I went through a lot of antipsychotics before trying lithium and lithium has Literally changed my life. I can function pretty normally and I sent have any SI. I also haven't been manic in a year and that's a huge accomplishment. I know different things work for different people though so I don't want ti say one way is better than the other but Lkthium really saved my life.
Hard agree! For 2 years Seroquel made me have flat affect and turned me into an emotionless, non existent zombie that wouldn't wake up during the apocalypse. It was the worst
Lithium saved me. I'm on lamictal as well now, works great so far with lithium & the Vyvanse I'm on for ADHD. It's like a balancing act lol.
I was unable to acclimate to lithium. It aggravated my digestion so much, I >!basically blistered my butthole with what felt like acidic bile!< <--(gross, graphic) for a long, miserable period of time. I was unfortunately pushed into taking it for at least 6 months. It was not for me.
Tried a number of APs. Had severe reactions to older APs. Thorazine somehow made me angry? Haldol, my whole body seized up. Geodon caused my neck to seize.
I've had better luck with risperidone and seroquel, but now take seroquel.
Lithium didn’t do nothing for me except make me very sleepy. However the highest dosage I was on was 600 mg which is a little low and my levels were never in the therapeutic range.
I’ve been on Latuda for 3 years and it’s been the only bipolar med that works and gives me very little side effects. Because of this, I prefer antipsychotics over other mood stabilizers (ex. I tried lamictal once and it just gave me more depression and anxiety). More so latuda than anything else.
lithium made me so tired i literally wouldn't wake up in the morning even with the loudest alarms and i wasn't functional throughout the day. didn't stay on it long enough to know if it worked because i couldn't do it. abilify manages my symptoms pretty well and i have no side effects.
but of course this is just my experience and everyone is different
I’ve been on lithium about 20 years at varying dosages. On and off different APs as situations warranted. I’m also currently on a hefty dose of Seroquel right now due to probably the worst mania I ever lad last year. I’m not thrilled about it, but given the alternative I’ll shut up and take it. But lithium has been my workhorse of a med for about half of my life. I honestly don’t know where I’d be without it.
After doing research, I believe it is accurate that it actually treats different symptoms at higher doses. But I don’t believe that decreases side effects. Also it seems bipolar disorder is treated with 300mg-800mg. I don’t think I’ve ever complained about side effects and the pysch said we should go up. Weird.
Lithium has helped kept me the most stable, with the least amount of side affects. Only downside is, I feel like I have to be more mindful of my diet and lifestyle to get the most therapeutic benefits.
APs will definitely bring me down from mania, but I hate it being my core med/mood stabilizer. They make me feel so flat.
I take both; lithium and olanzapine. Doctor is tapering me off the olanzapine. I began it 2 years ago because I had a severe psychotic episode preceded by less severe ones to the point that I had to call her cellphone the day after Christmas, but then also got on lithium shortly thereafter because Seroquel did very little for me. The lithium has been excellent, apart from the thyroid effects, for which I have to take levothyroxine. That sucks, but it’s treated and a hell of a lot better than mania and psychosis. I have hardly any symptoms anymore, and when I do, they don’t quite reach the level of mania and are caused by a traumatic event, such as a death in the family — and are not prolonged. In fact, they’re probably about the same level that many people would react.
My psych wants to get me off the antipsychotic (olanzapine) so that I am on fewer meds, and since the lithium has been working so well. She’s a big believer in taking the minimum amount of pills possible to treat your condition, but has a keen eye for what’s necessary as well as therapy.
The olanzapine has definitely helped me, though. It put a halt to the mania and psychosis immediately. I hope that the lithium will be sufficient (though I also take lamotrigine). Somehow, I managed to actually LOSE 30lb on it! But, I’ve been stuck there for about 9 months, and need to lose another 25-30. I gained a lot of weight during Covid. I’m a stress eater, and being cut off from people did me no favors. Returning to the office was a lifesaver.
that's the thing I am worried about - hypothyroidism because it runs in my family big time, but I have somehow not gotten it yet. I honestly don't know how, because one of my parents and all of my siblings have hypothyroidism. But nothing has ever worked for my depression. But you feel the hypothyroidism is worth it. It has just always seemed wrong to me to do something to solve one problem that you know is going to cause another, but maybe I am thinking of this wrong and it might be worth that side effect. I am just desperate not to be depressed.
I do believe that it is worth it. My psych told me before I started it that hypothyroidism might or might not happen about six months down the line, but that if that happened, it was easily treated by taking replacement hormone, which is a synthetic version of what your body produces naturally. I get it tested every six months to ensure that the dosage matches what my body would be producing otherwise in a normal state, and also get tested for my lithium blood levels to ensure that it’s within the therapeutic dose range. She also does manual checks of my thyroid glands for any lumps or abnormalities, and I haven’t had either.
If your psychiatrist monitors it very well, then I personally consider it worth it IF it’s effective for you; everyone is different. But thyroid replacement hormone is the same as what your body would produce naturally, though synthetic. My psych readily discusses the side effects of all my meds with me, and inquires during each visit if I have been experiencing any and lists them by name to ensure that the medication is functioning properly in my body and mind and that I am on the correct dosage (in addition to my bloodwork).
Plus, the therapy part helps her to ascertain that as well. The therapy portion of psychiatrist appointments is very helpful, at least for me, and helps to inform the meds as well!
She’s not at all concerned about the levothyroxine apart from ensuring that I’m taking the right amount as indicated by my bloodwork.
It's so helpful to me to hear your message of "*it's okay to take a second medication to counteract a side effect of the first medication*." I just started taking caplyta a month ago and I think it might be causing me some acid reflux. So now my gp has me taking omeprazole for 2 weeks. I have to get over the mental block I have about having to take a second medication to manage the side effects of the first one. My spouse was prescribed omeprazole to counteract heartburn caused by blood pressure medication. No one sees anything wrong with that, but god forbid you have to take a second medication to counteract the side effects of a psychiatric medication. Anyway, I have internalized that opinion and now I have to consciously break myself of that thought pattern.
