Lithium has held its own over the last five years. Many of the other medications that I’ve tried have come and gone leaving a trail of side effects in their wake. But not Lithium. It’s been a quiet workhorse relentlessly plodding away to keep my manic tendencies at bay. Lithium is in a class of medications called antimanics. It works by decreasing abnormal activity in the brain.
Lithium is prescribed to treat and prevent episodes of mania. Mania is a frenzied, abnormally excited mood state that impacts people with bipolar disorder. Bipolar disorder formerly called manic-depressive disorder is a disease that may cause episodes of depression, episodes of mania, and other abnormal mood states. When in a manic episode people often behave in ways that are very destructive and hurtful to themselves and those they love.
I’ve tried many other medications besides Lithium, but I always come back to the realization that for me Lithium works best and at a very low dose. I’m thankful that I’ve found a tool to help me manage my mood swings. People respond to medications very differently. What works for me may not work for you.You may have to try a few medications and change them around at different times depending on how your life is going – but hang in there - you will find a solution and you will get stable.
This is my opinion based on personal experience and is not research based or an opinion that is shared by the majority of people who propose helpful strategies for controlling and maintaining mood stability. I’ve been in cognitive therapy off and on for many years. The therapists I’ve seen have all been licensed and well educated. Each and every one of them had years of practice and were sincerely interested in helping their clients. I enjoyed talking with them and they were very good at helping me problem solve.
The one thing that they were not was able to do was pinpoint that I had bipolar disorder and direct me to a psychiatrist for help. In fact all of them were adamant that I was a “normal neurotic”. I’m not sure exactly what that means but if felt good to be reassured that I was within the normal spectrum.
During my most recent manic episode my therapist assured me that everything that I was doing was good for me including leaving my husband of 30 years, running away from home, etc. Even after the manic episode was under control my therapist refused to admit that I was bipolar or that I’d had a manic episode. She said that I was so self confident and self-assured and she was convinced in her mind that my actions were perfectly rational and in my best interests. Then she watched me crash and saw the other side of the illness. I stopped seeing her soon after that because I was not confident in her ability to help me pinpoint when an episode was starting up.
I learned a very important lesson from all this. If you do decide to participate in therapy whether it is cognitive, cognitive-behavioral, interpersonal & social rhythm therapy, just be sure that the therapist you select has a lot of experience working with clients who have bipolar disorder. Your psychiatrist may be able to recommend therapists with expertise in mood disorders.
I’m not sure any therapist could have kept me from making the mistakes that I made during my last manic episode, but I truly believe that a therapist with experience dealing with bipolar clients could have helped me minimize the damage that I did to myself, my family, and my bank account.
Bipolar Disorder is a genetic condition but it may not express itself even if you carry the gene(s) for it. It is widely believed that a triggering event in the environment coupled with a genetic predisposition towards the illness is needed for the disorder to express itself. The disorder can remain dormant for many years. Although it often begins to rear its ugly head in late adolescence.
After the initial trigger(s) activate the genes and the illness, it then presents as major mood swings that come and go over varying periods of time. These are called episodes. Every individual has their own unique triggers that can activate an episode. Although everyone is different and there are a variety of manifestations of the illness, many of the triggers are common and shared. For example, lack of sleep is often a trigger for a manic episode.
Again, even though the illness has a strong genetic component thought of as the underlying cause of the disease it may take a triggering event for the Bipolar Disorder to actually manifest itself. Trauma can trigger the disorder as well as travelling to a different time zone. Other common triggers include stress, hormones, and even taking street drugs. I’ve found that mood stabilizing medications are the key to keeping the episodes from recurring so quickly, and key to keeping them less intense and shorter in duration.
Prominent research scientists working to tease out the relative effectiveness of medical treatments for Bipolar Disorder use evidence based methodologies to provide relevant data for clinicians to use when prescribing medications for their patients. Clinical epidemiology uses evidence based methods and is “a basic science for clinical medicine”, and one that provides an additional approach to traditional medical research methods and to patient care (Sackett et al, 1991).
The Lithium Anticonvulsant Evaluation (BALANCE) study was a large-scale, randomized, and controlled trial that compared the long-term efficacy of lithium alone and valproate alone or in combination with each other. The principal investigator of the study, Dr. John R. Geddes and his research team collaborated internationally to conduct this ground-breaking study. The results are impressive, and of course more studies will need to be conducted to replicate their findings.
Overall:
- Lithium did better than Vaproate for mania.
- Lithium in combination with Valproate did better than Valproate alone.
- Lithium did better for depression.
Sackett, D. L., Haynes, R. B., Guyatt, G. H. & Tugwell, P. (1991) Clinical Epidemiology: A Basic Science for Clinical Medicine. Boston, MA: Little, Brown.
Slides leveraged from online slide deck titled: Why we need research: a short history of evidence-based psychiatry. John Geddes
Oxford Clinical Trials Unit for Mental Illness.
Lithium has held its own over the last five years. Many of the other medications that I’ve tried have come and gone leaving a trail of side effects in their wake. But not Lithium. It’s been a quiet workhorse relentlessly plodding away to keep my manic tendencies at bay. Lithium is in a class of medications called antimanics. It works by decreasing abnormal activity in the brain.
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