When to stop AP PRN?

If reading this will make you think negatively of me please don't read thank-you.

I'm only taking 12.5 mg every other day. I'm not sleeping with out it 1.5 hrs this afternoon in the last 48 hrs but before that due to AP I slept 14 hrs. I don't need to sleep that long.

I need to continue taking it right now?

- I'm still erratically physically lashing out at my husband (not often)
- verbally lashing out at my husband/ random yelling (less today)
- thinking my meds are going to kill me
- thinking meds are making me gain weight and that was "their" (pdoc, T, husband) plan
- sleep is for the weak
- Secretly hoping someone will get injured so I can see it and pick up the mess
- Shivers of rage when waking
- Thinking If I don't sleep it'll leave me less erratic, & angry

But....
- I feel calm
- I no longer want to intentionally cause harm to myself or others "because it would look pretty"
- my son can hug me without me squirming
- I can understand English if there's not a lot going on
___

I want to stop the AP as soon as possible yes partially due to the possibility of weight gain but also sleepiness. When do you think I could stop it because I'm no longer really a danger to anyone?

Yes, T knows I had all these symptoms last time I was there 9 days ago. T wants me on an AP all the time but that's not going to happen. T reminded me several times that I need to sleep and take my AP right now but she never said how long. I don't want to ask my husband because he doesn't want me on an AP at all but will tell T otherwise So I'm asking here. Again sorry for being scary crazy.

I would try it for a few more days if you can stand it. See if things straighten out. But if it's causing you to feel like they're killing you, maybe you could try a day without them. One where you don't have much going on to minimize the impact of stress. You also don't want to get dependant on it, as it's a prn, but if you need to take it by all means.

disclaimer: not a doctor, not even out of college yet. Doesn't like meds, for the most part.

There a lot of factors to consider and none of us could give you the correct answer because of it. The physicians should handle such questions; my suggestion is maybe asking for a different AP? I used to be on zyprexia and it made me sleep all the time, I hated that. It was only a prn, but I couldn't function on it since it made me too tired. They may suggest a new AP for you and it may improve your quality of life significantly. I take risperidone daily now and I've been pretty good with it; this med has improved my life for the better.

It's an as needed medication. I understand taking it for a little but when do you know when to stop?

I don't know, MM. I've been on an AP full-time since February and since it's the glue that holds me together, I don't think I'll ever come off of it entirely. Given the severity of your symptoms, I'm actually surprised your pdoc doesn't have you take yours on a daily basis....you certainly sound unstable and shouldn't be left to suffer like you are.

However, if you haven't tried Geodon (ziprasidone) it might be worth asking him/her about switching you to that. It doesn't make you gain weight, and at low doses it doesn't sedate you all that much. It takes a little longer than Zyprexa to bring one down off a manic episode, but it does work within 2-3 days.

The one thing that's hard to deal with is tapering down---withdrawal hits pretty hard. That's frustrating when you're trying to dial back on it, as I did a few weeks ago only to hit a wall. Apparently not taking an AP isn't an option for me at this time of life, but I LIKE being in remission. It's been over 2 years since I haven't had to fight this damn disease every. single. day. You deserve better too. Please talk to your doc!

I don't know, MM. I've been on an AP full-time since February and since it's the glue that holds me together, I don't think I'll ever come off of it entirely. Given the severity of your symptoms, I'm actually surprised your pdoc doesn't have you take yours on a daily basis....you certainly sound unstable and shouldn't be left to suffer like you are.

However, if you haven't tried Geodon (ziprasidone) it might be worth asking him/her about switching you to that. It doesn't make you gain weight, and at low doses it doesn't sedate you all that much. It takes a little longer than Zyprexa to bring one down off a manic episode, but it does work within 2-3 days.

The one thing that's hard to deal with is tapering down---withdrawal hits pretty hard. That's frustrating when you're trying to dial back on it, as I did a few weeks ago only to hit a wall. Apparently not taking an AP isn't an option for me at this time of life, but I LIKE being in remission. It's been over 2 years since I haven't had to fight this damn disease every. single. day. You deserve better too. Please talk to your doc!

