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what to do about breakthrough episodes when medicated?

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so i had a hypo episode a few weeks back that i *think* was attributed to raising my abilify and dropping the latuda. but then i crashed into a slight irritable depression.


is a med tweak in order? can it be made better with coping techniques? what do you do to cope? i see my pdoc on monday so i'll be talking to her about it. but i want to go in prepared with what to say and suggestions on what to do, as she is very receptive to my thoughts.


she told me abilify was a mood stabilizer, but i don't know if it's doing the trick, or maybe i'm not on enough, or maybe it's all hormonal due to my cycle. or maybe it's stress induced?



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I don't remember any issues when I was on Abilify, but my partner recently started it and he got slightly hypo for awhile...and he's not bipolar.  He wasn't hypo-hypo, just a lot more up than normal after taking it.  It went away after a week or two and he's on 10mg now (with an AD too).  I'm not sure about the irritable depression you're having now but it could be mixed, might be that Ablify is triggering/activating for you.  I have no idea obviously, but it's worth a conversation with your pdoc. 

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Abilify never really helped me all that much until I reached a 30mg daily dose. So ask your pdoc if he or she thinks a dose increase is in order or if you need to switch meds altogether.

For me 30mg is definitely the sweet spot. Any more and I feel out of it and sort of fuzzy or snowed. Any less and it doesn't seem to control my symptoms as well.

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My rule is that if my breakthrough symptoms have a life event trigger and I can reduce my stress, I use coping skills first. But I set a time limit, so 'if my mood hasn't stabilized in a month/two of using my skills' then I ask for a med tweak.

Autumn time, I always get depressed. So if I increase my self care and nutrition/access to support and therapy and am still depressed by Halloween, I see my pdoc for a med tweak.

If the symptoms are med related, I go to meds as a first resort. If I cannot be more skillful or I am too sick to use coping skills, again, I go to my pdoc.

Edited by Titania
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I made up a 'health care action plan' with my former tdoc in case of breakthrough episodes.  It's basically a chart that I have continued to edit over time.  On the far left I have a long list of potential red flags, with a bit of a severity rating.  One or two low-severity red flags might not mean much, unless you add length of time maybe, but a whole lot of low-severity flags could mean trouble, etc.  This covers possibilities from any of my mood episodes, and is the part I usually end up updating as I learn more.


The next part over is a list of things to do once I recognize enough warning signs.  Now, I'm told I have very good insight from my doctors and I believe this is what has helped me, but sometimes even I have to rely on feedback from others -- those with less insight when they are ill would likely have to rely even more on insight from those close to them, around them, etc.  This list covers far more than "phone pdoc, tell her all, and follow her instructions precisely," from phoning a distress line, going onto CB, getting outside more, visiting my sister or some friends, etc.  It's also a long list.


The third part is a list of ways to tell that I'm coming out of it and re-stabilizing, and reminders of how to go easy on myself while I'm coming out of it (especially if I needed an IP stay.)  I've added a lot more to this one as well because it includes post-mood-episode coping strategies since I'm one of those who can get "hangovers" even after the episode is gone/mostly gone, for up to a month or more these hangovers can last.


The specifics of what would be on your own treatment plan need to be dictated according to your particular symptoms, cycles, and needs.  It doesn't need to be in chart form like mine, and I tried to do the mood-tracking thing but just couldn't keep up with it, however I've successfully caught two breakthrough episodes since being diagnosed and medicated for bipolar, both of which required IP stays, and I'm pretty sure I managed to fend off a third thanks to use of PRNs and communication via e-mail with my pdoc.

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