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should I be on a traditional mood stabilizer?


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Okay, so, I'm on the maximum recommended dose of Invega (12mg), which functions as my mood-stabilizer. I've been diagnosed several times as having bipolar I. But I've never been prescribed a traditional mood-stabilizer like lithium, depakote, lamictal, etc. In the hospital they gave me haldol, my old psychiatrist (like 4 years ago) gave me Seroquel, and the series of nurse practitioners I've seen over the past few years at the community mental health clinic I go to have only given me more AAPs and have never so much as mentioned other mood-stabilizers despite the BP I diagnosis. 

 

I mean, Invega does okay I guess. It keeps me from being full-blown manic. It seems to have helped pull me out of the massive suicidal depression I was stuck in for so long, along with my AD. But anytime I've gone below 9mg, I go completely manic and start hearing voices. Now I can't even go below 12mg. I still get hypomanic every couple of months on it (though recently it's been more frequent, like every 3 weeks or so), and have to take emergency Zyprexa for a few days until my brain calms down some. And I still get mild to moderate depressive symptoms from time to time, which seem to be getting more severe lately (I had strong suicidal thoughts for the first time in many months a couple of weeks ago, but that could have been triggered by the enormous stress of sitting in a hospital waiting for my grandfather to die).

 

I hardly ever get any good sleep. I sleep about 2-4 hours a night if I'm lucky. Many times I go two or three days without sleeping at all. I don't know if being on a MS would help with that, but I can't go on much longer like this and I'm willing to try anything. I feel like I'm only getting worse, and I really don't want to go higher with the Invega dose. The cardiac risks with it scare me as it is, and I'm also on amitriptyline, which works better for me than any other AD ever has, but also has similar cardiac risks associated with it. 

 

I see my NP again on 04/30- should I ask her about trying lithium or something like it? Is there some reason she and the others before her have never prescribed it to me? I'm just confused and starting to get desperate. Invega mostly keeps me out of the extremes, but I don't know for how much longer, and I'm sick of the 3-6 week mood yo-yo cycle I seem to be stuck in despite being on such a high dose of this medication. 

 

edit: I should add, it would be different if I thought my NP had a clue as to what she was doing. I like her and all but I get the feeling her every medication decision is guesswork. Maybe that's not so and I'm not being fair to her, but it's the vibe I get during our appointments.

Edited by hagar running
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I am not currently on a mood stabaliser, either. I am *supposed* to be on an antipsychotic and 2 anti-depressants, but I stopped taking the antipsychotic a few weeks ago without telling my doctor. We had talked about possibly going back on lamictal, after a hiatus from it of about 2 years, but instead he prescribed me an AD. 

 

When I first started the lamictal, which has fewer side effects than Lithium or Depakote can (potentially) have, it really helped a lot. It kept me from having a major episode for about 3 years.

 

My psychologist recently noted that it was indeed odd that I was not on any sort of mood stabaliser, as is usually reccomended for bipolar. Today I have an appt with the pdoc and will tell him I stopped taking my AAP and I will request lamictal again. The AAP made me feel like a flat emotionless zombie. 

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hagar, goodness yes

I think you should add a mood stabilizer and Lithium is a great choice.

I love, love my brain on Lithium.

 

I am Bipolar 1 also and need a mood stabilizer plus an AAP.

 

Sleep is really, really important for us.  It is vital.  This not sleeping for several days

will just destabilize most BP 1.  You need good sleep, 7 or 8 hours a night.

I think of it as time for my brain to reset.

 

I have read somewhere that  younger doctors don't use Lithium as much because

they don't know a lot about it.  I don't know if that is true but it is interesting.

Both my pdoc and my husband's psychiatrist are over 55 years of age and

they both like to use Lithium.

 

I have been on Depakote which is helpful for mixed moods, though I had unacceptable side effects.

However there are a lot of people who love it, who gladly take Depakote.

 

And there is Lamictal - the work horse for depression.

 

Let us know what you do Hagar.

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I am not currently on a mood stabaliser, either. I am *supposed* to be on an antipsychotic and 2 anti-depressants, but I stopped taking the antipsychotic a few weeks ago without telling my doctor. We had talked about possibly going back on lamictal, after a hiatus from it of about 2 years, but instead he prescribed me an AD. 

 

When I first started the lamictal, which has fewer side effects than Lithium or Depakote can (potentially) have, it really helped a lot. It kept me from having a major episode for about 3 years.

