Give Us This Day, Our Daily Meds

My particular issue is with Bipolar 1, with psychotic features.  I have social anxiety which factors in as well as weird delusions.  The anxiety and delusions are pretty much one and the same.  They are often the things that will touch other people, while the rest is less obtrusive and can be hidden.

I have a tendency to hatch ‘mini-conspiracies’ almost daily.  They can be really paranoid as I think the worse about people, and life as it enfolds around me.  Facebook with its social networking helps, but it has also intensified my issues.  I am very much a recluse, and only get out and about twice a week. There are some who can see through my issues and really help. They are worth more then gold to me.

Depression, which is part of the Bipolar, has been more of a factor just in the last few months.  Suicide, that dark word, will deepen if the depression goes too long without lifting. It is an awful and brutal thing. My last bout was just two months ago and I quit functioning. I really did pray for death. Debilitated, I laid in bed powerless to do anything but sleep, and hide. I didn’t take a shower or bath for almost a month. Just the thought of being pelted by water seemed too violent.

Being a believer gives me a reason to live.  The Holy Spirit is so patient with me.  His companionship is far more helpful than any anti-depressant.  He doesn’t require that I become symptom free to fellowship with Him.  Instead, He weaves with the materials He has, and my discipleship is really no different than other Christian believers. This gives me a constant hope.

Overall, in spite of a very tumultuous, and ‘see-saw life’, I find that life with Jesus (discipleship) is truly grand.  He understands me, and is guiding me.  He is the Shepherd who is good, and I am His sheep who needs kindness and forgiveness always. He bruises no reed, nor does He quench the smoking candle (Matthew 12:20.)

One more thing.  Having a mental illness has, I believe, made me more compassionate and tender toward others.  When I meet a difficult person, I will be the last one to give up on him.  Others will bail out, but I stick.  I guess this can be a bad trait, but I can’t help it.  I love people, esp. those who hurt.

Here’s a list of my daily meds.  I hope this helps someone navigate the wild seas of psychiatry safely.

AM– lithium, 600 mg/Zoloft 200mg/Seroquel 400 mg/Provigil 200mg

NOON-Seroquel 200 mg

PM-lithium 600 mg/Seroquel 400 mg/Lunesta 2 mg

The lithium works mostly on mania, but does help depressive states.  The Zoloft is an anti-depressant (similar to Paxil)  The Provigil is for alertness, I have had issues with daytime sleepiness, esp. since my brain tumor.  Finally the Lunesta is a sleeping pill. This may seem a lot, but it has taken 2-3 years to get it figured out.  If I can help explain any of this, please let me know.  I aim to please!

Q & A: Will I need to stay on my depression meds forever?

Asked by Ally, Washington

“I am 26 years old and have had four major depressive episodes. I did not seek treatment until the last (and worst) episode and have since been taking two different antidepressants.

My question is this: Will I ever get off these meds?

To be honest, my last episode was so bad that I am not too keen on the idea of going without. However, I am aware that the more episodes of depression a person has makes the person that much more likely to have another one and that the severity of the depression gets progressively worse with each episode. I shudder to think what a worse episode would be but at the same time do not want to take medications that I do not need.

Expert Bio PictureMental Health Expert
Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Ally, let me start by applauding your very accurate understanding of depression, terrible illness that it is. Your question is an interesting one because, of course, you could get off the medications any time you like simply by ceasing to take them. But what you mean, of course, is whether you will ever be able to stop taking the medications and not have to worry about falling back into another depressive episode.

This brings up a very important point about psychiatric disorders: Anything is possible. So anytime someone asks a question that starts with some variation of “Is it possible …?” the answer is always, “Yes.” Why? Because all psychiatric illnesses are probabilistic, not deterministic. Probabilistic means that although some things are a lot more common than others, nothing is certain and nothing is impossible.

I sometimes resort to physics as a metaphor to explain this idea. Isaac Newton used mathematics to paint the universe as an absolutely rigid machine in which causes always led to results in a predictable manner. In his view of the universe, if you knew what every particle in the universe was doing at this second, you’d be able to predict all future events flawlessly out to the end of time.

