Jump to content
CrazyBoards.org

Recommended Posts

My doc does not think I am bipolar.

My last appointment he tried to add on pristiq which I said no to since I had a horrible reaction to trying effexor (debilitating panic attacks and anxiety).  I did tell him this but he suggested Pristiq.

Bad stuff keeps coming back now. Anger, rage, fleeting violent thoughts, passive suicidal ideation.  It is sort of like how things were prior to being on any meds. I am on 45 mg Mirtazipine Sol-tab.  Lorazepam 1mg prn.

Waiting until end of June to see my pdoc again.  May see him sooner if things don't improve.

Share this post


Link to post
Share on other sites
1 hour ago, Iceberg said:

Don't push "I'm bipolar" push "this is what I need addressed" 

I mentioned that I need help with anxiety and that my last med combo did nothing for it. It made other issues worse. 

He kept pushing antidepressants which have done not so well on. And I just don't know what to do.  They never quell the anxiety I feel.

Edited by wookie

Share this post


Link to post
Share on other sites

I am not pushing bipolar.  I just have had not so great responses to antidepressants.  My doctor would dose me up on antidepressants, and it just made me feel weird, and anxious from the drug.  I never felt okay. I would only feel okay if I added an anxiolytic.  I feel they're just throwing antidepressants at me, and nothing really makes me feel better.  

I explained to my doctor I'm anxious just about normal everyday things, and the antidepressants have never fixed it.

Share this post


Link to post
Share on other sites
46 minutes ago, Iceberg said:

what happened with abilify? A lot of your trials seem low dose

I freaked out on it. Developed akathesia and panic.

Had panic attacks and felt like I was losing my mind on effexor.

Edited by wookie

Share this post


Link to post
Share on other sites
41 minutes ago, Iceberg said:

there are other options for anxiety if that is your primary symptom

I suggested other things but they just offered to double up my ad

Share this post


Link to post
Share on other sites

I wouldn't wait till June. If Pristiq is having such a terrible effect, I would want to see my pdoc or at least gdoc. If something new makes you worse, your doc will want to know.

Share this post


Link to post
Share on other sites
4 hours ago, mcjimjam said:

I wouldn't wait till June. If Pristiq is having such a terrible effect, I would want to see my pdoc or at least gdoc. If something new makes you worse, your doc will want to know.

I was not given Pristiq.  It was suggested but given my reaction to effexor I was afraid I'd experience the same horrible reaction, since Pristiq is sort of a new and improved version of effexor (If I am not mistaken).

I am feeling better today but I am watching myself.

Share this post


Link to post
Share on other sites
On 4/27/2017 at 10:24 AM, wookie said:

I was not given Pristiq.  It was suggested but given my reaction to effexor I was afraid I'd experience the same horrible reaction, since Pristiq is sort of a new and improved version of effexor (If I am not mistaken).

I am feeling better today but I am watching myself.

@wookie What other options have you considered besides antidepressants? You mentioned anger, rage, and some fleeting intrusive thoughts. And you've also mentioned issues with anxiety. I tried for a very long time to treat my irritability, explosiveness, and rage with antipsychotics, but the doses I would have to take weren't tolerable. I was taking Lamictal at the time, and my doctor and I decided to try a more calming anticonvulsant. So I switched from Lamictal to Trileptal (oxcarbazepine). I started at 300mg twice a day and worked up to 300mg three times a day because I was feeling jittery the few hours before my evening dose. I ultimately decided I didn't want to take the immediate release anymore and that 3 times a day was annoying so I switched to the Oxtellar XR brand and never looked back. It *assists* with the anxiety but on its own wouldn't be enough. At least that's how I feel right now. But in regards to explosiveness and anger/rage, oxcarbazepine is where it's at. If oxcarbazepine isn't calming enough, carbamazepine (Tegretol) would be worth a shot. It's similar to oxcarbazepine but a bit stronger (and potentially more side effects).

If you take oxcarbazepine with an antidepressant and you're still having issues with intrusive thoughts, you can add a very low dose of an antipsychotic to skim the surface a bit.

  • Like 1

Share this post


Link to post
Share on other sites

 

3 hours ago, browri said:

@wookie What other options have you considered besides antidepressants? You mentioned anger, rage, and some fleeting intrusive thoughts. And you've also mentioned issues with anxiety. I tried for a very long time to treat my irritability, explosiveness, and rage with antipsychotics, but the doses I would have to take weren't tolerable. I was taking Lamictal at the time, and my doctor and I decided to try a more calming anticonvulsant. So I switched from Lamictal to Trileptal (oxcarbazepine). I started at 300mg twice a day and worked up to 300mg three times a day because I was feeling jittery the few hours before my evening dose. I ultimately decided I didn't want to take the immediate release anymore and that 3 times a day was annoying so I switched to the Oxtellar XR brand and never looked back. It *assists* with the anxiety but on its own wouldn't be enough. At least that's how I feel right now. But in regards to explosiveness and anger/rage, oxcarbazepine is where it's at. If oxcarbazepine isn't calming enough, carbamazepine (Tegretol) would be worth a shot. It's similar to oxcarbazepine but a bit stronger (and potentially more side effects).

