AboutIvan Goldberg, M.D. Expertise I am a psychiatrist/psychopharmacologist with many years of expereince in treating individuals with depressions, manic-depression (Bipolar Disorder), other mood disorders,. I am especially interested in the psychopharmacologic treatment of individuals with so called "treatment-resistant" syndromes.
Experience I have been on the staff of the National Institute of Mental Health, Columbia's College of Physicians and Surgeons, and the Columbia-Presbyterian Medical Center. I am currently in full-time private practice in New York City.
A.B. Johns Hopkins University M.D. N.Y.U. College of Medicine
I am the creator of Depression Central:http://www.psycom.net/depression.central.html
Question Doctor: My mom age 62 has been on lithium since 1991, her present dose is 750mg a day, one discrepency is her creatinine at 1.6 (which may be do to a brief trial of an ace inhibitor she was on) but if during her next blood work it is still elevated a change is in line i think my questions are
1. in the past she had taken 1000mg of depakote along with the lithium and at that dose she was terribly unstable, at 500mg a day she was ok, but if it would come to depakote only treatment am i right in thinking that 500 mg is just about useless?
2. Her present diagnosis is that of bipolar 1 with psychotic features, but since 1999 she has had 3 relapses while she was on lithium alone, and her blood levels were about .8 consistanly, is it likely she may be a scizzoaffective patient,, in that the lithium did nothing in blocking the episodes of mania
3. her present meds are the lithium and 2 mg of navane a day, if lithium is withdrawn or reduced can you recommend some agents that might be worth considering and the benefit of a navane increase if a decrease is needed in the lithium
Answer With a creatinine around 1.6 it very well may be necessary for your mother to come off of the lithium. It is important that the lithium be discontinued over the course of a few months, as rapid discontinuation of lithium is particularly likely to bring on sa manic episode.
Prior to discontinuing the lithium your mother should be on adequate doses of one or more mood stabilizers. In people with Bipolar-I Disorder I often use the combination of Depakote and Tegretol. This combination has been shown to be effective even when each of the agents by itself has not been successful in bringing about mood stability.
