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Cycles Within Cycles?


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Risperdal has "unmasked" bipolar symptoms within the last couple months. (Somebody else used that term.) I go up and down every 2-4 days. Looking back, before Risperdal, I had less obvious cycles that most likely lasted a few weeks to months. Even in my hypomanic cycles there is still some depression, sometimes more than others. I feel like I'm in a bigger down cycle. Or I hope so, because it would be REALLY nice if a longer term up cycle would come again. It may make the down cycles more tolerable, at least while the long term up cycle is in tact.

Does it work this way?

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I am still figuring out how the hell it works, but I kind of feel the same way.  it's like I'm always hypomanic now, sometimes it's good and sometimes it's a depressed, irritable, fuck everything I can't take it, crawling out of my skin feeling.  Mine can go from one to the other in the same day now!!!!

I would love to just be good hypomanic all the time.  That's what normal is to me and I think that is what I was most of my life in between bad phases lasting up to a year at a time (the good hypomania).  I think that good hypomania got me a degree, diploma, lots of IT certs and promotions.

I have nothing useful to say, but I'm with you on the wondering how this works.

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God yes. This is exactly what I was wondering. Since November, I've been, um, manic. Very manic. But I went through a phase of cycling for several days up, a couple of days down. Even now I'm manic, I keep weeping over silly things like I would in a depression.

It's something I'd like to bring up with my pdoc- she says lithium is not effective for rapid cycling, but I wonder if this is a different form of bipolar. I can just see lithium being the last drug we try in desperation and it working.

No real answers though.

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One pdoc I saw actually claimed lithium made rapid cycling worse. She was an appallingly bad pdoc, so I don't know whether there's any truth in that statement. If there is I imagine it would be to do with the AD effect of lithium. May ask my current pdoc next time I see her.

Never heard it from anyone else, just heard it's not that effective in rapid cycling.

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Well, with the risk of toxicity, weight gain, cystic acne and contant blood tests I would prefer to pass.  It seems most people aren't happy with it on this board.

And lamictal, which everyone seems to be on and all the threads of it not working, rash scares, etc. 

Yuck.

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Hey I'll trade you your long term manic for my long term depression. I also have a suspicion that Lithium will work for me, probably because I'm afraid of it and don't like the idea of it. For now my doctor wants me on Risperdal at .5 for a while which was raised recently and then possibly 1 mg. I won't have any appetite by then.

My ultradian up cycle is going to end any minute so I'm getting my typing in before the clock strikes midnight.

Here I am causing my own thread to go off topic. If anyone has any good data on cycles within cycles please let us know.

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Hey Lemon,

Pacanuck sent me this article on rapid cycling.  I thought it might shed a bit of light, although of course it says we have the hardest type to treat, lol.  That figures.

Rapid Cycling

Posted by David Neubauer, M.D.

on Wed, Feb 22, 2006, 4:27 pm PST

Post a Comment

In the realm of psychiatry, "rapid cycling" is not what Lance Armstrong does. Rather, it refers to a pattern of mood changes in some patients with bipolar disorder.

Individuals with rapid cycling have at least four episodes of depression, mania, hypomania, or mixed states per year. Most rapid cycling patients remain in an episode of depression or mania for several weeks. In extreme cases, they may cycle from pronounced mania to depression on alternating days, switching back and forth like clockwork. Whatever the individual's pattern, such frequent mood changes with little stable time in between can be devastating to patients and difficult for those around them.

Studies show that about 10 percent to 20 percent of bipolar patients fall into the rapid cycling category. It occurs more commonly in women. Many rapid cycling patients develop symptoms of bipolar disorder before age 17. Compared with other bipolar disorder patients, rapid cyclers appear to have a greater risk of suicide.

What causes this pattern of mood disturbances? So far, a definite answer has not been found. Some rapid cycling patients have been found to have decreased thyroid function and can benefit from thyroid medication.

It's also not clear how best to treat rapid cycling patients. Lithium is a standard treatment for patients with non-rapid cycling bipolar disorder but the situation with rapid cycling patients is less clear. Rapid cycling was first described more than 30 years ago in association with patients who did not respond as expected to treatment with lithium. Later studies, however, suggest that lithium can help rapid cyclers, as can other medications like divalproex, lamotrigine, and atypical antipsychotics.

