Have you ever been rapid cycling? If so, have you found any meds which have helped you cycle less rapidly? Or maybe you've found certain meds which have triggered rapid cycling in you??

My psych meds:
Abilify, Klonopin, Lamictal, Lexapro, Strattera

I need the Lexapro though. I tried going off it about 2 months ago and I became horribly depressed about 2-3 weeks afterwards. Lots of sui thoughts. Then I felt better after going back on it.

I'm hypomanic right now and I'm going to crash soon, which sucks. I was already manic last week with severe agitation.

[raspberrytorte]

Yes I've been rapid cycling in the past. Haldol made it stop.

[Wander]

I rapid cycle over the year with distinct episodes, around four episode events in total each year. However, last week I was clearly euphoric hypomanic during the day and severe suicidal manic at night. This happened for about a week and no med fixed the cycling. This type of cycling is not common to me but I do always have mood shifts during the days of my episodes but not actual cycling.

I feel for you Blue. I feel despair over my longer cycles. They seem inevitable and untouchable by meds. However, meds do seem to ease my episodes at times and perhaps shorten them thus giving me more stable time. How much stable time do you get? It doesn't sound like much. Maybe a med adjustment or review by new pdoc will help. (((Blue)))

[bizi]

could the stretera be contributing to your cycling?
bizi

Yeah. I usually ultra rapid cycle/utlra-ultra rapid cycle but clozapine/lithium combo brings me down to rapid cycle.

[Moose72]

Originally Posted by escapeartist

Yeah. I usually ultra rapid cycle/utlra-ultra rapid cycle but clozapine/lithium combo brings me down to rapid cycle.

What are the differences between those?

[BeyondtheRainbow]

I also needed clozapine to stop ultra-rapid cycling. I'm now rapid cycling but even that is less extreme. Unfortunately clozapine is supposed to be used as a last resort and you need to have failed a number of APs (my pdoc had me fail all that were reasonable for me to try, meaning I didn't do many typicals as I had bad/dangerous reactions to typicals and she only had me try a few) before they'll put you on it because it can rarely cause very serious side effects. Also you have to show you can be responsible about blood draws, weekly for 6 months, every other for 6 months and monthly until you come off it. So in my case I knew for several years I would probably need it someday but worked my way through other meds first before going on it in February.

My advice would be to consider ditching the Lexapro and see if another AD works for you. SSRIs are evil in my experience. Although they also didn't work for me so there's also that. I found ADs that were more sedating more helpful: imipramine (which also had the benefit of letting me really tightly adjust the dose with cycling using 10 mg pills), remeron (mirtazapine), can't remember what else I took long-term. I was not on ADs for a good while when I was newly diagnosed; they wanted to get me as stable as possible on other meds first and then added ADs when the other combinations didn't work.

I also wonder if Stattera is really your friend; I was on provigil/nuvigil but not until we knew well how I was responding to my baseline meds and could know it wasn't causing cycling.

Gabapentin helps me a good bit too. I take 800 mg at night now; in the hospital I was on 300 mg twice a day and 1200 mg at night. You can take a ton of the stuff and I find it calming. When I need a PRN I usually choose my PRN dose of it over my PRN Klonopin.

Abilify can be activating too. I found that activating was in general bad. That was true until I went on the MAOI AD many years into treatment and it is activating but can be balanced with my very sedating AP fairly easily which wasn't true for other activating ADs.

Have you considered getting a 2nd opinion from a really top doctor? You'd have McLean there in Boston which is supposed to be about the best psych hospital (and I'm sure they have OP) in the US and I'm sure there are other very good doctors. That was something I did early on and it REALLY made a difference. When I realized I was bipolar and my pdoc at the time was clueless about it I got into a doctor near me who is one of the top experts in bipolar in the world. I did a clinical trial with him and got a good start with meds plus a lot of education with him and then transitioned to my current pdoc who is very good with hard to treat cases and sees many BP patients who are hard to treat. She's also a pharmacist which just makes her better at her job. I've been with her 13 years now, diagnosed 14 years. SEeing a REALLY good dr. would be my #1 advice I think.

Sorry if this is too much; I'm trying to look back and think of what I would have wanted to know even a few years ago. My cycling was really not controlled consistently until this year so having any control is very new to me. It's very hard to live that way.

I've been rapidly cycling. I think meds are contributing. Still searching for my combo but doc and I are really hopeful on this current one.