If you take oxcarbazepine with an antidepressant and you're still having issues with intrusive thoughts, you can add a very low dose of an antipsychotic to skim the surface a bit.

I am going to run this by him.  I just felt like an anxious obsessive robot on two antidepressants.

Edited by wookie

Share this post


Link to post
Share on other sites

I find Trileptal to be very effective as a mood stabilizer, with zero side effects. From talking to my pdoc, it tends to be a 50/50 shot on efficacy. It does need to be dosed at least twice a day due to the short half-life, 3x day is preferable. I get by with twice a day and have no issues. It can affect your sodium levels at higher doses, but I haven't encountered any problems at 1200mg.

  • Like 1

Share this post


Link to post
Share on other sites
40 minutes ago, dtac said:

I find Trileptal to be very effective as a mood stabilizer, with zero side effects. From talking to my pdoc, it tends to be a 50/50 shot on efficacy. It does need to be dosed at least twice a day due to the short half-life, 3x day is preferable. I get by with twice a day and have no issues. It can affect your sodium levels at higher doses, but I haven't encountered any problems at 1200mg.

I will ask.  I am not sure where I fall in the depression spectrum.  It's so hard to tell what form of depression and anxiety I have.  I notice anxiolytics cause mood swings when used prn in conjunction with AD's.  I felt I was taking more anxiolytics with the additional AD's to counteract the effects.  I was sleeping at night but I was not feeling okay during the day.  Just can't handle shit I guess.  Just have chronic high generalized anxiety which isn't fun.

 

Share this post


Link to post
Share on other sites
1 hour ago, dtac said:

I find Trileptal to be very effective as a mood stabilizer, with zero side effects. From talking to my pdoc, it tends to be a 50/50 shot on efficacy. It does need to be dosed at least twice a day due to the short half-life, 3x day is preferable. I get by with twice a day and have no issues. It can affect your sodium levels at higher doses, but I haven't encountered any problems at 1200mg.

I have a comprehensive metabolic panel done every 90 days and I haven't had any abnormal sodium levels at 1200mg either. I too have heard that oxcarbazepine can be 50/50. It either helps or it doesn't but not really in between? Do you feel that it has a minor anxiolytic effect like I do?

1 hour ago, wookie said:

I will ask.  I am not sure where I fall in the depression spectrum.  It's so hard to tell what form of depression and anxiety I have.  I notice anxiolytics cause mood swings when used prn in conjunction with AD's.  I felt I was taking more anxiolytics with the additional AD's to counteract the effects.  I was sleeping at night but I was not feeling okay during the day.  Just can't handle shit I guess.  Just have chronic high generalized anxiety which isn't fun.

 

If you want to quiet your mind but you want to try alternatives before going to antipsychotics for intrusive racing thoughts, oxcarbazepine (Trileptal) would be a good place to start because it's more tolerable than its carbamazepine (Tegretol) predecessor. However, it may be less effective than carbamazepine just the same.

Additionally, if you're still taking mirtazapine, it may not be the greatest to start out with an antipsychotic because mirtazapine is a minor dopamine antagonist itself like antipsychotics. Believe me, I didn't get full control of my disorder until I accepted an anticonvulsant, an antidepressant, and an antipsychotic. They each do different things, but their purposes do overlap in some ways. Me for example, I find that fluoxetine, oxcarbazepine, and loxapine all treat specific facets of my anxiety that on their own would be pretty useless. In some cases, low doses of several medications can go much further than high doses of one or two. However, it sounds like your gdoc has a little trouble thinking outside the box in regards to going beyond the antidepressant class to more unconventional methods. Looking at your past RXs it doesn't look like you've ever had a trial of Prozac. You may find that it could help you. Lexapro knocked my anxiety right out of the park, but the only reason I wasn't depressed anymore was because I didn't really care about much. Then came the anhedonia and just general fatigue, low energy levels, and lack of motivation. Zoloft worked the first time I took it for about 3 years when I was younger, but a second trial was a wash. Viibryd caused me to have a hypomanic episode that lasted for a few months and made me balloon. I actually liked Pristiq but had to switch to Effexor because of insurance. Effexor pooped out so I switched to Cymbalta, which I liked immensely but it was causing me to rapid cycle so we titrated off to Lamictal at that point.

