Starting Lithium & doc hasn't ordered blood test...

I've been doing tons of research and all indications are that starting/taking Lithium needs to be closely monitored...

My doc called in the script before even taking initial blood tests... and has NO PLAN IN PLACE to test my blood levels. He just wants me to go ahead and start taking it. He said I could start by taking one or two per day (150mg).

Does this sound terribly unstructured? Are other docs this "casual" about the way they prescribe Lithium?

It is my understanding that there is a narrow therapeutic range, and there is no point in taking a dose so low that it is below therapeutic levels. I also understand the risks of lithium toxicity, and the importance of staying hydrated, avoiding NSAID's, limiting caffeine, etc. But I learned all this from my own research, my doc hasn't mentioned ANY of this to me!!!

I'm not asking for medical advice, just looking for perspective:
Am I over-reacting and being OCD by wanting a "plan" in place?
Or am I right to expect my pdoc to have some kind of a plan to follow and goal to aim for?

I haven't put one in my mouth yet because I don't feel comfortable with the situation so far!

Is this the only medication for you?

I am slightly below therapeutic level with Lithium. We started with 400 mg, then upped to 800, then 1200, now it's 1000. I was confused because 1000 can't really be therapeutic level (untested as yet) but doctor told me in this case Lithium works as a side med for my Depakine.

I don't know how outdated or not the list in your signature is or isn't but just thought I'd mention that.

The lack of blood tests seems odd indeed. I had a test before lithium, and then every time we raised the dose I'd have a test 5-7 days after. Perhaps call your doctor and mention that you've heard this mentioned many times and you feel very insecure that your blood is not getting tested? If there's an explanation, ask for it. You can even mention that you haven't taken any yet because you're too uncomfortable, maybe the doc treats you more seriously.

Big hugs.

From what I've seen, it depends on the doctor. I'm guessing it also depends a lot on the country.

My doctor isn't as rigid as most seem to be. I read the booklet or whatever you call it that comes with meds. It said you should get tested 1 week after starting lithium and then something like once every 6 months. My p-doc just started me on 400mg and had me do blood tests about a week later. She wanted to see if it was above the therapeutic level (it wasn't, of course!). But like she said, the important thing was how I was doing, not the blood levels. Sadly, they matched! When I upped to 800mg I had another blood test a week later. This time it was above therapeutic level and below toxic.

What I'm trying to say is that lithium needs to be closely monitored mainly because it can be toxic. I don't think 150mg are likely to get to that level. Maybe this is why you doc didn't order blood tests? I'm speculating, of course!

But I agree with Oliveira. If this is bothering you should ask your doctor about it, I'm sure there's a reasonable explanation! I don't think you're overreacting, btw. You're the patient, you have every right to want to know everything.

It's strange that he hasn't ordered a blood test... but 150mg is very low. I am on 900mg and still under therapeutic dose. But i also have 2 and a half kidneys (accoding to the doc i had as a child), so...

I think it very strange and irresponsible that your pdoc hasn't ordered lab work on the lithium levels. Mine were done immediately after maybe 2 weeks or less of taking the medicine. Also to see if the levels were good enough to raise or lower the dosage amount. I am now awaiting results on to the safety levels of the drug. I would definitely talk to him or her about your concerns. You need to be proactive with this if they are not doing their job. But aside from that, Lithium, for some people, is very effective and for me it saved my life. So don't give up on the drug. Talk to your pdoc!

BTW, I take 450 mg and it might be raised depending on the lab work. I should know in about a week.

I am currently on lithium 800mg as one of my mood stabilisers with a blood level of approx 0.6

When starting lithium I had pre bloods and then regular (every few days to start with then spreading out) blood tests. I now am meant to have a level done every 3 months (which i stretch out a bit) which my psych asks me for when i see her. Lithium does have a narrow therapeutic window and I believe it can be relatively easy to go toxic due to this. Imo it would certainly need careful monitoring at the start which could relax once stable on a dose. I dont know why your Dr is not doing this- it might be dose related but still...I would ask them specifically about this as I have not heard of things being so relaxed with starting lithium.

Hope things get sorted

hugs

Cracked

I wouldn't panic yet.

The first thing that needs to be done is to find out if you can tolerate the lithium and that only requires that you take a small dose to make sure it doesn't depress you, give you GI upset, etc.

Nothing bad is going to happen to you if you're below the therapeutic range except that you won't have any helpful symptoms. If you're titrating up, it will be a while before toxicity can become an issue.

When is your next appointment?

Also, has your regular MD run blood tests in the last year? All of my blood work goes to both my regular MD and my psych so they don't double up the labs. If your psych can see any other blood work, he won't need another baseline.

I went right on 1200mg without any bloodwork since I'd just had a physical a month or two earlier and only had even a question of toxicity when I became very dehydrated months later. By then I'd had one blood test and was in the generally accepted therapeutic range.

As far as a plan goes, it's too soon. First you need to see if Lithium works for you. After that, there is the question of IR versus ER, dosage adjustments, time of day, etc. and those can only be worked out over time. The therapeutic range can also vary from person to person, so it's much too soon to choose a maximum dose!

As long as you're seeing your psych within a month or so, my advice would be to chillax and jusr monitor your body. If anything feels off, let him/her know.

Jennifer

Okay, thank you for your responses everybody! I feel a lot better knowing that different docs may handle things a little differently, but there is a general consensus about having blood levels checked, etc.
I saw my GP and expressed mt concerns about my pdoc, so he is also working with me, and he is more of a "by the book" kind of guy. So I've now had my initial blood work done, and my GP recommended that my p-doc write me a standing order for lab work for my lithium levels, up to 2X per week, as needed (initially), at the lab near me. (This is because my pdoc's office is nearly 2 hours drive away, but my local lab can send results to both docs, so I will have a local doc as well as a long-distance pdoc both on my side).
This will be the only medication I will be using, so if I tolerate it well, we will just have to see what level may be effective for me.

"The time has come," the Walrus said... to take my Lithium???

There it is, that little brown bottle of pills, sitting on my dresser... and I think I've run out of excuses to procrastinate popping the first pill. Curses... what to do? Should I just do it? Should I just... start... taking it???
Aaaaagggghhh! This is so scary to me!!!!!!!!!

I'm glad you feel better about the blood work - that is so important. I had blood work done early on for lithium, but I have not had it in a while. Almost a year since my last one. My doc was concerned about it initially as I tend not to drink enough water, but once everything evened out, I was ok.

And, for what it's worth, lithium has been GREAT. Very minimal side effects for me (though I know everyone reacts differently) and it has helped me more than anything else. We're still fiddling with my other meds, but I have noticed the minute I stop taking lithium or reduce the dose, things get way worse.

I hope it works well for you. Keep us posted on the progress.

I have pretty heavy side effects but I assure you lithium isn't scary. The idea of going back to my mania from before lithium -- that is scary. Lithium's just a pill.

Big hugs -- I hope you feel better about it soon and that you're as lucky as Gratteciel with the side effects. Yay on your GP too!