How do you make a decision to stop/start a med your pdoc has prescribed?

[imsosad]

I'm still taking wellbutrin and lithium, just upped the lithium to 900mg. I haven't noticed a big difference in my depression with the addition of lithium. I do feel some "distance" from situations but the last few days have seen the return of tears and feeling useless and hopeless. I am still experiencing tremors/shaking in my hands, arms, legs, mouth. I asked the pdoc and she said it only causes slight tremors in the hands. I didn't feel like this before I started the lithium. I have upped my water intake and it doesn't seem to help. Sometimes it's so bad that I feel like I can't stand for any time, feels like my legs will not hold me.

So has anyone told their pdoc that they are going off a med when the dr doesn't believe they are having side effects? I know we are supposed to be able to refuse any treatment but does that label you a difficult patient or someone who doesn't want to get better?
I've been on this med for 2 months, I know that may not be enough time for it to work but I really hate these side effects.
I hate confrontations now and maybe I'm wrong....but then again maybe I would find it easier to be wrong than to argue with the doc...help....

[dave]

On several occasions I have told my pdoc that I want to stop a specific med because of unacceptable side effects. He has never challenged my decisions.

[paul m]

Hello Imsosad. You have come this far, so I would suggest that you ask your doc what the maximum amount of lithium that you should be taking( there is a formula) and then get him to prescribe that or at least work up to that very rapidly. Once you are at the max, you will know within two weeks whether or not your depression is better.

Your doctor has taken far too long to get you to 900 mg, he should have had you at that level within 2-3 weeks, assuming that you could get in for the blood work that would need to be done. Once at your max you will know within two weeks if it is working or not. Then you can make an informed decison on whether or not it is the med for you. Lithium is very easy to quite.

But to answer your question, I've quit a med (quite a few) due to the side effects. Some shrinks have no problem with this, others do.

Lithium side effects due subside. I take up to 1800 mg daily and I still shake some, but not nearly as much as I once did. I also have dry mouth, but those are the only two major side effects that I have left. Take Care. paul m P.S. 900 mg may be the maximum that you can take, it all depends on your weight and metabolism

[astronaut]

Hi imsosad,

I've never been on Lithium so I can't say anything about it in particular. I will say that I have told my pdoc many times that I needed to quit a med. Sometimes I wish I had of done so much, much sooner. Yeah, sure I need to respect the pdoc and give their suggestions a try if the pros seem to outweigh the cons BUT, I deserve respect too and I want my pdoc to see that I take my body and my treatment seriously and I am not going to just swallow pills like skittles and let the doctor tell me that they are working even if I feel sicker.

There is no sense fooling yourself or the doctor that a drug is working when it isn't. It is expensive and a waste of your time when you could be trying other drugs or methods to make you better.

Two months does seem like a long time to build up on a med. The only med that I ever took that it took a long time to raise the level to the therapeutic dose was Lamictal, because if the dose is raised too fast, there is a much higher risk of contracting a serious skin/blood pooling rash that can be fatal.

As long as you are respectful with the doctor and talk about what you are willing to do and what you are willing to tolerate, then the doctor should respect you for your choice and help you look for another solution.
Good luck with everything,
astronaut

[higgs_boson]

Imsosad,

I know this probably will sound a little too obvious, but be honest about your medication and its effects in front of your doctor. Avoid bringing up a confrontational tone, instead try reasoning by explaining yourself (clearly state the facts, for example "I'm not tolerating lithium because of the tremors, I can't even stand properly sometimes, ...", basically just what you did on this forum). I sometimes feel that we as patients tend to be too compliant (not that it's a bad thing, but it should have its limits in my opinion).

Also, you said you'd rather be wrong than to argue with your doc...listen, there's nothing wrong in having a conversation with your doctor, a well balanced and two-way conversation. Do not let your pdoc entirely direct your treatment, have the ability to give suggestions, do not hesitate and be upfront. If you don't say something, they will most likely make assumptions based on their observations. You must properly convey your experiences in order for them to properly make the correct observations so that they can correctly assess the situation.

Good luck!

[imsosad]

"be honest about your medication and its effects in front of your doctor. Avoid bringing up a confrontational tone, instead try reasoning by explaining yourself (clearly state the facts, for example "I'm not tolerating lithium because of the tremors, I can't even stand properly sometimes, ...", basically just what you did on this forum)."

