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Simon's Dad
New Member


Date Joined Jan 2009
Total Posts : 12
   Posted 1/18/2009 3:30 PM (GMT -7)   
Hi,

I've had depression pretty much all my life, I'm 57. I can look back at elementary school and see things that were signs of depression.

Before you say "You should be posting on the depression board" let me explain that the psychiatrist I'm currently seeing had decided I have bi-polar, not depression. This psychiatrist is a "pill pusher", not a therapist.

I joined the board to ask about others experiences with lithium.

My doctor wants me to start on it and has prescribed 300 mg BID (twice a day).

I've heard horror stories about lithium and I'm very worried about taking it.

I am going to have some blood work done tomorrow (Monday) and will start on the lithium Tuesday evening after I talk to my doctor.

One of the very clear warnings I have read about lithium regards heart disease.

I had a heart attack 6 years ago. I do not want to take anything that might cause additional heart problems.

So, I'm going to get in touch with my doctor Tuesday (he's not in on Mondays) and make sure he understands that lithium has warnings about heart disease.

He knows I've had a heart attack but he fails to tell me about possible side effects of the various medications he has had me on.

For instance, about a month ago he decided that I have ADD and prescribed a stimulant - Vyvance. I read up on it and learned such things as that you should not take any products with caffeine. I called him about that and other warnings - he did not tell me anything when he prescribed the Vyvance. He said, "Oh, well don't drink anything with caffaine." It would have been nice if he had gone over any precautions or warnings about the drug when he prescribed it.

I took the Vyvance for a month with absolutely no effect - so much for the ADD diagnosis.

I'm currently on 50 - 150 mg of Amitriptyline, 200 mg of Lamotrigine, and 300 mg of Seroquel - all taken about 4 hours before bedtime.

I also take a full strength aspirin, 40mg of Lipitor, and 3 fish oil capsules.

Does anyone on the board have coronary arterial heart disease and is taking lithium?

At my suggestion, the doctor wrote out a prescription for blood work and I'll have blood drawn tomorrow.

After reading a lot of web sites and other sources, I am concerned that he has not ordered more blood work, over the first few weeks that I'm taking the lithium for the first time.

I certainly don't want to have kidney damage, or other side effect, which is detected too late to prevent serious problems.

When I talk to the doctor Tuesday, I'm going to ask him about more testing for then next few weeks and then are regular intervals thereafter.

What is the experience here about blood tests when beginning lithium and then at intervals after the initial period?


Bob - Simon's Dad

See http://sugarcat_simon.home.att.net for the reason I am Simon's Dad - Simon was the greatest cat to every live.

April 19, 2011 - I just came back to give the new address for Simon's web site about Feline Diabetes. It is http://www.sugarcatsimon.com

Post Edited (Simon's Dad) : 4/18/2011 11:59:41 PM (GMT-6)


serafena
Veteran Member


Date Joined May 2007
Total Posts : 3715
   Posted 1/18/2009 6:38 PM (GMT -7)   
Hi Bob,

Welcome to HealingWell and to the bipolar board. I hope you will find some answers and some community here. We currently have the exact same question running in another thread, so let me point you there:

www.healingwell.com/community/default.aspx?f=13&m=1338356

Although your particular concerns are not mentioned in that thread, you might find some of what you're looking for there.

Lithium has been around so long that if you research it on the internet you're bound to find tons of horror stories -- but the truth is that it helps loads of people. Before you panic, try it. I get the sense that you're really not very confident about your doctor's knowledge and know how, and to me that says you need to be looking for another doctor, not spending so much time researching drugs on the internet so you can call him back before you fill the rx. You need to trust your doc, and if you don't have that, you need a new one.

You're perfectly within your rights to ask for more blood work if you want it and it will make you feel more at ease. I know one of the other lithium takers was saying they have to have their blood drawn every week for a month starting out on the drug. I don't know if there's a standard or not with lithium. Maybe it just depends on the doc.

Good luck to you, and thanks for joining,
serafena
Serafena
Co-Moderator, Bipolar Forum
Bipolar II


Simon's Dad
New Member


Date Joined Jan 2009
Total Posts : 12
   Posted 1/18/2009 8:36 PM (GMT -7)   
Serafena,

Thanks for the reply.

Let me explain a bit more about the doctor I'm now seeing.

In the fall of 2007, I don't remember exactly when but it was probably in early October or late September, my depression got very bad and I told my wife that sucide was on the table in that it might be an alternative to continuing to live with the depression I have had pretty much all my life.

