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La La LOLocaust

Antipsychotics for mania, mixed, and depressive episodes

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Okay, I'm both curious and desperate. I've just calmed down enough to type this thread thread.  I know people click on these things and read a little and don't respond. I am asking you guys to actually respond. Please, please, please. This is very serious. I am in a really, really shitty circumstance (at least to me) and it,  think, triggers severe episodes rather than the relatively controlled episodes I was having before I was in this boat. 

current meds: lamictal 400mg, wellbutrin 300mg, adderall 30mgx2, keppra 1000mg, zonegran 200mg,requip 2mg, inderal ER 80mg.

 

statement one: I used to take Zyprexa. High dose in high school, but too much weight gain. I've got a heart defect, so I have to be careful. Was recently on 5mg. Did very well. Pdoc ( a PA) took me off of it with no explanation. I think it was a mistake. The PA sucked, and he was canned.

I do get depressive episodes. I used to self-medicate with Heroin. But I've outgrown it. and two of my friends have died in the last month because of the fentanyl-laced heroin. I almost died in november. Sometimes I wish I had. I try to stay positive. I said I get severe episodes, and I'm primarily concerned with the mania or mixed states. I scream so loud my throat bleeds. I've been known to get so agitated, so angry, that I've ripped wooden furniture apart with my bare hands-- like an antique dresser, for instance. For months, I've been so unhappy, so miserable with my surroundings and the racing thoughts/negative self-talk, so dissatisfied with my life and yet unable to do anything about it, and so profoundly ill equipped to cope, I've said all I want is a chemical lobotomy. It's halfway hyperbole, but you get the point, I'm sure.

I said I self-medicated. Zyprexa didn't stop me from that. But I never flipped out, at least. Now, for the past two months, I've had unbelievable insomnia. I'm talking 1-2 hours per night.  The antipsychotics always helped me sleep.  Always; and I have never, ever done better -- emotionally, as a person, as a productive adult, et cetera. I need that. And I need to feel so calm that I can be content with my surroundings no matter what, because my flipping out is not rational, and I know that -- but I just can't help it. First I start yelling at myself, saying terrible things, and then it escalates into increasing agitation, and occasionally things like punching walls so hard my arm goes right through them, tearing furniture apart with my bare hands, and on two or three occasions, punching the floor so hard my knuckles break. Actually, I once punched a refrigerator so hard the door caved in. I'm not bragging. I would be unable to do this during a period of being "normal". Only during an agitated manic/mixed episode

 

the question: I need to ask my doctor -- this week -- about an antipsychotic. I just can't be without one. Low-dose Zyprexa is okay, but I believe that this condition is a function of our environment, and my environment is one in which I am unhappy.  I've been getting increasingly agitated by the day, and no matter what I do I can't sleep. I was considering asking about Seroquel, but I was also thinking about a typical like Haldol. I was hoping to get some thoughts. I'm specifically looking for a drug that will keep me calm enough all day to be content with my surroundings, so I don't get distracted by fits of rage, that won't cause severe weight gain, and that will help me fall asleep. I'm not asking/expecting medical advice. Just some feedback from knowledgable people or personal experience on what might be good things to ask the doctor about, and if I can't have it both ways (no weight gain and control of symptoms), possible compromises.

 

 

Edited by La La LOLocaust

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Have you considered Abilify? It seemed to keep the manic and mixed stuff away for me, as well as helping a little bit with the depression. I didn't gain weight on it, either (I was actually able to lose quite a bit). But for acute mania and mixed, I haven't found anything that works as well as Zyprexa. I only take it PRN, so I don't really have to worry about the side effects. Perhaps you could ask your pdoc about using it that way too.

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I can only speak on seroquel but it does a decent job at calming me down, if you had two or three doses daily that might help

I don't have bipolar but I find it helps with agitation 

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okay, first things, first.  Relief for the insomnia is key to get everything else stable.  Two months without proper sleep is way beyond what a person can handle.  I didnt see a sleep aid in your list.  Have you tried either Ambien, Lunesta or a benzodiazaprine, like Lorazepam?  Seroquel at lower dosages, like 200mg can relax one enough to sleep, especially if taken with a sleep aid.

Secondly, are you going thru this alone or is someone with you?  Because what you've described is absolute hell.  Is it possible for you to go to a walk-in clinic, or an ER department at your local hospital?  If I were experiencing this, i would need someone to listen well to what you are going through

Does the Adderall stimulate you or is to to calm down your thinking?

