willing to make some changes, but only to the extent that it is easy. Beyond that, forget it. Now, I am not blaming patients in the least. I am not blaming anybody. I am pointing out that people want quick fixes no matter the diagnosis. They don't really want to change and to really heal is to change. Otherwise, you take a medication and then you take another medication for the side effects of the first medication and on and on. Then everybody blames medicine, the healthcare workers, and the pharmaceutical companies and on and on. The pharmaceutical companies take advantage of these things. It is all just a vicious cycle.
You are speaking of things that has no basis of truth and that in itself is dangerous and extremely narrow minded.
@@landofthelostful as someone with bipolar disorder, I WHOLLY disagree with the point that lithium side effects are more significant than any SGA (second generation antipsychotic) let alone "almost all". Lithium is generally relatively safe if properly monitored and kept within the therapeutic range (or lower since low-dose lithium also has its uses and works for some patients), which it should always be.
Antipsychotics on the other hand almost always come with unavoidable, heavy side effects... The most obvious one being SIGNIFICANT weight gain (which doesn't or rarely happens on lithium, or at least not to that level) and metabolic syndrome, sedation, difficulty waking up in the morning and day-time drowsiness, anticholinergic side-effects (like dry mouth, plugged nose, etc), sleep changes (nightmares, sleep apnea if weight gain, etc), and generally not great for the liver even in healthy people... compared to something like quetiapine (Seroquel), taking lithium feels like nothing, as long as you avoid dehydration and other things that you should be avoiding anyway (like alcohol as you mentioned).
To me antipsychotics are extremely potent drugs that should, like benzodiazepines, preferably be used only for short-term acute treatment (e.g. manic episode or depressive episode adjunct therapy).
Although many guidelines may include them for maintenance, there is still less evidence that they should be maintained past the acute phase, and this is often criticized given the bad risk-benefit ratio of doing that, and the tolerance created over time that only makes it harder to get off them if needed (e.g. if a breakthrough episode happens and treatment needs to be switched), and exposes patients to withdrawal or rebound syndrome that can kick in even months later and look like another episode when it's not.
Their effect on the metabolism alone cannot be ignored and is a trade-off/risk that patients are rarely made aware of about with enough gravity beforehand, especially when it comes to maintenance.
A lot of them become more depressed after such massive weight gain. You might assume that the trade-off is worth it if it means gaining motivation back to exercise etc... but that's often too optimistic and leaves people worse off not only health-wise but about their self image. Even when the weight gain doesn't happen the sedation, fatigue and other side-effects, and just how they make you feel in general is just not ideal at all.
They are a useful tool in acute phases, but I can't recommend them at all as a first-line maintenance option. I would more readily recommend something like lithium or lamotrigine before settling on antipsychotics. When you start these outside of acute episodes, they are more likely to be good at prevention and act as passive maintenance treatments that you barely feel most of the time, with the right monitoring and hydration/nutrition (which you should be doing anyway).
Great video explaining using lithium. Doctor extremely knowledgeable.
Guy I knew back in the ‘70s took too much acid, had to go to hospital then to the crazy house. Has been on lithium and an array of other drugs since. Was a good guy, nobody even recognized him after that event.
That’s sad, I’m also very damaged from too many psychedelics
Makes me wonder what impact exogenous drugs play in current occurrence of schizophrenic-type of mental symptoms. Seems like modern street drugs, like meth, can really make things worse.
Lithium is a lifesaver , don’t like antipsychotics though
Agreed
Great video! I can only take the 450 CR tablets. My body doesnt agree with the other forms. Works great for me. Though tons of side effects.
Thank you so very much for this video..I better understand things now..I've been taking lithium carbonate for 7 years now...My regular dose is 450mg a day..I take 300 in the morning and then 150 at night. Sometimes though I have to take 600 mg a day..
1. Dose is important.
2. Dose is important according to behavioural evidence, and blood tests.
3. Dose volatility depends on many factors, as described by wellnowdoctor.
4. Loading and discontinuing should be done gradually.
5. Physical condition of patient should be taken into consideration.
6. Interaction with sodium, ACE inhibitors, and other drugs or OTC meds should be checked for their effect.
7. Blood tests and personal reports of the patient should be more frequent than once a year.
8. Age and weight may be considered.
9. Lithium is the gold standard for a debilitating and dangerous biological illness which has psychological and physical effects. It is worth monitoring with care, just like other debilitating diseases deserve and get care and monitoring.