I told her I was not considering suicide but that it WAS on the list of possible alternatives. She flew into action and got a referral to a counselor that a friend of hers had used when she and her husband were having problems. (at the time I was seeing a pill pusher who was prescribing amitriptyline 200 mg)

She also got the name of a psychiatrist. We went to the counselor once together and then I saw her alone. She was no help at all.

I saw the psychiatrist a few times - at $175 per 50 minute session or $3.50 per minute - and finally stopped because we simply could not afford it.

We have no medical insurance. My wife is self-employed, she is a cosmetologist (hair stylist) and I've been effectively unemployed since January of 1987. That, in and of itself, is a long store. Perhaps for another post.

AS I said, I was on amitriptyline 200 mg SID at the time.

The psychiatrist had me begin Abilify - I am no longer on it, after about 5 months with not positive effects, I stopped taking it - with the knowledge of the doctor.

I called around and found there is an organization called the County Mental Health Collaborative - the "county" is that of a large midwestern city, we live in a suburb of that city - that provides services at fees based upon income.

Since there is anonymity here, I can tell you that our Adjusted Gross Income for 2007 was only $19,800. Adjusted Gross is the last line on the front of a 1040 tax form.

I called that organization and they referred me to one of their member organizations. I found out, at the first appointment, that they only prescribe drugs, that is, they are "pill pushers" only and offer no therapy.

They were going to continue me on the ability - free of charge - but picking up the drug turned into an amazing comedy of errors - a comedy now but quite infuriating and depressing at the time.

After several attempts to hook up with the doctor assigned to me (a resident actually) to pick up drug samples (a HUGE comedy of errors) , I finally made some calls and wound up with an appointment for one of the very large organizations in the collaborative.

To make a very long story short - I saw one of their psychiatrists, the one I'm seeing how, and he decided I was bi-polar, in the first appointment.

Everyone else I've seen since 1970 has diagnosed me with depression.

At the first appointment when he asked about the medications I've been on - it is a long list - I happened to say that Prozac seemed to work for a few weeks, that I remembered an incident when my wife and I were on the way home from the theater and we stopped at a stop sign - I remember exactly where it was - and I realized that I was feeling better than I had for quite awhile.

I made the mistake of saying the word "manic" in describing how I felt at that time. I meant that compared to being depressed like I have been for years, I was happier and less depressed than I had for a long time.

Unfortunably I say manic, - I think I said something like "I felt almost manic" chuckle, chuckle

He picked up on "manic" and a few minutes later told me that he thought I was bi-polar, not depressed, and said "You've come to the right place."

Since then he has had me on several different drugs - mood stabilizers and such - with what I consider little improvement. about 6 weeks ago he decided that I also had ADD and put me on a stimulant, Vyvance, which I took for a month with absolutely no effect.

When he prescribes drugs he never went over their possible side effects or warnings - some warned about issues with taking them if heart diseawse was present. An other instance - when he started me on the Vyvance he said nothing about limiting, or eliminating, caffeine while taking the Vyvance. I learned of that one when I went looking for the package insert information for Vyvance.

On a couple of occasions I've had to remind him about my heart attack in November of 2002 - I had told him about it the first time I saw him.

You suggested that I might need to find another doctor - I agree but there is one problem.

I am seeing this doctor through part of the County Mental Health Collaborative - "County" as in the suburbs of a very large midwestern city. He left the organization and went back to only private office work. The organization decided to have me continue to see him and that they would cover the entire cost - I seem him at his office and he bills the organization for the visits. I pay nothing they mail me medications for free.

I'm hooked up with this organization in a rather different way than other patients.

I am afraid that I might not get the same financial support if I had to again go through the process of registering with them.

Not that I'm registered fraudulently or such, it is just that they never actually asked about our income level. I'm sure I would still qualify for services and prescriptions for free but I don't want to that the chance.

So, for now I research each drug he puts me on and then call him to discuss anything I've found which might be a problem with the particular drug.

My wife accompanied me to an appointment about a month ago - the appointment at which he decided I might have ADD.

She went with me last week when I saw him again. Between the two of them they decided that - as the doctor puts it - my problem may be both hardware (medication issues) and software (therapy issues).

Remember - he is a "pill pusher" not a therapist.

He recommend I get in touch with a particular organization because, as he put it, they are probably state funded and might offer counseling/therapy at reduced costs.

You'd think he would contact them for me, at least for the first contact.

I called them and left a message.

I also called around and found another organization which has reduced fees. For our income level the cost will be $52 per session. I made an appointment with them for Tuesday (day after tomorrow). Our income is such that seeing them once a week, for at total of $208, would be difficult.

