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Hi there. For a little background, I have recently started seeing a new pdoc and he thinks I have bipolar disorder. He has put me on Lamictal and I'm up to the full dose and it's really got me out of a funk :)

It's just... In our last session we were talking about my paranoia that I've been experiencing for the last few years since I binged on drugs and had amphet. psychosis. I'm not completely sure it is a like "mild psychosis" type of paranoia or just social anxiety or something. It seems to occur in both the hypomanic and depressive phase. Anyway.. He said he wants me to start a low-dose antipsychotic. I have expressed concern about weight gain which I experienced with Zyprexa in the past. He said he will use one without weight gain. I am also really concerned about tardive dyskinesia in the long-run. I didn't express that concern.

What is he likely to try me on? What are the long-term risks. How scared should I be? Is it only safe for the short-term? Will my paranoia/bipolar be worse after I stop?

?

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Hi there. For a little background, I have recently started seeing a new pdoc and he thinks I have bipolar disorder. He has put me on Lamictal and I'm up to the full dose and it's really got me out of a funk :)

It's just... In our last session we were talking about my paranoia that I've been experiencing for the last few years since I binged on drugs and had amphet. psychosis. I'm not completely sure it is a like "mild psychosis" type of paranoia or just social anxiety or something. It seems to occur in both the hypomanic and depressive phase. Anyway.. He said he wants me to start a low-dose antipsychotic. I have expressed concern about weight gain which I experienced with Zyprexa in the past. He said he will use one without weight gain. I am also really concerned about tardive dyskinesia in the long-run. I didn't express that concern.

What is he likely to try me on? What are the long-term risks. How scared should I be? Is it only safe for the short-term? Will my paranoia/bipolar be worse after I stop?

?

The two AP's that are generally tossed around when weight gain wants to be avoided are Geodon and Abilify, which are commonly used with treating Bipolar Disorder. Long term risks include tardive dyskinesia, diabetes, and metabolic syndrome though the latter two issues are probably more common in people who are already predisposed. You shouldn't be very scared, especially because of of the "low-dose" part-The lower the dose, the lower the incidences of long term risks and side effects. At the lowest doses of the AAP's, the risks are almost nil. Ideally people would only use AP's for the short term and then stop when they weren't needed because of the risks they bring. However, because AP's are used as prophylactics more than treatments, they are usually used for the long term.

I don't know if AP's make the underlying illness worse-In fact people would argue that not using AP's allows the underlying illness to get worse. It's my opinion that AP's can't make the underlying illness worse than it already is.

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It sounds like an AP or AAP would be useful for the symptoms you're having.

My first (and only) run-in with an antipsychotic was Seroquel. I was withdrawing from heavy marijuana use, and I was going nuts and couldn't sleep. I told my pdoc I was just going to smoke, and he called in Seroquel and told me to take that and go to sleep.

I slept so well, and it was a wonderful tool for quitting. So, in my case, the withdrawal was so miserable I was desperate enough to try anything.

Weight gain has never been a problem for me... I'm pretty lean and fit. But then, that hasn't been an issue with any medicine, so I don't know about Seroquel specifically, I think it depends on the person.

Hey, you can always stop if you don't like it or go up on the dose super slowly as you're comfortable, so you might as well give it a try.

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Hi there. For a little background, I have recently started seeing a new pdoc and he thinks I have bipolar disorder. He has put me on Lamictal and I'm up to the full dose and it's really got me out of a funk :)

That's great. Are you still taking the Zoloft? SSRI's usually make people with BP hypo. Are you experiencing any sort of Mania? If it's giving you any problems it could be worsening your issue below. Just FYI.

It's just... In our last session we were talking about my paranoia that I've been experiencing for the last few years since I binged on drugs and had amphet. psychosis. I'm not completely sure it is a like "mild psychosis" type of paranoia or just social anxiety or something. It seems to occur in both the hypomanic and depressive phase. Anyway.. He said he wants me to start a low-dose antipsychotic.

It sounds like paranoia to me. With some Psychosis thrown in there for fun. The AAP's should work for both, so I agree with your pdoc.

He said he will use one without weight gain. I am also really concerned about tardive dyskinesia in the long-run. I didn't express that concern. What is he likely to try me on? What are the long-term risks. How scared should I be? Is it only safe for the short-term? Will my paranoia/bipolar be worse after I stop?

AAP's are often used long-term. The only one that should be temporary is the Zyprexa due to the weight gain. People have been on AAP's for many years without suffering any long term risks. Tardive Dyskinesia can happen on any AAP, but it's not that common.. and on a very low dose, I'd almost guarantee that TD won't be a problem. Is it possible, yes; is it likely, no. Also, stopping only puts you where you were before, so no, your paranoia/bipolar won't be worse when/if you go off the AAP.

I definitely think you should try an AAP. Specifically Abilify. There is no weight gain, it takes you out of the depression aspect of BP, and will help the psychosis. Most BP'ers find it tolerable and helpful. But of course you'd have to try it and see how it works for you b/c everybody is different.

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Thanks for your replies guys. I feel a lot more confident now. I feel like I can trust you guys because you are so knowledgeable and have first-hand experience with these drugs.

Cetkat, I am still on Zoloft at 200mg. I am concerned it could make things worse now I know I may have BP. At the moment.. Since the lamictal.. I have felt really good (maybe too good?) sometimes but then I'll have a few days of depressed, can't get out of bed etc. And feeling pretty sad bout some stuff going on in my life. I was wondering if I was goin hypo at first.. But if I am.. It's not all how it happens. It's usually very distinct and more long term. Like a year of low and then a year of high and then it crashes again. I haven't actually been on meds during either hypo ep. Except the last was triggered by WB I think and I stopped taking it.

