My mother-in-law was recently diagnosed with terminal ovarian cancer.
She has received 4 of 6 prescribed carboplatin treatments. She has also
been manic depressive for the last 30 years but has been successfully
treated with lithium for the past 8 years. Following the last
chemo-therapy symptoms of mania reappeared. An increase in her lithium
dosage has aleviated the manic symptoms somewhat but not entirely. Does
anyone have experience with this situation or advice on course of action
regarding possible solutions?
reply
ca…@mail.island.net
Al Cass (ca…@mail.island.net) wrote:
: My mother-in-law was recently diagnosed with terminal ovarian cancer.
: She has received 4 of 6 prescribed carboplatin treatments. She has also
: been manic depressive for the last 30 years but has been successfully
: treated with lithium for the past 8 years. Following the last
: chemo-therapy symptoms of mania reappeared. An increase in her lithium
: dosage has aleviated the manic symptoms somewhat but not entirely. Does
: anyone have experience with this situation or advice on course of action
: regarding possible solutions?
I can speak in general terms; her psychiatrist is the best source
of information. The anti-psychotic drugs (e.g. Haldol, Stelazine, etc.)
may be useful in combination with lithium to control manic episodes.
Also, there are other mood stabilizers that may work better than lithium
in some cases, such as valproic acid.
As the ovarian cancer progress, special care will need to be taken
concerning the dosing of lithium, probably with more frequent measurements
of the serum lithium level. The reason is that lithium is excreted solely
by the kidneys. As fluid accumulates in the abdomen (ascites), as it
often does in the final stages of ovarian cancer, kidney function often
declines. This can lead to an accumulation of lithium on a dose that had
previously been quite tolerable and useful.
Eric Chevlen, MD
Given the hydration that’s typically given with platinum
treatment, it would not be surprizing if Lithium levels
fluctuated during treatment. Besides frequent monitoring of Li++
in the blood, you might consider adjunctive treatment with either
Tegretol, Verapamil, Depakote or Wellbutrin. Depakote and
Tegretol may be faster to take effect than either the Verapamil
or Lithium, and are frequently used in bipolars who have trouble
tolerating Lithium. H2
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H2