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My second post here, my first has some history. Just after that post I got sick. Not badly sick just sickness, vomiting, feeling totally crap and together with side-effects something just had to change. So I quit the lithium. 1200mg to zero. Unwise? The psych said so yesterday and I'd read enough here and elsewhere to know there was a risk but I didn't care. Not depression didn't care, but totally fed up and having to force a change didn't care about the consequences. I wanted to make myself heard.

I tried for a week almost to get help (I'm in the UK). Because I wasn't a danger to me or others I wasn't referred to the Crisis team but the GP said see the psych, the psych was on leave and his stand-in just wanted to be sure I wasn't a danger again (Complete waste of time speaking to him). Lose lose everywhere. Screw it, off Lithium for certain. I stayed on Lamotrigine and you would have to tie me down to take Duloxetine ever again.

Saw psych yesterday, explained why I had done this. When I explained how I gave up drink he saw that my zero approach to Lithium was how I am, it's what I do, "if you are going to do it then do it" sort of thing. He did advise he would have liked me to take up to a year to withdraw and that I could have a rebound reaction but hey, what's done is done.

I really do not think I'm BP but I don't know what I am. I said I wanted 3 things.

1. A CPN. He said he'll get one.

2. A re-diagnosis. With a med change + reading of full history + the CPN I'll get it.

3. Some PRN medication should I start to take off. He said No. He wants to see me at that point, it'll help the diagnosis etc. Can't argue with that.

So that's a pretty good result I suppose. I'm still at risk of this rebound but there is no way to control or predict that.

Tonight I take 50mg quetiapine, tomorrow 100mg and then it's 150mg a night for a month. Side-effects will make themselves known but it's not like I can ever not get them is it? And it wasn't side-effects that made me stop the lithium in the first place.

My wife has said it's been nice to see and hear me back after so long. That's good. And the tremor has gone, that's very nice. I feel clearer, like an unfogged window. Not high, not bouncy, not anything untoward at all, just clearer.

Now to see what the next 7 days brings.

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1. A CPN. He said he'll get one.

Can you please define the acronym?.

A CB glossary can be found >>here<<

An online search for CPN, turned up this list.

With my background I recognize CPN as Certified Pediatric Nurse, but as you mentioned your wife I do not think you are pediatric. However, my thinking and assumptions can be, and often are, way off the mark.

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I think it's Certified Psychiatric Nurse. Not sure, though. Since a lot of us are from the US, it is helpful to spell some of those things out for us ;)

I'm speaking from experience here when I say going off meds on your own is a very bad thing. I understand the fed up thing, but withdrawal is a bitch.

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"I forget all the drugs I've had but I do know my psych is looking at which to start again with. Current chemicals are Lithium Carbonate 1200mg, Lamotrigine 250mg and Duloxetine 30mg."

There is nothing on your About Me page of your profile. I searched through your posts and found this post from February. So what meds are you on exactly? It really helps to put your meds in your signature. Look around and you will see that a lot of people do that. It is very hard to give any advice unless I know all the information re meds.

Are you still dealing with depression? There is some reason that a doctor gave you a BP DX. What was that?

That is a very fast titrate up on the Seroquel. It is a strong med and some people need weeks to become used to it. Your mileage may vary of course.

"And it wasn't side-effects that made me stop the lithium in the first place." Really? Then why did you stop your Lithium? And you know it might have been a possibility to reduce your lithium dose. It is an incredible med for many people. But of course some people cannot tolerate it. Do you know what your blood level was at 1200 mgs?

My overall impression is that you have NOT built a good relationship with a psychiatrist. You need a doctor you can trust, a psychiatric nurse might work too. Don't just take yourself off of meds. Work with a professional. And the DX is not as important as treating your symptoms so that you can function in life. I encourage you to build a relationship with a doctor or a psych nurse who you trust and like. Psych meds are complicated, strong, and have side effects. We all need good medical care.

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My first Intro post: http://www.crazyboards.org/forums/index.php/topic/44653-its-the-questions-that-matter/page__p__465372__fromsearch__1#entry465372

Sorry for the lack of a definition - CPN = Community Psychiatric Nurse. I have asked before and never been granted anyone.

Until I decide on a sig:

Was until 2 weeks ago: Lithium Carbonate 1200mg, Lamotrigine 250mg, Duloxetine 30mg

Now: Lamotrigine 200mg

From tonight: Lamotrigine 200mg, Queitiapine as described above. (I know he's ramping it up fast)

And no, I didn't have any good doc relationships. New General Practitioner is fresh out of school, my Psychiatrist changed every 3 or so appointments, my requests for everything were ignored. I know I need good medical care and I also know that sometimes the only way to do that is to do something that makes them look at you, take back some control, draw a line in the sand that says "Come over here and help me". That's why I stopped the Lithium. I wasn't prepared to go back in yet again and say the same as before, to get told pretty much the same as before and for life to continue as shittily. Dropping Lithium wasn't going to do that much damage and to be honest if I'd ended up in a ward in some way that would have been mission accomplished. I don't want to be like this but only I know how I feel and doing this was communication.

I asked for a Community Psychiatric Nurse a long long time ago. I wanted so I would be seen in my environment, that I would be seen on those days when I didn't want to leave the house and have to talk to someone. I wanted someone to see me regularly enough that they could become a trusted way of communicating between psych and me. I wanted them to see the real me not the me that sees the psych every few months for a few minutes where all they do is say what they want you to hear. I wanted someone who could ask my wife how I'd been too. I didn't ask because I wanted a shoulder to sob on, I had good real solid reasons and the help never arrived.

