Naturalhealing: Lithium carbonate taper and Surmontil

[Naturalhealing]

Hello everyone,

 

My name is Giulia, I'm Italian, I'm 35 and I was diagnosed as bipolar type 1 in 2010.

 

After taking lithium for 10 years (Resilient 83 mg slow release ) , I started to reduce it in June 2022. My main motivation was to try to conceive a child without lithium.
Over the next 10 months, I reduced the dose by 20% each month.
I now understand that my reduction plan was too rapid, because after 10 months I stopped sleeping and went back into a long period of mania (3 months), hospitalised twice, followed by a long period of depression.

Now I'm back on lithium, this time carborate, 400 slow-release (Theralithe  400 mg slow release)

 

I would like to start the taper again, even though I'm afraid of reliving the mania and depression as withdrawal symptoms.

 

Has someone had the same diagnosis and has a psichiatrist to suggest, that could follow me in the tapering? 

 

Has someone of you been pregnant after the withdrawal? If yes, how did it go?

 

Thank you so much for your sharing!

 

Edited August 27, 2023 by manymoretodays
Updated name, none further, merged 2 Intros, changed title to reflect 2nd title

[Naturalhealing]

Hello everyone,

 

I haven't Started to taper the drugs yet. Yesterday my psychiatrist, in seeing my blood test results for lithiemy,  ( 0.67 ) , said to eliminate 1 capsule of lithium carbonate, passing from 2 tablets ( 800 mg in total) to 600 mg a day. I followed this advice, but I am wondering,  will not this abrupt reduction cause any side effect?

 

Also, has someone gotten off the antidepressant Surmontil? I am taking it since 20 July, 15 drops, but since I am experiencing insomnia during the last 3 nights, the psychiatrist told me to pass straight away to only 5 drops.

 

What are your thoughts regarding this matter? 

 

Thank you for your kind support! 

 

 

[FireflyFyte]

Hello Naturalhealing,

 

Please update your signature with your drug history which is explained at - How to Summarize Your Drug History in Your Signature

 

Here at SA, we recommend no more than a 10% drop of the previous dose per month. Going from 800mg to 600mg would be a 25% drop and higher than we recommend. Going from 15 drops of Surmontil to 5 drops would be close to a 70% drop. You can read about the harm reduction model of tapering at Why taper by 10% of my dosage?

 

We also recommend only tapering one drug at a time so if withdrawal symptoms arise we know which drug it is related to. You can read more about the ordering of tapering a Taking multiple psych drugs? Which drug to taper first?

 

If you have additional questions, we are here to help.

 

Thanks,

 

Firefly 

[Naturalhealing]

Thank you very much FireflyFeter.

 

For the Surmontil, since I started in the end of July 2023, I thought it was not a problem to get off it that fastly. Above all I trusted my psichiatrist.. but I must say that, since he told me to go directly from 800 mg of lithium carbonate to 600 a day, I started to loose trust in his capacity of understanding the withdrawal effects.

Would you say that it would be better for me to return to 800 mg of lithium a day, even If my lithiemy was 0.67? ( In my psichiatrist opinion, quite high )

And regarding Surmontil, it is the second day that I am not taking it. A part the usual pain in my neck and insomnia , which started 3 days ago, I am feeling normal..should I start again to take the 5 drops , in your opinion?

Thank you!

 

Naturalhealing 

[FireflyFyte]

22 minutes ago, Naturalhealing said:

For the Surmontil, since I started in the end of July 2023, I thought it was not a problem to get off it that fastly.

 

Four weeks is long enough to experience withdrawals from stopping the medication. Withdrawals may take days, weeks, or even months to surface so you might not be experiencing them yet from stopping at 5 drops. I would recommend going back to the 5 drops and holding there until you feel stable which could upwards of a month or longer. At that point, you can decide if you want to taper the lithium carbonate or the Surmontil. 

[Naturalhealing]

Thank you Firefly.

I have been without Surmontil for 2 days, since I am traveling and I don t have it with me, but this evening I will start again with the 5 drops of it.

 

Regarding Lithium, I took 600 mg for two days, but yesterday I returned to 800 mg, following your advice.

 

I see that my insonnia was due to the too fast withdrawal of Surmontil antidepressant, having followed the psychiatrist instructions.

 

Would you have some suggestions regarding how to fall asleep again?

 

Thank you for your help !!

 

Naturalhealing 

[FireflyFyte]

3 hours ago, Naturalhealing said:

Would you have some suggestions regarding how to fall asleep again?

 

Hopefully, once you stabilize on your current dosage your sleep will return to normal.

In the meantime, you can find some suggestions on aiding sleep at Tips to help sleep: so many of us have that awful withdrawal insomnia

[Naturalhealing]

Thank you Firefly for these useful pieces of advise!

[manymoretodays]

Hi there Naturalhealing and welcome aboard!

Thanks for getting your signature done!

And so sorry for your recent bad withdrawals and then need for hospitalizations.

 

I did find Surmontil or Triimpramine at Drugs.com, it seems to be a Tricyclic antiddepressant(AD).

https://www.drugs.com/cdi/surmontil.html

Do you know the dose of this drug that you are taking?

Reporting in drops(gtts) doesn't tell us much about the actual dose you take.