I really don't want a full time AP

Just out of curiosity, what is your objection to taking an AP? I know nobody wants to be on one but sometimes it's necessary for awhile, if nothing else than to get through a crisis and then taper off.

FWIW, I just about threw a fit when I was put on my first one. As a nurse I've given Zyprexa and other APs many times, always to people who had severe mental illnesses; knowing my pdoc was bringing out what I considered the "big guns" was scary. But it worked so well that I stayed on it for a few months, then went off when I was stable again.

Unfortunately it didn't last, and by early February I had to go on another one, which I still take and will for the foreseeable future. I don't know how I feel about that. But I really, really love being in full remission, and if a full-time AP is what it takes to stay there, I guess I'm stuck with it. There's worse fates.

What is your objection to taking an AP? I don't want to be on any medication. I'm taking 1/2 of an AP every other day right now and it's still driving me crazy. I don't even take tylenol.

I did not plan to take medication when I originally went in I went only for therapy. Without my awesome Pdoc, fear for hospitals and therapists insistence I would not be taking anything. If I didn't fully believe that my therapist would hospitalize me with out meds then I would not take them because even medicated I sometimes scare her. That's why after 2 yrs T finally convince me to keep a PRN around the house so I don't act on violent thoughts when my husband is sleeping if I'm up for several days.

Even temporary use of AP freaks me out. Med changes at all completely throw me off usually into a violent hypo-manic state. Hence, I have only recently increased my lamictal in June (to 150 mg) after 3 years of meds. Pdoc usually waits until I ask to increase anything.

- I refuse to have any side effects
- I refuse to take anything more than 1x a night
- I refuse to take any medication that even may cause weight gain
- I quickly stop taking medication
(I start getting paranoid that pdoc is trying to make me gain weight)
- I frequently need to skip or split medication so gelcaps are out
- I frequently need to pay out of pocket
- Even low doses of medication has weird side effects with me

I'd be willing to try a very small doses of abilify but there's no way I could pay out of pocket for the med. and my insurance does not cover it.

Understandable. I think everybody has a limit to what they will and will not accept when it comes to psychiatric treatment; yours is simply a little more stringent than mine. (Me, I draw the line at hospitalization---ain't gonna happen unless it's under a 5150.)

The problem here, I think, is that your illness is lying to you about how bad things really are. That's a hallmark of BP---we go into denial and believe that we're really OK, or at least we would be if people would just shut up and leave us alone. To the casual observer (me), you sound pretty scary......if you're still having random rages and fantasies about violence, if you're still having paranoid thoughts, they didn't do a very good job of stabilizing you at the hospital.

Unfortunately, it often takes medication to make all that go away, and your illness is lying to you to get you not to do what's needed to make it happen. That's one of the many cruelties of this disease---our brains tell us not to do the very things that help stabilize us, so we don't sleep, don't eat properly, don't take our meds....you know the drill.

FWIW, it took me a long time to accept that if I'm going to have anything approaching a normal life, I have to be medicated. Not everyone does; meds are not always the answer. Maybe you don't need them either once you get stabilized, but you really ought to consider taking them for now.

I remember when your tagline was something like "if I ever want to stop meds and therapy, slap me"; I wound up adopting that philosophy as my own and have told my family to do the same thing.

I've never been hospitalized and won't unless forced or T tells me I have to. T "nipped it in the bud" by asking me to take the PRN before things got really bad. This (above posts) aren't really that bad it normally gets a lot worse.

or at least we would be if people would just shut up and leave us alone Yes that one.
I do not plan to stop my MS or AD (AP qualities), but don't know when I should stop taking the PRN. I am still taking my medication including the PRN. I do plan to continue with my current meds. forever and ever. I hate the PRN and so does my husband because I'm sleeping way to much on it and I "look drugged". Yes he completely knows what's going on, every last demented thought usually as I think it, and no it doesn't scare him. He even laughed at me today when I said "Okay, I guess I'll admit I'm hypo-manic" which actually saying it is a new thing. Usually I feel others are over reacting until it scares me but when it scares me I can't bring myself to ask for help so I 'ride it out'.

fantasies about violence I haven't had thoughts of me causing violence in a couple of days, maybe a week? I am still having random rages, paranoid thoughts and only sleep when I take the AP. And.... and I realized that I was looking at my twisted little thoughts as art and I took the AP on my own! I know that doesn't sound like a big deal but it's a huge deal. Then a couple of days later I was having real trouble understanding English and T told me "You need to slow down, You need to sleep and you need to take your Anti-psychotic" She repeated it a lot so that's really the only thing I remember. She never told me when I could stop though.

