How severe does a mental illness need to be for something like lithium?

[Lizziesaurus]

As some of you know I'm somewhere on the bipolar spectrum, not too sure where yet as I'm yet to see any sort of specalist. My doctor insists I'm not that bad, and I know I'm not compared to some. However I can't seem to get across that just because I don't fit into a proper category such as bipolar 1 or 2 etc that it doesn't effect my life just as badly. I like this doctor, he used to be a psychiatrist so I know he knows what he's talking about but I'm currently on my second prescribed ssri and they don't work, in fact they make me feel worse. He says he does want me to see a pshyciatrist but apparently we have to show them 'we've tried all we can before seeing one' that's the NHS for you though I suppose.
So basically I'm wondering how 'bad' you have to be prescribed something stronger, not just lithium, I know there're so many other options out there, litiums the easiest to spell :winks: I mean, am I destined to be stuck on pills that don't help, constantly being brushed under the carpet 'cause I don't tick the right boxes? The stress isn't helping me, I know that, but I'm one of these people who likes all the information and it drives me bonkers that I don't have proper answers.

[ElizabethJane]

Dear Lizzie if only your questions have simple answers! I don't believe that mental illness has to be 'severe' to be prescibed a mood stabilser such as lithium. As you are probably aware I am taking lithium 1,000mg at night and it has transformed my life. Before lithium I had done the rounds of various treatments, hospitalised and drugs. I would strongly urge you to see a psychiatrist because the input from him will be invaluable. GPs can prescribe lithium but if yours does not think it will help then trust him for now. Lithium and other mood stabilsers have lots of side effects and require careful monitoring and blood tests. It is really up to whoever is looking after you whether they think that you would benefit from lithium or not (can't speak for the others) Lithium does require commitment from the patient and is usually for the long term. Some changes to liver, thyroid and kidneys if occur are irreversible hence the need for regular blood tests. You don't necessarily have to be 'bad' to be taking lithium. If you equate 'bad' with being seriously ill well yes when I first went on lithium I was 'bad' ie seriously ill. EJ

[harasgenster]

I'm sorry if this isn't what you want to hear, but trust the doc. I'm being hypocritical as I've just started a thread about me not trusting the docs' opinion for the exact opposite reason as you: they think I'm bipolar, I think I'm just anxious!

Perhaps we both have to start trusting doctors! They probably do know best what with their snooty medical degrees and all!

You say your doctor used to be a psychiatrist (so did mine, incidentally). Does he think you're bipolar?

In what way does the illness affect you?

Also, don't think of mood stabilisers as being stronger. It's not quite like that, I don't think. They're different, not stronger. (Don't quote me on that!) I'm on lamotrigine, which is a mood stabiliser they use for people with cyclothymia and bipolar II (I'm somewhere in the middle, apparently) but I think when they treat more severe forms of bipolar they mix it with other things as well.

I actually find it much gentler than SSRIs, to which I had a really extreme reaction.

If you really, really worried, you could always get a second opinion from another GP. But for now, maybe just go along with what the doc says. Maybe once he's tried everything, as you say, he will let you see a psychiatrist.

Also, drugs aren't supposed to work by themselves. They take a lot of work from you as well. Have you tried changing your life and the way you view things? I'm afraid whether it's bipolar or anxiety, the drugs are an aid and will not make you feel better by themselves.

I hope you feel better soon

[Lizziesaurus]

Yes he does think I'm bipolar, a 'mild' form. He keeps saying how it can take up to 2 years and I accept that I just feel like more could be done to help me. Even if it was a case of seeing someone who can help me sort my life out to help any meds, I really don't know where to start!
I say 'stronger' drugs because my doc keeps saying stronger, whether they are or not I know ssri's aren't doing much good on their own.

In the past I only ever noticed the depression side, because I always 'got better' I never saw anyone about it, now about 6 years on when I've realised it's got worse I knew I had to see someone. Before being on meds I was so up and down, throughout week, the day, even the hour (not the usual monthly or even yearly cycles of bipolar). I can't really say how it effects me now because I'm on sertraline at the moment and used to be on citalopram, they seem to be making my life more difficult at home and at work where I keep getting into trouble and when I try and explain my situation they have no sympathy. Not that I want sympathy, but I can be tipped over the edge really easily and they don't make it any better, so then when my moods bad I end up getting into more trouble because I'm stressed and angry etc.

