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SheltieUnderdog

Utterly intolerant to Antipsychotics, Strongly considering Lithium or Lamictal as Monotherapy for Schizoaffective Disorder.

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You should listen to the doctor and/or doctors who have seen you the longest, are most familiar with your case, and know your history the best. Doctors in jails and in hospitals have only a short time window to observe you. Often such diagnoses change when you see an outpatient doctor for a considerable amount of time.

I don't know if you are schizoaffective or not. I do not diagnose. I do, however, go on the title of the thread in which you are seeking advice. I reiterate again that lithium and Lamictal are not generally effective as monotherapy for schizoaffective disorder. That's all I want to say based on the title of this thread. Of course, if the illness becomes rather bipolar I then, yes, lithium can be very effective.

You are going to do what you are going to do regardless of my opinion. That's fine. It's your life. I wish you luck.

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A little poking around suggests to me that Depakote is weight neutral or causes a little gain. In your case I would think it was worth trying because the mechanism of action differs from that of AAPs. Conceivably you could lose weight because you wouldn’t be dealing with the AAP-specific side effects.

The thing is that everyone reacts differently to different meds, and you really aren’t going to know until you try. I know that’s no fun, but it’s true. And not only do you have to try, you have to give a med several months to really know for sure if it works or not. 

Since you have a fair amount of insight into how your manias feel as they begin, you could try working with your doctor/s to make a plan to get you sleeping solidly as soon as you notice one starting. That makes a huge difference for me; nothing messes me up worst or faster than not sleeping. So for example, after you find a mood stabilizer you like and that seems to be working pretty well, you could experiment with sleep meds. I need Ambien. Nothing else works. But I have seriously intractable insomnia. You could figure out ahead of time if you needed short-term benzos or trazodone or remeron or Lunesta (etc.) to keep your sleep healthy and stave off mania that way. And yes, in an absolute emergency you might even have to take an antipsychotic for a little while. It’s better than meeting your local boys in blue or involuntary holds. 

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As far as depakote. It was a miracle drug for me. It stopped hallucinations and racing thiughts in their tracks. I had a pdoc change it because he feels lamictal is safer, but the only side effects i had were: weight gain, i was able to lose what i gained after a couple of months by eating more protein, but i really craved carbs at first. And my hair was brittle so i had to condition it a lot and be gentle.

i keep toying with asking my pdoc (he is a different one). To change it back.

sza disorder dx has psychosis during mood changes and without. It sounds like you may want to get a second opinion on that.

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41 minutes ago, confused said:

SZA disorder dx has psychosis during mood changes and without. It sounds like you may want to get a second opinion on that.

I very much second that. Write down every single symptom you can think of before you go, so you can tell the whole story concisely. Leave out all medication talk until and unless it become relevant, i.e. new doc begins writing scrips.

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Posted (edited)
20 hours ago, jt07 said:

You should listen to the doctor and/or doctors who have seen you the longest, are most familiar with your case, and know your history the best. Doctors in jails and in hospitals have only a short time window to observe you. Often such diagnoses change when you see an outpatient doctor for a considerable amount of time.

I don't know if you are schizoaffective or not. I do not diagnose. I do, however, go on the title of the thread in which you are seeking advice. I reiterate again that lithium and Lamictal are not generally effective as monotherapy for schizoaffective disorder. That's all I want to say based on the title of this thread. Of course, if the illness becomes rather bipolar I then, yes, lithium can be very effective.

You are going to do what you are going to do regardless of my opinion. That's fine. It's your life. I wish you luck.

I think from your point of view that myself switching to a mood-stabilizer as monotherapy will pretty much entirely unmask which type of mental disease I have primarily. If it fails or works after a significantly long enough period of time, it will unequivocally expose whether I have schizoaffective disorder or bipolar 1 psychotic. If it turns out to be schizoaffective disorder, then I must take the antipsychotic PRN immediately. What I do know at this point is that mania plays a large role in whatever imbalance I have present. I can absolutely confirm that.

A final question I have for you is, can someone who's Bipolar 1 With Psychotic Features experience delusions when not manic or must the mania occur before all other symptoms? I know I was manic well before I hallucinated every time but I can't seem to remember if I was always manic while I was delusional. I believe I was, but I'm not completely certain. I just realized that this poses a risk. If I was depressed and delusional or baseline and delusional but not hallucinating at all would that indicate schizoaffective disorder?

Let's just pray that a mood-stabilizer alone is effective. The akathisia in a movie theater or a restaurant, oh my god.

Edited by SheltieUnderdog

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Posted (edited)
8 hours ago, Gearhead said:

A little poking around suggests to me that Depakote is weight neutral or causes a little gain. In your case I would think it was worth trying because the mechanism of action differs from that of AAPs. Conceivably you could lose weight because you wouldn’t be dealing with the AAP-specific side effects.

