How long does it take to come down from psychotic mania

My older (19 year old) son received a provisional diagnosis of bp1 early last year, but in October (the same month his brother was hospitalized for stimulant induced mania and psychosis)he was placed on cymbalta 30 mg for anxiety and depression. Two weeks ago he had a rapid manic switch with severe psychosis and has been in hospital for the past 10 days, received three shots of haldol to calm him and been placed on depakote, risperdol and klonopin. I have some questions, does this confirm bipolar 1 diagnosis or could it just be a reaction to low dose cymbalta? Secondly, he now looks like a zombie and can barely stay awake, still delusional though, is it normal to be so sleepy after a severe mania or is it just the medication and how long will it take for him to recover? I feel so sorry for him as he does not abuse drugs and has tried so hard to deal with his mental health through diet and exercise. His brother does abuse drugs and has been away in treatment since October with conflicting diagnoses (bp1, borderline, dsyruptive mood disorder etc). Thank you!

I am sorry that both your sons have bipolar.
This must be upsetting to you.
Does this run in your family?
Every one is different, it is hard for me to give you an idea about running its course..
You are being a good mom.
bizi

I cant take antidepressants myself as they push me into mixed episodes. Honestly, I started doing better after it was found that I DIDNT have just depression and was put on a mood stabilizer. I started doing better. Still felt somethihrg was sickeningly wrong but... did feel better. It took a while longer to go off the antidepressant but when I went off that... well. I started doing even better!

But its been a long ride. I will say after those med changes I started being able to make better choices as- I was so much less confused and terrified. But its taken a lot of therapy and energy and- although Im doing a lot better- its something I need to be constantly aware of.

Its awesome that you support your son. That will help him. Ive been doing it all on my own so maybe thats made it harder. A good support system can mean everything. So I know... you and your son can get through this.

But yes. I react badly to antidepressants. And though Im not a doctor and cant confoirm anything- its a very common thing. Especially with bipolar 1.

My mom was given the haldol shots in the hospital; they were very effective on hallucinations and very sedating in her case.

I don’t know how long they will keep him or how long the mania will last. I hope he responds well to his med regimen. You’ll need to be aware (if you aren’t already) that mania typically is followed by a crash down into depression.

On your Q about confirming diagnosis of BP 1–ask the psychiatrists what they think, or see if the nurses will tell you what they’ve put in his chart.

I'm so sorry for what you're going through. Generally, a provisional BP1 diagnosis plus an antidepressant-induced psychotic mania would be enough to confirm BP1. Some psychiatrists who are very conservative with the BP label may still hold off since there was a medication involved in the mania--mine did that and only diagnosed me when I became manic when not on an antidepressant--but for most doctors, your son would be considered BP1. As for the fatigue/zombie feeling, oh my do I remember that. It's probably a combination of the meds and coming down from the mania. I remember feeling like I'd run a marathon for several weeks after my mania ended--I was so achy and tired I could barely move. I was out of the acute mania after a couple of weeks, but it took a long time--like months--for all of the symptoms to resolve. Hang in there, though--things may look bleak now, but they will get better

hi. many hospitals tend to use higher doses of the drugs, especially the antipsychotics, than what he'll (hopefully) end up on long term.

just speaking as someone who's been thru this...when he's outpatient, see about trying to minimize or even stop the antipsychotic, when possible. each person is different, doctors also have different ideas on how to treat these things, but...--if-- someone can minimize the antipsychotic or taper off completely, that's always a good step (reduces long term risks considerably). just a suggestion, of course.

There are no obvious illnesses in parents except adhd, but there could be something else going on. The younger sister has OCD, panic disorder, MDD, adhd, GAD, I am worried about her too

It can take a while to come down from psychotic mania, in my experience. Many weeks and then there's the risk of crashing to depression. Try to be patient with him and keep showing your love. Time will heal.

I feel like I am in mourning, I have lost two sons in 4 months, I just don't know how to make life better for them, it is so sad.

Yes, I agree about the antipsychotics, his younger brother was thrown out into the Wilderness program on Saphris and we are now 4 months later tapering him off and placing him on lamictal - he never liked Saphris but it did its job. Seroquel did not seem to stop the psychosis in either of the boys.

That's a lot to handle.

Have you looked into NAMI family programs in your area? There may be a family support group available. NAMI is a great resource. www.nami.org
Just a thought.

I see you are also concerned about your daughter. It's all a lot to have on your plate. You are being a wonderful mom. Make sure you take good care of yourself, too, through this challenging time.

My heart goes out to you.

WC

Thank you, we definitely need some family support because nothing has prepared us for this. My daughter even ended up in ER last week from passing out repeatedly from a blood draw, just the icing on the cake really!

I am so sorry for what you're going through. I don't think you've lost your sons for good, though. I was incapacitated by my symptoms from 2005-2012, but ultimately made it through two graduate programs (one Master's, one Doctorate) in the health sciences. Working full-time has been a struggle, but I'm working 20hrs a week now and doing well with that. I don't rely on my parents for any financial support, and I feel happy with my life. Things seemed bleak for a solid 7 year stretch, but they did ultimately get a lot better. People who know me now can't even believe I was ever that ill because I'm currently flourishing.

I truly believe your sons will both get better. It does take time, but it will eventually happen, especially as long as they have your support. Remember the saying--the darkest hour is the hour just before dawn. Just when things seem at their bleakest, the darkness will begin to subside. Have you thought of seeking therapy for yourself? It's not easy dealing with multiple children with chronic mental illnesses. It could help a lot to have someone to share your struggles with--please remember to take care of yourself, too

I was manic for 6 months and ended up in the hospital. I stayed there for 6 weeks. I was almost stable when they discharged me.

Thank you, it is encouraging to know that one can pull through and make a good life, I don't have any experience with this illness apart from watching my children suffer so it is a comfort to know you are flourishing!