[vacantangel]

Hoping somebody can answer my questions. I'm BP2, PTSD and throw in a little SAD and lots of anxiety. Mainly my question is really about BP though.

When going to my pdoc, she seems to be more concerned with medicating me for my hypomania instead of my depression. I am on meds for my depression but the main concern does seem to be treating hypomania. Also, from my very minute knowledge, most mood stabilizers work mainly on the hypomania/mania end as well, although some like Lamictal and Lithium have some AD properties in them. My question is twofold:

1. Why is hypomania/mania the predominant state that is medicated?

2. Why are mood stabilizers also geared towards that?

Also, I know that some pdocs don't like to give their BP patients any ADs because it could trigger a hypomanic/manic episode.

What I really don't understand is that, at least for me, the depression could be far more dangerous if left untreated or undertreated with meds. I just feel that by putting the emphasis on the manic/hypomanic episodes, that maybe it is better placed on the depressive episodes? For myself, although I could engage in activities that could be harmful for me while hypomanic, while depressed, I can very easily fall so low as to become suicidal. Shouldn't the emphasis be more geared towards keeping the patient from committing suicide, therefore; concentrating on ADs?

I know I have a lot to learn about meds and this is one thing that I have been wondering about for quite some time and I keep forgetting to ask my pdoc about it.

Also, what do you think is the best result that could be achieved from mood stabilizers with ADs, meaning, is it possible to stop the rapid cycling, or is that something that I will always have to deal with regardless of meds? I can sometimes rapid cycle several times within one day, which is extremely tiring, confusing and frustrating.

Anxiously awaiting some answers to my questions. Thanks!

[wisewoman]

Hmmm, I am by far no expert on this but watching my son for the last 3 or so years with the same diagnoses as yours I will say that if you can find the right combo of mood stabalizers it does treat the depression. He is now on lithium and is doing well, (cross my fingers) I would actually share what you wrote with your pdoc. It is valid and should be discussed. Sometimes these darned drugs take a lot of trial and error. Good luck.

[kimmydawn]

hi angel girl

what a good question! i want to keep an eye on this post, because my brother is going thru exactly what you are and we have the same question.

thank you for bringing this up, and gl to you!

kd

[January]

Hi Angel,

I also encourage you to print your post and take it to your pdoc. That way he/she will understand your exact concerns.

In my case, my pdoc has me on Lamictal, Lexapro and Xanax. Lexapro is a wonderful AD. My hypo is so mild I seldom cycle, or if I do, no one except me really only notices.

This regimine has made a huge difference in my life. I came in primarily for depression and panic attacks. It was only after we cleared away a lot of that that the bipolar manifested to where we recognized it. Then she gave me lamictal, and I've done pretty well, in combination with counseling ever since.

I hope this helps.

Hugs,

January

[vacantangel]

Thank you for all your well wishes and replies. I'm currently taking

Tegretol 600mg
Wellbutrin 150mg
Effexor XR 225mg
Clonazapam 1mg
Xanax 2mg if I'm good more if I'm bad

I've tried and can't take Depakote, Lithium, Lamictal, Topomax, Celexa, I've had problems with all of them except for the Celexa, which didn't do anything for me

I realize that I have to be on a mood stabilizer or else my rapid cycling will probably revert back to changing approx 30 times a day. That was simply unbearable. It can still change several times a day but nowhere near the 30, now at most maybe 7, never really counted them. Still hard, exhausting and frustrating but I can accept that. What I can't deal with is the abyss. Feeling extremely suicidal and wanting absolutely no help while like that is a very common thing for me while residing in the abyss. So, I have to wonder, why that wouldn't be more of a concern.

BTW, I don't tell my pdoc that I'm still rapid cycling or even that I'm having hypomanic episodes at all. I've already requested another increase in my Wellbutrin to which I was turned down because she didn't want me to have any hypomanic episodes. So, if she knew I was already, she would most certainly decrease my ADs, which would send me straight to the abyss and I feel strongly about what the result of that would be. So, with all I've said in this particular reply, I won't be able to print the thread, I'll have to rely on my memory, which is extremely short-lived. ie: I forgot that I had even posted this thread this morning until I saw it on the list.

as you know, wellbutrin is an AD... hypomania/mania and depression are listed in the PDR as possible side effects , same goes with effexor... could this be causing the mood swings?
why 2 different benzodiazepines? (xanax & clonazepam) and why 2 different AD's? (effexor & wellbutrin)why all these different meds?
seems like the prority would be to reduce or stop the mood swings, not to just medicate each symptom as if they are not intertwined.

