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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.

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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

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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.

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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

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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

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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.

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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.

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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.

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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

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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.

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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.

 

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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.

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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.

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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.

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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.

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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. 

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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.

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

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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.

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