Can I take my meds only when I need to?

Hello all, I first posted this in the Newbies forum and was advised to post it here too. Its a bit of a long story, I hope you have some time for a read, I could use some input from anyone in a similar situation.

I'm a 46 year old male living in Sydney, I've been married 24 years and have 2 boys. I'm glad I found this forum, I'm hoping to find kindred spirits who value their physical as well as mental health.

I was diagnosed bipolar at the age of 43 after I had a manic episode. The episode was triggered by tremendous anxiety, I was going through a significant amount of emotional trauma at the time and I could not sleep. After 4 days straight with no sleep I believed I was the angel Michael and that I had a message from God to deliver to the world and was put in hospital.

Nothing like that had ever happened to me in my life before. In hospital the doctors asked me a lot of questions I thought were really strange, if I had ever felt I had no hope, if I had ever had thoughts about harming myself, questions I couldn't relate to as the answer was an emphatic NO! It seemed like they expected that I should have experienced those feelings.

I was put on medication, discharged from hospital after 3 weeks and told to make contact with a psychiatrist. The psychiatrist told me I had bipolar disorder and that I would need to take medication for the rest of my life. I was a very fit active and healthy person at the time and I hated the idea of putting foreign chemicals into my body. I still do.

I took the meds but told the psychiatrist I wanted to be off them. I could feel the meds made me feel unwell, I had lost my motivation to exercise, I suddenly lost the strength I had in my legs and could ride by bicycle fast anymore, for the first time in my life I experienced depression. I was suicidal, I had never felt that way ever in my life before. I blamed the meds. The only thing that kept me going was that my family needs me and the thought that one day I would be off the meds and then I would feel better.

Over time I tapered off the meds and eventually stopped them altogether. I was expecting to immediately feel better but that didn't happen. It took some time but I did start to feel better after a couple of months. After 4 months my wife tried to commit suicide. I couldn't see what I was doing but I was treating her terribly, I had no idea that there was anything wrong with my behaviour (I have never struck my wife but was quick to anger and would shout a lot) or how I made her feel. It was a big shock to me. While she was in hospital I was anxious again, I couldn't sleep, after 6 days of no sleep I believed I was Jesus and that I was going to be made king of the world. I called the ambulance to come and get me one morning at 3am, I couldn't take it anymore.

Different hospital, different psychiatrist, different approach with drugs. I was back at work in 2 weeks. I told my new psychiatrist that I hated being on drugs, and he has me on a very low dose so I don't feel too bad, I'm only on 2.5mg Zyprexa and I've been well for many months.

The problem I have is that my metabolism is very low, I have little motivation, I struggle to get out of bed in the mornings, I'm lazy, I don't help out much around the home and my wife has to get angry with me before I do anything. Its a bland existence. I've put on a lot of weight, I have no motivation to exercise, I just don't like me like this.

I have tried not taking my meds for a few days at a time to see if I would feel any different, and when I stop I feel better immediately. I have much more energy and getting out of bed is much easier. I just went 3 days off meds and felt awesome. I took my pill last night again and woke up this morning feeling terrible, it was such an effort to get out of bed.

I want the old active me back, but at the same time I don't want monster me back that gives my family a hard time. I think I can handle the monster, my eyes are open now to how I was before.

I'm thinking that maybe I could go without the Zyprexa and only take it when I need to, when I get anxious? Does anyone else have bipolar and doesn't take meds?

Sorry for such a long post, I hope I haven't bored you! I look forward to spending time on this forum.

I take meds consistently, and I sometimes struggle with it because of mental dulling and emotional flatness. But overall I'm doing better on meds than off. Zyprexa is one of the worst for weight gain. There are other options that are more weight neutral, and also may not make you feel so slowed down. Talk to your pdoc to see if there is something else you can try. It sounds like things get pretty extreme for you, pretty quickly off meds. If you know not sleeping is a trigger, maybe try to focus on regular sleep to stay stable? I hope you find something that works for you.

a real take away from leaving a psychiatric ward was... “you are feeling normal now becasue you are talking your medication. Do not stop because you feel ok”

I believe this

I'm not a doctor so I can't say. I can say that I have an atypical antipsychotic, Seroquel, that I am supposed to take regularly but I cannot deal with the sedating effects. Therefore I only take it during a nasty episode and then stop. There are a couple of people here who do that with APs. I also know that most APs are fast acting, so you won't need to wait too long to feel the effects, unlike mood stabilizers and antidepressants which can take weeks.

But you do need to discuss it with a professional.

