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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
Published May, 2003
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