[251turnaround]

Ever since I've been diagnosed, I've been put on or almost put on some pretty hardcore meds like lithium (which I currently take), clozapine, haldol, or invega. Three of my last doctors at various practices and hospitals were pushing for those meds but I didn't want to go on them.

I think it's a pretty aggressive response to what I see as a pretty mild case, really. Mania has never been overly destructive or scary for me, and I've never lost awareness of my state yet they want to put me on these hardcore treatments whenever my mood is on the up. My current psychiatrist tried to put me on haldol immediately the first day I saw her.

Is this a normal thing for patients? It seems so excessive and I don't like it. Having lithium is more than enough for me as I see it. I feel like I have no say in the matter.

[fern46]

If your symptoms are truly mild I agree that is a pretty aggressive strategy. I had extreme psychosis, but I was able to communicate to my doctors that I am med sensitive and they started me on a starter dose of an AP and then went from there. I was never put on a mood stabilizer. I responded well, so they kept me at the starter dose and never went up or added new meds.

I feel like overmedicating really shifts your brain chemistry and neural pathways in unexpected ways. It should be the goal of every practitioner to prove new and stronger meds are needed.

What is mania typically like for you? Do you have psychosis or bleedover symptoms when you are not in an episode?

[251turnaround]

Originally Posted by fern46

If your symptoms are truly mild I agree that is a pretty aggressive strategy. I had extreme psychosis, but I was able to communicate to my doctors that I am med sensitive and they started me on a starter dose of an AP and then went from there. I was never put on a mood stabilizer. I responded well, so they kept me at the starter dose and never went up or added new meds.

I feel like overmedicating really shifts your brain chemistry and neural pathways in unexpected ways. It should be the goal of every practitioner to prove new and stronger meds are needed.

What is mania typically like for you? Do you have psychosis or bleedover symptoms when you are not in an episode?

I get really talkative, outgoing, fast, and exuberant. I feel like I'm on drugs and can do anything because I'm convinced I'm the most awesome person on the planet. I dissociate sometimes and lose control over what I'm saying or doing which is kinda scary. Paranoia creeps in and I've thought cops were staking out my house. It didn't really feel all that severe to me despite what my doctors and family say. I ended up in the hospital for a bit last time because of it but at no point was I completely incoherent or hallucinating like crazy. As for psychosis, it's pretty mild for me and can happen after episodes. I mostly hear talking, sometimes screeching (hard to describe), see visual distortions like breathing walls or seeing steam come off my hands. The talking in my head is bad enough that I couldn't sleep. Nonstop chatter.

But yeah it's pretty mild overall. I don't know why I'm diagnosed type 1 to be honest.

Again, it's all really mild.

Originally Posted by 251turnaround

I get really talkative, outgoing, fast, and exuberant. I feel like I'm on drugs and can do anything because I'm convinced I'm the most awesome person on the planet. I dissociate sometimes and lose control over what I'm saying or doing which is kinda scary. Paranoia creeps in and I've thought cops were staking out my house. It didn't really feel all that severe to me despite what my doctors and family say. I ended up in the hospital for a bit last time because of it but at no point was I completely incoherent or hallucinating like crazy. As for psychosis, it's pretty mild for me and can happen after episodes. I mostly hear talking, sometimes screeching (hard to describe), see visual distortions like breathing walls or seeing steam come off my hands. The talking in my head is bad enough that I couldn't sleep. Nonstop chatter.

But yeah it's pretty mild overall. I don't know why I'm diagnosed type 1 to be honest.

Again, it's all really mild.

Even if your mania hasn't been dangerous, it doesn't sound mild. The problem is that if you have had full blown mania with psychosis, that someday if not treated properly (or at all) it could become dangerous or cause significant ramifications. People with hypomania generally do not hallucinate or have paranoia to the point of needing hospitalization. It's possible that you don't have full insight into your behavior during the time you describe.

Lithium is a traditional first medication for people with bipolar type 1. In that case, it's not generally considered particularly "hardcore", but that's not saying it isn't a serious medication with potentially serious issues attached to it, for some people. I will say that my assumption about clozapine is that it is often a last resort medication because of the risks and need for frequent blood testing. Invega seems to be more commonly prescribed, from my observation.

As fern wrote, antipsychotics are very common for people prone to mania. I see many even with bipolar 2 regularly taking them. In any case, ideally we want to be on the fewest medications possible that are still effective, and the most side effect friendly (or tolerable). Many psychiatrists like patients to have a good length of time stable before cutting down medications. How long have you been stable?

[fern46]

Originally Posted by BirdDancer

Even if your mania hasn't been dangerous, it doesn't sound mild. The problem is that if you have had full blown mania with psychosis, that someday if not treated properly (or at all) it could become dangerous or cause significant ramifications. People with hypomania generally do not hallucinate or have paranoia to the point of needing hospitalization. It's possible that you don't have full insight into your behavior during the time you describe.

