Normal is Not Working

9 weeks ago I had a manic episode. I was irritable, angry, and very quick to respond. I also was seeing colors and hearing music very vividly - it was magnificent!

I had been a member on my local mental health board for a year. A disagreement came up on the board and I nearly flipped out over it. My anger was out of control. I went to my pdoc and she prescribed Lamictal. 2 weeks into the treatment I felt calmer and less angry. A month into the treatment the beautiful colors and incredible music became normal. Not spectacular, just nice.

6 weeks into the Lamictal I began to feel mildly depressed. Yes, I was more agreeable. I didn't have wild confrontations with people. But my world had gone flat. After 8 weeks on the med I began to feel some unpleasant anxiety, in addition to the moderate depression.

I hate it.
I feel very isolated and distant from people, because I am detached. I'm still doing creative things, but it takes such effort.
This "normal" is not who I am. I feel like a picture that was filled with many gorgeous colors, but then the colors faded to almost unnoticeable.

Today I spoke with my therapist about how I'm feeling. She was understanding and said the goal of treatment is to feel like our best selves, not necessarily to be on a specific mg. of medication. She encouraged me to talk to my pdoc about the situation, which of course I will do. But my pdoc appt isn't until next week and she had nothing available sooner.

My plan tomorrow is to take 1/2 the tablet of Lamictal (it's 150mg. tablet).
After a few days I will see how I feel.
That's all. Just getting my thoughts out.

I take Lamictal also...this is what I understand:

People prone to mania take lithium (not always) to help with their manic symptoms.

People not prone to mania don’ t.

I’m not manic, just hypomanic...so I take Lamictal because I stabilize on the depressed side. So with a bit of a prozac I feel “normal”

I was on lithium and had a toxic reaction so pdoc stopped that right away. It was stopping the lithium that put me into the mania. It's too bad really, because the lithium seemed helpful.

Dying from toxicity is not helpful. Hopefully Lamictal will at about 200 mg or so. Good luck hon.

I mean the lithium was helpful before it became toxic.

What do you mean 200mg. or so? I'm on 150mg. now. Definitely don't want to increase.

If it’s working for you...then that’s your dose. For me...I need a tad more after a few years.

Hi Laurie—I’m wondering if you are just crashing down from the mania. It might not be the lamactil.

That’s what happens to me after going manic. I crash down into depression.

I don’t actually go manic unless it is set off by a drug. Stopping lithium is notorious for setting off an episode, worse than before you took lithium.

Thank you so much, kt. I have wondered the same. Essentially, am I having a mild depression having nothing to do with the Lamictal and everything to do with the manic episode following stopping the lithium? Or even, a depressive episode because I have bipolar disorder and right now depression is the cycle I'm in (the crash)?

I'm so glad you reminded me of these possibilities.

I guess if I halve the Lamictal dose for a few days I'll have a better idea of what's going on...hopefully.

I appreciate your replying to me, but I'm not sure you understood my OP.

I would wait until you talk with your pdoc before changing your medication dose. Is there any way you can reach them by phone before your next appointment?

No, which is frustrating. She's not in the office until Tuesday, the day of my appointment.

Hi *Laurie* I can understand your questioning the lamictal, I’m taking 200mg/day (BP 2) and I found I went through a bad spell of anxiety starting 2 1/2 months in (seems to be lessening a bit now 5 months in) but I’m tired of the “normal” being this mild/miserable depression. I’m going to bring it up at my pdoc appt in May.
The only thing I might add is it’s my understanding that coming off lamictal should be a slow taper like when starting it unless dealing with the rash.

I hope you feel better soon

Laurie, I'm just wondering if you can take 3/4 of your 150 mg tablet instead of taking just 1/2...?

Exactly. I don't understand...are "normal" people mildly depressed all the time? I mean, is that normal??

Thank you. I thought about that this morning. But I'd already taken 1/2 tablet. I am good at objectively noticing any symptoms, so I'll try the 1/2 tomorrow, too. If I don't feel right I'll go up a bit. By the time I see my pdoc on Tuesday I should have a decent idea of what's going on, and I can let her know.