 

Also the dose of Tavor, which seems to be lorazepam(the generic name)?

Easier for us to understand and assist if you can use generic names from here on out.  Many of us are based in the U.S., some from European countries, and also many from all over.  Less possibility of confusion though that way......using the generic names for your drug(s) and getting the doses in too.  In your signature as well, which I'm seeing.  And then be sure to update here, as you have, as well as in your signature.  Everything helps.

 

Are you planning on continuing the Tavor(benzo)/lorazepam and the triimpramine post Lithium taper?

 

And how are you doing now?  Are you feeling in a good place for tapering?  Are you interested in possibly going drug free someday?  Why have you selected the Lithium to taper first?

 

I don't know where you are at now, as far as understanding the factors of diagnosis and treatment of psychiatric or mental flucuations, so I'll give you this to peruse as well:

Again, chemical imbalance is a myth.Stop the lies please.

How did your diagnosis come about, if you don't mind saying.  It may be helpful to us and help us get to know you better, and in providing information.

 

I'll get you started and approved today, your second post will also need moderator approval......that's just the standard.  And also, perhaps another Mom, will come visit here, who has had similar to you, as well.

 

I'm going to leave you a couple links to topics as well, for your education, and reading, and reference too today.

 

Welcome again.

 

Antidepressants/withdrawal during pregnancy

 

Why taper by 10% of my dosage

 

Tips for tapering off lithium

 

Taking multiple psych drugs? Which drug to taper first?

 

And I'll stop there, so as not to overwhelm.

 

Welcome here again.  This is your introduction/journal page where you have now introduced yourself to the community, you can ask questions here, and communicate with staff and other members, regarding your tapering, support around WD(withdrawal), give updates, and just keep a record of your journey.

 

Love, peace, healing, and growth,

manymoretodays(mmt)

 

 

Edited August 27, 2023 by manymoretodays
asking for more clarity, doses, names of drug(s)

[manymoretodays]

Ack, just found a second Introduction of yours @Naturalhealing

Just one per member, it keeps all your information together, and decreases confusion.

In merging them together now though......it may be a bit confusing, as my response to your first Introduction, comes below your second Introduction, with responses.

 

Anyway.....this is your spot now.

[manymoretodays]

14 hours ago, Naturalhealing said:

Thank you Firefly.

I have been without Surmontil for 2 days, since I am traveling and I don t have it with me, but this evening I will start again with the 5 drops of it.

 

Regarding Lithium, I took 600 mg for two days, but yesterday I returned to 800 mg, following your advice.

 

I see that my insonnia was due to the too fast withdrawal of Surmontil antidepressant, having followed the psychiatrist instructions.

 

Would you have some suggestions regarding how to fall asleep again?

 

Thank you for your help !!

 

Naturalhealing 

 

Okay then too, this sounds sound above.  Although, it's going to get confusing as you made and are making again 2 changes at once.  We can't really get a good idea of what might relate to what.   Was it just 2 days then of insomnia?  And do stay put for at least a week now and let us know how you are doing.

Was your psychiatrist concerned about your level of Lithium?  And were you experiencing any symptoms of Lithium intoxication?

Here's a little bit about it:  https://www.ncbi.nlm.nih.gov/books/NBK499992/

 

And basic medication management should be left to those who prescribe it.  Hoping you were aware of all the ins and out of Lithium by now, and if not given information at the get go, will now begin to investigate on your own.  As I know, it's not just the levels or doses.......there's a lot of individual variation that happens and is important.  Anyway we're not prescribers or doctors and are more here for help with tapering.

 

When do you take each of your drugs now?  And do include the Tavor as well, your benzo, if used on a daily basis.  If not, when last used?  Include the doses too.  That will help establish a baseline for you.  Just begin to note the date, then the times on the left, and on the right note each medication by name, and dose.  Then also after you get that down.  Begin to note symptoms to the right of times as they occur throughout the day, and night(you can summarize nights in the morning if you want to).

This gives a good idea of what I am asking:

Daily drug and symptom patterns  you'll see a sample note in the first post.  Work it on paper first and then post a full 24 hours here.  Then another.  3 days worth is ideal for when you post that here.

 

Primarily though, next up......if you would just note times, drugs by name and dose first.  Post that in a reply. 

 

The notes or logs, drug and symptom patterns can prove to be invaluable both to us, AND to you in managing and knowing what might be doing what.

 

Anyway.......I'm rambling a bit, and likely overwhelming you at this point.  Welcome again.  And so you are doing okay overall and traveling and stuff?  That sounds good.

 

L, P, H, and G,

mmt

 

I just edited a bit more into my first post to you now.  A couple more questions around your actual dose of Triimpramine and just ideas for clarity when you post.  Thanks.

Edited August 27, 2023 by manymoretodays
more, and more, over and out, and additional final lines to post

[Naturalhealing]

Dear Manymoretodays,

 

Thank you for your kind message.

 

In november 2009 I had great emotional pain as my first boyfriend left me, the person who I was seeing as the only 'light' in my life. Following this I went to volunteer in India for 2 months, where I lost 10 kg and started not sleeping, but despite this I felt enthusiastic and always extremely positive. Immediately after India, in september 2010, I went to study in Spain, at the age of 21. I started giving hundreds of euros to a homeless woman. Crying for hours thinking about my family history. Feeling very close to God. Full of energy, I climbed mountains and did a lot of sports. In december 2010, following a week without eating or sleeping, which led to hallucinations, psychosis, anger agaist my father and hospitalisation, always in Spain, I was diagnosed as Bipolar 1 and put under Risperdal.

