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I was just diagnosed with cyclothymia (rather than depression/anxiety as the last 8 years); I've taken lamictal for years as an AD, but doc gave me 12.5mg seroquel to augment it since it only controls the irritability and does nothing for the depression.

 

I don't really have sleep issues. When I GET to bed, I always fall right to sleep and pretty much stay asleep all night except sometimes when my husband gets up at 4 AM... however I do work late several nights a week and have to get up when my toddler gets up about 7-7:30. So sleeping itself doesn't seem like an issue, although I have "sleep initiation issues" big time... maybe it's just have a toddler but even when I'm tired  (never sleepy) and know I need sleep, I'll stay up an hour or two longer for no good reason. I also wake up tired and sore and fatigued all day, but worse in the morning.

 

Note: I also have virtually no hypomanic symptoms, or maybe a few of the "soft" symptoms. 

 

So maybe the doc thought if I took seroquel before I wanted to go to bed, I'd be too sleepy to stay up, ha... that worked the first night, but last night I took it at 10:30, got to bed 1:30 am :-/ 

 

Both nights I was very sleepy... but took forever to fall asleep and woke up constantly, it was awful. I don't know how something can be sedating and cause insomnia at the same time! Reminds me a little bit of how painkillers felt.

 

Anyone else had experiences like this? Just hoping it'll go away... after 8 years of no relief, kind of excited about this new diagnosis, hoping something will finally work!

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Seroquel gives me akathisia, an awful internal restlessness that makes one need to move. So, it would sedate me but I'd wake up because it also made me absolutely need to move around. Note, though, I am kinda an exception. Research, and experience on these boards, shows that Seroquel is not known for causing akathisia in many people.

 

Seroquel is known for helping depression in some but that benefit usually is when taking 200mg, more or less. I could feel a slight benefit start at 100mg.

 

Be open to trying another AAP. Each is different. Seroquel is the most sedating but others can be, too. It sort of depends on how your body responds. Others also help with depression at lower doses.

 

You also might want to ask about regular sleep meds.

Edited by AnneMarie
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Generally Seroquel at a low dose like that is rather sedating and shouldn't cause insomnia at all. Are you taking the regular or the XR version? 

I know how you feel about sedating drugs that keep you up.. Kind of a conundrum. 

 

Seroquel is great for irritability. 12.5mg is really, really tiny. For depression, as said above, higher doses are used.

Abilify really helps with depression, but it gave me EPS. Some find it really activating (I did) and others find it sedating. A low dose of Abilify is good for depression. Just keep going on for a bit and see what happens, it can change over time. It took me months to get side effects from Abilify, for example. It may just go away.

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Well why would I need regular sleep meds when I sleep fine? A sedating med might force me to bed earlier, but I think it's more of a behavioral issue... I may not get ENOUGH sleep, but usually that's not an option, I can't go to bed earlier or sleep in.

 

Some make you sleepy enough to sleep shortly after you take them. I think it was Lunesta that knocked me out very quickly. Unless you have an MI reason to take an AAP, which it sounds like you do, there's some research suggesting that the z sleep meds give better sleep in terms of sleep stages like REM.

 

Have you tried sleep hygiene techniques? One is to lay down in a dark, quiet room and relax your body starting from your toes up to your head. If your problem is behavioral, this might do the trick without any meds.

 

If you have depression, I would have that treated independently.

Edited by AnneMarie
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Some make you sleepy enough to sleep shortly after you take them. I think it was Lunesta that knocked me out very quickly. Unless you have an MI reason to take an AAP, which it sounds like you do, there's some research suggesting that the z sleep meds give better sleep in terms of sleep stages like REM.

 

 

Oh boy is there a list of abbreviations on the forum? Ha I think I need to learn some new ones... MI, medically indicated I'm guessing? AP something antipsychotic? Ha sorry for my ignorance.... also don't know what "z" sleep meds are... I got REM okay though, lol :-D

 

Yeah it's weird, it made me very sleepy (like droopy eyed head-nodding kind), which I never get. I'm always tired but still revved up mentally, maybe. I think he thought since I wake up sore and tired even after 8 hours of sleep that maybe the quality of my sleep wasn't good, and there's the "sleep initiation" issues, too.

Have you tried sleep hygiene techniques? One is to lay down in a dark, quiet room and relax your body starting from your toes up to your head. If your problem is behavioral, this might do the trick without any meds.

 

Yeah, sort of... mostly some others like trying to start my bedtime routine earlier... laying down and relaxing in bed is great, but more a technique to FALL asleep which I rarely need... in order to do that I'd still have to shut off my computer and GET to bed! :)

 

If you have depression, I would have that treated independently.

 

The jury's out I guess, because they've treated my depression for 8 years with no success after many AD's, therapy, etc. So while I think I do have "depression", doc thinks it's enough towards the cyclothymic side that mood stabilizers/APs might be more useful, but guess we'll see.