You were not a bore. This is a safe place to talk, get things off yr chest, get support etc. I totally understand yr feelings of not wanting to be on meds because of side effects. I'm struggling with that too so.yr not.alone. I.lack motivation, feel emotionally flat and.really can't stand the weight gain. I did however find a good med recently that is helping me to lose.the weight I'd gained.. every person reacts diff to diff meds so be aware of that. I'm now on Latuda for bipolar depression and it seems to be helping with stabilizing my mood with no weight gain. there are meds that help with bipolar plus sleep issues too. Talk with yr pdic.before deciding to go off yr meds. For me I wouldn't choose to go on and off these meds. They are meant to help long term and if you've had psychosis meds are needed. I am not a Dr but those are my ideas. I actually tried to ween myself down to a lower dose on one.of my meds with my Dr approval. It went very poorly. I was trying to slowly ween off so I wasn't so meditated. It's hard to.stomach to know that alot of my stabilization is from meds. Have you gotten good results from therapy too? I go to weekly therapy sessions, see my pdoc every few months and more often if needed. I hope you feel more balanced soon. Good luck..

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There are several people here who are fighting the battle without meds; hopefully one of them will chime in and tell you what did and did not work for them.

I would look into physical problems that mimic bipolar if I were you. Mania without depression is rare. It happens sometimes, but not very often. Furthermore, most bipolar people experience their first symptoms in their teens and twenties. It can happen later, but again, it's very rare.

no meds here.

I use herbs and bach essences to deal with symptoms.

That and lot and lot of spiritual strenght.

I think with most meds going on and off is bad things, because they rewire your brain hence you need to go on them and off them slowly lest you cause havoc with your mind. Not sure about APs, some use these as needed.

I am considering being off regular meds but with a stash of Zyprexa to take only when I feel extremely elevated. I have not done it, but thinking about it. But I have bipolar without psychosis - in that one real mania episode I had - like you, I was almost 43 - I almost had a movie playing in my head, but I knew it was because of a heightened state of creativity, I.e. I didn't believe that the movie was real, I just wished I had a budget and skills to actually produce the movie. You, on the other hand, believed that you were archangel Michael. Note though that not sleeping for several days can turn a well person psychotic, so if there is a way to stabilize you enough for you to sleep regularly, you might never become psychotic again.

Bipolar is a strange diagnosis in that one episode of mania, without depression, qualifies, and yet the name of the condition is Bipolar - both poles.

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Oh, and you are in AU. There is a British AP many swear by, in low doses, as the gentlest sleep medicine without metabolic effects, unlike Zyprexa and Seroquel.

http://en.m.wikipedia.org/wiki/Clozapine

Several notes - first, it has a confusing name, as if it were a benzo. Second, bad things happen on high doses. If the smallest dose, 25 mg, is sufficient to keep you at bay, then it probably is one of the safest routes for you. Taking it PRN only when you feel so elevated that you cannot sleep is probably THE safest route. I am considering it, too, as al alternative to relying on Zyprexa prn. Note that you will need to know yourself REALLY WELL to try the PRN approach, because you will be nipping problems in the bud, and to nip something in the bud, you must not let that somwthing grow into a big plant in the first place.

would APs work for depression, though?

I think OP has no depressive tendencies, plus, with all his exercise and fitness work, he probably produces chemicals with an antidepressant effect endogenously.

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I'm on meds but I put strict rules on what I will and Wil not take. I have a tendency to get delusional so I take a very low dose anti psychotic prn. I don't see why you wouldn't be able to take a prn anti psychotic . I really think you need to get a full exam, even with neurologist but you need to put strict rules on when you take it

Venus- I take my ap when serverely depressed and thinking everyone hates me or other completely wrong things. Its helps with that but not the physical symptoms

I'm not medicated, meds had the opposite effect on me, they made me "more" bipolar instead of less, although the pdoc certainly thinks I'm medicated. Lol

That being said, I took one of his benzos during a rough time when an episode was nipping at my heels, and it helped to calm me, and also gave me good quality of sleep! Real sleep is always good for me, especially when an episode is lurking, helps reset my brain and brings things down to a more managable level.

Soooo, I'm considering actually using his Klonopin. Not daily like he instructed, but as a PRN (as needed basis) to help calm me through the storms.

I'm no doctor, and don't pretend to be one, and while I'm no fan of AP's, I certainly understand why they would prefer to tranq us, although I personally don't want to be tranqed daily anymore. Like I mentioned, a deep sleep does me wonders, but I don't think there's any pdoc who actually treats bp on an as needed basis. If you're lucky like some members here, they'll agree to an AP on a PRN basis, but would instruct you to take the MS and AD's daily.

As mentioned by Hammy, you'll have to know yourself very well in order to nip an episode in the bud, so a heightened level of self-awareness is key. You'll need to be able to identify your red flags and triggers, being a control freak doesn't hurt either. Lol, I should know.

Anywayyyy I didn't mean to ramble, I'm on an upswing, can't shutup and am kinda jumbled right now

to PC I hope you enjoy it here, lots of friends to ride along on this crazy-making rollercoaster!

Ps. You are soooo lucky that you don't suffer from the depression part, I envy yooooou!

Pps. Your post wasn't boring at all!

I'll shut up now!