I hope you can reply.  I am deeply concerned with your post and want to help if i can.

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First thing I would do is to get your sleep under control.  I would ask for a med to help you sleep.  A lot of the things you are describing could be related to lack of sleep.  I know I get like you talk about (in general) when I have had little sleep over the course of a few days, let alone months.  When I finally sleep, I wake up feeling so much better, with a better and different perspective on things.  And then go from there. mAybe you could ask for something to help your sleeping.

Have you tried propranolol?  It is a beta blocker but works well for anxiety also.  I take 10 mg AM, 10 mg PM, and it does pretty well. I am also on Klonopin, but if I weren't on propranolol I would be agitated more during the day. 

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One other thing ... I would ask about lowering the wellbutrin ...  That can give some people a lot of energy.  I know for me it does.

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Sorry to hear that you are struggling so much. I agree that lack of sleep is probably contributing to the out of control feelings and agitation that you are experiencing. When I am manic/mixed the first thing my pdoc does is to try and get me sleeping again because when that is sorted out my other symptoms start to improve.

Anyway I take Seroquel XR 800 mg, which really helps keep my mood stable. I have been on Zyprexa in the past which definitely sorted my mania out but I gained a massive amount of weight so didn't stay on it.

When I am acutely manic my pdoc usually puts me on Haldol 5 mg 3 times daily as well as clonazepam and a sleeping tablet and that combination on top of my usual medication brings me down, decreases the agitation and angry and gets things under control.

I wish you well and hope that you find a medication that suits you and brings you some calmness and peace.

 

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I take Loxapine which does help my agitation. I  was given a higher dose and when I took it I just felt stoned and fell asleep but only for an hour or so. It doesn't work for sleep fir me.

Also just started Abilify.

I hope you can find a right med for you. 

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Hi, I'm moving this to the anti-psychotics board. You should get more "eyes" there.

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Okay. I have been on abilify, twice. It wasn't helpful. I am on propranolol -- brand name is inderal. I refuse to take sedative/hypnotics. The dependence issue is just too serious.  Wellbutrin does nothing. It's garbage. You know what it does?  It makes me horny as fuck, and impotent. I hate it. I've been on it for years and it's never been anything but trouble. The adderall doesn't do a thing for me either, except make me grind my teeth. The adderall is garbage, too. I'm going to ask the doctor to try me on Focalin or Ritalin. My previous doc (the PA, who was fired) refused to do anything but increase the adderall.  Less than 60mg, no concentration, but it's probably hurting the sleep issue. Less than 60mg and no help with concentration. I want to try a less-potent, but equally effective stimulant. I've tried the non-stimulants -- strattera, intuniv. Garbage meds, all of them. Nuvigil was ineffective and expensive.  Honestly I don't care about that stuff at this point. The primary problem is getting my moods under control. I don't know what the fuck to  call them.I don't believe I'm bipolar. I think it's something else. 

 

I've been on Zyprexa with reasonable results but the higher doses cause severe weight gain. The lower doses (5mg) don't quite cut it for me anymore, I think I'm getting worse.  I was on Risperdal a long time ago and I remember reacting very poorly to that one. Never tried Seroquel but have always thought it was appropriate. I've also thought Haldol was appropriate. I have felt, for the past few years, that I just want to be sedated enough to smile and shrug and move on with my day. I really believe that I can't function any other way, because I haven't.

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Some thoughts:

I agree that the adderall might be causing sleep issues.  I am also on a stimulant (provigil ... not sure how expensive compared to nuvigil ... there is generic for provigil) and find if I don't take it (or have too low of a dose) my sleep really sucks.  But YMMV.

What is the reason pdoc prescribed wellbutrin in the first place?  Does your pdoc know you don't think it is helping you and is garbage?

Maybe if you give zyprexa another try at a higher dose it might work better for you and help you get some sleep.  Although I know what you mean about gaining weight while being on it.

Also a thought is that maybe you can get a med (whatever it may be) that lasts all or most of the day ... such as getting a med that is SR or XL), so it will last long enough and might keep you calmer during the entire day.  Or, maybe ask for a med to take 2-3 different times spread out during the day ... that would be more likely to spread out the med and keep you calmer throughout the day.

