Emotional range on meds

Hi all- long time lurker, infrequent poster. I have BP I with a diagnosis from Spring 2014 after a hospitalization due to psychosis. I have gotten my condition pretty manageable - I haven’t had a significant episode since Spring 2015. But I work a very stressful job, typically 7 days a week. In some respects I feel my bipolar is under control (because I have not had an episode recently) but I know in reality I suffer a lot from comorbid anxiety or sometimes get emotional, usually when I get a lot of bad news. I briefly considered picking up CBT and also pursued therapy. Inspired by the forums here, I went on a ketogenic diet that helped a lot to get me more stable (I used to self medicate with sugar).

Here’s the thing: I have been doing okay but have never been med compliant (probably not since Summer 2014). I was prescribed olanzapine 15mg at the hospital and thought it was too much. My job requires an agile brain and I didn’t want the brain fog. I still see a psychiatrist every month and he is pretty happy with me because he doesn’t have any idea. And if things do seem offkilter I will take probably half an olanzapine pill prn (maybe once every month or two).

I agree this isn’t a good path. Lately I have been thinking maybe the brain fog is worth it if I felt anxious less or had more narrow range of emotions. But at the same time I see lots of things on the internet that indicate the brain fog and weight gain are significant issues. I’ve also been around enough to know meds alone cannot fix everything. Guess I am just interested in any coping tips, advice, or otherwise that people might have.

I do know this long without meds is foolish. When I am stable and even keel on my own, it feels good. But I know that’s foolish. Thanks!

It’s not necessarily foolish to be without meds if you are managing well without them. Some people are able to use lifestyle changes as you have plus CBT and/or DBT therapy to manage quite well. However it’s no good to lie to your pdoc, because if things do go off, he won’t know how to help you. He will just up your med but not know that you hadn’t been taking it at all.

If you do decide medication might help, there’s more out there than just olanzipine. If you’re worried about brain fog and weight gain you can research other meds that may not have the same side effects.

My suggestion is that you spend time searching inside, focusing, and accepting that you have an illness that needs treatment. It's unfortunate and oftentimes hard to accept, but it is what it is. No one wants to be on meds, no one wants the side-effects, and everyone has reasons for not taking meds, but some of us need them.

My regular doc really discourages Olanzapine because of weight gain and gave me the ammunition to challenge the psychiatrist. It is an excellent PRN for mania. Can you trust yourself to take it? My two full-on manic events were 21 years apart, both triggered by prescriptions (diet pills and propanolol insomnia). Otherwise, just hypomania triggered mostly by stress. I was only diagnosed because of manic event #2 in 2015.

Seroquel seems to be not as effective. It’s great for sleep.

I’m not clear on lithium in terms of weight gain. I’m struggling more than I used to.

I am now in a high stress job. I need the lithium and the gabapentin to manage the anxiety, and the stress. I also see a therapist for anxiety. These all help quite a bit.

You need to talk to your pdoc about what medications you take and how often. It is their job to monitor that. Taking olanzapine prn to avoid psychosis is a hit and miss operation without the pdoc on board to monitor for signs and give advise on what to do. Even then it is tricky and not for the faint of heart.