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saoirse

Is mild/moderate hypomania sustainable? Can you just ride it out?

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My doc DOUBLED my Zoloft last week and ever since I haven't been sleeping or eating much and have been spending the nights talking to strangers on the internet (and I mean, like, for twelve hours straight.) But I feel invincible and excellent and I'm not making any dangerous decisions like the last time I was more manic. So my question: do you have to call your doc when you're hypomanic, or can you just ride it out? What would you do? I'm hoping to just ride this out for a while, although at the back of my mind there's that nagging fear "this is going to end, and you don't know when." 

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43 minutes ago, saoirse said:

My doc DOUBLED my Zoloft last week and ever since I haven't been sleeping or eating much and have been spending the nights talking to strangers on the internet (and I mean, like, for twelve hours straight.) But I feel invincible and excellent and I'm not making any dangerous decisions like the last time I was more manic. So my question: do you have to call your doc when you're hypomanic, or can you just ride it out? What would you do? I'm hoping to just ride this out for a while, although at the back of my mind there's that nagging fear "this is going to end, and you don't know when." 

Some of those sound like pretty big warning signs of heading to mania - I would 100% call your doc now, in case you start to lose insight 

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49 minutes ago, saoirse said:

My doc DOUBLED my Zoloft last week and ever since I haven't been sleeping or eating much and have been spending the nights talking to strangers on the internet (and I mean, like, for twelve hours straight.) But I feel invincible and excellent and I'm not making any dangerous decisions like the last time I was more manic. So my question: do you have to call your doc when you're hypomanic, or can you just ride it out? What would you do? I'm hoping to just ride this out for a while, although at the back of my mind there's that nagging fear "this is going to end, and you don't know when." 

Some of those sound like pretty big warning signs of heading to mania - I would 100% call your doc now, in case you start to lose insight 

curious- doubled from what? 

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I'm new to this dx, so I call for mild. You do seem like you're on your way to mania however. I would call if I were you

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33 minutes ago, notloki said:

No.

Succinct and to the point, lol. 

1 hour ago, Iceberg said:

Some of those sound like pretty big warning signs of heading to mania - I would 100% call your doc now, in case you start to lose insight 

curious- doubled from what? 

It's honestly just because of the Zoloft. I'm on 150 mg dose now which I'm assuming is a big dose. I don't even know if I'm bipolar. It could be the meds making me like this.

My family/friends told me to call so I did, and the doc got me in today. He said I'm obviously manic and that I need to sleep badly. Too bad Ambien isn't working. And that I don't want to sleep. But he doubled my Abilify. I think Abilify is sedating at higher doses, right? Who knows. Maybe it will help. I don't want to go manic, I am enjoying this hypomania. Everything looks beautiful. 

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1 hour ago, argh said:

I'm new to this dx, so I call for mild. You do seem like you're on your way to mania however. I would call if I were you

Ended up calling and he got me in immediately. Doubled my Abilify. I hope it doesn't work too fast.

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19 minutes ago, saoirse said:

Ended up calling and he got me in immediately. Doubled my Abilify. I hope it doesn't work too fast.

Abilify often isn’t the fastest antimanic AP- but it has definitely been shown to treat mania. What’s ur dose on the abilify? Probably figured that was better than a whole new med. also, did he do anything about the Zoloft? 

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Just now, Iceberg said:

Abilify often isn’t the fastest antimanic AP- but it has definitely been shown to treat mania. What’s ur dose on the abilify? Probably figured that was better than a whole new med. also, did he do anything about the Zoloft? 

20 mgs. I was on 10 before. And no lol, he kept the Zoloft and I'm not sure why. I've never done particularly well with antidepressants. 

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32 minutes ago, saoirse said:

20 mgs. I was on 10 before. And no lol, he kept the Zoloft and I'm not sure why. I've never done particularly well with antidepressants. 

Hmmm. Does he know that you think the Zoloft is causing this? 

