and that is my Thanksgiving evening

I am alone at home. Not cooking anything special. I am not lonely nor sad but I feel so disappointed and at a loss as to my next steps in treating bipolar illness. Just recently I tried the combo of Vraylar and Seroquel hoping that Vraylar would work for mood and a low dose of Seroquel would work for sleep. Two years ago I tried Vraylar alone and ended up not sleeping and ultimately feeling that it would devolve into mania, so I had to take Zyprexa again. This time I decided that it might work because after all Seroquel would be for sleep. For several days it sort of worked. I woke up very early but then took a nap and my total net sleep as measured by Oura tracker was about 7 hours which was good. But this past night Vraylar won and Seroquel lost: I fell asleep fast, then woke up in the middle of the night a couple of times but was able to to back to sleep, and woke up at 4AM and realized that I would not be able to go back to sleep.

I took another 25 mg of Seroquel (at bedtime I take 37.5 mg). It did not work at all. No sleep.

So at 4:45 AM I resorted to Zyprexa as rescue medicine and took 7.5 mg. I woke up at 8 AM but needed two naps later in the day to catch up.

Zyprexa works beautifully but I cannot take it for weight/hunger reasons. Lybalvi does not do the trick for me: I feel the same hunger as on Zyprexa.

I have tried so many things:

Clozapine caused debilitating depression at the slightest dose. I could not move.
Risperidone caused deeply gray and at times psychotic depression and severe EPS, killed sexuality completely
Geodon by itself was not enough for me to sleep, did not contain elevated mood, possibly caused anxiety a few times. I will now try it again in the company of Seroquel hoping that maybe this combo will do the job
Abilify extreme nausea and did not help with elevated mood. Now I have Zofran for nausea so I am open to trying again in the company of Zofran.
Lithium acne, hypothyroidism, and did not help
Tegretol rash and sore throat that would not go away, depression, at a low dose. I did not try long enough because I halted the trial due to rash.
Lamictal insomnia, possibly caused hypomania
Zyprexa plus Wellbutrin, with the hope that Wellbutrin will quell the hunger. Wellbutrin caused insomnia and I stopped sleeping. It did nothing to the hunger.
Saphris caused hypomania and I stopped sleeping.
Trazodone caused hypomania and stopped working for sleep
benzos do nothing for me at all. Do not help with sleep.
Ambien and other medications in that class do nothing for me at all. Do not help with sleep. Only select antipsychotics help me sleep. Without medications I cannot sleep and it has been going on for more than 10 years.
Latuda and low dose Thorazine immense sleep requirements, was on disability from work for this reason.
Latuda and low dose Seroquel less sleep than with Thorazine but still a lot. Unpredictable sleep. Often had to come home from work to take a nap and go back. When this happens, I cannot function at all. Cannot think of anything but when I would be able to sleep. Also Latuda kills the libido and creative drive. I could live with that if I was at least guaranteed that with normal amount of sleep I could function.
higher doses of Thorazine slept forever and ever. Maybe I should try again a very low dose, something like half a 10 mg tablet.
Topamax caused depression at the slightest dose. It did not immediately resolve upon discontinuation of the medicine because it has a long half-life. I was glad when it finally resolved and swore off trying again. I tried it with Zyprexa hoping that it would counteract weight gain from Zyprexa but depression set in and was so very bad.
Provigil and Nuvigil. Do nothing for me. If I am sleepy and take them, I remain sleepy and need a nap.
Haldol I was not able to sleep on it. Maybe I should try it with low dose Seroquel.
Gapabentin I take it but on it alone I cannot sleep.
Seroquel at high doses. Caused akathisia that was like torture. Gabapentin helps with that, but Seroquel alone is not enough as a mood stabilizer: I get elevated mood and stop sleeping. What I did not try is taking a small dose of regular Seroquel at bedtime for sleep and a high dose of Seroquel ER in the morning for mood stabilization. Maybe that will do the trick.
Dayvigo did not help enough with sleep and caused headaches

I have not tried Caplyta. There I am concerned that it would not prevent elevated mood. But worth trying to see for myself.

I guess there are so many FGAs I can try, especially now that I take high dose of Vitamin B6 which helps with EPS.