Because rapid cycling patients may have extended depressive episodes, the use of antidepressants also seems appropriate. A National Institute of Mental Health study conducted in the 1980s suggested that the tricyclic antidepressants then in use appeared to cause rapid cycling by increasing the frequency of mood changes. More recent studies do not support that conclusion. Nevertheless, antidepressants should be prescribed with caution for bipolar disorder patients, usually in combination with other mood stabilizing medications.

Patients with rapid cycling disorders are among the most challenging for psychiatrists to treat. In a sense, they are moving targets, suffering at both extremes of the mood spectrum. Medications must be used cautiously to help stabilize their moods without causing new problems.

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It's also not clear how best to treat rapid cycling patients. Lithium is a standard treatment for patients with non-rapid cycling bipolar disorder but the situation with rapid cycling patients is less clear. Rapid cycling was first described more than 30 years ago in association with patients who did not respond as expected to treatment with lithium. Later studies, however, suggest that lithium can help rapid cyclers, as can other medications like divalproex, lamotrigine, and atypical antipsychotics.

<{POST_SNAPBACK}>

Well, I sure hope Lithium works because I am a super fast cycler and tend toward mixed states.  Lamictal hasn't done shit.  Maybe the combo of Lithium and Seroquel will work.  And to answer the original question, I can identify several month long cycles, but within those cycles I tend to go up and down on a weekly or daily basis.

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Hi Synthetic,

How do you feel on the lithium and lamictal?  I take it the lithium is a new drug for you?  Sounds like you are like me in that you also have an anxiety disorder thrown in to complicate matters? 

Why are you on both lithium and lamictal?  I am curious to know the logic behind prescribing both instead of one.  Or are you coming off the lamictal and going on lithium? 

I'm just trying to edumakate myself before I get to see the pdoc.  Would you recommend trying lamictal as a first choice?

I was really hoping less Effexor and a little more Seroquel might be enough, but I'm probably kidding myself right?

Dee

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I have long cycles, which go on for several months, and within them smaller ones, which could take a day or week(s). I could be depressed but for a few weird days hypo or slightly less depressed, and so on. My current meds on ly take the edge off my mood swings.

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Hi Synthetic,

<{POST_SNAPBACK}>

Howdy.

How do you feel on the lithium and lamictal?  I take it the lithium is a new drug for you?  Sounds like you are like me in that you also have an anxiety disorder thrown in to complicate matters? 

Why are you on both lithium and lamictal?  I am curious to know the logic behind prescribing both instead of one.  Or are you coming off the lamictal and going on lithium? 

<{POST_SNAPBACK}>

Over the last month or so, my mental state kinda of spiraled out of control.  Last Wednesday, after a week of a particularly unpleasant mixed state, I wound up in a voluntary inpatient center.  At that point, I was on 250mg of Lamictal and had just started Seroquel.  Lamictal was either not helping or making things worse.  So, my pdoc and I agreed to try Lithium.  He also upped the Lamictal temporarily and I am going to slowly increase the Seroquel till I get to a level that works for me.  Once/if I get stabilized on the Lithium/Seroquel, I am going to push for going off of Lamictal. So, that's where I am at currently.  Oh, and the anxiety, yeah it sucks.  No meds for it yet, just some CBT type therapy.

I'm just trying to edumakate myself before I get to see the pdoc.  Would you recommend trying lamictal as a first choice?

I was really hoping less Effexor and a little more Seroquel might be enough, but I'm probably kidding myself right?

Dee

<{POST_SNAPBACK}>

It depends.  For some rapid cyclers Lamictal seems to work well, as in really, really well and they love it.  For some, like me, not so much.  If you are BP2, it is usually the first drug of choice, especially if you have more problems with depression than with mania.  But you say you are more hypomanic, so I would give Lithium some consideration.  A lot of people here seem to be doing well on a combo of Lithium and Lamictal, but I don't whether their symptoms are similar to mine or yours.  Also, Depakote and Topamax can work well for rapid cyclers, or so I hear.  Either way, I would suggest trying some sort of mood stabilizer.  Less Effexor and more Seroquel would probably be something worth considering as well, but in my opinion, if you're bipolar, you should at least try mood stabilizers as your main med and use APs and ADs as adjuncts.  But that's just my opinion.

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I am now on day 3 of 150 mg of Effex and I had a mellow weekend, not too hypomanic, no mixed state crap (mind you I stayed in all weekend). 

Thanks for expanding on that for me Synthetic.

I will stay on this lower dose for awhile and see how it goes while waiting for my doc appt.

Dee

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