Tag Archives: lithium

Lithium Nausea; Curbed By Tater Tots?

After four years of taking Lithium I have finally discovered a substance that nullifies lithium nausea.

This is big news, are you ready for this?

Potatoes! Or, more specifically, tater tots!

As I said, I’ve been taking lithium for four years now and though most of the initial nausea, tremors, and grossness has faded, I have always had trouble with the window between the time right after taking the lithium before I fall asleep. This has been especially bad if I can’t sleep (for whatever reason) and the longer I lay there, the more awful I feel… consequently making it even harder to sleep.

While I’ve tried just taking the lithium with food, I don’t like to eat a “meal” within two hours of going to bed because I have bad acid reflux and wind up with nasty heartburn. When I’ve tried staying up two hours after taking the lithium, I reach a point where my stomach empties (good for going to bed) but then the nausea hits me. In my experience, empty tummy = return of the nausea.

I discovered the method I’ve been using the last month or so when I began having really bad stomach problems (as a result of medication side effects). It only really works if I eat dinner at least three hours before I plan on going to bed (two hours before I take the lithium and tots so my stomach is empty, one hour before I expect to actually get in bed).

This has been my recent experimental tot-to-lithium nausea nullification ritual;

1. I bake up 6-8 tots (depending on my hunger level) and start them so they will be out of the oven an hour before I plan to get in bed. Keep in mind that involves subtracting oven pre-heat time and baking time (about 25 minutes total for my oven but each oven is a little different) from the time I want them done, so I start the oven up about an hour and a half before bed. Also, it is good to note that cooking 6-8 tots takes less time than, say, half the bag, so usually the full time printed is not necessary -I tend to knock off 3-5 minutes of the cooking time, but as I said, each oven varies.

2. Once cooled, I eat the tots (with a little salt), take the lithium, and enjoy a nice episode of whatever is on.

3. By the time I crawl in bed an hour later I have been surprisingly nausea free and slightly comforted by the tots. For whatever reason, this has made falling asleep significantly easier, and I have had less nausea upon waking up later than I did when I was taking the lithium before bed on an empty stomach.

The potato seems to have enough carbohydrates and starch to keep me feeling full even though it is only a few little tots, but not full enough that I feel bloated or have had to deal with acid reflux. I have not, however, been using any kind of condiments because this has generally just triggered heartburn once I am in bed.

I don’t expect this is a phenomenon specifically caused by tots, if you are a whole-food or organic eater it might be worth trying a few cubes of boiled or roasted potato instead. I just use the tots because they involve significantly less prep, and I find the thought of taking “potato pills” with my regular ones somewhat amusing!

I realize this is probably one of the weirdest things I’ve ever stumbled upon, but honestly it has really helped me so I thought I would share. Though I can’t guarantee this will work for you, a little experimentation could definitely be worth your while! Tot-on!

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A Missed Dose

In the last 28 years I have not skipped or missed a dose of medication.

Wednesday night as I huddled in the ER (for the second time in two weeks) the team of doctors and nurses surrounding me looked started as I told them this fact. I guess it never occurred to me that this might be unusual in any way, but in an emergency room where they’re relatively used to patients with mental illness suddenly stopping their medication and sailing into big episodes that might be landing them there… well, I quickly felt that the staff probably did not believe me.

It is true, though. And while most people would try to praise this as an act of good self control or healthy living I fear that the truth is actually somewhere in the realm of the opposite.

You see… when I was 17 I was taking an antidepressant that (little did I know) was slowly dissolving any semblance of sanity I had left at the time. Despite the fact that it was making me worse and worse, I took it religiously. At the time I was being treated for obsessive compulsive disorder, and frankly there were many things in my life that I needed to do religiously or I firmly believed I would die very suddenly.

I have always been the sort of person that once a routine has been established I have a very very hard time deviating from that routine, even when it is harming me. For the last several months, for example, I have eaten one large fried egg over medium and a slice of buttermilk toast for breakfast every day (at least, every day that I could eat). There are times when I struggle with the notion that I probably shouldn’t eat so many eggs (hello cholesterol), but the best I can do when I feel really ballsy is switch out the buttermilk toast for an english muffin. Not eating this breakfast is… well… wrong.