I'm going back to the doctors on the 31st and he's asked me to do a sort of mood diary kind of thing and to note down anything I think of out of the ordinary. Hopefully it'll show him more that I'm worse than he origionally thinks, I have trouble getting my feelings out properly, especially since doctors always rush you. Which is another reason why I'd like to see someone else who'd have the proper time to listen.

[ElizabethJane]

I'm sorry if this isn't what you want to hear, but trust the doc. I'm being hypocritical as I've just started a thread about me not trusting the docs' opinion for the exact opposite reason as you: they think I'm bipolar, I think I'm just anxious!

Perhaps we both have to start trusting doctors! They probably do know best what with their snooty medical degrees and all!

You say your doctor used to be a psychiatrist (so did mine, incidentally). Does he think you're bipolar?

In what way does the illness affect you?

Also, don't think of mood stabilisers as being stronger. It's not quite like that, I don't think. They're different, not stronger. (Don't quote me on that!) I'm on lamotrigine, which is a mood stabiliser they use for people with cyclothymia and bipolar II (I'm somewhere in the middle, apparently) but I think when they treat more severe forms of bipolar they mix it with other things as well.

I actually find it much gentler than SSRIs, to which I had a really extreme reaction.

If you really, really worried, you could always get a second opinion from another GP. But for now, maybe just go along with what the doc says. Maybe once he's tried everything, as you say, he will let you see a psychiatrist.

Also, drugs aren't supposed to work by themselves. They take a lot of work from you as well. Have you tried changing your life and the way you view things? I'm afraid whether it's bipolar or anxiety, the drugs are an aid and will not make you feel better by themselves.

I hope you feel better soon
I agree Harasgenster that mood stabilsiers work in a different way to ssris or snris such mirtazapine which I also take. I have far less trouble from the lithium than mirtazapine which I take. If you can lizzie I would try to see someone privately if you are not getting the answers that you want from your GP. I know that this can be hideously expensive. EJ

[Lizziesaurus]

My doctor himself mentioned if I wanted to get seen quicker go private, I really can't afford it though at the moment.

[ElizabethJane]

I'm sorry to have suggested it. You could try the MDF. Manic Depression Fellowship have a really good website and forum. I use this forum because it has some very useful and sensible information about lithium oln it. I'm not bi-polar. The website should be easy to find. I do not have a link. EJ.

[harasgenster]

Before being on meds I was so up and down, throughout week, the day, even the hour (not the usual monthly or even yearly cycles of bipolar).

Hm, maybe I am bipolar. My moods were up and down on the hour before I was on meds but I was using this as a reason why I couldn't be bipolar...

So your doctor doesn't want you on mood stabilisers at all even though you're bipolar? SSRIs never did me any good. Citalopram was great for the first six months because I was a different person! Really outgoing and confident etc. But then I just slid down. All of the other ones I was on when I was a teenager made me violent (I'm not a violent person by nature).

If the doctor says the drugs are stronger they are stronger. I really don't know anything about it, it was just the impression that I got.

I hope you don't mind, but would you be able to describe your moods to me? I'm trying to decide if they're right about my bipolar! I didn't realise you could have ups and downs within the hour in bipolar. When I was on NO meds (no SSRIs or mood stabilisers) for a few years I used to feel very, very elated - like ecstatic - then extremely depressed where I just couldn't get out of bed all in one day and for no reason that I could tell. I never became very sociable though or more confident or took risks, which is why I don't think I'm bipolar. The only time you could say I had an "episode" - where I was acting very differently to normal in a more outgoing kind of way - was when I was on citalopram. But to be honest, the people around me just said I was "like myself" again, by which they were meaning me when I was 12, before any of this started.

I was diagnosed because I had periods of optimism and pessmism, SSRIs made me worse and I had massively reduced requirement for sleep.

Do you recognise any of this?

Cheers

[Lizziesaurus]

From what I've read yes you can, it's called rapid cycling. They usually say it's more than 4 episodes a year but I found a website which I can't for the life of me remember but it described the different types which describe the shifts in mood in such short time periods. Like I said, I've not been properly diagnosed as of yet, I've only been going for a few months now, but I'm almost positive I have some form of this. I was misdiagnosed at first, being told to just do something I can look forward to and get out more, and I thought it must be the pill then my doctor dropped the bombshell that he thought I was bipolar and my jaw practically hit the floor because I'd been told it wasn't that I was looking for other explanations.

Citalopram had exactly the same effects on me, except of 6 months, the time span was around 5 weeks, by week 7 when I went back to say how I was doing I was basically a walking, talking zombie!