 

 

2013 I started with Lithium Carbonate Immediate release, then in 2018 switched to lithium sulphate slow release (83 mg x 2 per day) and am now currently on lithium carbonate slow release (400 mg x 2 per day)

 

Despite my psychiatrist's advice to take off a tablet of lithium, thus taking 600 mg per day, instead of 800, I have decided to go back to the initial dose, as the insomnia must surely be due to these sudden reductions in medication (Surmontil and Lithium), as kindly suggested by Firefly.

 

After the failure of my first attempt to come off lithium (June 2022-January 2023), which led to a 3-month period of mania, with psychosis, hallucinations, insomnia and deep depression, I now have the impression that the severity of my disorder does not allow for a life without lithium.

 

I would like it very much though! And that is why I am on SA, I would really like to be able to compare myself with someone who has received such a diagnosis and managed to get off lithium.

 

In June 2022 I started scaling down (too quickly) the lithium sulphur Resilient 83mg, as it was the only psychopharmaceutical drug I was taking.

 

Recently I had four nights of total insomnia. Fortunately last night was better. 

 

Yesterday 27/08/2023:

 

1 capsule of Lithium Carbonate 400 mg - 9 am

three magnesium sachets of 184 mg each - 6 pm

5 drops of Trimpramine (Surmontil) + 1 capsule of lithium carbonate 400mg - 8 pm

put my feet in a basin of hot water with sodium bicarbonate - 9 pm

sleep supplement 'ZzzQuil' (a gel capsule with melatonin 1 mg, vitamin b6, 1.4 mg, valerian 30 mg, chamomile 10 mg, lavender 10 mg) - 9.30 pm

went to bed at 10 pm

I woke up several times during the night, twice I got up, changed room, drank herbal tea to sleep, went back to bed when I felt sleepy

 

I haven't taken Loranzepam (Tavor) for 5 days now. In August I took it with an average of 2 times a week, 2 mg. Last time I took 1.5 mg of it, and it did not work.

 

I spent the weekend 'visiting' a neighbouring region, when some relatives were visiting. I felt sick most of the time, due to insomnia and pain in the right occipital region of my neck.

Does anyone suffer from the same ache?

 

I wonder if this pain in the back of my neck could have something to do with the thyroid.

This is because, during the recent lithium withdrawal, my thyroid levels showed a probable hypothyroidism (I have to redo the tests in September and, if so, the doctor will start prescribing me hypothyroidism medication. )

 

Has anyone, having come off lithium, been able to resolve their hypothyroidism?

 

Thank you for your help!

[manymoretodays]

On 8/28/2023 at 3:38 AM, Naturalhealing said:

1 capsule of Lithium Carbonate 400 mg - 9 am

three magnesium sachets of 184 mg each - 6 pm

5 drops of Trimpramine (Surmontil) + 1 capsule of lithium carbonate 400mg - 8 pm

put my feet in a basin of hot water with sodium bicarbonate - 9 pm

sleep supplement 'ZzzQuil' (a gel capsule with melatonin 1 mg, vitamin b6, 1.4 mg, valerian 30 mg, chamomile 10 mg, lavender 10 mg) - 9.30 pm

went to bed at 10 pm

I woke up several times during the night, twice I got up, changed room, drank herbal tea to sleep, went back to bed when I felt sleepy

 

I haven't taken Loranzepam (Tavor) for 5 days now. In August I took it with an average of 2 times a week, 2 mg. Last time I took 1.5 mg of it, and it did not work.

 

I spent the weekend 'visiting' a neighbouring region, when some relatives were visiting. I felt sick most of the time, due to insomnia and pain in the right occipital region of my neck.

Does anyone suffer from the same ache?

 

Hi Natural,

I had lots of neck aches and occipital pain later in my WD, when I was off everything for awhile.  To the point where I put on a cervical collar at times.  When I was going through a huge stressor too, my Mom's last days and death.  I used ibuprofen for the pain, although that may be contraindicated with your Lithium.  What can you use for pain?

 

Do you have a pre-existing thyroid condition?  And if so what do you take for that and when have you last had your thyroid checked- the various blood levels that they do?

 

Go easy on all those supplements.  As with the 2 drug changes you recently did........and then back again.......you might still be just restabilizing in the next week or two to balanced levels of your drug(s).  And that in itself can cause symptoms.

 

The only 2 supplements we recommend are:

BASIC SUPPLEMENT TOOLKIT

King of supplements: Omega-3 fatty acids (fish oil)

Magnesium, nature's calcium channel blocker

 

And then only add in one new thing at a time.  Start low, go slow, observe while making no other changes.  Many of us are increasingly sensitive during WD, and also from too many medication mishaps prior to arrival.

 

Thanks for the additional information.  How are you doing today?  Are you back home from traveling?  Try not to get ahead of yourself with tapering.  Give us a chance to get to know you, and give yourself a chance to get more familiar with tapering and make a good plan going forward.  This all takes time and patience.