Anyway, at 17, taking said antidepressant religiously and spiraling into a very dark, weird place I was quickly in an psychiatric inpatient hospitalization situation. Within 24 hours I became outrageously ill, and I’m talking the most ill I had ever felt in my life up to (and even after) that point. Eight hours of uncontrollable vomiting and dry-heaving, and dizziness to the point of being unable to even dress myself.

This also happened to be the time when one of the nurses decided to display an abuse of power, laughing at my sudden illness, yelling at me, accusing me of having an eating disorder, and refusing to help me for several hours. By the time I was able to deduce that I was having withdrawals from my usual medication regimen, the damage was already done, and the fear this experience had instilled in me took root very firmly.

I could not and would not ever stop taking any medication suddenly for any reason again if it was in my power, and the paranoia and fear that manifested from this situation has often swung me into the danger zone in the opposite direction. What I mean is that while I don’t feel compelled to stop taking my medication suddenly (or act cavalier about keeping up with taking it), I have become even more obsessive and paranoid about taking these pills. To top it off, I’ve had many instances of not being able to remember if I took them or not, and then accidentally taking them several times over just in case I had forgotten.

Realistically this doesn’t provide a much more safe environment, and suffice it to say that withdrawal of many drugs is probably extremely preferable to overdose.

I had been feeling really rough on wednesday, a lot of the dizziness and nausea from the week previous had returned. By the time I took my dosage of lithium for the night, I vomited it back up in a matter of minutes.

Though I had already been advised earlier in the day to go to the ER by my doctor to receive intervenes nausea medication and fluids, it wasn’t until the panic of suddenly being lithium free for the first night in four years set in that I was heading straight for the hospital. I was certain that if I didn’t feel horribly sick already (and I did) I was headed for a night of fire and brimstone.

By the time I got to the ER I was hitting patches of uncontrollable crying. I was terrified, and even though the seasoned internet sage reported I would likely only experience mental and mood symptoms from the missed dose, the way my body reacts to medications (or lack thereof) has been significantly different than the norm in almost every situation. I had no way to know what might happen next.

So the doctors dealt with the nausea and the fluids, and when I brought the idea of “missing” (or losing, rather) my lithium dose that night the doctor instinctively told me to take it again when I got home.

Now, given my history, this is something I had already considered myself. However, I had been pretty dehydrated for a week or so and I was concerned because dehydration can lead to lithium toxicity. When I said this to the doctor, I also mentioned that I have already experienced lithium toxicity before and wouldn’t like to do it again. His conclusion was that they would check my lithium levels in the blood they had already taken earlier when I checked in.

Thirty minutes later he walked into my room and commented that my lithium levels were a bit higher than he expected. He advised I wait until the next night to continue with my lithium.

Among the papers I was given when I headed home for the night was the lab report that included my lithium level. It was nearly twice my regular level.

When I read that I was immediately glad I had gone to the ER and not just taken the lithium again. If I had, I would have undoubtedly experienced lithium toxicity, as I was nearly there already. For the first time I felt grateful for having vomited… and I can’t help but feel slightly mystified at the possibility that my body was rejecting the excess lithium all on its own.

I am now back on track with my medications and working with a GI specialist to try to pinpoint the source of my stomach issues. It is a little funny how not eating can make eating something as basic as plain white rice taste amazing!

Wrapping Up the Seroquel Journey

Things with seroquel have gone from bad to worse to emergency status.

After lowering my dosage from 50 mg to 25 mg a couple weeks ago my GI issues seemed to get slightly better. The intense pain I was having subsided, and I was no longer running to the bathroom every thirty minutes. I took this as a sign that the bulk of the abdominal issues I’ve been having have been triggered by (and if not, largely fueled by) the seroquel.