After I had made that appointment, the other organization returned my call. I made an appointment with them for a week from Tuesday. They will only charge us $20, based upon our income. There's a big difference between $52 and $20 dollars and I'm hoping that the thearpist at this organization will be of help.

So, for the time being I'll stay with the "pill pusher", do my own research when he prescribes a new drug, and wait and see what comes of the two appointments I have at the organizations which provide therapy.

Something about mood stabilizers - my normal mood is depression, I don't consider that I've ever had a manic episode. If some of these drugs are supposed to stabilize moods, all I can say is that I hope they don't stabilize things as they are now, that is, I don't want to be stabilized at a depressed level :-)

I'll begin the lithium Tuesday evening and try and watch out for any side affects.

The thing is that I just don't buy into the bi-polar diagnosis - I'll have to wait and see if the doctor's (and perhaps therapist's) efforts work when viewing me as bi-polar.

Bob - Simon's Dad

serafena
Veteran Member


Date Joined May 2007
Total Posts : 3715
   Posted 1/19/2009 9:26 AM (GMT -7)   
Okay, I see.

So you've never had a manic episode? There are several levels of bipolar disorder, and he may be placing you into one of the "lower" ones, bipolar II, for instance. He may be thinking you have hypomania. Here's a link that explains that:

www.nimh.nih.gov/health/publications/bipolar-disorder/symptoms.shtml

But if you don't think you've ever had any kind of mania, then you need to explain that to the doc, because without mania,you're not bipolar. And it's not good to be put onto medications that aren't for you, so be a little more pushy about a diagnosis you don't feel fits you.

Understand that very few psychiatrists do therapy of any kind these days, so most are "pill pushers" as you put it. You don't have a very perceptive doctor, I don't think, but I don't think you're losing out on any therapy that other people get. I'm really glad to hear you're getting into counseling though, because it sounds like you will really benefit from it.

See if you can get yourself back on an antidepressant and see how it goes. What he's doubtlessly thinking is that AD's alone can make bipolar's manic, so when you used that word, he took you a little too seriously. I'm sorry about that. What a pain.

Good luck,
serafena
Serafena
Co-Moderator, Bipolar Forum
Bipolar II


Rocketman
Regular Member


Date Joined Dec 2008
Total Posts : 156
   Posted 1/19/2009 10:42 AM (GMT -7)   
Welcome Simon's dad
I hope you find this forum helpful. It sounds to me like you are on the right path to getting the treatment to help you control your condition. Having no insurance makes it an even tougher battle for sure. But hopefully yuor new doc can see some things that will help you. Be sure to include your wife in your treatment as much as possible. She may be able to tell the docs some things that maybe you don't realize yourself.
Good luck to you!
Rocket
"The struggles make you stronger, and the changes make you wise, and happiness has it's own way of taking it's sweet time.
Gary Allan- From "Life Ain't Always Beutiful"


Simon's Dad
New Member


Date Joined Jan 2009
Total Posts : 12
   Posted 1/19/2009 12:27 PM (GMT -7)   
Serafena,

Is there a way to "quote" a message to which you are replying?

----
As far as I know I've never had a manic episode. I read the page you referred me to and I just don't think the I've had an episode that qualifies as being manic.

The doctor once said that even just one manic episode would validate the BP diagnosis but I still don't think I've every had a manic episode.

I have tried to explain to the doctor that I don't think I'm BP but he sticks to his diagnosis.

I was called "Rapid Robert" by the director of a data processing shop at one of the largest bank holding companies in the state where I worked from September 7, 1976 until September 20, 1985 - we were bought out, we converted computer systems to those of the company who purchased us, and then 90% of us were out of jobs. I took another job which was wrong for me and then took another and that was the end of my career -- a very long story.

Syd, the directory of the data processing department at the bank called me Rapid Robert not because I was manic but because I was able to jump on new projects or problems and become productive or solve the problem before the others could even begin the project or recognize that there actually was a problem to solve.

I was the Systems programmer for the bank - the top technical position in a data processing shop and the person that everyone else relies on to fix any "un-fixable" problems. I was carrying a pager as far back at 1978 when it was only doctors who carried them. I was available 24 hours a day to resolve problems - hardware or software.

I mentioned this nickname to the doctor on the first visit, the visit where I inappropriately used the "manic" word, and I think he thought I was talking about manic behavior. I tried to explain to him that it was not manic behavior but that I through myself into my work with total concentration and was able to achieve results sooner than other people. He doesn't seem to understand the difference.

