li+/ travel

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I know the thread got closed and for good reason. However I wanted to add on a general level that I advise my bipolar pts to not do any significant travel until they are well controlled mainly because it is well known that circadian rhythm changes can bring on switching. I do not think altitude has much to do with as we would all die at 30k feet w/o a pressurized cabin?? How do you manage this Sazi?
 
Wht about North-South travel?
 
psisci said:
I know the thread got closed and for good reason. However I wanted to add on a general level that I advise my bipolar pts to not do any significant travel until they are well controlled mainly because it is well known that circadian rhythm changes can bring on switching. I do not think altitude has much to do with as we would all die at 30k feet w/o a pressurized cabin?? How do you manage this Sazi?
Click to expand...


I'm so confused, psici are you a psychiatrist or ologist? Or do you have script privelages? 😕

I don't know anything about Li and travel -sorry.
 
Heh....hmm - let's think.

well, we know that altitude effects the pharmacokinetics of drugs and how fast your ramen noodles will cook. We also know that people that live at high altitudes for long periods of time will have an increase in their plasma erythrocytes - basically hematocrit. This is why athletes that train in high altitude will have a short-lived advantage in competition at lower altitudes (I think 😕 ). We also know that clearance of some drugs decreases at high altitude.

We also know that lithium is not protein bound in plasma, but bound in erythrocytes. One would have good reason to think that high altitude exposure would increase plasma levels of lithium, while decreasing clearance.

Then again, the plane scenario is something we don't consider much; my favorite discharge plan is to stabilize and send on a plane. I haven't had (except in one case) the person return immediately thereafter in a decompensated state. :meanie:

That one guy flew to Vegas then came right back - but he's severely personality disordered, and his father couldn't stand him, so sent him back to NYC.........one-way.
 
I believe athletes train at high altitudes and then do better because they have increased the bloods ability to transport oxygen via hemoglobin. Do you know if being at high altitude, but in a pressurized cabin equals or has some relation to actually being out in the atmosphere at high altitudes. Another thing too, often long plane flights result in dehydration which could be risky for li+ toxicity?? Ironically some saline would increase clearance at that point.
 
Anasazi23 said:
Heh....hmm - let's think.

well, we know that altitude effects the pharmacokinetics of drugs and how fast your ramen noodles will cook. We also know that people that live at high altitudes for long periods of time will have an increase in their plasma erythrocytes - basically hematocrit. This is why athletes that train in high altitude will have a short-lived advantage in competition at lower altitudes (I think 😕 ). We also know that clearance of some drugs decreases at high altitude.

We also know that lithium is not protein bound in plasma, but bound in erythrocytes. One would have good reason to think that high altitude exposure would increase plasma levels of lithium, while decreasing clearance.

Then again, the plane scenario is something we don't consider much; my favorite discharge plan is to stabilize and send on a plane. I haven't had (except in one case) the person return immediately thereafter in a decompensated state. :meanie:

That one guy flew to Vegas then came right back - but he's severely personality disordered, and his father couldn't stand him, so sent him back to NYC.........one-way.
Click to expand...

We know all this, but still do not fully understand how lithium works in treating bipolar disorder!
 
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psisci said:
I believe athletes train at high altitudes and then do better because they have increased the bloods ability to transport oxygen via hemoglobin.
Click to expand...


I'm pretty sure this is the reason. The body compensates for the lack of oxygen by inceasing its hemoglobin levels. When athletes come back down to regular altitudes they have enriched blood. This is why Lance Armstrong gets blood transfusions on this rides. Increased hemoglobin. If you have ever gone to high altitudes (4,000+ meters) and gotten altitude sickness you would realize how hard it is to brethe up there. If you can get used to that you can be an animal down at sea level.
 
psisci said:
I believe athletes train at high altitudes and then do better because they have increased the bloods ability to transport oxygen via hemoglobin. Do you know if being at high altitude, but in a pressurized cabin equals or has some relation to actually being out in the atmosphere at high altitudes. Another thing too, often long plane flights result in dehydration which could be risky for li+ toxicity?? Ironically some saline would increase clearance at that point.
Click to expand...

http://www.hastc.nau.edu/altitude-services-bloodprofiling.asp

Pressurized cabins, from what I understand, closely mimic that of normal atmospheric pressure. I doubt there's a clinically significant difference in terms of that - I could be wrong.

