I have two questions:

1. I am currently taking 825mg of Lithium Carbonate. When I try to go to 900mg, I get a weird pressure in my head. Thus, I always go back down. Is that something that will go away? I think 900mg could be more effective for me. I just don't know what that feeling is.

2. My doctor has recently started me on Prozac 20mg to be increased to 40mg. Everything I read says that Prozac and Lithium are a dangerous combo. Is this safe? It is making me very nervous. If there is an interaction, is there something just as effective as Lithium that doesn't interact? I take Lithium for treatment-resistant depression, not Bipolar. I've taken Prozac in the past and it works well for me, so I wouldn't want to change that.

Thanks so much.

Lindsay

1. This is an interesting question. Many patients describe "weird" sensations in their head on antidepressants in particular, particularly an electrical or shock like feeling. It is possible that the side effect would go away with time, although it might not. My feeling is that unless a symptom can be explained by the condition itself, then it might be a sign of a side effect and one must be cautious with Lithium in general. Even though this is a great medication in terms of effect, it has equally strong side effects. Your dose of Lithium is so close to 900 mg., I would be prepared to leave well enough alone and maybe consider adding some Lamictal if you are not already on this medication. As always, you and your doctor know you better than I ever will and those opinions take priority. This is educational, not advice.

2. Adding Prozac to Lithium is more often safe than unsafe. There have been instances of Serotonin syndrome and problems with Lithium clearance, although these are rare. If you felt sick in any way after increasing the Prozac dose I would be concerned, even though this is highly unlikely. It has always been a mystery to me the interactions with these medications considering how often they are prescribed without incident. The biggest risk is induction of mania in a bipolar patient. One would more likely assume a complementary effect. Remember to discuss this with your doctor before deciding what to do, as he or she knows you better than I.

Hope this helps and thanks for the questions.