Any triathletes out there have experience training and racing while on lithium. I have been recently diagnosed with bipolar and it was recommended to start lithium. Recognizing that everyone reacts differently to these medications and the need to work this out with my doctor I am looking for anyone with real world experience with lithium (dehydration issues?) or other drugs treating bipolar. I am a middle of the of the pack, mid 30s male with four years in endurance sports. Every year i compete in a few sprints and olys and the occasional half iron. Thanks for any feedback.
Years ago I was on Lithium…first, use it as a tool to identify factors so you can avoid or be aware of situations. Some docs want you on forever…Mine did not think so and I am glad. It is very hard on the thyroid, so the means reg blood tests. Dehydration will probably be the biggest issue, must keep your hydration at the right levels. Get dehydrated can cause serious issues especially with kidneys…can dehydrate faster also.
You can race just have that hydration dialed in ALL the time. No pushing through a work out knowing your low, period. If you are on a long bike or run and start getting dehydrated…STOP, don’t push through.
Oh i read about other drugs question too. I am 53 and was diagnosed back in 83. That time they also put me on Pamalor (sp?) a heart blocker…had to stop that could not run. One drug was to cut off the highs the other the lows. They then tried klonapin, xanax and others. Took a long time getting me dialed in. Was taking 900mg of lithium twice daily in 450 pills. Last on it in the 90’s. After a time was on Zoloft. That has other drawbacks but had none doing ironmans, 200 mile bikes ect… In fact kept me about 7lbs lighter. Now not on anything again, though there are times I seriously look at temp taking meds for a time. At 53, just effects from age and maturity make it easier to be med free. Sport is NECESSARY for me, it is literally my med for stress. I have to work out especially with what I do (live with men in a home of guys getting out of prison, drugs ect…) Feel free to PM me if you want
Thanks for the input. Trying to sort this all out.
I don’t typically post as a rule, but felt this was important. My first recommendation is to check with your pdoc. He/She should always be your first point of reference. If they aren’t familiar with aerobic exercise and its effects on whatever meds you are on, then ask for a referral.
I can’t use lithium. It messes me up physically and mentally. Unfortunately, that means that I have a med cocktail that is too long to list. Fortunately my doc is a dedicated runner, and he recognizes the effects of the various meds I use (which includes strenuous exercise) on my symptoms. I also get regular blood work and make sure that everything is working the way it should.
Pay attention to yourself, talk to your doc, and best wishes.
Brian
everyone is different but I was a mess on lithium, gained thirty pounds and shook all the time, and has to be monitored all the time
This was quite a few yrs ago. I did not think it was still the first drug of choice for bipolar anymore.
On lamictal now and zero side edfects, and is working.
Good luck to you! Also training for me works like a medication and am thankful to have drs that see this.
Id see if dr would try another drug before lithium.
everyone is different but I was a mess on lithium, gained thirty pounds and shook all the time, and has to be monitored all the time
My friend had the same reaction.
everyone is different but I was a mess on lithium, gained thirty pounds and shook all the time, and has to be monitored all the time
This was quite a few yrs ago. I did not think it was still the first drug of choice for bipolar anymore.
On lamictal now and zero side edfects, and is working.
Good luck to you! Also training for me works like a medication and am thankful to have drs that see this.
Id see if dr would try another drug before lithium.
My wife is also an endurance athlete and takes Lamictal/Lamotrigine for bipolar. She struggled will the other stuff and this one was a miracle for her. For what it’s worth, I suffer from depression and have been on Lamictal for years. No side effects. Other drugs made training and racing nearly impossible at times.
Thank you everyone for the input. This pdoc is pretty thoughtful and has taken his time to diagnose and prescribe a treatment plan. I will work with him to figure this out. From what he has said, about a third of people can’t tolerate lithium but it is the best mood stabilizer in his opinion. Side effects are so individual it is impossible predict. I am going to discuss alternatives with him. I will give any updates in the future.
everyone is different but I was a mess on lithium, gained thirty pounds and shook all the time, and has to be monitored all the time
This was quite a few yrs ago. I did not think it was still the first drug of choice for bipolar anymore.
On lamictal now and zero side edfects, and is working.
Good luck to you! Also training for me works like a medication and am thankful to have drs that see this.