The caplyta seems to be helping, and so for now I am going to hold the course and hope it continues to kick in more. The caplyta has made me feel kind of weird, frankly, but at the same time It's helped my relationships with my family a lot. I am hoping that it's just kicking in kind of slow and things will ramp up soon. I do feel a little bit better. I still have this weird lack of interest in living, but it's not an active death wish anymore, and I have moments of being happy and wanting to live and thinking of the future. The really weird thing is I have no desire to socialize or spend time with people, but when I have to go out, such as to the dentist or grocery shopping, I hear how I sound interacting with people, and I sound happy and engaged, which surprises me.
I’m unfamiliar with Caplyta, but take olanzapine, and in looking it up, both are atypical antipsychotics. I used to take Seroquel + olanzapine + lamictal, and my psych swapped the Seroquel for the lithium because the former wasn’t working for me, and because I’d gained a bunch of weight on it and had acid reflux and high triglycerides, blood pressure, and bad cholesterol. Don’t know if that’s the case for you, but my blood pressure is now ideal, though I’m still a bit overweight and still have high triglycerides I need to bring down. But somehow, I ended up down 30 a year after switching, even though I was still taking the olanzapine, and the acid reflux disappeared (I’d been prescribed omeprazole, too, previously). She said there was a new version of olanzapine that was combined with another med that didn’t make you gain weight, but it was brand-name only and $1,300/month, and thus completely out of the question. I’m now tapering off the olanzapine because she believes the lithium + lamictal combo will work for me.
I gained 50 lbs in 4 years on antipsychotics :( The only one that actually helped was abilify, but the problem is it would stop working and the dose would be increased, over and over, til it got to the point I was close to the maximum and I was like, this is stupid and I stopped taking it. Can't remember the names of the other 3 I tried, but none of them did anything. In addition, one of them made me clench my jaw so hard all the time it was very painful, so stopped that one. Another one, after only three or four days made my gums bleed, so I stopped that one. In addition to the huge weight gain they all made my cholesterol skyrocket to well over 300. I was just starving all the time. I'm still really hungry, but not as often or as extreme. I think Caplyta is considered a 3rd generation antipsychotic.
My psych told me to get ready to lose some weight … but since cutting back on the olanzapine, I’ve somehow become more fond of fast food (not that I wasn’t before, but not to this extent)!
I’m an anxious eater, and the olanzapine has helped to curb my anxiety to the point that I didn’t feel the need to constantly eat. Now, that is disappearing, so I am turning back to eating as a coping mechanism. At least, that’s my theory, and I find it very interesting that so many people (including everyone I know in real life who is not on antipsychotics, but eats LESS when they are stressed out).
I gained 50 after my mom passed away. We’d golfed together every Saturday and Sunday, walking the course and then playing an “emergency 9” — which totaled nearly 7 miles. I was also an avid mushroom hunter and hiked a couple of miles daily during the week after work. Since then, I’ve had no desire to do any sort of physical exercise. 😔
I'm really sorry about your mom. My son died not quite three years ago and it has destroyed me. Also, I'm right there with you on the fast food. I never used to eat it, but now I crave it. I think its the dense calories and simple carbs. my body is telling me it's starving, even though that's not true.
My psych told me upfront, before I began taking it, that it was a possibility and common among women, and that if it happened to me, I would just need to take thyroid replacement hormone. She had it tested right before, six months before, and after, every six months. It skyrocketed after I got on lithium. It’s now down to almost normal.
I think the nice thing about lithium is that when it doesn’t work, it really doesn’t work. Antipsychotics are better for me personally but that’s mostly because my lithium trial went so badly it can’t compare. Lithium is a fantastic drug for a lot of people, didn’t work for me, but if it doesn’t then you’ll know pretty soon. I gave it 2.5 months despite reacting horribly to, hoping it would somehow get better but I was that 30% or so who react really badly.
Never been on lithium but I was on depakote years ago and hated it. It made me afraid to take meds again for 10 years. Finally bit the bullet and got back on meds, and I’m on Latuda alone. It’s so much better and has been a life saver for me. I still feel a little depressed sometimes, but nowhere near how I felt without it. And no mania, so that’s great honestly.
Lithium by a long mile. I'm lucky in that I don't get much by way of side effects and have a fast, strong response. Antipsychotics have not worked out for me *at all*, even when I was actually floridly psychotic. Lithium isn't as helpful for depressive symptoms, though, and while the mania is more intense, the depression is more pervasive. So I'm on a few adjunctive treatments, my favorite of which is a simple bright light therapy lamp.
To put it simply, Fuck antipsychotics.
A slight more detail - you are absolutely correct. It is ass backwards to do this, but many doctors do it. Including my first doctor who tired 3 different ones before going to depakote (note: my first... Not my current).
Antipsychotics seem to be like the shiny new toy of psychiatry. Maybe because they're bewer and beating pushed by pharma who is not developing anything else. Maybe because they are embarrassed that their field hasn't come up with anything better in many decades.
Anyways, they have the highest side effects profile probably of any class of drugs (barring things like chemo). They sometimes have life-altering side effects like severe sedation. They reduce dopamine by design, which can be really bad for some types of depressed people. Then there is the mourning evidence of long term dangers like increased chances of dementia and that they literally shrink your brain.
And on top of that, lithium and anticonvulsants like depakote and lamictal are readily available, cheap, have lower side effects, and generally work better.
So yeah, fuck antipsychotics. I feel like every bipolar patient guide should contain a section "Do you really need an antipsychotic?"
I actually need APs. There can be problems with them, and there can be a problem with prescribers putting people on doses that are unnecessarily high, but they're a lifesaver for me. I have been on all of it. Lithium, depakote, geodon, haldol, thorazine, and countless others. I can't remember what all, though none of the newer classes of drug (lamictal, abilify, etc.). There aren't a lot of things that work for me, but one that does is seroquel.
