2Qs: Slow-release Lithium : Does BP Change Over Time
First, I absolutely love your site. I was directed there by Psycho-babble,
and consider it to be a hidden treasure of information for me. I do,
however have a couple of general questions.
Does bi-polar disorder and its presentation change over time? It seems
that since I was a child to now (mid-30s) the episodes have gotten longer, more
pronounced, and more severe. Is that common?
Also, I am having a hard time getting on the right meds (tried all the standards
by now and am now attempting Topomax, but am not going to continue). I
read on Psycho-babble about lithobid, the slow-release form of Lithium, and they
had said it had fewer side-effects than regular Lithium. Does that mean
the toxicity risk is reduced as well? What are the data on that or can you
direct me to a site with good information on that particular med?
Thank you so much for your efforts into this and your personal site. You
are touching many lives indeed.
Dear Ms. D' --
Thanks very much for the feedback and the encouragement -- it helps a
1. Does bipolar disorder change over time?
Unfortunately yes. Not in everyone, but in many, perhaps most. It
gets more severe, often: more frequent episodes and more severe
2. Does slow-release lithium decrease the likelihood of
toxicity? Well, not exactly, but sort of: it probably decreases
having little "peaks" where tremor might be worse, or even unsteady
gait or confusion, if a person is running a very high level like 1.1 or higher
(I had one patient show this pattern with blood levels repeatedly confirmed
right at 1.0). If a person is into serious toxicity levels like 1.5, the
slow release pill probably doesn't offer much protection; maybe a teeny
There is interesting data to suggest that the long-term
negative effects of lithium on kidneys, which is to be worried about in people
who need to keep high levels like 0.9-1.1 for many, many years, might
actually be lower in people who take immediate release lithium once a
day. It's as though it's better to see a peak and then see lower
levels at some point in the day, for that issue. So that's why the story
More info' on lithium: umm, I'm thinking where
I've seen a lot of good stuff in one place. Nothing great (the Madison
Institute has a brochure but you have to buy it; it's pretty good, but I'll be
you know 80% of it already). Maybe the master textbook from around 1990,
which sounds dated but lithium's been around since 1947 as a treatment, so there
isn't that much new: Goodwin and Jamison, Manic-Depressive
Illness, in your nearest medical library or ask you local librarian about
how to get it on loan? I haven't read the lithium chapter but Goodwin is
"the man" on the subject. There was supposed to be a new edition
out sometime soon or recently, too. Or you could try just searching
Goodwin F and lithium...
Published May, 2003