[Wanderlust90]

Anyone had an improvement of anxiety symptoms on a particular mood stabiliser? Lithium didn't help anxiety. Neither did either the snri or ssri I've tried. Both snri/ssri caused agitation, restlessness & hyperactivity enough to land a bipolar II dx. I feel like the ADs make it all worse in a way.

The first med I tried for depression & anxiety was pristiq, it was horrific & caused dysphoric hypomania, I didn't know this at the time & my GP decided it was best to increase the dose, which made it even worse then finally got a psychiatric referral. That pdoc started lithium with a suspicion of bipolar which helped a lot but didn't get rid of the depression. I ended up stopping the lithium because I thought it was blunting my emotions too much. Kept taking pristiq & ended up in another dysphoric hypomania.

Then chenged to prozac only, & almost immediatly bumped up to 40mg as a new pdoc in the area I have moved to thought it was just depression & anxiety. I had a somewhat euphoric hypomania in response & was restated on lithium again. I've since stopped all meds & although I can tell I'm far more volatile & mercurial I actually feel better overall.

I am adamantly against antipsychotics at this stage. I have concerns about D2 receptor antagonism. After having used meth for 3 years, I had taken metaclopramide (maxalon) an antiemetic that also antagonises D2 receptors multiple times when using due to the nausea it created & the maxalon ruined the experience every time. The feel good wellbeing & comfort was replaced by an anxiety driven unstable energy but at the same time I was totally unmotivated all of a sudden. This is the experience I've been struggling with on a daily basis so I'm not about to start an antipsychotic anytime soon until I've given everything else a go.

Anyway anyone know of the miracle anxiolytic mood stabiliser I'm after?

[Wanderlust90]

Oh that & I either have restless legs syndrome or persistent psychomotor agitation. I do not need anything that may cause or potentiiate akathesia like symptoms.

[BeyondtheRainbow]

Depakote was pretty effective for anxiety for me. Trileptal totally knocked me out (on a teeny dose, it was weird) so I'd guess it's good too. Gabapentin is supposed to help anxiety and I think my small dose does (I don't tolerate higher doses of it).Hydroxyzine works for me sometimes ( used it long-term for a while and did well on it when I was doing something in therapy that was causing enough anxiety that my therapist and pdoc discussed it before we started and got me well-established on it then did the therapy work and it was good for that; I've used it short term as well. It's been weird; I used to do well on 50 and now 10 knocks me out which will be in my favor while coming off Seroquel). I'm sure there are others; those are the ones that come to mind as most effective over the years. Topamax also probably helps but with my other meds being sedating I've never been able to tolerate more than a little of it.

[Wanderlust90]

I'm very much considering just asking my current pdoc (who doesn't seem interested in me unless I'm actively suicidal) to start me on depakote, maybe lamictal but I'm not sure on that one, I've read many posts that say it can cause a little bit of hypomania? The depression but also frequent attacks of agitation & anxiety are my main concerns at the moment. Hydroxyzine I'm curious about also, to help stabilise sleeping patterns without using an antipsychotic. Thanks for your feedback!

[Lost_in_the_woods]

I read ur posts often wanderlust and I feel for you big time... I have for most of my life been diagnosed with trMD and BPD (also GAD and trauma and dissociation).... but and alternative Dx of BP2 has also followed me around. I have been through the gauntlet of failed med attempts! Been on practically every thing.... most just made my depression worse. The last few years I have been being on a controversial regiment of Adderall and klonopin.. it's not ideal by any means but as long as I keep myself to a strict schedule, remember to eat and make to do lists to focus on..it keeps me outta of my head and negative thinking.. Most days I actually get some stuff accomplished! This past week I just had Latuda added on. So far so good... fingers crossed! I guess what I'm trying to say is keep the faith! and know ur not alone in frustration.

[BeyondtheRainbow]

I never had trouble with lamital and hypomania but I was always on it with depakote and lithium (and I still got hypomanic, just not from the lamictal). It increases the depakote level so the two cancel each other out somewhat. Although for me that meant I was sick a lot from what I think was too much lamictal (I was in a clinical trial with the combo of the 3 drugs and partway through they upped everyone's lamictal saying a higher dose was better. I started throwing up soon after and it took a while to figure out what was causing it, especially since I was done with the study and with a new pdoc about the same time.) But now they don't usually prescribe that dose that often I don't think so the further trials must have shown it was too much (and apparently that the combo I was on didn't work since it was never published).

I liked lamictal a lot the 2nd time with better dosing but I got to the end of the high risk period for the rash, was happy, and within days got the rash very badly. So, no more lamictal for me.

I did depakote for a long time and it was good at what it did, I just didn't process it well and required a huge dose which had more side effects than a normal dose (3200 mg of ER).So when Seroquel was working well I was glad to go off Depakote. But for the years I needed the stuff it was exactly what I needed.

[Wanderlust90]

Originally Posted by Lost_in_the_woods

I read ur posts often wanderlust and I feel for you big time... I have for most of my life been diagnosed with trMD and BPD (also GAD and trauma and dissociation).... but and alternative Dx of BP2 has also followed me around. I have been through the gauntlet of failed med attempts! Been on practically every thing.... most just made my depression worse. The last few years I have been being on a controversial regiment of Adderall and klonopin.. it's not ideal by any means but as long as I keep myself to a strict schedule, remember to eat and make to do lists to focus on..it keeps me outta of my head and negative thinking.. Most days I actually get some stuff accomplished! This past week I just had Latuda added on. So far so good... fingers crossed! I guess what I'm trying to say is keep the faith! and know ur not alone in frustration.

I hope the Latuda works for you, I've heard it's had great success in treating bipolar depression.

Thanks for being supportive!

[Moogieotter]

Hi,

Depakote was good and strong as a MS for me. If I was in bad mania or a crisis, I'd go on it no problem. It works fast, just a day or two to hit therapeutic levels. Might not be the best long term MS. Also helped when I was in drug and alcohol rehab.

Good luck!

moogs

I don't think that any of the mood stabilizers are great for anxiety by themselves. I'm very happy on a small dose of lamictal and klonopin. I have risperdal if I need it, but hate AP's with a passion so rarely do.

Okay, not 'very happy' but more like comfortable and functional. Ish.

[Wanderlust90]

Originally Posted by jupiter3

I don't think that any of the mood stabilizers are great for anxiety by themselves. I'm very happy on a small dose of lamictal and klonopin. I have risperdal if I need it, but hate AP's with a passion so rarely do.

I would love some klonopin, with my hx it's not going to happen.

[BeyondtheRainbow]

I would seriously consider trying hydroxyzine. I've had times I've taken it and the effect hasn't lasted long (usually when I'm in the hospital and taking it as often as possible and at a higher dose) and I had several years when I took it 10 mg either scheduled 3 or 4 times/day or PRN depending on circumstances and then again at bedtime in a 50 mg (50-70?) dose and it worked pretty well. I think I was able to be off benzos for a while that way and I know that when I was suicidal they removed me from benzos and put me on hydroxyzine until I was a bit safer and it worked pretty well during those weeks which were some of the hardest of my life. My own pdoc put me back on it fairly soon after the hospital when she felt it was safe enough since I didn't have access to my meds but I think I was off it a month or maybe 2 and went back on because I couldn't sleep or something completely typical for me that the benzos help.

It is much better than benadryl (which after being given a bunch of doses of it in the hospital with akathesia imposed on mania once we finally realized makes me agitated; it does not do that at all). I am certain I'll be on a lot of it in the hospital and will be glad to have it (I've been trying to not use it so that I'll respond the best possible in there to it).

It's really not bad stuff. I discovered it worked for me accidentally; when I had lamictal rash it was prescribed in pretty high doses to keep the horrible itching under control and to make me sleep so I wouldn't scratch. I realized that I was more calm that week than ever so we tried it PRN and then routinely at bedtime and it was good. I don't remember when or why I stopped it.

[Wanderlust90]

Thanks! I'll def be bringing it up with him. I think he will be receptive to the hydroxyzine as I really feel I need benzos but he's cautious given the substance abuse. The only other thing I was willing to give a go other than the mood stabilisers at this stage is mirtazipine, to aid sleep & agitation & maybe help keep depression at bay too. So I'm not sure whether to push the idea of depakote & mirtazipine, or lamictal & hydrozyzine. Starting 2 simultaneously is probably not the best idea though. But I figure depakote might help anxiety & the hypomanias, & with mirtazipine to keep the black dog away but also help sleep. Or lamictal as an antidepressant mood stabiliser with hydroxyzine to help with anxiety & sleep. So I suppose you can see I'm keen to have something to combat the agitation & anxiety foremost, prevent depression & aid sleep. If only it were so easy! I don't think he will be pleased when I go back to see him with a list of meds, including med combos I want to try & the admission that I ceased all of his meds without his approval or even telling him. I will add that I feel really secretive about how I feel. I don't like my partner knowing what I'm feeling most of the time. He doesn't understand the fluctuation of symptoms or my inability to pull myself out of them, so he just believes I'm being dramatic. I do a lot of hiding of symptoms when I can. This has gone off topic haha sorry.

[BeyondtheRainbow]

I know that it is not approved for this and that probably nobody else has ever had this happen but I swear that mirtazapine was a mood stabilizer for me for a good while. I took it when I was pretty new and then had to stop it because it was too sedating in grad school. I wound up back on it in grad school and about 6 months later is when things changed and I now know I was going from rare manias to BIPOLAR. But I got through 8 months, including 6 months of clinicals, and then the first 6 months of working and taking my boards without the bipolar really breaking loose and the only explanation I have for that is mirtazapine since as soon as I stopped it I was fiercely and truly bipolar (but still a year from diagnosis). It felt like a mood stabilizer does now that I know the feeling. I think for whatever reason it was just enough to keep me from losing it completely during that really critical time period.

[Wanderlust90]

Originally Posted by BeyondtheRainbow

I know that it is not approved for this and that probably nobody else has ever had this happen but I swear that mirtazapine was a mood stabilizer for me for a good while. I took it when I was pretty new and then had to stop it because it was too sedating in grad school. I wound up back on it in grad school and about 6 months later is when things changed and I now know I was going from rare manias to BIPOLAR. But I got through 8 months, including 6 months of clinicals, and then the first 6 months of working and taking my boards without the bipolar really breaking loose and the only explanation I have for that is mirtazapine since as soon as I stopped it I was fiercely and truly bipolar (but still a year from diagnosis). It felt like a mood stabilizer does now that I know the feeling. I think for whatever reason it was just enough to keep me from losing it completely during that really critical time period.

I would be overjoyed if I could control my symptoms with one mood stabiliser! But that may be wishful thinking.

[BeyondtheRainbow]

Me too. And of course mirtazapine isn't supposed to be a stabilizer at all. It just seemed to give me one crucial year that I don't think I would have had well, honestly I wouldn't have had if my pdoc at the time hadn't died. Because I didn't want to stay on mirtazapine b/c of weight gain (5 whole lbs...little did I know) and sedation but then he died suddenly and there wasn't a psychiatrist to change things.

I know that sometimes people are able to come off a lot of meds when they get on clozaril. The current plan is to keep it low dose and keep my extra meds but I'm hoping that I'll be able to get rid of gabapentin and topamax eventually since both are low dose and just add a little bit of calm to my life. I guess we'll see. I can't imagine taking less than a huge handful of pills every night plus 1 1/3 patch. Some of my handful will leave with Seroquel so soon I'll have less to deal with. I can't even imagine what it will be like for pill box filling time to not be dreaded because it takes so long.

[Wanderlust90]

Do you get much nausea? I seem to get increasingly more nauseated the more meds I take. It was probably just because I always had lithium as one of the combinations. It makes me anxious to take them because of it.

[BPFigment]

What about trying seroquel it acts as a pretty good mood stabilizer been on it for a long while. I probably need to increase the mg but I want to be in hypomania or I don't get anything done.

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[BeyondtheRainbow]

Not really. I had a lot of nausea and daily vomiting on a high dose of lamictal plus depakote which increases the levels of one of the drugs (I think the lamictal?). After that the only nausea I had was when my lithium levels crept up, which did happen after I was toxic the first time. It seemed like I was more sensitive to it after that. But if I reacted with lots of water and some salt when I first was nauseous from lithium I was fine. Otherwise the only time I've had trouble with nausea was last summer whenever my loxapine dosage was increased I'd be sick for a few days but that drug only lasted a few months before I got EPS pretty badly and had to stop. I do take meds for GERD and that helps a lot. I'm supposed to take them BID but am a failure at AM meds so mostly only get it at night. We'll see what happens when I'm supposed to take Clozaril in the morning. Maybe I'll figure out how to handle AM meds again. I used to do it without problems and now I'm so bad at it I even take levothyroxine at night.

[Wanderlust90]

Originally Posted by BPFigment

What about trying seroquel it acts as a pretty good mood stabilizer been on it for a long while. I probably need to increase the mg but I want to be in hypomania or I don't get anything done.

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I really just don't want to take any antipsychotics at this point although it may be at my detriment.

[Wanderlust90]

Originally Posted by BeyondtheRainbow

Not really. I had a lot of nausea and daily vomiting on a high dose of lamictal plus depakote which increases the levels of one of the drugs (I think the lamictal?). After that the only nausea I had was when my lithium levels crept up, which did happen after I was toxic the first time. It seemed like I was more sensitive to it after that. But if I reacted with lots of water and some salt when I first was nauseous from lithium I was fine. Otherwise the only time I've had trouble with nausea was last summer whenever my loxapine dosage was increased I'd be sick for a few days but that drug only lasted a few months before I got EPS pretty badly and had to stop. I do take meds for GERD and that helps a lot. I'm supposed to take them BID but am a failure at AM meds so mostly only get it at night. We'll see what happens when I'm supposed to take Clozaril in the morning. Maybe I'll figure out how to handle AM meds again. I used to do it without problems and now I'm so bad at it I even take levothyroxine at night.

I got GORD too, nexium helped a lot.

AM meds are the worst, I don't usually eat breakfast either so that makes its harder to remember & also more likely to cause nausea. Some are doing weekly thyroxine dosing? Not sure if that would be a good idea with bipolar but maybe something to look at & mention to pdoc if interested. I read it here Once weekly thyroxine treatment as a strategy to treat non?compliance

[BeyondtheRainbow]

I think it is reasonable to at least try without an AP. I tried every AAP there was except Zyprexa and Seroquel in the course of 2 years or so in the mid-2000s. Zyprexa we saved back because I have a scary family history with diabetes and after working at a place where the pdoc used Seroquel to snow people I was terrified of the drug. So except for a few months on Geodon before getting EPS I was only on stabilizers for quite a few years with a few days of APs that failed. Finally in 2007 I had to try Seroquel (no more reasonable stabilizers left?) and I found out that it did not mean being snowed. When XR came out I begged to go on it and was on it before the pharmacies were even stocking it and that turned things around for me. I then got off Depakote and onto Emsam and had my first fairly stable months ever. So that story does end with the AP making it better but I did ok without one for quite a long time too. I was working full-time. I was off on disability twice and then again when I started Seroquel. I didn't get fired from a job until I was on Seroquel so my work may actually have been better before Seroquel (or I had better jobs; take your pick. i actually think being fired twice was partially related to those 2 jobs I wasn't supposed to be full-time but they needed someone full-time and couldn't find someone for the 8 hours I didn't work so it was dumped on me and then I couldn't keep up well. plus I was not a perfect employee. And one job had a long hx of firing people and replacing them with cheaper new grads which I obviously did not know before working for them). But anyway, rambling. Point is that I did ok and you might too. Especially if you can control anxiety.