The thing is that everyone reacts differently to different meds, and you really aren’t going to know until you try. I know that’s no fun, but it’s true. And not only do you have to try, you have to give a med several months to really know for sure if it works or not. 

Since you have a fair amount of insight into how your manias feel as they begin, you could try working with your doctor/s to make a plan to get you sleeping solidly as soon as you notice one starting. That makes a huge difference for me; nothing messes me up worst or faster than not sleeping. So for example, after you find a mood stabilizer you like and that seems to be working pretty well, you could experiment with sleep meds. I need Ambien. Nothing else works. But I have seriously intractable insomnia. You could figure out ahead of time if you needed short-term benzos or trazodone or remeron or Lunesta (etc.) to keep your sleep healthy and stave off mania that way. And yes, in an absolute emergency you might even have to take an antipsychotic for a little while. It’s better than meeting your local boys in blue or involuntary holds. 

I'm going to mention Lithium and Depakote and relay some of the information I have gotten and go with whichever one my psychiatrist recommends to use first.

I've never been diagnosed with insomnia but my situation is that if I get a good nights rest, I can't sleep for **** the following night and the next day I'll be tired enough that I'll sleep the respective night at the end of that day. I'm not very active with the exception of the akathisia and physical therapy 2x per week. I am currently morbidly obese and have too many orthopedic problems to be active so that may play a role in why I have trouble sleeping in general. I currently depend on Clonazepam 2mg for sleep. I was on Trazadone previously and found it less effective overall, I had to be somewhat tired for it to work at all.

I have sleep apnea and went for an overnight study recently and they wouldn't allow me to carry any medications with me in the facility without authorization from the prescribing doctor (in this case my psychiatrist). The pulmonary center gave me nasty attitude and didn't want to do any additional work getting the script faxed over and deemed it unnecessary so I arrived without the Clonazepam and only slept for about 1 1/2 hours the entire night, not even long enough for them to get the mask on me and evaluate me properly. I now have to return for the sleep study with my Clonazepam in order to even hope to fall asleep long enough the 2nd time. The pulmonary center only started requesting that my psych fax over the script after the 1st test failed and I wasted my time driving and sleeping there that night. They didn't even apologize for not listening to me originally. Just an example of my sleep issues.

Edited by SheltieUnderdog

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8 hours ago, SheltieUnderdog said:

If I was depressed and delusional or baseline and delusional but not hallucinating at all would that indicate schizoaffective disorder?

Depressed and delusional can happen as part of bipolar disorder without it being schizoaffective (because it is during a mood episode). Technically if you have delusions at baseline, with no mood symptoms, I believe that would be suggestive of schizoaffective.

That said, I think there is a lot of gray area and different doctors may call it differently. My current diagnosis is depression with psychotic features but lately Ive been struggling with delusions even when I'm not particularly depressed. If you look at psychotic depression as a situation where depression just gets so extremely severe that it brings on psychosis, I do not fit that profile. However I think part of the reason they are still seeing it as a mood disorder is because my delusions tend to be mood-congruent. So the content of your delusions might be relevant, like if they are mood incongruent and "bizarre" that may suggest schizoaffective.

Im not a doctor and not trying to diagnose one way or the other, just laying out what I understand from my reading trying to understand my own disorder, and what my doctors have told me.

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56 minutes ago, Juniper29 said:

Depressed and delusional can happen as part of bipolar disorder without it being schizoaffective (because it is during a mood episode). Technically if you have delusions at baseline, with no mood symptoms, I believe that would be suggestive of schizoaffective.

That said, I think there is a lot of gray area and different doctors may call it differently. My current diagnosis is depression with psychotic features but lately Ive been struggling with delusions even when I'm not particularly depressed. If you look at psychotic depression as a situation where depression just gets so extremely severe that it brings on psychosis, I do not fit that profile. However I think part of the reason they are still seeing it as a mood disorder is because my delusions tend to be mood-congruent. So the content of your delusions might be relevant, like if they are mood incongruent and "bizarre" that may suggest schizoaffective.

Im not a doctor and not trying to diagnose one way or the other, just laying out what I understand from my reading trying to understand my own disorder, and what my doctors have told me.

How long can a period of mania or depression last while someone's delusional with BP1 Psychotic?

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2 hours ago, SheltieUnderdog said:

How long can a period of mania or depression last while someone's delusional with BP1 Psychotic?

It really varies. Without the right medication, weeks, months, over a year.

 

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2 hours ago, SheltieUnderdog said:

How long can a period of mania or depression last while someone's delusional with BP1 Psychotic?

