I was about 21 when I was initially prescribed lithium. My first experience with a psychiatrist had not been a good one. I had not been listened to, and had felt patronised and judged for some of the life choices I’d made. Eventually, after several distressing visits, I got to see a second psychiatrist who was much nicer. He listened quietly to a description of my symptoms and suggested that I might have bipolar disorder, and that I should begin taking lithium.
Before I could start lithium, he explained, I would need to undergo a range of physical health checks at the local general hospital. I spent a miserable, lonely day moving from department to department; I didn’t feel I could ask anyone to take a whole day off to keep me company. I had an ECG conducted by a pimply young man about my age; I couldn’t say which of us was more embarrassed as he stuck electrodes on and around my bare breasts. Next up was a chest X-ray, followed by a further wait to get bloods drawn to test thyroid and kidney function.
The tests frightened me. Did I want really want to take something that could have such an impact on my physical health? Lithium seemed very heavy-duty, especially for someone as young as I was. And then there were the dire warnings about lithium in pregnancy (it can cause birth defects, especially to the developing baby’s heart), when I was already planning to start a family after graduation. I never went back to that psychiatrist, never took the lithium, and didn’t pay the bipolar diagnosis much attention (HINT – MISTAKE).
I’m not the only person who regards lithium with fear and awe. As http://www.psycheducation.org/, a useful resource on bipolar treatment, puts it:
many people worry that lithium is one of psychiatry’s “Big Guns”, something we use for patients with really severe mental illnesses. They think, “Hey, I’m not that sick”, and conclude that lithium is not right for them.
That quote describes perfectly how I have always felt about lithium. Anything requiring weekly (at least initially) blood tests to ensure you are not being actively poisoned by it feels huge and risky.
Lithium didn’t always have to overcome an image problem. In the nineteenth century it was applied to a range of medical disorders, including renal problems, gout and rheumatism. A number of the bottled mineral waters still on the market today (including Vichy and Perrier) at one time used their relatively high lithium content as a selling point. I had no idea until I started researching this article that, just as Coca-Cola was initially marketed with an extra kick from cocaine, 7-up initially contained lithium citrate. This was the active ingredient that the company boasted, “dispels hangovers” and “takes the ‘ouch’ out of grouch.”
Today lithium is prescribed to treat bipolar disorder and major depression in both its citrate (as a liquid) and carbonate (as a tablet) forms. A quick Google search reveals that there are many people happy to testify that lithium changed their life for the better. There is good statistical evidence that it reduces the incidence of suicide in people who take it, and following an initial study in Japan it has even been suggested it could be added to drinking water as a public health suicide prevention measure. There are also some studies suggesting that lithium neuroprotective; in other words, it actually improves the health and growth of brain cells and may event prevent the development of dementia in later life.
The snag with lithium is that it operates within a narrow window. Too little in the bloodstream, and the patient sees little beneficial effect. Too much, and toxicity results, potentially causing kidney damage, thyroid problems, seizures and even coma. People starting lithium need to sign up for a programme of regular blood tests to check the blood serum level and their renal and thyroid functions. Lithium can also have dangerous interactions with other drugs, so every single time somebody on lithium is prescribed a medicine or buys one over the counter, they need to make the doctor, dentist or pharmacist. Everyone prescribed lithium in the UK should be given a “lithium pack”, produced by the NHS National Patient Safety Agency, which contains a record book for the dosage prescribed and results of blood tests, and a Lithium Alert Card to make clinicians aware in an emergency that the person takes lithium.
I’m due to start taking lithium next week. I have my weekly phlebotomist’s appointments booked at my GP surgery. I’m starting in a week when I don’t have too many responsibilities, in case the potential side-effects of early treatment (which can, apparently, include drowsiness – and I’ll be taking the lithium alongside my amazing sedative antipsychotics! – and upset stomach) are an issue. 16 years after I was first prescribed it, lithium still feels like something big.
I think you are brave and you clearly see that you need to give it a chance. I have had a similar experience to you – I found GP’s unhelpful however and fed up of being told I suffer from depression when there were so many other issues that needed addressing. I went to Doctors in 1988 for 1st time but my ‘state’ was blamed upon the fact I had just had my 2nd child – ergo baby blues. The second time I went in 2003 – but this was so overdue and I should have gone back a long long time before that. I am also an alcoholic (9 years in recovery now though 🙂
Feeling slightly better in 2008 I flushed the meds and thought ‘I can do this’ – I am an incurable independant thing – I thought I was doing ok but in fact I got worse & worse from Day1 but couldn’t see it myself, and I blamed work, life pressure, my childrens problems, – my co-dependancy 😦
I never got proper treatment and now I have totally accepted that this is ‘me’, I am like this and I can’t change it, just need to work at it.
We have recently moved house & I have to get to know a new GP now, and go through it all again. Take it easy, a step at a time and I look forward to what you have to say, going forward. It *is* a big thing, you are brave & responsible and I admire you for that 🙂
With my best wishes, Lel xxx
Really appreciate your supportive comments, Lel 🙂 Know completely what you mean about having to start all over again when you move, I really hope that you can find a supportive GP in your new area – I have been really lucky with mine in that she is sympathic, but she admits her knowledge re: MH and prescribing is limited. Maybe someone with a different outlook can be more help to you xx
I know that it may or may not work for you but I can tell you that it is nothing short of a miracle drug for my cousin. He has been on it for 20+ years.