10. Monotherapy should be preferred to combining psychoactive drugs, even though it may take some more time. If one drug is a challenge due to its complexity, two or three can rise exponentially in interactions.
Bottom line, reading some material on the safe use of lithium, and considering personal reports can eliminate many adverse effects and the risk of toxicity. This can also make the procedure of lithium treatment a much easier job for practitioners.
Thank you kind person!
Thanks Doctor, I take lithium and this discussion was very helpful.
Hello, I’m a new subscriber to you channel. You definitely know what you’re talking about, sir. I have a request: Could you please do a video on Thorazine (chlorpromazine). I have bipolar type 1 I take Lithium CR-450 mgs. bid. Though now they’re adding Thorazine 100 mgs four times a day. (Q.I.D) Nervous about Thorazine.
thanks
Thank you for such an informative video, I currently take Quetiapine for pyscosis from Bipolar 1, I am going on to Lithium in the upcoming months I am hoping it is the right medication for me, though the side effects worry me but they can't be worse than what I get from Quetiapine.
How are you doing on Lithium?
It was a life saver for my son
does a smart phone help
I'm on lithium, 900 mg a day. I have BPD & Bi-Polar Disorder. It's good but I don't like having to have to take blood levels every month or so.
I'm schizoaffective (depressive type), I've been on many antipsychotics but they work bad. Today I got lithium to try to boost my antipsychotic. I'm half very angsty about the new drug and half thinking about the nirvana song.
Love this Doctor I'm on Lithium Depakote and Klonopin for Manic Depression finally I'm getting better
Lithium Orotate may help! ❤️
Long term use of klonopin is insanely dangerous. I am almost on a year of a taper and the side effects are near being tortured slowly. It is often seen as malpractice.
Hopefully you do well or change to a longer acting benzodiazepine.
Jahid Afridi
That who put you on Klonopin is a criminal!
You may probably know what I’m talking about by now!
If you take Klonopin one time a week you’ll develop tolerance because this crap has an incredibly long half life!
Also,I don’t understand why were you put on both lithium and depakote together!? This is a prescription of death(liver+kidney)damage and you’re happy you’re getting better!!
This guy must be a genius. Recalling all facts and knowing how all drugs function in the brain and body- crazy! LOL! But helpful to a lot of people!
Teleprompters help lol
I could recall half of this stuff from memory just from 20+ years of treatment of bipolar disorder. Find yourself a doctor who actually explains what they are doing and why and doesn’t just throw pills at you
Yes Jessica! I don’t take anything, but yess! People need well educated docs!!
@clint lol I think he really does know it all
Recommendation of two books on lithium and manic-depression:
"Manic Depressive Illness"
Frederick K. Goodman
Kay Refield Jamison
Oxford U. Press 1990
"Lithium in Neuropsychiatry"
The Comprehensive Guide
Michael Bauer
Paul Grof
Bruno Muller-Oerilnghausen
INFORMA 2006
Hi, can you please talk about SAMe?
What is side effects of high level of lithium in blood ?
Lithium Orotate?
Well, this guy knows his stuff!
But I can't tell whether he's reading off a teleprompter or not. If not, he's hired! Lol.
Yes but he died btw...
I ❤ ur smile!!!!!!!!!!!
Is Lithium and Lamictal a safe combination? I read a study saying they’re not supposed to be mixed.
No it's not a good combination I took lamictal with it was a bad combo
Well that’s what I take and it’s improved my life considerably. Everyone is different and responds differently, that’s why there are different medications for the same condition. I tried many combinations before I arrived at lamictal + lithium.
It’s a good combination!!! Lamictal helps depression polo if the lithium isn’t enough
does lithium make the brain heavier?
whats the difference between lithium carbonate and orotate
Andrew James well, lithium orotate is bought over the counter and far less potent then carbonate. Orotate isn’t recommended by most psychiatrists because levels won’t be monitored. Even though orotate is much lower compared to prescription lithium carbonate though it should still be monitored.
