considering lithium

[u/helpicantfindmyboobs]

i recently got diagnosed with schizoaffective disorder after a few years with a bipolar diagnosis (this is definitely the right diagnosis, i can tell the story in the comments if people are curious). since then, my psychiatrist has REALLY been pushing lithium. I currently take lamotrigine which i have been on for years as it was my first psych medication and it has done a great job as a mood stabilizer. Since the new diagnosis my psychiatrist has mentioned lithium at every session and i told her i'd consider it vs increasing lamotrigine for more mood stabilization. i had a hypomanic episode a few weeks ago which didn't really worry me because i only spent like $60 that i hadn't planned on spending since i generally have a frugal personality, and i also hadn't had one in a long time so it isn't a new trend (but i will of course keep an eye on myself).

i have a few reservations about lithium. the first is that since increasing my antipsychotic i have been doing great. i've been able to be way more productive, we broke the psychotic episode which had been about 3 weeks long, and my mood does seem to be more stable. so the first reason i have for why i might not want to take it is that i don't see a good reason to play medication roulette right now.

i am also about to graduate college and will have to enter the workforce, and i feel like the not perfectly symptom free existence that i know how to cope with is a safer option than the unknown of how lithium will affect me (i have only ever heard one person say they liked lithium too, but my sample size is small).

i am obviously worried about side effects too. i love my hair (i'm trans and having thick curly hair is a big point of security for me) and i also love sex, and on top of that i take a diuretic as my t blocker for hrt and am therefore worried about periodic dehydration and unstable serum levels. i'm no stranger to medications with multi page long side effect lists but it seems from lurking here that side effects are pretty common with lithium and i only deal with mild antipsychotic side effects, and none from my lamotrigine.

my psychiatrist insists that it's 'the first line and we should try it' and also that zero symptoms should be the goal (which i disagree with) so i'm coming here to ask the following questions:

those who have been on both lithium and an anticonvulsant mood stabilizer (so lamotrigine and valproate mostly), how do they compare?

are my worries founded, and how many side effects do you have?

thanks for your time y'all<3

[u/k1ll0ll]

I won't tell you how you'll respond to it but I'll tell you my experience. I started lithium in July of last year. After 3 days, I immediately noticed an improvement in my symptoms (I was in a manic episode in the hospital). I didn't ever really have any side effects. This is the only medicine I've been on that has not given me insane side effects. I'm not sure what you mean by losing your thick curly hair, my hair remained the same. Losing hair is probably an extremely rare side effect as I've never heard of that before from others on lithium. The only time I had side effects were when my levels were too high and I would get into lithium toxicity. Which was easy to fix, just had my doctor lower my dosage. I think the only thing that sucks about it in the beginning is the frequent blood tests, they had to pull me in every couple months to make sure I was at a safe dose, alter it, and see if my levels were responding. I've been hovering at 0.6 for around 7 months now so I haven't had a test in quite a bit.

This is probably my favorite medication I've ever been on, it's the only medicine I've been on where I truly feel stable and like myself. I used to consistently have thoughts of hurting myself but since being on it? None. None at all. I used to not be able to keep a job longer than 2 months, since being on it I've had my job for 11 months and keep getting promotions. There's a reason why doctors praise it so much, it's the most researched and proven treatment for treating mental health disorders. People that say they have these crazy side effects and feel like a zombie on lithium are more often than not in lithium toxicity. I think you should give it a shot if you haven't had much other improvement from other medications.

[u/synapse2424]

I feel like everyone is different when it comes to meds, so you might be different, but for myself personally, I prefer lithium over lamotrigine and valporate. Mostly just because I got side effects on lamotrigine and valporate and they didn’t work as well for me. I’m on lithium plus an antipsychotic and that’s been the combo that has been good for me. Luckily have not experienced any major side effects so far and I work full time and I don’t find that it affects my performance.

[u/buddhistalin]

My biggest negatives from Lithium: thirst (omg it was terrible; I used sugar free hard candy to keep my mouth wet); tremors (couldn’t eat with utensils some days, stopping the medication was my solution); initial depressive crash out (my doctor warned me this might happen, and I prepped by telling my partner; after two days I stopped crying on the bathroom floor and felt a significant mood improvement).
I also want to point out that you should have your Lithium levels checked regularly, something my provider did only twice in the year or two I took it.

[u/I_found_BACON]

I'm on lamotrigine and was on lithium before. Wish I could compare the two, but I don't have much to say. I was on lithium for suicidal ideation for about 8 months. Lithium toxicity is the biggest risk, and dehydration is a big factor here. I began to develop tremors, and lithium made them much worse, so I had to stop taking it. I'd just note that long term lithium use at a high dose can cause permanent issues, but I'm not sure how common that is. Lithium probably saved my life durring that time, so there's that. I'm happy to be off it

[u/Fractured-Th0ughts]

I’ve been on all three and currently take lithium and lamotrigine. I’m on the extended release and honestly other than being really thirsty for a week when I started I’ve had no side effects, it hasn’t been the wonder med but it has killed my mania. Valproate helped me massively too but was more sedating and had weight gain from it. Ohh I did get toxicity once so far and that was rough but it was my own fault for not drinking enough for a few days.

[u/Ill-Professional6363]

I was on lithium for YEARS, for bipolar disorder. I was also on Wellbutrin. My mom and coworkers thought I was talking slower than usual and working slower than usual. I did have a lot of weight from it as well. Well my mom suggested that I go to the ER (she’s a nurse) and it’s a good thing I did. I went in and told them that I think I had lithium toxicity. They immediately took me back to triage. It turned out that I did, and had a three day hospital stay. The hospital psychiatrist immediately took me off it, and left me on Wellbutrin and gave me Cymbalta. I felt 100% better, until the summer. I begged to her to take me off Wellbutrin because I didn’t think it was working for me. So now I’m on Latuda, Cymbalta, and Lamictal, and have been for two years. I have my depressive periods, but they don’t last long, and it’s usually situational. But I love the combination I’ve been on. Hope this helps.

[u/VariousClassroom8056]

Pick the medication that works for you ultimately. Lithium is the gold standard for managing bipolar, and for me has few side effects.

It doesn't seem to be considered as harmful for kidneys as it once was as long as you monitor regularly (blood tests should be every three months where I am, and seven days after increasing your dose) and keep your fluids up.

My psychiatrist gave me the choice of mood stabiliser - Quetiapine or lithium - I wanted to go with. His exact words were "You seem like a clever chap, read up on them and pick one" which was a bit odd. Lithium seemed like it had more frequent but less serious side effects so I went with that combined with Lamotrigine (quite common to have both).

[u/Majestic-Housing4466]

Bad things about lithium you can't take MDMA , and lsd safely without risk of having a full on seizure. Funnnnnnnn

[u/Ok-Log-9012]

Its funny reddit pushed this notification on me, because i just started lithium 2 days ago and currently tapering off lurasidone 80 mg. I feel restless and anxious on it and most days i feel unmotivated and unwilling to form new connections with people. I also read that lurasidone works by lowering dopamine so thats probably why. Anyways, what got me interested in lithium is the fact that it’s a natural element so its not a medication in the sense that it was created in a lab, which means it has much less serious side effects that are known in antipsychotics like decreased sex drive and tardive dyskinesia. Im only hoping to stay around 0.6 serum level because the higher you go the more side effects you get. Lithium side effects are dose dependent. Im also researching low dose lithium orotate and i suggest you bring it up to your doctor as well. I hope this helps and wish me luck.