All in all though, the more I read your posts the more it sounds like you should be trying anticonvulsants and antipsychotics. Branch out a little. But it also sounds like you're going to have to see a psychiatrist to get to that point.

Share this post


Link to post
Share on other sites

I may rant a little.

My gdoc kept pushing mirtazipine in addition to cipralex to get me off lorazepam.  I ended taking more lorazepam in the end while not feeling too great.

I agree that a different class of meds  may be a better option.  Just getting my psychiatrist to agree with me and see beyond my gdoc's professional opinion is a bit of a challenge.

I feel if I come across like I read something on a forum it won't bode too well for me either.

Share this post


Link to post
Share on other sites
1 hour ago, browri said:

I have a comprehensive metabolic panel done every 90 days and I haven't had any abnormal sodium levels at 1200mg either. I too have heard that oxcarbazepine can be 50/50. It either helps or it doesn't but not really in between? Do you feel that it has a minor anxiolytic effect like I do?

I get so much anxiolytic benefit from Rexulti that if the Trileptal does contribute, it's relatively minor. The biggest effect I notice is a general smoothing of my mood so that I don't swing up/down much at all. It tends to make a mood feel more generalized, so, for example, if I'm irritable, it's less acute and severe. Easier to manage that way.

@wookie perhaps looking SNRIs would help you. MDD is typically treated when them, and the only one you've tried (from your sig) is Effexor. My SO has MDD, and Cymbalta has been extremely effective, although it does have some drug-drug interactions to look out for (omeprazole being a big one.) There's also Wellbutrin, but it can increase anxiety in some people.

You've got options, so I would be persistent. If it's not working, change it.

  • Like 1

Share this post


Link to post
Share on other sites
1 hour ago, dtac said:

I get so much anxiolytic benefit from Rexulti that if the Trileptal does contribute, it's relatively minor. The biggest effect I notice is a general smoothing of my mood so that I don't swing up/down much at all. It tends to make a mood feel more generalized, so, for example, if I'm irritable, it's less acute and severe. Easier to manage that way.

@wookie perhaps looking SNRIs would help you. MDD is typically treated when them, and the only one you've tried (from your sig) is Effexor. My SO has MDD, and Cymbalta has been extremely effective, although it does have some drug-drug interactions to look out for (omeprazole being a big one.) There's also Wellbutrin, but it can increase anxiety in some people.

You've got options, so I would be persistent. If it's not working, change it.

I've heard good things about Rexulti.

My effexor trial jacked my anxiety through the roof.  I haven't flipped out on ssri's so much so I am okay with them.

My psychiatrist is not really creative and neither is my gdoc.  I bumped up my appointment until next week. It was either try seeing if they will take me inpatient to try meds or have them send me home with a short term fix that does nothing in the long run.  I figure I'd have to saw my own arm off for them to consider taking me inpatient.

Share this post


Link to post
Share on other sites
4 hours ago, wookie said:

I feel if I come across like I read something on a forum it won't bode too well for me either.

All you have to say is, "I have a friend."   :)

4 hours ago, dtac said:

My SO has MDD, and Cymbalta has been extremely effective, although it does have some drug-drug interactions to look out for (omeprazole being a big one.) There's also Wellbutrin, but it can increase anxiety in some people.

Cymbalta is pretty awesome actually. For me, It was stimulating but good for anxiety at the same time. Wellbutrin on the other hand was stimulating and antagonized my anxiety at 300mg if I had so much as one cup of coffee. It was more tolerable as the Aplenzin brand. In retrospect I would only ever take this again at 150mg as an adjunct.

@wookie If you say that you're having even passing violent thoughts or suicidal ideation, that would warrant them to change your meds if you were insisting on it. But they could just as soon tell you that you HAVE to go to inpatient. 

  • Like 1

Share this post


Link to post
Share on other sites
13 hours ago, Iceberg said:

Another vote for rexulti 

This drug changed my life. I don't care what people say about it being a knock-off of Abilify, it is not the same drug, and it does not produce the same side-effects. I've been on it over a year and it's absolutely amazing (for me.) It should be a consideration if you can afford it.

  • Like 1

Share this post


Link to post
Share on other sites

@wookie how have things been for you these past weeks? Did you get the opportunity to talk with your doctors?

Share this post


Link to post
Share on other sites
5 hours ago, browri said:

@wookie how have things been for you these past weeks? Did you get the opportunity to talk with your doctors?

