[gwenlian]

My husband and friend are worried that I'm over medicated but I'm not sure. I really like my psychiatrist, she listens to me and talks to me about the meds. My dx's are Bipolar I and Generalized Anxiety Disorder. Here are the meds I'm taking:

Geodon, 80mg in am, 160mg in pm
Welbutrin 450mg
Effexor 450mg
Klonopin 1mg every 4 hours
Lamictal 300mg

The Effexor just got increased on Thursday and Friday I was my usual anxious depressed self, Saturday I had a manic episode that turned into a mixed episode and then finished with some hypomania. This morning I woke up feeling pretty good but as the day progressed so did my depression and anxiety.

I've only had one true manic episode/mixed episodes 4 years ago that lasted for a little over a week. I've been dealing with depression and anxiety mostly. I was still having a high level of depression so six months ago she first raised my Geodon to 320mg total and that didn't work so she put it back down to 240mg. Then she started me on 150mg of Effexor and it was starting to work but I didn't know if I could deal with the sexual side effects so we switched that out to 50mg of Zoloft which was a disaster. After the Zoloft she put me back on the 150mg of Effexor then a month later raised it to 300mg. I was inpatient two weeks ago and the only thing they did was cut my Welbutrin down to 150mg which caused me to be more depressed. She raised the Welbutrin back up to 450mg and started me on the 450mg of Effexor.

I really like her and finding a new good psych is so hard that I'm reluctant to get a second opinion. Do you think a second opinion is a good idea or are my meds albeit high still in the realm of normal?

[glok]

Hello, gwenlian. Do you think your psychiatrist would be willing to talk to your husband about his concerns? If so, he could go with for your next meeting with the psychiatrist.

I wish you well.

[Vossie42]

Maybe you need that much medication to be functional. It does seem like to me to be a lot of meds. I do wonder if some of the meds are to counteract the side effects of other meds. However, I'm not you. Only you can be the judge of whats effective for you. As Glok suggested, maybe your psychiatrist would be willing to talk to your husband and reassure him that you're not taking too many meds.

[Altered Moment]

It seems a bit much to me but what really matters is how you are doing on them. Why Geodon? Do you get psychosis? Why so high a dose of two AD's? Those are questions I would ask. Usually it would be one AD with Lamictal and Klonopin. Like I said though what really matters is what works for you. If it ain't working switch things up. And if it ain't broke don't fix it.

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[Vossie42]

Originally Posted by gwenlian

My dx's are Bipolar I and Generalized Anxiety Disorder. Here are the meds I'm taking:

Geodon, 80mg in am, 160mg in pm
Welbutrin 450mg
Effexor 450mg
Klonopin 1mg every 4 hours
Lamictal 300mg

I'm a little confused about why you're taking Welbutrin. I thought it was contraindicated for a bipolar I and anxiety. Welbutrin can make anxiety worse. But you say you have problems with depression, so the Welbutrin would help with that.

Maybe you feel anxious by late afternoon because the Geodon you took in the morning wore off. I found that when I went off of 80 mg Geodon cold turkey, I experienced an insane amount of rebound anxiety. My p-doc had to add 40 mg of Geodon back in for a couple of weeks to taper me off of it. I still felt anxiety, but it was tolerable. Maybe you would do well to take 120 mg in the morning instead?

Lamictal is good for dealing with the depression associated with Bipolar I but it is not so good at dealing with the mania part. You need something else for that. I personally found Lamictal to be to "activating" for me. I was a ***** while on it. I was also stupid. Lamictal caused serious cognitive impairment and sensitivity to the sun for me.

How are things going for you now? As other posters have said, if it ain't broke, don't fix it. Your husband and friend will just have to trust you and your doctor that what you're taking is right for you. After all, they are not in your shoes. They don't have to deal with what you're dealing with. They really have no say in what medications you take. Do they just not like the dosages of your medications and the number of different medications you take? Or is there something specific about your behavior that they're worried about and are attributing it to your medications?

[Hobbit House]

That's a lot of klonopin, I was on klonopin and I know that you need more and more to stay at the same level but I question every 4 hours?? Still if it works I wouldn't mess with it.

[vans1974]

Originally Posted by gwenlian

My husband and friend are worried that I'm over medicated but I'm not sure. I really like my psychiatrist, she listens to me and talks to me about the meds. My dx's are Bipolar I and Generalized Anxiety Disorder. Here are the meds I'm taking:

Geodon, 80mg in am, 160mg in pm
Welbutrin 450mg
Effexor 450mg
Klonopin 1mg every 4 hours
Lamictal 300mg

The Effexor just got increased on Thursday and Friday I was my usual anxious depressed self, Saturday I had a manic episode that turned into a mixed episode and then finished with some hypomania. This morning I woke up feeling pretty good but as the day progressed so did my depression and anxiety.

I've only had one true manic episode/mixed episodes 4 years ago that lasted for a little over a week. I've been dealing with depression and anxiety mostly. I was still having a high level of depression so six months ago she first raised my Geodon to 320mg total and that didn't work so she put it back down to 240mg. Then she started me on 150mg of Effexor and it was starting to work but I didn't know if I could deal with the sexual side effects so we switched that out to 50mg of Zoloft which was a disaster. After the Zoloft she put me back on the 150mg of Effexor then a month later raised it to 300mg. I was inpatient two weeks ago and the only thing they did was cut my Welbutrin down to 150mg which caused me to be more depressed. She raised the Welbutrin back up to 450mg and started me on the 450mg of Effexor.

I really like her and finding a new good psych is so hard that I'm reluctant to get a second opinion. Do you think a second opinion is a good idea or are my meds albeit high still in the realm of normal?

