Mixed States

[lemonflavor]

I've been recently diagnosed as mild BP II (or whatever) and am having trouble knowing what this mixed state stuff is, how variable it is and how drugs may or may not be causing or worsening it.

I've had transition days where I'm going from up to down and get depressed while the stimulation is still there. However today I'm in this extremely frustrating state where I'm extremely tired, but when I try to take a nap, I can't relax. It's just general tension type anxiety, not panic type.

In the past I always thought this was due to TCAs because they are sedating but also act on norepinephrine at the same time. But I'm not so sure now. I'm taking Clomipramine, but that isn't all that sedating (not anything like amitryptyline) and it has the least action on norepinephrine of the TCAs. Plus a therapeutic dose is supposed to be 100mg.

Do you do anything to deal with this? I could take Ativan and take a nap but for during the day I like to only use it when I'm really anxious.

This is also when I start obsessing and thinking bad thoughts (like the disability application process!).

Frustrated.

[tallulah]

hi lemon,

im sorry that you're going through this right now.

[lemonflavor]

as far as the meds go, have you spoken to your pdoc?  it might be something that you and s/he will have to work on if it is indeed causing this...

<{POST_SNAPBACK}>

I will definitely bring it up next time I see him. We're just starting the long process of tailoring drugs to bipolar instead of just depression and anxiety.

These mixed state days recently only last a day or two thank goodness. Although now that I'm in it I wonder if it will end. I don't want to use my benzo priveledges right now but maybe now is the time to use them.

Thank you for that thread. When reading it I was thinking, oh I'm not that bad. But then why was I mad at a dirty frying pan and why was I fantasizing about suicide during my attempted nap? (Don't worry I won't do it.)

[ncc1701]

Heya lemonflavor,

Cripes, I *hate* frying pans.  And naps. 

Here's what I said about mixed before:

Always:  anxiety, anxiety, anxiety.

Always:  angry, angry, angry.  This was largely killed by Lamictal.

Depressed (3 months out of 4):

Who gives a damn.  Not me that's who.  Hate me.  Hate the world.  Need a rest.  God I wish the car would crash.  Wish I could make myself drown.  Or freeze to death, they say that's quiet.  Fuck.  Whatever.  Just, whatever, whatever.  Hungry, sleepy, grumpy, various other dwarfs, whatever.  People suck, they scare me, can't talk to them, can't work, can't read, can't go to school.

Mixed/manic (4-8 weeks out of 52):

***All of depression, plus***:

Can't sleep, feed me.  Shut the fuck up, I'm talking, this is IMPORTANT.  I'm NOT YELLING.  Can't slow down enough to stop.  Can't focus, can't concentrate, can't fucking read for ten minutes.  What, you can't understand me??? Listen faster, idiot, you're such an idiot.  Fuck you, you hate me, you suck, go away dammit, I'll kill us both.  Crash the car, crash the car, crash the car, fiery collision would take me away and you with me, idiot anonymous (innocent) driver.  Fucking/Shopping/eating/alcohol will make it  better.  Well, it didn't, so now it's your fault, maybe ours both, let's buy a bunch of crap, fuck a lot, and have a big fire and die.

---

Ugh.

The thread is:

http://www.crazyboards.org/index.php?showt...=0entry125658

That.

Lots of people sound mixed to me.

More common than I ever thought, from school anyway.

--ncc--

[Dee]

My doctor and I have been mistaking mixed states for anxiety most of my life.

It feels so much like anxiety, restless, irritable, insomnia, "crawling out of your skin", a deperate feeling of wanting to take some kind of pill to come down, to relax.

It's a terrible, terrible feeling.  IMO it feels worse than straight depression.

[Rabbit37]

It's a terrible, terrible feeling.

[Judy Doom]

ncc's post pretty much answers mixed states for me.  I second those emotions.

[NARS]

No, I can't describe it, because if I do, it'll trigger a mixed state sort of feeling and I'll need to take down time to deal with it.  Matter of fact, I often won't read threads which involve long descriptions of mixed states because they can be triggering for me.  But I will say that my mixed states can go on for months if I don't get treated for them.

mcc and devilla said it well, though.

[lemonflavor]

But I will say that my mixed states can go on for months if I don't get treated for them.

<{POST_SNAPBACK}>

Can I ask how it is treated? OK if you'd rather not.

[NARS]

Can I ask how it is treated? OK if you'd rather not.

<{POST_SNAPBACK}>

[ncc1701]

Heya lemonflavor,

Well, Lamictal seems to be helping, at least with the rage.

I've been thinking about adding an antipsychotic for when things get bad.

Some of my patients at least have had some success with lithium plus antidepressant or antipsychotic, or Epival plus AD or AP.

Plus appropriate therapy.  Including a *lot* of education.

I agree with NARS that therapy is huge.

My therapist sucked, she made things worse, but it's okay.

My family doc and both psychs I've seen have been awesome.

I feel like we're on a team.

For me, therapy right now is in books, based on CBT mostly.

I have one on anger and one on depression and anxiety.

I tried therapy BL (before Lamictal) and it didn't take.  I couldn't buy into it.  I couldn't make myself change my thoughts.  I couldn't focus.

It's coming along a bit now and I think I'm getting somewhere.

--ncc--

[Dee]

I'm hoping to find out soon.

[BlackCat]

lemon,

I have always had mixed states...they are HELL on earth. I take an antipsychotic now and they come less often but oh man. And I can be triggered if I read too much about them, too. It's kinda weird, I guess.

My last Pdoc...the dumb ass.. suggested knitting after a real bad episode as I wrote in my thread..but I would not suggest that. The needle might end up in someone's eye.

I went back  to my old Pdoc and he gave me the Antipsychotic.

