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What is the best med for mixed states?


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Does anyone know of a good med that squashes mixed states? My sleep has been dwindling to 2-4 hours a night, I am crawling out of my skin, irritable, anxious, and depressed. I saw my pdoc today (he recently put me back on lithium after an uninformed doctor took me off of it) and gave me the script for the blood test to check my lithium levels. In the corner I saw a code and didn't know what it was, so I googled it -- it apparently means "Bipolar I, mixed state, severe, without psychosis." I didn't think I presented THAT badly to him, but apparently my judgment is off right now. Maybe. i dunno.

Is lithium good for mixed states? What will get me out of this hellhole fastest? Any personal anecdotes for what worked best for you? 

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Don't read into the code much it's basically just so inaurance will cover you, they aren't always accurate representations. Lithium helps definetly in the long run but I've found isn't a great short term solution. The most well-known knock out drug for mixed/mania is zyprexa but it is very sedating....might help your sleep tho. Other sometimes used options are risperdal, latuda (if it's more on the depresson side), abilify (I wouldn't personally) and Vraylar- but Vraylar is still pretty new so I'm not sure there's much head to head comparison. Add on benzos help in short term too 

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The problem with Zyprexa, if taken daily over time, is likely to raise your blood sugar by increasing insulin resistance, mess with your lipids in a negative way, cause weight gain, and induce Metabolic Syndrome. Other than that it is a great drug. Unless you have diabetes occasional use as needed probably will avoid these side effects. Acceptable as a rescue med.  

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I didn’t go on to risperdal several years ago for the purpose of squashing a mixed state, but it is a very fast acting med. Not immediate results like the highly sedating prn meds, but I saw incredible results in my ocd/depression fog in less than three days. While there’s a chance you can stay on it a while, and I never had a problem with weight gain, there is a chance of elevated prolactin levels. My pdoc has said that it’s not meant to be taken long term, as in years. 

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2 hours ago, notloki said:

The problem with Zyprexa, if taken daily over time, is likely to raise your blood sugar by increasing insulin resistance, mess with your lipids in a negative way, cause weight gain, and induce Metabolic Syndrome. Other than that it is a great drug. Unless you have diabetes occasional use as needed probably will avoid these side effects. Acceptable as a rescue med.  

This. Great med that almost immediately took away my paranoia and delusional thoughts.  But in just under two months I gained almost 25lbs.  I met someone in the hospital who had been on it a long time ago, before the class action law suits happened.  He got diabetes from Zyprexa and was on a relatively low dose 2.5mg.  

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Any suggestions on the dosage + timeframe using Zyprexa as an emergency "rescue drug" for mixed depressed/anxious/agitated states? I also deal with intense mixed mood states like the OP. They are unbearable approximately 3 days per month...I wonder if Zyprexa would be a good choice in this case? (only 3 consecutive days per month). Benzos make me depressed and groggy.

The action is immediate, correct? And good for taking in the evening, since it can induce sleep, but probably too sedating for daytime...Also, I'd think you could avoid the weight gain/diabetes issue, if you only take it very intermittently.

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1 hour ago, Blahblah said:

Any suggestions on the dosage + timeframe using Zyprexa as an emergency "rescue drug" for mixed depressed/anxious/agitated states? I also deal with intense mixed mood states like the OP. They are unbearable approximately 3 days per month...I wonder if Zyprexa would be a good choice in this case? (only 3 consecutive days per month). Benzos make me depressed and groggy.

The action is immediate, correct? And good for taking in the evening, since it can induce sleep, but probably too sedating for daytime...Also, I'd think you could avoid the weight gain/diabetes issue, if you only take it very intermittently.

For PRN start as low as possible and work up as necessary. It can be used at night but really low doses (2.5) are sometimes used for dysphoric mania breakthrough symptoms. I took 2.5- 5 mg as needed regardless of the time. That's for the seriously screwed up tho. Typically 2.5 is the lowest dose. Onset of action is pretty fast...especially the sedation 

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