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I'm sick of relapsing so often


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Sorry to bring down the mood. I'm just so fucking sick and tired of feeling like I have finally moved through my never-ending depressive episodes only to be smacked in the face by another one just a couple months later. This past episode was hell; hospitalized twice during it, medication tweaks I can't even recall, and finally a partial-hospitalization program and IV ketamine treatments. I thought I was good. I really, really thought I was good. Even semi-healed, naively (I highly recommend ketamine). And granted, this isn't nearly as severe as it could be, and I know I have my mood stabilizers and hard work to thank for that. But its just infuriating and so incredibly frustrating. I hate switching meds, I hate letting my psychiatrist down when I have to tell her my mood has started to plummet for the umpteenth time after being "good" for a period of time, and I hate feeling like I am, once again, going to drown from this disease.

This all happened because I think starting Risperdal a couple months ago secretly made me hypomanic, which I interpreted as just feeling "better', and then I inevitably crashed. Normally I am in and out of wildly mixed episodes, so this purely depressive crash after pure hypomania is new to me. Its a fucking letdown, thats for god damn sure. I'm sorry for venting. I just have no where else to go. Any words of wisdom? I'm already fearing the inevitable: breakdown, hospitalization, losing/quitting my job, starting all over again.

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My input would be that you don't have a responsibility to your pdoc to get and stay better. Yeah relapsing sucks, but that is why we pay doctor to handle  the stuff. If you weren't sick you wouldn't need the doctor. I am not trying to minimize the feeling of shit not working and starting all over, just that  in regards to the pdoc's feelings about you relapsing you shouldn't carry a responsibility of not letting them down    

Edited by Iceberg
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7 hours ago, mjs190 said:

Sorry to bring down the mood.

You have no need to apologize here.

7 hours ago, mjs190 said:

I'm just so fucking sick and tired of feeling like I have finally moved through my never-ending depressive episodes only to be smacked in the face by another one just a couple months later.

I can definitely say I can identify with these feelings for whatever it's worth.

7 hours ago, mjs190 said:

This past episode was hell; hospitalized twice during it, medication tweaks I can't even recall, and finally a partial-hospitalization program and IV ketamine treatments. I thought I was good. I really, really thought I was good. Even semi-healed, naively (I highly recommend ketamine). And granted, this isn't nearly as severe as it could be, and I know I have my mood stabilizers and hard work to thank for that. But its just infuriating and so incredibly frustrating.

Oof... I think we're in a somewhat similar situation... I think we've very briefly communicated off and on during our respective episodes.

I'm not out of the woods (not close) yet, but I feel like before I can even get shakily on my feet just for a few seconds, I'm already stumbling and falling back down to my knees again before getting my balance on my feet.

I think you have come farther than I have, based on what you've said here.

8 hours ago, mjs190 said:

I hate switching meds, I hate letting my psychiatrist down when I have to tell her my mood has started to plummet for the umpteenth time after being "good" for a period of time, and I hate feeling like I am, once again, going to drown from this disease.

Switching meds is a pain, yes. But like @Iceberg said, you don't have a responsibility to your pdoc to get and stay better. There seems to be what I would even dare to call "an illusion" about you of "letting your pdoc down" and "bringing the mood down around you" (regarding the latter, even in situations in which that would be totally "expected" or "appropriate," like on sites like this, and I can only imagine also talking amongst close friends, too (?)). Remember that it's okay to be not okay, and there are people out there, both professional and unprofessional, who are willing to help you on and be a part of your journey. (You may make some very close, meaningful friendships out along the way, too, if you're not watching carefully. ;))

Your pdoc is there to guide you however is necessary to see that you get out of this rut, no matter how many times it recurs and no matter what time this is that it has recurred. If your pdoc doesn't believe she alone possesses the resources to guide you where you need to be, she will refer you I'm sure. I can only assume she has done so before because of your PHP history, your hospitalization history, and even ketamine treatments. Just be open, honest, and transparent with her. Maybe there is something you two haven't tried yet? Something...