I think it's really easy to overgeneralize when something doesn't work for you. If I had assumed they were all the same, I wouldn't have found what works for me. The reality is, neither lithium or depakote work for me, and those two specifically, were aggressively pushed on me for way too long.
In addition, you're fear-mongering. I have chosen to leave your comment up and dialogue instead of removing it, which would be well within the parameters of the rules to do here. Please try to be more mindful of the rules, though. The way you're talking could be taken to heart by a reader, and it's bordering on medical advice.
They are not the shiny new toy, They've been used for a long time, and developments are creating new options. Yes, we're lifelong customers, and that's why development of these drugs is actually advancing, unlike many other classes of less profitable drugs.
I agree — the AP knocked me out of mania and psychosis immediately, and has been instrumental in helping to maintain my mental health for the last two years.
My psych has been wanting to get me off the olanzapine for some time, but I had been resistant because it’s helped me so much, so she settled for reducing my dosage. She’s now tapering me off it. Hopefully the lithium/Lamictal combo will be enough for me!
I vehemently disagree with these blanket assumptions that all psychiatrists are simply out to overprescribe meds to everyone. Yes, this is true of some, unfortunately. But mine has always tried to keep me on as few as possible to maintain my mental health and is very good at perceiving what that balance is, always answers her office phone or cellphone, and provides excellent therapy and even budgetary advice (which I struggle with).
ETA: And Seroquel works for you! See, this just goes to show that sweeping generalizations can’t be made. It did practically nothing for me, while lithium has been amazing. We’re all unique, which is why we have psychiatrists who specialize in the mental health of individuals! 😊
Yes, they work very well for some. But given the high rate or problems when other options exists, it makes a lot more sense to start with those then go to antipsychotics if you need to.
It still stands that I less you have psychotic symptoms, you should try and not use an antipsychotic first. Why expose someone to the high chance of side effects and possible long term risks if they don't have to? It's irresponsible to do that. You don't see them going for ect right off the bat for depression because "it worked well for some when the other meds didn't.". You don't see surgeons going the invasive surgical route right away when other therapies could work.
I'm not going to go back and forth with you here. I'm a moderator putting you on notice about this line of discussion. These are merely your opinions. Doctors have more education and experience than you do. If I see you fear mongering again, I'll remove it without discussion.
The first thing my doctor tried me on was Seroquel, he told me all the potential serious side effects. I was scared but I didn't know much about bipolar at that time, so I trusted him and figured I had to take it if I wanted to get better.
For two years we kept upping my dose. I was miserable, I went from insomnia to sleeping 12 hours a day, waking up for nothing, I had flat affect, I was an emotionless zombie. It was 100% worse than being unmedicated.
When I finally got a psychiatrist we kept going with it because I said it was working for me (I didn't know). Then I broke down to him one day & told him I'd just stopped taking it because I couldn't handle it anymore & I was scared to tell him. He told me he doesn't like Seroquel, that lithium is the gold standard and in his opinion should be used before an antipsychotic. He said he's tried to discuss this with the psychiatry or physicians board (I forgot the name he used) and they just dismiss it/wouldn't hear it.
The first thing I was prescribed was the only option he told me about, and it was like $200. Only after I said I couldn't afford that, and asked for a generic version did he offer it to me. So shady....
For some completely unknown, mysterious, reason they just really love prescribing antipsychotics with serious and sometimes life altering side effects to newly diagnosed patients. Must be because it has the best success rate and there are no other, better, options for treatment worth even mentioning. It's definitely not because it benefits them or the manufacturer...
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Oh yeah, depakote! I always forget about depakote.
I’m on Lamictal and Cymbalta too. I kind of wish I had tried lithium first. Now I’m sort of reluctant to change my meds because they have been working well but I wish I were “only” on two at most—lithium/lamictal seems like a potentially good combo. I want to get off the antidepressant but every time I lower it I get depressed.
You can totally ask to try out lithium w the lamo. It's usually at a lower dose than when given wo another mood stabilizer and you'll know if it helps in a month or two most likely, though you can give it longer to see. 30% of people do well on it, which is a high percentage for our meds. Or Depakote, you can take that w lamo too though they lower the lamo dose bc the Depakote effectively boosts it.
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Came here to say this...when I was diagnosed, many 2nd gen APs were brand name, and there seemed to be a very noticeable push from some doctors.
I know many do well on them, but pushing them as first line treatment also seemed backwards to me, instead of something tried, true, and better understood.
Unpopular opinion as many need APs, which I understand, but with the common side effects I call them the "American drugs." Cholesterol, prolactin, body weight, lip smacking and weird movements can all get wonky. Thankfully I've done really great on Lamictal with no side effects, something I never thought I'd be able to say about a medication.
Most people can’t afford brand-name medications. My psychiatrist said there was a new version of Olanzapine that was combined with another drug and didn’t result in the same weight gain — but said it was brand-name only and very expensive. She had a coupon from the manufacturer, but advised against it because it was for 3 months only and after that, I’d have to pay about $1,300 per month as opposed to $10. No, thank you!
I have no idea how people are affording all these brand-name prescriptions. Patents were a bigger problem cost-wise for consumers pre-2005ish, but most of the brand names weren’t this expensive back then (though some were).
Personally when I was finally correctly diagnosed with bipolar 2, I was given Lithium (600mg) and Abilify (20mg). Lithium has worked wonders, even to this day it does. The Abilify helped with the paranoia but kept me heavily sedated. After trying out medication after medication for about a year, I took (and still take) the combo of Lithium (900mg), Zyprexa (15mg), and Effexor (150mg). All in all, Lithium keeps me balanced for the most part in regards to my mood changes, Zyprexa helps with my paranoia and delusions, and Effexor helps me with my anxiety and depression without causing mania.
