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How Long Does Lithium Take To Set In?

Posted on Fri, 27 Feb 2015

Question: started taking lithium 7 days ago with 30mg of avanze which ive been on for over a year, no lift in flatness feeling, how long should this take?

Answered by Dr. Dr.Saatiish Jhuntrraa (3 hours later)

Brief Answer:
Please wait for 2 weeks more

Detailed Answer:
Hello
thanks for choosing HCM
you have been prescribed avanza with lithium . I need to know whether you have unipolar or bipolar depression , any comorbidity and previous trial with lithium. the dose of lithium you are taking May be low , or it may be pre mature to expect benefit . it is likely to start benefit after serum level of more than0.6-9 m mol is taken for 1-3 weeks . please wait
dr Saatiish Jhuntrraa

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr.Saatiish Jhuntrraa (2 hours later)

my depression is unipolar and no comorbidity. the question is:- do you think
Lithium is likely to lift mood as I have found that taking avanza on its own even in a high dose dosent lift my mood. is lithium likely to do that?

Answered by Dr. Dr.Saatiish Jhuntrraa (2 hours later)

Brief Answer:
Yes, it is augmentation for antidepressant

Detailed Answer:
Hello,

Yes, lithium can act as augmentation for treating depression but I would have tried 45 mg before trying lithium, I also would have tried SSRI before thinking on Lithium.

Dr Saatiish Jhuntrraa

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Dr.Saatiish Jhuntrraa (3 hours later)

thank you, but why would you try a ssri 1st and if so what ssri would you add, I had previously taken Effexor 225mg with 45mg avanza which lifted mood but something wasn't quite right, couldn't enjoy anything.
1. what ssri would you add to avanza?
2. why would you do this instead of Lithium?

Answered by Dr. Dr.Saatiish Jhuntrraa (40 minutes later)

Brief Answer:
SSRI have more robust antidepressant action

Detailed Answer:
Hello,

SSRI is the drug of choice for Unipolar depression. Around 33% recover fully after 12 weeks trial of these medicines. We need to augment or change the medicine of different class (effexor is a good choice) and we can try to add this definitely and see what happens, I would prefer escitalopram 20 mg for 8 weeks in addition to avanza 45 mg and its antidepressant effect is more than Lithium.

DR SAATIISH JHUNTRRAA

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Dr.Saatiish Jhuntrraa (12 minutes later)

one of my options was to go off avanza altogether because of weight gain and try the drug called tryptanol - reason being my mother was on it many years ago and found it very successful.
1. what is your opinion of the drug tryptanol and using it today?

Answered by Dr. Dr.Saatiish Jhuntrraa (31 minutes later)

Brief Answer:
Tryptanol is a very good drug

Detailed Answer:
Hello
Weight gain is a major problem with avanza. Tryptanol is a very good and effective drug but dryness of mouth, day time sedation and constipation are the problems. I reserve this only for those who can tolerate it

DR SAATIISH JHUNTRRAA

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Dr.Saatiish Jhuntrraa (10 hours later)

Thank you, what period of time would be needed for washout period to go off Avanza and Lithium and start on tryptanol.

also with the sedation from tryptanol?, is that with lower dose and does it lift with time.

what do you see as the challenge of taking Lithium compared to a ssri?

Answered by Dr. Dr.Saatiish Jhuntrraa (8 hours later)

Brief Answer:
4 WEEKS needed for washout

Detailed Answer:
Hello
Washout period is around 3-4 weeks but depends a lot on your metabolic rate, weight and inherent capacity to metabolize that salt. To manage sedation, start with low dose and make weekly increments of 12.5 to 25 mg . yes, there tends to be tolerance for sedation with passage of time but really, this varies a lot from person to person. lithium and SSRI re not comparable because lithium is a mood stabilizer and SSRI antidepressant. so it is a different class of medicines.
DR SAATIISH JHUNTRRAA

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Dr.Saatiish Jhuntrraa (1 hour later)

1. lithium is a mild antidepressant - is that correct?
2. If I only have depression, not bipolar then should I be taking a mood stabilizer?
3. if I stop taking lithium tonight(only been on it 8 days) how long before I can
start taking an ssri?

Answered by Dr. Dr.Saatiish Jhuntrraa (1 hour later)

Brief Answer:
Wait for 5 days

Detailed Answer:
Hello
1- No, lithium per se is not antidepressant but can augment the effect of antidepressants in some cases
2-no, if you have unipolar depression , do not need to take mood stabilizer but in certain situations when the disease is very resistant, and other strategies do not work, mood stabilizer like depakote or lithium may be tried
3- I suggest to start on SSRI 5 days after stopping Lithium
DR SAATIISH JHUNTRRAA

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Dr.Saatiish Jhuntrraa (43 hours later)

have increased avanza from 30 to 45mg, anxiety seems to have heightened - is that normal?

Answered by Dr. Dr.Saatiish Jhuntrraa (1 hour later)

Brief Answer:
Sedation should increase.

Detailed Answer:
Hello,

Normally, sedation should increase. I think, you need a detailed interview and then decide on line of treatment. I would suggest to see a Psychiatrist for evaluation and treatment.

DR SAATIISH JHUNTRRAA

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Above answer was peer-reviewed by : Dr. Ashwin Bhandari