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MI on this website means Mental Illness.

z sleep meds are sleep meds like Ambien, Lunesta and a few others which have technical names beginning with a z like zopiclone.

This link is to a thread on acronyms used here http://www.crazyboards.org/forums/index.php/topic/64026-acronyms/

AP is for older antipsychotics like Haldol. AAP is for atypical antipsychotic, the more modern ones like Seroquel.

 

If your problem sleeping is the act of getting into bed and shutting the lights and electronics off, meds aren't your solution.

 

Bipolar can have cycles in the years. It's also possible that a person's cycle is between depressed and agitated depressed. Agitated depression has "energy" if only experienced as irritability and/or racing thoughts. Straight depression usually lacks that "energy" component. I say usually because straight depression for some includes anxiety, which can be hard to distinguish from agitation.

 

One of the signs of bipolar is depression that doesn't respond to antidepressants. If there are no other symptoms, it is up for debate whether the disorder is actually bipolar. What matters is that many of these people find that bipolar stabilizers including the AAPs and Lithium and anticonvulsants like Depakote and Lamictal help alleviate the depression. Antipsychotics known to help with depression include Abilify, Latuda, Geodon, Saphris, and a few others. I would be open to trying them if I was you. (ETA (edited to add): Seroquel also is one of the AAPs found to help some with depression. It, however, can be very sedating and you definitely would need to take a lot more than you are right now.)

 

Your GP sounds knowledgeable. I'd ask him/her for a referral to a pdoc (psychiatrist) who specializes in bipolar. Pdocs tend to be more knowledgeable about symptoms and psych medication, which can make a real difference in treatment.

Edited by AnneMarie
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Sorry, I need to edit my signature with my meds... I've taken Lamictal (150mg 1x/day, recently upped to 200mg) and it controls my irritability (but nothing else) really well. That was one of the tip offs to my doc I think. Also take adderall for ADHD

 

Again not looking for a diagnosis here! But I found this yesterday:

 

  1. The patient has had repeated episodes of major depression (four or more; seasonal shifts in mood are also common). **I have bad memory of this but feel like my depression has been pretty constant, although worse in the last year
  2. The first episode of major depression occurred before age 25 (some experts say before age 20, a few before age 18; most likely, the younger you were at the first episode, the more it is that bipolar disorder, not "unipolar", was the basis for that episode).
  3. first-degree relative (mother/father, brother/sister, daughter/son) has a diagnosis of bipolar disorder. **Not sure of this... both my parents have depression/anxiety issues but no clear bipolar symptoms that I can see
  4. When not depressed, mood and energy are a bit higher than average, all the time ("hyperthymic personality").
  5. When depressed, symptoms are "atypical":  extremely low energy and activity; excessive sleep (e.g. more than 10 hours a day); mood is highly reactive to the actions and reactions of others; and (the weakest such sign) appetite is more likely to be increased than decreased.  Some experts think that carbohydrate craving and night eating are variants of this appetite effect. 
  6. Episodes of major depression are brief, e.g. less than 3 months.
  7. The patient has had psychosis (loss of contact with reality) during an episode of depression.
  8. The patient has had severe depression after giving birth to a child ("postpartum depression").
  9. The patient has had hypomania or mania while taking an antidepressant (remember, severe irritability, difficulty sleeping, and agitation may -- but do not always -- qualify for "hypomania").
  10. The patient has had loss of response to an antidepressant (sometimes called "Prozac Poop-out"):  it worked well for a while then the depression symptoms came back, usually within a few months. 
  11. Three or more antidepressants have been tried, and none worked.

The ones in blue are definitely true for me. Plus major impulse control issues. Are addiction issues specifically related to bipolar? I can see how that would be impulse control as well... if that's the case, I have issues with that and my father and brother have addiction issues, too.

 

My GP thought Abilify or seroquel were both worth trying to augment lamictal, so he decided to try seroquel first. He said for cases like mine (non-psychotic) that generally a "whiff" of an AAP usually did the trick, guess time will tell.

 

Thanks for being so informative, everyone... I know I still need a lot more info from my doctors and hopefully the NP/therapist I'm seeing next week will have some insights.

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If antidepressants didn't work for you, then the next thing to try are stabilizers. You are on Lamictal already. It may actually be helping your depression, btw. You wouldn't necessarily be able to tell unless you stopped, which doesn't sound like a good idea since you know it is helping other things. So, adjunct AAPs are the next most logical step. It doesn't matter whether your dx is Major Depressive Disorder (MDD) or bipolar (BP) or something else. What matters is treating the symptoms. But, yeah, I know that having a diagnosis is nice and it's even nicer when you neatly fit into the categories or at least understand how you do fit.

 

Have you read this? It's a nice overview of Bipolar II. http://www.psycheducation.org/depression/02_diagnosis.html

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