BP2 and PTSD

I have PTSD after a bone marrow transplant for leukaemia 2 years ago... following a year-long recovery I have had hypomanic episodes and now I am in depression since July 2023.
Pre-cancer diagnosis I had treatment for MDD about 10 years ago... they had me on SSRI's; escitalopram mclobemide fluoxetine olanzapine quetiapine- the only thing that seemed to help was the Seroquel 150mg at night for about 4-5 months. The depression didn't lift and I got so low I had an attempt. Quit everything after that but continued with the Seroquel for another 3 months or so which helped me sleep and slightly helped with distress. I was in a depression for over a year.
Things got 100% better a couple of years later when I reached a new bottom and started IV ketamine treatment. After about 6-8 treatments I felt like a new person and was comparatively stable for 2 or 3 years with depressions lighter and lasting only 2 or 3 weeks vs months.
Then Covid happened and I got my cancer diagnosis and was in a system shock for a year or so. I was bizzarely switching from cheerful to being in shock until I got my transplant and then spent a year of pain in recovery. The depression returned and then hypomania soon after for a couple of months. The good news is I am in remission yet the depression has returned harder than before with anxiety thrown in the mix.
I tried ketamine infusions recently and they did nothing. My new psyh diagnosed me with bp2. Now I am on Abilify (aripiprizole) and titrating Lamictal (lamotrigine) to treat this current spell of depression.
I cry daily and spontaneously when I'm not staring at my computer screen with no interest at all. I have days of clarity where I can do some self-care and do simple things like washing/tidying-up and cooking, or join a forum such as this today.
I have forgotten who I am and what dreams and goals I have for the future are fleeting fantasies. I just don't care anymore. I can not concentrate on anything for more than a few minutes- I just turn myself off and cry. I have left the house 3 or 4 times in the last 4 months. My friends and family avoid me as much as I avoid them (staying in bed most days).
I am using valium once every evening to deal with anxiety wich seems to help with the crying.
I am here to share my story and get advice on treatment plans to deal with this horrible depression. Am I missing something?

I am so sorry for the depression and the anxiety you are experiencing and for all of your health ordeals.


My diagnosis is severe major depression with psychotic features. Have you ever been assessed for that? I can definitely relate to some of what you described.


I also have severe anxiety and some OCD.


Btw, welcome to the forum. I hope you will be able to connect with helpful people

Thanks for the welcoming response. I'm sorry to hear about your own experience.

This is only my second experience with a psychiatrist and I think they try different medications until something works... I am a survivor and want to make the best of the time I have. Finding good effective medication would be the answer to my prayers. Self-medicating like in the past (alcohol, cannabis) is not an option for me. I don't drink alcohol anymore and cannot tolerate cannabis too much. I am not interested in getting high much- I just want to be able to get through the day functioning. I am taking valium for anxiety because where I am there is no access to a drug I was on during my chemo/transplant which was Stresam/Etifoxine. That drug got me through the worst of it. I still don't know why it isn't available outside certain countries...
From my experience so far-
Abilify 50mg daily has managed to help deal with compulsive and impulsive behaviour.
Starting Lamictal at 25mg for about 10 days now has done something to lift the depression. I am waiting another 4-6 weeks before I am at 100mg/daily.
Valium 10mg at night daily has helped me sleep and handled the distress somewhat.

I have been told I do not have psychosis although I feel like I am losing my mind most days...

Since this is the first time I have been on this combination of medications I guess I wanted to get some feedback from anyone else with the same kind of treatment. I am quite nervous about results in the future. For now, I will stick to the programme but I have a long road to recovery and I don't want to miss out on precious time.

hi @ karbybp2 welcome to MSF. I am sorry you are feeling challenged these days.

You said: "I have been told I do not have psychosis although I feel like I am losing my mind most days..." A friend has had low to moderate cannabis use and has experienced things similar to psychosis. Studies I read link cannabis use in some people to psychotic symptoms.

Is it possible you could experiment with not using cannabis for a month or two and see if things improved? It might be worth a try unless your doctor prescribed cannabis for your health.

Welcome to the community. @CANDC

Hi again karbybp2,

Thank you for your kind words...