[vacantangel]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
as you know, wellbutrin is an AD... hypomania/mania and depression are listed in the PDR as possible side effects , same goes with effexor... could this be causing the mood swings?
why 2 different benzodiazepines? (xanax & clonazepam) and why 2 different AD's? (effexor & wellbutrin)why all these different meds?
seems like the prority would be to reduce or stop the mood swings, not to just medicate each symptom as if they are not intertwined.


</div></font></blockquote><font class="post">

I suppose that the wellbutrin mixed with the effexor could be causing my mood swings. I wasn't getting enough AD effect from my Effexor and it was thought to be causing me to be sick, so then Wellbutrin was added to compensate.

Clonazepam was given by my GP. It is for Restless Leg Syndrome. It does absolutely nothing whatsoever for my anxiety, that is why I also have Xanax.

I am not too interested in stopping my hypomania as it can sometimes be quite enjoyable and why rob myself of the only joy that I get? I don't tell my pdoc about the mood swings. I only tell her about my debilitating depression that is so overwhelming and out of control at times, a great deal of the time.

I'm just curious though as to why pdocs are more interested in the hypomania end of it as opposed to the depression, especially whens severe suicidal ideation comes into play. It just makes no sense to me.

i am so similar to you.. in the way i described my symptoms to my doctor....
i did not want them to label me so at first i avoided mentioning the mood swings.... i first took care of my anxiety which was preventing me from driving and stuff. i got various benzodiazepines for that from docs and from friends. (xanax, serax, valium)
then the depression was out of my control so i told a doc and got zoloft....
i used zoloft when i was low and the antianxiety's when i was too far manic.....
this was a major prob. i became a pill popper for a couple years.
finally i went to the doc and got honest. he knew right away that i have bipolar disorder. and he knew as i did, that bipolars should not take AD's .
i have found the depression to be worse at times also, but the consensus is, stop the cycles, and you stop the depression.
just like if you had a tonsil infection, you would need to fight the bacteria with antibiotics. you would be negligent to simply mask the symptoms with a throat lozenge!
i am a hypocrit, because of my denial and fear, i dont take the meds for my bipolar disorder ... i have them, but im woking up the courage to take them continuously.
are you afraid of a misdiagnosis? are you afraid of feeling better? are you afraid you will miss out on something? why do you want to keep your mood swings a secret like i do?

[rhcpgirlaji]

1. The reason doctors are primarily concerned with controlling the manic episodes is because the suicide risk skyrockets during manic periods compared with depressive episodes. That may sound bizaare, but if you'll follow me for a moment I think it will make sense. About 1/4 BPD people attempt suicide at some point, but during a manic episode this risk increases almost 35 times. Why? Well, to explain that I think we should look at why anti-depressants are touted for increasing the risk of suicide, especially in kids. It comes down to the fact that depressed people, generally speaking, can't conjure the strength to do anything, including kill themselves. However, once they start an anti-depressant, they may suddenly have the motivation to go through with it because the pills have started working enough to increase energy but not enough to alleviate depression. Therefore, it makes sense to me that someone with bipolar would be more motivated to actually attempt suicide after having suddenly snapped out of a bad depression. I'd guess this would be amplified in rapid-cyclers. Talk to your doctor and ask why he/she is more concerned with treating the mania. I could be off base here, but I think it's logical and factual from what I've read/experienced.
2. I personally think that I suffer more from major depression and hypomania than full-blown mania. If I am in fact bipolar, I'm a pretty rapid-cycler. I think it's also possible that I'm cyclothymic but I think my depressive end too bad for that. Anyway, does anyone know anything about Symbyax? I have only read two articles about it, but it's basically a mixture of Prozac and Zyprexa. It seems worth looking into, so if anyone has input/info please throw it out there.
3. That said, I haven't been formally diagnosed with BPD but rather with ADHD. (I'm 23 but was diagnosed as a teenager.) I'm not entirely sure if I'm misdiagnosed as ADHD and BPD are similar in symptoms and often confused or if I legitimately have both (which I've heard is not uncommon). Anyway, I just wondered if you've had a formal diagnosis that eliminated the possibility of adult ADHD because some things you said seemed more characteristic of that than BPD. I'm new to this forum so I don't know if "pdoc" means primary care doctor or psychiatrist, etc. Again, I'm not doctor, so I'm just asking. <font color="blue"> </font>

[vacantangel]

rhcpgirlaji

First, I would like to welcome you to psych central. I'm sure you will enjoy this site. I have only been here a very short period myself and am very glad to have been given the link to find my way here.

