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I am a little unsure of my mood lately. Basically I’ve started feeling better after a long long time of severe depression, probably due to an increase in Prozac.
 

After years of not even showering or leaving the house I suddenly felt like fixing all the problems in my life and going out and about (I am normally agoraphobic).

 

I started a strict diet to lose weight and started seeing a personal trainer 3 x a week, I quit smoking and started again, looked for jobs, ended up getting one at the gym I go to.

 

After not having sex for like two years suddenly I am doing a different guy every night, with no condom. I don’t care. I feel full of drive. Normally I spend most of my time asleep and the rest of the time lying in bed or on the couch but now I suddenly wake up very early a lot of the time.

Sometimes my speech is tiny bit pressured I think. I have been spending too much. My mother told my pdoc that I seem a bit manic to her. Pdoc didn’t say anything. I really pray this is normality and not mania because I don’t want to crash.

 

I want to keep working and Working towards having a great body. Some reasons I think it’s not mania: no racing thoughts, speech only a bit pressured at times, still sleeping most nights, still feel tired if I don’t sleep, delusions and paranoia better than they have been in years, I’m trusting people again, also I’m on an AAP and lithium so that should keep a lid on the hypo, right?

What do you guys think? Should I ask my doc for a temporary lithium increase? I tolerate it very well.

I’d also be interested to hear in what ways you recognise your own hypo/manic episodes, if you ever can?

 

Edited by mcjimjam

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How long ago was the Prozac bump? Sounds like you should get in touch with your doc to get his assessment and handle meds from there... some of those activities sound quite risky 

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I usually rely on tdoc to tell me what my mood is, up or down. Do you have someone like that in your life?

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5 minutes ago, aura said:

I usually rely on tdoc to tell me what my mood is, up or down. Do you have someone like that in your life?

I have a tdoc and she doesn’t seem to be worried about my mood, or she hasn’t expressed any worry anyway. But mum knows me better and sees me more. She’s a health professional too. Has worked on psych wards etc. there’s a saying like “mother is always right” and I find that to be so true. Usually when we disagree i eventually realise she was right and I was wrong.

1 hour ago, Iceberg said:

How long ago was the Prozac bump? Sounds like you should get in touch with your doc to get his assessment and handle meds from there... some of those activities sound quite risky 

You know it’s complex and I have a very loose grip on time. There were two Prozac bumps and also a period of time I stopped taking it in between. The sex isn’t so risky because I’m on Prep so won’t get HIV at least. Maybe some other STI.

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Yes but I think pdoc might be very interested in what you just said and how ur defining “risk” 

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I have a terrible time recognizing hypomania in myself. My depressive episodes are years long so when I finally start feeling better, it's so amazing that I don't want to hear that it might be too much of a good thing. I'm finally coming out of yet another long depressive episode, so I'm in the same spot you are. But it seems since you came up so suddenly, and with the increased sex and spending, I think it would be worth talking it over with your pdoc. 

I wish I could live the rest of my life in a hypomanic state. I feel like it would let me make up the lost time for the many years I've spent lying in a darkened room wishing I was dead. But that damn crash at the end is such a killer that I know better.

I don't know about you, but I'm tired of hyper-analyzing my mood state all the damn time. I know that's the cost of having this stupid disease, but still I get tired of it. I wish I could just feel good and not be worried in the back of my mind that something may be wrong, again. 

I hope you can talk this over with your pdoc and figure out if you're in a new episode or not. Good luck to you.

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I think the risky sex with many partners and not safe is a red flag. BTDT and it seemed the best thing ever at the time but looking back, no. Other STIs are not insignificant so don’t make the mistake of minimizing them, and I don’t know if you’re meeting your partners in a safe way?  Also overspending can drag you down for a long time. So I do think you need to be very specific with your team of pdoc/tdoc about exactly what’s going on, beyond “having sex again “ or the vague type things I used to say, if that’s what you’re saying. I do get the feeling of wanting to keep the up part, but it’s possible to feel pretty good without the risky parts taking over, if your meds get adjusted. For me, it all got more out of control before I really was clear about what I was doing, and that made it harder to get everything balanced. No, I’m not a pdoc, but I do know yours should hear enough specifics to know what’s up. I had to get pretty graphic and specific or at least it felt that way. It’s hard to talk about this things, at least for me.  I hope you can get situated with your meds soon. 

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You sound to me like your brain engine is running hot, and one way or the other, whatever’s causing it, you need to get the risky sex under control ASAP. You might not care now, but what you’re doing can have repercussions that will impact you for the rest of your life.

Talk to your pdoc. Maybe print out what you told us. 

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Posted (edited)
On 7/31/2020 at 5:07 PM, mcjimjam said:

I am a little unsure of my mood lately. Basically I’ve started feeling better after a long long time of severe depression, probably due to an increase in Prozac.