This way of thinking about things works very well for many practical things like firing cannon balls, sending rockets to the moon or building bridges, but it turns out that when you look really closely at matter, it only approximates the certainty that Newton described. This realization has become enshrined in a theory called quantum mechanics, which — in essence — says that no final certainties exist in the physical world, only various degrees of likelihood.

For example, although most of us think of atoms like little solar systems with the nucleus being like the sun and electrons swirling around it like planets, the physical reality is much weirder. In fact, an electron only tends to stay close to the atom of which it is a part. The further away you go from the atom the less likelihood there is for finding one of its electrons, but the chance isn’t zero, and it is possible that you might find an atom’s electron on the other side of the universe. It’s not impossible, just so unlikely that it might as well be impossible.


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Lithium: Help for the Afflicted


Lithium (brand names Eskalith, Lithobid, Lithonate, and Lithotabs) is the most widely used and studied medication for treating bipolar disorder. Lithium helps reduce the severity and frequency of mania. It may also help relieve bipolar depression. Studies show that lithium can significantly reduce suicide risk. Lithium also helps prevent future manic episodes. As a result, it ma y be prescribed for long periods of time (even between episodes) as maintenance therapy.

Lithium acts on a person’s central nervous system (brain and spinal cord). Doctors don’t know exactly how lithium works to stabilize a person’s mood. However, it helps people with bipolar disorder have more control over their emotions and reduce the extremes in behavior. It usually takes one to two weeks for lithium to begin working.

Your doctor will want to take regular blood tests during your treatment because lithium can affect kidney function. Lithium works best if the amount of the drug in your body is kept at a constant level. Your doctor will also probably suggest you drink eight to 12 glasses of water or fluid a day during treatment and use a normal amount of salt in your food. Both salt and fluid can affect the levels of lithium in your blood, so it’s important to consume a steady amount every day.

The dose of lithium varies among individuals and as phases of their illness change. Although bipolar disorder is often treated with more than one drug, some people can control their condition with lithium alone.

Lithium Side Effects About 75% of people who take lithium for bipolar disorder have some side effects, although they may be minor. They may become less troublesome after a few weeks as your body adjusts to the drug. Sometimes side effects of lithium can be relieved by tweaking the dose. However, never change your dose or drug schedule on your own. Do not change the brand of lithium without checking with your doctor or pharmacist first. If you are having any problems, talk to your doctor about your options.

Common side effects of lithium can include:

  • Hand tremor (If tremors are bothersome, an additional medication can help.)
  • Increased thirst
  • Increased urination
  • Diarrhea
  • Vomiting
  • Weight gain
  • Impaired memory
  • Poor concentration
  • Drowsiness
  • Muscle weakness
  • Hair loss
  • Acne
  • Decreased thyroid function (which can be treated with thyroid hormone)

Notify your doctor if you experience persistent symptoms from lithium or if you develop diarrhea, vomiting, fever, unsteady walking, fainting, confusion, slurred speech, or rapid heart rate. Tell your doctor about history of cancer, heart disease, kidney disease, epilepsy, and allergies. Make sure your doctor knows about all other drugs you are taking. Avoid products that contain sodium, such as certain antacids. While taking lithium, use caution when driving or using machinery and limit alcoholic beverages.

If you miss a dose of lithium, take it as soon as you remember it — unless the next scheduled dose is within two hours (or six hours for slow-release forms). If so, skip the missed dose and resume your usual dosing schedule. Do not “double up” the dose to catch up. There are a few serious risks to consider. Lithium may weaken bones in children. The drug has also been linked to birth defects and is not recommended for pregnant women, especially during the first three months. Breastfeeding isn’t recommended if you are taking lithium. Also, in a few people, long-term lithium treatment can interfere with kidney function.

A word of encouragement.  I’ve been taking 12oo mg of Lithium twice a day for over three years now, with just minor side effects.  (Mostly a bad hand tremor.)  Taking Lithium has stabilized me and protected me from my more bizarre behavior.


Reviewed by the doctors at The Cleveland Clinic Department of Psychiatry and Psychology.

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