I had an appt with my pdoc (psychatrist) today and I actually remembered to ask her this question. She basically gave me the same answer as you did but with less detail. She said that ppl with BP are at far more risk while manic/hypomanic than when depressed. Also, I do know from researching my disorder that the comments you make about having the energy to go through with a suicide are not usually sufficient when you are extremely depressed. It is usually done when the person is starting to feel somewhat, maybe a lot better. However; that is not true for everyone. For me, it has always happened at a point where I couldn't be any lower if I tried. It had never been a premediated act, but moreso one of desperation at the given moment that I was in.

The med you mentioned, sorry, can't remember the name, I've never heard of it so I personally know nothing about it.

As far as being properly diagnosed. Yes, I've gone through extensive written and verbal testing at a psychiatric center by a qualified psychatrist. I was originally sent there by my T (therapist) at the time for testing to see if I was BPD. The pdoc told me after all the testing was done and evaluated, that it was too soon to know if I should also be slapped with that one and said I would need to be first well stabilized on a mood stabilizer to stop the ultra rapid cycling and then I should go back for further testing. I never went back so I don't really know if I have it but for me, I already have enough diagnosis to worry about, without having to think about adding one more, plus it can sometimes be difficult to find a pdoc who will take on a BPD, so I didn't want that diagnosis attached to my file.

I hope I remembered to answer all the questions you presented, if not, fire away again and if I have the answers, I'll be happy to oblige.

Again, welcome to PC.

[vacantangel]

Hi wisewoman! I'm glad that your son is doing well. That is so refreshing to hear. Trial and error is the story of my life. It is so frustrating and I've quite frequently gotten to the point where it is extremely tempting to throw the whole whack of pills down the toilet and go drug free. However, when the rational part of my brain (or whatever is left of it) kicks in, I know that would definitely not be a good idea for me. Rapid cycling at least 30 times a day is pure hell!!! Certainly don't want to go through that ever again. As far as your comment about being on the right combo of mood stabilizer that could be sufficient for treating depression??? Not in my case, my depression goes way too low for the amount of AD properties that are in mood stabilizers. Lithium and Lamictal as far as I know, are the best mood stabilizers for treating depression in addition to the mania. Unfortunately, I've already ruled them both out in my never-ending trial and error search and I still had to take high dosages of ADs. Unfortunately, what works for one, may be different for another. I'm personally still looking for the right combo. I may have finally hit it now but I don't think my family would agree with that statement as my moods can get quite out of control as far as they are concerned. Only time will tell. I hope your son continues to do well.

[vacantangel]

kimmydawn

I hope your son finds the right combo of meds soon that will help him. Good luck!!!

[vacantangel]

Hi January

I'm glad that you have started to find the right combo that is helping you. I personally really like Effexor XR for depression, other people's opinions may vary. As far as panic attacks are concerned, I think I forgot to mention that I also deal with that. Without a doubt Xanax. I call it a wonder drug. Works FAST and that's what I wanted and it WORKS. Side effects could be drowsiness. It can sometimes knock me out but I'd rather have that then a panic attack or all the strife I've had to deal with in the last few months both online and IRL. You might want to talk to your pdoc about those 2 options or get his advice on what he would recommend. I should tell you though that they are addicting but the way I look at it, if you need them, you need them. You're most likely going to be taking them for the rest of your life, unless you learn how to stop a panic attack, so what does it matter if you become addicted. That's my philosphy anyway. FWIW!!!

[vacantangel]

Hi cottoncandy

Sorry for getting to you last, I guess I replied these in a mixed up order. No, I'm not afraid of a misdiagnosis. I've gone through extensive written and verbal tests that took several hours, very draining and this with PTSD was what resulted from the testing. I was very upfront with my symptoms at the time. That was done at a psychiatric center and not with my current pdoc.

