Eskalith Dose & Sexual Dysfunction
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Q:  Eskalith Dose & Sexual Dysfunction

I am on Eskalith CR at 1800 Mgs.  I was wondering if reducing this a little could help the sexual side effects.  Also do you know of any other antimanic medications that cause low sexual side effects?  Also how much do you think Wellbutrin helps sexually?I was thinking of Serequel.  I am 28 years old.  Thanks for your time.


Dear Matt -- 
"Impotence/sexual dysfunction" is on the list of lithium side effects all right, but I've not ever seen any discussion of whether this is a dose-related problem.  Since you've obviously learned quite a bit, you're probably quite aware that your lithium should be running at the lowest blood level that will give you good protection against relapse of symptoms -- and that this level is pretty tricky to determine, I mean, how are you supposed to know how low you can go without actually having a relapse to find out?!

So, the problem here is that the issue is bigger than sexual function, it's about the whole ball game.  So one could rephrase your question (as you may have intended but were trying to save electrons, thank you): "how much risk would I be taking to reduce my dose a little in the hopes that it might ease up a side effect I'm having?"  

For that, we'd start by looking at your current blood level.  Overall, higher levels do clearly provide better relapse protection, and anything under 0.6 (some would say 0.5, others 0.7, especially in Britain and the United States, respectively) is running some risk.  As you may know, all of those numbers derive from studies of bipolar I where "relapse" is more obvious; for bipolar II or more subtle forms of bipolar I, this issue is yet more complicated and has to be guided by the next set of principles, namely: 

How much risk would you face if you did start to relapse, i.e. what have your previous episodes been like, how long to get out of them, how much damage during, what medications did it take to get control, etc. 

So, you can see this rather simple question gets complicated fast.  I hope you'll discuss this "how much risk would I be taking?" question with your doc', and that you get a satisfactory answer. 

As for Wellbutrin, yes it looks like that approach does work all right but immediately you face the question (sounds familiar?) of "how much risk am I taking to add an antidepressant to my mood stabilizers?" and that, though controversial in terms of just how much, is very clearly risky for most people with bipolar disorder. 

And, Seroquel?  Not much experience with it, too small a sample to really say anything just yet, as far as effects on sexual function.  Meanwhile, it hasn't been the stunning success in terms of symptom control that Zyprexa has been, i.e. it's not clear that it can be relied upon like one can rely upon lithium. 

Hope that helps some.  Complicated, isn't it?

Dr. Phelps 

Published June, 2003


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