 

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I've never told them about the wellbutrin. I was taking it for anhedonia, because I had been addicted to heroin, and had gone through a suboxone/rehab program and found that I was very much incapable of experiencing any pleasure. I'm still that way, now, though. Except for brief moments when I enjoy writing. I have a new pdoc now (same practice, different provider, old one got canned, he was a real prick)  and I'm going to just level with him about everything because I've had enough. I'm not functional -- at all.  And I literally can't go on like this. I'd rather die. But it's a simple matter of medicating me right. Aside from the insane fits of rage that terrify everyone around me (I'm generally very gentle and I think it shocks people when they see it), I just cannot cope with the world outside of my house. The people, the noise, everything is jarring. Being in crowds makes me sick to my stomach. I feel like everyone is watching me. Everyone is judging me. Everyone is mocking everything I do. I want to get away. Although I do have some social anxiety, this isn't that.

 

I felt like all of my class mates in some of my classes were constantly staring at me and laughing at me, so I skipped classes and failed four of them, but that was preferable to how I felt when I was in class. I used to work at a corporate restaurant and I had intervals where I believed all of my coworkers were conspiring against me. They were all laughing at me. They were all angry because they hated me. They were all making fun of me. Every time they laughed it was because they were mocking me. These thoughts, which were unfounded and probably untrue, made me so angry that I started to become depressed and at the same time felt like retaliating and so I quit my job, citing my mental health. I never told my pdoc about that, though, because at the time I was seeing a PA who was just a real prick who didn't listen anyway. I just have a constant fear that everyone and everything is out to get me and it makes everything I do extremely difficult. Even ordering a drink at a starbucks or something is nerve-wracking for me. This is why I say I just want to be sedated enough to shrug, smile, and move on. I know I'll never be normal enough to be well-adjusted. I just want to be calm enough to get through my day and not be in a constant fight-or-flight mode.

Edited by La La LOLocaust

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3 hours ago, La La LOLocaust said:

I've never told them about the wellbutrin. I was taking it for anhedonia, because I had been addicted to heroin, and had gone through a suboxone/rehab program and found that I was very much incapable of experiencing any pleasure. I'm still that way, now, though. Except for brief moments when I enjoy writing. I have a new pdoc now (same practice, different provider, old one got canned, he was a real prick)  and I'm going to just level with him about everything because I've had enough. I'm not functional -- at all.  And I literally can't go on like this. I'd rather die. But it's a simple matter of medicating me right. Aside from the insane fits of rage that terrify everyone around me (I'm generally very gentle and I think it shocks people when they see it), I just cannot cope with the world outside of my house. The people, the noise, everything is jarring. Being in crowds makes me sick to my stomach. I feel like everyone is watching me. Everyone is judging me. Everyone is mocking everything I do. I want to get away. Although I do have some social anxiety, this isn't that.

You said in OP you needed to ask your pdoc this week about all of this.  Do you have an actual appt or is it a phone call?  I guess either way I hope you are able to talk to your pdoc about all of this so you have a chance to level with him and to work together and get meds adjusted (or whatever).  I would emphasize the sleep issue.

Quote

This is why I say I just want to be sedated enough to shrug, smile, and move on. I know I'll never be normal enough to be well-adjusted. I just want to be calm enough to get through my day and not be in a constant fight-or-flight mode.

I can understand why you would want to be sedated long enough so you didn't have to deal with all you have written about here. 

If you see your pdoc in the next couple of days, or even whenever you see him next, I think it would be a great idea to print out your posts here and actually read them to your pdoc (IMO when a pdoc is given papers to read, they scan them and don't get the point at all).  But when I, (as an example), read the papers to my pdoc, I find he gets the point better.  I read slow and look up every once in awhile and ask 'do you get what I am saying?' and then have him repeat back what I'd just written.

Anyway, I hope you can see your pdoc, and I hope some if not all of what I wrote helps.

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Yes, I have an appointment on Wednesday, but I've contacted the office and asked them to reschedule it for earlier, if possible, citing my recent problems.

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That is great!  I hope you can get an earlier appt.  Crossing my fingers for you.  I'd give a call to the office in the morning to follow up with the request for an earlier appt.

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Appointment today at 11:15. Not a wink of sleep tonight. I guess last night, now. Jesus. This never used to be like me. Fucking hell. I need to be calm. I'm not depressed. I'm agitated, crazy, and maybe not bipolar. That's for another day, though. I've always thought I've had schizoaffective disorder but figured it didn't matter because the treatment was much the same. My life is weird right now. I'll keep it short. I'll be staying with my mother, who is profoundly difficult to be around. She has never let go of my her divorce, 11 years ago. She has, for the last 10 years, constantly accused me of replacing her, leaving her, not caring about her,, she doesn't matter matter. Says things like her son can't be bothered to pick up the phone and call, the list goes on. She says awful things. And it's true, I don't speak to her on the phone, because she isn't capable of having a nice conversation. 

