Suggest Treatment For Insomnia When On Lithium

Brief Answer:
lithiu is good for resistant depression, thyroid monitoring necessary

Detailed Answer:
Hello XXXXXXX

Thanks for writing to us and good information.I read your query and understood your concern.

You have been on anti depressant since long. 30 years of depression is very long. Yes you are right that lithium is used in bipolar depression. (Depakote is also used in bipolar.)However it is also used in depression when other drugs are not so much effective. That is why your doctor has probably add the same.

Lithium has very low therapeutic index.It means there shout be a range in which serum level of the lithium should be maintained in body. If below the level it is not effective and if more than that level it causes side effects.
It should be used with caution in elderly and patients with thyroid problem.Hypothyroid is common side effect.You already have sub clinical hypothyroidism means in your case thyroid monitoring must be done regularly.
Lithium can cause nausea, diarrhea, dizziness, muscle weakness, fatigue, and a dazed feeling. These unwanted side effects often improve with continued use. Fine tremor, frequent urination, and thirst can occur and may persist with continued use. Weight gain and swelling from excess fluid can also occur. Lithium can also cause or make skin disorders such as acne, psoriasis, and rashes worse. The amount of lithium in the body must be carefully controlled and is checked by blood tests to prevent side effects.
From available history if you have been given all anti depressant medicines and no improvement, lithium can be a good option with some risk and under doctor's supervision.

Yes depression and insomnia are strongly associated. Insomnia is one of the criteria for depression.You are already on klonopin 0.5 mg and belsomra 15 for sleep disturbance.
In my opinion klonopin dose can be increased if you are not improving with 0.5 mg as form history I do not think that you have significant sleep apnea.

And yes always follow 'Sleep Hygiene' (sleep measures to improve sleep). You might be aware of the same and you can find the same with following link:
http://sleepfoundation.org/ask-the-expert/sleep-hygiene

Hope I have answered your query,I will be happy to help further.
Regards,
Dr.Chintan Solanki.

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Brief Answer:
yes lithium can cause leucocytosis, SSRI is first choice

Detailed Answer:
Hi XXXXXXX

Thanks for follow up and some clarification about CLL and bipolar.

It is told that patients with COPD should not be given much dose of benzodiazepine like klonopin. But in clinical practice I have never seen significant worsening of respiratory problem with klonopin. Klonoin can cause tolerance after chronic use. But my opinion is that you can be given up to 2 mg dose of klonopin at night for sometime if effective for sleep.

If you are not bipolar of course depakote has no role in my opinion. But yes lithium is indicated in unipolar depression also if SSRI fails to treat.

You are absolutely right that lithium can cause lecocytosis but it is always almost reversible. But considering history of CLL we should be cautious in your case.

You did not mention that you have not been given SSRI. Otherwise it is first choice in unipolar depression(In bipolar depression use of SSRI should be with some mood stabilizer like depakote or lithium otherwise it can precipitate episode of mania).
Therapeutic level of lithium is reached in 7-10 days.But lithium is not all going to help in sleep directly.

Hypothyroidism, CCL and old age are the factors not in favor of use of lithium in your case til other options are there.

Yes SSRI must be given if there is unipolar depression instead of lithium.
I would suggest Sertraline (zoloft) or Mirtazapine(remeron)in your case. These are antidepressants with some sedation property which can help in insomnia also.

Hope this answer is helpful. Feel free to discuss further.

take care.

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