 

My psychologist recently noted that it was indeed odd that I was not on any sort of mood stabaliser, as is usually reccomended for bipolar. Today I have an appt with the pdoc and will tell him I stopped taking my AAP and I will request lamictal again. The AAP made me feel like a flat emotionless zombie. 

I hope your appointment went well and you were able to restart lamictal. I've had the flat zombie effect on previous AAPs but Invega has actually been pretty good in that regard for me, thankfully. May I ask why you had to go off the lamictal when you first took it? The only thing that makes me nervous about it is the long process of titrating up to a therapeutic dose that I've read about. I don't know how long I could handle the instability. 

 

 

hagar, goodness yes

I think you should add a mood stabilizer and Lithium is a great choice.

I love, love my brain on Lithium.

 

I am Bipolar 1 also and need a mood stabilizer plus an AAP.

 

Sleep is really, really important for us.  It is vital.  This not sleeping for several days

will just destabilize most BP 1.  You need good sleep, 7 or 8 hours a night.

I think of it as time for my brain to reset.

 

I have read somewhere that  younger doctors don't use Lithium as much because

they don't know a lot about it.  I don't know if that is true but it is interesting.

Both my pdoc and my husband's psychiatrist are over 55 years of age and

they both like to use Lithium.

 

I have been on Depakote which is helpful for mixed moods, though I had unacceptable side effects.

However there are a lot of people who love it, who gladly take Depakote.

 

And there is Lamictal - the work horse for depression.

 

Let us know what you do Hagar.

Thank you so much! I needed the validation that, yes, there is something not quite right with this situation. I've been looking at lithium for a long time now, I really want to try it. Youth could certainly be a factor as all the mental health professionals I've seen in recent years have been on the young side. And I completely agree with regard to the importance of sleep- the multiple sleepless days always coincides with the swing into hypomania, followed by Zyprexa, followed by mild to moderate depression. It's exhausting, yet I still can't sleep. And I'm on 150mg of elavil for goodness sake. I can't help but wonder if that's part of the instability equation as well, but then, I was so deeply depressed before I was prescribed it so I'm wary of messing with that one. Anyway, thank you. I will definitely follow up with this post!

 

 

It couldn't hurt to discuss it with your pdoc. It may just be the trick to getting you out of that three week cycling you spoke of.

Good luck and let us know how it goes!

Thank you! I will. You're right, I'm definitely bringing it up. I just needed partly to vent and partly to get some validation about all of this.

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If it helps, I used to be just on AAPs...but on Invega I found I needed a mood stabilizer, and I've just stuck with Lamotrigine ever since.  Sometimes I'm not sure I still need it, but if it ain't broke....

 

I think that it's worth talking to your pdoc about, for sure. 

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I saw the pdoc yesterday and he took me off the risperidone and back on lamictal. Hagar I originally stopped taking it because the former pdoc I had would just raise my dose anytime I had an issue, and eventually raised it up a little too high for me and I had some side effects. I decided then to try a combo of AAP and AD's instead of a mood stabaliser, and it worked ok for me but I was flat and had no personality. I am not worried about titrating up to a theraputic dose since I am currently stable.

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Definitely going to join the chorus here and say you definitely need to talk to your pdoc about mood stabilizers - been through many cycles like that before we fiddled around and found a mood stabilizer that does the trick to stop my cycling.

 

I would definitely suggest adding Lamictal into the list to talk to your pdoc about - I've been a terrible rapid-cycler for many years and this second go-around with it has been a wonderful thing.  (First go-around was back in 2005, pdoc back then wasn't the brightest crayon in the box and yanked me off of it because he was impatient, and...well...other things I won't mention in public.)   It was a very slow process to titrate up on it with me being the weenie that I am and my pdoc being so careful and understanding, but we seem to have found that the "sweet spot" for me is around 200 mg and I barely ever go into even a mixed state, let alone hypomanic or into my full-blown manic episodes.  Admittedly, it doesn't do much for my depression, but we had been close to a breakthrough on finding the right mix of ADs to get that sorted out before she left to take another job.  :   (Needless to say, whatever new pdoc I get will have a desk sailing at their head if they try to get rid of my Lamictal.)

 

I guess part of the reason I recommend giving it a go too is because the side effects have been reasonably tolerable, even for my med weenie ass.  I got headaches and a bit of agitation at too high of a dose and it aggravates my contact dermatitis and latex allergies to all hell, but that trade-off has been worth it for me (and the generic is quite cheap if you can price match it to Costco, which is a plus if your insurance sucks or don't have any!)

 

Really not sure why your NP wouldn't have recommended a mood stabilizer after you described your symptoms, but it's definitely something to ask about next time.