I spoke to my psychiatrist, and I am leaving all the prescribing up to him, instead of my GP.  I have been feeling better, and I am on 30mg of Remeron now.  I am taking far less Ativan now.  I cut back on it two weeks prior to seeing him and my mood swings stopped.  So I have reverted to only taking Ativan for an emergency situation as I think it was triggering my depression with more frequent use.  I go back again on June 13, with my partner in tow (as a witness) to see how I am doing then.  I am doing far better, now that I am off the other antidepressant.

We'll see how I am doing again in another two weeks.  The crazy train has passed me by for now.

  • Like 1

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now


  • Similar Content

    • By Carrie26a
      My Dr recommended that I try ketamine for my depression. I have bipolar 1, anxiety and depression. I've heard of this being a street drug so I'm nervous to try it. I wondered about others experiences. 
    • By ReincarnatedCow
      I'm not suicidal, at least I don't think I am at the moment.  I do have plans in place for if something goes wrong but i'm fully aware I wont act on them. But if someone were to pull a gun on me or something like that, I would most likely tip him. I'm not actively trying to kill myself, but I would not mind dying. Can anyone else relate or am I going crazy?
    • By mmaryland
      Does anyone else have experience with Rexulti completely destroying their depression? For me, Rexulti almost had a same day anti-depressant effect and controls depressive episodes acutely and astoundingly fast. I literally feel anti-depressant effects in as little as 3 hours after I take it. When I look back to when I was on it, I now realize that I didn't have a single bout of depression during that time, it just was not super effective in controlling mania. I think Rexulti is a hell of an anti-depressant, a way improved drug than abilify with less than half the side effects, no lethargy or cognitive impairment either which is always surprising to find in an antipsychotic. I know it has an indication for adjunctive therapy in adults with MDD but none for bipolar depression... maybe Lundbeck is just waiting for close to the expiration of the patent before the release new clinical trial data and extend their patent after they get the bipolar depression indication approved, but that's just a thought.
      Anyone else have a similar experience with Rexulti, brexpiprazole? Please let me know about your time on the medication and if it sat well with you or not so much. Interested in if others are also getting this rapid and significant anti-depressant effect from this drug or if it's just me
    • By SilentlyScreaming
      So I'm going to make this short and sweet for you all.
      Lately, I've been suffering big time with depression. I find it hard to get out of bed the past week. It's a miracle when I make it to shower. Even then it's only for like 10 minutes. I barely eat, sleep has been uneventful. It's either I wake up every few minutes or I sleep too much. There's no in-between.
      And I only leave the house for appointments.
      I know the answer may seem simple... get out of bed. But it's becoming increasingly difficult. Does anyone have any advice? Is this just me?
    • By AbilifyedBunny
         
      Hello crazyboards,
      All of a sudden, I have been depressed over the past couple days.  For a while now I have been on a path of personal growth, and trying to improve my life by continuing to make gradual changes and be a more active participant in life.  A lot of the positive changes have enriched my life greatly.  One of the positive changes I made, was attempting to dump my crazy ex who has proven *impossible* to get rid of. (But that is another story for another thread.)  To be honest, some days are difficult.  I have been going through a lot of transitions.  I recently had a milestone birthday (30), I have out grown a lot of the people in my life (who are actually pretty effed up individuals under the surface), and there has been serious strain on close relationships.  
      To try to help manage some of the stress I saw a healer for some energy work.  Afterward, it seemed to help tremendously.  For a solid month I was full of energy, taking excellent care of myself, and very productive.  Cue two days ago, and the honeymoon phase is over.  All of a sudden this silent depression started creeping in.  On a surface level I feel that I have nothing to be terribly depressed about.  On a deeper level, I know that my life is less than ideal.  The difference, is that I am usually filled with a positive "can do" attitude about improving it.  Of course, there is also the ever-present struggle with the illness which many of us can sometimes be in denial about. 
      So for whatever reason, it happened.  I got depressed.  Not-sad, melancholy, hopeless, overcome with emotion,-depressed.  Just depressed.  I think it started when I tried to do a positive thing for myself, at which I failed.  About five days ago I attempted to finally quit nicotine gum for good.  I quickly realized that this simply would not be possible for me at this time in my life. 
      Lately, I have little motivation to do anything.  For about a week now, I have gone back to taking poor care of myself and eating poorly.  Nothing sounds "inviting" to me when I think of fun things I could do.  My emotions are dulled, yet on some level I feel this pesky throbbing ache coming from somewhere...Like as if I were getting hit with a hammer...in the heart.   
      I am writing this thread for no other reason than to just say that depression blows....the big one.  And if you are reading this and you are depressed, you are not the only one.
      I am going to fight it though.  I am going to continue to do non-depressive things until my attitude follows my life style.  In the meantime, it sucks trying to function when you are "running on empty" so to speak.    
×