Lithium, maybe it’s one of the last frontiers of scary-medications-no-one-wants-to-take. It’s been used for centuries, yet it has taken a back seat to some a newer, sexier anti convulsants that don’t come with all the blood tests and toxicity risks. Whether it’s because it featured in the title of one of Cobain and Co’s eponymous songs or because it’s a natural substance we happened upon, it’s famed for the myths and powers ascribed to it.
I had a mood disorder for years and years before anyone gave me Lithium. Once we figured out that anti depressants made me jittery and eyebally and anti psychotics made me feel like the living dead, there were other directions to go in. Namely Sodium Valproate, an anti convulsant used to treat epilepsy, and later bipolar. When my psychiatrist prescribed it to me, he muttered about weight gain and then said ‘You may have your hair fall out. It happens. The plus side is, if it does fall out, if it does grow back, it will grow back curly. We don’t really know why it does that…’ Like my gorgeous ginger crowning glory was some kind of civilian casualty.
It wasn’t as bad as all that. Some of my hair shed, just bits and bats, not enough to affect how it looked, but enough to have to clean out the shower plug. I gained some weight, but my slow descent into obesity had be going on since the anti psychotic days. Sodium Valproate did little good for me, but it didn’t little harm either. We got stuck in the no mans land of ‘It’s not working, but it’s not creating a crisis, so we’ll just hang on here for while.’
(Raise your hand if you’re there, and take a slug on some gin. It’s an infuriating place to be.)
Eventually, some spectacularly bad life events (I fell in love, unwisely, moving across the country after quitting my job) ended up with me in a ward. This was 2008. I had two admissions in two months, the second one I was nearly sectioned. I’m one of those people who gets quite mental without realizing it, a hospital admission is usually my cue to scrabble for insight. There is nothing like a keypad and locked door to make a person question why they ended up there.
I saw the consultant. I decided to invoke the power of Lithium. I didn’t know much about it, or anyone really who was on it. Well Richard Dreyfuss is on it. Carrie Fisher was on it. But I don’t *know* them. I just sat there, all sad in yesterdays clothes and I pressed for Lithium. I was granted my wish. Because starting Lithium is a royal pain in the arse, being on a ward was ideal to start.
I had an ECG, which I hate having because the pads never stick to my boobs properly and keep pinging off, so the nurse has to keep putting them back on and I feel like we’re in a Carry On film. Trauma of that aside, I had to have a blood test, a blood pressure test, weight taken, someone admonished me for weighing as much as I did when the ward was serving me two hot puddings a day. The dose was titrated (a fancy word for increased) up gradually over a few days.
It felt like being a boat, just all the time. A sort of nauseating, sealegs type of feeling. I didn’t vomit or anything. I spent a week on leave, bobbing back between the hospital and home, sinking myself in baths, all quivery and overcome. I had my blood tested a few times until we arrived at a dose. The blood tests test the concentration of it in my blood, there is a ‘therapeutic range’ people are kept in, between 0.6-1.2 mmol/L, over that and there is a risk of toxicity.
Lithium toxicity is one reason people are so terrified of Lithium. It’s a naturally occurring chemical, kind of like salt. It was first used in the 2nd Century AD, though no one really got the market on it till the 1940′s, when Dr Cade injected a form of it into guinea pigs and found they became lovely calm rodents, which I think is what he hoped his patients would become. There was a lot of work in the 1960′s to further it’s use among patients with manic depression. It used to be sold as a food seasoning, which is odd when you think about how paranoid people are about it now. We don’t know how it works as a medication, just that it often does, very well. It has the longest studied track record of the medications out there, it’s far more effective and tested than any other one available and it was the first ‘medication’ for mental health issues, which helped move away from ECT.
Lithium toxicity is a build up in a persons system of Lithium, from things like dehydration, changes in salt intake, doubling doses or taking them too close together, using NSAIDS (Ibuprofen) and overuse of diuretics like alcohol and caffiene. The symptoms are:
Tremors/uncontrollable eye movements/vomiting/diarrhea/drowsiness/confusion/coma/slurred speech/ringing in the ears/ muscle weakness etc.
All the above looks pretty terrifying. However this can all be avoided by having regular blood tests to monitor levels, taking doses exactly as prescribed and being careful when taking other medications. Plus once you know there is a risk, you get on top of any mysterious symptom as above, pretty much as soon as you get it. My levels can go a bit wonky but I’ve never had any level close to toxicity since I began in 2008, and I’m known for dicking around with my dose and drinking a bottle of wine every now and then.
It’s hard to describe what Lithium does for me without lapsing into hyperbole, but really, it saved my life. Within days I felt this odd sensation, a sort of balanced, calm flavor that I realized over time was what everyone else called ‘normal’. It didn’t sedate me, it just lopped off the heavenly heights and the hellish lows and gave me somewhere to set up camp in, somewhere in reality. I’d been spent year trying to slough off layers and layers of depression, every time finding a new kind of despair. I didn’t need to do that anymore, it was gone. Underneath it was me, it took some time to get acquainted with the non depressed me, but I liked her. I like who I am on Lithium. It feels weird to admit that something on the Periodic Table I learned at school would hold the key to my sanity but it absolutely does. I don’t get the side effects anymore. The worse I get is a dry mouth, which means more dental work, but other than that it’s plain sailing.
There are plenty of sites on the internet with scary horror stories about how Lithium will eat your brain and ruin your life. I’m sorry my experience of it isn’t a little more rock and roll. Lithium gives me back m life, without it having much of an intrusion in my life. Yes I have to pay for it (grr) but £7.60 pr month is a small price to pay for having a life. I have to take it at the same time, every three months I get punctured for my lovely blood, I now have to brush with a fluoride toothpaste and I can’t go wacky with table salt but it’s probably one of the least maintenance medications I have ever been on.
Here are some angsty songs about Lithium though:
Which suggests that, as pharmaceuticals go, you might be able to pen a ditty about this one. Plus, in a way, Princess Leia took it. So that must up the cool points!