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hagar, goodness yes

I think you should add a mood stabilizer and Lithium is a great choice.

I love, love my brain on Lithium.

 

I am Bipolar 1 also and need a mood stabilizer plus an AAP.

 

Sleep is really, really important for us.  It is vital.  This not sleeping for several days

will just destabilize most BP 1.  You need good sleep, 7 or 8 hours a night.

I think of it as time for my brain to reset.

 

I have read somewhere that  younger doctors don't use Lithium as much because

they don't know a lot about it.  I don't know if that is true but it is interesting.

Both my pdoc and my husband's psychiatrist are over 55 years of age and

they both like to use Lithium.

 

I have been on Depakote which is helpful for mixed moods, though I had unacceptable side effects.

However there are a lot of people who love it, who gladly take Depakote.

 

And there is Lamictal - the work horse for depression.

 

Let us know what you do Hagar.

i second everything said here.  my first few docs just prescribed me go knows what until i ended up in the hospital.  luckily the two docs i had while in there, even though they were younger (at least one was), were more "old school" in their medication treatments and went right to the lithium.  my last doc there was also able to find me a pdoc outside the hospital who had been a resident under her so he has the same mentality - which is actually really great for me bc i can't tolerate anything but mood stabilizers.

 

lithium is an absolutely amazing drug.  of course, everyone tolerates things differently, but it's something that has such a long history of working so well, it shouldn't be discounted.  for me, i'm on three mood stabilizers (lithium, depakote, and topamax), but the lithium does the bulk of the work and i felt it very quickly after they first prescribed it.  the depakote works on the breakthrough mixed episodes i was having and the topamax smoothed out any residual anxiety and quelled the weight gain.  i find as soon as my levels drop on any of them (esp the lithium or the depakote) the anxiety, depression, mania, etc. all start poking through but i also start seeing things out of the corner of my eyes again, thinking i'm hearing things, etc. (i've heard debate whether or not a mood stabilizer alone can work for symptoms like that - it does for me - VERY well).

 

anyway, just wanted to second you getting on a good mood stabilizer.  of course i'm partial to lithium, but find what works for you and let us know how you're doing.  good luck!

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Oh how I love thee- my ode to lithium.  Any time some pdoc decided it was an old, outdated med, I suffered greatly, as those on CBs have seen.  On lithium I feel almost normal-almost!  It is also the only MS to keep suicial thought at bay during mixed episodes.  For me, at least.

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I would, but the nurse practitioner is only there one day a week so I'm not sure I could get in any sooner. I could always try going as a walk-in but I've done that before and sat there basically all day and never got in. I have a therapy appointment there this week though, so I'm gonna ask and see what I can do.

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Oh how I love thee- my ode to lithium. On lithium I feel almost normal-almost!  It is also the only MS to keep suicial thought at bay during mixed episodes.  For me, at least.

How do I love thee Lithium?  Let me count the ways.

 

(even though I ended up in the hospital toxic, very sick)  

 

I went right back on Lithium, lower dose, some new guidelines.

I love Lithium.

I would, but the nurse practitioner is only there one day a week so I'm not sure I could get in any sooner. I could always try going as a walk-in but I've done that before and sat there basically all day and never got in. I have a therapy appointment there this week though, so I'm gonna ask and see what I can do.

You sat there all day waiting for help and they did not squeeze you in, at least, at the end of the day???

sort of heartless   :(

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  • 3 weeks later...

Just an update-

Had my appointment today. My PN seems to think that if I can just get some good quality sleep every night, the mood swings would get under control. So she gave me a script for Ambien. I'm gonna see how this all goes. She said if that doesn't help we would discuss some other possible treatment like another mood stabilizer. I'm willing to try this first. Once again, thanks for your replies everyone!

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  • 2 weeks later...

I'm a little late....just came across this now. 

 

Lithium was lovely. Actually, it was the combo of Lithium, Seroquel, Lamictal and Klonopin that was so lovely. My brain felt....quiet. That said, me and Lithium didn't get a long very well and my doc took me off it. I was sad. Since Lithium he has never tried another mood stabilizer, that is until now. Now he is finally talking about using Depakote. 

 

I honest to goodness hope your doc puts you on a mood stabilizer with your AP. I'm no doc, but just from my own experience. AP's seem to be good at working quickly to get you stable, but it's the mood stabilizer that keeps you there and without it, I get wonky. 

 

Good luck with the Ambien. I don't remember my dose, but it did nothing for me at all. It works for some people, but for me, it was like eating candy. 

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