And yeah 20 mg abilify is defiantly a potential antimanic dose 

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13 minutes ago, Iceberg said:

Hmmm. Does he know that you think the Zoloft is causing this? 

And yeah 20 mg abilify is defiantly a potential antimanic dose 

I didn't bring it up because I (stupidly) assumed he'd assume that, given that it's an SSRI. I also kind of thought the Depakote was supposed to stop SSRI's from making you going manic???? I don't know. 

I love Abilify, no weight gain and helps psychosis and makes me feel very happy, so I hope this dose continues to help!! I just don't want this feeling to end

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Sorry I’m on my phone so I can’t see ur meds so I missed the Depakote. Depakote has a wide range do you know the level?

also even thought u didn’t say anything about the Zoloft that is a big increase for a BP person odd that he didn’t think of or at least mention it 

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5 minutes ago, Iceberg said:

Sorry I’m on my phone so I can’t see ur meds so I missed the Depakote. Depakote has a wide range do you know the level?

also even thought u didn’t say anything about the Zoloft that is a big increase for a BP person odd that he didn’t think of or at least mention it 

My Depakote levels are just about perfect, actually!! I can't remember the exact level.... I think that's why I was surprised the Zoloft made my mood swing upward. I thought lithium and Depakote were the best anti-manics out there? who knows

 

And yes I know!! 150 mg is a LOT. I know a lot of psychiatrists don't even prescribe antidepressants to people on the BP spectrum. I guess he thought it would be okay with the Abilify and the Depakote

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Even if they do- doubling it is a pretty huge jump which makes it risky. I would say that Depakote and lithium are the best mood stabilizers for mania, Depakote often more actute uses than lithium but lithium great for long term stability of both sides. However, I wouldn’t say they are the “best” above some of the antipsychotics especially for quick onset 

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3 hours ago, saoirse said:

I don't even know if I'm bipolar. It could be the meds making me like this.

I feel the same way. For me, maybe it's snowballed with the bupropion monotherapy into all of this mess.

The swings, at least upwards have been more pleasant since meds, but are swings. The lows, unless caused by an AD (damn you mirtazapine), don't get anywhere near as low or as mixed/agitated.

i suppose chemically i haven't responded well to ADs, like yourself. And mood stabilizers have helped immensely despite the fact that RCTs have demonstrated that they don't help much in unipolar depression (i know everyone is different and others here may have unipolar but benefit from them greatly)

I too am surprised by your doc increasing prozac. when i reported a mild elevation about a month ago, my doc cut my bupropion dose in half, upped my lamotrigine and even decreased my trazodone as "it can cause agitation in some people as it's originally an AD" per my doc.

 

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8 minutes ago, argh said:

I feel the same way. For me, maybe it's snowballed with the bupropion monotherapy into all of this mess.

The swings, at least upwards have been more pleasant since meds, but are swings. The lows, unless caused by an AD (damn you mirtazapine), don't get anywhere near as low or as mixed/agitated.

i suppose chemically i haven't responded well to ADs, like yourself. And mood stabilizers have helped immensely despite the fact that RCTs have demonstrated that they don't help much in unipolar depression (i know everyone is different and others here may have unipolar but benefit from them greatly)

I too am surprised by your doc increasing prozac. when i reported a mild elevation about a month ago, my doc cut my bupropion dose in half, upped my lamotrigine and even decreased my trazodone as "it can cause agitation in some people as it's originally an AD" per my doc.

 

Right??? I've been hypomanic and manic several times, but all of these psych meds can cause mania, right? I mean even Lamictal made me manic for god's sake. Stopping Seroquel made me manic too lol. Sometimes I wonder if I should just go off of my meds and see what happens for real.

My upswing are allllllllways euphoric. Which is very nice. But then, that makes people think I'm classic bipolar I, which I'm really not so sure. 

And yes, ADs don't help me either. They do nothing, they make me agitated, or they make me manic. I don't know why I'm still on them when my doctor has me diagnosed as bipolar I. He's a very good doc otherwise.

