Long term use of lithium and antidepressants
Q: Dear Dr. Phelps: I have been receivng treatment for depression for several years, but just recently I have been diagnosed with bipolar II disorder. I now take 40 mg of Paxil and 750 mg of Duralith daily. I realize now that I have suffered from bipolar disorder for about 16 years, and the outlook is long term medication use. I am concerned about the long term use of antidepressants and lithium on my physical health. What are your feelings on this? Thank you. Heather
Dear Heather --
I'm not sure how you came by your concern about antidepressants, but you have good company on that. See, for example, this article quoting Gary Sachs, the Harvard bipolar guy, on that subject. You may need to register (free) on Medscape first to see it.
You can read my guidelines to clinicians on how to handle a patient in your circumstances. In general, the idea is to transition to mood stabilizers, tapering off the antidepressants, very slowly (Sachs recommends 25% per month tapering down, so for you that would be 10 mg. per month or 5 mg every 2 weeks). Then, if more symptoms show up as you go down, fill in with mood stabilizers rather than an antidepressant.
Long term lithium requires checking your kidney function every 6 months along with your thyroid, but if you don't let your "creatinine", a standard measure of kidney function, creep up over time, you are almost certain to be protected against the "diabetes insipidus" that lithium can cause. Usually this is a problem if people are on high doses for years. You can keep your lithium dose low by combining it with other mood stabilizers, also at low dose, if you find recurrent symptoms on lithium at 750mg.
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