Is Lithium Effective In Treatment For Mania And Bipolar Depression?

Posted on Thu, 8 Oct 2015

Question: Hi,
What is the reason my son, 19 would be on both Lithium 450mg bid and Geodon 60mg am and 80mg pm? We are a little confused on why the combination? Feels tired and hates the meds.
Situation:
Loosly diagnosed mixed bi polar
3 times in last 1 1/2 years inpatient for Mania
Main symptom now while on these drugs is strong depressed mood/Suicidal thinking
Is in performing arts and has terrible self image. Concerned about the weight gain with the drugs.

I tell him Lithium helps with mania and bipolar depression. He is convinced he does not need Geodon too. What can I tell him it is good for?
XXXX

Answered by Dr. Dr. Chintan Solanki (45 minutes later)

Brief Answer:
geodon causes the least weight gain among all mood stabilizer

Detailed Answer:
Hello XXXXXXX

Thanks for writing to us.

Your son is very young. At age of 19 he has suffered bipolar disorder with mixed features and 3 times indoor treatment has been done in last 1.5 years. This means he requires strict maintenance therapy to prevent relapse.
Lithium alone works as a mood stabilizer and prevent relapse in many patients. But in patients with rapid cycling and more severity other medicine is needed. Geodon is one of them which is mostly used with lithum as an adjunct therapy to prevent relapse in maintenance phase of Bipolar disorder. Considering these all facts it seems that he is on right medicines.
Geodon is less likely to cause any weight gain. So if he is improving no need to worry.

But you mentioned that he has still suicidal thinking and depressed mood on these medications. If medicines are regular there for more than 1 month and problem is same I think his medicines should be changed.

Lamotrigine is a good choice in bipoar depression or even sodium valproate is better than geodon for bipolar depression. Another option is ECT (electro convulsive therapy).

Discuss these aspects with his treating doctor for his better health.

Hope I have answered your query, I will be happy to help further.

Regards,

Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Chintan Solanki (45 minutes later)

Thank u for your thoughtful answer. His Psychiatrist loves Lamictal and had XXXXXXX on a combination of Lamictal and Cymbalta for about a year. XXXXXXX stopped taking his medicine routinely
And gradually went into a manic state.
He has been on so many drugs and he complains about feeling foggy, lethargic, zombie like. It is not easy as u know. No he says drugs are making him very sleepy and he feels weight gain. I thought Lithium causes excessive weight gain?
Do any of these cause drowsiness?
Also, what are your thoughts on Abilify for my son?
Thank you, XXXXXXX

Sorry forgot. How often should he get lab work for Lithium and kidney function levels?

Answered by Dr. Dr. Chintan Solanki (14 hours later)

Brief Answer:
Geodone can cause drowsiness, abilify is good option

Detailed Answer:
Hi XXXXXXX

Thanks for follow up and sorry for delayed response.

Lamictal alone should not be used in patient with bipolar patient without cover of mood stabilizer. Lamictal treats bipolar depression well but cannot prevent biploar mania always.

If he was only on lamictal and cymbalta possibility of manic episode was there and he actually passed through the same.

Yes I can understand that any patient who is on multiple medicines can suffer form side effects.

His symptoms - foggy, lethargic, zombie- are may be side effects of Geodon. He is on high dose of geodone and this medicine can cause sedation/drowsiness in almost 10-15% of patients.

Lithium can cause weight gain but no so much. Due to his illness he might be not much active as well as not able to take care of his food habits and can be one of reasons of his weight gain also.

Abilify is indicated for maintenance and treatment of bipolar mania or mixed episode. It is the drug with the least side effects. If diagnosis of mixed symptom is confirmed abilify is likely going to help.

Feel free to discuss further.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Chintan Solanki (12 hours later)

Thank you
Excellent and helpful responses.
Regards, XXXXXXX

Answered by Dr. Dr. Chintan Solanki (3 hours later)

Brief Answer:
Welcome

Detailed Answer:
Hello,

Thanks and welcome.
If still any query there, I will be happy to answer. If not, you can close the discussion and if feasible give your feedback and rating so I can improve my service. In future you can contact me directly on this site if you wish with this link:
http://bit.ly/drchintansolanki

by clicking on 'Ask me a question' on same page.

Take care and wish hi early recovery.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Chintan Solanki (1 hour later)

Only other question is how often should my son get his Lithium levels abd Kidney Fx checked?
Thank you again, XXXXXXX

Answered by Dr. Dr. Chintan Solanki (43 minutes later)

Brief Answer:
initially more frequent , later on large interval

Detailed Answer:
Hi,

First of all before starting the lithium both tests should be done. The after reaching to optimum dose (roughly after 15 days). Then every 3 months. If patient is stable it can be done every 6 months also. Sometime due to physical problems like diarrhea, dehydration , fever or when we suspect lithium toxicity we can go for lithium level immediately.

Kidney function tests is not regularly necessary in healthy patient.As I mentioned for lithium when any physical problem is there we can go for kidney function to assess renal clearance.

All the best.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar