Grrr...

Also, have you come off an SSRI before? It can cause some unpleasant effects, including agitation I'm pretty sure. (It's been a long time since I did it so I can't say my memory is clear but I spent about a year going on and off of zoloft and it wasn't pleasant). So maybe staying away from anything else that is stimulating that you can avoid might help? (Coffee and vynase spring to mind)....

My pupils do this too. I have a very strange picture of it

This is just not okay. Your mania is turning on you. It is going to get worse and worse from here. I have a good idea of this agitation you are talking about.

If I were you I would want somebody to say this to me....

You may not feel like you "need" IP now. BUT your KIDS need you to. When there are children involved we have to act sooner. Better safe than sorry. You can never be too safe with your kids.

You said before that your mania was making you a better more engaged mom. Now the tide is turning and you are so agitated that is is hard to just exist let alone parent. I know.

Please go to the hospital now. I don't care if you hate me later. This has gotten to the point where I am thinking about you and you babies all of the time and I am praying.

You are one of us strong Bipolar warrior moms! You have held on with amazing strength. Use that strength now to get yourself safe. Go to the hospital. Don't make this episode a part of your children's childhood anymore.

I told you about my friend and how I said stuff like this and she sad nothing even while in her line of work she was seeing families, individuals, and childhoods being destroyed by Bipolar.

Bad and scary stuff can happen in this illness. We have to be on our guard.

I have never been IP so I don't truly understand what it is I am begging you to do but I do hope that if and when someday I come on this forum feeling and saying what you are going through that you will dig up this old post and make me take my own advice.

Sweet friend. What are you waiting for? What will have to happen for you to think you have to go get help now? Do you really want to wait until there is a crisis? A crisis that might be traumatizing to you and your babies?

But I seriously do want to know what will have to happen for you to feel like you need to get help now?

cash - Please go inpatient. Do it before you end up involuntary. During my last episode I tried so hard to focus, but in the end I just lost it. Everyone hates the hospital. But they'll be able to adjust your meds, get you feeling better a lot faster. Sometimes we just need to go because everything becomes too much, intolerable, living nightmare. I wish I would have just gone voluntarily, but I was so stubborn. It would have avoided a lot of unnecesary drama (and extra medical bills for that matter).

I never even considered this! Also, something is making me crave sweets like a frigging pig. I though Vyvanse was supposed to make you eat less!

I wrote this note to Dr G., the doctor from WEBMD. We will see what he has to say:

Hi Dr. G,

My mania has gotten out of control. My symptoms have become overt. I requested to move my doctor's appointment up to yesterday and was able to do that. I explained all of my symptoms, especially this harrowing agitation. It is unmanageable. He wanted to let the 2.5 MG of Klonapin do it's job. The only change he made was cut my Zoloft in half; he even left me on the 50 MG of Vyvanse. I know you can't give me treatment advice (although I've never wished more that you could) and I am afraid to go against his advice. Here is my question, my symptoms are becoming unmanageable and it will be 8 weeks before I can see a new pdoc. My current doctor seems ineffective for this episode. A friend said I belong in the hospital because I said I needed to stab my stomach and let it bleed out. I said I needed to die. I said those things because I needed a release from this extremely appalling agitation. I do feel vigorously that I need to hurt myself or even someone else but I don't have the impudence to do such a thing. Do I need the hospital? My other question is this. I have considered calling my doctor and letting him know that I was unsatisfied with our appointment (I think, based on our relationship it will be received well enough) and I feel we need to try something stronger than the Klonapin. Is there something I can recommend to him? Thanks for your help.

Thank you,
Sarah

I'm walking into the clinic tomorrow. I am going to tell them it is an emergency and see what they say.

Yes; I agree entirely. I am taking them on and off. Part of me is just afraid not to take my doctor's orders even if I don't agree with them.

When you walk in go EARLY! I mean in the morning so you can def be seen. Trust me. I've done it before

I'm glad you are going tomorrow and that you plan to tell that this is a crisis situation. Please, if they can't help you, give in and go IP. I know you've said you don't think they'll accept you but they will. You're wanting badly to hurt yourself, you are afraid of what you might do to yourself, you are so manic you are very uncomfortable and agitated (which is potentially dangerous), and you are becoming more and more this way. Your mania is causing you to think things that you know are dangerous and scary but you can't stop it because it is mania, uncontrollable by nature.

You can't wait 8 weeks. I was TERRIFIED of hospitals and refused to consider them for many years. When I knew I was going on the MAOI I knew that I would have to go IP to get on it safely, especially they way we did it with overlap between it and imipramine. My pdoc thought a 6 week taper would be ok and so I had things set up for work to be off at the 6 week mark and had that date in my head. And then 4 weeks passed and I was in a scary place, flushing my excess meds and barely surviving work. I refused to go in at that point because I was "going to make it to 6 weeks". Ha. I made it to about 5 and had to say that I couldn't work anymore because I couldn't focus on my patients and I was spending their sessions thinking how much I hated doing what I was doing even though I actually loved what I was doing and loved 99% of my patients. (Ok, 95% ). And so I went in and I spent the entire first day crying and the only reason I could give was that it was such a relief to be out from under the rules I had created for myself and to be somewhere that I could feel miserable safely.

You need to go now, whether it is tonight or tomorrow, but you need to do it. It will feel SO GOOD to get off all those stimulants. I truly believe that will be half your battle because once you're off so much stimulant medication and on something more calming besides klonopin you'll lose that horrible agitated, can't live in my own skin thing that is so horrible. And once you're in those stimulants can go fast and be replaced at the same time by drugs that are better for you.

I know you can't see it probably. It's hard to ever see it and that's part of the evilness of the disorder. But really, they can make you feel better and isn't that what you want????

I hope it goes well, hun. I hate you're having to go through this. You're in my prayers.

Good luck Cashart. Thinking of you

Here is his response:

Joseph F Goldberg, MD responded:

Dear Sarah,
Sorry to hear of your ongoing difficulties. Again, I am cautious to "second guess" the treatment of someone I myself haven't evaluated or am treating....but, that said....just about every practice guideline written in the last 15 years strongly advises the elimination of antidepressants when even low-grade symptoms of mania are present, much less escalating mania symptoms. Stimulants also really have no role when agitation is present but, like Zoloft, can worsen existing mania symptoms. I think it would be reasonable to ask your doctor what his assessment of your DSM-IV mania symptoms is, and if there are at least 2 symptoms from the list of 7 that are present, let him know your concern that the continuation of any antidepressant dose with any stimulant is known to aggravate mania symptoms; and ask about his objection to initiating a standard antimanic drug (lithium, Depakote, Tegretol, any atypical antipsychotic) as the core treatment.
Hospitalization decisions require face-to-face assessments and depend on many factors beyond just risk of self-harm, including, what the outpatient treatment is. Generally speaking, for serious symptoms that don't necessarily require an inpatient level of care, practice guidelines tend to advocate some higher level and frequency of care than visits 2 months apart. Partial hospital programs or intensive outpatient programs, depending on what part of the country you're in, typically are set up to provide closer monitoring (several days per week) and structure to assure a proper level of care. If you aren't satisfied with the level of care and standard of care you're receiving then, again, it's entirely reasonable to seek a second opinion.
Good luck!
Dr. G.

Hugs friend. Hugs. So much light and love to you. We are all with you.

Rolling Stones: Paint it Black

Sitting here waiting. SOOO nervous! I feel like I need to pace back and forth but that would embarrass me so much so instead I am shaking, rocking back and forth and breathing so loudly. SO much less embarrassing, let me tell you. I am about to flipping lose my cool and go crazy on these poor people.

Where are you? At an appointmemt? Hospital? Sorry this thread grew by 5 pages since I last read it so I'm not caught up. Are you getting any help or relief.

Oh I think you're at the walk in clinic. Good for you! Especially for getting up so early to go!

Undetstand cash. I have a doc appt in an hour and I'm so nervous.

Thank you both so much! I have chilled out but will likely be waiting for hours.

You msg have to wait, yes. But I've done this and helped a LOT. You're doing the right thing my friend

((((Cashart)))))

You are amazing! I am sure this is sooooo hard. I say pace if you want dang it!

I once had to wait and hour at just a regular doc while mixed and soooo agitated and I barely kept it together. I still remember it so vividly because it was such torture. I admit I did kind of ***** out on them. I also remember pacing like crazy around my therapists office before appointments. Oh man.

Again I am so impressed you went. Give yourself a huge pat on the back!!!!!!

Again we are here with you!

You are NOT alone

Pocket rider!

Pace if you need to! SHOW them that you are in a serious place. It's not going to be the first time they saw someone who was agitated and torturing yourself won't help. I'm really glad you are there and I hope you get answers soon.