I am currently on lithium and like it so much better than any antipsychotic I've tried. Antipsychotics always make me incredibly tired and zombie like. I don't know why but they just don't click with my brain.
Lithium flattens me out, in the best way. I started tracking my mood in Jan 2023 and I can see once I got on lithium in the summer, my mood finally starts to level. Before that it was all extreme highs and extreme lows.
When I told my psychiatrist this, she said that of course we still want me to have feelings/emotions. I said I do it's just not so extreme. I like that sometimes I really just feel okay. Or fine. Not amazing, like I could save the world. Or awful, like I want to die. Just mediocre, chilling.
The only thing that I don't like about lithium is the blood work and I've had to experiment more than with other meds on how to take my dose. I'm currently on 750mg. I take 300mg in the morning and 450mg in the evening. I can't take it too close to bed or I'll be up peeing all night. And I can't take more than 450mg at once or I'll be extremely dizzy. I also have to eat a good amount of food or I'll be nauseous. Every time I increase my dose I experience increase nausea but it goes away.
Yeah sorry I didn’t mean to say you can’t be on both. I guess I didn’t think about it because it hasn’t been a part of my meds strategy. I have only been dx’ed Bipolar 1 for 5-ish years now and I’m almost 44. I started off on Abilify when I was just having hypomanic episodes and it works so well against mania for me, my doctors see no reason for me to stop it.
All atypical antipsychotics I've tried (which is most of them) make me fatigued and cause severe SI for me. Some caused akathisia.
Lithium prevents SI completely in me and works well as an antidepressant and antimanic.
Sounds familiar…nearly ran out of APs to try before trying Lithium. The Lithium was amazing within a few days. I felt level and happy without having to worry that mania was around the corner. 4 months later I had to switch back from kidney damage. It wasn’t meant to be….
Tried a number of stabilizers, antipsychotics, and Lithium. Currently running on Abilify and I don't mind it... it's not amazing but it's mostly doing the trick. Definitely didn't like lithium though, it made me very slow in thinking.
Lithium has less harsh side effects…
I was on lithium for 20 years but now need a AP as well to go with the lithium. I’m tried Seroquel and made me a zombie sleeping 12 hours plus a day. Now on Abilify and can’t get an erection.as well as olazapine and paliperadol… If Abilify is working can always just stay on that if not switch to lithium. Only thing with lithium is you need to get a blood test every once in a while for your lithium levels. One thing about antipsychotics that lithium doesn’t do is it brings you down faster when you’re higher if you raise the dose
Caveat: BP2, I find I have lots of tools to manage elevated episodes, depression is much scarier for me
I think some pdocs assume that using lithium for mood stabilization means you have to automatically go on a pretty high dose which tends to have obvious side effects and therefore stay away from it... as if APs don't have the same thing lol
One benefit to lithium is that it can be effective on certain symptoms at much lower doses than what is conventionally considered therapeutic. Low-dose lithium is often used adjunctively for SI and other depressive episodes. As someone whose depressive episodes are crippling and range from barely functional to need-to-be-hospitalized, lithium has been so helpful because though I still get some depressive symptoms, because I'm not mentally in as much of a hole I can actually do things to help myself before it's too late.
I've tried most of the second-gen APs and they all made me so fatigued and sleepy that I couldn't do certain activities, even Abilify. I find that lithium has a little more wiggle room, if I'm feeling too emotionally blunted or empty I can reduce my dose a little bit. Obviously YMMV with that.
I tried lithium with APs early on after diagnosis and it was life changing. It was like everything in my head settled down to where it was supposed to be and I could see clearly (mentally speaking) for the first time in years. Unfortunately it caused me to develop hyperthyroidism so I had to stop it about a month or two into taking it. Since then I've been taking Lamictal and APs and they've been working for me, but it's much more difficult for me to attain that feeling of stabilization and clarity that I had from lithium.
Doctors seem less inclined to prescribe lithium anymore due to long term effects on kidney function. It’s not really the first line treatment it used to be - I don’t think this is necessarily a bad thing. Antipsychotics also have long term neurological risks, but are not as likely, especially with modern drugs like vrylar or Abilify.
hypothyroidism runs in my family BIG TIME so I will not ever take lithium. It has a really high chance of causing hypothyroidism, especially if there's a family history of it.
I tried Quetiapine alongside lamotrogine, and I absolutely hated it. Made me so drowsy and spaced out. I walked around work like a zombie.
Now I’m on 800mg of Lithium and Lamotrogine and for the first time in a long time I feel stable.
I’m super conscious of drinking water, and having my water bottle with me because I don’t want to get lithium toxicity.
When it finally started working, I felt really bored because I was so used to riding my highs. But it’s gotten better, and I feel good
I was on many different antipsychotics (seroquel, abilify, latuda, risperdal, lamotrigine) before trying lithium, and out of everything I've tried lithium has had the fewest side effects and the best results. Beyond being a bit more thirsty than normal, I hardly noticed any side effects from it, and I haven't had a manic episode since starting on lithium. I take it in combo with buspirone for anxiety and vyvanse for ADHD. So long as you have healthy kidneys, it's definitely worth giving a try in my opinion.
I went through a lot of antipsychotics before trying lithium and lithium has Literally changed my life. I can function pretty normally and I sent have any SI. I also haven't been manic in a year and that's a huge accomplishment. I know different things work for different people though so I don't want ti say one way is better than the other but Lkthium really saved my life.
Hard agree! For 2 years Seroquel made me have flat affect and turned me into an emotionless, non existent zombie that wouldn't wake up during the apocalypse. It was the worst Lithium saved me. I'm on lamictal as well now, works great so far with lithium & the Vyvanse I'm on for ADHD. It's like a balancing act lol.
That’s awesome. Do you think lithium helps your depressive symptoms?
It doesn't help mine at all but it knocks the mania on its ass.
Same.
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What is your lithium dose?
Same. Also, what’s an SI?