That would make sense. I remember at the top end of the fluoxetine dose range that it was pretty stimulating. Even at 40mg.

Quote

After years of not even showering or leaving the house I suddenly felt like fixing all the problems in my life and going out and about (I am normally agoraphobic).

Improvement in agoraphobia and personal hygiene on a combination of fluoxetine/brexpiprazole wouldn't be surprising. That's the kind of combination that will put a jazz in your step ;) 

However, starting to have this sense that all of your problems are suddenly effortlessly surmountable could border on "grandiosity" or "invincibility" both of which are dangerous parts of the array of bipolar symptoms.

Quote

I started a strict diet to lose weight and started seeing a personal trainer 3 x a week, I quit smoking and started again, looked for jobs, ended up getting one at the gym I go to.

Have you found yourself smoking more or less since getting to this dose of brexpiprazole? Good you were able to start a diet and get to the gym again.

Quote

After not having sex for like two years suddenly I am doing a different guy every night, with no condom. I don’t care. I feel full of drive. Normally I spend most of my time asleep and the rest of the time lying in bed or on the couch but now I suddenly wake up very early a lot of the time.

Okay so this is usually one of MY red flags. I truly think that everyone's bipolar disorder is unique or that there are certainly many subgroups beyond bipolar 1 and 2. With that, there would be certain symptoms that are more prominent than others and also from person to person, the "red flag" symptoms (i.e. the ones that show up first).

I, like you, generally lie in bed for a bit before getting up. Or I might fall back asleep and wake up later if it's not time to wake up yet. When I'm headed towards hypomania or I'm in hypomania, I may still get tired in a day, MAYBE. But the most noticeable thing is that I wake up in the morning feeling WIDE AWAKE, rip-roaring ready to go. Now since we've gotten my valproate level in the normal range, that doesn't really happen anymore.

Quote

Sometimes my speech is tiny bit pressured I think. I have been spending too much. My mother told my pdoc that I seem a bit manic to her. Pdoc didn’t say anything. I really pray this is normality and not mania because I don’t want to crash.

So it may be worth bringing up that brexpiprazole has been associated with a modest deterioration in impulse control as well as compulsive behaviors like gambling, online shopping, risky sex like you've mentioned above. I believe aripiprazole was far worse for this, but I haven't seen long-term numbers from brexpiprazole yet to say for sure one way or another.

Quote

I want to keep working and Working towards having a great body. Some reasons I think it’s not mania: no racing thoughts, speech only a bit pressured at times, still sleeping most nights, still feel tired if I don’t sleep, delusions and paranoia better than they have been in years, I’m trusting people again, also I’m on an AAP and lithium so that should keep a lid on the hypo, right?

it SHOULD, but brexpiprazole and lurasidone are the two AAPs that really failed to treat (hypo)mania effectively but they're very effective for treating bipolar depression. They seem to be good for the depressive side of things, whereas when it comes to mania, they really need to be used in tandem with something else for complete symptom control, like lithium or valproate (have you ever tried valproate?)

Quote

What do you guys think? Should I ask my doc for a temporary lithium increase? I tolerate it very well.

I think that you should present all of this to your pdoc exactly the way that you presented it to us. And I know that's easier said than done sometimes, being this open with your pdoc. But if I were your pdoc and you described this to me, I would be grateful because your self-awareness and attention to those details seems to be pretty impeccable. So you give him the list of symptoms you've been experiencing that you think are problematic like the increased spending, risky sex, feeling like you can conquer all of your problems, etc. Then tell him the reasons why you think you aren't hypo like you described above: delusions and paranoia are well-treated, getting good sleep and feeling tired if you don't sleep, only slight pressure of speech, etc. If I were a clinician, that gives me as complete a picture as any.

Increasing lithium may not be a half bad idea, but that would depend greatly on your lithium level and if there's even room to increase (most people taking 900-1200mg/day). You may know this already, but a safe therapeutic blood level of lithium is 0.6-1.2mEq/L. Toxicity can happen at 1.5mEq/L and higher. Severe toxicity at 2.0mEq/L and medical emergency at 3.0mEq/L. I'm assuming you're on 1000mg based on your signature. I'm also assuming you have access to lithium CR (controlled release) in 300mg and 450mg tablets. It would be possible to go to 1200mg, I think.

Quote

I’d also be interested to hear in what ways you recognise your own hypo/manic episodes, if you ever can?

Like I said above, being wide awake pretty much from the moment I wake up gives me pause and I start to pay closer attention to my mood. Irritability is another major problem for me. I can be in a much cheerier mood than usual, but I will still inexplicably snap at people. Like my actions towards others may completely contradict my mood.

