I’m happy to have my fellow mental health advocate and friend Sasha Kildare posting today. Before reading her post I didn’t know too much about Lithium as I have never taken it. Her piece is both insightful and informative.

My relationship with lithium

I call lithium my insurance. I used to call it my enemy.

My childhood was culturally rich and abundant with educational opportunities. It was also marked by domestic violence from the time I was a toddler. I blocked it all out by telling myself that when I moved out, the torture would end. However, when I finally did go away to college, the violence kept playing like a movie in my head, and nightmares of it ruined my sleep, which led to depression and then a psychiatrist.

At 18, the dose of lithium I was prescribed made me so lightheaded that all I wanted to do was lie down. I felt like a zombie. I hated it. I hated myself. I now know that I have low blood pressure, and lithium lowers my blood pressure even further.

My first psychiatrist gave me zero insight into how to manage bipolar disorder other than “take medication” and “take more medication.” This was before the Internet.

Benzos

During my young adult years, I was prescribed many different medications. At 19, I was prescribed a benzodiazepine, benzo, (Valium, Ativan, Xanax are the most popular ones) for anxiety. Minor tranquilizer. Highly addictive. It took away my anxiety, and it eventually took away my soul.

My observation has been that many with bipolar also have addictive tendencies. Perhaps the mental anguish caused by the mood swings makes substances that numb the pain seem attractive. Ironically, the denial that enables addicts to remain addicts also enables a segment of the healthcare industry to create addicts.

The compulsivity that fuels addiction can express itself in many ways, and addicts often trade addictions that can include behaviors, such as unhealthy relationships and gambling, as well as substances, such as sugar, alcohol, and drugs.

Outside of a hospital setting to help deal with someone in the throes of psychosis or to treat shock symptoms of the survivor of a traumatic accident, I do not understand why benzos are so readily prescribed when so many with bipolar have addictive tendencies. Cognitive behavioral therapy can help make possible the lifestyle accommodations and healthy habits that can help one cope with the anxiety that often accompanies bipolar.

Therapy

I was hospitalized in three different states. At 18, I emerged from my first hospitalization a shadow of my former self.

Eight hospitalizations later, during my last hospitalization at 26, I ended up receiving treatment and vocational rehabilitation that changed my life. I began the process of learning how to take care of myself.  By going on disability for a year and a half, I had medical insurance that enabled me to receive therapy for the first time. The therapeutic process began to unlock my subconscious. I had been completely unaware that the vicious degrading comments that I had grown up hearing played low-volume in my psyche.

To this day, I still occasionally experience flashbacks of the violence, but I don’t relive them, and they no longer upset me.

In general, I do not get along with medication, or street drugs, or sugar, for that matter. After my last hospitalization I was able to accept that bipolar was not going away. I committed to taking one medication, an anti-convulsant that functioned as a mood stabilizer, and I let go of the benzos. Youth, the lack of symptoms the great majority of the time, the subconscious pain, and not having insight into what triggered episodes had set me up for recurring episodes.

My manic episodes were doozies — my judgment would take a sabbatical. City streets at midnight became my playground, and I am lucky to be alive.

Exercise as part of the equation

After my last hospitalization, I started researching bipolar disorder and learned that 30 minutes of exercise a day is the most effective treatment for mild to moderate depression. I committed to exercising regularly.

Lithium and pregnancy

At 33, I wanted to have a baby. Research revealed that lithium was a safer choice during pregnancy. Even though I hated lithium so much, I decided to give it a second chance, albeit at a lower dose. After two miscarriages, my obstetrician and I came up with a plan. I would check for pregnancy as early as possible and ease off the lithium within a few days if I learned I was pregnant. My psychiatrist was less than thrilled, but I suspected that the pregnancy hormones would keep me safe, and they did by making me tired and granting me sound sleep. (The miscarriages were due to low progesterone, not the lithium, but my biological clock was ticking.)

Recent research on treating bipolar disorder with Lithium

The San Diego Tribune recently published an engaging article detailing the history of lithium treatment, new research that finally explains its molecular mechanism, why it works for bipolar disorder, and a variety of quotes from experts, including the following one:

“Lithium is our gold standard treatment for bipolar disorder,” said Gerald A. Maguire, M.D., chair of the Department of Psychiatry and Neuroscience at the University of California, Riverside.” (Bradley J. Fikes, Lithium’s mechanism in treating bipolar disorder discovered, San Diego Tribune, May 9, 2017)

Medical journal articles don’t make for cozy reading, but they do report critical scientific research. I listed two of them regarding lithium’s efficacy in treating bipolar disorder:

·      Response to Lithium in Bipolar Disorder: Clinical and Genetic Findings, Janusz K. Rybakowski, ACS Chemical Neuroscience, March 13, 2014.

·      Lithium for bipolar disorder: A re-emerging treatment for mood instability, Melvin G. McGinnis, MD, Frcpsych, Current Psychiatry, June 13, 2014 (6): 38-44.

I consider myself very lucky

Without the treatment that I received during my last hospitalization, I would not have been able to lead a healthy, productive life.

Lithium became a critical part of my stay-well plan. But that is only because I had a doctor who stayed current with research and was willing to prescribe me a lower dose than the therapeutic dose that once was recommended. The lower dose works and has minimal side effects.

If I hadn’t learned to complement my lithium with exercise, I probably would never have become a “lithium excellent responder.” I cannot manage depression without exercising 30 to 45 minutes five times a week. Perhaps the main effect that lithium and regular exercise together provide is the ability to get to sleep quickly and to sleep soundly. For me, insomnia fueled depression and eventually mania. If I don’t get proper sleep, no medication in the universe can keep me healthy month after month and year after year.

From a consumer perspective, there is an additional benefit to lithium — it does not cost much.

Sometime stand-up comic Sasha Kildare’s first novel is Dream Walking… Coming back from coming undone. You can find her blog at Dreamwalkingthenovel.com and at @sashakildare.