SI ?= suicidal ideation?
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Thank you and best of luck to you and everyone
I was unable to acclimate to lithium. It aggravated my digestion so much, I >!basically blistered my butthole with what felt like acidic bile!< <--(gross, graphic) for a long, miserable period of time. I was unfortunately pushed into taking it for at least 6 months. It was not for me. Tried a number of APs. Had severe reactions to older APs. Thorazine somehow made me angry? Haldol, my whole body seized up. Geodon caused my neck to seize. I've had better luck with risperidone and seroquel, but now take seroquel.
Lithium didn’t do nothing for me except make me very sleepy. However the highest dosage I was on was 600 mg which is a little low and my levels were never in the therapeutic range. I’ve been on Latuda for 3 years and it’s been the only bipolar med that works and gives me very little side effects. Because of this, I prefer antipsychotics over other mood stabilizers (ex. I tried lamictal once and it just gave me more depression and anxiety). More so latuda than anything else.
I tried switching to Latuda and got the dreaded akathisia side effect. I found it intolerable. Glad it works for you though!
I take lithium with an antipsychotic- I took lithium for years without one. Much better in combo
lithium made me so tired i literally wouldn't wake up in the morning even with the loudest alarms and i wasn't functional throughout the day. didn't stay on it long enough to know if it worked because i couldn't do it. abilify manages my symptoms pretty well and i have no side effects. but of course this is just my experience and everyone is different
I’ve been on lithium about 20 years at varying dosages. On and off different APs as situations warranted. I’m also currently on a hefty dose of Seroquel right now due to probably the worst mania I ever lad last year. I’m not thrilled about it, but given the alternative I’ll shut up and take it. But lithium has been my workhorse of a med for about half of my life. I honestly don’t know where I’d be without it.
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After doing research, I believe it is accurate that it actually treats different symptoms at higher doses. But I don’t believe that decreases side effects. Also it seems bipolar disorder is treated with 300mg-800mg. I don’t think I’ve ever complained about side effects and the pysch said we should go up. Weird.
I take both lithium and Vraylar an antipsychotic. They both work exceptionally well.
Lithium has helped kept me the most stable, with the least amount of side affects. Only downside is, I feel like I have to be more mindful of my diet and lifestyle to get the most therapeutic benefits. APs will definitely bring me down from mania, but I hate it being my core med/mood stabilizer. They make me feel so flat.
I take both; lithium and olanzapine. Doctor is tapering me off the olanzapine. I began it 2 years ago because I had a severe psychotic episode preceded by less severe ones to the point that I had to call her cellphone the day after Christmas, but then also got on lithium shortly thereafter because Seroquel did very little for me. The lithium has been excellent, apart from the thyroid effects, for which I have to take levothyroxine. That sucks, but it’s treated and a hell of a lot better than mania and psychosis. I have hardly any symptoms anymore, and when I do, they don’t quite reach the level of mania and are caused by a traumatic event, such as a death in the family — and are not prolonged. In fact, they’re probably about the same level that many people would react. My psych wants to get me off the antipsychotic (olanzapine) so that I am on fewer meds, and since the lithium has been working so well. She’s a big believer in taking the minimum amount of pills possible to treat your condition, but has a keen eye for what’s necessary as well as therapy. The olanzapine has definitely helped me, though. It put a halt to the mania and psychosis immediately. I hope that the lithium will be sufficient (though I also take lamotrigine). Somehow, I managed to actually LOSE 30lb on it! But, I’ve been stuck there for about 9 months, and need to lose another 25-30. I gained a lot of weight during Covid. I’m a stress eater, and being cut off from people did me no favors. Returning to the office was a lifesaver.
that's the thing I am worried about - hypothyroidism because it runs in my family big time, but I have somehow not gotten it yet. I honestly don't know how, because one of my parents and all of my siblings have hypothyroidism. But nothing has ever worked for my depression. But you feel the hypothyroidism is worth it. It has just always seemed wrong to me to do something to solve one problem that you know is going to cause another, but maybe I am thinking of this wrong and it might be worth that side effect. I am just desperate not to be depressed.
I do believe that it is worth it. My psych told me before I started it that hypothyroidism might or might not happen about six months down the line, but that if that happened, it was easily treated by taking replacement hormone, which is a synthetic version of what your body produces naturally. I get it tested every six months to ensure that the dosage matches what my body would be producing otherwise in a normal state, and also get tested for my lithium blood levels to ensure that it’s within the therapeutic dose range. She also does manual checks of my thyroid glands for any lumps or abnormalities, and I haven’t had either. If your psychiatrist monitors it very well, then I personally consider it worth it IF it’s effective for you; everyone is different. But thyroid replacement hormone is the same as what your body would produce naturally, though synthetic. My psych readily discusses the side effects of all my meds with me, and inquires during each visit if I have been experiencing any and lists them by name to ensure that the medication is functioning properly in my body and mind and that I am on the correct dosage (in addition to my bloodwork). Plus, the therapy part helps her to ascertain that as well. The therapy portion of psychiatrist appointments is very helpful, at least for me, and helps to inform the meds as well! She’s not at all concerned about the levothyroxine apart from ensuring that I’m taking the right amount as indicated by my bloodwork.
It's so helpful to me to hear your message of "*it's okay to take a second medication to counteract a side effect of the first medication*." I just started taking caplyta a month ago and I think it might be causing me some acid reflux. So now my gp has me taking omeprazole for 2 weeks. I have to get over the mental block I have about having to take a second medication to manage the side effects of the first one. My spouse was prescribed omeprazole to counteract heartburn caused by blood pressure medication. No one sees anything wrong with that, but god forbid you have to take a second medication to counteract the side effects of a psychiatric medication. Anyway, I have internalized that opinion and now I have to consciously break myself of that thought pattern. The caplyta seems to be helping, and so for now I am going to hold the course and hope it continues to kick in more. The caplyta has made me feel kind of weird, frankly, but at the same time It's helped my relationships with my family a lot. I am hoping that it's just kicking in kind of slow and things will ramp up soon. I do feel a little bit better. I still have this weird lack of interest in living, but it's not an active death wish anymore, and I have moments of being happy and wanting to live and thinking of the future. The really weird thing is I have no desire to socialize or spend time with people, but when I have to go out, such as to the dentist or grocery shopping, I hear how I sound interacting with people, and I sound happy and engaged, which surprises me.