 

L, P, H, and G,

mmt

[Naturalhealing]

Dear Manymoretodays,

 

For the moment, for the pain in my neck, I am only using a tiger balsam cream, which gives a minimum of relief, and tomorrow I have an appointment with a kinesitherapist. I started sleeping with the window closed to avoid humidity and I think my neck liked it.

 

Today I started taking Omega 3 fatty acids (for 3 capsules: EPA 225 mg, DHA 150 mg and 30 mg vitamin E).

 

Yesterday 28/08/2023:

 

1 capsule of Lithium Carbonate 400 mg - 9 am

three magnesium sachets of 184 mg each - 6 pm

5 drops of Trimpramine (Surmontil) + 1 capsule of lithium carbonate 400mg - 8 pm

put my feet in a basin of hot water with sodium bicarbonate - 9 pm

sleep supplement 'ZzzQuil' (a gel capsule with melatonin 1 mg, vitamin b6, 1.4 mg, valerian 30 mg, chamomile 10 mg, lavender 10 mg) - 9.30 pm

went to bed at 10 pm

I woke up fewer times during the night, drank herbal tea, went back to bed when I felt sleepy. I seem to be coming out of insomnia :).

 

Once the tapering of the antidepressant Surmontil is finished, I will begin, very slowly, the tapering of the lithium carbonate.

From what I read in the topic " Tips for lithium withdrawal" it seems that it is not advisable to split slow-release lithium capsules, such as the Eskalith CR pills. 

Do you know if the French equivalent 'Theralite', 400mg slow release lithium carbonate, can be spit out or not?

Would it be better to switch to an immediate-release dose for tapering?

 

Thank you for your kind help!

[Naturalhealing]

With regard to the thyroid, on 14/3/2023 my values were: FT3: 3.6, FT4: 14.0, TSH: < 0.01.

On 4/4/2023 they were: FT3: 3.0, FT4: 5.7, TSH: 0.17.

On 04/5/2023 they were: FT4: 7.4, TSH: 5.19 .

This was the period following the tapering, during 10 months, of lithium sulphate slow release, and the subsequent retaking of lithium following the hospitalisation, so presumably the values were disturbed by these changes in lithium intake.

Now, in few days I will go for blood tests, including thyroid values. After that the doctor will tell me if it is necessary to take the medication for hypothyroidism. I sincerely hope it won't be the case. 

 

I will also ask for an intolerance test for gluten and dairy products, as from what I have read in numerous feedbacks, these nutrients often lead to inflammation, in the case of a diagnosis of bipolarity, and it would be better to avoid them. How does all this resonate with your own experience or knowledge?

 

Thanks in advance!  

[Naturalhealing]

( the reference intervals are :  

FT3: 2.4 - 4.0

FT4: 5.5 - 12.0

TSH: 0.25 - 4.50 )

[manymoretodays]

Hi Natural,

What is dose on the Surmontil 5 drops?  There should be a dose in milligrams that you can find on the label I hope.  And that sounds like a good plan.  To do the tricyclic AD first, and then the Lithium.  Sometimes members can manage doing alternating tapers too.  We are definitely going to need to know what your present dose of Surmontil/ tri impramine is in milligrams(mg) before trying to taper that at all.  So see if you can find that information.  I'm hoping you find out how many milligrams are in how many millileters in the prescription you have now, and then also how many mg in your present 5 drops that you take.

On 8/29/2023 at 11:46 AM, Naturalhealing said:

Do you know if the French equivalent 'Theralite', 400mg slow release lithium carbonate, can be spit out or not?

Would it be better to switch to an immediate-release dose for tapering?

I don't know yet on this ^  Some extended or slow release when split, become immediate release.  Where yours is dosed twice a day, the 400 mg, it can't be that long acting or slow release.  I can look into this more though and will.

 

 

I am no thyroid expert, that's for sure.  My own history is I had some symptoms of hypothyroidism, while on drug(s) and some lab evidence as well.  I only did a brief period of Armor pig thyroid and then was taken off I believe, or quit taking it.  Later lab results and symptoms were no longer anything to worry about regarding hypthyroidism.  So I lucked out, with maybe a drug induced hypothyroidism........that later resolved.  I'm happy about that.

 

We've got a good topic, which I hope will help you answer your questions:

Thyroid symptoms: hypothyroid,Hashimoto's

I know there is a good information on the lab results in that topic, and more.

Will you be tested or have you been tested for Hashimoto's?

 

Also one of our adminstrative staff people is great with understanding of Hashimoto's and thyroid management, as she had to figure out quite a bit for herself.  Here's a link to her topic:  Karma: Tapering Effexor, Gabapentin, and Xanax  So you can take a look and see how she has managed to taper, while figuring out her best treatment plan for Hashimoto's hypothyroidism too.  It's pretty inspirational I think, and she's come a long way with her tapering while working and functioning pretty well.  I think she'll respond to questions and give input too on either the Thyroid topic or her own.  So if a specific thyroid related Question, you could reach out to her. 

 

You can notify another member or staff too, unless you see that they ask that you don't, by simply typing a @ symbol, and then begin typing in the name of who you wish to be notified......and the name selection will appear, then click on the name of who you wish to notify.  That can work out too.