Just curious, how long do your periods of "remission" (AKA "good periods" or whatever you like to call them) tend to last? How "complete" do you think they actually are? I'm just curious... Since I became very ill back in 2012, I don't think I've had anywhere near a "complete" remission... ever... Only partial remission (like 50% at best) is as best as it has gotten since then, and I primarily deal with depressive episodes (occasionally with mood-congruent, I believe, psychotic features, if it lasts long enough and/or is severe enough...).

8 hours ago, mjs190 said:

This all happened because I think starting Risperdal a couple months ago secretly made me hypomanic, which I interpreted as just feeling "better', and then I inevitably crashed. Normally I am in and out of wildly mixed episodes, so this purely depressive crash after pure hypomania is new to me. Its a fucking letdown, thats for god damn sure. I'm sorry for venting. I just have no where else to go. Any words of wisdom? I'm already fearing the inevitable: breakdown, hospitalization, losing/quitting my job, starting all over again.

What dose of Risperdal were you on (if you remember). Do the "-dones" tend to have that effect on you? (I'm just trying to think of why an antipsychotic that so commonly has such strong tranquilizing effects would have a pro-manic effect in you.) What is your history with reactions to antipsychotics (if you feel like getting into it)? (I'm particularly interested in looking at this from a pharmacodynamic point of view, just a heads up.)

That most-hypomanic/manic crash is just devastating... Even lightly mixed episodes have that effect on me: a huge, huge crash.

Please don't feel bad for venting or anything, that's what this site is here for. We're here for you.

I have some potential ideas here, but nothing too concrete... Just questions at this point... lol.

Hopefully you can get to the bottom of this all before it gets to that point.

Keep in touch with us, don't be afraid to open up. :) 

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I can relate.

The only words of wisdom I have are that you're definitely not letting your psychiatrist down. You obviously have no reason to blame yourself; you're taking medications and trying new ones when they don't work. It's not anyone's fault that that isn't always enough.

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Offering my support.  I avoid my appointments sometimes because I don't want to tell.the doc I "failed" another med, when the truth is the med failed me.

A thought a couple of years ago I would be on the mixed/depressed train ride forever but I actually did spend a good year or more in a good place (except for some lingering ocd).

I spent many years doing the breakdown/hospital/lost job routine but it has gotten better.  No hospital and stayed semi -functional for a while now.

I am only saying this as a way of offering some hope it can get better.  Don't think too far ahead and assume it will end badly.  I ended badly for a lot of my life but somehow it's gotten a little better, not sure what the secret sauce is but don't think that just because things ended that way before they are always going to.

You've got resources in the earlier replies that can offer some med advice, all I have to offer is a recommendation to not lose hope.  

Everything I have said may also be very cheesy and completely annoying so I will accept that.

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2 hours ago, Complicated toad said:

Offering my support.  I avoid my appointments sometimes because I don't want to tell.the doc I "failed" another med, when the truth is the med failed me.

A thought a couple of years ago I would be on the mixed/depressed train ride forever but I actually did spend a good year or more in a good place (except for some lingering ocd).

I spent many years doing the breakdown/hospital/lost job routine but it has gotten better.  No hospital and stayed semi -functional for a while now.

I am only saying this as a way of offering some hope it can get better.  Don't think too far ahead and assume it will end badly.  I ended badly for a lot of my life but somehow it's gotten a little better, not sure what the secret sauce is but don't think that just because things ended that way before they are always going to.

You've got resources in the earlier replies that can offer some med advice, all I have to offer is a recommendation to not lose hope.  

Everything I have said may also be very cheesy and completely annoying so I will accept that.

Not cheesy at all and very helpful to hear, I appreciate your response toad.

