Agitation, Irritability, Insomnia

I have been experiencing ongoing agitation, irritability and insomnia.

I saw my pdoc and we were going to use Seroquel, which tends to help quickly.
I cannot use Seroquel or many other med options because of my Current EKG, which show my QTc interval is already almost maxed out with current meds.

We are trying gabapentin. I am tolerating MUCH more than I have ever been able to tolerate, so something is going on. I still cannot sleep, day or night.

Today I am unable to tolerate noise. The quietest noises are WAY TOO LOUD! I have had to ask people to whisper when talking to me. It's best if I isolate because I am jumping and cringing with the slightest sound. Even my laptop keyboard noise is FAR TOO MUCH NOISE!

Does anyone else experience extreme noise sensitivity when going through a period of agitation?

Does this sound like agitation which can go along with Bipolar illness?

Thanks so much!


WC

ohhhh boy I can get agitated asf. Would saphris be a viable option? That knocks me out of **** fast. I just take it as a PRN now.

I've felt the overstimulation b4 and it really sucks. Can they put you on a mood stabilizer like lithium or depakote to help?

I hate being agitated. I feel like I just can't find a place for myself and noise makes me crazy. So sorry you're going through this...you have my sympathies.

Thanks for your response and your suggestion. I see pdoc tomorrow and will ask her about Saphris.


WC

Thank you for responding. We are trying gabapentin x 3 days so far. We might have to switch to the golden standard: lithium or Depakote. I see pdoc tomorrow.


WC

I appreciate your response. I am sorry anyone must suffer with this. You give a good description. I can relate! I just want to crawl into a dark, quiet hole or cave!


WC

Your responses are very helpful. I have been trying to sort out what symptoms are Bipolar illness, which are c-PTSD and which may be migraine/migraine equivalents. There may be some overlap. I am BPII and I get deep depressions and/or these episodes of agitation.

I feel like there is a war going on inside, as though I can feel the agitation fighting against the sedation of the medication so to speak. Strange feeling.

I am glad I see my pdoc tomorrow.

I deeply appreciate responses. Very helpful!

With Deep Appreciation,

WC

Yes, there certainly could be overlap.


I have found that Gabapentin 300mg./daily is really helping me with bipolar anxiety and agitation. (Higher doses caused me to feel extremely unwell...weak, vertigo, exhaustion).

I agree with others about checking into an additional mood stabilizer.

As for noise - oh, my gosh, yes! Even the sound of someone talking feels like agony. Interestingly, if I play music that always makes me feel good. All other sounds - ugh.

Yes the noise sensitivity got intense for me when I was very agitated, although I am not one to say if it goes with bipolar since not sure what's going on with me. I also experienced light and touch sensitivity. I found myself with my jacket over my head, plugging my ears and closing my eyes, curled up in the car once when driving with my boyfriend during one of these phases. He thought the music was too loud, didn't have the heart to tell him his voice was aggravating and also felt like he was screaming in my ears haha. I am sorry for what you are going through and I hope you find something that works

Thanks Laurie! I may just need more gabapentin, I do not know for sure. I am not maxed out on it and I do start to feel better approx. 2 hours after taking 600mg. I am not taking it around the clock yet and I think I need to do so. (I am more agitated than I was 4 days ago when pdoc prescribed. I do see her tomorrow.
Thanks again!

WC

I get overstimulated easily. I've had that all my life. Especially to noise and crowds, though I could stand a lot more in the way of noise than my daughter can. I still don't like noise and/or crowds. However, I have a father I'm 99% sure is on the autism spectrum with Aspergers. My daughter has sensory processing disorder (makes parentlng a challenge, every sense of hers is affected). Anything & everything with the potential to overstimulate her senses, and she is out of sorts.

I remember absolutely hating the noise of the school cafeteria when I was in middle & high school. In high school, where we had a little more choice in where we ate our lunch, I'd often choose to eat outside, even when it was extremely hot or cold (well, at least to someone used to living near Houston).

I'm not doctor, but maybe the noise sensitivity and agitation for you is getting worse with lack of sleep? Do you manage much sleep at all at night? Around how many hours? I hope your pdoc appt. goes well tomorrow.

Thanks for your response! Yes, I can relate! I often have both light sensitivity and sensitivity to scents/odors, too.
Thanks so much!

