Hello, all. I am seeing my pdoc on Friday and we will be discussing my apparently somewhat persistent mania as well as my not long-ago psychotic episode(s). I currently take 1200 of long-acting lithium, which I believe saved my life in 2008, when I started it. Also now on 30 mg of Abilify and 25 mg qHS of Seroquel--both restarted and started (respectively) this past month. I have been on Wellbutrin 300 continuously (extended release) since 2012--this time. Have been on and off Provigil since 2010, depending on whether I have had insurance coverage and also whether the generic had yet been released. It is very expensive. I also have an Rx for Zyprexa 10-15 mg for emergency sleep issues.

My current major issues are: 1) I became extremely psychotic in early December--first psychosis since I was in the hospital in 2016; 2) Along with that psychosis, I was quite manic; 3) The psychosis and the mania have both persisted despite resuming Abilify (I was not on a dedicated AP when I became psychotic--more on that below) and adding a quite low dose of Seroquel at night and also having prn Zyprexa available; 4) Sleep is basically and has been for a few months, a crisis. I cannot fall asleep unless I am virtually stumbling with exhaustion and I cannot stay asleep. I have been on the vast majority of meds used for sleep and at this point, nothing but maybe 600 mg of Seroquel would probably put me to sleep--and I will not do that for metabolic reasons. I am thin and want to stay that way, not for vanity, for cardiac health, mostly. 5) I did become manic in 2005 while on both Cymbalta and short-acting Wellbutrin. Problem here is that Wellbutrin is one of almost no antidepressants that has worked for my depression reasonably well. Were we to stop it, I literally fear for my life. But, if I have to , I guess I will. Not sure what Dr. C is going to say on that. I do have serious suicide attempts in my past while in massive depression.

So, given all this, I am looking for people to share experiences, should they wish to, about what might have worked for you for mania +/- psychosis in the past--or present, even. Also, how do you deal with your sleep situation? I purchased a pretty nice 20-lb weighted blanket. I think quite honestly that my sleep is currently so messed up that it is impossible to know how much or if the blankie will help. I am hopeful.

Now, couple last things. We have d/c'd the Provigil for a couple of weeks and the sleep did not improve. Plus, I have slept fairly well for years--close to 10--while on it, though I recognize that does not mean it might not be an issue now. But stopping it seems to indicate it may not be related to the current sleep stuff. I can't take Lamictal--bad side effect in past. Also, I stopped my own Abilify because I could not sign my name, so bad was my movement problem in my hands. It was frustrating and embarrassing. I became psychotic as a direct result of this decision, so I now know I cannot be off all antipsychotics. Lastly, I have never taken Haldol or Thorazine or Clozaril, but would be willing to do anything--including the dreaded Clozaril.

So, there you go. Sorry this is so long. Many thanks to anyone with any feedback you deem appropriate.