I usually don't gauge myself off of how I feel though. Like if I feel like I can achieve my goals, who am I to say that I can't? However, when my reactions to my environment around me (e.g. people) don't make sense or my responses are out-sized relative to the "stimuli", and when physically the gears start to feel like they're running hotter, I pay closer attention.

Edited by browri

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On 8/4/2020 at 11:50 PM, browri said:

That would make sense. I remember at the top end of the fluoxetine dose range that it was pretty stimulating. Even at 40mg.

Improvement in agoraphobia and personal hygiene on a combination of fluoxetine/brexpiprazole wouldn't be surprising. That's the kind of combination that will put a jazz in your step ;) 

However, starting to have this sense that all of your problems are suddenly effortlessly surmountable could border on "grandiosity" or "invincibility" both of which are dangerous parts of the array of bipolar symptoms.

Have you found yourself smoking more or less since getting to this dose of brexpiprazole? Good you were able to start a diet and get to the gym again.

Okay so this is usually one of MY red flags. I truly think that everyone's bipolar disorder is unique or that there are certainly many subgroups beyond bipolar 1 and 2. With that, there would be certain symptoms that are more prominent than others and also from person to person, the "red flag" symptoms (i.e. the ones that show up first).

I, like you, generally lie in bed for a bit before getting up. Or I might fall back asleep and wake up later if it's not time to wake up yet. When I'm headed towards hypomania or I'm in hypomania, I may still get tired in a day, MAYBE. But the most noticeable thing is that I wake up in the morning feeling WIDE AWAKE, rip-roaring ready to go. Now since we've gotten my valproate level in the normal range, that doesn't really happen anymore.

So it may be worth bringing up that brexpiprazole has been associated with a modest deterioration in impulse control as well as compulsive behaviors like gambling, online shopping, risky sex like you've mentioned above. I believe aripiprazole was far worse for this, but I haven't seen long-term numbers from brexpiprazole yet to say for sure one way or another.

it SHOULD, but brexpiprazole and lurasidone are the two AAPs that really failed to treat (hypo)mania effectively but they're very effective for treating bipolar depression. They seem to be good for the depressive side of things, whereas when it comes to mania, they really need to be used in tandem with something else for complete symptom control, like lithium or valproate (have you ever tried valproate?)

I think that you should present all of this to your pdoc exactly the way that you presented it to us. And I know that's easier said than done sometimes, being this open with your pdoc. But if I were your pdoc and you described this to me, I would be grateful because your self-awareness and attention to those details seems to be pretty impeccable. So you give him the list of symptoms you've been experiencing that you think are problematic like the increased spending, risky sex, feeling like you can conquer all of your problems, etc. Then tell him the reasons why you think you aren't hypo like you described above: delusions and paranoia are well-treated, getting good sleep and feeling tired if you don't sleep, only slight pressure of speech, etc. If I were a clinician, that gives me as complete a picture as any.

Increasing lithium may not be a half bad idea, but that would depend greatly on your lithium level and if there's even room to increase (most people taking 900-1200mg/day). You may know this already, but a safe therapeutic blood level of lithium is 0.6-1.2mEq/L. Toxicity can happen at 1.5mEq/L and higher. Severe toxicity at 2.0mEq/L and medical emergency at 3.0mEq/L. I'm assuming you're on 1000mg based on your signature. I'm also assuming you have access to lithium CR (controlled release) in 300mg and 450mg tablets. It would be possible to go to 1200mg, I think.

Like I said above, being wide awake pretty much from the moment I wake up gives me pause and I start to pay closer attention to my mood. Irritability is another major problem for me. I can be in a much cheerier mood than usual, but I will still inexplicably snap at people. Like my actions towards others may completely contradict my mood.

I usually don't gauge myself off of how I feel though. Like if I feel like I can achieve my goals, who am I to say that I can't? However, when my reactions to my environment around me (e.g. people) don't make sense or my responses are out-sized relative to the "stimuli", and when physically the gears start to feel like they're running hotter, I pay closer attention.

Thanks for your response. I have been smoking a lot lately but now the last few days I have been vaping instead and hope to continue that. Things have calmed down some now. Not having sex so much. Feeling fairly chilled. I think I’m okay. My lithium level is 0.6 btw

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On 8/8/2020 at 5:39 AM, mcjimjam said:

Things have calmed down some now. Not having sex so much. Feeling fairly chilled. I think I’m okay.

That's good to hear!

On 8/8/2020 at 5:39 AM, mcjimjam said:

My lithium level is 0.6 btw

Oh then you have plenty of room to grow then if you needed to. Although it sounds like maybe a lithium increase isn't so necessary? Worth still talking to your pdoc about it because hypomanic episodes can be followed by depressive episodes or further cycling without an adjustment.

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