Manic Episode - anyway to shorten?

I’m a 37 year old male - came out of a three year deep depression about 5 to 6 weeks ago. Since late November these are my symptoms:

On a 1-10 scale I'm a 13
Redlining all the time
Racing thoughts like cars on a racetrack
Ecstatic
Outgoing
Extrovertive
Spending exhorborently
Skin on fire, tingling, extreme itching
Feel like I could lift a car
Feel like I could fly
Cant smoke enough cigs
Not showering or brushing teeth

My dr is changing my mess today to Resipadol and Vistaril (have been on Abilify & Lexapro). Anyone have any suggestions for shortening this manic espisode?

If you are bipolar 1 the lexapro could have set it off. Give your new meds some time Risperdal should work pretty quickly.

Thank you

Yes I am bipolar I

You need a mood stabilizer first and foremost. Before antidepressants and antipsychotics a mood stabilizer must be prescribed

I agree about the mood stabilizer, something like Lamictal. I have to have the Lamictal with the antipsychotic and then usually they tinker with those when I'm hypomanic. I don't let myself get full manic, then the odds of hospitalization are way high. I agree the Lexapro set it off. SSRIs are not good for bipolar. Your pdoc did take you off the Lexapro or have you tapering it down?

Do you have sleep meds? Getting sleep (and enough of it) is key to getting me down. Can you sleep? If not, can you call your pdoc and ask about sleep meds?

Yes I can sleep. Yes they re taking me off lexapro today. They also took me off lamictal for extreme itching 2 weeks ago. Thank you all.

If it were me in your current situation would ask for a very short term Zyprexa , that tends to knock people off mania quickly

Hope you find relief fast !

I disagree with the MS suggestion and agree w/Christina - evidence suggests that antipsychotics squash acute manic episodes faster than mood stabilizers. In my personal experience, risperdal is an overkill in that it causes depression, but everyone is different. I would try Zyprexa for a few days to end the episode and then work with the dr on a more permanent cocktail of meds.

A decent dose of zyprexa for even just a few days will beat the **** out of mania.
Seroquel would be option number 2.
Risperdal, jmho but not a good clinical idea.

That you are sleeping is excellent and that in itself is imperative to level out.

Be cautious of long-term use of APs. There is minimal to no clinical evidence that they are effective maintenance, lest severe, severe cases.

Mood stabilizers, yes. Likely imperative.

Don't overlook behavioral work too. It is critical to have exercise, nutrition, social supports, and daily structure that includes sleep hygiene, regular hygiene, clean clothes, clean house, etc as part of the picture. Small goals can help with that, and they will snowball to your benefit.

In the absence of those things, the likelihood of clinging to an AP is much higher, whether that comes from you or pdoc. But yes, as some have said, it's highly likely a mood stabilizer is needed long-term.

Try to space out the cigs a little bit too. I understand that situation really well. Not the time to quit or even consider, but space them out a little bit better and you can do that with awareness (which you already are aware that consumption has increased which is the first step). Fewer cigs = slower metabolism of meds.

Meds and sleep. Also don't do things that will exacerbate the mania. If you run or exercise, maybe switch to walking or some other calming activity for example. Avoid caffeine and any recreational drugs.

I am in the Zyprexa camp for quickly bringing mania to a close. Another possibility is Oxycarbemazpine.

I don't take conventional mood stabilizers anymore as I just get side effects without any benefit in reducing hospitalizations.

I am on Zyprexa just right now as a short term measure because my sleep has been interrupted by early waking and I don't want to go through the hell of another episode. I get a kind of dysphoric, paranoid mania and can wreak financial destruction too.

In my experience, you need to take a dose that is sedating to start to bring the mania under control. Zyprexa causes metabolic problems for me so I don't like to take it long term. For that I have Rexulti and I had done well on it for a year without any problems until my sleep started to fall apart.

Sometimes it just seems my life is an inescapable hell. I spend time here and also on a cancer forum, because i have been diagnosed and treated with one of the dreadful ones, lung cancer. Then i see that people can have full lives anyway or some to be in a state of constantly falling apart.

