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Rabidtears

Roller coaster has slown down/ genetic test?

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It has been a while since I have posted about my dx of bp1. First off, I have not had anymore depression since I was taken off of zoloft 100mg and started on wellbutrin 150mg xl. That was in August last year I believe. I can't remember the last time I have ever gone this long without being depressed. I have also not had any euphoric moments, nor have I had anymore mixed episodes. 

What I have been having trouble with is agitation and irritation. I can be perfectly fine one moment, but as soon as things are "not right" or "how I think they should be" then I start getting really agitated because that is NOT how it is supposed to be. I know this is more or less irrational. It may just be life stuff as opposed to my disorder. I still have no tolerance for a lot of noise. Most noise. Usually having quiet here at home is impossible unless everyone is at work or school. As soon as it begins I am like a rubber band tightly pulled. Or a time bomb. Someone can say something in just the wrong way and it can set me off. I don't know. Putting it to writing makes it seem insignificant, but there it is. I also have not had ANY interest in visiting family or friends or anyone else. Not really anyone who doesn't already live with me. Not for the last year.

I am titrating down from Lamictal 150mg and started Vraylar 3mg to see if it would help with the agitation/irritation and still maintain stability along with my wellbutrin. I am supposed to take Nuvigil 250mg for Narcolepsy, but I have had trouble with getting a letter of medical necessity...or the form actually reaching the clinic from the pharmacy...Anyways, I'm rambling. Again.

I have never heard of Vraylar. Does anyone have any experience with it? Lamictal has always caused my skin to burn a lot, and when I first started it I felt like my blood was molten. There was no rash though.

While I was with my pdoc she mentioned a genetic test that she said would check my genes for possible interactions with different medications as well as deficiencies. My results came back in about 2-3 days. She said it was good that we were d/c'ing Lamictal because it showed up as either there could be negative interactions or would require a great amount of dosage adjusting or something like that. I think she said there were no interactions with my genes with my previous meds so I was likely experiencing side effects. Also, she said that I had a reduced sensitivity to anti-depressants which probably explains why zoloft never worked like it should have. The last thing about the test that I remember is that I have significant deficiency in folic acid. She said that folic acid helps to break down or process our medications or something???? and that I would have to take a broken down form of that and it should help my meds to work better. I just have to save up money for it each month because insurance does not cover it.

Has anyone else had a test like that done?

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This question is more of wondering. I was reading a pinned post about mania/hypomania/mixed/psychotic episodes. If someone might be able to help me with a bit of clarification? And I'm sorry but I didn't know how to move a quote from one thread to another. I deleted what I did already understand as far as my experiences.

"

Examples of psychotic features are hallucinations are delusions and hallucinations.

Other psychotic symptoms can include disorganized speech and thought. An observer of this will likely not be able to understand or make any connection between one topic and the next.

Examples of psychotic features are hallucinations are delusions and hallucinations.

A delusion is an untrue thought.

Delusions can be either grandiose or persecutory.

Someone can think they are capable of fantastic things, or are a fantastic being [a king, a millionare, a healer] or think that they are being followed, something bad might happen, someone might want to hurt them.

http://www.blackdoginstitute.org.au/bipola...a.cfm#Psychotic

Other psychotic symptoms can include disorganized speech and thought. An observer of this will likely not be able to understand or make any connection between one topic and the next. "

 

                                   I on occasion do have periods of time where I might feel like I am being watched by some unknown viewer who has ill intent. It only happens rarely, but it is so strong of a feeling that it is impossible to reason my way out of. I hide from anything reflective in those states that might give "the watcher" a way to see me, whether it is sitting in the hallway away from windows and mirrors or a well lit closet or whatever. I had always attributed this to anxiety attack, but is it?

"Feeling like something bad might happen" is how I feel in those moments. They can last for hours. One time I was driving with a friend one night. We were going up a hillside and out of the blue a feeling of the most god awful dread washed over me. It was almost paralyzing fear. I went home, ran inside, covered all of my windows and still hid in the hallway. I KNEW that if I had kept going that we would not have seen daylight.

Would you consider that anxiety or a form of psychosis?

The reason why I ask about psychosis is because of stuff like that, and also because of how I felt back in 2016. I just lost it. I have posted about that episode already here somewhere, but I lost all control, all reason. I could not think straight at all. I couldn't keep my mind still nor my body. That was my first major experience with the "bad" mania or mixed episodes. I snapped and destroyed a room in my house. Over something fairly minor at that. It was like boiling point. That compounded with my inability to mentally function pushed me over the edge. After scaring the kids with that episode I just collapsed and cried. I cried and raged for a long while because I KNEW I was going crazy and there was no saving me. I can't really say much more about it without risking adding false memories but I just wanted to get the gist.  I believe that was caused by the medication I was on at the time? Trileptal. I was hospitalized soon after that episode and they took me off of that. My mind began to clear and improve.

