Beyond the Session: In-Depth Answers to Your Mental Health Questions
Unanswered Questions From YT LIVE on 05.18.24
Moonradiate asks: “How do you manage lithium in a person with POTS?”
A: Postural orthostatic tachycardia syndrome (POTS) is a disorder of the autonomic nervous system that causes an abnormally large increase in heart rate when sitting up or standing. POTS can cause dizziness, lightheadedness, and a rapid heartbeat, which are relieved by lying down again. If the person with POTS is standing up while these symptoms are occurring and not able to lie down, they may even pass out as the body wants to maintain homeostasis (balance) and not go into autonomic instability with too high of a heart rate and lowering of blood pressure which can lead to shock.
Managing lithium in a person with POTS involves similar aspects as those without POTS with a few specific considerations due to the unique challenges posed by POTS symptoms, primarily related to blood pressure and heart rate regulation. Here are the key points to consider:
Monitoring Vital Signs: Regularly monitor blood pressure and heart rate to ensure they remain within the normal therapeutic range. POTS can cause fluctuations in these vital signs, so it's crucial to observe any changes that lithium might cause.
Side Effects Management: Be vigilant about the potential side effects of lithium, as individuals with POTS may be more sensitive to these effects. Common side effects like dizziness, nausea, and tremors can exacerbate POTS symptoms.
Hydration and Diet: Maintain a balanced diet and stay well-hydrated. Dehydration can increase the risk of lithium toxicity and worsen POTS symptoms. Additionally, do not make sudden changes to your salt intake. A sudden decrease in sodium intake may result in higher serum lithium levels, while a sudden increase in sodium might prompt your lithium levels to fall rendering the medication ineffective.
Lithium Toxicity: Be aware that symptoms of lithium toxicity, such as nausea, vomiting, dizziness, and tremors, can be particularly severe in individuals with POTS. Promptly address any signs of toxicity to prevent complications.
Individualized Care: While the general approach to managing lithium is similar to that in individuals without POTS, it requires extra vigilance regarding how lithium impacts POTS symptoms. Tailor the treatment plan to the patient's specific needs and response to the medication.
In summary, managing lithium in a patient with POTS involves careful monitoring of blood pressure and heart rate, managing side effects, ensuring proper hydration and diet, and being particularly attentive to signs of lithium toxicity. Adjustments may be needed based on the patient's unique response to treatment.
True Human asks: “After trying most modern anti-depressants I found only Elavil works great for anxiety but with severe side effects. What's the alternative?”
A: Elavil, a tricyclic antidepressant, is effective for treating anxiety and depression but often comes with significant side effects such as sedation, dry mouth, constipation, weight gain, and irregular heart rate. Due to these side effects, SSRIs (Selective Serotonin Reuptake Inhibitors) are typically favored as first-line treatments for anxiety and depression because they generally have a lower incidence of such adverse effects.
However, instead of solely relying on medication to manage symptoms, it's crucial to explore and address potential underlying causes of anxiety and depression. This approach involves getting comprehensive lab work to identify any biological issues contributing to mental health symptoms. Starting with basic labs, such as those offered here [Levelheaded Mind Mental Health Lab Packages](https://www.levelheadedmind.com/mental-health-lab-packages), can reveal deficiencies or imbalances that need to be addressed.
Once these underlying issues are identified and treated—such as by correcting nutrient deficiencies—many patients find they can taper off antidepressants and manage their symptoms more effectively without medication.
In addition to addressing biological factors, it's important to engage in therapy, which is a first-line treatment for anxiety and depression. Techniques like mindfulness, vagus nerve activation to enhance vagal tone, and somatic therapies (such as yoga for trauma and anxiety) can be very beneficial. Working with a somatic therapist to develop an individualized plan can also be highly effective.
In summary, while Elavil can be effective, its side effects may make it intolerable. Alternatives include investigating and treating underlying biological causes and incorporating therapeutic practices to manage anxiety and depression holistically.
Q: Viperz Rada asks: “I take 6 mg of Ativan every day. Is that a high dose and how long would it take to detox from it?”
A: Benzodiazepines, such as Ativan (lorazepam), carry a significant risk of benzodiazepine-induced neurological dysfunction (BIND), which affects at least 20% of users. You can learn more about BIND in this detailed video here. Taking 6 mg of Ativan daily is indeed a high dose, and tapering off this medication requires careful planning and consideration of several factors, including the duration of use, previous withdrawal experiences, and individual response to dose reduction.
The Maudsley Deprescribing Guidelines provide three tapering schedules: fast, moderate, and slow. Depending on your specific situation and the tapering schedule followed it can take anywhere from 20 to 80 weeks to safely reduce and eliminate your Ativan use. For more on tapering strategies, watch my video on deprescribing tips here.
Before starting the tapering process, it's crucial to address any underlying issues that might be contributing to your anxiety, such as nutrient deficiencies or medical conditions like hyperthyroidism or early stages of Hashimoto’s thyroiditis. Comprehensive lab work can help identify these issues. For recommended lab tests, visit Levelheaded Mind Mental Health Lab Packages.
Another related question from Karen Constantine: “Are there any exceptions to this (BIND risk)? I've been prescribed 4-6 mg of Xanax daily for over 25 years.”
A: While the risk of BIND is significant (20%), it is not 100%. Long-term use, especially at high doses like 6 mg of Xanax, increases the likelihood of neuroadaptation, requiring higher doses over time. This can eventually lead to the medication becoming less effective and potentially causing paradoxical effects. Tapering might become necessary, and the risk of BIND will still be present. It's essential to weigh the risks versus the benefits of continuing such medications, as with any treatment.
Bottom Line:
Benzodiazepines, including Ativan and Xanax, are effective for managing anxiety and other conditions but come with significant risks. Long-term use can lead to benzodiazepine-induced neurological dysfunction (BIND), affecting at least 20% of users. High doses and prolonged use increase the likelihood of dependency and withdrawal challenges. Tapering off benzodiazepines should be done carefully and under medical supervision, considering individual factors and potential underlying causes of anxiety. Comprehensive lab work and addressing root health issues can support a safer tapering process and improve overall outcomes.
