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Advice on two aps or an alternative?


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My psychiatrist of two years has gotten me out of a depressive episode twice now. And both times said that since he’s not a hospital doctor most of his patients are depressed so he doesn’t give enough thought to mania. He recently took me off abilify (a mainstay for 10 years) to put me on Caplyta. It helped the depression immensely but then I became slightly too elevated. I called and asked to be put on vraylar (because I don’t want to feel sedated at all). He said my insurance wouldn’t pay for vraylar and caplyta. But he didn’t make any suggestions other than I could take my leftover abilify, which I didn’t do  

Eventually after 3 weeks of what I can only describe as the worst hypomania ever, I went to my pcp thinking I had hypothyroidism because I had such severe psychomotor agitation. My labs and ekg were normal then I stayed up til 6am and did some really fucked up humiliating shit and eventually realized I was hypomanic. I took a few zyprexa zydis and slept over the next few days. My pcp gave me some klonopin to get me through til my psych appointment. Not good.

What should I expect? I take requip for depression, adderall ir and xr, and supposed to take lamictal but I swear it’s the most worthless drug that I can’t make myself take, caplyta and traz. Then klonopin for the past week which has been really bad. Pretty sure I’m in a mixed episode. I’ve taken depakote and lithium. But I don’t wanna deal with side effects and lab work and I’m 100 pounds over weight. Any ideas? Should I post this somewhere else? Looks like I need a mood stabilizer, but I would prefer an ap. 🤔 

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@iLove I think youre going to be out of luck getting insurance to cover anything not old or super cheap as ap combo with caplya. I think that if you feel caplya helps depression, a mood stabilizer is probably in order, It would suck to add an ap that alters or negates the caplya effect. Also, a lot of studies suggest correcting one ap by adding another doesnt always improve outcomes. Have you tried tegretol? i think there is some blood work but less frequent than other two you mentioned. 

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On 6/27/2022 at 2:44 PM, Iceberg said:

@iLove I think youre going to be out of luck getting insurance to cover anything not old or super cheap as ap combo with caplya. I think that if you feel caplya helps depression, a mood stabilizer is probably in order, It would suck to add an ap that alters or negates the caplya effect. Also, a lot of studies suggest correcting one ap by adding another doesnt always improve outcomes. Have you tried tegretol? i think there is some blood work but less frequent than other two you mentioned. 

He ended up prescribing trileptal. He had a lot of good reasoning. The dude is like an idiot savant with meds. Like autism special interest and learn everything about it. I think I’m autistic so not denigrating. But as much as I hate the appointments and communication, he seems to know his shit with meds. So we’ll see in a week. He also gave me neurontin for anxiety. Odd that I’ve never been described either. 
I appreciate you and everyone else so much. 
Btw on my scripts, he categorized bipolar affective disorder, unspecified. Am I wrong to be annoyed by that? I said I’d seen him two years but he mentioned today I’ve been seeing him right at a year. Last august I had a manic episode when my mom was put in icu with Covid. I find it annoying that he downplays my illness. For one I have bpd, and I need a lot of validation. For two, it’s not like I have some bpII crap. But I’ve also been in an episode too so being extra sensitive probably too. 

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3 minutes ago, Iceberg said:

In my experience this means nothing, it’s basically just for insurance 

I 100% know you’re right. I’m just really sensitive.

Btw I didn’t discuss today with my psych a few things I planned to, and my fiancé went with me to help me talk about everything but I didn’t have a chance to talk about everything like 15 point iq loss in ten years, aggression and violence, severe short/med/long memory loss. I have wondered if I have alcohol related brain damage because I used to drink a lot. I also can’t understand things as quickly and easily as I used to. 

I’m 43 diagnosed at 32. Is this normal bipolar related brain degeneration or should I ask to see a neurologist? I don’t know because I’m a hypochondriac but my fiancé thinks there’s some kind of issue besides mood going on as well. I don’t know. Fml 😝 

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On 6/28/2022 at 11:48 PM, Iceberg said:

In my experience this means nothing, it’s basically just for insurance 

Work in a psych hospital on a bipolar & schizophrenia unit and can confirm. If the intake psych can't hone in on a diagnosis at the time and/or get outpatient collateral, they're likely to give a bipolar disorder I, nos (not otherwise specified), mood disorder, nos etc. Otherwise, insurance won't pay for admission or continue to pay. It's a place holder essentially until the on-unit psych doc can talk to the patient and hopefully get more diagnostic clarity.

I've also seen DSM code numbers on the invoice my psychiatrist sends to my email and when I googled it at the time, they came up with Major Depressive Disorder, Intermediate and it may or may not have had at one point a specifier "In partial remission" as well as Social Phobia/Social Anxiety Disorder. 

And I don't know what dosages you're on honestly, but if you do in fact have BPAD, the stimulants could very likely be destabilizing you. At the hospital I work at, stimulants are big no no's with bipolar disorder, even if you're taking it as prescribed and not taking extra. 

Edited by psychwardjesus
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19 hours ago, psychwardjesus said:

Work in a psych hospital on a bipolar & schizophrenia unit and can confirm. If the intake psych can't hone in on a diagnosis at the time and/or get outpatient collateral, they're likely to give a bipolar disorder I, nos (not otherwise specified), mood disorder, nos etc. Otherwise, insurance won't pay for admission or continue to pay. It's a place holder essentially until the on-unit psych doc can talk to the patient and hopefully get more diagnostic clarity.

I've also seen DSM code numbers on the invoice my psychiatrist sends to my email and when I googled it at the time, they came up with Major Depressive Disorder, Intermediate and it may or may not have had at one point a specifier "In partial remission" as well as Social Phobia/Social Anxiety Disorder. 

And I don't know what dosages you're on honestly, but if you do in fact have BPAD, the stimulants could very likely be destabilizing you. At the hospital I work at, stimulants are big no no's with bipolar disorder, even if you're taking it as prescribed and not taking extra. 

There is a special unit just for bipolar/schizophrenic patients or those are some diagnoses you see?  I am in US, in CA.  I have been in several hospitals and work in a crises stabilization unit and have not seen anything specified like thst.  I have been on a secure unit where everyone was higher acuity.  

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