[Wander]

I want to add that my T and pdoc have helped me get rid of as much stress in my life as possible - this has really reduced the length of the episodes. I have also stopped smoking marijuana, know you don't smoke it, but things like that really effect our BP. Good diet and regular exercise of course, helps too. Keeping a routine is important but it must be so difficult for you when cycling so rapidly.

Hang in there Blue. Things will get better.

Originally Posted by Moose72

What are the differences between those?

Rapid cycling is 4+ episodes a year
Ultra rapid cycling is 4+ episodes a month
Ultra ultra rapid cycling/ultradian cycling is daily mood shifts

Originally Posted by Wander

I want to add that my T and pdoc have helped me get rid of as much stress in my life as possible - this has really reduced the length of the episodes. I have also stopped smoking marijuana, know you don't smoke it, but things like that really effect our BP. Good diet and regular exercise of course, helps too. Keeping a routine is important but it must be so difficult for you when cycling so rapidly.

Hang in there Blue. Things will get better.

I hope you don't mind me interjecting and clarifying something. Cannabis can effect some people with BP or people without. Not as a rule or always. Cannabis can be useful for some. It can be used as medicine in many areas. Psych meds can cause many problems, including death. What works for one might kill another unfortunately.

[Wander]

Originally Posted by ElsaMars

I hope you don't mind me interjecting and clarifying something. Cannabis can effect some people with BP or people without. Not as a rule or always. Cannabis can be useful for some. It can be used as medicine in many areas. Psych meds can cause many problems, including death. What works for one might kill another unfortunately.

I totally agree. Perhaps I had the wrong strain for my BP. Maybe a lower THC higher Cannabinol would actually help me? I wish I had access to medical marijuana to at least try. At the moment though while I have only access to random street grade weed I must abstain.

Good point though.

My own rapid cycling happens fairly routinely several times a year - usually if there is a sudden change in the weather. It really puts me off kilter. You are apt to describe the uneasy state of aggitation and irritablity.

[~Christina]

10-15% of people with BP are real rapid cyclers.

Many people consider rapid cycling when in fact a person hasn't spent a month or so at baseline. I spend a year all over the map my Pdoc said this isn't rapid cycling we haven't found your baseline yet ! which make sense . How can you compare stable versus episodes when you don't know stable ?

Rapid cycling is considered 4 distinct 2 + week or more episodes in a revolving 12 month period.

[BeyondtheRainbow]

oops, wrong thread. Sorry.

[Moose72]

Originally Posted by escapeartist

Rapid cycling is 4+ episodes a year
Ultra rapid cycling is 4+ episodes a month
Ultra ultra rapid cycling/ultradian cycling is daily mood shifts

Ok then that's not me. I get manic or depressed once a year

[franz kafka]

I rapid cycle on and off. Sometimes I'll have years of stability, then I'll get hit with episode after episode, then back to baseline. I guess I'm either rapid cycling or stable, now that I think of it. I've had probably 6-7 episodes this year (mostly depressive).

[Nate7907]

I am right now, thanks cymbalta!

[st0psign]

I've rapid cycled, I can be totally up one day, and down in the dirt the next. Hell, I've even been depressed in the morning and by 2 I'm back on top of the world. rapid cycling is hell, and I have yet to find a med combo that helps with it...

[Melmo]

I think I am rapid cycling. About 2 weeks ago I had a few days where I felt great, life was great and things were perfect. Last night I felt so depressed I was sitting on the bottom of the bathroom tub with the shower on crying my eyes out and had a random thought of taking a whole bottle of pills. I find my mood can change day to day or week to week.

Originally Posted by BeyondtheRainbow

I also needed clozapine to stop ultra-rapid cycling. I'm now rapid cycling but even that is less extreme. Unfortunately clozapine is supposed to be used as a last resort and you need to have failed a number of APs (my pdoc had me fail all that were reasonable for me to try, meaning I didn't do many typicals as I had bad/dangerous reactions to typicals and she only had me try a few) before they'll put you on it because it can rarely cause very serious side effects. Also you have to show you can be responsible about blood draws, weekly for 6 months, every other for 6 months and monthly until you come off it. So in my case I knew for several years I would probably need it someday but worked my way through other meds first before going on it in February.