[lemonflavor]

My mixed states seem to be getting worse, but thankfully each one usually lasts only a day. I called my doctor today and I'm going to raise Risperdal again but so far it's not helping. Another month until we decide to scrap Risperdal or add something to it. Seems neverending.

I was reading about depression today and became more depressed. It may be coincidence, but now that a couple of you mention reading about mixed and triggering, it seems it could go for depression too.

I was going to read some books like An Unquiet Mind but I think I'll hold off on that for a while.

[ncc1701]

Heya lemonflavor,

Yah I get triggered (mainly depression) by crazy patients if there's enough of them in a row (like today).

There are days when I have to watch TV and stay the hell off the boards, too.

Hold off on Unquiet Mind or Brilliant Madness until you feel more stable.

They're insightful but can trigger for sure.

Have you looked at Bipolar Disorder Survival Guide?

Wurkt fr me.

(Hukd on phoniks workt fr me.)

I tell my doc and colleagues to recommend it (BPSG, not so much Hooked on Phonics, although that's also a good one, just for different issues) to their other BP patients.

--ncc--

[lemonflavor]

Have you looked at Bipolar Disorder Survival Guide?

<{POST_SNAPBACK}>

Funny. That's what I was reading when it triggered. I was reading the depression chapter, then the suicide chapter was even worse.

I didn't get a lot out of the book and realized I'm already doing many of the coping things mentioned. But I did get a little insight into a few things.

[Loon-A-TiK]

Lemon,

I'd say the mixed states are worse by far than manias or depressions for me. Anxiety is always present in all mood conditions, but gets amplified in mixed states. 4 out of 5 of my hospitalizations were due to mixed state hell, and 1 due to psychosis. Point being- BEWARE of the mixed state! They can escalate, just like other mood states, and land you in the ER.

The BP Disorder Survival book is good. It didn't trigger me but then again, I was medicated so hard that I couldn't really keep my eyes open to read for long. That was in the days of 800mg Seroquel.

I use moodtracker.com to track my moods, sleep, and anxiety, and there's a journal there too. It is helpful to track to see if something is making you worse, or if something is helping. You also have to check if you took your meds or not. I know sometimes I see my morning meds on the counter and not in my body where they belong when I get home from work. Usually those are the sucky mixed days!

Go with a nice mood stabilizer. Lamictal is better against mixed states than Lithium, but the combo of the two is really rock solid. I like Lithium but it made me stupid.

[myrkkyhammas]

mixed state = manic nihilism.

by far the most horrible thing. ever. ever ever ever.

schizophrenia ain't got nothing on mixed states.

[Dee]

That's too funny.  Nietzsche must have been in a constant mixed state.  I agree.  I'm a total nihilist, but even more so when I am in a mixed state. 

I'm not sure the schizophrenics would agree with your other comment though. 

I can't even imagine the horror of hallucinations.  I've had a bad acid trip and to live with that always would be the ultimate hell IMO.

But yes, mixed states are horrid and scary.

[scatty]

I'm in mixed hell right now.  Yesterday I spent half the day screaming and half the night crying.

[lemonflavor]

Well it's getting worse. I've been in some sort of mixed state for almost a week. It culminated with me breaking down in front of my wife today which is embarrassing (being a man and all) but we had a good talk.

I'm one of those crazy born again Christians and I pray a lot and read etc. but today I really couldn't stop the onslaught of negative and angry thoughts and it scared me. Don't know if it's coincidence or not but I raised Risperdal from .75 to 1mg last night per doctors approval. So I have to give it a chance but I'm not hopeful and not looking forward to the next few weeks.

I took 1mg Ativan so I could take a nap and it did absolutely nothing. That was scary too. Couldn't even begin to relax. So I have some Seroquel samples, I may take a half tablet tonight and see if I can sleep more. I have samples of Lamictal but unfortunately those are like sugar pills. Too bad I have all those old ADs around that won't do me any good. I threw my Zyprexa away because it was the drug from hell, especially the withdrawal.

I now realize I was mixed a lot of the time in my past, it's just that it's getting worse. And I don't know if Clomipramine, a TCA that I benefit from, is making it worse.

I'm mainly just venting because I'm scared. I hate crying. Some people say it's good for you but I don't like it. I welcome any suggestions unless it has to do with "relaxation techniques" or herbal tea.

Edit: I forgot to ask-can a drug like Zyprexa or maybe Seroquel really stop mixed states or does it just cover it up until it passes?

[Dee]

Lemon, seroquel kills the mixed states for me and puts me back to the usual hypomania I have had lately.  I only take 50 mg a day, and I cant handle it at work because it knocks me out, but if its bad I will take it the minute I get home, pass out and wake up better.

At work if it's out of control and I think I am going to cry or rage I take valium (10 mg).  It takes the edge off, but only slightly.

But that's just me.

[lemonflavor]

Thanks for the advice. I took 25 mg Seroquel last night and slept late this morning. I feel much quieter so far and very tired. I don't know how you guys can work full time jobs during all this.

[Dee]

Lemon,

I swear I can only do it one day at a time.  Every day I fight the urge to call in sick. 

I'm so glad the seroquel helped.  I know it can make you groggy in the AM, but I take it as early as I can when I'm in a "state".

XO

[SerraGeorge]

What helped me slow down the frequency of mixed states was giving up my beloved anti-depressants for half the year. We experimented with dropping them in the spring and summer because I didn't really *need* them then. For fall and winter, I take a very low dose of prozac with careful monitoring. My pdoc is really good about listening to me and letting me do what I want, so that helps. Basically, his practice is to avoid anti-depressants for people with bipolar disorders whenever possible. For me, that's worked reasonably well.