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On 6/17/2020 at 12:04 AM, mikl_pls said:

Just curious, how long do your periods of "remission" (AKA "good periods" or whatever you like to call them) tend to last? How "complete" do you think they actually are? I'm just curious... Since I became very ill back in 2012, I don't think I've had anywhere near a "complete" remission... ever... Only partial remission (like 50% at best) is as best as it has gotten since then, and I primarily deal with depressive episodes (occasionally with mood-congruent, I believe, psychotic features, if it lasts long enough and/or is severe enough...).

 

Thanks for responding. This past remission was about 4 months, after 6 ketamine treatments in January/February (my brain has a hard time recalling the specific time of past events.) I've had even longer periods of success, like maybe a year, even at times without AAPs on board. For a while during nursing school I was on a combination of Depakote, Lamictal, and Wellbutrin, although in hindsight I may have been mildly hypomanic, or at least a having ups and downs that weren't full-blown symptomatic of a disease course. 

On 6/17/2020 at 12:04 AM, mikl_pls said:

What dose of Risperdal were you on (if you remember). Do the "-dones" tend to have that effect on you? (I'm just trying to think of why an antipsychotic that so commonly has such strong tranquilizing effects would have a pro-manic effect in you.) What is your history with reactions to antipsychotics (if you feel like getting into it)? (I'm particularly interested in looking at this from a pharmacodynamic point of view, just a heads up.)

I started taking it for a depressive episode with mixed features and high anxiety. I went from 1 mg to 1.5 mg to 2 mg finally. It made me feel energized and I had to take it in the AM because PM dosing gave me severe insomnia. At first, I questioned with my therapist whether I might be hypomanic. My speech was more pressured than usual, I was upbeat, a little euphoric at times, but no impulsivity or mixed components that I can recall. It really helped for the first month or so. But then I crashed so rapidly. Purely depressed, miserable, tearful, all the neurovegetative symptoms of a depressive episode. 

Latuda made me very anxious, and didn't help brighten my mood. I understand it is not a rapidly-acting medication though and I've never stuck it out long enough to find out how it may work for me. Those are the only two -dones that I have tried. And that is not the first time Risperdal hasn't worked out for me in the long-run.

Interestingly, the last time I took 2.5-5 mg of Zyprexa as a PRN to quell a mixed depressive episode, it sent me into a 3 hour long rolling panic attack. Zyprexa used to be my last resort med and it consistently helped, but the past few times I have taken it, I've been hit with panic and misery. Its like AAPs are suddenly not agreeing with me after years of utilizing them with mostly success. The only one I can rely on is Seroquel XR, which I'm currently taking a high dose of in lieu of Risperdal (400 mg, maybe going to 600 mg depending on response). Perphenazine caused a lot of anxiety and racing/bizarre thoughts, as did Abilify to some extent, too. Its definitely not akathisia, as there's no inner tension. Its in my head. I just don't know what to make of it. I should mention that Haldol really, really helps settle things down for me in a pinch, without causing weird problems.

Seroquel is really the only medication I know the pharmacodynamics of backwards and forwards, maybe Risperdal, too. But the others I'm not as well versed beyond the basic receptors the interact with. I have no idea why I'm suddenly responding this way to these meds, and neither does my doc, though I did read an article about Risperdal causing hypomania in patients. I can try to dig it up.

Edited by mjs190
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Loose advice: the little things do count.

Sleeping and waking and eating at the same times. Getting sexual intimacy with the same partner. I’m not a good record keeper but I find I even have to regulate more or less my exposure to the sun. 

Recently a string of cloudy days was kicking my ass and when the sun came back I gave in and took a couple of sunbaths (this is at home, we get sunlight well into our apartment in winter despite being in a dense urban area and looking at buildings in all directions with no view). Third day, it threw me off. I picked up fights online in places you’re not supposed to pick up fights.

I theoretically haven’t had any relapse in maybe a decade, but still get “subclinical” episodes from tiny triggers.

Mind the tiny triggers.

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  • 2 weeks later...

mjs190, I don't have any words of wisdom to impart, but just wanted to let you know that I too am so sick of this fucking disease and overwhelmed by the constant soul-sucking depression. I've not ever been hospitalized, but have definitely lived through the complete mood collapse, job loss, bankruptcy, etc.