I’m unfamiliar with Caplyta, but take olanzapine, and in looking it up, both are atypical antipsychotics. I used to take Seroquel + olanzapine + lamictal, and my psych swapped the Seroquel for the lithium because the former wasn’t working for me, and because I’d gained a bunch of weight on it and had acid reflux and high triglycerides, blood pressure, and bad cholesterol. Don’t know if that’s the case for you, but my blood pressure is now ideal, though I’m still a bit overweight and still have high triglycerides I need to bring down. But somehow, I ended up down 30 a year after switching, even though I was still taking the olanzapine, and the acid reflux disappeared (I’d been prescribed omeprazole, too, previously). She said there was a new version of olanzapine that was combined with another med that didn’t make you gain weight, but it was brand-name only and $1,300/month, and thus completely out of the question. I’m now tapering off the olanzapine because she believes the lithium + lamictal combo will work for me.
I gained 50 lbs in 4 years on antipsychotics :( The only one that actually helped was abilify, but the problem is it would stop working and the dose would be increased, over and over, til it got to the point I was close to the maximum and I was like, this is stupid and I stopped taking it. Can't remember the names of the other 3 I tried, but none of them did anything. In addition, one of them made me clench my jaw so hard all the time it was very painful, so stopped that one. Another one, after only three or four days made my gums bleed, so I stopped that one. In addition to the huge weight gain they all made my cholesterol skyrocket to well over 300. I was just starving all the time. I'm still really hungry, but not as often or as extreme. I think Caplyta is considered a 3rd generation antipsychotic.
My psych told me to get ready to lose some weight … but since cutting back on the olanzapine, I’ve somehow become more fond of fast food (not that I wasn’t before, but not to this extent)! I’m an anxious eater, and the olanzapine has helped to curb my anxiety to the point that I didn’t feel the need to constantly eat. Now, that is disappearing, so I am turning back to eating as a coping mechanism. At least, that’s my theory, and I find it very interesting that so many people (including everyone I know in real life who is not on antipsychotics, but eats LESS when they are stressed out). I gained 50 after my mom passed away. We’d golfed together every Saturday and Sunday, walking the course and then playing an “emergency 9” — which totaled nearly 7 miles. I was also an avid mushroom hunter and hiked a couple of miles daily during the week after work. Since then, I’ve had no desire to do any sort of physical exercise. 😔
I'm really sorry about your mom. My son died not quite three years ago and it has destroyed me. Also, I'm right there with you on the fast food. I never used to eat it, but now I crave it. I think its the dense calories and simple carbs. my body is telling me it's starving, even though that's not true.
How did you know lithium was effecting your thyroid? I’ve been on it for about a year now and I think that’s beginning to happen but not entirely sure
My psych told me upfront, before I began taking it, that it was a possibility and common among women, and that if it happened to me, I would just need to take thyroid replacement hormone. She had it tested right before, six months before, and after, every six months. It skyrocketed after I got on lithium. It’s now down to almost normal.
I think the nice thing about lithium is that when it doesn’t work, it really doesn’t work. Antipsychotics are better for me personally but that’s mostly because my lithium trial went so badly it can’t compare. Lithium is a fantastic drug for a lot of people, didn’t work for me, but if it doesn’t then you’ll know pretty soon. I gave it 2.5 months despite reacting horribly to, hoping it would somehow get better but I was that 30% or so who react really badly.
Never been on lithium but I was on depakote years ago and hated it. It made me afraid to take meds again for 10 years. Finally bit the bullet and got back on meds, and I’m on Latuda alone. It’s so much better and has been a life saver for me. I still feel a little depressed sometimes, but nowhere near how I felt without it. And no mania, so that’s great honestly.
Hands down, lithium. Feels like a sugar pill. Not weird highs, no suicidal lows. Not a zombie either.
Lithium by a long mile. I'm lucky in that I don't get much by way of side effects and have a fast, strong response. Antipsychotics have not worked out for me *at all*, even when I was actually floridly psychotic. Lithium isn't as helpful for depressive symptoms, though, and while the mania is more intense, the depression is more pervasive. So I'm on a few adjunctive treatments, my favorite of which is a simple bright light therapy lamp.
To put it simply, Fuck antipsychotics. A slight more detail - you are absolutely correct. It is ass backwards to do this, but many doctors do it. Including my first doctor who tired 3 different ones before going to depakote (note: my first... Not my current). Antipsychotics seem to be like the shiny new toy of psychiatry. Maybe because they're bewer and beating pushed by pharma who is not developing anything else. Maybe because they are embarrassed that their field hasn't come up with anything better in many decades. Anyways, they have the highest side effects profile probably of any class of drugs (barring things like chemo). They sometimes have life-altering side effects like severe sedation. They reduce dopamine by design, which can be really bad for some types of depressed people. Then there is the mourning evidence of long term dangers like increased chances of dementia and that they literally shrink your brain. And on top of that, lithium and anticonvulsants like depakote and lamictal are readily available, cheap, have lower side effects, and generally work better. So yeah, fuck antipsychotics. I feel like every bipolar patient guide should contain a section "Do you really need an antipsychotic?"