 

On 8/30/2023 at 1:30 AM, Naturalhealing said:

I will also ask for an intolerance test for gluten and dairy products, as from what I have read in numerous feedbacks, these nutrients often lead to inflammation, in the case of a diagnosis of bipolarity, and it would be better to avoid them. How does all this resonate with your own experience or knowledge?

Hmmm, for now.......I can refer you to this topic, which then is indexed in the first post into lot's of other topics, to find out more on food intolerances and you:

Important topics about tests, supplements, treatments, and diet

I know many will just do elimination diets, one thing at a time, with observations, to figure out their own best food intake that offers adequate nutrition.  Other than mood changes do you experience other food intolerance symptoms now?

 

This is good that you are looking into everything now.  And I'm hoping you will begin finding your stable point on your present dosing.......just what that is like now.  I'm also interested to know what a few days looks like with regular dosing of your medications.  Would you give a try at some daily notes, or drug and symptom logs......just a couple days, like 3 would be great to see.  There's a link to the how to in my post back on Sunday.  Get the times, all drugs and supplements in by name and dose to the right of times, also symptoms if any right now, to the right of times throughout the day, summarize sleep and general well being or not so well being. 

 

You sound good, last couple of posts.......getting ready, looking into things.  This is a wonderful  approach.

 

L, P, H, and G,

mmt

[Naturalhealing]

Hello MMT,

 

Thank you for your kind reply.

 

On 9/1/2023 at 4:45 AM, manymoretodays said:

What is dose on the Surmontil 5 drops? 

 

I am currently taking 5 mg of Surmontil (Triimpramine).

The plan is to reduce it by 1 mg each week.

 

I have just had blood tests:

Liver and kidneys values are ok

Thyroid:

TSH: 1.76 (should be between 0.27 and 4.20 so ok)

REVERSE T3: 10.9 (should be between 9.3 and 17, so ok)

ANTI TPO (anti-thyroperoxidase antibodies): 142 ( should be less than 34, not ok )

TG ab (Anti thyroglobulin) : 132 ( should be under 115, not ok )

 

I think this is Hashimoto's thyroiditis and that my doctor will give me medication for this problem. I believe that the lithium I am taking since 10 years  has caused this issue, or at least aggravated it.

I  checked out the topic Thyroid symptoms: hypothyroid,Hashimoto's

Is there anyone who, once the medication was stopped, brought the thyroid  values back to normal?

 

The doctor said there are no ways to detect an intolerance to gluten and dairy products.

I'm still sticking to my gluten-free, dairy-free diet.

 

For the past two days, I've stopped taking magnesium because I had the impression that it would increase my neck pain.

 

1/9/2023

a.m.: 1 slow-release Lithium Carbonate tablet

Lunch: 3 capsules of Omega 3 fish oils (EPA + DHA = 250 mg)

Dinner: 3 capsules of Omega 3 fish oils (EPA + DHA = 250 mg)

8 p.m.: 1 slow-release lithium carbonate tablet + 5 mg Surmontil

9.30 pm.: sleep supplement 'ZzzQuil' (a gel capsule with melatonin 1 mg, vitamin b6, 1.4 mg, valerian 30 mg, chamomile 10 mg, lavender 10 mg)

 

Emotionally, I feel fine, with the sole exception of August 30, when I woke up with anxiety, then cried a little, but the anguish passed. I think it was caused by the anxiety for my final job interview.

 

Have any of you experienced Dr Clive Sherlock's "adaptation practice" program? I'm wondering if it's an effective enough practice to avoid falling into mania (when I go off lithium, or even during the reduction).

 

And I discovered the site https://www.bipolarawakenings.com/

Have any of you had consultations/retreats with Sean Blackwell?

It seems that some people have managed to "recover" from type 1 bipolar disorder and live without medication.

There may be hope.

 

Thank you for your precious help !!

 

[Naturalhealing]

Hello everyone,

 

I hope you are doing well.

 

2/9/2023

8 am 1 slow release Lithium carbonate tablet

lunch: 3 capsule of Omega 3 fish oils ( EPA + DHA = 250 MG)

dinner: 3 capsule of Omega 3 fish oils ( EPA + DHA = 250 MG)

8 p.m: 1 slow-release lithium carbonate tablet + 4 mg surmontil

9.30: sleep supplement "ZzzQuil"

Emotionally and Phisically: fine

 

3/9/23

 

8 am 1 slow release Lithium carbonate tablet

lunch: 3 capsule of Omega 3 fish oils ( EPA + DHA = 250 MG)

dinner: 3 capsule of Omega 3 fish oils ( EPA + DHA = 250 MG)

8 p.m: 1 slow-release lithium carbonate tablet + 4 mg surmontil

9.30: sleep supplement "ZzzQuil"

A bit of insomnia during the night so I drank herbal infusion

Emotionally and Phisically: fine. 

 

I calculated that to make a safe tapering from lithium carbonate, which I have been taking for 11 years, I would have to do it in 3 years, at the rate of 10% maximum. And after this period, I understood that I would probably need some more time to settle down in emotions and physically.

 

I wish to have a child, and I am almost 36 years old.

So I thought of proposing to my psychiatrist to replace the lithium carbonate with Lamotrigine.

