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Hello, everyone, this is my first post on crazyboards, first time poster long time reader. Let me get this out of the way and say please let me know if I'm doing anything incorrectly, thanks! Ok, so here's my question: I was diagnosed with bipolar type I my freshman year of college and have been on medication for the past year and a half. I have an almost constant extreme mania when I'm not on meds (only brief, but extreme depressive episodes mixed in) and I seem to adapt to any of the AP's that the pdoc and I try, I have been through Seroquel (knocked me out for 16-20 hours at any dosage level), Abilify, Geodon, Xanax, and Lamictal. At the moment I am taking 160mg of Geodon spread throughout the day and 200mg of Lamictal morning and night (been on these two for the past 3 months) and I have been extremely happy with this up until the past week.

My problem is, the pdoc and I will find an AP that works for 1-3 months, then I have constant breakthrough episodes of mania even as we up the dosage of the AP's, but as the AP's go up my depressive episodes occur more and more frequently so we added the Lamictal to combat the depression, however I can't seem to find any type of meds that can consistantly and effectively combat my mania. Obviously, there are still quite a few more AP's to try, however, I would like to stay away from the typicals as I already twitch enough as it is and don't want to risk any more. This is kind of broad and I'm not sure if we are supposed to ask this, but what have people had luck with overcoming extreme mania? And I literally do mean extreme, the meds have prevented me from being hospitalized in the recent months, but I still cannot seem to get a healthy balance.

I am extremely uncomfortable with being medicated, however, I do recognize that the meds help so I'm past that phase and all pdocs I seem to have a distrust of, as if they are merely working for the pharmacutical companies, pushing whatever drugs get them kickbacks (if it isn't obvious I am very manic today, even with the AP's hence my problem). This distrust, coupled with a bit of paranoia, has lead me to be unable to work out an effective remedy so I have decided to post and see what everyone's opinion on this is. Thank you for your time and consideration. (Kick me if I did something wrong, k? ;))

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1. How did you do on lithium? If you haven't been on it, is there a particular reason or concern?

2. For that matter, did you try any of the other anti-epileptic drugs (such as Depakote, Tegretol, etc.)?

3. Have you had a neuro exam?

The antipsychotics are great rescue drugs, and they're great for psychosis, but for long-term maintenance they aren't always enough on their own (or even with Lamictal.) This is one of the places lithium shines.

Also, you can get a Lamictal level. It's not particularly helpful in predicting clinical response, but it will let you know if you're a very rapid metabolizer and if there's room to go up with the dose.

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you cant do anything that wrong on this forum even if you try ;) unless you are a total soziopath. and that doesnt include using the f-word... i mean fuck you know....

sorry for bad english. i'm feeling totally awkward right now.... freaky

ehm...yeah. here we go :

geodon is not only an antipsychotic but also sort of an antidepressant, as it inhibits the reuptake of serotonin and norepinephrine (antidepressants exectly do that) and i'm sort of wondering if this can be eh,.... bad eh....for...you.

if you have the feeling that you are cycling more often, i would say you could blame geodon IMO. i am not blaming your doc of prescribing you meds that are bad for you. geodon is aproved for mania and there must be a reason for that. but at least theoretically it could destabilize people. and i dont think you need anything remotely resembling an antidepressant. [link=http://www.google.de/search?hl=de&safe=off&rls=GGGL%2CGGGL%3A2006-22%2CGGGL%3Ade&q=ziprasidone+induced+mania&btnG=Suche&meta=" target="_blank]case reports[/link]

another AP that can send people to mania is risperdal. for whatever reason. at least it did that to me BIG time and there or some case reports about that on the internet. [link=http://www.google.de/search?hl=de&safe=off&rls=GGGL%2CGGGL%3A2006-22%2CGGGL%3Ade&q=risperidone+induced+mania&btnG=Suche&meta=" target="_blank]case reports[/link]

the med that works wonderfully for my mania is Zyprexa. but there are also case reports on zyprexa causing mania.

zyprexa is a good med and it seldom causes the twitching stuff afaik. you can gain weight and there is a very small chance of getting diabetis but overall these are really overrated and hyped up by the media and lawyers. and it's also a wonderful prn drug. it kills mania in 30 mins or so, even 1/2 of the smallest pill.

and lamictal is not that good for mania. in fact, in europe it failed to get aproved for mania or maintenance treatment of bipolar. and there must be a reason for that. we are not dumb :) . its basicly only aproved for "depressive phases of bipolar disorder" over here.

so what i would say you could ask your doc for:

lithium is a good mania killer but i have no personal experience with that.

Valproic acid is supposedly very good for mania but less good for depression. (the brand name is depakote or epival or something in US)

and both of there are cheap as dirt unless you dont like generics.

mixing valproic acid with lamictal might be a good idea (i know one doc who is really likes this idea). but you must take half the dose of lamictal that you are taking now. and you may get The rash.

litium on it's own or with lamictal might be a good idea too. but valproate needs less often bloodwork done and is generally safer.

I'm sort of wondering what your doc is thinking. either he likes to experiment with newer medication rather than the old ones or he loves to prescribe expensive meds.

my doc does it the other way round. he starts with meds that are on the market for long enough to have proven their efficiency and safety.

now i'm tired. of writing. i go to bed. it's 7 pm after all. :)


polar bear

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For my mania I've been taking Zyprexa Zydis 5mg. It works very well for me. I haven't destabilized since I've been on it. However, it has caused some weight gain for me. I've tried other APs, Risperdal & Invega didn't help my symptoms at all, Abilify made me restless (akithesia), and Seroquel surprisingly made me hallucinate. Zyprexa has been a godsend for me and but for the fact that it causes weight gain, I've not had any problems with Zyprexa. Just has to be taken at night because it can be sedating.

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Hrmph. Just my opinion, you understand.

Start old school, lithium, Acs (depakote's a fave). Add in the atypicals as needed.

For certain types of mania, different types of meds--topamax doesn't hit all types of mania, but for me, it was the bomb. I wouldn't recommend it as a cure-all but would aim it more specifically. Atypicals, well, I'd generally like to see them used as adjuncts to the more baseline antimanics--lithium et al.

There's charts for this. The Texas bipolar algorithm or whatever it is these days.

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