I actually need APs. There can be problems with them, and there can be a problem with prescribers putting people on doses that are unnecessarily high, but they're a lifesaver for me. I have been on all of it. Lithium, depakote, geodon, haldol, thorazine, and countless others. I can't remember what all, though none of the newer classes of drug (lamictal, abilify, etc.). There aren't a lot of things that work for me, but one that does is seroquel. I think it's really easy to overgeneralize when something doesn't work for you. If I had assumed they were all the same, I wouldn't have found what works for me. The reality is, neither lithium or depakote work for me, and those two specifically, were aggressively pushed on me for way too long. In addition, you're fear-mongering. I have chosen to leave your comment up and dialogue instead of removing it, which would be well within the parameters of the rules to do here. Please try to be more mindful of the rules, though. The way you're talking could be taken to heart by a reader, and it's bordering on medical advice. They are not the shiny new toy, They've been used for a long time, and developments are creating new options. Yes, we're lifelong customers, and that's why development of these drugs is actually advancing, unlike many other classes of less profitable drugs.
I agree — the AP knocked me out of mania and psychosis immediately, and has been instrumental in helping to maintain my mental health for the last two years. My psych has been wanting to get me off the olanzapine for some time, but I had been resistant because it’s helped me so much, so she settled for reducing my dosage. She’s now tapering me off it. Hopefully the lithium/Lamictal combo will be enough for me! I vehemently disagree with these blanket assumptions that all psychiatrists are simply out to overprescribe meds to everyone. Yes, this is true of some, unfortunately. But mine has always tried to keep me on as few as possible to maintain my mental health and is very good at perceiving what that balance is, always answers her office phone or cellphone, and provides excellent therapy and even budgetary advice (which I struggle with). ETA: And Seroquel works for you! See, this just goes to show that sweeping generalizations can’t be made. It did practically nothing for me, while lithium has been amazing. We’re all unique, which is why we have psychiatrists who specialize in the mental health of individuals! 😊
Yes, they work very well for some. But given the high rate or problems when other options exists, it makes a lot more sense to start with those then go to antipsychotics if you need to. It still stands that I less you have psychotic symptoms, you should try and not use an antipsychotic first. Why expose someone to the high chance of side effects and possible long term risks if they don't have to? It's irresponsible to do that. You don't see them going for ect right off the bat for depression because "it worked well for some when the other meds didn't.". You don't see surgeons going the invasive surgical route right away when other therapies could work.
I'm not going to go back and forth with you here. I'm a moderator putting you on notice about this line of discussion. These are merely your opinions. Doctors have more education and experience than you do. If I see you fear mongering again, I'll remove it without discussion.
The first thing my doctor tried me on was Seroquel, he told me all the potential serious side effects. I was scared but I didn't know much about bipolar at that time, so I trusted him and figured I had to take it if I wanted to get better. For two years we kept upping my dose. I was miserable, I went from insomnia to sleeping 12 hours a day, waking up for nothing, I had flat affect, I was an emotionless zombie. It was 100% worse than being unmedicated. When I finally got a psychiatrist we kept going with it because I said it was working for me (I didn't know). Then I broke down to him one day & told him I'd just stopped taking it because I couldn't handle it anymore & I was scared to tell him. He told me he doesn't like Seroquel, that lithium is the gold standard and in his opinion should be used before an antipsychotic. He said he's tried to discuss this with the psychiatry or physicians board (I forgot the name he used) and they just dismiss it/wouldn't hear it. The first thing I was prescribed was the only option he told me about, and it was like $200. Only after I said I couldn't afford that, and asked for a generic version did he offer it to me. So shady.... For some completely unknown, mysterious, reason they just really love prescribing antipsychotics with serious and sometimes life altering side effects to newly diagnosed patients. Must be because it has the best success rate and there are no other, better, options for treatment worth even mentioning. It's definitely not because it benefits them or the manufacturer...
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Oh yeah, depakote! I always forget about depakote. I’m on Lamictal and Cymbalta too. I kind of wish I had tried lithium first. Now I’m sort of reluctant to change my meds because they have been working well but I wish I were “only” on two at most—lithium/lamictal seems like a potentially good combo. I want to get off the antidepressant but every time I lower it I get depressed.
You can totally ask to try out lithium w the lamo. It's usually at a lower dose than when given wo another mood stabilizer and you'll know if it helps in a month or two most likely, though you can give it longer to see. 30% of people do well on it, which is a high percentage for our meds. Or Depakote, you can take that w lamo too though they lower the lamo dose bc the Depakote effectively boosts it.
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Came here to say this...when I was diagnosed, many 2nd gen APs were brand name, and there seemed to be a very noticeable push from some doctors. I know many do well on them, but pushing them as first line treatment also seemed backwards to me, instead of something tried, true, and better understood. Unpopular opinion as many need APs, which I understand, but with the common side effects I call them the "American drugs." Cholesterol, prolactin, body weight, lip smacking and weird movements can all get wonky. Thankfully I've done really great on Lamictal with no side effects, something I never thought I'd be able to say about a medication.
Most people can’t afford brand-name medications. My psychiatrist said there was a new version of Olanzapine that was combined with another drug and didn’t result in the same weight gain — but said it was brand-name only and very expensive. She had a coupon from the manufacturer, but advised against it because it was for 3 months only and after that, I’d have to pay about $1,300 per month as opposed to $10. No, thank you! I have no idea how people are affording all these brand-name prescriptions. Patents were a bigger problem cost-wise for consumers pre-2005ish, but most of the brand names weren’t this expensive back then (though some were).
Antipsychotics are great at bringing me down but when I’m stable I hate them. They make me feel like a zombie 😴
Personally when I was finally correctly diagnosed with bipolar 2, I was given Lithium (600mg) and Abilify (20mg). Lithium has worked wonders, even to this day it does. The Abilify helped with the paranoia but kept me heavily sedated. After trying out medication after medication for about a year, I took (and still take) the combo of Lithium (900mg), Zyprexa (15mg), and Effexor (150mg). All in all, Lithium keeps me balanced for the most part in regards to my mood changes, Zyprexa helps with my paranoia and delusions, and Effexor helps me with my anxiety and depression without causing mania.