Then, ideally, wait 1 or 2 years after childbirth to start the Lamotrigine reduction

 

What do you guys think about this? Can this be a good idea?

 

Thank you, I wish you a lovely day

 

NH

[FireflyFyte]

2 hours ago, Naturalhealing said:

So I thought of proposing to my psychiatrist to replace the lithium carbonate with Lamotrigine.

Then, ideally, wait 1 or 2 years after childbirth to start the Lamotrigine reduction

 

What do you guys think about this? Can this be a good idea?

 

We are a site dedicated to safely tapering off of psychiatric drugs. We cannot advise on medication changes/substitutions, this is something that you should discuss with your doctor.

[manymoretodays]

On 9/2/2023 at 1:41 AM, Naturalhealing said:

I am currently taking 5 mg of Surmontil (Triimpramine).

The plan is to reduce it by 1 mg each week.

 

Hi Naturalhealing,

That would be a rather large leap by our standards. 

See:  Why taper by 10% of my dosage

Did you get a chance to read through this above?  If not, please do so now or take a second look.

 

You'd be going down by 20% every week the first week, and it would likely work out to be by more progressively as your dose got lower. What you want to do is a linear taper and that could lead to problems.  I would not recommend dropping your Triimpramine by 1 mg every week.

 

To calculate a 10% taper from 5 mg:

5 mg(present dosage) X .90 = 4.5 mg,  the 4.5 mg would be your first reduction, and some will do even less than 10% too, to test the waters and see how they personally do with reductions.

 

Then the next reduction, or taper would be based on 4.5 mg of Triimpramine:

4.5 mg X .90 = 4.05 mg would be a 10% taper then from the 4.5 mg dose

 

Generally, a good HOLD time after a taper is 4 weeks, and totally okay to do 6 weeks

 

Once you do your first taper by 10% or less, it is a good idea to make observations too, to pay attention and jot down if any symptoms of WD(withdrawal) set in, and pay attention to when they leave too.  That can help with future planning.  Knowing exactly how you react to tapers.

 

Here is what came up when I did a google search on Lithium and thyroid problems: Lithium and thyroid problems......hmmm, unable to share that.  There's a lot out there though and I expect you have begun to do your research as well as talk with your doctor. 

* Importantly, from our stand point, and harm reduction.......it's going to be important to decide if a more rapid taper is necessary with your Lithium, due to your thyroid involvement.  If not, with the Lithium, it's going to be the same principle with tapering.  The 10% or less, from each previous dosage.  This is harm reduction in the tapering world.

 

 

With me, my numbers did normalize as far as TSH and T3 and T4 evaluations go.  After I was off Lexapro, as well as some other drugs.  Lithium was pretty short term for me, but may have played a role.  I don't know.  Other symptoms for me, were I was very tired and run down, and some weight gain as well.

 

I did see your numbers, lab results with the thyroid and anti thyroid tests.  Thanks for sharing here.  Again, I am no expert in that department.  I'll put you in for other staff input now too, in case or with hopes that maybe someone else might be more helpful with input around your thyroid, and well with everything. 

 

I could use some help figuring out how to best help you, and what to focus on most, first.  I tend to think it's your thyroid, but I'm not sure.

 

I'm seeing a book mentioned and also I think an additional web site by the same name called "Stop the Thyroid Madness" in the Thyroid symptoms topic too.  That underlined passage should take you there.  And man.......I could see how easy it might be to feel overwhelmed by information right now, so if you are doing well enough.......I continue to encourage you to go slow to learn, and make plans.........you don't have to come to a standstill........yet I think it might make sense to do so.  You can certainly post some of what you have posted here, over in that topic, the Thyroid symptoms topic.  In fact I would encourage that you do that.  Not all are on Lithium there, but thyroid stuff comes up with other drugs we work with too. 

 

Thank you so much for the notes too.  I'm not really seeing any symptoms at all, ever noted, that could relate to your drug(s), or supplements right now.  Of note too though......in preparation for tapering and to not be taking so many things.......I'm a little concerned about:

10 hours ago, Naturalhealing said:

9.30: sleep supplement "ZzzQuil"

 

10 hours ago, Naturalhealing said:

A bit of insomnia during the night so I drank herbal infusion

 

How soon do you go to ZzzQuil and have you looked at what is in it? 

What herbal infusion?

 

These kind of additions may prove to be NOT helpful anymore if you want to taper, and get to a point to begin that.

There are non-drug sleep tips, a link to that topic, up above too, from another moderator.......which should be helpful.

Me, I would not recommend any combination type supplements right now, which I think both of the ones I quoted are.  It makes it really hard to know what does what.  AND you might be sensitive to things, even now, before tapering.......after your last attempt to taper the Lithium.

I'm guessing that you might have just tapered way faster than we would have ever recommended.

Also possible that it wasn't just some degree of  natural Bipolar-ism that came into play, but that the too fast taper, in itself, set off some kind of mania reaction as WD symptom.

 

So I am glad you are here now.  To learn, and work to avoid the same kind of taper that may land you right back on a drug or drug(s) due to WD symptoms.  This does require a lot from you......to stay on top of things, to read, and absorb what you are reading, and not get frustrated........it would take anybody time to get their grips on the many factors you have going........your hopes for a pregnancy sooner rather than too much later........this thyroid imbalance, and then just general tapering principles too.  Takes time.  I'm glad.....so glad that things feel okay overall right now.