I think mania does damage to the brain so I would endeavor to bring this to a close as soon as possible.

Having insight that you're manic is a good first step.

Yeah, for me, insight goes out the window when I get very ill. And also a view to the consequences of my actions. I don't know how common the latter is.

others have said this but lexapro put me in the hospital ... it is a very bad drug for bipolar issues ... your off it now I hope your issues lighten up ... good luck ....

You just can’t beat a bottle of hard liquor like vodka or whiskey. As soon as the laughing is done...boom, flat out.

But, hours later when the mania overrides the alcohol...you’ll rather be dead then having to deal with a sick, wide awake hangover that last days.

It’s no fun now, so I wouldn’t dare go try it unless it was an accident.

When I had my first manic episode 10 years ago, I had for the first time ever been seeing a psychiatrist who put me on 60 mg of Celexa for chronic pain, which he said was 'somatoform disorder'. He knew my father is bipolar and when I started calling his office complaining of manic symptoms and unbearable anxiety, an inability to sleep, he didn't change my meds. Then I started having auditory hallucinations and called his office and he still didn't change my meds. I ended up calling the mobile unit team and they took me in to hospital. I passed out under the flourescent lights which triggered unbelievable facial pain, like trigeminal neuralgia.

I woke up behind locked doors and was labelled as a psychotic bipolar at that time. I was crying from incredible shooting pains across my face. I tried describing the pain but no one did anything for 4 or 5 days until a nurse said I was having symptoms of trigeminal neuralgia and got a doctor to prescribe me carbamazapine, which quelled the pain.

When i got out of the hospital I went to the dentist and she looked in and saw immediately I had a cracked too, which was what was triggering the pain. I ended up having it pulled as it was too far gone to fix.

Needless to say I never went back to that psychiatrist again. I wonder how many other patients he wrecked by his negligence or lack of knowledge, which ever it is.

I got on a waiting list for another one but it was 8 months from discharge to when I could see him. In the meantime I just had a gp to prescribe me meds.

8 months wait to see a psychiatrist.. What country is that????

That was in Canada. At least he agreed to take me as a patient. There was no follow on care when I left the hospital except for my gp.

Welcome to PC and to the Bipolar Forum!

I am sorry you are having a tough time.

I live with BPII, so don't have great suggestions for you; yet, our friends here have some great suggestions.

So glad you have jumped in and are making yourself at home!
I hope you find the information and the support you may be seeking.

I hope to see you around the forums.


WC

Thank you all for the kind replies and useful information.

Zyprexa was one of the first meds they tried when I was first hospitalized 4 years ago with bipolar 1. After 2 days i was having heart palpitations so they stopped it.

My mania today has subsided. I've only had 2 vistaril in the 2 hours I've been up as opposed to 10 yesterday (up at 4am, bed at 9pm). I dont really feel the sedative effects of vistaril. Still tinkering with the dosage.

I see my dr again tomorrow for our scheduled appt and I'll make sure to tell him every bit of what went on these last 3 days.

Thank, peace, love,
Getya

Ok I'm not sure vistaril has a sedative affect. I took about 12 9ver the course of yesterday, no naps, up at 9am sleep at 5am.

Today I've woken up at 930, so 4.5 hours of good sleep and I've taken 8 vistaril (2 when I woke up at 9, 3 at 1030, 3 at 12) and it barely slows me down.

Anyone have advice on a stronger med for short term mania control? I see my dr in 3 hours.

Thank,
Getya

Benzo's like ativan, xanax, and klonopin are great for as needed relief of mania.

Ok great thanks for the reply Guiness.

Things on this thread I disagree with:


Lamictal is not a good treatment for an ongoing mania because it's weak on mania and it takes so very long to ramp up to an effective dose.


There are not studies that that refute the use of antipsychotics as longterm mania stabilizers.

And last of all. Maybe a benzo might help if extreme anxiety is part of your mania, but they certainly aren't considered effective treatments for mania episodes in general.