My moods depend alot of the time on what's going on around me, if something good or bad happens, it intensifies the mood and it's alot more extreme than anyone 'normal' would have. If there isn't anything spurring the mood on then the depression could be anything from having a really lazy day, not wanting to speak to anyone or do anything to full blown balling my eyes out, stopping myself from self-harming (I used to do it when I was younger), constantly thinking about suicide and basically not being able to function, also drowning my sorrows in drink and self-medicating with pain killers, not an overdose just taking them for no reason. Something I remember now doing as a teenager.
The high moods can again range from abit of excitement about nothing and can go again within a minute or two to then not needing alot of sleep, not caring about spending money I don't have, being over friendly and/or flirty and a feeling of adrenaline and like butterflies in my tummy, like I'm ready to just go go GO! An awful sense of adgitation and twitchiness, like tapping my foot really fast.
I also get anxious alot, whether it be that something bad's going to happen to worrying I'm about to drop dead.
That's probably the best I can explain it, hope this helps!

Also, thanks Elizabeth, don't be sorry to mention it! I'll definitely have a look into that website!

[suzy-sue]

I was on a mood stabiliser before I was perscribed Antidepressants Lizzie .I also know of other people who have been perscibed them by their GP . I hope your Diary helps your Dr understand your problems better and you get the help you need .All the best Sue x:hugs:

[Lizziesaurus]

So do I!
My other problem is work, I don't want sympathy or to be treated differently, I just wish they understood and could speak to me in such a way which doesn't stress me out or cause my mood to spiral down (which happened the other day). We have a new boss coming in this next week so I'm hoping to speak to him, see what he says but I don't even know my rights concerning it all.

[harasgenster]

From what I've read yes you can, it's called rapid cycling. They usually say it's more than 4 episodes a year but I found a website which I can't for the life of me remember but it described the different types which describe the shifts in mood in such short time periods. Like I said, I've not been properly diagnosed as of yet, I've only been going for a few months now, but I'm almost positive I have some form of this. I was misdiagnosed at first, being told to just do something I can look forward to and get out more, and I thought it must be the pill then my doctor dropped the bombshell that he thought I was bipolar and my jaw practically hit the floor because I'd been told it wasn't that I was looking for other explanations.

Citalopram had exactly the same effects on me, except of 6 months, the time span was around 5 weeks, by week 7 when I went back to say how I was doing I was basically a walking, talking zombie!

My moods depend alot of the time on what's going on around me, if something good or bad happens, it intensifies the mood and it's alot more extreme than anyone 'normal' would have. If there isn't anything spurring the mood on then the depression could be anything from having a really lazy day, not wanting to speak to anyone or do anything to full blown balling my eyes out, stopping myself from self-harming (I used to do it when I was younger), constantly thinking about suicide and basically not being able to function, also drowning my sorrows in drink and self-medicating with pain killers, not an overdose just taking them for no reason. Something I remember now doing as a teenager.
The high moods can again range from abit of excitement about nothing and can go again within a minute or two to then not needing alot of sleep, not caring about spending money I don't have, being over friendly and/or flirty and a feeling of adrenaline and like butterflies in my tummy, like I'm ready to just go go GO! An awful sense of adgitation and twitchiness, like tapping my foot really fast.
I also get anxious alot, whether it be that something bad's going to happen to worrying I'm about to drop dead.
That's probably the best I can explain it, hope this helps!

Also, thanks Elizabeth, don't be sorry to mention it! I'll definitely have a look into that website!

Hi, that's great, thank you.

I think part of my problem was not really understanding what the difference between anxiety and cyclothymia was, because anxiety can make you react to an emotional extreme to triggers (including making you feel excited, due to the adrenaline). I'd always thought it was that cyclothymia was when the moods come for no reason rather than there being a cause but it looks like the water is even murkier than I thought!

Thanks very much for describing it to me. I might never know which one I have but the mood stabilisers have made me much more stable and I guess that's what counts :)

I hope the mood diaries go well and you get more help soon.

Take care

[ElizabethJane]

I'm not bi-polar but before I was put on lithium my moods were extremely erratic. My behaviour was very showy, flirtateous and occasionally very promiscuous. The worrying thing was that I did not care what the consequences were! The opposite end of the spectrum was the crashing depressions and suicidal thoughts terrible paranoia. I'm much more levellled down. I miss the flirtateous side of my personality so maybe I'm not different from you after all. EJ.