I had never experienced that feeling of hopelessness, fear, the inability to function (felt different than the same feelings you get with depression if that makes any sense at all). I was terrified.

Was that possibly psychosis? or just a bad side effect? Or a medically induced psycosis? 

I am not looking to "add" to my diagnosis. I am just trying to understand. I apologize for the lengthy post. Thank you to anyone who can help. <3

 

Edited by Rabidtears

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Also, that same year I did have a few hallucenations. The smells that weren't there, or that were distorted I think may have been from topamax because that ended when I stopped taking it.

I saw a man that I had seen in my dream standing in my doorway staring at me as I was randomly waking up one night. Then I rubbed my eyes and he was gone.

Not long before that I was on the couch and everyone was asleep but me. About 4am. I heard a man say really loud "ALYSSA." An even tone, just loud. It started me massively. My husband was asleep and it was not his voice.

**I think my docs have attributed the second two to narcolepsy.

A few years prior to that I was asleep. It was daytime. I heard a sound that sounded like a jet engine crashing and exploding. It was so loud and so real that I fell out of bed because it startled me. (I didn't see anything outside, I drove around, checked news articles, and the internet to no avail)

If I am sleep deprived then I do have visual hallucenations, but I'm assuming most people do? I've had a few of those.

I thought it might be helpful to add those tidbits. 

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@Rabidtears So the folate thing that your doctor was mentioning:

A lot of foods that we eat are fortified with folic acid, which is a synthetic form of folate. By contrast, TRUE folate comes from leafy greens among some other foods. Some people have a mutation at a gene called MTHFR which encodes the body's ability to make methylenetetrahydrofolate reductase. This metabolizes both folic acid as well as the folate found in leafy greens into a form that can cross the blood-brain barrier called L-5-methylfolate by adding a methyl group to their chemical structure. In people with the deficiency, they are unable to perform the conversion or their ability to is greatly diminished. In this situation, folic acid supplementation can actually make this WORSE. For people with underactive MTHFR, it is critical to take L-5-methylfolate and NOT folic acid.

Once L-5-methylfolate makes it into the brain, it is a critical precursor for the synthesis of new neurotransmitters like serotonin, norepinephrine, and dopamine. Therefore, people with this MTHFR mutation tend to have lower levels of neurotransmitters and many times experience depression and fatigue because of this.

You can get "pre-methylated folate" over-the-counter. However, there is a prescription form that I'm sure your doctor is interested in called Deplin. It's is technically a "medical food" and not a medication because it is a supplement. Not a lot of insurance companies cover it. However, you can obtain it directly through the manufacturers mail-order problem. They will work with your insurance, and if the insurance won't cover it, you won't pay more than $58/month.

As for the agitation and irritability that you are experiencing...in my experience....it is most likely the bupropion. However, I have heard that cariprazine (Vraylar) can be stimulating and agitating for some people. However, technically speaking cariprazine should temper the irritability and agitation of bupropion, but it may make insomnia worse.

Another suggestion I would have is to talk to your doctor about the bromide form of bupropion (bupropion hydrobromide) which is brand name Aplenzin. I found that it didn't make me feel as amped or jittery as the hydrochloride form (Wellbutrin) and studies in rats showed that seizures caused by bupropion hydrobromide were less severe and were shorter-lived than those caused by bupropion hydrochloride (but the actual number of seizures wasn't fewer).

When did you start Vraylar?

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@browri, I am just seeing your response and thank you so much for the explanation!! Deplin is what my pdoc prescribed for me. I have been trying to catch up on my bills so that I can try to stay caught up so I can pay for it monthly instead of occasionally. 

If it is the buproprion worsening my agitation then I'm kind of at a stale mate I guess because it has worked wonders for my depression since I have started taking it. 

I started taking Vraylar in January. For the first two months or so I felt great. I was not nearly as agitated. Yet recently, it has begun feeling like it is no longer really working like it was. That has been my problem with most medications I have tried. They will work great for approx. two months or so then it feels like it is no longer working. I asked doc if I could look at the genetic paperwork (because I find that stuff fascinating) but I should have known it would all be over my head lol. I do remember seeing "refractory" on there though. 

I have a lot of trouble with anxiety. I'm hoping that once I start taking the deplin that maybe my medications will work more like they should and maybe, just maybe that will help with the anxiety. *I apologize if I am rambling, we had a scare at an egg hunt today, big crowd and my toddler disappeared so I'm spazzing without spazzing. derealization going on right now* 

 

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21 hours ago, Rabidtears said:

@browri, I am just seeing your response and thank you so much for the explanation!! Deplin is what my pdoc prescribed for me. I have been trying to catch up on my bills so that I can try to stay caught up so I can pay for it monthly instead of occasionally. 

If it is the buproprion worsening my agitation then I'm kind of at a stale mate I guess because it has worked wonders for my depression since I have started taking it. 

