Is it worth trying lithium?

[Aridane]

Newly registered and first post. Please bear with me.

Back in 2004, I was diagnosed with bipolar disorder (BiPolar II). I did not then really believe the diagnosis - and it is only this year that I have accepted the diagnosis.

I have had three 'episodes' in my life - hypomania, followed by depression - in 1997, 2004 and this year. So far, the hypomanic episodes have been treated with antipsychotics, and depression with antidepressants.

I find it difficult to ask for help. I only told my sister about the bipolar diagnosis this year. I am ashamed about the diagnosis.

I am currently depressed, and after a couple of months of putting up with it, went to my GP and am on my third day of fluoxetine. (Previously have had sertraline - which didn't really seem to lift the depression).

When I saw the psychiatrist earlier this year, following a hypomanic episode, he suggested lithium as a possibility. However, I said to him that I though lithium disproportionate for what were only three episodes in 50 years - and he said that was fine, and I could be treated with antipsychotics (olanzapine) for hypomanic episodes, and antidepressants for depression.

However, I just feel so bleak and hopeless. I am just wishing my life away. When I wake up at weekends, it is with disappointment that I am awake and have to start the day. Would prefer to sleep my life away. Having now accepted the diagnosis, I have a sense of dread that I will never be back to normal, and have lost a sense of who I am.

Anyhow - enough of the self-pitying depressive ramble.

I was wondering whether I should re-visit my decision not to move on to lithium. Is there anyone here with BPII, with infrequent episodes, who is on lithium? Do you take it for life? Does it help with depressive episodes, or only with hypomanic episodes?

Just lost and miserable.

Aridane, I'm really sorry that I don't have any answers for you (I came over here to seek advice), but I wondered if you are still in contact with your psychiatrist, and whether it would be worth returning to them for depression help, rather than the GP?

I'm relatively new to psychiatric care (since April), but at the moment, the GP is communicating with him, and isn't giving me anything for any brain stuff without checking with him first.

It really sounds as though you need it all connected up.

But like I say, I'm a newbie to anti-psychotics.

I've only seen the psychiatrist once - my GP knows me better (15+ years), and picked up on mental health issues during my first two 'episodes' - when I went to see her about other, physical-health related, issues.

I guess as a starting point I should discuss lithium with her (I see her next Wednesday).

Sounds silly - but lithium just seems such a stark admission that I have a major mental health problem, whereas anti-depressants don't seem such a big deal...

That seems fair enough. The only reason it popped out at me is that I can't take SSRIs. I never have been able to as I react peculiarly. When we discussed the bipolar thing yesterday, the psych said 'that explains the SSRI reaction. Often bipolar people don't respond well to SSRIs'.

Now I grant that this is hearsay based on an offhand remark from one psychiatrist, but I wonder whether this is sort of specialist information that the GP might not know (if it is actually a problem and not me getting the wrong end of the stick).

If you're concerned about the lithium, perhaps another answer might be to ask about a different form of anti-depressant; a triclyclic or tetracyclic as some sort of next-step. But yes, I'd suggest that discussing again with the doctor might be the best way forward.

And once again, I don't feel best placed to offer advice - I know nothing about this. It's just having heard that just yesterday, it stuck out from your post, and I thought there was probably no harm in saying.

I'm fairly new to Bipolar also and anti-psychotics - they way it has been explained to me by my Psych is I will stay on what ever medication works for me for 12 weeks at least, then depending on how I am he will cut me down and see how my mood goes, he did say I might be on medication for a while but it's all down to how I react, or my mind reacts to coming off them.

I've been seeing him since June and we have yet to find the medication to slow down my racing mind.

I think you should tell your doc how you feel and maybe get a re-referral to see the Psych team?

I completely forgot to say the thing that I'd have said prior to becoming bipolar obsessed: 6 days is not long enough for the SSRI to take effect. Before you try any other changes, it's worth waiting for 6 weeks or so for it to kick in.

But like I said, my mind has moved onto bipolar like it's got the all the secrets of the universe wrapped up inside it. Forgive me; it's, well, y'know...

As has already been said people with bipolar react very differently to antidepressants than other people. One of the very best things I did for my depression was ditch the anti-d's and just take a mood stabaliser / anti-psychotic (in my case quetiapine). Now if I be depressed the dose is increased and it sorts out my depression very quickly.

Obvious,y everyone's different but it might be worth you thinking about it. You'd do better to see a psychiatrist though.

As for lithium, it didn't help my depression at all. I still took quite a hefty dose of venlafaxine with it but had I dropped the venlafaxine back then maybe it would have done. Who knows?

Lithium helps me when I am depressed. It does not cure it but makes it less severe. I suffer mainly from mixed states. Lithium has side effects like tremor, weight gain and it can cause thyroid problems, all of which I have :(. But not many meds work on me.

Hi aridane. Firstly I want to acknowledge your bravery in coming to terms with your diagnosis of bi polar, it must have been very hard and well done for confiding in your sister it is so important for you to have support of your family. I don't have bipolar but have worked in mental healthcare for over 20 years and this includes working with people with bipolar. My experience is that many people are anxious about starting lithium and with you only recently being able to come to terms with your diagnosis it must seem as though this is another massive hurdle to overcome. I would arrange to see your psychiatrist and don't be afraid to ask for another one if you don't feel comfortable or confident in their way of practice, it is very important that you have a therapeutic relationship so that you can get the best of care in the good and the difficult times. There are other options in relation to mood stabilisers not just lithium, sodium valproate is one that also can be used for bipolar, your psychiatrist should be up to date with all treatment options and this is why it is important to discuss all the options and make an informed decision based on what is right for you.
I hope you get the answers you are looking for and keep well. Best wishes.

Thank you all for your responses - much appreciated