Id see if dr would try another drug before lithium.
My wife is also an endurance athlete and takes Lamictal/Lamotrigine for bipolar. She struggled will the other stuff and this one was a miracle for her. For what it’s worth, I suffer from depression and have been on Lamictal for years. No side effects. Other drugs made training and racing nearly impossible at times.
My wife has had Bipolar II for many, many years. Lithium is very old school. Lamictal/Lamotrigine for a mood stablizer would likely be a better choice. Note: I’m not a doctor but have spent enormous time with my wife trying to get meds right. Everyone reacts differently. If you need an antidepressent in conjunction with a mood stablizer, brupropion (Wellbutrin) is an excellent starting point. It seems to be the exception in the category of drugs for side effects. Most will cause weight gain, libido loss, naseau etc.
As always, YMMV. Best of luck on working this out. It’s a life changer.
I wanted to give an update to those that were kind enough to respond and those who may be researching in the future. I wish I had better news but after investing a few months to gradually introduce lithium into my system it just didn’t work out. When I got to the therapeutic level I quickly got sick with side effects including nausea, gi distress, constant metallic taste in mouth. It really did a number on me and was not mild. My pdoc decided to pull the plug and go in a different direction. The lithium did not effect my training or hydration and I think was starting to work so I am kind of bummed. Don’t be afraid to try it if it is recommended. Not sure what to do next, it’s complicated. Thanks again.
Another update…After stopping the lithium I was started on zoloft and have been on it for a few months now. So far it has improved my mood and irritability … small improvements for anxiety or obsessive thoughts. Being bipolar does not effect me day to day like the OCD/anxiety but how they are intertwined and related is difficult if not impossible for me to understand. I was not depressed so no report of how zoloft works for that.
Since I am only on zoloft it was explained to me there is a small risk (in my doctors opinion) that zoloft could trigger mania down the road and if so we will treat it. As far as effect on training my head cold has caused way more problems than any of these drugs so far.
I will be posting some updates from time to time in the hopes this will help someone down the line in a similar situation. The most important thing I have learned so far is that medication is not that big of a deal. I used to be against it but really you have to be patient and weigh the side effects against the relief of symptoms. Also want to note that I am a pretty regular person with a job family etc…there is a stigma for mental illnesses that I still struggle with and causes embarrassment. Very few people (2) know what is going on with me and doubt that anyone would suspect anything is wrong.
Thanks for reading.
Thanks for the updates, glad to know you have found something that is providing some health.
The more people talk openly about their own mood disorders/mental illnesses/anxiety/depression like you are doing, the quicker the stigma subsides.
There are lots of thoughtful people here on ST and it seems like you got some good responses.
Thanks much for sharing - and for pointing out the stigma associated with mental illness - too many people suffer in isolation.
Best wishes.
Sorry to hear Lithium didn’t work out.
I think I PM’d you about my experiences training on it.
If your cocktail is getting more complicated, and you have any questions about the following drugs that aren’t lithium, feel free to PM me. One thing to think of is that even though they’re anti-psychotics, a lot of the atypicals do double duty as mood stabilizers as well and people with no psychotic features do take them (I have psychotic features and may in fact be schizoaffective bipolar subtype - though I’m very high functioning).
Anyways, any questions on training, or just in general, these meds, let me know:
-lamotrigine (lamictal)
-ativan
-cogentin (for akathisia from meds)
-pregabalin
-seroquel (IR and XR)
-provigil
-ziprasidone
-abilify
-saphris
-invega
-celexa
Can give you some feedback as a psychiatrist who works with athletes.
Lithium is an excellent mood stabilizer, but has drawbacks for endurance athletes.
Can cause weight gain and hypothyroidism.
Can cause polyuria which can lead to dehydration.
If someone becomes dehydrated and or hyponatremic (like in IM) the kidneys will try to reabsorb ions (sodium) and water. The kidneys recognize Li molecules to be similar to sodium and will reabsorb excessive lithium which can lead to toxicity. Lithium toxicity can be life threatening.
For this reason I would not recommend lithium for someone who is doing IM (or even 1/2IM) because dehydration is common. Significant dehydration is not rare. At the least, if you need to be on lithium, and want to participate in extreme endurance events, would recommend consulting with a nephrologist.