A matter of getting used.
When I met my 3rd and actual wife of 28 years, I couldn't stand her. Arrogant, etc.
Now I love her so much it sometimes hurts.
My actual house took three years of wining about the other house.
Two more to like it a little. Now I'm planning to die here. Go figure.

I knew a great man who had been a top (sergeant) in the VietNam war. He used to say, "A human being can get used to anything."

No, feeling emotionally flat and mildly depressed is not normal. I have ups and downs but that's more the human experience then my MI.

Thanks so much, Fharraige. I think you've hit on something that I haven't thought of...I'm not experiencing ups and downs. Excellent point you've made. I'm only experiencing "flat". I feel like a cardboard cut-out of a person, not a living woman. All I want to do, really, is be asleep in bed. Just BLAH.

I think Key tones is right. You might still be crashing from your mania. I would give the lamictal a chance until you can talk to your pdoc. JMHO.

Thanks, Guiness. I hear you - you might be correct, this could be the post-manic crash. I kind-of hope it isn't, but...could be.

The thing about my pdoc is, she'll tell me to do what I think is best. They tend to do that with me these days. I've been on psych meds for 33 years, I guess they think I can figure things out by now. Frankly, sometimes I wish my pdocs would be a little more...doctorly.

Update...

Yesterday and today I took 1/2 the prescribed dose of Lamictal (so 75 mg). Today I feel better, more normal in the sense that I wasn't falling asleep all day, didn't feel depressed, and have more energy. I'm a tiny bit scattered, but I have had a busy day (Thursdays I facilitate my NAMI group, which involves some traveling and energy output), plus some other things I needed to do.

This, so far.

Oh, man!

I love the mania. I’m on three different antipsychotics and I have wondered, lately, how I would feel if I stopped taking them. Difficult to explain but I ride at a low level of mania/psychosis most of the time. It’s lovely.

I know nothing of Lamictal. My docs prescribe old, old, old medications because I’ve been taking them for years and years. I’m the only person that I know of still taking chlorpromazine (Thorazine).

As others have suggested, coming down from a full manic high usually slips one into a depressive low. Or a flat, numbed feeling. In my experience.

I’m not sure about the “feel like our best selves” treatment explanation. I don’t think that I’ve ever felt my “best.” My aspiration is to feel like my mediocre self, the self that I deserve.

Anyway. I do think that it is worth considering that you’re experiencing the bipolar boomerang. I wouldn’t decrease the med unless your pdoc approves, though. I’m crazy queer about taking meds as prescribed — I’m one of those people who drug-shames others who take 3 aspirin when the directions clearly read that an adult is to take 2 of the damned things.

I don’t know that the sentiment helps but I completely empathize with what you’re feeling and I think that I know how bad it sucks. We are each unique within our disorders, I believe, yet I am always amazed when I’ve discovered just how much we share.

You are one of the best here. I’m guessing that you’re one of the best there.

Get well soon.

Trying to bring cognitive science into discussion, eh?

Taking the U.S. population into consideration, my take is that many — a slight majority — are mildly depressed. All of the time. Of the remaining, I think that a little less than ½ are mildly depressed sometimes, but not often, and that less than ½ are never depressed. The remainder are us. The crazies.

And then there’s the fact that it’s the least educated people that are the happiest. I guess that they would fit in the never depressed category.

Since ‘normal’ is difficult to define I suggest using the words ‘baseline’ and ‘alterations.’ I would need to adjust my percentages to establish the baseline but I think that I could safely say that mild depression is commiserate with the baseline of the U.S. population.

We - those of us who are misfits - are alterations (or ‘an alteration). And the baseline will adjust to include us.

Cool question.

That ‘flatness’ is indicative of a depressive state. You wrote that you were manic? And now you’re BLAH?

That’s the circle of life. Um, the cycle of the bipolar life, I mean.

I slept through Thursday.