I guess this isn't relevant. But, while I don't live alone, I don't have any support here, either. My father is just completely and totally oblivious to the extent of my illness. When I had to move back here, I asked him to read about it so he would understand, because I hadn't seen him in so long. He read about boats he wanted to buy, and augments he wanted to buy for his motorcycle, instead. I'm dead serious.  And I got some pretty shitty, discouraging news today from the only really supportive person in my life. So I need to figure out what to do with my doctor. I doubt I'll get any real help, though. I guess I'll have to just be an asshole an insist because 5mg of zyprexa isn't going to work for this, and I'm not going on 20mg again and gaining a million pounds.  The guy who replaced the incompetent guy I had before, he's clearly fresh out of school. He's very cautious. That's fine, but too cautious for me. Can anyone advise me on how I might handle him? I know this is last-minute, but It's worth a try. I need to try and change my adderall IR to dexedrine, vyvanse, or a methylphenidate, whatever is going to be more calming, more likely to be calming, or gentler. And I need to be back on an antipsychotic.  He seems like he'll only adjust one thing at a time, and if pressed, I'll take the AP, but I hope he doesn't put me back on fucking zyprexa at the same goddamn dose. How am I supposed to make it clear that this is serious?

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I'll take the AP, but I hope he doesn't put me back on fucking zyprexa at the same goddamn dose. How am I supposed to make it clear that this is serious?

 
 

If he does say that he is putting you on zyprexa, ask him if he cares about your physical health at all, seeing that it makes you gain weight, which ultimately could lead to physical health problems such as type 2 diabetes (and there are others such as on this link:  http://www.cdc.gov/healthyweight/effects/). 

I'd ask why only zyprexa because there are plenty of others out there that are also APs that could be tried.  I'd ask for his reasoning as to why only zyprexa then go from there. 

Idk how to ask about how to change to the dex etc instead of the adderall. 

And then if you see him not letting up on the zyprexa, I would say just what you posted, "How am I supposed to make it clear that this is serious?"

I'm so sorry you are going through all of this.  I hope the appt goes ok.

 

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Have you tried lithium? I think it works great and is cheap and has little side effects (just increased thirst for me). I agree with others that you need something temporary for sleep. I found seroquel works the best. Once you get your symptoms under control, you'll sleep better. I use to suffer extreme insomina but now I no longer need a sleep aid. Hang in there.

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Okay, first of all I want to genuinely thank every one of you who has responded because it's bad enough being misunderstood or dismissed by people who can't - or won't understand these things. Coming here for help and getting nothing is very discouraging, so thank you.

That said, the PA i'm seeing now (seeing the actual pdoc in June) is new to the practice, and very young. Probably fresh out of school, and it shows because he's pretty cautious, but I think responsibly so and not to cover himself. He doesn't listen to me yammer on and nod along, detached. I watched him pay attention and hear me. He was processing what I was saying and taking everything into consideration. He's a great guy.

We're cutting the adderall IR in half to 30mg once per day, but I may not even take that. His opinion is that I was definitely on a bloated regimen that was not helping me. Based on my history of success with Zyprexa, and the rapid response, we agreed it was a reasonable place to start. We agreed to try 7.5 mg for now, if the side-effects get too severe, we'll try something else.  So we need to weed out the other things but not all at once.  I can say that even after one dose of Zyprexa I really do feel a lot better. I'm sure I'm going to gain weight. But I put it into perspective when I thought, what's worse, at my age? Being skinny and literally tearing furniture apart in fits of rage or being a little chubby and being a productive adult?

 

 

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I'm glad your appt went well!  It really seems like he listened, and even made changes to doses to 2 of your meds, which you were hoping for.

 

I think I worded something wrong in a post above about weight gain on zyprexa.  And I really apologize about it.  I mentioned being overweight from a med and how it isn't good for you, but I didn't take everything into consideration.

You are right about this:

Quote

I'm sure I'm going to gain weight. But I put it into perspective when I thought, what's worse, at my age? Being skinny and literally tearing furniture apart in fits of rage or being a little chubby and being a productive adult?

The reason I mentioned the weight gain in the post is because there are people out there who sometimes have to stop a med because they are gaining so much weight that it is affecting their physical health.

I do understand that being a little heavy isn't a big deal to some people, especially if they feel much better taking the med, and that some weight gain won't matter in the realm of things.

So I apologize for writing it the way I did.

 

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