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Meds maybe don't quite cut it


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So, I'm currently on Depakote only, the blood levels are just in the middle of the therapeutic range. About 2 months ago, I started noticing a mood upswing, it was mild at first, but I did not do anything to stop it from getting out of control, quite the opposite, I basically did everything to escalate it. The mania was short (about 2weeks total) and predominantly euphoric and I crashed, but not too badly. About two weeks of mild depression, which is not too bad, but I worked hard to not ket it get out of hand.

 

When I was off meds completely, something like this would have turned into months of suicidal ideation and mixed mania and  and a crash to much more severe depression, so I suspect the Depakote is doing it's job, just not quite.  Now I am noticing some hyomania coming along again, and I really do not feel like going through the mania and crash again. On the other hand, some part of me is telling me how nice it would be (I'm telling it to shut the fuck up and remind myself how it went last time I gave into it). I'm planning to be more responsible this time and manage myself better, but I'm also wondering if some small med adjustment is at hand.

 

I'm seeing my doc in about a week and will ask him about possible med changes, but would like to ask you before: is this enough grounds to make changes to my medication? Do I just expect too much from the med if I think it will keep me from being very very tempted to do stupid things? Is there the med combo that keeps one stable without being zombified? I'm a bit scared of adding more med because I was quite over-medicated at some point and it felt terrible, I was very depressed, had no sex drive, no energy, no joy.....

 

I am aware no one here is a doctor and in the end the doc wil have to tell me what are the options, I just want to hear some opinions.

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I tried to use Depakote alone, and I honestly wish I had just taken the antipsychotic drug that was also prescribed. My mood swings became worse, with time and this lead to hospitalizations. I was deathly afraid of medications but some new antipsychotics exist that are not as side-effect inducing. I used Depakote the first couple of months, after I became hospitalized. Some ones you might want to look into that aren't so terrible are Latuda, Geodon, or Abilify (in that order). But again let the doctor make the final call. Depakote works to even out your moods but it definitely won't control it the way antipsychotics do. If you are against antipsychotics all together, and just outright refuse it, Lithium is a gold standard for people with Bipolar Disorder, but regular blood testing will always be an issue. Research antipsychotics medications and concerns, before you see a doctor. And the chat on this site is incredibly helpful if you want to talk to someone first hand. Some admin and mods that have been on many medications or are very knowledgeable are "Not me" and "sylvan"...you could try private messaging them some time, or finding them in the chat. 

 

*Note if you research Abilify and do want to bring it up with your doctor you should be warned that at low doses it has been shown to cause hypomania, and mania in certain individuals. 

Edited by Forbidden91
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Forbidden, as well you know, just because a med doesn't work for you does not preclude its helping someone else. A lot of people on CBs (including myself) have found Depakote to be very helpful, if not life-changing.

 

And anyway, you cannot say Depakote, an AC, is so terrible (sorry it didn't work out for *you*), and then go on to compare it to AAPs. Apples and oranges.

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It is hard not to give in to the mania and try and escalate it even further. That I know. Just keep reminding yourself of all the pieces you have to pick up when it's over and you crash. You are doing a good job of keeping that in mind.

And who knows? You may only need an increase in your depakote and may not need to try a new med. your pdoc will have to ultimately know what is best for you. Which you already know.

Anyways good luck at your appointment and keep us posted!

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Antipsychotics, especially atypical's, are much different than anticonvulsants. They work in completely different ways, especially Abilify, which is somewhat different from other atypicals. 

I need an anticonvulsant (or, better, lithium, which I can't take, the true mood stabilizer) with antipsychotics because not all antipsychotics stabilize mood as well as an AC. 

Depakote is one of the top to try, its great for rapid cycling and it is about even with lithium in side effects. Monotherapy (one drug) may not work for everyone, but there are other meds to try. Sometimes a benzo can calm down mania (my first bipolar drug combo was klonopin and depakote, just as an example) or different meds may be added. It helps many people, but if it isn't helping you, you definitely should see your doc and discuss it and what options there are. Some meds are better for other people. Not everything works on the first try, sometimes more meds are needed, or just a dose adjustment. 

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Forbidden, as well you know, just because a med doesn't work for you does not preclude its helping someone else. A lot of people on CBs (including myself) have found Depakote to be very helpful, if not life-changing.

 

And anyway, you cannot say Depakote, an AC, is so terrible (sorry it didn't work out for *you*), and then go on to compare it to AAPs. Apples and oranges.

Absolutely.  It saved me and got me out of four months of a rapid cycling mixed state.  Now I am thriving with Depakote added to my current cocktail. 

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I'm mostly happy with Depakote, I think it did wonderfully in reducing the range my moods have. And I haven't gone onto mixed moods on it, which was really a big problem  for me. The side effects are ok for me. I don't want to go off it.

 

The mania I got on it was really 'my fault' because I completely gave into it. I do realize though that it takes more than meds to keep stable. I'm actually kind of happy at the moment, the way I escalate usually is by going out, getting really drunk, flirting with every guy and girl I find attractive, talking over everyone and being the center of attention (in short, being an asshole). I just got back from a friends party and I did none of these things, which felt not possibly as exciting, but really good. I had a plan of how many drinks I'd allow myself before leaving and I kept to it.

 

I think I'm just get really nervous now because the mania got so out of hand once on Depakote that I feel I'm not sure it will be able to keep me in check. Maybe I should sit it out and just trust that I can control myself and keep the mania of with the help of Depakote if I want to.

 

When I got on Depakote, one of the things that was important to me was minimizing side effects like memory loss and similar stuff, my doc said Depakote would be best for that. My job is very important to me and I need my brain to function well. So, unless Depakote stops doing the things it does well, I'm reluctant to go to another mood stabilizer. I have some Klonopin and use it when things go bad and I feel I need an emergency stabilizer, it gives me a terrible hangover though, so I'm not using it often.

 

I'll keep you posted what the doc says.

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I can understand this. While latuda takes the edge off (something which no other med has done), it doesn't make the depression go away completely. I'm in a really dark place right now- like the "I can hardly move or string words together" depression, but- hey- I'm not delusional, so that's something.

I'm not feeling the manias anymore so much as an awareness that "I'd be manic as sh** without this med right now". What I still need is help with sleeping. I think that's why I'm still getting depressed. I'm not getting any kind of good sleep. I've been resistant to taking anything for sleep because I have a small child who still gets up sometimes in the night, but maybe it's time.

So, I'm having sort of the opposite experience with my aap. No mania or mixed state, but still the depression. I don't mean to hijack- I think it's interesting that the aap's left us both with an awareness of the mood still being there, but not fully taking over.

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