# Lithium and clomipramine



## stringbean (Oct 3, 2011)

Hi all, 
after being on clomipramine for 9 months and then having various things added to help my mood and being taken off them due to reactions my PDoc is now trying me on a low dose (200mg) of lithium. He assures me that i ONLY have ocd and depression(easy for him to say) and seems a little cross with me for not getting better.

Anyway i am on day four of the lithium and i must say i feel worse than when i started it, its supposed to help even out my mood and help my depression but can any one advise - is it normal on this drug to feel worse before you feel better as i have had this from antidepressants but was told it would not happen with this??


----------



## Daniel (Oct 3, 2011)

I don't know about lithium, but are you seeing a therapist?


----------



## stringbean (Oct 3, 2011)

yes a cbt therapist. I was told that this would help with the depression and also augment my anti depressant but didnt want to feel worse.


----------



## Daniel (Oct 3, 2011)

What helps you boost your mood?   I mean, even of the medication is affecting your mood to some degree, can you still go for a walk, etc?


----------



## H011yHawkJ311yBean (Oct 4, 2011)

Maybe you can have a physician or your therapist do a blood test...?  

On the other hand a lot of medications can make you feel crummier before you start feeling better.  I don't know if Lithium is one of those, but didn't the pharmacist or doctor or therapist go over it with you?  If not call one of those folks up and ask...


----------



## stringbean (Oct 4, 2011)

Thank you for your replies. I spoke to my PDr and he wasnt much help just said i shouldnt feel worse on it but my anxiety is through the roof and I am finding it hard to function.
I am still working but not sure how long i can keep it up! I am due a blood test tomorrow, but need to find a way to feel better and get through the day.


----------



## Always Changing (Oct 4, 2011)

> You might have to take this medicine for several weeks before you begin to feel better. Talk to your doctor if you have any questions.


 from the article below. 

Lithium (Oral Route): Proper use - MayoClinic.com


----------



## stringbean (Oct 7, 2011)

Thank you so much for replying, i actually had a couple of better days, then a couple of crap days but hoping the drug is getting into my system and working a bit.


----------



## stringbean (Oct 10, 2011)

I think i have had the worse time ever today. Not been able to concentrate and felt on the verge of a panic attack all day long. I have now been on lithium 200mg for ten days and had two positive days after four days but since been feeling hopeless.
Anyone offer me any words of encouragement and anyone on lithium that recognise this pattern, I would be eternally grateful


----------



## Retired (Oct 10, 2011)

Here are some reliable resource links you may like to explore to help understand lithium:

Lithium (Oral Route) - MayoClinic.com

Lithium: MedlinePlus Drug Information


----------



## Daniel (Oct 11, 2011)

> I think i have had the worse time ever today. Not been able to concentrate and felt on the verge of a panic attack all day long. I have now been on lithium 200mg for ten days and had two positive days after four days but since been feeling hopeless.
> Anyone offer me any words of encouragement and anyone on lithium that recognise this pattern, I would be eternally grateful



Just for your own reference:



			
				stringbean said:
			
		

> I have now been on 5mg of olanzapine for two weeks and feeling a lot better but then for the past two days i have felt at times, jittery and unable to focus and the old feeling of panic that i am going to go mad and lose control.
> the question is this standard with this medicine or has it stopped working, I am worried that although i felt so much better to start now back to the way i felt before i started taking it. Not sure i can fight anymore
> 
> http://forum.psychlinks.ca/prescrip...-drugs/26932-why-olanzapine-2.html#post190973





			
				stringbean said:
			
		

> I am still alot better than before but i seem to be slightly worried all the time and then i will get a wave(bit like panic/ adrenalin) where i think I cannot cope then it subsides and this goes on and off for the day.
> I am happy to up the dose and persevere, I cannot believe its only been five weeks and seven in total as i have felt better than i have ever felt before but worried to rely on something that is not going to continue working????
> 
> http://forum.psychlinks.ca/prescrip...c-drugs/26104-anafranil-query.html#post185414





			
				stringbean said:
			
		

> at times to day felt 'I am going to be ok and will get through this' then randomly a feeling of anxiety comes over me and the 'i am losing control and i am never going to get better' It doesnt feel as intense as a panic attack and not sure if its the ocd as that is normally thought that triggers the panic but this seems visa versa.
> 
> http://forum.psychlinks.ca/general-support-and-advice/23697-does-anyone-feel-like-this.html



So it seems that the pattern of anxiety and problems concentrating has more to do with your pre-existing symptoms, such as from OCD/anxiety, than with lithium.

