question-icon

Is sustained release or extended release better?

default
Posted on Mon, 30 May 2016
Question: should i start the lithium by 300mg twice a day immediate release sustained relaease or extended release?does it come in sustained release

blood lithium levels should be checked in 4 to 5 days ,
could i phone u when i see a physician that isnt a psychiatrist & after u speak to the physician ,he could write me a prescription,my psychiatrist is out of city ,he isnt coming until april 4 ,if i see a family physician he is more likely to listen to what i suggest if u speak to him since you are a psychiatrist.
doctor
Answered by Dr. Alexander H. Sheppe (4 hours later)
Brief Answer:
Private Consultation

Detailed Answer:
Hello, and thanks very much for using my direct private service.

I typically start with lithium carbonate immediate release 300mg at 9AM and at 9PM. It does come in an extended release formulation, but that formulation does not give accurate levels at first, so I don't use it until we have established a dosage that gives a good level. You should check a blood level in 5 days, drawn 1 hour before the AM dose. The target blood level is any number between 0.8 and 1.2.

We are not allowed to use phone services on this website, but you can certainly print out my recommendations and show them to your primary care doctor. Many primary care doctors are comfortable prescribing lithium, and hopefully my recommendation printed out and given to them will increase this likelihood.

Please ask any followup questions you may have. Then, please remember to rate and close this answer when you are finished and satisfied.

Thank you for using my private direct service. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, you can always ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by : Dr. Naveen Kumar
doctor
default
Follow up: Dr. Alexander H. Sheppe (57 minutes later)
u mentioned something about primary care doctor ,i am in canada alberta so i have seen clinics that say primary care but i am unsure cause u might have assumed i am in the USA,i have a family physician & my psychiatrist is currently out of city & is coming on April 4 th. interms of withdrawing from bupropion ,bupropion is a drug that has least side effect or withdrawal symptoms but relatively isnt as effective as other drugs.am i right?usually the effective drugs tend to have more sideeffect & more withdrawaal symptoms than those that are less effective ,for example bupropion,and abilify have low sideeffects but they arent as effective as other antidepressaants or antipsychotics respectively,am i right?so i realaize that the withdrawal symptoms depend on several factors like a persons physiology ,the amount of time i had been on the drug ,i had 'en on 300mg bupropion for 5 months & 20 days ,before that i was taking 250mg 200mg 150mg 100mg ,of the extended release & sustained release bupropion.so if i taper down to 150mg of bupropion for almost 7 days & try to stop it & see if i have a withdrawal effect ,and stay for an additional 7 days if i have withdrawal effect ,& staart lithium if i have no withdrawal effect how is that . i like to stop bupropion & try lithium as soon as possible.is there a means that u guys or ur colleagues in canada could write a prescription
doctor
Answered by Dr. Alexander H. Sheppe (59 minutes later)
Brief Answer:
Private Followup

Detailed Answer:
Yes, primary care physician is the same thing as family physician, sorry for the confusion.

It is not true that stronger drugs have more side effects and more withdrawal. Very powerful drugs can have few side effects and withdrawal. Buproprion is a powerful drug and has relatively few side effects and little withdrawal. Your plan of tapering to 150mg for 7 days and then stopping is safe. You could then start lithium. Unfortunately we cannot write prescriptions from this site, only give advice. You will have to have your family physician write prescriptions for you. But this is an appropriate plan for you in terms of tapering off Wellbutrin and starting lithium.

Please ask any followup questions you may have. Then, please remember to rate and close this answer when you are finished and satisfied.

Thank you for using my private direct service. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, you can always ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers


Above answer was peer-reviewed by : Dr. Naveen Kumar
doctor
default
Follow up: Dr. Alexander H. Sheppe (3 hours later)
all of ur responses have ur name ,i contacted u a few days ago in addition to today so i know ur name now & that u r a psychiatrist in new-york,so if bupropion is a powerful drug as an antidepressant ,then it isnt as effective for me ,cause what is effective for some persons may be non effective for others.i see.i like to follow ur advice of starting lithium after reducing & stopping bupropion,i hear some times that combining two incompatible antidepressants could cause undesired effects like serotonin syndrom,could u tell me what serotonin syndrom is ,what levels it has ,is it always fatal or it is fatal only when serious,what type of antidepressants cause serotonin syndrome when combined ,say for example if effexor & escitalopram were combined could they cause serotonin syndrom?antidepressants are of several kinds like SSRU=selective serotonin reuptake inhibitors,trycyclic antidepressants,etc,interms of effectiveness and also less side-effects & withdrawal effects what are the most effective drugs?also what dose could i increase the lithium to & after how many days if 300mg twice a day immediate release needs to be increased to a higher strength.
doctor
Answered by Dr. Alexander H. Sheppe (29 minutes later)
Brief Answer:
Private Followup

