Lithium side effects (Very Worried)

[Bugsy]

Our son has been taking lithium for several months now. It has been the first and only thing that has made a positive difference. We have seen a large decline in his stability during the past 2/3 weeks. At first we attributed it to trialing tenex for focus but after stopping the tenex for a week or so things are still declining. We had his blood drawn on Wednesday and a psychiatrist appointment on Thursday. His lithium level had been fairly steady at 1.0 for the past few months and now was at .8. psychiatrist feels that the instability may be due to the decline of the lithium level and it may be an inconsistent level right now. So he raised his am dosage from 300 mg to 450mg and kept the pm dosage the same for now (300 mg).

For the past month or so our son has often looked nausea but denies it. Well, today he was vomitting, extremely sluggish and complained that his heart hurts. He laid in the fetal postion dosing in and out for hours.

The psychiatrist on called was great and said to try to get many liquids in him, do not give the lithium dosage tonight and not to hesitate to keep calling him and/or go to the er for a lithium check.

I have been so worried for the last 2/3 weeks. He has begun to meltdown/rage again. The teachers see a big change in him since Thanksgiving. His moods are cycling evey day (elated when he wakes, afternoon meltdowns, aggressive, bazzaar behavior and by bedtime somewhat calm).

We have not been able to let him go to anything (talent show, dinners out, Chanukah dinner at school). We keep telling him that he will get his "healthy behavior" back.

Lithium was the only bit of help. Now we find out it has been making him feel sick to his stomach. Upping it a bit and he is vomitting and his heart hurts. My heart hurts too. I am so nervous that we will not get him back without the help of lithium. I feel like I can't go through this again. Years of trying to help him and only a few months of improvement.

 

[smallworld]

I'm so sorry things are heading south.

I've read that when Lithium is initiated and the dose is increased, side effects that typically subside in a few days as the body adjusts are nausea, vomiting, diarrhea, abdominal distress, headache and excessive thirst. Sometimes the side effects can be dealt with by raising the dosage more slowly or changing the schedule of dosing.

However, fatigue, sleepiness, nausea, stomachache and diarrhea can also be a symptom of Lithium toxicity. If he still feels poorly tonight, I'd think I'd err on the side of caution and have him looked at the ER.

Hugs to you and Bugsy tonight.

 

[jannie]

I know very little about the side effects of Lithium....when did you begin the increase in the Lithium? How was he acting on Friday and Saturday? Has he improved today or have things gotten worse this evening?

Is there any chance he is just getting sick? any fever?

Was difficult child on new long acting tenex or just the original one?

I am sorry he is having such a hard time...I know this is hard on the entire family...Maybe some Chanukah presents will cheer him up :wink:

Sending hugs....

 

[smallworld]

How long has he been on Strattera? What dose? How much does he weigh?

 

[Sara PA]

A common side effect of Strattera is nausea. And it's famous for making kids angry, aggressive and just plain nasty. It's an antidepressant and it can cause mood cycling. Those psychiatric side effects usually becomes noticable around three months or so after the child begins taking it, sometimes sooner.

If he isn't drinking because of the Strattera induced nausea, the lithium can become toxic.

Watch the heart. Seroquel like all the antipsychotics can cause problems with the electrical impulses which control the heart. In fact, all the drugs he is taking are on the Long QT Syndrome list of drugs.

I wouldn't focus on just the lithium if I were you.

 

[Bugsy]

It was regular tenex.

His behavior has been so strange. Words cannot even describe.
Thursday was the psychiatrist appointment and we upped the lithium on friday morning. His behavior was off the wall before Friday and continued the same on Saturday. Last night he did some very bazzar things at dinner. He ws jumpy and looked like he was seeing things (but would not explain his weird behavior). Today he woke me at 5:00 because of a bad dream which he does often now. Then he was back up at 6:00 and was very hyper, elated and not in control. Then he just flopped down, said his stomache hurt and that is when the nausea, vomitting, sluggishness etc. started.