I wanted to give the remaining 25 mg of seroquel time to let the side effects from reducing my dosage subside so I could see if 25 mg would still be causing me problems. After three weeks the nausea I was having in the evening started to grow. I found myself needing to pop a tums every hour, and then every thirty minutes, and then every ten minutes. I used pepto bismol and pepcid and drank ginger ale, and by the time I could see where things were heading, I tried to make an appointment with my GI doctor. That appointment still hasn’t happened yet, it takes place later this week.

Soooooo the only thing I could do was to contact my psychiatrist and express (quite urgently) that I needed to be taken off the seroquel completely. He consented, but by that time it was too late.

The nausea became completely overpowering, and I became so dizzy I couldn’t look at the television screen or even the screen on my phone without vomiting. My stomach pain (like the nausea and dizziness) grew exponentially and last Thursday I quickly found myself in a situation where it had been 24 hours since I could keep water or food of any kind down.

My doctor had given me some anti-nausea medication that wasn’t working. By the time I got to the ER they shot me full of two more kinds that didn’t help. The third helped, but made me dizzy until I became nauseated again. Well that, and it gave me hallucinations.

By Thursday night I had only been able to eat about 600 calories total over the previous three days. I’d had three hours of sleep (because the nausea was so intense). And even though I’d stopped taking the seroquel the day before (after shit started hitting the fan so I knew this wasn’t a product of withdrawal) things continued to escalate for another 24 hours.

The reason I went to the ER was because after going so long without water (and subsequently becoming dehydrated) I knew I would need some fluids or I would run the risk of experiencing lithium toxicity again. That and I needed something to help with the nausea because I wanted desperately to sleep.

Two sacks of fluid via IV and (I think) three types of anti-nausea medication later (frankly I can’t remember a lot after the hallucinations took place) I asked them to let me leave. The staff seemed in no hurry to find “the cause” of my intense pain and nausea/vomiting and I wasn’t concerned about that because I largely believe it to be the seroquel. I also have that appointment later this week with my GI doctor anyway who knows my history and seems like a pretty smart lady, so all I wanted was something to help me make it through the week to the appointment.

Though I had expressed my theory about the seroquel, there were several other theories going around. Maybe an ulcer was to blame, or pancreatitis (which it isn’t, the test came back negative later), or any other number of things.

The concoction of medicines they injected me with in the ER allowed me to sleep for the first time in several nights, and while on Friday I was sill experiencing pain and extreme fatigue my nausea was improving. I also managed to eat half a bowl of soup, and a few crackers without incident.

By Saturday my appetite was slowly returning. I felt hungry for the first time in over six weeks (as the seroquel had suppressed my appetite over that entire time) and my energy and alertness were beginning to return. Though I was still having stomach pain and nausea, they were largely only taking place after eating and in the evening again.

On Sunday I felt relatively normal, despite only being able to eat very small amounts and being fairly dizzy upon walking around. The pain was still present, but again, mostly after eating and in the evening when my stomach is the most full.

I have been avoiding all foods that don’t mix well with ulcers (dairy, caffeine, pretty much everything I was avoiding before this anyway when my symptoms were getting worse) just in case an ulcer is playing some kind of role in this situation.

At this point just the fact that my symptoms have been improving like this (and within 48 hours of stopping the seroquel) I feel certain that if that medication wasn’t causing the bulk of the issues, it was at least feeding the fire. My issues seem to be receding now instead of ramping up, so either way I feel like I’m on top.

Goodbye Summer, Hello Relief!

As a child, summer was always a time to celebrate. After all, there was no school, no homework, and (if I was lucky) no real responsibility in sight. Unfortunately as an adult, my feelings about summer have changed dramatically.

The funny thing is, I know that in winter I’m complaining about Seattle winter. Dark days, the constant drizzle, and experiencing days, weeks, and even months sometimes without seeing that big yellow orb in the sky.

But now, as an adult, I am finding summer to be equally as challenging. While I admit it feels quite odd to feel so depressed when the sun is shining, the issue I have is with temperature.

Living in a cold corner of the country, we get excited when things warm up at the beginning of summer to about 65 degrees. By 70-75 degrees, people are sporting bikinis. The typical home in the Pacific Northwest however has not been built for true heat, so when things start getting into the 80’s and even the not-so-lucky 90’s there is a distinct lack of air conditioning that makes these temperatures more livable in other parts of America.