Although newer antipsychotic drugs are helpful (and some are FDA approved) for bipolar disorder, some patients do not respond well to them. They can also cause weight gain/lipid/blood sugar abnormalities.
Lamictal is an effective well tolerated mood stabilizing medication. There is rare risk of serious rash; it needs to be titrated up gradually - can take a month to get to therapeutic doses.
Finally, would be cautious about taking any antidepressant medicine if you have underlying bipolar disorder. These can can have mood-destabilizing effects in bipolar patients.
Good luck
I too am an Endurance athlete that struggles with Bi-polar disorder.
I spent 8 long years trying to figure out what the hell was wrong with me. I was told I had OCD, anxiety, depression, etc.
I finally got a doctor that realized what was going on. During my manic phases I would stay up for days and train like an idiot. I loved the high, and being extremely physically fit thanks to the extra energy my manic episodes offered. The problem was the depression after the fact was crippling.
The last 2 years I have been on Lamictal and Serequol XR. My mood has greatly stabilized and Im able to hold a normal job and pay my bills (something never possible before.) I do feel as though my training/racing has been somewhat affected. I do not have that “ass muscle” anymore. When the times get tough I use to be able to mentally muscle through anything. Now it feels easier to roll over and play dead. Which forced me to change my training and racing strategy (probably for the better.)
If anyone has any questions about my experience, please feel free to PM me.
I am seeing a definite increase in the use of Latuda recently for BPD. Dunno if the pharms are pushing it or it is just a good alternative.
Just wanted to update while things are good. Zoloft was working ok but sleep was terrible. Stayed with it and doctor added on nightly small dose of clonzopam. My doc thought I had a sleep disorder combined with the zoloft insomnia.
That addition made things click. For the first time in my life I feel like I am getting real sleep. My anxiety and OCD are way way down and my mood way more stable. Before last year I avoided psych meds at all costs….now that I am open to try meds I can look back at where I was with more clarity. My sense of normal was way off. Normal for me was feeling shitty all the time. Normal was also thinking that my emotional issues were normal…which I now see were extreme. (If any of this makes sense.)
As far as triathlon, I am not training very much. There are a few reasons for this. My obsessiveness is down and part of that included exercise. I also used exercise to help me feel better which I need less of. Also had a huge work change. So I am trying to work triathlon more into my life now….maybe fewer races but a happier self (I hope).
If anyone reading this is struggling emotionally you are not alone. Find a good doctor if you can. I have been to some dark places so I know how it is. But there is help out there…even the smallest motivation to find it mind bring you relief in the long run. Good luck.
Glad that things are working out for you.
Given the response you have had to an SSRI and good sleep, I have to wonder if you have been appropriately diagnosed.
I think that it is important for all people who get diagnosed with a mental health issue to inform themselves about what they have been diagnosed with. There are “fads” in psychiatry regarding diagnosis. Someone from some famous institution publishes papers based on research that they are invested in (often funded by drug companies) and then promote their research ad nauseum. It diffuses into the psych literature and then a trend of treatment follows that later turns out to be loosely based on the research. This is what has happened with “Bipolar Disorder” over the last decade. This is especially apparent in Child Psychiatry but has filtered into the Adult population as well.
These days every child or adult who has problems with anger regulation is being “diagnosed” with and being treated for Bipolar disorder. The medicines used to treat Bipolar are some of the most powerful ones we use and have the most dangerous and often permanent side effects. In my practice alone 20-30% of kids have at one time been diagnosed with Bipolar. But they are not. Parents themselves report that they have been diagnosed with Bipolar but when a manic episode is defined for them they report things like “Oh, that’s never happened to me. I just get angry a lot”. Not Bipolar.
If you have never had a period in your life during which you have had no sleep (zero!) or significantly reduced sleep (1-2hrs/night) for 5-7 consecutive days AND you were acting really, really crazy and “out there”, you are not Bipolar! Same sleep pattern but less crazy for Bipolar II.
If anyone is diagnosed as having Bipolar Disorder. Do your research. Reputable sites only (APA, AACAP, etc.) And think about getting a second opinion.
I don’t know your specific circumstances/symptoms but you might think about getting another opinion.
Consider most of this post to be a general PSA for those that might read this thread.
Keep on keeping on!