"if I ever want to stop meds and therapy, slap me" I still completely in agreement with this statement. I know I'll be on medication forever, but I do want out of the mental health system at some point. I've seen the mess it causes in family's when violence and paranoia strike because of non-compliance.

Since the AP is a prn you're not building tolerance to it. If you took it every day your body would get used to its side affects within a few weeks and generally it would make you less tired. You could possibly ask your pdoc for a smaller dose or a med change.

My worry is that I've taken it every other day for almost 2 wks

You will not get past the side effects justtaking it every other day, and it is probably not doing you much good that way.

I am concerned that your illness is clouding your judgment about this, like bipolarnurse said. You have pretty constant violent thoughts, sometimes outbursts at your husband, your son has commented on your anger as you mentioned in another thread. Honestly, you often sound very severe in your symptoms and medication might could stabilize you. I am concerned that at times the extreme thoughts and actions you have shared here are far beyond safe and stable, and I am concerned not only for you, but for your whole family. Can you consider that medication could help stabilize life for all of you? Please don't take this as criticism or scolding. That is not my intent at all, but I am honestly at times very scared about your situation.

Please don't take this as criticism or scolding.*I'm not taking anything as a criticism. I posted here because I want everyone's opinion partially because at times I don't trust mine or my husband's. I only see my therapist 2x a month. It's difficult to see my symptoms as severe given where I've been as this is not that bad. I'm not afraid that I'll hurt them or myself either intentionally or unintentionally, I'm able to communicate, understand, I don't have to drowned out the noise (in my head or normal outside noise) with music, I'm occasionally sleeping on my own (1-4 hrs), I want to be part of the family, I'm not hallucinating (even my 'normal' tactical hallucination) and I'm still taking in normal (for me) amounts of food/drink. I worry that sometimes I make things sound worse they actually are due to my writing style but at the same time not. This (above posts) I view as slightly hypo-maniac and very short term. I'm starting to gather that 'outsiders' see it as much worse, like they would consider it time for the hospital? I do think the AP is helping as things have gotten better not worse. My PRN is to knock me out until I'm able to get to pdoc for changes in meds when needed and again to me this isn't at that point. I'm only taking the PRN because my T told me I need sleep, slow down, and take it. This is not a time that I'd send my son to family. This said I do plan to ask pdoc to increase my MS and add abilify or the other weight neutral med (I forgot the name bipolarnurse said it) until next time I see pdoc because PC and T think that's what I need. I'll also find out when to call pdoc and how. Like I said I'm very proud that I caught it this early.

Here's the thing about weight gaining meds even after I get out of this I will stop the meds because of the possibility of weight gain because of my ED. Even currently I view taking the AP as gaining a pound a pill and this is not due to mood. The other problem with AP is I'm often out of state (because of family emergencies or holidays) when refills are needed So I need to borrow money and i can not have an expensive AP Which is one of the reasons we are all on the same MS. I think one of the difficult issues is no matter what I have violent thoughts and my husband has suicidal thoughts it just depends on the severity. I cannot have anything in the house that you could OD on because of him. The lamictal he won't OD on because of "skin fally offey disease". I'm in no way ever suicidal. So our doctors have to play this complicated balancing act between the three of us.
I do want to remind everyone that at This time my husband is able to care for our son and we do not live on our own until this May and we have not since our son has been borin. My husband is planning to go in patient if suggested. In September we are planning to move to an area that has higher level care w/o residental treatment.I am very concerned my writing style is effecting the severity of the situation.

Seriously thank-you for writing back and your opinions on my posts do mean a lot to me. Please don't think I'm at all being dismisive because in these matters I trust your opinions before myself or my husband. I know i can be frustrating most of the time. Even with all of our own issues we are still very good parents even if at times we don't sound like it. This is not our own opinion but the people around us to that interact with our family on a daily basis. We shield him from most of our own behavior even at our worst.