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dancesintherain

beginnings of a mixed episode?

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how do you tell the early signs of a mixed episode?  particularly versus emotional dysregulation? 

I'm registering as mild depression on the screening measures, but it feels really different from ordinary depression to me. 

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For me I start getting really irritable. With family members, with strangers, though I don't generally say anything to the strangers. I'll just be like "why isn't this line moving faster?" or "why are you sitting so close to me when there are a million seats? " And I start getting sensory overload. Sensitive to sound, wanting to hide in my bedroom. And also really negative thoughts about myself. But for me all of that happens really quickly.

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Anger. Lots of it. Reckless driving.

I hope you aren't heading towards a mixed episode and that things even out.

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Thank you all, I appreciate the feedback and examples.  I’ve only caught a mixed state when it was unbelievably obvious before, hence the question about earlier signs.

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Harp, Aura, and Butterfly all have it right.

I get very irritable and very impatient. With everyone and everything. Everyone is an idiot and pissing me off. I have too much energy, and it’s an uncomfortable, prickly energy. Noise, which is my bugaboo anyway, becomes quite intolerable, and god help any child who makes one of those loathsome shrieking noises near me. 

My pdoc-approved emergency measure is to start eating Seroquel by the handful until a) I feel better, b) I can get in to see her or, ideally, c) both. I have extra Seroquel around for just such occasions.

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Thanks Gear.  I’m definitely not at the place that you all are consistently describing yet.  So that’s good.  Can’t say I haven’t been there before!

It just doesn’t feel like your ordinary depression.  It’s mild, so maybe that’s what I’m not used to.  I wonder if it’s situational (predominantly job-related).  My tdoc thinks it might be as well.  He wants me picking in advance something (including something small) that I can look forward to at the end of the day.  And trying to get social contact with a work colleague or two in order to increase the time not spent in my cubicle in isolation from the world (the asking and anticipating is hard, the doing is usually good).  He still wants me to check in with my psychiatrist, but he is wondering if small changes like this might help.

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7 minutes ago, dancesintherain said:

Thanks Gear.  I’m definitely not at the place that you all are consistently describing yet.  So that’s good.  Can’t say I haven’t been there before!

It just doesn’t feel like your ordinary depression.  It’s mild, so maybe that’s what I’m not used to.  I wonder if it’s situational (predominantly job-related).  My tdoc thinks it might be as well.  He wants me picking in advance something (including something small) that I can look forward to at the end of the day.  And trying to get social contact with a work colleague or two in order to increase the time not spent in my cubicle in isolation from the world (the asking and anticipating is hard, the doing is usually good).  He still wants me to check in with my psychiatrist, but he is wondering if small changes like this might help.

I think those all seem like reasonable next steps 

12 hours ago, argh said:

if anyone has a "wtf is going on" with an "in case of crazy, break glass" sort of advice, i would appreciate it as well.

As in a prn? Or behavioral stuff? 

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Usually my anxiety spikes, because my bipolar and anxiety play off each other in all the worst ways. Like on top of my normal anxiety issues, I'll start getting this feeling like I want to crawl out of my skin and my normal irritability (because I'm usually mildly irritable regardless) skyrockets through the roof. And I have energy, but it's very uncomfortable energy? And because I'm trying to release the tension somehow, I'm most likely to self harm while mixed so if I get self harm urges, I figure I'm probably mixed.

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2 hours ago, Gearhead said:

Harp, Aura, and Butterfly all have it right.

I get very irritable and very impatient. With everyone and everything. Everyone is an idiot and pissing me off. I have too much energy, and it’s an uncomfortable, prickly energy. Noise, which is my bugaboo anyway, becomes quite intolerable, and god help any child who makes one of those loathsome shrieking noises near me. 

In the week-long mixed episode I had in the Spring, I had to take my kid to the pediatrician's office. Holy hell. I had to wait five minutes at the desk, which felt like two hours, some jerk sat next to me for no reason, and there were babies, so many babies, crying and screaming and making other intolerable sounds that babies do. And then Alvin and the Chipmunks came on, and they were singing, and I thought I was going to have to be taken out in handcuffs. 

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9 minutes ago, argh said:

Bit of both actually

Behaviorally, I mostly find withdrawing is the best thing for me. Sometimes a calming meditation, like one for panic. And Xanax. I'll tell my husband I think I'm mixed, and might not be completely responsible for what I say but I don't mean any harm, in order to mitigate any verbal fight I might start, and go hide in my room for a while. Obviously that will work less well at work, unless there's a quiet spot to decompress, like a conference room.  But my mixed things are generally like thunderstorms that come and leave relatively quickly.

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29 minutes ago, argh said:

is irritation more of something on the depressive side of the mixed episode or the hypomanic?

how about noise? i find noise to be overwhelming, but my therapist things i'm on the autism spectrum on what used to be the aspergers side

Irritation can be either side for me. And noise is a red flag- pdoc can sometimes tell if something’s wrong based on how much people chewing pisses me off 

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1 hour ago, argh said:

is irritation more of something on the depressive side of the mixed episode or the hypomanic?

how about noise? i find noise to be overwhelming, but my therapist things i'm on the autism spectrum on what used to be the aspergers side

So for me this is the general mixed formula. 

1) try to add PRN benzo

2) if that doesn’t work keep the benzo and bump the best mood stabilizer (depending if your on the depression/manic side) 

3) if still not helping you bring in the big guns usually for PRN. Often people use zyprexa or haldol but I prefer Thorazine. If leaning manic and things are spiraling, then I essentially  knock myself out for a few days where either it passes or the bumped mood stabilizer has taken things back under control. If it’s depression I take less, only enough to cap the agitation while we come up with something to manage the depressed mood.

im on phone what meds have you tried PRN before/currently on? 

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1 hour ago, argh said:

Im on 150mg bupropion xl, 200mg lamotrigine, 1200mg gabapentin.
i dont have a prn proper. My instructed break glass deal is to just call the office. 

i usually dick with my meds and increase the gabapentin to prn myself. I dont touch the lamotrigine because..lamotrigine. I have been dicking with my bupropion and trying the ir version recently.

i did take more gabapentin the other day..feel much better today...going to continue a bit more for a few days. Also bumped up my trazodone To knock me the fuck out.

i dont have dx hypomania (Hence mood disorder dx) and clearly do not get mania, so i dont have an antimanic. Depression is more my problem really. Im not sure my mixed episodes are truly mixed as it is depression with spicy features. Though my pdoc did identify a few episodes as mixed.,,but never elaborated on why.

im rambling so ill put a lid on it.

No your fine. I did have some mental health professional tell me you can get mixed, agitated depression states without being bipolar.

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12 minutes ago, argh said:

Ah, that makes sense. Are mood stabilizers generally used for that?

i do have hypo-ish symptoms, so maybe something is going on there with mixed stuff. I have an appointment tomorrow so ill have the pdoc clarify that.

It seems that for “non-bp” agitated depression there isn’t really an overarching consensus. Personally I would look at lower dose AAPS that have been shown to help depression. As you know they each have their issues- zyprexa weight, seroquel sedation, abilify can go either way, and rexulti doesn’t have a ton of anti manic potential at lower doses. Vraylar might be an option, but while I liked it, many here seem to think it’s a total wild card. There is also latuda but I don’t think that pdocs are using that as a first line unipolar treatment. Could you add a short term benzo? 

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