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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Roslynn on May 20, 2022, at 14:39:21
Hi all,
I had to stop lithium due to kidney problems. I was taking it to augment my other depression meds (not for mania).
So far, I haven't been able to find a decent replacement. I'm on Latuda but it doesn't seem to be helping. Lamictal gives me cognitive problems. My mood is sliding down each week.
Anyone have any thoughts or suggestions? My other meds are effexor, latuda, seroquel, ativan, and ritalin. Diagnosis is major depression, OCD, and anxiety.
Thank you for any help!
Roslynn
Posted by Christ_empowered on May 21, 2022, at 9:04:55
In reply to substitute for lithium?, posted by Roslynn on May 20, 2022, at 14:39:21
hi. sorry about your difficulties.
not to sound obnoxious, but what did the lithium help with that other drugs have not been able to do for you?
for whatever reasons, the diagnosis "depression" covers lots of problems. vague...very, very vague.
was there a calming effect? I've never taken lithium, personally. less agitation? did it make the other meds work better?
my first, random thought would be a different atypical. maybe rexulti? I've been considering a switch. sort of...Abilify, part II. supposed to help depression by itself and boost other drugs with less akathisia and such than Abilify. If I recall correctly, it also avoids prolactin elevation and EPS, etc.
have you ever tried supplements? some people swear by taurine...small studies suggest that 4 grams/daily help people with psychosis who are also on tranquilizers. by itself, there is a calming effect...GABA-ergic, if I recall correctly.
how long have you been off of the lithium? just asking because I remember skimming over an article...both lithium and clozapine have well-documented discontinuation syndromes. maybe...and I hate saying it, I do...but maybe try to just give it some time?
hope this helps. :-)
Posted by rjlockhart37 on May 21, 2022, at 10:04:00
In reply to Re: substitute for lithium?, posted by Christ_empowered on May 21, 2022, at 9:04:55
magnesium would be ultimate alernative, it works on the nervous system calming stress signials and excitory nuerotransmitter glutamate. You have to take it, at higher doses to notice it's anti-stress properties. Supplemental magnesium has no effect, you have to buy magnesium the supplement at the store, and take larger doses, and don't worry it's not toxic, the only thing if it is taken too much, it will cause gastro-side effects but it's nothing harmful. I discovered magnesium's anti-stress properties when i took 2 of 500mg capsules, and noticed a calm and stablization. Look into it, it has to be taken at larger doses, to notice it's anti-stress properties
Posted by rjlockhart37 on May 21, 2022, at 10:07:30
In reply to Re: substitute for lithium?, posted by rjlockhart37 on May 21, 2022, at 10:04:00
look into finding 500mg capsules, or 400mg. Those are higher stregnth, and take 2 of them, it worked for me, it calkming element just like lithium, reduces stress nuerotransmitters
Posted by Roslynn on May 21, 2022, at 15:14:03
In reply to Re: substitute for lithium?, posted by Christ_empowered on May 21, 2022, at 9:04:55
>
> was there a calming effect?Yes, it was calming I think as well as helping my overall cognition/executive function.
<did it make the other meds work better?>
Yes especially the ritalin which helps me with mood and motivation in the morning.
> have you ever tried supplements? some people swear by taurine...small studies suggest that 4 grams/daily help people with psychosis who are also on tranquilizers. by itself, there is a calming effect...GABA-ergic, if I recall correctly.
>Thank you for the suggestion.
> how long have you been off of the lithium? just asking because I remember skimming over an article...both lithium and clozapine have well-documented discontinuation syndromes. maybe...and I hate saying it, I do...but maybe try to just give it some time?
>
> hope this helps. :-)
I didn't realize there was a discontinuation syndrome.Thank you for all your feedback!
Posted by Roslynn on May 21, 2022, at 15:17:25
In reply to Re: substitute for lithium?, posted by rjlockhart37 on May 21, 2022, at 10:04:00
> magnesium would be ultimate alernative, it works on the nervous system calming stress signials and excitory nuerotransmitter glutamate. You have to take it, at higher doses to notice it's anti-stress properties. Supplemental magnesium has no effect, you have to buy magnesium the supplement at the store, and take larger doses, and don't worry it's not toxic, the only thing if it is taken too much, it will cause gastro-side effects but it's nothing harmful. I discovered magnesium's anti-stress properties when i took 2 of 500mg capsules, and noticed a calm and stablization. Look into it, it has to be taken at larger doses, to notice it's anti-stress properties
Thank you for the suggestion. I will look into this!
Posted by Roslynn on May 21, 2022, at 15:19:18
In reply to Re: substitute for lithium?, posted by rjlockhart37 on May 21, 2022, at 10:07:30
Posted by Jay2112 on May 21, 2022, at 17:50:41
In reply to substitute for lithium?, posted by Roslynn on May 20, 2022, at 14:39:21
> Hi all,
>
> I had to stop lithium due to kidney problems. I was taking it to augment my other depression meds (not for mania).
>
> So far, I haven't been able to find a decent replacement. I'm on Latuda but it doesn't seem to be helping. Lamictal gives me cognitive problems. My mood is sliding down each week.