I take Zoloft for panic attacks but perhaps they won't come back if I get off it maybe they won't come back? I haven't had one for the year that I've taken it. I tried lowering the dose by 50mg and couldn't deal with the w/d. Might try reducing by 25.

I like the sound of Abilify but its not covered and costs too much. My options I can afford are Zyprexa, Seroquel, Geodon and Risperdal. I'd like to maybe give Seroquel a go because I'd like to sleep well and be less on edge. It may not make me gain like Z and I am naturally very thin and take weight gain shakes everyday. That's how bad Z was in that respect.

Is it a lot less weight-gainy than Zyprexa? I just don't want to gain 50% of body weight worth of fat haha..

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If not Abilify then probably Geodon (though I am able to take Abilify only because my pdoc gives me samples - ask about that if you need to). I believe Seroquel had a greater tendency to weight gain than Abilify or Geodon, though that might not make much difference if you are starting out very thin.

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NOTHING beats zyprexa for weight gain, so seroquel should be worth a try. I did gain some with it but we're alking a few pounds here, not a house. My main weight gainer that I have to fight is depakote, heh. Which i am successfully doing.

you could try seroquel xr if your insurance will cover it, sometimes the slow release meds seem to have a more even distribution and less S.E.s I did used to want to eat more after my immediate release seroqeul, but i took it that way on purpose because it makes me sleep better.

A lot of folks move from zyprexa to seroquel for presciseley the reasons mentioned.

I have been at (at times quite high) doses of AAPs for going on 12 years now and no signs of TD yet. I get monitored yearly, and I'm fine. like others have said, very low low risk.

i caution bipolars with abilify, myself, for some it is just too activating. for the depressive types, it can work well. Geodon, if you can figure out the tricky dosing, can work well. i am fearful of that med myself and never tried it but i have heart risk in my family and it is just to similar to abilify for me....

Anna

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I know Seroquel has weight gain as a side effect, but I've stayed exactly the same, so don't let that scare you. And as Anna said, if you're starting thin, you have less to worry about.

And just to reiterate what others have said, TD is SUCH a low risk, it almost never happens. And in low doses, especially.

I hope we alleviated some of your fears! I know how stressful new meds can be...

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Ok he put me on 25-50mg PRN of Seroquel. He had changed his mind since our last session about me needing an AP. It was his last day as my doctor so I don't think he was at all happy with prescribing it when he can't follow it up. He gave it to me more for anxiety and insomnia I'm having at the moment because I asked him to (he wanted me on benzo's but they don't work well for sleep, for me).

Is there any mood or AP benefit at such a low dose?

He said he'll talk to my GP before he leaves so the GP will manage my Meds for now until ii have a new pdoc.

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Haha yeah I slept 12 hours. Which I don't mind as long as I fall asleep earlier enough to wake up at reasonable hour. I don't mind taking it with dinner and bypassing the lonely nights to wake up before midday (which would be great, I have delayed sleep phase syndrome, goin on 8 years).

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Also... Anna, for the drug to help me with a suspiciousness towards other people would I need at least 200 or at least 400mg?

I had mood help at 100mg.. so it can be different. My BP friend was helped at 300mg. Now I'm at 400mg and I do notice a difference in mood.

Suspiciousness of others really does sound like something you need an AAP for.

Are you still on the Zoloft? That can set of mania and sometimes paranoia.

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Cetkat, I am wanting to try lowering my Zoloft to 175mg and seeing how I feel. I had the paranoia before Zoloft. My last hypomanic occurred and burnt out just before I was put on Zoloft. Why wouldn't AP's help paranoia? What else would help?

Anna, I'll talk to my gdoc (won't have tdoc or pdoc until march and april respectively). Hopefully he'll be on board with increasing quell. I know a gdoc wouldn't initiate antipsychotic therapy but maybe he'll be ok with titrating it. Do you think quell helps with paranoid ideation? It may be a BPD symptom as it isn't mood congruent (in fact maybe worse in depression?)

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Cetkat, I am wanting to try lowering my Zoloft to 175mg and seeing how I feel. I had the paranoia before Zoloft. My last hypomanic occurred and burnt out just before I was put on Zoloft. Why wouldn't AP's help paranoia? What else would help?

Anna, I'll talk to my gdoc (won't have tdoc or pdoc until march and april respectively). Hopefully he'll be on board with increasing quell. I know a g

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Cetkat, I am wanting to try lowering my Zoloft to 175mg and seeing how I feel. I had the paranoia before Zoloft. My last hypomanic occurred and burnt out just before I was put on Zoloft. Why wouldn't AP's help paranoia? What else would help?

Because if you are experiencing BP, it would be the best thing to do. Especially since you had the paranoia before starting an SSRI. Ask you doctor about what type of AP would be best and if you may need a mood stabilizer.

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What would be the best thing to do sorry? :s

I'm on Lamictal as my mood-stabilizer and probably will titrate Seroquel, while trying to wean off Zoloft. That is what I want to do though. Pdoc seemed to want me

to keep taking Zoloft and take no AP. Wanted me to use benzo's instead.

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That's ok.. it can be complicated. The best thing to do is to get an AAP that helps your paranoia. Basically, you need to get off the SSRI first and foremost before you go around trying different AAP's. Benzos are great for anxiety..I'm on Xanax myself.. but you've got to get the mood situation controlled before anything else. SSRI's like Zoloft should not be used in BP cases. Now you just need to try the different AAP's so see what helps most. Personally, if you can't get Abilify, I'd try Risperdal since it doesn't have many side effects and helps to quiet your thoughts. Ultimately, you just have to find what's best for you. However, I'd definitely stay on the Lamictal. Period. Hopefully your new pdoc can guide you more.

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