Some people are insensitive enough to tell me that I should exercise to get tired and then I would sleep. Everything has been tried and when I exercise, which I do and will continue to do for other benefits, I still need medication for sleep.

When I am underslept, I often feel very unpleasant discomfort on the left side of the chest. Sometimes it is to the point that I call the sensation "squeezed heart". I so far have never encountered another person with that symptom. It might be a physical manifestation of anxiety. There is nothing wrong with my heart which has been checked.

I guess this is called treatment-resistant or intractable bipolar.

How about lixapine? I really liked it until I developed EPS. I seem to remember that’s not
Common for that drug. It’s maybe something to think about.

It has "difficulty falling asleep or staying asleep" listed as a side effect, but still worth trying.

50mg of loxapine makes me sleep like a baby . It's worth a shot.

I will definitely try it! Yay!

I used to take 150mg before bed... That REALLY made me sleepy. (Now I only take 25mg, which doesn't make me sleepy.)

I feel good about trying FGA's because I now have Vitamin B6 which, I think, stopped EPS from Latuda, so I have hope that it will be powerful to counteract EPS from FGAs. It is a new took in my toolkit.

I am also, for now, restarting Geodon at a low dose. Let us see what happens. geodon plus seroquel, let us see how they play together.

Whatever dose I was on (it was 30 or 50, leaning toward 50), taken all at once at night, it made me pleasantly sleepy. I really liked that feature. Actually until it turned me into a mess I liked the whole experience with the med and wish it had worked out.


It has the added appeal that it metabolizes into a tricyclic AD (sorry, can't remember which), so you can get a little depression boost without another med.

I read that is is tricyclic AP, the first time I encountered that term, but did not know what it means. Now I understand.

I hope the Geodon/Seroquel combo helps.
Chlorpromazine is another sedating FGA you haven't listed. I started having TD like symptoms on it and had to stop but it did good things for me while I was on it.

I had an unfortunate experience on geodon. I didn't tolerate it well. It gave me heart problems and messed with my blood pressure.

I hope the seroquel/geodon combo works well for you!

I completely forgot about Thorazine and I did not list it.

It caused abnormally high liver enzymes which went back to normal upon discontinuation. Also, even on as little as 10 mg, I needed exorbitsnt amounts of sleep.

I was feeling great on 40 mg Geodon, experienced something like a return of old me, but gradually it was making me sleep less and less and this past night I had to take 10 mg Zyprexa ODT as a rescue medicine, to sleep.

This afternoon I will pick up Geodon 20 mg from the pharmacy and resume the trial at a lower dose. For now, Seroquel is powerless to counteract insomnia caused by 40 mg Geodon.

Taking 20 mg of Geodon now and hoping it won't cause insomnia.

Did you sleep alright?

I slept well! Thanks for asking. I woke up only once in the middle of the night and then I had a vivid and meaningful dream before waking up for the whole day. I did not need a nap. I managed to WFH, go to the DMV and attend my 2nd Orangetheory class. Now I am winding down for the night.

I cannot believe 20 mg Geodon plus 75 Seroquel worked so well. Of course, it is a small dose of Geodon and wonders of it is going to be enough antipsychotic to keep my mood stable, but so far I am not wired and not hypomanic. Today I am repeating the same combo.

Another night of decent sleep. Went to bed shortly after 10pm and woke up just before 7am. Did however wake up twice or thrice in the middle of the night.

Will take another 20 mg Geodon with breakfast. Keeping my fingers crossed.

I woke up several times in the middle of the night but still felt just fine when I finally got up shortly before 7. I am having a productive day.

Just worried that in the longer run I will develop hypomania because 20 my of Geodon plus 75 mg of Seroquel would not provide sufficient antipsychotic quantity.

Couldn't one or both of those doses be changed to prevent hypomania?

I tried 40 mg of Geodon and it caused insomnia and being wired, essentially leading to precursors of hypomania. Seroquel can probably be increased as long as it continues working as a sleep aid: I take Seroquel for sleep.

This is new to me that 40 mg of Geodon causes insomnia and being wired. In the past I took the FDA approved max of 160 mg and at some point even more, 180 mg, without that effect.

Something must have changed in me endogenously to cause these new sleep sensitivities.

I also tried a starter dose of Vraylar and it caused me to cease sleeping.