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Soooo Tired of the Rollercoaster


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So I'm in a state funded program which is great because I'm on disability and my Medicare hasn't started yet and they cover all my meds, but really sucks because I only get to see my pdoc every 3 months. The last few times I've seen him I've been manic and 3 months ago, VERY manic, now within the last 2-3 weeks I've finally hit rock bottom, far worse than usual. Any suggestions or ideas? This is the first time I've had a depression spell in over 6 months. There's never an in between. Anyone have any ideas on meds that have worked for you?

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Have you tried calling your pdoc, to see if you could get an earlier appointment?

There's really no telling what med is most likely to work best for you, especially without knowing what you're currently taking, or what you've taken in the past.

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The current meds I'm on are Lithium 1200mg, Lamictal 150mg, Geodon 80mg, and Klonopin 1.5mg. I've been on Abilify, Ativan, Celxa, Depakote, Effexor, Lexapro, Paxil, Prozac, Risperidal, Seroquel, Trazadone, Trilafon, Xanax, Zypresa just to name a few. Lithium has always seemed to work best, but it I've always had to have something else with it..

The pdoc works here and in at least 1 other office, most of the time they'll only give me the nurse if it's a life or death emergency and she can't do much of anything without emailing/talking to him and then I have to wait again. Never once have they even let me leave a message on his voicemail.

I have a case manager, but she's great to talk to but that's about it. Two visits ago I was very unstable, I was there to see him and my case manager and she told me he couldn't see me and I'd have to wait 2 MORE months to see him, I fell apart because I was so unstable in front of everyone in the waiting room THEN they let me see nurse that and she told the doctor he had to see me. It's a screwed up system but it's all I can do until the Medicare kicks in in Feb 2012 (WAY TO FAR AWAY) and I can switch pdocs and go back to my last one (I loved her).

According the the state program I'm in I don't qualify for any therapy only for visits to the case manager (every 3 months), the doctor (every 3 months), nurse to follow-up on new meds only and the med chic that gives me my meds (once a month).

I asked last time about a full med change but he won't do that without putting me in the hospital and with no insurance they'd have to put me in a State hospital with a court order which I'm not "sick enough" to do. I've gone through a med change on my own at home before with my last pdoc because I refused to let her put me in the hospital, but she was also there for me 24/7 if I needed her (but I didn't).

After 3 weeks of being at rock bottom, the manic symptoms are starting to show up so my guess is by the time I see him next week I'll be manic again.

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You know, this may be one of those times where a mood chart would be helpful. Chart all this stuff so you've got something concrete you can hand to the doctor when you finally get to see him. I know that doesn't help for the here and now but it'll give you something to do while you wait and it might be helpful in the long run.

LOL! I keep a mood chart, the last two visits the pdoc has just said well this is great but how do you feel today. Because I see him every 3 months I starting the charting, but he never seems to be concerned with it only how I feel at the moment. I think it would be relevant how I "feel today" if I saw him every week or two weeks, but considering I've gone from manic, to a very bad depression and am headed back up again in the last three months I thought the chart would be helpful but apparently it won't be if he does what he's done before. :angry2: Another reason why I can't wait to be able to see my old pdoc when I have insurance again.

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*Attention, incoming uninformed opinion from non-medical type person* WHOA. WHOA. I can certainly understand needing an additional drug to work with the lithium to help you out, but, look at the list of all the meds you are on. What the heck? Just imagine all the possible interactions between all of that stuff. You've gone from a slight ongoing chemical imbalance in your brain to a freaking barrage of chemicals slamming your neurotransmitter levels. That doesn't mean you should be non medicated, but really, this is just nuts. You should be weaned back down just to lithium and then have one drug introduced at a time over a three to six month period. Not three or four at a time. What is it with the medical profession and basic scientific method anyway? This sounds like they decided to throw the kitchen sink at your illness and then they are surprised when you still have trouble? Just something to think about. I mean, myself, I don't need anti-psychotics, they all put me to sleep, just lithium by itself takes care of me just fine. Good luck. Hope somebody makes an effort to help you.

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P.S. I don't like Klonopin, I have yet to speak to anyone who has done spectacularly well on that drug. Klonopin and alcohol addiction very nearly killed my ex wife before I helped her kick her habits.

It's just my opinion, I could be wrong.

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*Attention, incoming uninformed opinion from non-medical type person* WHOA. WHOA. I can certainly understand needing an additional drug to work with the lithium to help you out, but, look at the list of all the meds you are on. What the heck? Just imagine all the possible interactions between all of that stuff. You've gone from a slight ongoing chemical imbalance in your brain to a freaking barrage of chemicals slamming your neurotransmitter levels. That doesn't mean you should be non medicated, but really, this is just nuts. You should be weaned back down just to lithium and then have one drug introduced at a time over a three to six month period. Not three or four at a time. What is it with the medical profession and basic scientific method anyway? This sounds like they decided to throw the kitchen sink at your illness and then they are surprised when you still have trouble? Just something to think about. I mean, myself, I don't need anti-psychotics, they all put me to sleep, just lithium by itself takes care of me just fine. Good luck. Hope somebody makes an effort to help you.