I came to the doctors saying I thought I was bipolar. They diagnosed me bipolar 1 because they thought I was having a mixed episode (which at the time wasn't considered indicative of anything else). The meds made me far worse; mood, cognition, and ambition all took a dive. I went back and they said I don't sound bipolar at all, so they changed my diagnosis to mood disorder nos, and now I'm waiting for a neuropsych exam.

The one strange thing is that I did have a 4 month period of delusions, but my obsessive compulsiveness kept me from trying to deliver my message to the world until it was perfect, and after 1000+ pages, I lost interest and shredded it all.

I think its possible but you need to have a HUGE tool box full of coping skills and have the ability to use them under stress and know when you need to break down and take a med

Hi all, thank you for your input, its all been very helpful. I don't have a problem with depression, I can't say I've ever had a problem with mood swings. I have had 2 manic episodes, both of them were triggered by anxiety lasting several days preventing me from sleeping. I believe that if I can prevent the anxiety and avoid sleep deprivation, I can avoid psychosis. The last time I stopped taking my meds I was stable for 4 months and I was working right up until my first day of anxiety. I didn't feel anxious during the 4 months either, I felt pretty much normal. The anxiety came suddenly, along with it the sleep deprivation, and at the time I had no Zyprexa to take as I had been on Sodium Valproate. I tried taking the Sodium Valproate as soon as I realised I was in trouble but it didn't work. When I went into hospital they gave me 10mg Zyprexa and relief was instant, no more anxiety and I slept for 12 hours straight. I am confident that I could stop taking my meds now and only take the Zyprexa as and when required when anxiety comes along, and it doesn't take much Zyprexa to have the desired effect, just 2.5mg is more than enough for me. I'm sure Big Pharma won't like this as they'll be making much less money, but at the end of the day its my health that is at stake, I can't go on putting on weight and having no motivation to exercise.

Hey Trippin2.0, I'm a JHB boy, moved to Aus in 2008, sorry for the cricket!

Wow a Johannesburger! Facy meeting you here

No worries, lol, my mom's devastated that Graham Smith retired.

Could it be that the anxiety you feel created the episode the is actually the start of an episode? Internal agitation, ruminating and lack of sleep can all be manicky symptoms. It can feel a lot like anxiety in some cases.

Maybe a mood stabilizer rather than an AP would be a good option. Not all of them make you feel flat and lazy.

Going med free can be done, but its really important to learn to recognize your patterns and symptoms. Taking really good care of yourself, too. Starting and stopping them probably isn't a great idea, unless something is prescribed PRN.

Personally, I love my meds and hope that I never have to be without them.

It would be a great idea to have the neuropsych test while not medicated at all. Effective medication can mask symptomatology. Two of my recent neuropsych evals show nothing on Axis I, apparently because Lithium masks the bipolar. If you are not taking anything, you will get a true, unadulterated reading.

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Depakote is not a good candidate for a prn drug. Zyprexa is, but Depakote isn't. It is just not that kind of a medication, and, as you probably know, there are blood tests to assess the level of Depakote in the serum. Zyprexa acts instantly and there are no blood tests for Zyprexa.

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This is why I believe I can get myself out of trouble with Zyprexa and take it only when I need to when I can't sleep. I know I did have a hypomanic phase before my 2nd manic episode, but during this time I didn't do anything disruptive and I was still sleeping ok and was functioning ok at work. I wish I had Zyprexa when I could feel myself tipping over, I knew when I needed help, and I'm confident that I will know again, but now having Zyprexa will make all the difference and I can avoid psychosis as it works instantly.

I wasn't happy before taking mood stabilisers, and I think any other medication will make me feel just as flat/level, I mean thats the point of meds isn't it? I'm not interested in trying out a med that doesn't make me gain weight if it will make me feel flat. I don't want to feel flat, I want to experience my emotions. When I say flat I don't mean depressed, I mean neither depressed nor happy, somewhere in feelingless land. Feelings are good and I want them back. So I can feel like getting out of bed in the morning, and feel like exercising, without having to force myself to do it because there doesn't seem to be any point.

I sent you a PM because I was so curious, but what are some of the herbs and essences you use? What kind of BP do you have? Personally, I really dislike the side effects of my medication, and if it were possible to lower my doses and counteract that with supplements (of course, I'd discuss this with my doctor), I'd love to do that.

Yeah, I am not ignoring you, just wanted to reply when I had more time.

I use customized mixture of bach essences, which is homeopathic like remedy.

I have st. john's wort tincture, which i use occasionally (one has to be very careful with this).

to calm down i have lemon balm, valerian, majoram, levander.

There are mood foods like legumen (I do like beans and hummus fortunatelly).

for other supplements - omega3, lecitin, occasional guarana (that's more of study and work drug for me, but it helps me out of depression when i need), gingo biloba...

Gotta say I am from very spiritual background, so lot of the things others consider distressing or as symptoms are kinda... part of the whole life experience to me. I guess it gave me an edge somewhat.

Thanks - that was really helpful. I didn't think that you were ignoring me -- sometimes private messages get buried, or I don't notice them because I don't get email notifications.