During the last month he is drinking huge amounts. Example: breakfast: a water bottle, a capri sun water pouch and an orange juice.
He has been looking nausiated and doing a weird swallowing thing.

We were hoping he may be sick but no fever and no other symptoms.

By 4:00 tonight he perked back up and ate a small snack and drank a capri sun water.

I really think it is the lithium.

He did not even play with his Chanukah present tonight but he did light the candles, which is very important to him.

I took our oldest to the Chanukah dinner on Thursday night and our son was so upset that he could not go, but trust me he could not go. We keep telling him that we are helping him get his healthy behavior back. I was glad our daughter was with her friends because I was in the bathroom crying most of the evening. When I saw his class get up to lead us in a song I broke down and ran out.

He misses so much. Our family misses so much. We are back to living in isolation.

He is not out of control is the sense of needing to be out of the home, which i probably would not do any way. There are no decent places here to do that.

At this point I am just rambling, worried sick, sad for him and for us and crying my eyes out that we have lost our son again.

I do not know how many times we can go through this.

 

[smallworld]

That's where my quesions were leading, Sara. Bugsy's mom, I agree with Sara that you should look at Strattera as a possible source of nausea and mood instability. Furthermore, antidepressants can cause hallucinations (seeing things).

 

[Bugsy]

Thank you for the additonal info.

He has been slowly weening the strattera up for many months (probably 5 or so). He weighs 70lbs and is taking 65mg a day. I do not think it has been helping.

As for seroquel,he takes 650mg through the day. He has been taking it for well over a year. It was the only thing that helped him to sleep and to give a speck of calmer.

I think the psychiatrist is great. He has been the best person since we started this process and we have gone through a bunch of doctors. He was out of Harvard and worked with the top people inthe field.

I think it is time to reevaluate all of his medications.

 

[Steely]

My son has been on Lithium forever, it seems. Not sure if what you are describing is coming from Lithium or not, but blood work and a thyroid test can tell you that immediately.

My son was on Lithium and Seroquel at the same time, like your son, and I can tell you that it took quite a toll on his little body. I think 650mg of Seroquel is a lot! That in combo with Lithium, could be really affecting his physiology.

in my opinion, I would consider consider tapering down on the Seroquel, if you are going up on the Lithium. Both are sedating, and mood altering, and it may be that dose of Seroquel is too much with the increase of Lithium.

 

[smallworld]

Here's a dosing chart for Strattera:

http://www.johnswank.com/strattera_dosing_chart.htm

Your difficult child is considerably above the FDA-approved Strattera dose for his weight. Very good consideration for why he's feeling nausea and why he may be experiencing mood instability. I'd ask the psychiatrist about weaning him off (slowly to minimize withdrawal effects).

 

[Sara PA]

The dose range for adults taking Seroquel is between 75 and 800 mg/day. There is no range for children because it isn't approved for use by children. However, there were a lot of parental reports of children being put on doses around 800 mg/day at Mass General a few years back. IIRC, most parents though the children did better around 400 mg (but I could be wrong).

Just because he's been on the Seroquel for over a year doesn't mean some of these problems aren't caused by the Seroquel. The effects of these drugs is cumulative; like with TD, sometimes side effects don't appear until after the person has been taking it for a while.

Your son is only six. He's taking an awful lot of drugs for a child that young. Lithium is approved only for kids over 12 and even the Strattera isn't approved for children under six.

 

[Steely]

Exactly Sara, that is what happened with us. My son was 15 and on 400mg of Seroquel for 2 years, and suddenly the cumulative side effects were too much. He did so much better once we lowered the dose of Seroquel and eventually eliminated it.

Bugsy, your son is on the really, really high dosages of both Seroquel and Strattera, I would call psychiatrist and tell him you are not comfortable with this. Who knows what is going on, but I think at least those 2 medications need to be lowered. As far as Lithium, I guess I would not increase anything, until those 2 are lowered. Lithium has been a lifesaver for my son, and it is an amazing mood stabilizer.........so I would not rule that out completely, for now, if you are seeing results..........I would just step back and evaluate all the medications objectively.......