Mood stabilizers have helped me quite a bit too, but it's the antipsychotics that have helped me the most!!!!!! Abilify is a godsend.

2 hours ago, Iceberg said:

Even if they do- doubling it is a pretty huge jump which makes it risky. I would say that Depakote and lithium are the best mood stabilizers for mania, Depakote often more actute uses than lithium but lithium great for long term stability of both sides. However, I wouldn’t say they are the “best” above some of the antipsychotics especially for quick onset 

Do you know how long it takes for Depakote to kick in to stop hypomania/mania? I want to enjoy this while it lasts

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33 minutes ago, saoirse said:

Right??? I've been hypomanic and manic several times, but all of these psych meds can cause mania, right? I mean even Lamictal made me manic for god's sake. Stopping Seroquel made me manic too lol. Sometimes I wonder if I should just go off of my meds and see what happens for real.

My upswing are allllllllways euphoric. Which is very nice. But then, that makes people think I'm classic bipolar I, which I'm really not so sure. 

And yes, ADs don't help me either. They do nothing, they make me agitated, or they make me manic. I don't know why I'm still on them when my doctor has me diagnosed as bipolar I. He's a very good doc otherwise.

Mood stabilizers have helped me quite a bit too, but it's the antipsychotics that have helped me the most!!!!!! Abilify is a godsend.

Do you know how long it takes for Depakote to kick in to stop hypomania/mania? I want to enjoy this while it lasts

Ymmv I guess it never actually helped me even at max levels

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2 hours ago, saoirse said:

Right??? I've been hypomanic and manic several times, but all of these psych meds can cause mania, right? I mean even Lamictal made me manic for god's sake. Stopping Seroquel made me manic too lol. Sometimes I wonder if I should just go off of my meds and see what happens for real.

My upswing are allllllllways euphoric. Which is very nice. But then, that makes people think I'm classic bipolar I, which I'm really not so sure. 

And yes, ADs don't help me either. They do nothing, they make me agitated, or they make me manic. I don't know why I'm still on them when my doctor has me diagnosed as bipolar I. He's a very good doc otherwise.

Mood stabilizers have helped me quite a bit too, but it's the antipsychotics that have helped me the most!!!!!! Abilify is a godsend.

I think you might have gotten it per the DX criteria in the DSM 5. So maybe not a questionable DX via your doc, but technically correct by the book. BP1's criteria is that you have a single manic episode..so based on what is quoted below and the fact that you have in fact had a manic episode, you get a BP1 DX. I'm almost convinced that I got a BP2 DX because of ADs and if anything i was pretty subsyndromal prior.

Or at least that's my interpretation.

https://link.springer.com/article/10.1007/s00213-013-3358-4

"

in contrast to DSM-IV-TR, DSM-5 adds the note to the diagnostic criteria of manic episodes as follows: “A full manic episode that emerges during antidepressant treatment but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a bipolar I diagnosis” (American Psychiatric Association 2013). Also, hypomanic episodes have a similar note in DSM-5 (American Psychiatric Association 2013).

"

I do want to emphasize that I have no intention of stopping my meds. I'm still better than i ever was, despite the cycling. Your choice to maybe stop it is up to you.

Edited by argh
reasons

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@saoirse Seems bizarre...so you're Bipolar 1, (with history of previous manias, psychotic episodes and insomnia), your pdoc suddenly doubles your Zoloft?? What is the Zoloft for? I'm not even Bipolar and Zoloft was the only SSRI that gave me psychotic symptoms, delusions, paranoia, insomnia. Seems like an illogical move on his part. And yes, if you are not sleeping, feeling incredibly happy and talkative, energetic, chatting with strangers for 12 hours straight....that could be classified as full Mania (well, according to my old pdoc)

Edited by Blahblah

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Call your doctor back and explain that this happened when you doubled the dose of Zoloft. He needs to know this. SSRIs don’t make just anyone manic, but they sure as hell can do it to bipolar patients.

You need off this train, and fast.

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