Withdrawal from Lithium? A breeze. No side-effects but then I quit drinking from 120+ units a week to zero overnight and was totally fine there too. (UK recommended units (was/is?) 21/week for a man, 14 for a woman) (I had a Liver Function test a few months later - it was perfect. Even the doc was surprised). (Your Mileage Will Vary).

My diagnosis was made by some junior wannabe psychiatrist who didn't dare open her mouth in front of the Consultants back in 2003. She wrote, others have blindly followed. What I actually want is no meds, nothing and to get a diagnosis on what I am like now. Today, this month, this next year. I In the end though the label doesn't matter - I know that - the right mix of meds do and I do trust this psych to deliver. If I didn't I'd be off them all. But the right drugs are what is needed and now it's time for quetiapine. I am assured that regardless of the label that the behaviours and thoughts I have will be addressed by this drug. Which is fine by me, it's what I want. And I know that I could be in line for a couple of weeks of side-effects which I would not have had if I had stayed on the Lithium but then I'd be no further forward if I still was.

And yes, psych meds are powerful things which is why I believe that every doctor must fully satisfy themselves that the drug regime is the correct one and consult the patient fully. I do not believe I got that, not at all. Of the ways I had at my disposal (self-harm again, starting drinking, wanting admission to a hospital) I think I chose the safest route - time will tell on that one and if something bad happens it will be my fault. Totally mine, I would not offload that onto anyone. But I do not regret it.

If you have a good relationship with those involved in your care then you are very very lucky.

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xyzzy, you have been trying

you really do deserve to have a good psychiatric care practioner

the system sounds very messed up

in the states it is largly a question of insurance and availability

much harder to get psych care without private insurance

but over the last few years I have talked with patients in the UK struggle, really struggle to obtain psychiatric care

it took years but I finally found a good doctor and a good psychologist, but it took a long time

at one point I spent six months trying different doctors, I would see them for three visits and then NOPE

this is NOT the doctor for me, move one and try another

needless to say this was difficult and friggin expensive

but I finally found my care team

hang in there, I see why you question your diagnosis

keep an open mind

I HOPE Seroquel works for you, take it early in the evening if you have to get up and work in the morning

Extended Release works differently than regular, some people try both

and I take both ER and regular

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The NHS is a mess but it has been so for many years. I do believe that here if you want to be heard you have to do something to make them see you, you have to force them to open their notes and justify their position. I'm lucky in that I have a very supportive wife who puts up with my crankiness and other moods.

I read a lot of posts on Metafilter and a few blogs by people with BP. I have no idea how your system works - what I mean is it's all about cash first and then you? I cannot understand that. The attitude of the Govt down seems wrong. I know too little to be able to fully discuss it though. I do know our National Health Service from both sides though and it's still broken.

This might sound wrong, might seem I am biased which I am but for the right reasons. This psych is the first 2003 whose native language is English. Born, raised, educated in the UK. I have had a greek psych, a turkish psych and several asian psychs. It's hard enough trying to describe to my wife how my thinking is broken some days so it's impossible to tell that to someone who probably doesn't understand the really crucial parts of what you are saying - or not saying. So my frustration also built from that - I'm talking, they aren't understanding and they are telling me what to do. They simply didn't have enough of a clue. That is not the case now, it's an opportunity for me to move forward at least until he moves on.

I think I cracked the sig and About Me though :)

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It is also the way that training runs in the UK.

You tend to see Foundation Dr's who are rotated every 3 months.

I am getting much better Psych care from my GP than I have since CAMHS (Child and Adolescent Mental Health Services) and I lose them in the summer because I am leaving Uni.

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That isn't actually at all a fast titration of seroquel. Some people start at much higher dosages, without a titration at all, and do just fine. I don'have any idea what is meant by calling it an especially strong med. It's no, "stronger," in any way I can think of, than any other med used for med stabilization or elevation. The main side effects with seroquel are sedation, which tends to reduce over time, and weight gain, which you won't know about for a little while. Just don't be surprised if you end up needing a higher dosage, as 150mg is barely above that used as a sleep aid.

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50mg and next day was okay.

100mg and the next day (yesterday) and I slept more than I was awake, felt sedated, drunk.

150mg and this morning I am sedated, unsteady, blurred vision, thirsty++. Never had this before. Managed to get the next 7 days off work because I can't do it in this state.

Not looking forward to tomorrow after another 150mg.

I'm really hoping this is transient.

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Can't remember typing that. I just woke up. Wiped out, never ever been like that. While I was zonked my wife rang the pdoc who said to stop the 150mg and to drop down to 25mg for a while and he'd review it rising.

So..... pdoc says I need meds as just Lamotrigine will not hold me, that Quetiapine is good and because of my actions in suddenly withdrawing (which I am still happy with) he got me to 150mg. I know that isn't a high dose and I also know that it could turn out to be very good for me but if I am down to 25mg and the end dose he is (was?) aiming for is upwards of 150mg then what on earth will 25mg do except start to get my brain acclimatised to the drug? I mean if 25mg is not an effective dose for me then I'm not getting any benefit so why bother?

I am not saying I shouldn't. I don't want or need to annoy the pdoc - I do trust him. But he wanted me on something and that something is 6 times stronger than what I will be on when the script arrives. And if he wants to ramp that up slowly (I hope) then until he gets to that desired 150mg there is not exactly a lot holding me - and I wanted nothing.

I'm sure he'd say that 25mg would be helping to which my reply would be "Well lets see how long it can help for shall we?" but I don't think I'd win there.

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