With that in mind, that is part of the reason I have been somewhat absent in the blogosphere through the middle part of this week. In addition to the knuckle-dragging depression I’ve been having, my medications (which seem to constantly warn me not to get “too hot”) make it even more difficult for me to cool down. Once I get warm, I can’t seem to cool off again very easily.

In the end, there is only so much time I can spend in a cold shower, or hanging out in an air conditioned grocery store before people start getting concerned. Even with windows opened strategically and every fan we own pointed right at me I was still averaging a body temperature of 100-101 degrees, and while the internet seemed happy to suggest I “sip a cool drink” I really wasn’t kidding anyone… the heat this week left me miserable.

Usually I can tolerate a pretty significant amount of misery before becoming agitated, but after three nights of waking up every thirty minutes due to the heat I was overjoyed to see some big, grey, poofy clouds this morning. I’m hoping a little cool air can help with my irritability and give me a chance to take a nap because frankly… I’m exhausted and I am well approaching the snapping point. I can’t really imagine how this lack of sleep has not triggered mania this week, maybe that is a sign of the tight grip depression has on me at this point? I don’t know.

I know in four or five months I’ll be eating my own words and I will be desperate for a little sunshine, but at this point, at the close of summer, I feel happy to hand over the keys of summer in exchange for the cold, grey, relatively stable weather of the rainy season.

Lithium and NSAIDS

While Lithium is one of the most commonly prescribed mood stabilizers for bipolar disorder, it is also a drug that requires careful monitoring and comes with a big list of do’s and don’ts. After all, there are many different things that can effect the amount of lithium in the bloodstream at any given time, and ideally we want that amount to be stable.

In a perfect world, someone who takes lithium needs to be fairly vigilant. What I mean by that is that though there are things we can’t exactly control that might impact our lithium levels (sweating a lot, vomiting, diarrhea, fever), there are some specific things we can do to avoid spikes or troughs in lithium levels. Things like eating a diet with a consistent amount of salt from day to day, avoiding having too much caffeine, remembering to take/taking lithium at the same time each day, and (today’s focus) avoiding NSAIDS.

Avoiding NSAIDS might sound simple at first, especially if you have no idea what an “NSAID” is. This acronym is short for Nonsteroidal Anti-Inflammatory Agents which boils down to the group of over-the-counter and prescription drugs used to treat aches, pains, and inflammation. These medications include:

  • Aspirin
  • Ibuprofen, which can be purchased generically or found in brand name products like Advil or Motrin
  • Naproxen, which can be found in Aleve or Naprosyn

There are also a whole host of prescription NSAIDS and you can find a comprehensive list created by the FDA here.

The reason NSAIDS shouldn’t be mixed with lithium is that they can raise the amount of lithium in the bloodstream. Those of us who take lithium have our blood drawn fairly often is to ensure that the amount of lithium in our blood stays at a therapeutic level (a safe amount that is in the range of what should help our symptoms). The tricky bit is that just above that therapeutic range is the danger zone, where lithium toxicity occurs.

Most people who have lithium levels in the therapeutic range seem to be able to manage small fluctuations, however big spikes (say, due to using an NSAID) can throw one into that danger area where toxicity begins. That is part of the reason it is so important to try to maintain a consistent lithium level, and while people who follow the guidelines that come with their prescription shouldn’t have a problem, those that go rouge (or who don’t know enough to avoid things like NSAIDS) can be putting themselves at risk for serious injury.

Usually over the counter medications of this type all have “NSAID” written in big letters on the box, so steering clear of purchasing them is fairly straightforward. The problem I have ran into (time and time again) is how often I am told to take ibuprofen by many different medical professionals, in regard to treating problems that aren’t related to mental health.

In fact, if I had a dollar for every time I’ve been told I should take an NSAID by a medical professional who knows what medications I am taking (hello, lithium!) I could at least take myself out for a nice dinner!

This has been the case when I have had oral surgery and seen doctors for anything from headaches to back pain to menstrual pain to you name it. 