I started taking Vraylar in January. For the first two months or so I felt great. I was not nearly as agitated. Yet recently, it has begun feeling like it is no longer really working like it was. That has been my problem with most medications I have tried. They will work great for approx. two months or so then it feels like it is no longer working. I asked doc if I could look at the genetic paperwork (because I find that stuff fascinating) but I should have known it would all be over my head lol. I do remember seeing "refractory" on there though. 

I have a lot of trouble with anxiety. I'm hoping that once I start taking the deplin that maybe my medications will work more like they should and maybe, just maybe that will help with the anxiety. *I apologize if I am rambling, we had a scare at an egg hunt today, big crowd and my toddler disappeared so I'm spazzing without spazzing. derealization going on right now* 

 

I would say that if anxiety, irritability, or agitation are the problems; they tend to be associated with bupropion. However, it looks like you're already on the lowest dose of the XL. I'll reference back to my last recommendation which is to try the Aplenzin brand if your insurance is willing to cover it. The savings card makes it pretty cheap. While I felt that bupropion generally elevated my anxiety, I felt that it was far less pronounced on the Aplenzin brand because it was so much smoother and less noticeable than the generic XL.

If your insurance will cover it, you pay the first $5 (first $100 if your commercial insurance won't cover it at all), but then it gets tricky in how much they pay (current as of this writing):

Aplenzin 174mg (eq. Wellbutrin XL 150mg) $43.39/pill

Aplenzin 348mg (eq. Wellbutrin XL 300mg) $57.29/pill

Aplenzin 522mg (eq. Wellbutrin XL 450mg) $130.16/pill

So you see the benefit levels are pretty high. They really want you to take this brand. In my experience, it was worth the switch. Not a lot of pdocs have experience with it though because they write it off as a "me-too". For the MOST part it is, but there are some subtle differences. And if your non-preferred brand copay is low enough and you only end up paying the $5/month, it might actually end up being CHEAPER than the generic depending on what your copay is now.

For irritability, agitation, or anxiety, if Aplenzin isn't an option, and because you are already on the lowest dose of Wellbutrin, you could try the 4.5mg dose of Vraylar. Although for depressive moods, in trials, Vraylar didn't have a ton of additional positive effect beyond 3mg (even 1.5mg depending on which study you're reading).

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I too have the MTHFR gene variant and found your information to be really useful.  Wellbutrin I found to be activating and caused irritability and full blown panic attacks. I had taken it years prior for 6 months and found it to just be stimulating then, however, the same dose (150) 8 years later placed me into an anxious, irritable nightmare with periods of high energy. Increasing the dose, required me to take a couple days off work while I slowly decreased and discontinued the drug. People only noted I was irritable and spoke way more than I normally do at work, but inside I felt like I wanted to explode trying to keep everything in order to keep it together. 

Funny how medications can turn on you, or your biology turns on medications. 

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I wish just reissued Wellbutrin after getting “stabilized” on Depakote first for a couple of weeks or so. I am trying to only take the latter at night— as it gives me massive fog head during the daytime— but if I don’t take them together, I find myself experiencing the same symptoms... and worse.

for example: doing violent squat-thrusts on my neighbor’s lawn at 3 AM, and then accusing him of being a hybrid Alien when he awoke from his slumber and confronted me. 

(Psssssst. Just between us... I still think he is and plan to fucking PROVE IT.)

otherwise: Wellbutrin 300 XL was the only drug to get me out of bed after a severe 3-year tussle with clinical depression. I wasn’t well groomed then... homeless now, and I am better groomed. I couldn’t even bring myself to brush my teeth but once or twice a week.

goddamn that was a long post response... Sorry, it’s the WB. Took it sans Depakote this AM with a couple of 400 MG Neurontin... Prior to checking-in on my account, I was just doing bare-knuckle push-ups on the playground concrete, much to the horror of the surrounding parents. 

Fuck them— I cannot afford a gym membership.

not sure how any of this nonsense relates to your post outside of Wellbutrin... but good luck!

Edited by Brian LeFevre
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By ahole pdoc had the genetic test done on me. He didn't really share any results (but he never shares anything). He just stuck me on Latuda, which seems to be expensive but I don't know how I am going to afford it because as of the 15th I will have no job and the 28th no health insurance and he knows this. For those of you who took the genetic test, did whatever modifications your pdoc do to your cocktail because of test recommendations help? I feel blind on this.

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Have you looked into your state's Medicaid? I'm currently unemployed (due to being terminated as I couldn't complete my workload due to periods of bipolar depression and schizophrenia - I'm finally getting treatment with Latuda) and I got on CT's Medicaid until I can find employment again. It pays for everything, including my Latuda, and there are no co-pays for pdoc visits, specialists, or medication. On the 15th you should try applying and see what you might be eligible for. 

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