I agree with CANDC about trying to go off cannabis to see if that has a positive effect on you. Does your pdoc (psychiatrist) know about your use? If not, it's worth discussing it, imo.

As for me, I had MDD for years and then became depression with psychotic features. Currently, I take 3 antidepressants (fluoxetine/Prozac, buproprion/Wellbutrin, mirtazepine/Remeron), plus Abilify 30 mg and Ativan.


If you want to learn more about my diagnosis, this is a scale for it:


Psychotic Depression Assessment Scale
https://psychoticdepressionassessmen...lish_pdas1.pdf


Research behind the scale:
English PDAS | The Psychotic Depression Assessment Scale (PDAS)


I'd be curious to know more about your "hypomanic" episode... what was it like? what symptoms did you have? Have you ever been manic?


Maybe someone with BP2 will respond to this thread with more info about their experiences.

Thank you so much. I have been mostly sober intermittently for at least 4 years (no recreational drugs/alcohol/smoking tobacco). The relapses are minor (1 beer a month or 1 cigarette every 2 or 3 weeks, maybe a puff of a cannabis vape 2 or 3 times a week). I know that cannabis use can set off psychosis so I avoid it as much as I can. When I am 'well'- it has no place in my life. Ironically, I started using it again (not heavily as before in my 20's/early 30's) after my chemo to manage pain and appetite but have gone without for weeks since then, but that doesn't change my situation. I have mostly eliminated these self-medicating substances from my life but when at low or high points I tend to slip a little.

It has been a pattern in my life to avoid things like nicotine caffeine and thc when I am trying to overcome depression- but these days I feel I am falling back to old habits only because I am so desperate to move on. I have no interest in using after what I've been through.

I will definitely take your advice and avoid! It's just been so difficult to deal with the suffering.

I know from experience that things DO get better... it's just that I don't have the luxury of time. I am in distress most days but that seems to be improving. I've got no more tears to shed.

Psychotic Depression Assessment Scale

Thanks for that! I do not seem to fit the criteria. My personal experience is just uncontrollable crying and terrifyingly negative thoughts. I think the cancer diagnosis has unfortunately shut down my coping system and now I am at a loss to recover- I already said my goodbyes.

For all intents and purpose, I should be out living life and celebrating. Instead I have become housebound for the last 3 months and find it extremely difficult to engage with friends and family.

I will take your advice and cut out the cannabis again (it's only been a week or two of 1 or 2 vape puffs and maybe some edibles). It was an experiment to see if it would help me concentrate more and enjoy certain things like reading or playing (which it has a lot!). Unfortunately, sometimes it DOES make me slightly paranoid and downward spiralling.

Thanks again for your generosity and sharing. I think I am processing my PTSD.

Oh and my hypomanic episodes are just a lot of spontaneous travelling and socializing- huge outburts of creativity (I work in music and video production), as well as some extreme overspending and giving to charity. Another aspect is delusions of grandeur as if I were here to save the world and everyone around me (which mostly ends in causing more damage but not all the time!)

((((karbybp2))))

Thanks for your detailed responses. I am so sorry with what you've been going through.

When is your next appointment with your pdoc? How often do you see him/her?

Thank you again. I will be following up end of the month... Will share updates on here xoxox

Yes, do share updates.

Wishing you well... hope you feel much better...xoxox

I got the lamotrigine rash so I had to stop it. That was really scary. Now I have rashes and bruising all over my arms and thighs. Will be seeing a new pdoc as soon as they can find an appointment. The depression is unreal.

So sorry about the rash, karbybp2... AND the depression...


((((Hugs))))

Depression can be so bad, I know. Hang in there...

Hope you get an appointment with your new pdoc soon!

Hi, hospitalization and medical treatment can definitely be traumatizing. The effects of my medical and psychiatric hospital stays linger, because they were emotionally and physically violating. There was nothing pleasant about IVs, getting nasty procedures done and being locked up in a psych unit. I'm sorting through all the trauma now, through psychotherapy. It's making a difference. I feel better about life and my interactions with medical staff now. Have you considered talking to a therapist?

Unfortunately, I don't have any medication suggestions.

I talk to a therapist online once a week...