I think you make some very valid points about all the meds I plan on bringing up to my pdoc on Tuesday. He does seem to keep adding more and more. I was never on any anti-psychotics until recently. The Geodon helped for about a week with my insomnia issues and that was it. Rather than treat my insomnia with a sleeping pill he keeps adding or upping the other drugs I'm on. My last pdoc had the philosophy that without a good sleep pattern you can't stabilize and she prescribed sleeping pills that seem to help more than all these added drugs, this pdoc insists that insomnia is just a symptom of mania and the mania needs to be treated then my sleep with be stabilized. I'm just so tired of the up & down of things, and even worse I've learned to hide how bad it is from the people around me (including my husband) so the people around me don't realize I'm in trouble until I've done something stupid. I'm getting much better about letting my husband in on things (especially after the last manic spell). He plans on coming to see the pdoc with me Tuesday for the first time since I've been seeing the doctor, not sure how that is going to go.

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You do have to make your own med decisions and if you don't like your pdco there aer others, but keep in mind no one on here is a "medical professional"

and one woman's problem with mixing klonapin and etoh doesn't make it YOUR problem, either.

So, yeah. YMMV and all that. If a sleep med is good for you, then make that happen with whatever pdoc of your choice that you feel you CAN work with.

Anna

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You do have to make your own med decisions and if you don't like your pdco there aer others, but keep in mind no one on here is a "medical professional"

and one woman's problem with mixing klonapin and etoh doesn't make it YOUR problem, either.

So, yeah. YMMV and all that. If a sleep med is good for you, then make that happen with whatever pdoc of your choice that you feel you CAN work with.

Anna

I'm kinda stuck with my pdoc for now .:( It's a state program that pays for everything and he's the doc. Otherwise we have to pay for everything ourselves which we can't afford. I hate taking so many pills every day, although I have been on more at times, sometimes I do think some of my past meds may have made it worse than it would be, and I have gone off all meds before (that was not fun) once I got them out of my system I was fine...for a while. Then when the first major mood swing hits and I get overly angry at my children (one of them is ADHD, we don't pair well together at times...others its great cause I have as much energy has he does LOL) or go on spending spree that leaves us unable to pay the bills I realize that I can only live without the medications at a price-hurting the people around me that I love. So I know I have to stay one them I just wish the damn doctor would get it right. The mood swings are still there, very noticeably there and my anxiety (specifically social anxiety) is getting worse, not better. I've been doing lots of reading and my husband is coming with me so he'll remember all the things I'm to manic to remember to mention.

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*Attention, incoming uninformed opinion from non-medical type person* WHOA. WHOA. I can certainly understand needing an additional drug to work with the lithium to help you out, but, look at the list of all the meds you are on. What the heck? Just imagine all the possible interactions between all of that stuff. You've gone from a slight ongoing chemical imbalance in your brain to a freaking barrage of chemicals slamming your neurotransmitter levels. That doesn't mean you should be non medicated, but really, this is just nuts. You should be weaned back down just to lithium and then have one drug introduced at a time over a three to six month period. Not three or four at a time. What is it with the medical profession and basic scientific method anyway? This sounds like they decided to throw the kitchen sink at your illness and then they are surprised when you still have trouble? Just something to think about. I mean, myself, I don't need anti-psychotics, they all put me to sleep, just lithium by itself takes care of me just fine. Good luck. Hope somebody makes an effort to help you.

Outrider, sometimes, when you realize you don't know what you're talking about, it's best not to talk so much. I don't know what you're basing this,"advice," on, but it seems like not much.

You have no idea if CherishedDarkness started off with, "a slight ongoing chemical imbalance in your brain," no idea about the severity of her symptoms, now, when she was initially diagnosed, or at any moment when her med decisions were made.

Lithium, lamictal, and geodon hardly constitute, "a freaking barrage of chemicals slamming your neurotransmitter levels.". Add in the klonopin, it still doesn't. Of the meds listed, only geodon is known to act directly on neurotransmitter levels. Lamictal stabilizes neuronal membranes, by inhibiting sodium channels, and then maybe modulates presynaptic release of some excitatory neurotransmitters, or at least, that's currently the best guess anyone has as to its mechanism. Lithium, for all the research that's been done, nobody really has a convincing idea of its mechanisms. Klonopin binds to GABA receptors. Thereby enhancing its effects, without, I don't think, actually increasing its concentration.