 

[Bugsy]

Thanks for the help and support. I know that his medications are all at high dosages. I bring it up to the dr. all the time. The pharmacist always questions it too.

I have a call into the psychiatrist. I will strongly express my concerns regarding the amount of medications. I have no idea what to do about his morning medications. He is a bit nausea but says he won't vomit. Every so often he says his heart is beating hard but then it stops doing that.

Thanks again,

 

[Sara PA]

Heart palpitations. Drug related. Especially the Seroquel but the others can be contributing.

 

[slsh]

Bugsy - I think the best way to get a handle on this is blood work. Not only a lithium level but I would ask for a thyroid panel as well. thank you was on lithium for about 2 years and in the end it fried his thyroid. He didn't have any symptoms but did end up with a goiter - made him look like he had swallowed a bean bag that got stuck at the base of his neck. Skewed thyroid hormone levels can cause also cause palpitations and GI symptoms.

I would insist that a physician take at look at him personally and get that lab work drawn. Poor kiddo... it's just so hard sometimes.

 

[klmno]

Bugsy, it sounds like you have great responses and are doing the right thing. For my 2 cents- my difficult child has stomach upset every time lithium dosages increase. At one point, they lasted 3 weeks and psychiatrist changed him to time-release version (lithobid) and lowered dosage. psychiatrist said he didn't think lithium would really be causing stomach upset though (really??). Also, psychiatrist told me lithium can't make "cycling" or "hyper" periods worse or more frequent, but I'm not convinced of this either. It has taken the edge off of my difficult child's raging, but other than that, cycling has not improved, nor has hyperness, and I'm not so sure it hasn't made it worse. I know it's the answer for a lot of people and our psychiatrist is convinced it's the right answer for difficult child, but I'm pretty leary about it. When depakote was first added, difficult child said his "chest was hurting a lot and he couldn't breathe normal". I thought it was the dosage of depakote, but now I'm wondering if the lithium didn't play into that, too.

Let us know what your psychiatrist says- I'm going to keep a watch!!

 

[Bugsy]

I spoke with the psychiatrist. I like him so much, thank G-D.

He is very honest and very responsive. He can't be sure if it is a virus, the upping of lithium, the combo of medications or what but he feels that since my son has been showing signs of nausea for a month or 2 his gut feeling is it is the strattera. We are lowing it from 65 to 43 and then possible lower or gone.

He said that it would not be surprising if the strattera was causing instability and nausea.

So for now, we will keep the lithium at 600mg/day and lower the strattera. We'll see how that goes. Meanwhile bugsy is still having stomach upset today but has not thrown up. He has run to the bathroom a few times,but no vomit. He has NO medications in him yet today. We are hoping to get some food in him and give him his night dosage of lithium and seroquel. He is in a good mood and doing fairly well. Nothing really bazaar.

Thanks for the help, support and for a place to go when there was no place or body that could truly understand.

Bugsy's mom

 

[Janna]

My son, Dylan, was on Lithium for 16 MONTHS with excellent stability (in conjunction with an AP - Abilify). His levels always went up and down, from .7 - 1.1, on the same dose. It just stopped working. I have no reason why. He was up to 1050 mg a day at 11 years old. Just didn't do anything anymore.

Be careful, Lithium can cause hypothyroidism. Are you aware?

Don't think THAT would cause the tummy upset, but just something you should watch for.

I'm pretty sure if he was toxic he'd have the shakes pretty bad as well.

My kiddo is off. Sorry to say, I'm glad. He gained 40 pounds, soaked the bed every night, and had the hypothyroidism (which put him on ANOTHER drug - Synthroid). Don't miss it.

Hope things get better for your kiddo. I'd keep up with the blood draws, until he's stable again, just to be safe.

 

[gcvmom]

FWIW, antidepressants can cause the heart rate to increase by as much as 20bpm, and they can also make your heart feel like it's pounding. That's happened to me, so to counteract the effect, my psychiatrist rx'd Inderal (propranolol), it's a non-selective beta blocker mostly used to lower blood pressure, but it's helped my symptoms a lot.