I think technically that there isn't a time limit.  Like there isn't one with bipolar generally.  I have a friend who spent a year in and out of psych hospitals being misdiagnosed and mistreated and it took that time for something to knock the mania and psychosis out.  (His med that killed it all was invega.)

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Posted (edited)
2 hours ago, dancesintherain said:

I think technically that there isn't a time limit.  Like there isn't one with bipolar generally.  I have a friend who spent a year in and out of psych hospitals being misdiagnosed and mistreated and it took that time for something to knock the mania and psychosis out.  (His med that killed it all was invega.)

That's still an antipsychotic. They put me on Invega 78mg by injection in the hospital after I resisted arrest in July 2012. It was my 2nd encounter with akathisia and ultimately made me figure out that the restlessness was being caused by the meds they were giving me and not just hyperactivity from my mind racing. My first ever AAP was Abilify in 2011 and I couldn't understand why I simply couldn't manage to sit still for very long. The Invega made me identify this after I went over a year unmedicated and had zero restlessness. The Invega also worsened my gynecomastia and put my prolactin levels off the charts for a male.

My current psych at the time tried cogentin, then artane, and both failed to counteract the aksthisia.Then he basically just told me to live with it.

Edited by SheltieUnderdog

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Right—that’s why I quoted the part I was replying to.  I recognize it’s an AAP.  It was an example of the fact that the bipolar mania and psychosis lasted for a year.

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Whether you're BPAD I w/ psychotic features or Schizoaffective: Bipolar type, you're likely going to need an anti-manic drug. As someone else already said, Lithium is the gold standard for mood stabilization and does wonders for people when it works, but it doesn't work for everyone and has the potential to cause serious medical issues. It's also a drug you have to commit to as it'll take time and bloodwork to get you to a therapeutic level and make sure it's not causing harm to your kidneys. And even when you reach a therapeutic level, you'll still have to do blood tests every 3-6 months as long as you're on the drug as well as be careful of drug and food interactions. I think you might be barking up the wrong tree with Lamictal though. > 400mg/day is typically only prescribed when used as an anti-seizure drug, not a mood stabilizer. And even then, Lamictal is only really known for use in the depressed phase of bipolar disorder, not mania. 

You also honestly haven't tried many AP's from either generation. Trilafon, Prolixin, Stelazine, Loxitane, Orap, Rexulti, Vraylar, Geodon, Clozaril, Seroquel, Zyprexa, etc.

 

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18 hours ago, SheltieUnderdog said:

I'm going to mention Lithium and Depakote and relay some of the information I have gotten and go with whichever one my psychiatrist recommends to use first.

I've never been diagnosed with insomnia but my situation is that if I get a good nights rest, I can't sleep for **** the following night and the next day I'll be tired enough that I'll sleep the respective night at the end of that day. I'm not very active with the exception of the akathisia and physical therapy 2x per week. I am currently morbidly obese and have too many orthopedic problems to be active so that may play a role in why I have trouble sleeping in general. I currently depend on Clonazepam 2mg for sleep. I was on Trazadone previously and found it less effective overall, I had to be somewhat tired for it to work at all.

I have sleep apnea and went for an overnight study recently and they wouldn't allow me to carry any medications with me in the facility without authorization from the prescribing doctor (in this case my psychiatrist). The pulmonary center gave me nasty attitude and didn't want to do any additional work getting the script faxed over and deemed it unnecessary so I arrived without the Clonazepam and only slept for about 1 1/2 hours the entire night, not even long enough for them to get the mask on me and evaluate me properly. I now have to return for the sleep study with my Clonazepam in order to even hope to fall asleep long enough the 2nd time. The pulmonary center only started requesting that my psych fax over the script after the 1st test failed and I wasted my time driving and sleeping there that night. They didn't even apologize for not listening to me originally. Just an example of my sleep issues.

I have sleep apnea too and my sleep doc actually prefers me not to use any meds for sleep as they can relax the muscles in your mouth and throat and make your apnea worse. Just FYI. 

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13 minutes ago, zisforzyprexa said:

I have sleep apnea too and my sleep doc actually prefers me not to use any meds for sleep as they can relax the muscles in your mouth and throat and make your apnea worse. Just FYI. 

Thanks but I don't think I'd be capable of falling asleep on most nights without taking Clonazepam as a sleep PRN.

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Bummer about having to repeat the test. My meds are not as sedating, so i took them early, before i went. I was asleep by 9.i slept partway with no cpap and then they put it on me.

i think asking about Li and depakote is a good plan. They both require bloodwork to make sure you are in the therapeutic range.