This is where the vigilance I was talking about before comes in. Know your medications! Know what drugs interact with them! Because if you are relying on a doctor, nurse, dentist, even a pharmacist to catch a bad interactions before it happens, think again.

As someone who has firsthand experience with lithium overdose (due to lithium levels getting too high in my bloodstream) I have to admit (albeit a bit ashamedly) that I haven’t experienced lithium toxicity once, but twice now.

Here’s the thing… instead of relying on the warning labels on the lithium and everything I believed about avoiding NSAIDS up to that point, there was a time where I caved. It was just after I had my wisdom teeth taken out, and I shuffled up to the pharmacist with some ibuprofen (what my dentist had suggested would be my “best option” to help me heal quickly). Despite my groggy concern, this particular pharmacist told me it would be fine to mix lithium and ibuprofen, as long as I didn’t take “too much.”

At home I reconsidered the situation.

“I am in so much pain,” I thought, “and what could one or two little ibuprofen do? I mean, doctors keep nagging me about taking it and that pharmacist said it would be ok… maybe I should just take a couple.”

It was not exactly the most sane or rational moment I’ve ever had.

No, I didn’t slip into a coma (but I’m not saying that isn’t a possibility when mixing these drugs), I didn’t have any seizures (again, that is a possible sign of severe lithium toxicity). Basically, I got lucky. My lithium levels were bumped up to the early stages of toxicity with symptoms similar to the ones I had the first time. It was a weird and scary place to be, and despite my general brain confusion at the time I had the wits to toss out the rest of the ibuprofen.

I know how difficult it can be to keep things straight when it comes to psychiatric medications, especially in situations when they aren’t improving our rationality or our thoughts are clouded by pain or mood swings. I was pretty shaken by my experience and how quickly I was effected, especially since I had been told by so many doctors I would be fine. When it comes to NSAIDS and lithium, here are a few things you can do to avoid my mistake!

  1. If you keep NSAIDS in your home (for a partner, roommate, or relative’s use) store them in a separate area from your usual medications. This can help keep you from taking them by mistake.
  2. If you see a doctor who suggests “ibuprofen”, “NSAIDS”, or “an anti-inflammatory” to treat your pain, speak up! Remind them that you take lithium and cannot mix those drugs and ask if there is anything else they can suggest.
  3. If you are looking for an over the counter pain reliever, those containing acetaminophen (like Tylenol) can often be an option (as it doesn’t react the way an NSAID does with lithium), though these drugs have their own set of associated risks. Be sure to ask your doctor what is right for you.
  4. Educate yourself! Doing your best to understand the medications you take and how they effect you can potentially keep you from a life-threatening situation. If you have unexpected symptoms after making a change in diet, exercise/exertion, medication, or illness, there may be changes in your lithium level and you should contact your prescribing doctor.
  5. Protect yourself. You are the gatekeeper, the one who decides what things enter your body and what things don’t make the cut. Likewise, doctors can be overworked, distracted, or not have a lot of knowledge about psychiatric medications or disorders, so even if you are seeing someone you trust, it is ok to get a second opinion or do more research before ultimately adhering to their advice. If something seems wrong about the advice you’ve been given (or the medicine you’ve been prescribed) always, always ask about it.

After experiencing a minor level of lithium toxicity from taking an NSAID I thought it was important for me to share my experience and let people know that there are a lot of conflicting opinions about mixing lithium and NSAIDS, as far as from the doctors, pharmacists, and dentists I’ve seen. Many of the medications taken for psychiatric disorders are very potent, and it is extremely important to take note of the risks and interactions between them. Knowledge is a huge tool when it comes to the success of our health and welfare, and taking an active interest in your treatment and treatment options (for mental and physical health) is extremely important.

The Well is (Abruptly) Running Dry

You might remember that in my last post I mentioned that I had six months of refills on my medications, so it wasn’t a huge deal that I couldn’t get in to see a psychiatrist right away.

Oops!

Apparently I, having no concept of time whatsoever, didn’t realize I’ve filled all those. The bottle I had put half of this month’s Lithium in for my trip to Florida was old, and the promised number of refills available on the label isn’t actually true.