[Lizziesaurus]

I know what you mean, when citalopram made me completly numb I in turn felt worse, I missed feeling; then, as soon as I stopped taking them and it all came back and I hated my life again and its unpredictability. Now on sertraline I'm no different, and just experiencing side effects.
After about a week of low mood today around 7ish at work I just sort of went 'ping', like someone flipped a switch and for no reason whatsoever my mood shot up, I couldn't keep control of how fast my thoughts were, in fact I couldn't keep up with myself nevermind anyone else. I was also talking so fast I had to think about it to slow myself down so people could understand me.
Now, I'm back to feeling quite flat and in a low mood. I feel like I'm caught between fire and flood, take medication and feel nothing, don't take medication and go up and down more times that a yoyo at a world yoyo championships!!

[Jebdog]

Hi guys, I'm wondering if I'm some sort of bipolar spectrum the spells I have are either fairly normal, able to function fine, enjoy things, don't think I'm manic or anything (have asked opinion of people round me and no one says I'm too bad) whilst the other side is I'm anxious with depression there, worry a lot more than normal and functioning a lot less. Sounds mild but sometimes the down and anxious spells keep me in bed all day. Often these spells last 2-3 weeks (good) and 1-2 (bad).

I take fluxotine which I've been on for a while, but this pattern I describe has continued so not sure it is doing anything. See doctor Wednesday morning to discuss. Might ask to be referred as it's been going on for some time, although like you guys say it may be tough to get referred. Other option is going private, my question here is can you get NHS prescriptions if you go private?

My other question is can you have the sort of cycles I describe and not be bipolar?

Thanks,
Jeb.

[Lizziesaurus]

I'm definitely no doctor, but I went through the same 'amI bipolar? or is this just normal?' cycle for years, it got misdiagnosed a couple of times, but luckily I now know. Ask the doctor, he should be able to give you a good idea.
Also, no idea about the prescriptions but I'd like to know that as well!

On another note, I've been given more reason today to believe sertraline isn't working for me. My moods gone up again for no apparent reason. They shouldn't be called antidepressants, in my mind they should be renamed as sedatives/appetite suppressants. Anyway, I'm not complaining, I've got 2 days off work now so I'm hopefully going to enjoy it! I'm going to take my tablet about half an hour before I plan to go to sleep, see if it knocks me out all night, that might be hoping for abit too much though, failing that the wine might help!!

[ElizabethJane]

Hi guys, I'm wondering if I'm some sort of bipolar spectrum the spells I have are either fairly normal, able to function fine, enjoy things, don't think I'm manic or anything (have asked opinion of people round me and no one says I'm too bad) whilst the other side is I'm anxious with depression there, worry a lot more than normal and functioning a lot less. Sounds mild but sometimes the down and anxious spells keep me in bed all day. Often these spells last 2-3 weeks (good) and 1-2 (bad).

I take fluxotine which I've been on for a while, but this pattern I describe has continued so not sure it is doing anything. See doctor Wednesday morning to discuss. Might ask to be referred as it's been going on for some time, although like you guys say it may be tough to get referred. Other option is going private, my question here is can you get NHS prescriptions if you go private?

My other question is can you have the sort of cycles I describe and not be bipolar?

Thanks,
Jeb.
Hi Jeb I see my psychiatrist privately and he is expensive. Sometimes my psychiarist will write out a private prescription which my GP will change to an NHS one.My usual meds my lithium and mirtazapine prescribed by the private psychiatrist are dispensed on the NHS. This will only work if your GP is prepared to do it. Most will not. They will also not change a prescription over if the item is really expensive. The practice manager decides. I had a cream prescribed recently that was £70.00 a tube. I paid for it myself. EJ.

[Jebdog]

I guess it depends on the price of the medication ultimately. Would your medication be a lot more expensive if you had to pay private do you know? Was the 70 pound cream related to the depression or something else?

Finally did you suffer from anxiety in the depressive spells? And is this relieved by your current medication?

My doctor does not believe I have bi-polar as I show very little sign of mania.

[ElizabethJane]

I guess it depends on the price of the medication ultimately. Would your medication be a lot more expensive if you had to pay private do you know? Was the 70 pound cream related to the depression or something else?

Finally did you suffer from anxiety in the depressive spells? And is this relieved by your current medication?

My doctor does not believe I have bi-polar as I show very little sign of mania.Hi again the cream was prescribed for a different condition. I don't think that it was available on the NHS. Most anti ds are available on the NHS. If the medication is expensive then the practice can refuse to write out a prescription for it. It is up to the practice/prescription manager. I have suffered from terrible anxiety in the past. This has included racing thoughts, rumination and panic attacks. Thankfully I am in remission from that. I am taking lithium and mirtazapine for severe recurrent depression. My mood swings have been on the severe end in the past. Thankfully the lithium has sorted that out. EJ.