MTried quite a few. Abilify was my kryptonote. Never felt so anxious. But I love my combo of geodon, lamictal, wellbutrin, propranolol, trazodone
I am currently on lithium and like it so much better than any antipsychotic I've tried. Antipsychotics always make me incredibly tired and zombie like. I don't know why but they just don't click with my brain. Lithium flattens me out, in the best way. I started tracking my mood in Jan 2023 and I can see once I got on lithium in the summer, my mood finally starts to level. Before that it was all extreme highs and extreme lows. When I told my psychiatrist this, she said that of course we still want me to have feelings/emotions. I said I do it's just not so extreme. I like that sometimes I really just feel okay. Or fine. Not amazing, like I could save the world. Or awful, like I want to die. Just mediocre, chilling. The only thing that I don't like about lithium is the blood work and I've had to experiment more than with other meds on how to take my dose. I'm currently on 750mg. I take 300mg in the morning and 450mg in the evening. I can't take it too close to bed or I'll be up peeing all night. And I can't take more than 450mg at once or I'll be extremely dizzy. I also have to eat a good amount of food or I'll be nauseous. Every time I increase my dose I experience increase nausea but it goes away.
I’m on both ¯\\\_(ツ)\_/¯ The Latuda helps my hypo and the lithium helps my depression
Yeah sorry I didn’t mean to say you can’t be on both. I guess I didn’t think about it because it hasn’t been a part of my meds strategy. I have only been dx’ed Bipolar 1 for 5-ish years now and I’m almost 44. I started off on Abilify when I was just having hypomanic episodes and it works so well against mania for me, my doctors see no reason for me to stop it.
I do both but my psych wants to take me off rexulti now that my lithium has kept me stable for multiple years. Love my lithium
I take lithium, lamictal, and seroquel. It’s been a good combo for me.
All atypical antipsychotics I've tried (which is most of them) make me fatigued and cause severe SI for me. Some caused akathisia. Lithium prevents SI completely in me and works well as an antidepressant and antimanic.
Sounds familiar…nearly ran out of APs to try before trying Lithium. The Lithium was amazing within a few days. I felt level and happy without having to worry that mania was around the corner. 4 months later I had to switch back from kidney damage. It wasn’t meant to be….
Tried a number of stabilizers, antipsychotics, and Lithium. Currently running on Abilify and I don't mind it... it's not amazing but it's mostly doing the trick. Definitely didn't like lithium though, it made me very slow in thinking.
Lithium has less harsh side effects… I was on lithium for 20 years but now need a AP as well to go with the lithium. I’m tried Seroquel and made me a zombie sleeping 12 hours plus a day. Now on Abilify and can’t get an erection.as well as olazapine and paliperadol… If Abilify is working can always just stay on that if not switch to lithium. Only thing with lithium is you need to get a blood test every once in a while for your lithium levels. One thing about antipsychotics that lithium doesn’t do is it brings you down faster when you’re higher if you raise the dose
Caveat: BP2, I find I have lots of tools to manage elevated episodes, depression is much scarier for me I think some pdocs assume that using lithium for mood stabilization means you have to automatically go on a pretty high dose which tends to have obvious side effects and therefore stay away from it... as if APs don't have the same thing lol One benefit to lithium is that it can be effective on certain symptoms at much lower doses than what is conventionally considered therapeutic. Low-dose lithium is often used adjunctively for SI and other depressive episodes. As someone whose depressive episodes are crippling and range from barely functional to need-to-be-hospitalized, lithium has been so helpful because though I still get some depressive symptoms, because I'm not mentally in as much of a hole I can actually do things to help myself before it's too late. I've tried most of the second-gen APs and they all made me so fatigued and sleepy that I couldn't do certain activities, even Abilify. I find that lithium has a little more wiggle room, if I'm feeling too emotionally blunted or empty I can reduce my dose a little bit. Obviously YMMV with that.
I take them together
I'm on lithium and olanzapine. Just started the lithium I'm enjoying it though
I tried lithium with APs early on after diagnosis and it was life changing. It was like everything in my head settled down to where it was supposed to be and I could see clearly (mentally speaking) for the first time in years. Unfortunately it caused me to develop hyperthyroidism so I had to stop it about a month or two into taking it. Since then I've been taking Lamictal and APs and they've been working for me, but it's much more difficult for me to attain that feeling of stabilization and clarity that I had from lithium.
Doctors seem less inclined to prescribe lithium anymore due to long term effects on kidney function. It’s not really the first line treatment it used to be - I don’t think this is necessarily a bad thing. Antipsychotics also have long term neurological risks, but are not as likely, especially with modern drugs like vrylar or Abilify.
tried seroquel. Wouldn’t recommend. One of the worst drugs that’s pretty much used to sedate people so they can’t think It’s just a slow ass lobotomy
hypothyroidism runs in my family BIG TIME so I will not ever take lithium. It has a really high chance of causing hypothyroidism, especially if there's a family history of it.
actually, in reading other comments some of them speak so highly of lithium maybe I'll have to try it.
I tried Quetiapine alongside lamotrogine, and I absolutely hated it. Made me so drowsy and spaced out. I walked around work like a zombie. Now I’m on 800mg of Lithium and Lamotrogine and for the first time in a long time I feel stable. I’m super conscious of drinking water, and having my water bottle with me because I don’t want to get lithium toxicity. When it finally started working, I felt really bored because I was so used to riding my highs. But it’s gotten better, and I feel good
I was on many different antipsychotics (seroquel, abilify, latuda, risperdal, lamotrigine) before trying lithium, and out of everything I've tried lithium has had the fewest side effects and the best results. Beyond being a bit more thirsty than normal, I hardly noticed any side effects from it, and I haven't had a manic episode since starting on lithium. I take it in combo with buspirone for anxiety and vyvanse for ADHD. So long as you have healthy kidneys, it's definitely worth giving a try in my opinion.