He does complain that it makes him drool but that is a small price to pay as he was not a functioning member of society at the time it was prescribed.
Thanks for the good wishes! Since I have been talking about it online, I have met a few people who are full of praise for what it’s done for them or someone close to them. Makes me feel more optimistic about it 🙂
I take lithium and have no great side effects but great benefits. A little more zits maybe! But that was remedied by a trip to my dermatologist.
Thanks Sarah, really helps me to find people with positive experiences… there are so many scare stories out there. Just started the lithium yesterday, so will be a while before I can say how I’m finding it.
Lithium was what finally got me out of partial hospitalization. I was at rock bottom (bipolar 2) and nothing was working.
I really felt like lithium was the last ditch effort, and had avoided taking it. There is a stigma attached to it, more so than other drugs. Like you’re really crazy if you take Lithium.
I take Cephalaxin (an antibiotic) Tazorac and Aczone (creams) to combat the zits. My dermo says the creams also prevent wrinkles 🙂 At first I didn’t mind the zits because I was so grateful to feel better from the Li but after a while my vanity returned.
Hi there. I started lithium about a month ago and I can’t even describe how much better I feel. I was in a very, very nasty low stage with my bipolar disorder, to the point of being suicidal. I had no energy, no urge to even leave the house most of the time. My bipolar disorder and the misdiagnosis of it has affected every aspect of my life; work, family, friends. Since starting the lithium, anyone I’ve been in contact with has noticed a difference. My therapist even said I LOOK different. The only side effects I’m noticing is a little bit of shakiness sometimes, but I’ll take that any day over how I felt before. Thank you so much for your blog. While we know we’re not alone…it’s nice to have written proof we’re not. 🙂
Hi Amy, really appreciate you leaving a comment – every “good news” lithium story I hear gives me more confidence and lessens the anxiety. This is only day 3, so have my fingers crossed!
I’ve been on Lithium since 1996 aged 19. At the the time the prognosis from the hospital to my family was I wouldn’t make my 21 birthday. So Lithium has had an effect. However, I have had 3 severe depressive episodes (recurrent depressive disorder) since and am currently on a high treatment dose to stave off another. I have intermittent problems with acne, am constantly thirsty have had some weight gain and hands that regularly shake and jerk occasionally.
I really hope you find that Lithium works for you.
Hi Stephen, it’s my second line treatment as the atypical antipsychotics haven’t done the job and are still really sedating… so I’m hoping the lithium will help. I’m also keeping an eye on my weight, I already put some on with the antipsychotics and I have to take both meds for a while! Someone else mentioned the acne :-S
oh yeah, something else, they thought I had epilepsy a while back and gave me topamax, it is also used for bipolar, it will kill your appetite. I slimmed right down, if anything I had to force myself to eat. It gave me a bad memory and I’m going back to school so I switched to Zonegran, a similar drug that kills the appetite as well. I’d say ask about it. They both help for mood stabilization so I just stayed on it.
After a lifelong struggle with bi-polar and major depression, which I self-medicated with alcohol and drugs, I was finally prescribed lithium four years ago. I have been hospitalized so many times, seen so many doctors, and in all that time no one tried me on lithium. It has made an amazing difference. I have gained some weight, but I’m also 48 and menopausal, so I don’t know how much of the weight gain to attribute to the lithium. My illness had progressed to a point where I was literally living in a homeless shelter I was that ruined by addiction and ironically I started the lithium the day I was there. I still have ups and downs, but they are mostly in a normal range that I can handle better than the way I used to be. We have adjusted the dosage so I’m taking the least amount I need for it to help, and I like the idea of not taking more than you need of anything. Best of luck with it!
Ah, thanks, Nina… everyone that makes a point of sharing their *good* lithium stories helps me to feel more confident about the new treatment plan (only on day 4 as yet).
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I have been on Lithium (carbonate) since March 1989 when I was diagnosed as bipolar (or manic depressive as we used to like to call it!). I was seriously hypomanic/manic and occasionally depressed (in those days the downs lasted less than a week at a time: now it’s years on end). In the early days, my blood serum levels were around 0.3 to 0.4 and the LiCO3 tablets were increased in stages from 2 to 5 (400 mg tabs, making a daily dose of 2,000 mG). Enough, you might think, to steady the moods of a horse. I reckon that I’ve ingested about 50 Kg over the years.
But I was drinking heavily at the time. I quit drinking just before the New Year 1989 and then over the following two months saw my blood serum level shoot up to 1.3. The therapeutic range is 0.6 to 1.0 (more or less). The booze was simply washing the lithium out of my body.
Giving up drinking meant that I was able to drop my daily tablet regime to 3 (they have since dropped further, to 2 1/2 Priadel/day)
I suppose that Lithium has helped me. I must admit that I miss hypomania – it was all so much good fun (damnit) – but not full mania or deep depression.
Good luck with your journey with Lithium…. but be sure not to miss your phlebotomist appointments.
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