 

And as far as the Omega 3's, fatty acids it looks like you could most definitely be increasing that dose, and then also finding a preparation that has more per each capsule of the DHA + EPA combined, so you don't have to take tons of capsules to get a decent dose.

Your magnesium as well might benefit from some tinkering by you.  Many will split that up throughout the day, which you do to some extent.  Do you feel like it is calming?  Do you feel like you need calming prior to taking it? 

I'm not even seeing that in the notes you've supplied.  Non the less, I do thank you for doing the notes.  And I do see a summary below some of them.  Next time, when asked to provide notes here, do get more of what you are doing, and feeling, in a various times through the day.  I encourage you to keep going with them too, on paper, or online somewhere, for you........your usage and monitoring right now.  We may ask for more later too.

 

Do your best to read the topics provided(the links are above), so you can find things out for yourself too, and put into practice what we have here.  I'm referring to the sleep, Omega 3's/fatty acids, magnesium topics now.

 

Okay......wow.......and I hoped you nailed your final job interview too.

Thanks so much for the Notes, and getting to most of my questions too.

 

L, P, H, and G,

mmt

 

 

Edited September 5, 2023 by manymoretodays
clarity

[Altostrata]

Hello, @Naturalhealing I am confused what is happening here.

 

On 8/26/2023 at 12:52 AM, Naturalhealing said:

Yesterday my psychiatrist, in seeing my blood test results for lithiemy,  ( 0.67 ) , said to eliminate 1 capsule of lithium carbonate, passing from 2 tablets ( 800 mg in total) to 600 mg a day. I followed this advice, but I am wondering,  will not this abrupt reduction cause any side effect?

 

What is a lithiemy test? What does this result mean?

 

Since you are under the active care of a psychiatrist, why did you not ask the psychiatrist about potential withdrawal effects?

 

If you are suffering organ damage from a drug, you need to balance the risk of withdrawal effects against ongoing drug damage. If you need to quickly reduce a drug to save a vital organ, you might have accept the risk of withdrawal.

 

On 9/4/2023 at 6:54 AM, Naturalhealing said:

3/9/23

 

8 am 1 slow release Lithium carbonate tablet

lunch: 3 capsule of Omega 3 fish oils ( EPA + DHA = 250 MG)

dinner: 3 capsule of Omega 3 fish oils ( EPA + DHA = 250 MG)

8 p.m: 1 slow-release lithium carbonate tablet + 4 mg surmontil

9.30: sleep supplement "ZzzQuil"

A bit of insomnia during the night so I drank herbal infusion

Emotionally and Phisically: fine. 

 

In your daily notes, please include the dosage of each drug.

If you want to taper lithium, see Tips for tapering off lithium
 

On 9/4/2023 at 6:54 AM, Naturalhealing said:

I wish to have a child, and I am almost 36 years old.

So I thought of proposing to my psychiatrist to replace the lithium carbonate with Lamotrigine.

 

Did you discuss this with your psychiatrist? 

 

It appears to me that you have reported spells of feeling ill after a drug change. If I were you, I'd minimize drug changes.

 

FYI Hashimoto's alone is not treated with thyroid drugs, it's not the same as hypothyroidism. Many people with Hashimoto's do not develop hypothyroidism. But if the lithium is causing thyroid inflammation, that could be the source of the Hashimoto's antibodies. The neck pain could be coming from your thyroid, this requires a physical examination. You need to talk with your doctors about this.  

 

It's important for you to look up adverse effects of each of your drugs so you can recognize them if they should appear.

[Naturalhealing]

On 9/5/2023 at 1:59 AM, manymoretodays said:

 

Hi Naturalhealing,

That would be a rather large leap by our standards. 

See:  Why taper by 10% of my dosage

Did you get a chance to read through this above?  If not, please do so now or take a second look.

 

 

Hello MMD,

I was tapering at that rate following the psychiatrist advice. I did read the topic, I can taper slower.

 

On 9/5/2023 at 1:59 AM, manymoretodays said:

How soon do you go to ZzzQuil and have you looked at what is in it? 

What herbal infusion?

In the sleep supplement 'ZzzQuil' there is melatonin 1 mg, vitamin b6, 1.4 mg, valerian 30 mg, chamomile 10 mg, lavender 10 mg.

Herbal infusion is made with: melissa, Californian poppy, cornflower, Thai basil, marjoram

 

I usually take them everyevening, 30 minutes before going to bed, they really help.

Yesterday night I did not take them and I had difficulty falling back asleep in the middle of the night.

 

Thanks for your valuable advice, I purchased a supplement with more DHA +EPA combined.

 

Hello, @Altostrata 

Lithiemy is used to monitor the level of lithium in the blood to check for intoxication. 

My last blood test showed a lithium level of 0.67 mmol/L. Values between 0.6 and 1.2 are considered normal, but since high levels of lithium in the blood can more easily lead to intoxication and kidney and thyroid problems, the psychiatrist suggested that I scale back the lithium, from 800 mg to 600 mg per day ( I tried this and had severe insomnia, so as described in previous posts, I went back to the 800 mg dose. ) I really don't know which is the best choice.

