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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by sac on September 24, 2004, at 21:35:25
Hi, I recently started lithium (Eskalith CR) 450mg. at a low dose to stabilize my bipolar II. I must be having a strange reaction because, while it definately has helped to boost my mood, I am unusually overactive. I also take 20 mgs. fluoxetine. I'm wondering if the lithium is increasing the blood level of the ssri. I once became manic when I was on 40mgs. prozac/day and I sort of feel that same sense of akathisia/overactivity. Any ideas?? Thanks.
Posted by SLS on September 24, 2004, at 23:08:59
In reply to Does lithium increase fluoxetine level??, posted by sac on September 24, 2004, at 21:35:25
> Hi, I recently started lithium (Eskalith CR) 450mg. at a low dose to stabilize my bipolar II. I must be having a strange reaction because, while it definately has helped to boost my mood, I am unusually overactive. I also take 20 mgs. fluoxetine. I'm wondering if the lithium is increasing the blood level of the ssri. I once became manic when I was on 40mgs. prozac/day and I sort of feel that same sense of akathisia/overactivity. Any ideas?? Thanks.
SSRI + lithium has been known to produce serotonin syndrome, a state of serotonergic overload that might account for the induction of manic-like symptoms. It might even be an induction of mania in the absence of serotonin syndrome. I would speak to your doctor and determine how much time to give what you are experiencing to resolve on its own. It might be nothing serious. In the meantime, you might want to take your body temperature and make sure that it is not too high. Hyperpyrexia (high temperature) is one of the more serious symptoms of the syndrome.In the case that you are becoming manic in the absence of serotonin syndrome, does it make sense to treat the mania with another medication? Has your depression been resistent to all other treatments?
- Scott
Posted by ace on September 24, 2004, at 23:17:59
In reply to Re: Does lithium increase fluoxetine level??, posted by SLS on September 24, 2004, at 23:08:59
> > Hi, I recently started lithium (Eskalith CR) 450mg. at a low dose to stabilize my bipolar II. I must be having a strange reaction because, while it definately has helped to boost my mood, I am unusually overactive. I also take 20 mgs. fluoxetine. I'm wondering if the lithium is increasing the blood level of the ssri. I once became manic when I was on 40mgs. prozac/day and I sort of feel that same sense of akathisia/overactivity. Any ideas?? Thanks.
>
>
> SSRI + lithium has been known to produce serotonin syndrome,However Scott, at low dose of Lithium, I believe this would be safe....
a state of serotonergic overload that might account for the induction of manic-like symptoms. It might even be an induction of mania in the absence of serotonin syndrome. I would speak to your doctor and determine how much time to give what you are experiencing to resolve on its own. It might be nothing serious. In the meantime, you might want to take your body temperature and make sure that it is not too high. Hyperpyrexia (high temperature) is one of the more serious symptoms of the syndrome.
>
> In the case that you are becoming manic in the absence of serotonin syndrome, does it make sense to treat the mania with another medication? Has your depression been resistent to all other treatments?
>
>
> - Scott
Posted by SLS on September 24, 2004, at 23:43:52
In reply to Re: Does lithium increase fluoxetine level?? » SLS, posted by ace on September 24, 2004, at 23:17:59
Hi Ace.
> > SSRI + lithium has been known to produce serotonin syndrome,
> However Scott, at low dose of Lithium, I believe this would be safe....I wouldn't know. I'm not sure what dosages of lithium this has been observed with. I think that such a reaction would be idiosyncratic to the individual and not to be judged as safe based on dosage. Taking one's temperature would probably be prudent. Chances are that it is not serotonin syndrome.
It might be that mania can be induced in vulnerable individuals by the addition to an SSRI a dosage of lithium that is high enough to act as an antidepressant augmentor but too low to act as a mood stabilizer.
- Scott
Posted by sac on September 26, 2004, at 12:40:52
In reply to Re: Does lithium increase fluoxetine level??, posted by SLS on September 24, 2004, at 23:43:52
Thanks for your reply. Body temperature is normal at 98.6. I feel like I am experiencing akathisia. I take the Eskalith CR at night and I'm wondering if I should split the dose and take it 2 x a day. Any opinion? Thanks.
Posted by SLS on September 27, 2004, at 7:12:41
In reply to Re: Does lithium increase fluoxetine level?? » SLS, posted by sac on September 26, 2004, at 12:40:52
> Thanks for your reply. Body temperature is normal at 98.6. I feel like I am experiencing akathisia. I take the Eskalith CR at night and I'm wondering if I should split the dose and take it 2 x a day. Any opinion? Thanks.
Hi Sac.
Gosh. My opinion is that it is worth the experiment to see. If you really like the effect adding lithium has made upon your mood, playing with the dosages of these drugs seems to be worthwhile. However, if the akathisia persists - a side effect sometimes seen with Prozac - I would move on to another drug that inhibits the reuptake of serotonin and continue with the lithium. Do you think that makes sense?
- Scott
Posted by sac on September 27, 2004, at 9:15:40
In reply to Re: Does lithium increase fluoxetine level??, posted by SLS on September 27, 2004, at 7:12:41
> > Thanks for your reply. Body temperature is normal at 98.6. I feel like I am experiencing akathisia. I take the Eskalith CR at night and I'm wondering if I should split the dose and take it 2 x a day. Any opinion? Thanks.
>
> Hi Sac.
>
> Gosh. My opinion is that it is worth the experiment to see. If you really like the effect adding lithium has made upon your mood, playing with the dosages of these drugs seems to be worthwhile. However, if the akathisia persists - a side effect sometimes seen with Prozac - I would move on to another drug that inhibits the reuptake of serotonin and continue with the lithium. Do you think that makes sense?
>
>
> - ScottYes, I agree that it's worthwhile to tinker with the dosing. In the past with other meds, just changing the dosing schedule has helped to eliminate problems. I do like the effect I've gotten with the Lithium so far and I'm on such a low dose 225 mgs. (1/2 tablet of Eskalith CR 450mg). I wonder if I need a higher dose of Lithium. I don't know why I feel speedy on it. Maybe it is, as you say, the combo with Prozac.
This is the end of the thread.
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