---------- Post added at 01:43 AM ---------- Previous post was at 12:19 AM ----------

Are Mondays more stressful for you?  I am sure they are more stressful than Sunday, assuming you have that day off.  I mention it since you started this thread on a Monday.

As you probably know, since OCD is an anxiety disorder, additional stress tends to elicit a greater degree of symptoms.


----------



## stringbean (Oct 13, 2011)

Thank you so much for replying and pointing out that i feel like this regardless of the drug. I have since been back to the Dr and my level is .2 so they have upped the dose to 400mg. Does anyone know if this is still a low dose in comparrison to the dosage for bipolar as i have been told this is to augment my antidepressant.

Many Thanks


----------



## David Baxter PhD (Oct 13, 2011)

The specific dosage of lithium varies from one individual to another. What matters are your blood levels, rather than how much of the medication you're taking (similar to Synthroid for thyroid disorders).


----------



## stringbean (Oct 21, 2011)

Thank you Dr Baxter. I am trying to keep going, I have been on 400mg now for 8 days and to be honest i feel terrible, the ocd is bad and the depression (i think thats what it is, havent felt like this since post natal) Could you advise when i will feel better. I have left a message for my pdoc but he seems to be losing patience with me as he feels i am on the correct meds for my condition but I cannot help feeling that they are not working.


----------



## David Baxter PhD (Oct 21, 2011)

Lithium is not like other medications, stringbean. It can take up to 6 months before you start to feel better, depending on how quickly your blood levels get into the "therapeutic range". After that, if it is working for you, the benefits can continue to increase for up to a year.

But lithium is not going to do anything for OCD, really. You may need to add in an anti-obsessional, though your doctor probably wants to see how you adapt and respond to the lithium first.


----------



## stringbean (Oct 21, 2011)

god I cannot wait that long. I have been given it to augment the clompramine which I have been assured is the best for obsessional thinking, therefore in theory this should help the ocd also to help with my depression and low mood that has resulted from this awful disorder! Does that sound feasable


----------



## Daniel (Oct 21, 2011)

BTW:  



> 'awfulizing' means tending to describe something as 'awful', 'horrible', or 'the end of the world'. This only makes it seem more frightening.
> 
> http://forum.psychlinks.ca/obsessiv...5-key-cognitive-errors-in-ocd.html#post175547


----------



## stringbean (Oct 21, 2011)

not sure what that means


----------



## Daniel (Oct 21, 2011)

Awfuling is one of a number of things that people with OCD do that keeps their anxiety going, including trying to cope with anxiety in OCD ways like ruminating, seeking reassurance, or other avoidance behaviors/rituals.

As has been mentioned before, the book Brain Lock is very good:

http://forum.psychlinks.ca/obsessiv...our-steps-dr-jeffrey-schwartz-brain-lock.html


----------



## stringbean (Oct 21, 2011)

thanks Daniel for this. I must say that generally I am a glass half full not half empty sort of girl. But as i have pure o i do ruminate a lot and I am trying very hard just to let the obsession sit and not engage in it. I have read brain lock sometime in the last 20 years (thats how long i have had it) and have tried CBT before  and now on a further course but i think its the depression that is causing me such awful symptoms, at least i can recognise the ocd but feeling so low is not me.


----------



## Daniel (Oct 21, 2011)

One way of looking at depression is that it is the result of avoidance behavior.  Most people with anxiety tend to chronically avoid certain situations since they often trigger anxiety.  So some form of exposure therapy can be helpful.    In the case of depression, the emphasis is often on just being more active as in behavioral activation. 