WC

Thank you for your response! All of my senses can be involved sometimes.
Yes, sleep is a huge issue right now. I get 0-3 hours at best. This has been going on too long now! My pdoc was hoping one dose at night would help me to sleep. No! I think I now need a mood stabilizer around the clock in order to chill. Will see what pdoc has to say.
Thanks again!

WC

it looks like Depakote is also a risk for QTc prolongation.

I have previously been in a state where I have begged for Depakote... a few times. Depakote has worked.


WC

I've had gabapentin work differently for me different times.

I was first on it with akathesia/mania combined and I was so sedated I couldn't function and the dose had to be lowered a bunch of times but I stayed of 400 mg for sleep.

When I changed from Seroquel to clozapine I was extremely agitated and unable to tolerate any noise or even conversation. That was IP so they put me on more and increased it daily until I was on 1800 mg/day, divided.

After I was on clozapine a while that was way too much and we backed down slowly to 800 mg at bedtime and 100-200 mg PRN. I've been on that for 2.5 years without issues aside from being too sedated from my entire cocktail combined.

Now my pdoc is hoping to wean me back to 400 or so once summer and my higher risk for mania passes.

It's a weird drug but it has really helped me. When I was IP I kept telling them it felt like all my skin was gone and I was nothing but bare nerves which was intolerable.

My weighted blanket really helps with this if one of those is an option for you.

WC I get your agitation fighting the medication sedation part. It fights back and forth. Gabapentin worked for me for a while and I just had to keep going up on it for anxiety, agitation or sleep. So I went back to xanax or ativan. I have been in a very agitated state plus depression lately.
I hope you find relief. The other thing for me is like meditation music.

Thank you for your response!
I have also found Neurontin/gabapentin works differently for me at different times. in the past, I could not tolerate more than 100mg per 24 hours. My pdoc had prescribed based on that report, just 4 days ago. She had prescribed a bottle of liquid gabapentin. I have increased the dose to 600mg. at bedtime over this weekend. I need more; I need it during the day, too.
This pdoc is new to me and I am wondering what she will think/say about my having done this; yet, I HAD TO DO IT! It has been a matter of survival.

I took 600mg almost 4 hours ago. I had started feeling better at 2 hours later and still am feeling better; yet, it is going to wear off. I might take a morning dose of 300-600, we will see. I doubt I am going to sleep tonight. Once I cut the agitation some, I feel wired underneath... happy and singing rock music! Lol! Feels surreal.

I will see pdoc in approx. 14 hours. I can get through it until then. Concerned because I have a few other obligations afterwards. I'll be needing more gabapentin (or something else) by then and I won't have time to come back near my home or pharmacy in between. I guess I will bring my bottle of gabapentin liquid with me.

Thanks for mentioning the weighted blanket. I should look into it. I am usually so warm I cannot use a blanket though. I'll think it over.

I truly appreciate your response!
I hope you have a good night tonight.

WC

Thanks for responding!
I am glad you get the part about the agitation fighting the medication/sedation. Yes, it fights back and forth. I can relate.

I am very sorry you have been suffering.

I had been using some temazepam at night for sleep, but it had stopped working. Pdoc put me on gabapentin, as our choices are limited. it looks like I need more medication, around the clock.

When I cut the agitation, I am feeling happy and want to listen to rock but will not! It will only make things worse! Meditation music sounds like a better option! Thanks for the suggestion.

I hope you feel much better soon!

WC

Just FYI as my pdoc says gabapentin for psych stuff can go up to 2000 mg. TBH though for nerve pain I've heard people taking 3700 mg. He said over 2000 mg it loses its therapeutic whatever. (sorry my brain is shutting down).

When he first took over my gabapentin prescription I was on 2400 mg. I got him to take over the prescription because it didn't do **** for nerve pain but worked wonderfully for anxiety. I worked on it for 2 years to lower it and now take 200 mg in the AM and 1200 mg in the PM. Tried going lower but the anxiety came back, so I'm a happy camper at this dose.