I'm going to wait and see if the lithium does any good and if it does not, I will try and see another doctor through the organization who is paying the bills for my current doctor.

He is just certain that I'm BP and I don't think so.

Three or four years ago, my wife was contacted about a trial of cymbalta. She gets migraine headaches - has had them since she was very young - and has been in some drug trials for that and when the cymbalta trial started, they contacted her to see if she was interested.

She joined the trial and had good results with the cymbalta - she's not really depressed but it did help her mood. I heard her tell her sister that it was her "happy pill."

I talked to them about my joining the trial but they wanted me to stop taking the amitriptyline. I tried reducing it slowly but by the time I got down to none I was a wreck.

I have been taking amitriptyline since 1984 and I am dependent upon it to get any sleep.

After about two weeks of reducing the dose to none, I wasn't sleeping well - never realy fell heavily asleep and woke up every 45 minutes or so - and was also reacting the not having any time of antidepressant.

I didn't join the trial because of this.

My wife continued on with the cymbalta but had to stop, after the trial, because of the cost.

I want my own "happy pill"!

I've been on Prozac, Wellbutrin, Elavil, Pamelor, Tofranil, Marplan (an MAOI), and maybe Zoloft (I'm not certain if I've been on Zoloft or not)

There might be some I don't remember - I've tried a lot of antidepressants.

With some of them I might not have been on them long enough, for others there either were no good effects or the effects didn't last.

I'm currently taking 10 mg of amitriptyline, 200 mg of Lamotrigine, and 300 mg of seroquel. The doctor wants me to start on lithium and I'll do so tomorrow evening once I double check with him about it and my heart disease (MI on 11/10/02)

I will also have him set up blood work for the first few weeks to monitor kidney, liver, thyroid, lipids, and lithium levels.

I had blood drawn this morning for base line readings and I asked the nurse about ongoing testing with lithium and she agreed that I needed test for at least the first few weeks and then at lager intervals it I stay on the lithium.

As I said, right now I'm getting the doctor's costs, prescriptions, and blood test for free.

If that changes, if we have to pay for any of those costs, it will be a deal killer - we won't be able to afford them if they are much above say $150 a month - and that would be straining the budget.

So far they have covered the cost of all the drugs except Vyvance. For some reason I was unable to get that through them and had to apply for a 30 day prescription for free.

Had the Vyvance actually helped me, I don't know how we could have afforded it. For that reason I guess it is good that it didn't have any effect on me. I would hate to find a drug that helped only to be unable to afford it.

As I said, I'll give the lithium a try and will also try and get the doctor to reconsider his diagnosis of BP.

I talked to the director of the health organization, which is cover my costs, about seeing someone else and he said that was possible. I didn't see anyone new right then because it was right when the doctor, and my wife, decided that I had ADD and I started taking Vyvance.

I wanted to give the Vyvance a try before switching doctors. I will now give the lithium a chance and if it does nothing (nothing good, that is) I will probably try to see another doctor.

I am disapointed that the Vyvance was not effective. I read a lot of postings on message boards from people who had miraculaus results from Vyvance.

It sounded to good to be true and that is how it turned out, at least for me.

It seems to me that diagnoses need to be based on more than just first impressions, as this doctor has done. There are tests, such as the MMPI, which shed light on problems such as depression and I feel that some testing should be done, at a minimum to support a diagnosis and at best to determine if the diagnosis is correct.

I will discuss this with the doctor and if he sticks to his BP diagnosis with my not responding to any of the drugs for BP, I will see about getting another doctor who at least doesn't jump to a conclusion on the first office visit.

I will post an update in a week or two after I have been on the lithium.

If lithium doesn't help me, I want to try all of the antidepressants again in order to be sure that I have tried them long enough to know for sure whether the help or not.

Bob - Simon's Dad - http://sugarcat_simon.home.att.net or http://www.sugarcatsimon.com (that one redirects to the other one)

Lainny
New Member


Date Joined Jan 2009
Total Posts : 2
   Posted 1/20/2009 8:09 AM (GMT -7)   
Look for Lainny's post in a new thread on the main bipolar index. Thanks.

Post Edited By Moderator (serafena) : 1/20/2009 8:40:05 AM (GMT-7)


serafena
Veteran Member


Date Joined May 2007
Total Posts : 3715
   Posted 1/20/2009 8:39 AM (GMT -7)   
Hi Lainny,

I'm going to move your post to a new thread on the main page so we don't "hijack" Simon's thread. Look for it there.

serafena
Serafena
Co-Moderator, Bipolar Forum
Bipolar II

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