You seem to be basing your nonmedical medical advice on your own experience. Lithium momotherapy works well for you. That's great, but it means absolutely nothing as far as what anyone else should be doing with meds. You have no real idea about the op's response to lithium, or any of her other meds. Assuming lithium should form the backbone of her cocktail, because it works so well for you is potentially dangerous advice, especially when you go so far as to recommend she stop all of her other meds. And your theoretical schedule for adding meds in, where is that coming from? Maybe it would be great, in some theoretical perfect universe, in which this lengthy process isn't prolonging an actual person's instability. In reality, most people would prefer to get stabilized a lot more quickly than that, and then, once stable, work on any fine tuning meds might need. And that's been the approach taken by every pdoc I've ever seen. That said, you have no idea how, or over what period of time, the op's meds were added. The presumptions you're making about them, and what would be good for her, have no basis.

P.S. I don't like Klonopin, I have yet to speak to anyone who has done spectacularly well on that drug. Klonopin and alcohol addiction very nearly killed my ex wife before I helped her kick her habits.

It's just my opinion, I could be wrong.

Again, your ex-wife's experience with klonopin has absolutely nothing to do with what anyone else's is likely to be.

For the record, klonopin has been my very occasional PRN for years, never been a problem.

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Cherished Darkness, to get back to your original question, looking at the meds you're currently taking, my nondoctor suggestion for addressing depression would be to start with increasing either geodon, or lamictal. Geodon, if it helped, would probably kick in more quickly.

The sleep thing is an endless problem for me. Regardless of mood state, I have sleep issues. Seroquel is the only thing that's ever worked consistently for me, but sleep meds vary a lot from person to person.

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Cherished Darkness, to get back to your original question, looking at the meds you're currently taking, my nondoctor suggestion for addressing depression would be to start with increasing either geodon, or lamictal. Geodon, if it helped, would probably kick in more quickly.

The sleep thing is an endless problem for me. Regardless of mood state, I have sleep issues. Seroquel is the only thing that's ever worked consistently for me, but sleep meds vary a lot from person to person.

Since my original post I've actually started back out of the depression, I just haven't hit bottom that hard, that quickly in a long time. My Geodon is 1-2 pills at night so I started taking 2 a little before the post but I'm headed straight back up again and the anxiety is back worse than ever. I sleep (sorta) when I'm depressed, but my sleep has dropped back to 2-3 hrs a night again (another reason I know the mania is on it's way). Just waiting on the racing thoughts and crazy obsessions that come with it. If I follow my pattern I'll be manic when I see the pdoc again Tuesday. I've taken Seroquel before for sleep and and all it did was make me again weight....would have much preferred my manic obsession with pixi-sticks & Kit-Kats to have done that LOL. I've been on a number of sleeping pills, some at the highest doses possible.....they work a night or two then don't help.

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Well thankfully for the notifications I program into my phone I didn't miss my appointment that was scheduled TODAY not tomorrow....(and my husband wonder's why I write things down in 3 places LOL) So according to pdoc here's the plan...I'm going to start cutting my Lamictal dose tonight and over the next 2 weeks to get completely off of it. My meds will be in Wednesday and he'll start me on Depakote (he didn't tell me the dosage guess I'll find out then), and we'll be upping my Geodon from 80mg to 160mg over the next two weeks and instead of 0.5 of klonopin in the morning and 1mg at night, he's changing it to 1mg 3 times a day. Guess we'll see where this lands me in the next few weeks. I'll have blood levels a week after starting the Depakote and a follow-up with the nurse a week after that and they'll change/adjust according. Thank you everyone for your help.....I may not say much elsewhere in the forum but I'm always lurking. :rolleyes:

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Cherished Darkness, to get back to your original question, looking at the meds you're currently taking, my nondoctor suggestion for addressing depression would be to start with increasing either geodon, or lamictal. Geodon, if it helped, would probably kick in more quickly.

The sleep thing is an endless problem for me. Regardless of mood state, I have sleep issues. Seroquel is the only thing that's ever worked consistently for me, but sleep meds vary a lot from person to person.

Uh Sash... I get the sense that you are missing the bigger underlying pattern. You and I never agree on anything. Like, ever. Primarily because you approach things from a cautious, methodical, by the numbers type methodology whereas I call them like I see them using snap judgements, generalizations and my own and other's experience. I think the benefit to people like Cherished is that they get to see our interplay and get the benefit of the broadest possible interpretation of things. Again, I'm not criticizing your approach, I just get the sense you are going to get increasingly frustrated when I don't do what you think I should do. Why not just say up front "you and I are never going to agree" and then state our respective cases for the benefit of the overall community? Most of them are plenty smart enough to call me on something when I sound unreasonable. Anyway, I am glad to say that I finally have met someone who has had a good experience with Klonopin. And no offense intended.

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