It's hard to say if there's a clinically significant difference in dehydration on a short or moderate plane flight. The web shows that plane air is at around 1% humidity - significantly less than that of most areas of the country in terms of normal air humidity. There will be so-called insensible water loss due to this, but it's hard to say how much. Lots of bipolars sleep for 10 hours at at time without drinking, so I'm not sure a 10 hour flight would be much worse. Again, we have to consider the lower relative humidity in this equation.
 
I recently attended a talk given by Husseini Manji, and he spent quite a bit of time talking about the current conceptualizations of the mechanisms of Li, specifically related to GSK3. The data are pretty compelling, but he was clear to emphasize that they were also relatively preliminary.
 
This is true. In many cases, we have only a preliminary understanding of the mechanisms of action of drugs which are likely complex, such as lithium.

I just don't like the assertion from people not in psychiatry who click on the epocrates button 'Other Info' then scroll down to 'Mechanism of action,' then say, "Hey, I know just as much psychopharm as a psychiatrist!" or, "Psychiatrists don't even know what's going on with their drugs - nobody has any idea!" simply because epocrates says "Exact mechanism of action unknown."

This does NOT mean that they made up some compound in a lab somewhere and tested it on every known disease and waited for efficacious results - then marketed it as such. There's enough pharmacology in all of these meds to make your head spin, depending on how deep you want to get into it.

This mostly comes from people in other medical specialties or not in the profession at all.
 
Anasazi23 said:
This does NOT mean that they made up some compound in a lab somewhere and tested it on every known disease and waited for efficacious results - then marketed it as such. There's enough pharmacology in all of these meds to make your head spin, depending on how deep you want to get into it.
Click to expand...

The fact that the pharmacology is complicated does not bring us any closer to understanding the actual mechanisms of action of these agents. Cost/benefit is also critical, especially given the potentially lethal side effects of some psychotropics (I know, I'm preaching to the choir).

"The mechanism of action of buspirone is unknown." http://www.rxlist.com/cgi/generic/buspir_cp.htm

"The mechanism of action of ziprasidone, as with other drugs having efficacy in schizophrenia, is unknown" http://www.rxlist.com/cgi/generic2/ziprasidone_cp.htm

"The neurochemical mechanism of the antidepressant effect of bupropion is not known." http://www.rxlist.com/cgi/generic/bupropz_cp.htm

"The precise mechanism by which atomoxetine produces its therapeutic effects in Attention-Deficit/Hyperactivity Disorder (ADHD) is unknown, but is thought to be related to selective inhibition of the pre-synaptic norepinephrine transporter, as determined in ex vivo uptake and neurotransmitter depletion studies." http://www.rxlist.com/cgi/generic3/strattera_cp.htm
 
PublicHealth said:
The fact that the pharmacology is complicated does not bring us any closer to understanding the actual mechanisms of action of these agents. Cost/benefit is also critical, especially given the potentially lethal side effects of some psychotropics (I know, I'm preaching to the choir).

"The mechanism of action of buspirone is unknown." http://www.rxlist.com/cgi/generic/buspir_cp.htm

"The mechanism of action of ziprasidone, as with other drugs having efficacy in schizophrenia, is unknown" http://www.rxlist.com/cgi/generic2/ziprasidone_cp.htm

"The neurochemical mechanism of the antidepressant effect of bupropion is not known." http://www.rxlist.com/cgi/generic/bupropz_cp.htm

"The precise mechanism by which atomoxetine produces its therapeutic effects in Attention-Deficit/Hyperactivity Disorder (ADHD) is unknown, but is thought to be related to selective inhibition of the pre-synaptic norepinephrine transporter, as determined in ex vivo uptake and neurotransmitter depletion studies." http://www.rxlist.com/cgi/generic3/strattera_cp.htm
Click to expand...


This is exactly what I'm talking about. It's not "unknown." Just not known like how we know heparin or aspirin, for example, works.

Try writing in "unknown" on the mechanism of wellbutrin on your PRITE.
 
Anasazi23 said:
This is exactly what I'm talking about. It's not "unknown." Just not known like how we know heparin or aspirin, for example, works.

Try writing in "unknown" on the mechanism of wellbutrin on your PRITE.
Click to expand...

Self-referential paradox? 😱
 
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