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On 6/17/2020 at 11:45 PM, mjs190 said:

Thanks for responding. This past remission was about 4 months, after 6 ketamine treatments in January/February (my brain has a hard time recalling the specific time of past events.) I've had even longer periods of success, like maybe a year, even at times without AAPs on board. For a while during nursing school I was on a combination of Depakote, Lamictal, and Wellbutrin, although in hindsight I may have been mildly hypomanic, or at least a having ups and downs that weren't full-blown symptomatic of a disease course.

I'm sorry it took me like half a month to get back to you!

Wow, so that's actually a pretty long remission period for my standards... (I too have a hard time recalling specific time of past events.) A year of remission is almost unheard of for me... lol.

So you tend to do better without AAPs?

On 6/17/2020 at 11:45 PM, mjs190 said:

I started taking it for a depressive episode with mixed features and high anxiety. I went from 1 mg to 1.5 mg to 2 mg finally. It made me feel energized and I had to take it in the AM because PM dosing gave me severe insomnia. At first, I questioned with my therapist whether I might be hypomanic. My speech was more pressured than usual, I was upbeat, a little euphoric at times, but no impulsivity or mixed components that I can recall. It really helped for the first month or so. But then I crashed so rapidly. Purely depressed, miserable, tearful, all the neurovegetative symptoms of a depressive episode. 

Wow. That's really bizarre! I've heard of Latuda, for example, dong that to many people, but never Risperdal.

On 6/17/2020 at 11:45 PM, mjs190 said:

Latuda made me very anxious, and didn't help brighten my mood. I understand it is not a rapidly-acting medication though and I've never stuck it out long enough to find out how it may work for me. Those are the only two -dones that I have tried. And that is not the first time Risperdal hasn't worked out for me in the long-run.

(My best friend is taking Latuda 20 mg and we believe it is making him anxious, possibly.)

Hmm, so you've mostly tried the -pine AAPs? Zyprexa and Seroquel I'm sure, possibly Saphris? Proabbly not Clozaril...

On 6/17/2020 at 11:45 PM, mjs190 said:

Interestingly, the last time I took 2.5-5 mg of Zyprexa as a PRN to quell a mixed depressive episode, it sent me into a 3 hour long rolling panic attack. Zyprexa used to be my last resort med and it consistently helped, but the past few times I have taken it, I've been hit with panic and misery. Its like AAPs are suddenly not agreeing with me after years of utilizing them with mostly success. The only one I can rely on is Seroquel XR, which I'm currently taking a high dose of in lieu of Risperdal (400 mg, maybe going to 600 mg depending on response). Perphenazine caused a lot of anxiety and racing/bizarre thoughts, as did Abilify to some extent, too. Its definitely not akathisia, as there's no inner tension. Its in my head. I just don't know what to make of it. I should mention that Haldol really, really helps settle things down for me in a pinch, without causing weird problems.

WOW... Ok so as we know it, Seroquel XR is your only go-to AAP.

Perphenazine caused anxiety and racing/bizarre thoughts? That's literally a paradoxical reaction if I'm not mistaken. Perphenazine is used in combination with amitriptyline for anxious depression (Etrafon/Triavil) and is said to be an intermediate potency FGA, but it looks pretty high-potency to me based on the numbers. Could be wrong though. I was fixing to say maybe it was akathisia, but I know what you're talking about as my best friend has this type of reaction seemingly to all antipsychotics (atypical so far).  If Haldol works, have you ever tried Prolixin? I'm just curious since it's sort of regarded as the phenothiazine version of Haldol and has less risk for heart problems, movement disorders, etc. Personally, my favorite is Stelazine, you may have known for a while though. It's not especially a quick-acting antipsychotic, but it's super nice for anxiety of all types, mood-brightening effects, and tics (which I deal with Tourette's syndrome).