[Lizziesaurus]

I don't have any signs of mania as you would see in a symptom list, my moods just go up up what I believe is not normal. Also the meds I'm taking now seem to make the problem worse.
Luckily ov found an app on my iPad that you can update with diary entries, sleep patterns and mood swings, hopefully this will help when I go to the docs so i don't just have written down scribbles of my moods.

[ElizabethJane]

Dear Jebdog Lithium will do nothing for anxiety as it is a mood stabiiser Mirtazapine is primarily an anti d although sometimes prescribed for anxiety. If I had severe anxiety I would ask for pregabalin. EJ

[deepreason]

Hiya all, new member here, thought I'd chip in a little.

Sorry to contradict EJ but mood stabilisers can help with anxiety, as can anti-depressants. My pdoc once described mood stabilisers to me as a "brain brake": they can slow down the run away style of thinking. I've been on Pregabalin in the past and switched over to Sodium Valproate (mood stabiliser) which I found did the same job as the pregabalain but more powerfully.

A really good website to have a read of, for those of you with concerns as to where you may fit on the spectrum between Bipolar 1 and unipolar depression is http://www.psycheducation.org/depression/02_diagnosis.html#soft
It really is worth educating yourself bout your own health as I know personally I don't always agree with what a doctor tells me.

A couple of you earlier in the thread also talked abot mood swings occuring daily, even hourly, the term you're looking for there is Ultradian cycling. An alternative diagnosis to consider though would also be Atypical depression which can be characterised as very labile or reactive mood.

For those of you currently at the mercy of the NHS, think carefully about whether you really could afford to see a pdoc privately, even if it was just for an intial consultation to get a second opinion on your diagnosis. If you guessed at maybe £200 you'd be in the right area, something I know isn't possible for some people but for others maybe work it out in terms of packs of fags or saturday nights out at the pub, maybe it is doable for something as important as your health.

[harasgenster]

I'd agree that mood stabilisers are good for anxiety. I'm on mood stabilisers because I'm diagnosed bipolar but I disagree with the diagnosis.

They help me sleep and my mind going too fast was my main problem. To some extent they have calmed me down, although I still have some problems with rapid and confusing thoughts.

This is a symptom of anxiety, though. I wouldn't say mood stabilisers have done that much for depression.

Still think mood stabilisers are a bit of last shot with most docs, though. I've been offered them for severe insomnia and mood swings as well as bulimia. They've only ever been offered to me in circumstances where the docs didn't think AntiDs would help, and I often find ADs don't suit me - made me too "high" and erratic or they made me too angry/empty.

As for the guy who wondered if he was bipolar: It's totally normal for your mood to swing around, particularly if you suffer from a mental health disorder. Hypomania or mania is more likely to be diagnosed if you are taking risks, going for very long periods without sleep (but not feeling tired), taking on a lot of work at once but not finishing any of it (possibly living in a very messy environment at the same time - everything else is forgotten), being more promiscuous, being hyperactive to the point of being dizzying for others, speaking extremely quickly, being "life and soul of the party" etc.

Hypomania is a mild version of mania - you might not take as many risks etc. - it will probably not effect your functioning. It is more characterised by extreme optimism (like thinking you're going to be famous, for example, or rather thinking you have all the qualities needed to be famous). It's arrogance followed by self loathing followed by arrogance.

I'm not a doctor so take all that with a pinch of salt. That's just from research I did after my diagnosis. I was diagnosed on the basis of going for days without sleep and not feeling tired, having periods of extreme optimism (arrogance) and extreme pessimism (self loathing), taking on loads of projects at once to the detriment of hygiene/environment, and being hyperactive enough to be dizzying for others (although this was only when on citalopram). I don't personally understand why these can't just be symptoms of anxiety, though. Even during periods of arrogance I still felt unhappy, etc., suggesting it was more like overcompensation. Plus I kept my arrogance to myself. I think bipolar people are so sure of their own abilities they are not embarrassed to tell others.

Cyclothymia is diagnosed by dysthymia/hypomania - so down but not majorly depressed and then up but not truly manic. Bipolar II is major depression/hypomania - you would have to suffer at least one episode of severe depression for this. Bipolar I - major depression/mania - this is the one most people think of as "manic depression".

Wouldn't worry about psychiatric disease, basically. It's really not that common :)

Erm, yeah, I wrote all that then read the link from DeepReason and had most of the things on there. Whatever, I still don't have it! :p At least I know why I was diagnosed that way, though!