Detailed Answer:
Serotonin syndrome is typically only caused by mixing a tricyclic antidepressant with another antidepressant, or an MAOi antidepressant with another antidepressant. Mixing an SNRI+SSRI as you say typically will not cause it.

This syndrome causes flushing, rapid heartbeat, fever, and can be fatal, but if treated promptly in an emergency room can be managed well with IV fluids and people will recover.

The antidepressants are all roughly equal in efficacy and differ only by their side effect profile; TCAs and MAOIs have more side effects so are used less often.

If the lithium level is low, the dose is increased depending on how low the level is, up to as high as 1200mg a day.

Dr. Sheppe

tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
default
Follow up: Dr. Alexander H. Sheppe (1 hour later)
could u tell me the catagory of the below antidepressants SSRI SNRI MAO inhibitor TCA,first generation or second generation or atypical and typical antidepressants

effexor or venlafaxin
bupropion
escitalopram or lexapro
citalopram or celexa
abilify
lithium
imipramine
amitryptline
mirtazapine

doctor
Answered by Dr. Alexander H. Sheppe (5 minutes later)
Brief Answer:
Private Followup

Detailed Answer:
It would be my pleasure!

SSRI antidepressant: escitalopram or lexapro, citalopram or celexa
SNRI antidepressant: effexor or venlafaxine
TCA antidepressant: imipramine, amitryptline
Atypical antidepressant: bupropion, mirtazapine

Atypical neuroleptic (augmenting agent for depression): Abilify
Mood stabilizer (augmenting agent for depression): lithium

You have one more question remaining in this thread before it needs to be rated and closed.

Dr. Sheppe

tinyurl.com/DrSheppeAnswers

Above answer was peer-reviewed by : Dr. Prasad
doctor
default
Follow up: Dr. Alexander H. Sheppe (11 minutes later)
does typical & atypical mean 1st generation & second generation antidepressants
respectively with atypical being the latest and typical the drugs from the mid 2oth century

could lexapro & venlafaxine be taken together
doctor
Answered by Dr. Alexander H. Sheppe (4 minutes later)
Brief Answer:
Private Followup

Detailed Answer:
Antidepressants are not separated by generations this way, they are separated by classes. The classes are SSRI, SNRI, TCA, MAOi, and atypicals (the atypicals do not fit into these other specific classes). TCAs and MAOis are older antidepressants. SSRIs, SNRIs, and atypicals are all newer antidepressants.

You may actually be thinking of neuroleptics (antipsychotics), which are separated by age into typical and atypical, with the typicals (like haloperidol) being older and the atypicals (like Abilify) being newer.

I hope this was helpful. Please rate and close this answer thread at this time. Please don't hesitate to open a new question thread at my private link if you have any further or new questions:

tinyurl.com/DrSheppeAnswers

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
Dr.
Dr. Alexander H. Sheppe

Psychiatrist

Practicing since :2014

Answered : 2240 Questions

premium_optimized

The User accepted the expert's answer

Share on
Is sustained release or extended release better?

Brief Answer: Private Consultation Detailed Answer: Hello, and thanks very much for using my direct private service. I typically start with lithium carbonate immediate release 300mg at 9AM and at 9PM. It does come in an extended release formulation, but that formulation does not give accurate levels at first, so I don't use it until we have established a dosage that gives a good level. You should check a blood level in 5 days, drawn 1 hour before the AM dose. The target blood level is any number between 0.8 and 1.2. We are not allowed to use phone services on this website, but you can certainly print out my recommendations and show them to your primary care doctor. Many primary care doctors are comfortable prescribing lithium, and hopefully my recommendation printed out and given to them will increase this likelihood. Please ask any followup questions you may have. Then, please remember to rate and close this answer when you are finished and satisfied. Thank you for using my private direct service. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, you can always ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers