Episodes. Ride it out or change meds?

I've noticed many of us here have been complaining of being In a mixed state, myself included. I'm currently on seroquel 300mg, and Latuda 40mg. I know my new pdoc has me under medicated. I've told her time again that I need a stabilizer!

What do you guys do? Change meds or just ride it out? How long is the ride?! And are there any meds out there that help with mixed states? I'm miserable!

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Great question. I have been wondering that myself. Medication seems to be more of an art than a science. Since everybody is different, what pdoc really knows what will help in the end. Of course there is a lot of science behind their guesses its just that they really don't know how we as individuals will react. For example last terrible mixed state I was in all sorts of meds were thrown at me and in the end it was a stimulant that dragged me out of it. Who'd of thunk that? I'm glad my pdoc kept plugging away.

Sorry you are miserable. It is worth trying new meds as they might be the ones that help you. Mood stabilisers are a good start point as they can be instrumental in treating BP. Mixed states are hell. I hope you find some peace.

I'm sorry you're so miserable!! What has helped me in mixed states is increasing Seroquel. I know it's considered an AP, but I think in a way it's a 'mood stabilizer' in the sense that -3 pdocs have told me- it helps with both depression and mania -(whereas, for example, I think Latuda just helps with depression, and Lithium, my pdoc tells me, is mostly good at staving off mania). So if your pdoc is reluctant to prescribe a mood stabilizer, maybe s/he could up the Seroquel?

Best of luck, I know you've been through the ringer and back lately and I hope you feel better soon!

Good morning!

As I read your entries, you seem to know yourself quite well.
My suggestion will fall short of what you "know" you need to do.
I feel you truly hold the best answer.

I hope today is a fun day for on some level. You have a lot going on.


WC

I'm riding out the insanity at the moment. My T says "for the love of God, call your pdoc and ask to go back on lithium."

I'll probably only call him if I start self harming. I see him in a week and a half anyway. Lol

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I agree with WC, you seem to know yourself well and seem to know what kinds of meds you respond best to. I'm so sooty you are in a mixed state. Please stay safe and I hope you received the answers you seek. Good luck.

Thinking of you RX, you've really had a rough time with your meds. Big HUGS

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Thanks guys. I got my pdoc appointment moved up to Monday. But if this dr is once again going to ignore my suggestion and not listen to me, I may have to find a new pdoc. This one is nice, demure, blonde, tall, but can't make a decision for the sake of anything. She tells me I'm very knowledgeable of my meds and MI... Maybe I should teach her something.

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I do think it's up to us to teach the doctors. I hope you can get through to this one.

When I would go mixed I would start to lose touch with reality. I had to go to the hospital. The pdocs didn't call them mixed, they said mania with psychosis.

I would tell her I want to try this med. I need you to hear me, this is the med I want to try. Please prescribe it. When my last pdoc wouldn't take me off zyprexa, I brought my sister with me. They seem to listen better if you have someone else with you. Can you bring someone else?

when I was having two episodes a year, for nearly 8 years, I would normally be on lamictal and effexor as maintenance in between...but it seems only depakote and seroquel were able to bring me out of the episodes themselves...mine always started as hypomanic, morphed into manic, swirled a while in the mixed (depressed agitation high anxiety/energy) at which point I figured out it was time to see the dr..and after about 2 days on depakote and seroquel, the ABS brakes would be applied to the mania and I would crash into depression...then slowly climb back up out of the hole...I don't stay on that combo though because of side effects..when I restabilize I usually ask to go back to the lamictal and effexor. Somehow I have been able to stay stable these past two years on lamictal and effexor, I think it is because my hormones are no longer in an uproar..yay for 2 years of post menopause!

I could bring my bf so he can tell her how j flipped over a freakin coffee table on his foot and threw two chairs across the room! Maybe then she'll listen lol

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Maybe, lol.

I really recommend seeing a doctor at teaching hospital if you are hard to diagnose or treat. This has saved my life a few times over. I don't know what part of MI you live in but there is a Mood Disorder Clinic called the Depression something but with bipolar included in the things they treat (weird I know) at U of M
Depression Center Specialty Programs

and University Hospitals in Cleveland has one as well if you are somehow (I can't picture this geographically) closer to Ohio (that's where I was diagnosed and first treated and the pdoc in charge there is one of the best drs. for bipolar in the world).

One of the benefits is that (at least at University) I enrolled in a clinical trial and got an extremely thorough assessment by someone who knows all about people with atypical bipolar like mine and then 6 or 7 months of free treatment as I did a study with them. When I finished I was given the choice of continuing with a dr there, given some referrals or I could find my own pdoc. I wound up going with the one at my therapy center and she is amazingly good and now works for a huge teaching hospital and I've found a lot of benefit there. She's more accustomed to trying unusual approaches, she's more comfortable with meds that aren't used often, she remains involved in my care when I'm IP, she can consult with the top pdocs in the world (including the one from diagnosis) if needed and generally there is just more help there than just seeing a pdoc in their office. Another nice thing is that the big places can offer more financial assistance (even when not in a study) than other places. I've gotten free care for 2 years when I was not insured through one of them.

I think there are just situations where the average pdoc is stumped because the presentation is too unusual and med response atypical. I suffered so much because I didn't have doctors who would admit this to me and then my whole world changed when I found the pdocs in the mood disorder center and then my own pdoc.

I live right by UofM! Great work. Huge football family coming out if there. Thank you for the info I will definitely look into it. I'd try anything at this point. Thank you!

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As an OSU fan we probably shouldn't be speaking (totally kidding, I'm a Western Michigan grad). Don't be surprised if they have a long wait list. University did for me. However when I was told it would be so long I started crying and they got me in a few days later. That was back before mental health insurance was required and so I couldn't go IP to get started faster that way as they usually recommended. So they may have some leeway if you convey urgency.

It doesn't appear that U of M has a mood disorder IP unit but their IP sounds REALLY nice, even nicer than the mood disorder unit I go to which is extremely nice. So that would be a less than torturous option if needed and might get you into the clinic faster if they can't do that for you Inpatient Psychiatry Facilities - U-M Psychiatry

There is hope. And there are doctors who can really help, it just isn't always easy to find them. My experience is that this may be something good for you; I hope it is.

I hope your appointment goes well...keep us posted! xo

Hello,
I am newly diagnosed (and new to the forum, hi everyone!) and I am just wondering the exact same. This thread has been really helpful! I started Sertraline (zoloft 50 mg) as my only medication 10 day ago and since then everything has gone a bit crazy.
I think I am in a mixed state for the first time in my life and feel like absolute hell. I thought depression was bad, but now I am still depressed but filled with crazy energy and agitation that I need to relieve and hear a little voice within me that says self harm is the only way to relieve all that tension.
I wanted to ride it out since I've heard that sertraline can feel like that in the first few days and because I've got an appointment with a bipolar specialist (at a teaching hospital lol, great tip!) on Tuesday anyway, but now I am feeling worse than ever and just want to stop taking the sertraline

Welcome to PC!

For some reason I stopped getting updates to this thread. But my appointment was Monday before this past one and we started on gabapentin and im titrating up every week. I'm still having issues waking up though. The grogginess from meds make me a complete *****. Like, don't even talk to me unless I've had two energy drinks! Other than that I'm doing really good on the gaba. I've been asking for this med for awhile now and it's working for my anxiety too. I've been needing my PRN less!

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Meekayla, welcome to PC.

Yes, gabapentin is also good for anxiety. I've been on it for quite a while now. It definitely helps.

Sorry to hear you're still having issues with waking up, though.