I think on of my pdocs said anyone on Bupropion and Venlafaxine is called Californina rocket fuel! Since those are at such a high level disphoric mania is most likely going to occur! If it was up to me I'd lower your AD's or even get off those two and try Brintellix at 20mg and up the Lamictal to as high as 600mg a day that's what I take since at a higher dose it has more anti-depressant effects. and consider Bupar to augment the anti-depressant and if you still depressed simply switch from Geodon to Latuda!!! Best of luck!!

[gwenlian]

I just got discharged today from being inpatient and they called in a consult with a psychopharachologist to try and straighten out my meds because I was having mood swings from the effexor. I'm now on:
Geodon 80mg morning and night
Welbutrin 150mg
Effexor 300mg
Klonopin 2mg 3x's a day
Lamictal 300mg

I'm on the geodon as a mood stabilizer. My inpatient psychiatrist said that after I do mt IOP if I'm still having depression then he wants me to look into ECT. He also doesn't think I'm bipolar since I only had that one manic episode four years ago. I see my out patient psych at the end on the month so we'll see what she has to say about my current meds and any changes she wants to make. Thanks for the input from all of you, it's been very helpful.

[NowhereUSA]

i echo the klonopin amount! that seems like a lot of klonopin. i do suppose it works on other people differently, but i take .5mg at night to help with sleep. my pdoc had prescribed 1mg but that was too much for me. i would take 1mg back when i had horrible panic attacks and i felt like a zombie.

[vans1974]

Originally Posted by gwenlian

My husband and friend are worried that I'm over medicated but I'm not sure. I really like my psychiatrist, she listens to me and talks to me about the meds. My dx's are Bipolar I and Generalized Anxiety Disorder. Here are the meds I'm taking:

Geodon, 80mg in am, 160mg in pm
Welbutrin 450mg
Effexor 450mg
Klonopin 1mg every 4 hours
Lamictal 300mg

The Effexor just got increased on Thursday and Friday I was my usual anxious depressed self, Saturday I had a manic episode that turned into a mixed episode and then finished with some hypomania. This morning I woke up feeling pretty good but as the day progressed so did my depression and anxiety.

I've only had one true manic episode/mixed episodes 4 years ago that lasted for a little over a week. I've been dealing with depression and anxiety mostly. I was still having a high level of depression so six months ago she first raised my Geodon to 320mg total and that didn't work so she put it back down to 240mg. Then she started me on 150mg of Effexor and it was starting to work but I didn't know if I could deal with the sexual side effects so we switched that out to 50mg of Zoloft which was a disaster. After the Zoloft she put me back on the 150mg of Effexor then a month later raised it to 300mg. I was inpatient two weeks ago and the only thing they did was cut my Welbutrin down to 150mg which caused me to be more depressed. She raised the Welbutrin back up to 450mg and started me on the 450mg of Effexor.

I really like her and finding a new good psych is so hard that I'm reluctant to get a second opinion. Do you think a second opinion is a good idea or are my meds albeit high still in the realm of normal?

Hey sorry to hear, I'm no pdoc but from my experience being on such high doses of Welbutrin and Effexor if you're bipolar, you're just going to be in a distressing dysphoric manic state most of the time. A couple of suggestions: switch from Geodon to Latuda asap...Latuda is incredible for bipolar depression for me I needed 120mg. But it's remarkable and is weight neutral. Then have your pdoc or another consider bumping up the Lamictal...I take 600mg because at that dose it works more of an anti-depressant. Now, it is was me, I get of Welbutrin since it makes me irritable and tapper of Effexor and switch to Fetzima...about 80mg is typically effective for depression. Then, I'd consider adding Lithium starting at 300mg ER bid, then taking a blood level and go from there. Obviously, you'll have to find a doc that will consider that but so 4 things here: Latuda, Lamictal at 600mg, Fetzima, and Lithium all help bipolar depression, mixed episodes and mania! Best of luck!!!!

[vans1974]

Originally Posted by gwenlian

My husband and friend are worried that I'm over medicated but I'm not sure. I really like my psychiatrist, she listens to me and talks to me about the meds. My dx's are Bipolar I and Generalized Anxiety Disorder. Here are the meds I'm taking:

Geodon, 80mg in am, 160mg in pm
Welbutrin 450mg
Effexor 450mg
Klonopin 1mg every 4 hours
Lamictal 300mg

The Effexor just got increased on Thursday and Friday I was my usual anxious depressed self, Saturday I had a manic episode that turned into a mixed episode and then finished with some hypomania. This morning I woke up feeling pretty good but as the day progressed so did my depression and anxiety.

I've only had one true manic episode/mixed episodes 4 years ago that lasted for a little over a week. I've been dealing with depression and anxiety mostly. I was still having a high level of depression so six months ago she first raised my Geodon to 320mg total and that didn't work so she put it back down to 240mg. Then she started me on 150mg of Effexor and it was starting to work but I didn't know if I could deal with the sexual side effects so we switched that out to 50mg of Zoloft which was a disaster. After the Zoloft she put me back on the 150mg of Effexor then a month later raised it to 300mg. I was inpatient two weeks ago and the only thing they did was cut my Welbutrin down to 150mg which caused me to be more depressed. She raised the Welbutrin back up to 450mg and started me on the 450mg of Effexor.

I really like her and finding a new good psych is so hard that I'm reluctant to get a second opinion. Do you think a second opinion is a good idea or are my meds albeit high still in the realm of normal?

Another thought- you might like Nefazodone instead of Effexor! It's an SARI, approved for MDD, OCD, anxiety and PTSD...it's also weight neutral and has no sexual dysfunction problems. 400mg-600mg at night. Now just thinking about it that's probably the best and quickest way you'd feel better! Just stop Effexor and start Nefazodone...but that's just my opinion! I'd research the meds, call pharmacists and read what others say! Good luck!!