2Qs: Slow-release Lithium:Does BP Change Over Time
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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.

God bless,
 


Dear Ms. D' -- 
Thanks very much for the feedback and the encouragement -- it helps a lot!  

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 episodes.  

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 bit.   

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 is mixed. 

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...

Dr. Phelps
 


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