Lithium is a traditional first medication for people with bipolar type 1. In that case, it's not generally considered particularly "hardcore", but that's not saying it isn't a serious medication with potentially serious issues attached to it, for some people. I will say that my assumption about clozapine is that it is often a last resort medication because of the risks and need for frequent blood testing. Invega seems to be more commonly prescribed, from my observation.

As fern wrote, antipsychotics are very common for people prone to mania. I see many even with bipolar 2 regularly taking them. In any case, ideally we want to be on the fewest medications possible that are still effective, and the most side effect friendly (or tolerable). Many psychiatrists like patients to have a good length of time stable before cutting down medications. How long have you been stable?

Well said BirdDancer.

It may feel minor to you 251turnaround, but I can see why they might be suggesting the approach they are considering the psychosis and breakthrough symptoms. Maybe you can request small doasages and then moving up only if symptoms persist. There is a happy medium to find. They are not your boss. You are a team, so asking for a plan that makes sense and works for you is more than reasonable.

[251turnaround]

Thanks for the replies.

I see my pdoc this month I think, I keep bringing up the vast number of meds I'm on, but she seems reluctant to budge on most of them.

I'll see what I can do I guess. I just hate being on so many meds.

[*Beth*]

Your mania, as others have pointed out, seems like...well, mania. From what I know of lithium, it sounds appropriate to treat the mania you can have.

That said, I feel as you do, so I understand...why treat parts of my disorder that are not the most disturbing to me? My mania is stable, but I still have non-stop anxiety and a degree of depression. And I hate being on meds.

I guess they treat the symptoms they can, not necessarily the symptoms we'd always choose for treatment. Also, pdocs have an objectivity that it's very difficult to have about ourselves. For example, your pdoc might pick up on a set of symptoms that could put you in danger of being arrested, or losing relationships.

All that said, most of us here on pc are in treatment for a mental illness. Having a MI sucks big time. And I don't think any one of us wants to be on meds.

[Fuzzybear]

I was put on seroquel - 200mg a day, by a GP

I am not taking it now...

I think sometimes they do not give enough time to listen

[~Christina]

The thing about hypo/mania and psychosis is that the person having it often can not remember just how bad it is.

From your description I would not consider you as being mild. But that doesn’t mean you need snowed under with meds , who wants that ? No one I know.

I think you can approach your Pdoc and T and come up with a plan to slowly wean off one of your meds and see how things go ... you first need a slow taper, every med has a half-life that needs factored in and then your brain needs time to go back to working sans that Med, years ago I went off lithium, it sucked for me. But honestly my brain didn’t really go back to functioning on its own for at least 3 months.

So talk to your Pdoc, as long as you go very slow and have a plan in place that if you suddenly start to have X symptoms you can get right in to see what adjustments are needed.

All along the way you need to be actively using coping skills, good healthy foods, sleep hygiene, exercise , certainly track your mood daily, you can catch an episode coming before your in the middle of it.

Just be honest

[251turnaround]

Originally Posted by ~Christina

The thing about hypo/mania and psychosis is that the person having it often can not remember just how bad it is.

From your description I would not consider you as being mild. But that doesn’t mean you need snowed under with meds , who wants that ? No one I know.

I think you can approach your Pdoc and T and come up with a plan to slowly wean off one of your meds and see how things go ... you first need a slow taper, every med has a half-life that needs factored in and then your brain needs time to go back to working sans that Med, years ago I went off lithium, it sucked for me. But honestly my brain didn’t really go back to functioning on its own for at least 3 months.

So talk to your Pdoc, as long as you go very slow and have a plan in place that if you suddenly start to have X symptoms you can get right in to see what adjustments are needed.

All along the way you need to be actively using coping skills, good healthy foods, sleep hygiene, exercise , certainly track your mood daily, you can catch an episode coming before your in the middle of it.

Just be honest

Thanks, Christina.

I'm hoping some time in the future my doc will be willing to lower or eliminate some of my redundant meds, but right now she's hesitant because I'm still trying to recover from a possibly med change-induced depressive episode.

[~Christina]

Originally Posted by 251turnaround

Thanks, Christina.


I'm hoping some time in the future my doc will be willing to lower or eliminate some of my redundant meds, but right now she's hesitant because I'm still trying to recover from a possibly med change-induced depressive episode.

Thats smart that she wants to wait for you to find stability for a while. Bipolar episodes up or down are very exhausting and we literally need time to heal the same as if your were to have some kind of physical surgery.

[Wander]

I have also been diagnosed with BP1 with psychotic features. My pdoc wants me on the least amount of meds possible. I’ve been stable for a year now on a low dose of Lithium and Geoden. I’m so thankful I’m not drugged to the eyeballs unnecessarily. However, when in a severe episode I am put on high doses of several meds until I’m stable. Being stable without awful side effects is the goal.