My advice would be to consider ditching the Lexapro and see if another AD works for you. SSRIs are evil in my experience. Although they also didn't work for me so there's also that. I found ADs that were more sedating more helpful: imipramine (which also had the benefit of letting me really tightly adjust the dose with cycling using 10 mg pills), remeron (mirtazapine), can't remember what else I took long-term. I was not on ADs for a good while when I was newly diagnosed; they wanted to get me as stable as possible on other meds first and then added ADs when the other combinations didn't work.

I also wonder if Stattera is really your friend; I was on provigil/nuvigil but not until we knew well how I was responding to my baseline meds and could know it wasn't causing cycling.

Gabapentin helps me a good bit too. I take 800 mg at night now; in the hospital I was on 300 mg twice a day and 1200 mg at night. You can take a ton of the stuff and I find it calming. When I need a PRN I usually choose my PRN dose of it over my PRN Klonopin.

Abilify can be activating too. I found that activating was in general bad. That was true until I went on the MAOI AD many years into treatment and it is activating but can be balanced with my very sedating AP fairly easily which wasn't true for other activating ADs.

Have you considered getting a 2nd opinion from a really top doctor? You'd have McLean there in Boston which is supposed to be about the best psych hospital (and I'm sure they have OP) in the US and I'm sure there are other very good doctors. That was something I did early on and it REALLY made a difference. When I realized I was bipolar and my pdoc at the time was clueless about it I got into a doctor near me who is one of the top experts in bipolar in the world. I did a clinical trial with him and got a good start with meds plus a lot of education with him and then transitioned to my current pdoc who is very good with hard to treat cases and sees many BP patients who are hard to treat. She's also a pharmacist which just makes her better at her job. I've been with her 13 years now, diagnosed 14 years. SEeing a REALLY good dr. would be my #1 advice I think.

Sorry if this is too much; I'm trying to look back and think of what I would have wanted to know even a few years ago. My cycling was really not controlled consistently until this year so having any control is very new to me. It's very hard to live that way.

Thanks for your response

The only other AP I've tried is Latuda, and that one was waaay too sedating. I asked for something that wasn't sedating, and the one my pdoc and I came up with was Abilify.

I had awful eyesight effects on Abilify at first, but they seem to have subsided after I started drinking more. Same with the dizziness. But it is certainly activating -- I agree.

I would like to try a different AD, but I guess that won't happen for a while. My pdoc just boosted my Lamictal to 400mg and my Abilify to 30mg, and he wants to see if that prevents hypo and manic episodes, I guess. Maybe he's not the right pdoc to have.

I don't even know if I want Strattera anyways. It doesn't help with my ADHD, so I've found it useless. We're only trying it because Adderall made me full-blown manic. But I was rapid cycling even before I took the Strattera. So while Strattera may cause rapid cycling, it's certainly not the only med which does.

I don't know what's with gabapentin, but it made me irritable all the time, so my pdoc advised me to stop taking it.

I could look into McLean and see if they can help. Thanks for the idea.

[BeyondtheRainbow]

I really recommend seeing the best possible doctor and often that means the best possible hospital. I drive 2.5 hours each way to see my pdoc and have benefited greatly from her being at a top hospital. She wasn't originally and I wound up at the hospital because she moved there but it has worked out to be the best thing that could have happened. You don't necessarily need to change pdocs, but the 2nd opinion from an expert can be enlightening.

I was in one of the clinical trials for lamictal, actually one trying to see if in combination with lithium and depakote if it might help resolve rapid cycling. (Lithium and depakote do and they thought lamictal would make sense to further help since it helps with depression. As far as I know the study did not show this at all.). I think getting everything possible out of lamictal is a good idea as it is a relatively "easy" drug, at least compared to most of the AAPs.

Unfortunately it just can take time to get it right. It took me 14 years to get the best control I've had and where we aren't constantly adjusting meds to my mood. That's extreme but it does take patience that is really hard to find when you feel like you are constantly waiting.

[xRavenx]

My pattern used to always be having long, drawn out episodes. Hypomania, Mania, mixed episodes that would last a long time, followed by crashing into a depression. Sometimes I still have long episodes.

However, I'm suspecting that I am having issues with rapid cycling lately. My episodes lately seem shorter, but still often intense, with some mixed mood in between. I am still struggling to find a med combo that consistently helps. It seems what works for one person can be entirely different for someone else. It's tricky.