On 9/6/2023 at 7:58 AM, Altostrata said:

Since you are under the active care of a psychiatrist, why did you not ask the psychiatrist about potential withdrawal effects?

He is completely unaware of the effects of withdrawal

On 9/6/2023 at 7:58 AM, Altostrata said:

On 9/4/2023 at 3:54 PM, Naturalhealing said:

I wish to have a child, and I am almost 36 years old.

So I thought of proposing to my psychiatrist to replace the lithium carbonate with Lamotrigine.

 

Did you discuss this with your psychiatrist? 

Not yet, I hope to book a visit with him these days.

 

Thank you for your help!

 

6/9/23

 

8 am: 1 slow release Lithium carbonate tablet 400 mg +  Omega 3 fish oils (225 mg EPA +150 mg DHA)

1 pm:  Omega 3 fish oils ( 700 mg EPA  + 500 mg DHA )

7 pm: Omega 3 fish oils (225 mg EPA +150 mg DHA)

8 p.m: 1 slow release Lithium carbonate tablet 400 mg + 4 mg surmontil

A bit of insomnia during the night

Emotionally: Since yesterday afternoon I have been feeling rather sad.
Not depressed, but down in mood.

Phisically: I feel pain in my leg muscles, but it is normal since I cleaned all the doors and windows in the house.

 

[Altostrata]

On 9/4/2023 at 6:54 AM, Naturalhealing said:

So I thought of proposing to my psychiatrist to replace the lithium carbonate with Lamotrigine.

Then, ideally, wait 1 or 2 years after childbirth to start the Lamotrigine reduction

 

Making drug switches always brings an increased risk, because the switch might not work and you get withdrawal from the first drug, or you could get adverse effects from the new drug. As we provide peer support for going off drugs, we do not advise on switches for therapeutic reasons -- you seem to think that you need either lithium or lamotrigine to control psychiatric symptoms, even though you might be a different person than you were 13 years ago when you were diagnosed. This is something you need to discuss with your doctor.

 

I am sorry your doctor gave you bad advice about tapering lithium and doesn't know anything about withdrawal. Since you're taking 800mg a day, you might have been fine with a reduction of 80mg. See Tips for tapering off lithium
 

I would not attempt to reduce dosage until all withdrawal symptoms have gone away.

 

Please use trimipramine in reference to Surmontil and change your signature accordingly. Thank you.

 

 

[manymoretodays]

On 9/7/2023 at 3:13 AM, Naturalhealing said:

Emotionally: Since yesterday afternoon I have been feeling rather sad.
Not depressed, but down in mood.

Phisically: I feel pain in my leg muscles, but it is normal since I cleaned all the doors and windows in the house.

 

Improvements since you posted ^ ?

And good to recognize you might have overexerted versus any symptom from your recent drug changes.

 

Try to notice too, or put in your Notes when you first recognize any symptom, to the right of a time, and then if it feels better later, then note that time and which symptom was relieved to the right of the time.

I like too, to see if you try any non-drug coping.....put that in the notes too.  Like if feeling sad......and trust me, it's okay to feel sad from time to time, or a little down........but of course no one wants to dwell in it forever........so you could put in......if you listened or watched something funny or distracting and if that helped, or if you did some yoga or got out in the sunshine, or forest.....and that helped.

 

All kinds of non-drug coping in our Symptoms and Self Care forum too, if you are new to thinking outside of the box of "illness", or beyond a diagnostic label.  I did read what you posted as far as when you got diagnosed and put on these types of drugs

On 8/28/2023 at 3:38 AM, Naturalhealing said:

In november 2009 I had great emotional pain as my first boyfriend left me, the person who I was seeing as the only 'light' in my life. Following this I went to volunteer in India for 2 months, where I lost 10 kg and started not sleeping, but despite this I felt enthusiastic and always extremely positive. Immediately after India, in september 2010, I went to study in Spain, at the age of 21. I started giving hundreds of euros to a homeless woman. Crying for hours thinking about my family history. Feeling very close to God. Full of energy, I climbed mountains and did a lot of sports. In december 2010, following a week without eating or sleeping, which led to hallucinations, psychosis, anger agaist my father and hospitalisation, always in Spain, I was diagnosed as Bipolar 1 and put under Risperdal.

 

And tough stuff......could it have been the insomnia and not eating, rather than some bipolar 1 happening?  It's not like anyone, ever, to date has found any biological basis to bipolar.  You've had it hard though, and I do commiserate, and again applaud you.......for now reaching out, and learning, and beginning to plan for perhaps a better future.

 

Best, L, P, H, and G,

mmt

[Naturalhealing]

Hi everyone, sorry it has been a while since I last posted here. 

I finished the reduction of surmontil (Trimipramine) in mid-December 2023. Everything went well thankfully. 

In early January, I started tapering the lithium carbonate. -10% per month, with daily micro tapering.

Doing research on this website regarding the topic of bipolar disorder, I see that for the most part there are experiences of people who have been diagnosed with this disorder due to the side effects of some antidepressant (such as mania).

 

In my case, in 2010 I had mania with psychosis without being on any medication. Does this mean that I actually have this " mental illness " that needs lithium for life?

 

Thank you in advance for your feedback!