>
> Anyone have any thoughts or suggestions? My other meds are effexor, latuda, seroquel, ativan, and ritalin. Diagnosis is major depression, OCD, and anxiety.
>
> Thank you for any help!
>
> RoslynnHi Roslynn:
I have a few thoughts, having been on all (not at once, though) of the meds you listed.
I'd say one med to look for as a replacement for lithium would be low-dose Depakote. The higher you get, though, the further worry about depression.
I might suggest a small dose of nortriptyline, or even amitriptyline,as these have some of the strongest research to back their use up in depression.
If you are looking for an atypical antipsychotic for irritability/social anxiety, Risperdal is the 'gold standard' for those symptoms.
Check them out in Pubmed. (p.s. Gabapentin and pregabaline are also awesome add-ons.)
Jay
Posted by Roslynn on May 22, 2022, at 14:55:43
In reply to Re: substitute for lithium? » Roslynn, posted by Jay2112 on May 21, 2022, at 17:50:41
> Hi Roslynn:
>
> I have a few thoughts, having been on all (not at once, though) of the meds you listed.
>
> I'd say one med to look for as a replacement for lithium would be low-dose Depakote. The higher you get, though, the further worry about depression.
>
> I might suggest a small dose of nortriptyline, or even amitriptyline,as these have some of the strongest research to back their use up in depression.
>
> If you are looking for an atypical antipsychotic for irritability/social anxiety, Risperdal is the 'gold standard' for those symptoms.
>
> Check them out in Pubmed. (p.s. Gabapentin and pregabaline are also awesome add-ons.)
>
> JayDear Jay,
Thank you for your suggestions. I will look into them. I appreciate your thoughts.
~Roslynn
Posted by Hugh on May 23, 2022, at 11:47:49
In reply to substitute for lithium?, posted by Roslynn on May 20, 2022, at 14:39:21
https://www.tandfonline.com/doi/abs/10.1080/14728222.2019.1581764
https://pubmed.ncbi.nlm.nih.gov/28178624/
The dietary supplement agmatine is an NMDA antagonist, like ketamine. Agmatine appears to have the same antidepressant and pain relieving properties as ketamine, but without its side effects.
In a pilot study that used agmatine to treat small fiber neuropathy, the study participants took 6 445-mg capsules of agmatine sulfate per day (3 capsules twice daily or 2 capsules three times daily). At the end of two months, all patients showed improvement, but to a varied extent. The average decrease in pain intensity for all 11 patients was 46.4%.
"Evidence for Dietary Agmatine Sulfate Effectiveness in Neuropathies Associated with Painful Small Fiber Neuropathy. A Pilot Open-Label Consecutive Case Series Study"
Posted by SLS on May 24, 2022, at 23:17:58
In reply to substitute for lithium?, posted by Roslynn on May 20, 2022, at 14:39:21
> Hi all,
>
> I had to stop lithium due to kidney problems. I was taking it to augment my other depression meds (not for mania).
>
> So far, I haven't been able to find a decent replacement. I'm on Latuda but it doesn't seem to be helping. Lamictal gives me cognitive problems. My mood is sliding down each week.
>
> Anyone have any thoughts or suggestions? My other meds are effexor, latuda, seroquel, ativan, and ritalin. Diagnosis is major depression, OCD, and anxiety.
>
> Thank you for any help!
>
> Roslynn
There are two things you can do that might allow you to stay on lithium.1. Since you respond to lithium so well, you might consider trying a low-dosage strategy. Low dosages of lithium often work for depression, but not mania. At 300 mg/day, there is usually little risk of it causing nephrotoxicity. You might respond to it equally well, if not better, than treatment with a higher dosage.
2. Although the toxicity of lithium at 300 mg/day is usually minimal, you can reduce the load on the kidneys even more if you take your entire daily dose at bedtime.
- Scott
Posted by Hugh on May 27, 2022, at 12:01:46
In reply to Re: substitute for lithium?, posted by rjlockhart37 on May 21, 2022, at 10:04:00
Magnesium L-threonate crosses the blood-brain barrier better than other forms of magnesium.
https://www.lifeextension.com/magazine/2020/6/magnesium-l-threonate-regenerates-brain-structures
Posted by Christ_empowered on May 27, 2022, at 20:51:09
In reply to Re: substitute for lithium?, posted by Hugh on May 27, 2022, at 12:01:46
maybe a different atypical? do you do well with the latuda? do you do well with the major tranquilizers, in general?
ever tried trileptal? just thought of it...low doses can help agitation and some mood issues with fewer adverse effects, for some people, than tegretol or other mood drugs. minimal blood work, usually recommended more for mixed states and mania, but helps some forms of depression, too.
Posted by Lamdage22 on June 5, 2022, at 12:47:38
In reply to Re: substitute for lithium?, posted by Christ_empowered on May 27, 2022, at 20:51:09
Can she keep taking a very low dose of Lithium for anti-suicidal effects? Do you have those?
This is the end of the thread.
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