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    Suggest the ideal dosage for Lithium taken for depression

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Posted on Mon, 30 May 2016 in Mental Health
Question: i like to know if i should use the same starting & target dose of lithium carbonate for depression as it is used for bipolar disorder or mania.

my psychiatrist is out of city so i havent seen him or other physician lately
doctor
Answered by Dr. Ashok Kumar 34 minutes later
Brief Answer:
It is slightly lower (300mg for average adult) or equal dose for depression

Detailed Answer:
Hello,
Thanks for using Healthcaremagic.

I read your query and understand your concerns.

The dose of lithium used for bipolar depression is slightly lower than what is used for bipolar mania. For example if your dose for bipolar mania was 1200 mg per day please start with 900 mg per day of lithium. To generalize the dose of lithium is around 300 mg less for bipolar depression or unipolar depression in compare to bipolar mania dose. I must acknowledge that few patients need same dose and over a time the call for increasing dose should be taken when required.

In addition it is also important to go for lithium monitoring when you newly start it or change dose. The ideal time of lithium blood level is 7 days after the last dose change and 12 hour from the last dose. The target lithium level for depression is 0.4 to 0.6 meq/l of blood level.


I hope this helps you.
If you have more questions feel free to write back to me.
Thanks and regards.


Above answer was peer-reviewed by : Dr. Naveen Kumar
doctor
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Follow up: Dr. Ashok Kumar 4 hours later
i mentioned bipolar & mania since i find an information about dose for bipolar & mania but i couldnt find information for dose for depression online .my medical condition is i have depression & schizophrenia,5.75mg of risperidone is taking care of the voices,the mood problem, boredom to take care of my self or absence of motivation to study or to take care of my self is the main problem at this time,i guess bipolar depression is when a person has times of feeling sad followed by times of being extremely excited & pleased,& overactive so they feel like somebody that took street drug,mine is i have symptoms of depression but i dont feel the opposite extreme situation that is i dont feel extremely pleased so i am assuming i dont have bipolar,i have unipolar depression ,u may tell me what u believe based on what i told u about the symptoms that i experience.another physician had told me to start with 300mg of lithium twice a day,but i was unsure if it should be extended release ,immediate release or sustained release.
u mentioned something about the ideal time of lithium blood level being 7 days after last dose change & 12 hours from last dose,i didnt understand that properly,
is that the time that the lithium level in my blood should be checked in a laboratory or the time the lithium ll be released to my blood .
doctor
Answered by Dr. Ashok Kumar 20 minutes later
Brief Answer:
It should be checked in laboratory

Detailed Answer:
Hello,
Thanks for follow up.

Most of the times we start the lithium 300 mg three times a day in case of bipolar disorder and mania and in your case it should be 300 mg less from that. I mean to say that what other doctor advice is perfectly right in recommending the lithium dose.

For twice daily dosing (600 mg per day) it will be appropriate to take immediate release as no sustained release are available in 300 mg strength. Only immediate release are available in 300 mg strength.


Regarding lithium level determination it should be checked after one week of last dose change. Suppose you start 300 mg twice a day dose you need to check lithium level after one week. When checking lithium level blood should be withdrawn 12 hour after the last dose. For example tomorrow you want to assess your lithium level at 8 AM in morning your last dose should be today 8 PM in evening.

It should be checked in the laboratory.

Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for my future patients.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashok Kumar 11 minutes later
how should further increments in dose be made typically,how long should i stay on a starting dose of 300mg twice a day before i increase it?what is the maximum 24 hour dose?by how many milligrams should the dose be increased each time?
doctor
Answered by Dr. Ashok Kumar 23 minutes later
Brief Answer:
Average dose is 900-1800 mg per day for adults

Detailed Answer:
Hello,
Thanks for reverting back to me.

The increment in dose should be made following the blood level assessment of lithuim. Since it takes one week to stabilize dose we can increase the dose at the interval of one week after getting the blood reports.

Our target for depression is 0.4 to 0.6 meq/l of lithium in body.

Every increment should be made with increase of 300 mg lithim per day over the existing dose. For example if you are currently on 600 mg of lithium per day the next dose should be 900 mg per day.

Although the dose range varies from person to person due to various factor most patients need the 900-1800 of lithium per day.

I hope this helps you.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashok Kumar 4 hours later
thanks for the clear explanation & for responding promptly.could u tell me the lowest possible dose that lithium comes in ?if i should change from immediate release to sustained release or extended release or if i should continue with immediate release if an increase in dose is required?
doctor
Answered by Dr. Ashok Kumar 2 hours later
Brief Answer:
300 mg the minimum dose form

Detailed Answer:
Hello,
Thanks for reverting back to me.

The lowest from of lithium is 300 mg and that is the minimum possible dose for lithium.

When there is increase in dose required it is better to change to sustained release as the it is more convenient to take twice daily dose than taking it three time.

For example when it reaches to 900 mg per day 450 mg of sustained release can be taken twice a day rather than 300 mg three times a day.

I hope this clarifies.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Ashok Kumar

Psychiatrist

Practicing since :2000

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