BTW, regarding "pure O," ruminating can be just as compulsive a behavior as handwashing, if not more so.  So with OCD, there are usually other compulsions as well, though they may not feel distressing since, like all compulsions, they are used to relieve or prevent anxiety.

---------- Post added at 05:58 PM ---------- Previous post was at 01:22 PM ----------

Regarding depression as secondary to OCD:



> OCD patients display low QoL [quality of life] that in some studies matches or even falls below scores obtained from chronic and disabling conditions such as schizophrenia. QoL is most consistently associated with depression, a disorder which is present in ~50% of these patients. To a lesser degree, QoL correlates with obsessions, and in some studies also with compulsions. Our Internet survey shows that patients have multiple social and work-related problems associated with OCD. While our study mainly involved adults, similar problems have been reported among children and adolescents.
> 
> Reasons for low QoL are multidimensional and may largely vary across subjects. Initiation of treatment is often started at a point in time where the illness has progressed and important resilience factors and resources (eg, social support and employment) have already been compromised.
> 
> http://www.uke.eu/kliniken/psychiat...psychotherapie/cns_spectrums_Suppl_Moritz.pdf


----------



## stringbean (Oct 22, 2011)

Thank you for this, i am definately try to take on board behavioral activation. I really appreciate all your replies.
I spoke to my Dr yesterday and he has upped my clompramine to 225gm and also low dose lithium to augment it.

I wonder if you know how long will it take for the upped dose to take affect is it similar to when you first start the drug, its just i seem to feel a little wired today but hope its just settling in process.


----------



## Daniel (Oct 23, 2011)

Have you considered viewing your medications more like supplements rather than the primary treatment?  I usually don't say that about medications, but you seem -- over the course of time in your posts -- to put more hope in the medications than in yourself. Are you seeing your psychiatrist more frequently than your therapist?


----------



## stringbean (Oct 23, 2011)

Thanks Daniel. I wish I could look at the meds as supplements but to be truthful i have a real problem with taking tablets and in the past have taken them and as soon as well stopped! so trying to be optimistic about them and more positive.

I have suffered from ocd for over twenty four years and had bad spells that i have treated with medication and my last spell started nearly a year ago and that prompted me to see a psychiatrist who in turn has been trying me on the meds that i have mentioned and for the first time i have commited myself to take exactly what i am told.
He also thinks that the psychologist is what i need most to change the way i react to what i think(if that makes sense) so I am seeing the psychologist more regularly than the psych.


----------



## stringbean (Oct 24, 2011)

*question re lithium*

Sorry Dr Baxter if this needs to be merged but wanted some advice re lithium.
I am now on 400mg for 12 days- I have been given this to augment my clomipramine and also help my recurrent depressive disorder (from ocd battles) I was wondering when I would start feeling the benefits as of yet have not felt any. 
I read in one of the stickys re resistant depression and adding a second med and that article sounding promising and hoping that this will be the case with me.


----------



## David Baxter PhD (Oct 24, 2011)

*Re: question re lithium*

12 days is not very long at all when starting medications or increasing dosages. I know it's frustrating but you'll need to have patience and trust that your doctor knows what s/he is doing.


----------



## stringbean (Oct 24, 2011)

thank you for replying, patience is hard when you are feeling so rubbish, and also having a bit of trouble having trust in my physician. 
I read your sticky re thinking the unthinkable and it was really informative and I could recognise my pure o traits straight away and it was reassuring (oops) that it backed up that it can take all day for someone to try and put the answers to things,
.


----------



## stringbean (Oct 28, 2011)

can anti depressants or mood stabilsers make you feel worse, or make your symptoms worse


----------



## David Baxter PhD (Oct 28, 2011)

Not usually but yes, it's possible. If so, the remedy is to change the medication to something similar.


----------



## Daniel (Nov 2, 2011)

BTW:



> The more you are able to recognize that your fears are  unfounded, exaggerated or irrational, the more likely you are to respond  to treatment with medication.
> 
> About.com - Will OCD Medication Work for Me



It seems to go without saying, though, since that would predict a better outcome even without treatment.

Anyway, from a new study:



> Depression was not  predictive of treatment response in any of the treatment modalities for  up to 5 years of follow-up. Changes in OCD symptoms largely predicted changes in depressive symptoms but not vice versa...
> 
> Treatment of OCD with comorbid depression should focus on amelioration  of OCD symptoms. When OCD treatment is successful, depressive symptoms  are likely to ameliorate as well.
> 
> ScienceDirect - Journal of Affective Disorders : The impact of depression on the treatment of obsessive?compulsive disorder: Results from a 5-year follow-up


----------



## stringbean (Nov 6, 2011)

Thanks Dr Baxter and Daniel, I appreciate the replies.
I have had a few better days so I dont think the medication is making me worse as if it was I wouldnt be having better days would i??


----------



## David Baxter PhD (Nov 6, 2011)

No, not likely. Glad to hear things are improving.


----------



## stringbean (Nov 7, 2011)

Spoke too soon, had a humdinger today but am sure that is to be expected, some good, some bad. I need to believe that this is working for me as from yours and Daniels posts i feel that if i dont think positively i am likely to not have positive responses from medication.


----------



## AmZ (Nov 7, 2011)

Sorry to hear that you are having troubles with the medication there and for seeing if it works for you. 

You're right, it's always good to be in a positive mode of thinking, but it's obviously not all about that - The medication needs to be good for you too.

I am also going through the process of finding what works for me so I totally empathise with the frustrations that it brings.

Wishing you the best.


----------



## stringbean (Nov 7, 2011)

thanks Amz, how are you doing?


----------



## AmZ (Nov 7, 2011)

stringbean said:


> thanks Amz, how are you doing?



You are welcome - I hope the medications get sorted out very soon.

I'm OK thank you, doing a bit better for a few days which has been a relief. I won't jump in on your thread though


----------



## stringbean (Nov 7, 2011)

I am pleased you are feeling better even if it is only a few days, it hopefully gives you more hope for better days. Do you find that you have some good days but also some really bad days?

Also so kind of you to reply to my thread i am grateful that anyone reads my ramblings and worries.


----------



## AmZ (Nov 7, 2011)

stringbean said:


> I am pleased you are feeling better even if it is only a few days, it hopefully gives you more hope for better days. Do you find that you have some good days but also some really bad days?
> 
> Also so kind of you to reply to my thread i am grateful that anyone reads my ramblings and worries.



Of course people read and reply to you  You are worrying yes, but that's only natural, don't be so hard on yourself. And you are far from rambling... Just look at my 1000+ posts here! 

Most of my days have been bad days with maybe a few hours here and there of feeling a little better. We're still working on the medications.
But how I have been feeling in the last few days was the way I was feeling when I last left the hospital twice, but then relapsed and returned back. It's like the sun came out of the clouds... I don't know how else to put it. But my head is feeling clearer, my mood has lifted and for the first time in a good couple of months, can I genuinely smile. So, I hate speaking too soon, but maybe my med combo is finally where it needs to be.

How are you doing? Tell me a little, if you like, about what is going on with you


----------



## stringbean (Nov 7, 2011)

oh bless you, I am so pleased that you are feeling better, I will keep my fingers crossed for you.

Mine is a long old story, had ocd for twenty odd years and been on and off meds for a good while. Had a bad relapse last xmas and since then been seeing a psychiatrist. 
He took me off all previous medication and has been trying me on clomipramine and now augmenting it with lithium and have upped the clomipramine to the max dose about two weeks ago and have had some good days but the bad days scare me.

Anyway you try and keep positive, I did read some of your posts when you were in hospital and so pleased that you are feeling well now, I will send a prayer out for you(not really religous, but trying everything lol) and for me and hopefully our positive vibes will help each other  x


----------



## AmZ (Nov 7, 2011)

Bad days are scary, I agree.

I am wishing you better days too!

Thank you very much.


----------