I'm going to write all the symptoms down and how they affect me. I think this will help me approach the dr as a conversation instead of me fumbling around for the right words and sounding like an idiot. Paul, I'm going to take your suggestion and ask her what is the maximum dose and if I can go right up to it. But I have decided to also tell her that if the symptoms get worse, I want off it. I also haven't had any additional blood work since I first started it so I think I have to ask about that too.

I get so frustrated that things like this that shouldn't be a big deal take on epic proportions. Where did that person go who could ask the questions, make decisions?

Thank you all for the help.

[paul m]

Hello Imsosad. You really do need blood work after every dose change and on a regular basis after that (every 2-3 mths is suggested) . The reason for the blood work is that lithium can affect several very important body functions( thyroid gland for one) and too much lithium is very harmful. The regular blood gives us lots of notice before permanent damage is done.

While the docs do have a general guideline to go by this can be dependant on how good our body is at metabolizing the lithium. The formula is 15-20mg per kg of body weight. That is a 50 kg person (110 lbs) could take between 750 and 1000mg daily. It is only a guideline, not a rule.

To little lithium, as determined by a blood test, is worse than useless. It has no healing powers, but it does have the power to cause lots of side effects.

Everyone who takes lithium should have at least the following checked whenever they get bloodwork done. Lithium levels, creatine (kidney function), TSH (thyroid). Some docs don't do this, they just ck the lithium levels.

Good Luck and I hope that you feel beeter soon. Take Care. paul m

[A.E.V.]

thankfully my pdoc knows how sensitive I am to these meds, so if I say I need to come off for reason xyz, he does not stop me... in fact, he will suggest coming off and trying something else!

it's not always been that way between my pdoc and I, he used to be more of the "I have the certificates, therefore I know more than you do" type of attitude.
but when he saw I was educating myself with the meds and their side-effects as well as their effects on me, and started to be honest and open with him, then he changed attitude completely.

hope this helps, because I know how frustrating it is to take meds and only feel side effects and nothing positive!

[imsosad]

Paul,
Is that formula for anyone on lithium? Just looking around on the net it seems like people with bipolar take a much higher dose than people taking it as an add-on for depression. I guess that will be one of the questions on my list.

[astronaut]

Hi imsosad, good idea about writing down all the side effects and symptom changes and any questions you have. That is a great way to start.

Anne, that is great that you and your pdoc have had an evolving relationship which has enabled you both to respect each other. Great work on your part for being educated and honest about your experiences on the meds!

astronaut

[paul m]

Hello Imsosad. You ask a good question in regards to lithium and uni polar depression. Lithium has became a drug that the doctors try as an add on for depression. It really doesn't have a high cure rate for those with depression. However, while the short term side effects suck, it's a relatively quick and easy medication to try to see if it works.

I refer you to, two articles below. Both are reputable studies and both deal with lithium as an add on. It might be noted that the articles were published in 1999 and 1995 and there are studies going back to 1968 in regards to lithium as an antidepressant agent for unipolar depression. There are newer articles, but both of these explain it well.

""""Both of these articles state that results should be seen in 4 weeks or less. That is the most important point. If lithium is going to work as an add on it works quick( once up to a working dose)""""" There is no point in suffering from lithiums side effects if it's not going to work.

One article states that we should try for a minimum reading of .5 and the other article suggest a range of .4-.8mmol/l .When you see mmol/l that is just a unit of measurement of something in our blood. You will see lithium levels reffered to as so many mmol/l.

It is of course best if we take as low a dose as possible and I have seen some people take only 300mg of lithium daily. However it would appear that the amount of lithium that you are taking is doing very little for you

One other explaination why some people appear to take less is that extended release lithium is not very common in Cda, but very common in the USA. With this type of lithium a lower dose is needed. The side effects also tend to be less, but it is hard to come by in CDA. Lithium citrate used in Europe requires an even lower dose than our commonly used lithium carbonate. I hope this helps. Take Care. paul m

http://www.ncbi.nlm.nih.gov/pubmed/10505584

http://apt.rcpsych.org/content/1/4/102.full.pdf