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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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On Lithium, Depakote, Atenolol, Prostique, Wellbutrin For Bipolar Disorder. Shaking, Spacy, Difficulty To Focus. Help

i have bipolar disorder. I am taking lithium 300am/600hs,depakote 750bid,atenolol 25qd,pristique 100am and wellbutrin 450 qam. about 2 months ago my work was affected by shaking,spacy,can't stay on task (i am a mental health social worker). My boss told me today that if I don't figure out what is wrong and get better i will lose my job. also they want me to take a medical leave of absence. help.
Fri, 8 Nov 2013
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Psychiatrist,  's  Response
Thank you for your query. It seems you are on the higher side of dosages of all the drugs you are taking. moreover, valproate (depakote) inhibits lithium metabolism and can raise lithium levels further.
If you are shaky, and having any of tremors, or difficulty in walking or standing, reeling sensation, slurring of speech, visual difficulty, loose stools, you may be having lithium toxicity.
If a patient would have come to me with your complaint, I would have requested for a serum lithium estimation, along with liver function test, sodium, pottasium and creatinine estimation. If the lithium levels appeared to be in a higher range (>1.2mEq/Lt), I would have decreased the dose of lithium or stopped it for the time being, along with advising adequate hydration.

I would request you to consult your psychiatrist urgently for your symptoms and management of the same.

Hope I've been able to satisfy your query. please feel free to ask for any further clarifications. Best of luck.
Dr. Sourav.
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On Lithium, Depakote, Atenolol, Prostique, Wellbutrin For Bipolar Disorder. Shaking, Spacy, Difficulty To Focus. Help

Thank you for your query. It seems you are on the higher side of dosages of all the drugs you are taking. moreover, valproate (depakote) inhibits lithium metabolism and can raise lithium levels further. If you are shaky, and having any of tremors, or difficulty in walking or standing, reeling sensation, slurring of speech, visual difficulty, loose stools, you may be having lithium toxicity. If a patient would have come to me with your complaint, I would have requested for a serum lithium estimation, along with liver function test, sodium, pottasium and creatinine estimation. If the lithium levels appeared to be in a higher range ( 1.2mEq/Lt), I would have decreased the dose of lithium or stopped it for the time being, along with advising adequate hydration. I would request you to consult your psychiatrist urgently for your symptoms and management of the same. Hope I ve been able to satisfy your query. please feel free to ask for any further clarifications. Best of luck. Dr. Sourav.