The new AAP, Caplyta, is literally a butyrophenone, in the same class as Haldol and droperidol. Its pharmacology is nothing alike, of course, but just figured I'd throw that out there. Potent 5-HT2A antagonism, SERT inhibition, D2 bimodal modulation (presynaptic partial agonism + postsynaptic partial antagonism), glutamate increase through D1 receptor stimulation, and aside from the PI sheet, I found out there's some D4 affinity and some pretty potent α1A/1B/1D antagonism (causes pretty nasty orthostasis with me all the time). This antipsychotic has been a game changer/life changer. The difference in me has been night and day. I still am not where I need to be, and still take Stelazine 5 mg bid prn to patch things up here and there, but it's great. My insurance somehow covers it, all they wanted was a PA, and I got that through my gdoc since my pdoc doesn't give PAs too reliably (plus it was my gdoc who prescribed the Caplyta anyway). It's an option that is out there should you wish to literally go out on a limb and try it. The SERT inhibition could be problematic for you since I seem to remember you don't do too particularly well with SSRIs, and it's just about as potent as its D2 modulation. Right now there's only one dose, 42 mg, and it's the dose for schizophrenia at the moment.

I just can't imagine why these antipsychotics are giving you these reactions though. Could be the 5-HT2C antagonism/inverse agonism? Seroquel and its metabolite aren't too potent on 5-HT2C antagonism as Zyprexa is, but it's more potent than Risperdal is (or at least tighter affinity... not necessarily "more potent...")

On 6/17/2020 at 11:45 PM, mjs190 said:

Seroquel is really the only medication I know the pharmacodynamics of backwards and forwards, maybe Risperdal, too. But the others I'm not as well versed beyond the basic receptors the interact with. I have no idea why I'm suddenly responding this way to these meds, and neither does my doc, though I did read an article about Risperdal causing hypomania in patients. I can try to dig it up.

What about Seroquel and its metabolite do you personally think pharmacologically make it the only one right now that you know of that you can depend on? I'm curious what your take on all this is, because this doesn't seem to make sense to me at all, yet it isn't uncommon.

Sorry you're going through this, I hope you're doing better, @mjs190. Sorry again it took me so long to respond.

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  • 1 month later...
On 6/16/2020 at 3:42 PM, mjs190 said:

Sorry to bring down the mood. I'm just so fucking sick and tired of feeling like I have finally moved through my never-ending depressive episodes only to be smacked in the face by another one just a couple months later. This past episode was hell; hospitalized twice during it, medication tweaks I can't even recall, and finally a partial-hospitalization program and IV ketamine treatments. I thought I was good. I really, really thought I was good. Even semi-healed, naively (I highly recommend ketamine). And granted, this isn't nearly as severe as it could be, and I know I have my mood stabilizers and hard work to thank for that. But its just infuriating and so incredibly frustrating. I hate switching meds, I hate letting my psychiatrist down when I have to tell her my mood has started to plummet for the umpteenth time after being "good" for a period of time, and I hate feeling like I am, once again, going to drown from this disease.

This all happened because I think starting Risperdal a couple months ago secretly made me hypomanic, which I interpreted as just feeling "better', and then I inevitably crashed. Normally I am in and out of wildly mixed episodes, so this purely depressive crash after pure hypomania is new to me. Its a fucking letdown, thats for god damn sure. I'm sorry for venting. I just have no where else to go. Any words of wisdom? I'm already fearing the inevitable: breakdown, hospitalization, losing/quitting my job, starting all over again.

How you're feeling is to be expected and perfectly normal and as long as you're taking your meds, going to therapy, etc. — you know, keeping up with self-care — you're not letting anyone down, least of all your psychiatrist. 

For what it's worth, I can tell you coming from the other side of the glass, as they say — working directly with people in mental health — I never feel let down or disappointed by someone coming back inpatient for care. If anything, it's the opposite — that I feel as though I let them down.

One of the things I do genuinely feel, though, is gratefulness that they've come back to get help and aren't actively suffering and without it, dead, or in jail. 

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