If you want to know about saphris it comes in 2.5 mg, 5 mg, 10 mg. (maybe 7.5 mg it's a bit fuzzy. i don't think so though). I can take up to 25 mg. It's a sublingual and tastes horrible but if you put it in your mouth under your tongue then shut your mouth tight and i mean tight and keep it like that for 10 mins you don't really taste it. If it gets in the rest of your mouth it'll numb the hell out of it (kinda reminds me of the white stuff). Also it made me hungry asf so I made sure I was about to pass out before taking it. I'd take it and be out in 5-10 mins. BUT it can have the opposite effect and keep you up. It's a crap shoot. I'd sleep 11-14 hrs a night on it. It was really rough when I was really bad and had to take it in the morning and night but then got a bit better and took all of it at night. I have a high tolerance for meds so you might not need a huge dose. Also there is no generic yet. Final thought. Black cherry my ***.

Another thought I had while I was sitting here thinking about this, do you think maybe you're having a mixed episode? I get wild agitation in those. Another med I take is Equetro which is basically a shiny new form of carbamazapine that's extended release that had more bioavailability of the med in your system. It has less side effects than generic carbamazapine and I had no weight gain on it, if you're worried about that. (i've actually lost a lot of weight on this combo of meds amazingly). It's marketed for mixed episodes in bipolar if you go to their website. they also have a coupon.

Anyways I'll stop rambling, I was just still thinking about this and agitation is the worst. Been there, done that, still finding keys from a keyboard I flung. ha. The other meds I'm on are lamictal and geodon but I don't think they'd help with agitation.

Are you on a benzo? Kpin knocks me down a few notches when I take it but I hate taking it. Just a thought.

Sorry. I got my nuvigil prescription today. *shuts up*

Hi Moreta!
I appreciate all of your feedback! Every bit of it!

I might be in a mixed episode, I don't know?
Is this how a mixed episode manifests?

Funny you should mention a benzo. I have just added in temazepam, which was not enough on its own. It might help when added to the gabapentin? I am about to find out. Otherwise, I won't be sleeping again tonight.

Thanks for educating me on Equetro. I will look into it and will mention it to pdoc in a few hours! I have taken Tegretol before, years ago.

Nuvigil, eh? I had stopped my Adderall over a month ago because I had started to become more anxious. I had also dropped Wellbutrin for the same reason. Maybe it was the start of this episode? I had gotten severely agitated recently on Ambien... and have not recovered. I am getting deeper into this episode, whatever it is.

Does it sound mixed to you?

I feel a bit hypo with a layer of severe agitation. Once I cut the agitation enough with gabapentin, I am not tired, I am very happy!
When the agitation comes back, as med wears off, I am in agony again.

Thanks so much for all of your feedback!

*** Marches off to Equetro site***


WC

Saphris has the potential for QTc prolongation.
Equetro may be an option, but it needs labwork monitoring, which I am hoping to avoid. I have no intentions of taking lithium, either. They are options though!

Thanks, Moreta!


Wc

The funny thing with BP is that everyone's BP can manifest differently. There's some similar characteristics but things can be slightly different.

Just FYI I think mixed episodes are only with BP I but BP dx's can change. *whispers*agitation can be part of mania. I was BP II forever until a mania episode. You might want to look into that. Are you on an antidepressant? ADs can do weird ****. Has anything else changed recently med wise? I think it's been long enough from coming off the addy and wellbutrin it shouldn't be causing this. I've never had the temazepam so can't speak to the effectiveness of it. Looks like it's just for insomnia. I hope it works for you and you get some sleep.

I'd like to add a lot of things can be part of mania. Apparently severe anxiety can be part of mania. IKR who knew? Always gotta love when you go to the pdoc's office and they tell you your manic and having a nervous breakdown. haha. ummm. ok?

Also if you feel the need to throw stuff I suggest styrofoam cups. They don't really do much damage.

*final note*just like with carbamazapin if you get on Equetro you have to go get blood work done to check carbamazapine levels.

Severe anxiety (with or without agitation) can definitely be a dysphoric mania. Sheer hell. And in my experience, requires a different treatment approach than non-bipolar mania does. For example, I had a vile, severe anxiety that kept going and going...pdoc kept prescribing standard anti-anxiety meds, which didn't do anything at all. Finally, my current pdoc prescribed Gabapentin and that has really helped level off the anxiety.

I hope you get some relief soon.
You sound miserable.
(((((HUGS)))))
bizi