So now I’m in a position that I’ve chastised others for being in. I have five days worth of Lithium left, and then…

…well, I don’t even want to think about what comes next. I’ve experienced extreme withdrawal symptoms from having my medications stopped abruptly before, and I am terrified of the consequences. (The ironic part is that the withdrawal symptoms I had were so traumatic that it kept me from wanting to be medicated for eight years, I never wanted to be put in that position again.)

My options seem as thus:

1. Attempt to refill the prescription as normal and request my pharmacy ask my (old) psychiatrist for another prescription. (Done.) This is a real long shot, but my old psychiatrist has shown pretty much nothing but mercy for me up to this point. Maybe he’ll set me up with one little month’s worth? I understand his hands might be tied on this, but I figure there is no harm in trying.

2. Express to my therapist the direness of the situation and see if she can pull some strings to get me a replacement prescription prior to my intake with their psychiatrist. (I’ll take care of that in a few hours.) I realize this too is a long shot, but since I am in a precarious position I don’t have any qualms about trying anything and everything to try and get this figured out before my time runs out.

3. Make an appointment with my primary care provider (hopefully before my time runs out) and request a month’s prescription to last me until I can (hopefully) see my new psychiatrist. My PCP has had a lot of qualms about the notion of prescribing psychiatric medications (something I respect but can also put me in a bit of a pickle) and to top it off, he is one of the most popular doctors at the hospital I go to for care (so he usually is booked a week out in advance). I think the best route to take here is to try to make an appointment near the end of the week, and then cancel it if plans 1 or 2 should happen to work.

4. My only other option is to cut back. I take 1200 mg a day (four capsules) and if I immediately cut down to three capsules a day I could give myself one, maybe two extra days to scramble and figure things out. This is obviously my last choice of my options, but again, I am terrified at the notion of having to jump from 1200 mg to zero mg. I feel fairly confident that I can get one of options 1-3 to work so I am not going to immediately titrate down, so lets hope I get lucky somewhere down the line this week.

Frankly I’m a little upset at myself for not having caught this sooner (but I’ve been out of town, so really how could I?).

I find that I get confused most easily by medications that require me to take multiple tablets or capsules per day, because when I look in the bottle it always looks like there are a lot in there. Realistically, even if there are 20 pills of Lithium in there, that is only 5 days worth of medication.

Like I said, I feel pretty confident that one of these plans will work in my favor… but you’d better believe I am going to make a big fuss when I get into my local clinic to see my therapist today about needed to see the house psychiatrist as soon as possible. Way to light a fire under my ass, Lithium!

Revenge of the Tremors

Like many others, I first started experiencing tremors when I began taking Lithium. My knees would wobble, my hands would shake, and suddenly my handwriting looked like that of someone in grade school.

Since starting Lithium in early 2011 though, the tremors have mostly disappeared. I would say for the first six to eight months they were pretty significant, but then they faded away (to my pleasant surprise).

Yesterday I was on a mission to take Luna to the vet. The vet’s office is about a mile and a half away, and for reasons I will spare you, I needed to get Luna there without letting her walk around. That meant carrying the 16 pound dog up a very steep hill, waiting for a bus, and then carrying her from the bus stop to the vet’s office on the other end of the ride.

Not a big deal, right? I am young(ish). I’m by no means strapping, but I thought I would just suck it up and handle it.

After five minutes of standing and holding (a very confused) Luna at the (wet) bus stop I began to have second thoughts about my plan. I could see that the muscles in my arms were becoming strained, and not only was Luna shaking from the cold, but I began shaking from the weight.

By the time we made it to the vet, the tremors had returned with a vengeance. Something about the combination of fatigue and strain left me with hands that were fluttering wildly. I tried to itch my nose and instead slapped myself in the ear as onlookers in the vet’s office pretended not to notice. Using the touch screen on my iphone was a definite impossibility.

As time wore on yesterday (and I didn’t carry anything else around) things settled down, but I was shocked at how quickly and severely the tremors returned in a time of strain. I guess I’d have to say now I know better, and I will definitely be on the look out for similar situations again.