Lithium Oritate is natural supplement and it's not monitored
Orotate is lithium bond with oratic acid which carries lithium through blood brain barrier. Lithium is mostly needed in the brain so taking low dose of lithium orotate is better choice than poisoning body with super high doses of lithium carbonate to get just a lil bit into the brain. You don't risk ruining your kidneys with lithium orotate. You only need like 5 mg a day which isn't dangerous for body yet effective for brain.
Nothing happens to the thyroid with Citrate.
I took 300 mg of Lithium once and I became so hostile and aggressive that I was punching walls and behaving erratically. Not the drug for me.
Obsessive Delusion low dose lithium did the same. Immediate release, right? The capsules? CR helped dramatically though. Currently on 900 mgs..
Not for everyone sorry it was a God send for me
Taking lithium myself. It’s been like the equivalent of unlocking the door of the brazen bull and being able to escape.
I probably would have already committed suicide had it not been for lithium.
Lithiumcitrate is perfect.
I have been taking Lithium for 38 years. Prior to that I was being treated with medication for Schyzophrenia. I am now 77. I have many unpleasant side effects
I just started taking lithium 4 days ago and my menstrual cycle is Extremely heavy. I am on day 10 with no end in sight!
I'm in my 3rd year... I plan to get off Lithium between my 5th and 8th year.
@@cheryld4437
I hope all is well. Thank God for this med, I'm glad I don't think I'm Jesus, lol.
Help
42 mg is enough 3 times a day. Litarex.
Carbonate is a posion for brain.
I have bi polar and on 1200mg of Lithium. The worse thing for me it makes me very tired.
david jones lethargy and the drowsiness sucks from lithium carbonate.
Has your doctor checked your thyroid? Lithium is often given with Synthroid as it suppreses TSH.
No that’s good stay out of the public that’s working the way it should
900 LCR here. I love love love looooooove my lithium 😂. my suicidal tendencies went away.
Do you still taking it I’m thanking to tell my doctor to put me on it I have anxiety and depression
For me, Lithium was hell on earth. I wasn’t in my right mind. I was manic, aggressive, depressed, anxious, hallucinating and had NO Sleep! Basically Hell in the form of a pill. I was so aggressive that the cops had to be called. I’m not usually so aggressive despite having Disruptive Mood Dysregulation Disorder. (DMDD)
Use lithium oratate only not the script form.
What type of lithium was it and what was the dose? I bet it was the syntethic litium carbonate form and it was a high dose as prescribed to people with bipolar disorder
It's odd that your description of symptoms from lithium are what I had when I was unmedicated bipolar 1. Thanks to zyprexa and lithium, I can function again.
Separate each medication from Litarex and tell the truth about each of the binding agents separately in several films.
Absorbtion of lithium by citrate is 100% perfect.
Lithium. Oratate not the script kind.
Sounds like a big pain in the ass.
Lithium Citrate has no side effects.
And honestly most likely an ex pharmacist. Because I can assure everyone, doctors don’t know too much about medicines and how they help, or make worse in individuals. 😉😛
Love him. A passionate research guy!
He is a Doctor. He says it in his first sentence and its written
You tell a story as a confused man telling all side effects of everything at once to make us confused.
Lithiumcitrate is not a drug. It is pure 7UP.
Hannibal is multi skilled
Drs
Bipolar ppl seem like story tellers and comedians.
Yeah, on a good day we're fun
I was intrigued how all this doctor talked about was 'people', presumably other people, people other than himself. I would say he wanted to distinguish himself as normal. But, all his face expression was a mystery to me. He was using his mouth excessively to emphasise his words. And moving his head in a rather odd way.
To be quite honest I wasn't completely sure if he was being simply sarcastic, or ironic, or whether he even believed what he was saying at all. Or whether he was trying to emphasise his point so much as to be saying 'Don't believe a word of what I am saying.'
But as someone who is actually taking Lithium and has been for decades, well let's say 'I wouldn't be making these comments to my GP, or Case worker, or CPN, or psychiatrist. Or for that matter any number of other people, because they wouldn't believe me anyway, would they? They would just be keen to increase my does of medication. It's true isn't it. But he looked to me like he wanted to exaggerate everything, very odd.
The
Lithium oratate plus Neuro. Mag. And omega 3 s. For bipolar. The organic form of lithium oratate is not as toxic as the script form. When combined with Neuro. Mag.
💯
You are not honest! Litarex is enough.
42mg 3-4 times a day Litarex. Tevapharm.