Q:  Spironolactone & Increasing Lithium

Sorry in advance for this lengthy missive.  I have read the information regarding hormones and mood with great interest- I have been diagnosed with PCOS for six years and with Bipolar disorder for two (but both were misdiagnosed since puberty- I am 31).  I have dreamt of one majic pill that would "fix" me.  But...   In the meantime, I have been taking Metformin for six years and my mood cycles have sped up and gotten more severe since then so I cannot be part of the positive research results.  Depression has been pretty persistent for the last five years but am currently switching Lamictal for Welbutrin (and also take Lithium 600 mg- level about .7).

Finally my questions...  I have been taking spironolactone for 6 years along with the metformin and my androgen levels have decreased substantially- I think they are about a quarter of what they were when I started treatment (DHEA and free-testosterone).  Both are in the "high normal" range but, is it possible that these levels are too low for me and causing more depression?  I would stop taking it if it would help although it has helped with the PCOS cosmetic symptoms.   I also wonder whether there would be any efficacy of increasing my lithium level to combat depression?  I don't know if I could handle more without toxic symptoms (especially with the spironolactone) but, would be willing to try if it would stop the ride!  Thanks- again, sorry for the LONG question....
 

Dear Ann --
That's a very specific short question, on the relative scale of things, and I appreciate the "chock up one more on the negative side" note re: metformin and mood symptoms.

In general we commonly see lithium have stronger antidepressant effects when the level is closer to 1.0 than to 0.7. And, as you anticipated, people also get more side effects up there. I looked for reports of problems combining lithium with spironolactone and found only an old report saying they might synergize, that might be worth looking up using your local librarian: Gillman. As you've probably figured out, if you change the spironolactone dose while you're on lithium, check your lithium level.

Dr. Phelps

Published September, 2004