[caringmum]

What would help with the depressive crash following severe mania and psychosis? My son is on invega sustenna and still has some residual psychotic symptoms but he is crashing hard and wants a med to counteract this - what would you recommend? Wellbutrin, lamictal, a stimulant? An SNRI contributed to the manic switch to start with, but I am hoping there is something out there that will help him.

Wasn’t your son in the hospital for a long stretch of many weeks without responding to treatment? What did they finally do to bring him down? How long was he in?

Does he have any addiction/overdosing issues? My mom did, so that played into what they would prescribe. Also I’m wondering because it sounded like the sudden extreme mania/psychosis and not responding to treatment IP was a surprise.

[emgreen]

Unfortunately, one size doesn't fit all. Sometimes they have to try more than one to get results...that was my experience at least. I hope yout son gets some relief soon.

[caringmum]

Originally Posted by key tones

Wasn’t your son in the hospital for a long stretch of many weeks without responding to treatment? What did they finally do to bring him down? How long was he in?

Does he have any addiction/overdosing issues? My mom did, so that played into what they would prescribe. Also I’m wondering because it sounded like the sudden extreme mania/psychosis and not responding to treatment IP was a surprise.

Yes, he was in for 30 days between March and April - they wanted him in for longer. He is far from well now but depakote brought the mania under control, and the invega shot is easing psychosis, but he stopped depakote and will not take any more invega. There are still delusions and there are rapid mood swings, no substance abuse issues though - it was a low dose SNRI that activated him after 4 months. Think there have been signs for a couple of years though. We have three more weeks of the invega to stay in his system, after that if he refuses meds who knows what will happen.

That’s a tough spot to be in if he won’t take meds.

It seems odd that he wasn’t started on a mood stabilizer for the downside...at least prescribed one. Mania crashdown into depression is extremely predictable and typical.

Lamactil is what is typically prescribed for bipolar depression as a mood stabilizer where there is high risk of mania. I can’t take it because it gives me a terrible headache. It has rare but serious/fatal effect that has to be considered and watched for.

[caringmum]

Originally Posted by key tones

That’s a tough spot to be in if he won’t take meds.

It seems odd that he wasn’t started on a mood stabilizer for the downside...at least prescribed one. Mania crashdown into depression is extremely predictable and typical.

Lamactil is what is typically prescribed for bipolar depression as a mood stabilizer where there is high risk of mania. I can’t take it because it gives me a terrible headache. It has rare but serious/fatal effect that has to be considered and watched for.

He was prescribed lamictal but he refused to take it. His brother is doing very well with lamictal. He also refused depakote after a month He has no insight.

[~Christina]

If he is refusing all meds then its not going to matter what he is put on

Does he have a T ? I hope so , Maybe his T can help him understand how the meds will make him feel better as he isnt listening to you which is common for family to not get through.

He might need further IP to find some stability so he can think more clearly..

Im sorry you and him are going through such a hard time

I used to dole meds out to my mother daily and watch her swallow them. Otherwise she did not get to see my daughter. When she didn’t want to cooperate, there was nothing I could do, but try to get her committed when she wasn’t safe.

I don’t know what else to say. You need to decide what you can control him with.

[caringmum]

He was committed by the hospital, 4 out of 6 weeks and forcibly injected with haldol 4 times, not sure what more we can do. He is very inconsistent with therapists. He is also too smart for his own good.

There is a caregivers support section on the board.

We can’t help you with your question if he doesn’t accept treatment.

[caringmum]

Originally Posted by key tones

There is a caregivers support section on the board.

We can’t help you with your question if he doesn’t accept treatment.

Thank you! He says he will take something for depression and asked me to research, so i am researching! Sorry if this is not the correct forum for me but I get more out of this forum because it is more targeted to what I seek to understand. The problem with Lamictal is it does take a while to ramp up, I was looking for additional information. Thank you for your patience and help.

I would be loathe to mention anything but a mood stabilizer given what you’ve told us - he shot pretty high up w/psychosis and then refused meds to come down or get stable.

Besides, the psychiatrist needs to be willing to prescribe it as well.

He may need to be readmitted as it stands - that depression after extreme mania is pretty horrible and should be seen/assessed by a psychiatrist to be sure he is safe. Especially since he isn’t taking the Lamactil

[Pookyl]

Originally Posted by caringmum

Yes, he was in for 30 days between March and April - they wanted him in for longer. He is far from well now but depakote brought the mania under control, and the invega shot is easing psychosis, but he stopped depakote and will not take any more invega. There are still delusions and there are rapid mood swings, no substance abuse issues though - it was a low dose SNRI that activated him after 4 months. Think there have been signs for a couple of years though. We have three more weeks of the invega to stay in his system, after that if he refuses meds who knows what will happen.

Mood stabilisers stop the highs and the lows. I take Depakote, Lithium and Seroquel daily regardless of whether my mood is up or down.
Depakote is the only drug I’ve taken that has successfully stopped suicidal thoughts.

[tecomsin]

Originally Posted by caringmum

What would help with the depressive crash following severe mania and psychosis? My son is on invega sustenna and still has some residual psychotic symptoms but he is crashing hard and wants a med to counteract this - what would you recommend? Wellbutrin, lamictal, a stimulant? An SNRI contributed to the manic switch to start with, but I am hoping there is something out there that will help him.

It's quite common with bipolar not to have insight into anything other than the depressive episodes. Perhaps you can convince him that in order to feel better he needs to be on several meds, including a mood stabilizer or antipsychotic. If he went manic before on an antidepressant then that would be an exceptionally poor choice without another medication to stabilize him.

[caringmum]

Originally Posted by key tones

I would be loathe to mention anything but a mood stabilizer given what you’ve told us - he shot pretty high up w/psychosis and then refused meds to come down or get stable.

Besides, the psychiatrist needs to be willing to prescribe it as well.

He may need to be readmitted as it stands - that depression after extreme mania is pretty horrible and should be seen/assessed by a psychiatrist to be sure he is safe. Especially since he isn’t taking the Lamactil

Yup, he is back in hospital because of depression and psychosis. He is now on latuda, invega and lamictal. This is exhausting!

[Wild Coyote]

(((((( caringmum ))))))

Please remember self-care is vital.

You have my admiration.

WC

[downandlonely]

I hope your son gets stable soon and will agree to stay on meds.