 

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43 minutes ago, confused said:

Bummer about having to repeat the test. My meds are not as sedating, so i took them early, before i went. I was asleep by 9.i slept partway with no cpap and then they put it on me.

i think asking about Li and depakote is a good plan. They both require bloodwork to make sure you are in the therapeutic range.

 

How did they ultimately treat your sleep apnea? Only with a cpap mask or did you require surgery and was the treatment effective?

I'm roughly 290lb currently due primarily to the antipsychotics and what bothers me the most is that they're blaming so much of it on my weight. What bothers me is that I was snoring profusely, gasping for air, had recurrent nightmares, and was tired as **** and had fatigue when I'd wake up when I was still skinny so it's really not weight predominant. I don't know how similar your situation is, but I know from my own experience that sleep apnea isn't completely synonymous with being overweight and obese. I think doctors just like to tell you that you ought to lose some weight because it sounds good. Obviously I'd like to lose weight, they act like I'm gauranteed to do it I take their advice. And I'm not even going to tell you what my experience with the bariatric surgeon I saw was like. All I can say is that I declined and I'm in need of a second opinion.

I took the Clonazepam at around 7:45 and arrived at about 8:30. It didn't work for me being taken that early. My typical bedtime is around 1:30am.

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I am overweight/obese. 180 lbs at 5'5".  I snored when i was thin. But, i went for the test because i was always tired and my husband told me i stop breathing  i am severe when i sleep on my back and moderate on my side.  The cpap worked in the lab, but i could not get it to fit and sleep with it at  home. So, i got a mouthguard made and i wear a belt that keeps me on my side. It works well, when i actually wear it. I have trouble finding the right time to put it in and i get comfortable in bed without it .

the mouthguard is only approved for mild to moderate apnea. I had to do a side sleep test at home before they would approve and my insurance doesn't cover most of it i did not consider surgery.

i tried to get approved for a diet med Qsymia, but my insurance won't pay. And it was too expensive out of pocket.

they all tell me to lose weight, too. It is hard. You will have more energy when you have the apnea under control. I would not have been able to get any exercise, i walk our dog. I was  trying to sleep and not feeling rested before.

before i knew i had apnea, i thought my fitbit was defective because it would not record sleep. Now i know i was not sleeping well enough. It is showing actual hours of sleep now. My sleep is still wacky and i still get tired, but it is an improvement.

 

i never took lithium but i gained weight on depakote, not like zyprexa which was way worse.  I am thinking of asking to go back on it, though. I have a lot of intrusive thoughts lately and nothing is helping

.good luck finding something for your mind and the apnea

 

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Posted (edited)
32 minutes ago, confused said:

I am overweight/obese. 180 lbs at 5'5".  I snored when i was thin. But, i went for the test because i was always tired and my husband told me i stop breathing  i am severe when i sleep on my back and moderate on my side.  The cpap worked in the lab, but i could not get it to fit and sleep with it at  home. So, i got a mouthguard made and i wear a belt that keeps me on my side. It works well, when i actually wear it. I have trouble finding the right time to put it in and i get comfortable in bed without it .

the mouthguard is only approved for mild to moderate apnea. I had to do a side sleep test at home before they would approve and my insurance doesn't cover most of it i did not consider surgery.

i tried to get approved for a diet med Qsymia, but my insurance won't pay. And it was too expensive out of pocket.

they all tell me to lose weight, too. It is hard. You will have more energy when you have the apnea under control. I would not have been able to get any exercise, i walk our dog. I was  trying to sleep and not feeling rested before.

before i knew i had apnea, i thought my fitbit was defective because it would not record sleep. Now i know i was not sleeping well enough. It is showing actual hours of sleep now. My sleep is still wacky and i still get tired, but it is an improvement.

 

i never took lithium but i gained weight on depakote, not like zyprexa which was way worse.  I am thinking of asking to go back on it, though. I have a lot of intrusive thoughts lately and nothing is helping

.good luck finding something for your mind and the apnea

 

Im 5'8 and 288lb. The heaviest I've been is 306lb. From the first test alone, they're saying my sleep apnea is severe and that's why they want me to return. They said they must get the mask on me for further determination on how to treat my individual case effectively.

I'm severe on my side and extreme on my back. I also toss and turn violently in my sleep and have restless leg (not related to akathisia) which is why I don't think the mask will work properly at home. Do you think I'll require surgery based on all this information? Just asking?

Edited by SheltieUnderdog

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I don't know. Maybe you wont jerk around as much with the mask? Do they know you have rls? They can monitor that, too. I don't

also, if you dont breathe through your mouth, i do, you can just wear the nasal and not a full mask.

the people i have talked to who wear a cpap swear by it. I just couldnt get it to work for me.

 

There us a sleep disorders forum here. You may want to start another post asking about surgery and movement during sleep with cpap.

 

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