The bone marrow transplant was me in isolation for 2 weeks on chemo- then at least 8 months of recovery.

I would take that again anyday over the depression I'm in right now.

I don't think the new psychiatrist will help but I've got nothing to lose.

I've been in bed crying for the last 3 weeks- housebound since July.

Sorry the lamotrigine didn't work out for you. (I read your initial post and was going to say give it some time to work. I'm on an Abilify/Lamotrigine combo and it helps)

Med-wise: Have you tried other anticonvulsants--tegretol/depakote/trileptal/gabapentin/topamax? Or even lithium?(usually used for mania but I've found it's helpful for de
pression too). Are newer atypicals like Vraylar, Rexulti, or Latuda options to try?

What's your lifestyle like? Could there be anything majorly contributing to the depression or a lot of little things adding up that you could change? Is your therapist helpful or do you end the session feeling worse?

Sorry I have been in such a bad place...
I currently sleep around 18 hours a day.
I can't believe I haven't mentioned this but due to infections from the cancer all my upper jaw teeth have been removed. The lower jaw has 3 failing implants and 1 tooth that will all be removed in 2 weeks after which I will be fitted with a complete lower arch. The process takes 6 months... I will still have to wear a denture for my upper jaw unless I consider zygomatic implants.
The depression and bp comorbidities have played a part in the damage to my oral health (inflammation, infection etc.) so I am worried this cycle will happen again.
I don't think any kind of medication is going to help me at this point but I am still waiting for an appointment with a psychiatrist. Surely somebody can help?

When is your appointment with a psychiatrist? Is it soon?

Maybe just practicing some extra good old distress tolerance in the meantime... ?

I am trying to chill and sleep as much as I can... I just don't think going through these extreme ups and downs is normal anymore

@karbybp2

Welcome! To me it looks like you are giving up trying to have a better life. I may be wrong, but if I am right, please search for a book on motivation at Amazon that you feel for. (I bought a book there about motivation and it was very helpful. Don't remember the title). What impressed me was that the author thought me that I was not lazy. I had to (re)learn how to motivate myself.

When you have been through so much, it is easy to understand if you want to give up, but please don't do that.

You have to fight for your life! Many people here have done that, and found that life can be worth living, even with a diagnose. (By the way, to be psychotic means to see or hear things that are not there or to have an idea that differs very much from how people normally thinks, like thinking that your neighbor is from Mars.)

I send good wishes for your therapy and in the hope that they will find a medication combo that work for you!

((((karbybp2))))

I'm so sorry for your suffering. I have also lost teeth and it's traumatic. You are not alone!

Would you consider going to a hospital to check yourself in so that you are cared for, for awhile?

I think you really need to be in hospital for a bit so that your depression can be monitored and treated within a safe space.

It's also very challenging to advocate for yourself when feeling so down... is there anyone, like a social worker, who could accompany you? Call and ask your psychiatrist for a referral to hospital and to a social worker who can accompany you and check up on you once you're out of hospital again.

Make sure to tell your psychiatrist that you'd rather chemo with 8 months recovery than the depression you are dealing with now.

Also, mention that you sleep 18 hours a day and have difficulty performing daily activities, and give examples... (like not being able to wash, if that's the case, or cook, or eat etc.)

I really think you should be in hospital where they serve you 3 meals a day and where they can start tackling this horrid beast that is depression.

Please give us updates if you can...

I have people supporting me at home... this is not the first time I have gone through this- it's just the first time I've actually realised how serious a problem it is. I have surgery for my teeth next week. Then I will have to take some time to recover (it's gonna be a nightmare but I've been through worse). I think after I stabilise my physical health I will definitely find a place that can help me. Right now I am just self-medicating and trying to make it through the day... I have had bad experiences with rehab and hospitals in the past- too much trauma to even deal with now. I think I need to build myself a healthy framework and slowly start building myself again. It's just this recurring pattern that kills me...

(((karbybp2)))

So sorry for your suffering.

It's good to know you have people to support you at home. I was under the impression that you were completely alone. Lean on them, lean on us...

I hope all goes well for you and that you start feeling better soon.


Do take good care...

Keep us posted on how you are doing...