Lithium for undiagnosed patients

[Chocolate Fireguard]

Hi everyone.

I was just wondering whether it's 'good practice' for a doctor to consider prescribing lithium to somebody who's not been diagnosed with anything solid (other than an 'acute psychotic episode' at one or two points).

To give you some background, my girlfriend is currently seeing a private doctor - one who works at the priory - who has yet to diagnose her but saw her when she was having a psychotic episode and was inpatient a couple of years ago before I met her. She has had one proper psychotic episode whilst I've been with her, but other than that she seems relatively stable to me & we spend every day together. She has some OCD-type tendancies & gets 'hyper' quite a lot, but this seems to be more of a character thing than anything else. She states that her moods are "all over the place", though I haven't personally noticed this to be the case (she says she tries to hide it). Her & her mum have described her as being 'manic' before, but from my understanding of mania & even hypomania, she doesn't seem to fit in with it. I think part of her personality is just that she likes to do things a lot & gets easily bored.. I think she's more ADHD than manic myself.

So this doctor has seen her twice over the last year, as far as I'm aware, both appointments for about half an hour in the last month. He asked her to keep a mood diary, scoring the whole day from 1-10 which I've not seen the whole of, but the days I did see seemed to be fairly even at about a 7-8 (she claims that the finished version was plotted on a graph & was up & down). He's prescribed her sodium valproate for now (which I've been on myself) & asked her to try this for 2-3 weeks & contact him if she doesn't like it at any point & he will change it. It sounded like, from what she said, they were going to try the SV for 2/3 weeks & if there's no improvement, just move on - that seems quite quick to me, but alas I'm not an expert. There seems to be the view that they are just 'trialling' this medication & he's said that they will probably need to try a number of drugs before they find one which works (which I think makes her instantly believe that this one isn't going to do anything - which doesn't seem to be the best start). The next drug which has been mentioned is lithium, which from what I've heard is quite a hardcore drug. Is it common for a doctor to prescribe lithium as a mood stabiliser to somebody with no diagnosis who isn't displaying serious symptoms..?

I know I'm not a professional & I probably shouldn't speculate, but it just seems odd to me & I don't trust this doctor. I also feel like a really horrible girlfriend for not just going along with it & supporting her & the doctor's decisions - especially as I seem to be the only one who shows any sign of disagreeing with anything said. I just find it hard to connect what's being said with what's in front of me, because to me she doesn't present as somebody who would need this sort of intervention (especially if they try lithium).

If you got this far, congratulations & apologies for the ramble.

Any comments would be much appreciated, though please be assured that I know that I'm probably being a really nasty human being by even posting this.

Thanks.

[tiptoes]

I can only go by my own experience but I was treated with medication prior to any diagnosis. Although I wasn't actually treated with lithium in the end it was brought up on a number of occasions as a suitable option for me.

For me one of the important things to agree to take a new medication or a dose change is to ask about the prescribing doctors rationale - how does he think it will help? What makes this medication a better fit than an alternative? What sort of time frame it will take to work? If it doesn't work what are the options? How much is this medication likely to impact in my day to day life? etc.

It was how I responded to the various medications that they tried that helped them give me a diagnosis that fits.

In terms of monitoring mood, there is a site called moodscope.com which asks to you rate how much you feel various feelings an emotions such as excited/anxious/hostile/proud etc and then gives you a mood score based on your answers. I quite like it to monitor my mood as it doesn't require me to be objectively aware of what mood state I am in and allows me to spot more subtle changes in my mood. It might be something for your partner too look into.

[Unbreakable.]

Have you discussed your doubts with your partner?

I don't think you come across as horrible. Being aware of symptoms /diagnoses / medication means that one has certain expectations as to how illnesses present itself. So now wonder you're being skeptical when what you see is very different from what you know about mental illness.
I agree that not everything people think is mh is mh and that for some reasons there are people out there who really just want to believe they are “crazy“. So I l probably would feel similar in your situation.

Have you ever talked to people who agree that her mood is all over the place and asked how your partner presents herself around them? Maybe that will give you a better idea of whether she's different around others.

I'm sorry I didn't really comment on your concerns re the doctor and medication. I just feel. that agreeing or disagreeing with that wouldn't do much for you and that maybe focusing on how to deal with your doubts might be more constructive. :)