Expert: Ivan Goldberg, M.D. - 1/15/2009

Question
I have seen my Dr.of psychiatry for 4 years. Initally I thought it was just depression. I started to read and finally identified other mood flux that proprably put me in the bipolar ll category. I injured my back and was put on prednisone. By the 2nd day I was having mood swings that terrified me. I believed I had no control over them. I had suicidal thoughts and my Dr. gave me seroquel and told me to take the Lunesta for sleep with Diazepam. Well, now I'm charting my moods and my therapist has identified I'm cycling from a "normal state" to anxiety (possible mania) then debilitating depression. Each time gets worse. My psychiatrist then suggested lithium. He said take for a few days;get blood work. Then only take it when I exhibited an episode. Is that the proper way to administer lithium. Can that stabilize you taking it only when you hit a wall? Very concerned about thyroid problems and cognitive impairment with taking the lithium. Can you shed some light or point me in the direction of a Dr. that specializes in bipolar ll disorder. If that's what I have.Many thanks

Answer
Hi Lorraine . . .

There is good evidence that lithium is an effective way of preventing the destabilization of moods that can be induced by prednisone. For lithium to function well in this role it is usually prescribe for as long as the person takes the prednisone and possibly for a few weeks after the prednisone is taped and discontinued.

While the possibility of lithium-induced hypothyroidism is upsetting, most people find lithium-induced mood cycling much more upsetting and dangerous.

Best regards . . .

Ivan
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