I *was* hiding my hypomanic episodes from her because lately they have been in the form of euphoria. Why would I want to give that up? That is the ONLY time that I ever feel good. Doom and gloom is my usual state. My hypomanic episodes can also manifest as hostility and irritability. They're not so fun and I could do without and I know my family would be very happy to see them gone. BUT the euphoria??? NO WAY, I'm keeping that. My feelings were that if I was honest with my pdoc and tell her, then she would decrease my ADs in order to decrease the chance of me going hypomanic. Unfortunately, my little scheme did not work today. She knew right away I was hypomanic. Surprisingly, she made no adjustments to my meds and gave me coping strategies to handle the hostility, anger, irritability hypomanic episodes that I get very frequently. She didn't make much comment in regards to my euphoric hypomania which I am currently experiencing. I was happy with the outcome and she now knows the truth. My mom also discovered that I was hypomanic today too when I went to see her. I usually try to hide it from family too because they know how reckless I can be while in this state and I don't like to worry them. Am I afraid of getting better? This is a life sentence sweetie, ain't no such thing as getting better, only maybe managing it better. I think therapy will help with that too. I think I answered all your questions.

I have been reading a lot of your posts of your own experiences and I personally think that you need to take your mood stabilizer every day. I forget which one you have, sorry, bad memory!!! Brain's been fried. I think you would soon find that you would start to feel a lot better if you did. You could still cycle but the intensity of each episode, would probably be less. Why are you afraid to take it? Also, I don't think it is doing you much good to take it sporadically. They usually take a few weeks to even work and you will probably even have to increase the dosage before you notice any difference. You obviously get very low when you crash, I really think the mood stabilizer would be a very good idea for you. Maybe think about increasing the dosage on your AD as well. Don't be afraid of your diagnosis. It is what it is. The big thing that I personally had to come to terms with is that this is it for the rest of my life but it doesn't necessarily mean that I can't *feel* better. With the right meds and therapy, you can come to some degree of feeling better than you probably do right now. JMHO FWIW!!!

I've been very concerned about you when I read your posts. Are you taking anything for the psychosis? From what I recall reading, I think you have not told your pdoc about that either???? Maybe I don't recall properly, wouldn't surprise me if I'm the one that is wrong. Don't follow what I do by keeping secrets of my hypomania, anyway, she knows now, I couldn't hide it today. DAMN!!! It's only in your best interest of helping you to feel the best that you can by being totally honest with your pdoc about all the things that you are experiencing. I really worry about you and everything that you're going through. I hope that you continue to post about what is going on with you. I think it helps to talk and get some of it out where people can listen, understand and give you loving support. I hope that I have not upset you with anything I have said. It's advice given with loving care and yes, I very much care about you. Keep talking sweetie.

{{{{{{{{{cottoncandy}}}}}}}}}

[wisewoman]

Angel girl, my only concern for you is what I know academically. The more BPD is allowed to have free raign, the worse it gets. Early, successful treatment is best. As for my son. It's all a guessing game but he is an adult and must learn to handle whatever is happening with him psychologically.

[vacantangel]

wisewoman

You are probably right but don't you think that it could be hard to tell if I have BPD? When I'm hypomanic, it usually manifests as anger, irritability and hostility, all traits of BPD too. I do have a lot of other BPD symptoms as well but as I think I said before, if I also acquire that label, it is that much more difficult to find anybody to treat me, at least where I live. Most therapists want no part of it because of the length of time it takes and the very low success rate. Their time is much better spent helping a number of other patients than one probable lost cause.

As far as your son is concerned, we're all in that position really. Are you also suffering from something yourself or are you here to learn how to understand/support your son?

[adieuolivaw]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
So, with all I've said in this particular reply, I won't be able to print the thread, I'll have to rely on my memory, which is extremely short-lived. ie: I forgot that I had even posted this thread this morning until I saw it on the list.

</div></font></blockquote><font class="post">

ANGELGIRL: You can just copy and paste any of these posts into a wordprocessor, remove the part you don't need, arrange it to suit yourself, and then print it out. And don't forget to name & save it. No need to rely on memory.

If you don't have your own separate wordprocessor, all people who use Windows have a little wordprocessor called Wordpad. Just go to Start/Programs/Accessories/Wordpad. That's your built-in wordprocessor. Easy to use.

Adieu

[kybodyguard]

I was taking effexor Xr 75 mg three times Daily But it wasnt cutting it.I was on 50 mg elivil for sleep and now I am on Remeron 30 mg,and 2 mg of Risperdol.I was thinking Suicide Big Time.Now I am on Zoloft 100mg twice Daily,Visteril 50 mg Three times a Day,Risperdal 2mg at night,30 mg of Remeron,and 1000 mg of Depakote. It works somewhat But I still get moody and Hypded plus Depressed a little.

[danofzoo]

Hi Angel, I definately think showing your post to the P-doc is a good idea, the very fact that you keep "forgetting" to discuss these issues says a lot. If you feel your depression is reaching a critical point,by all means be assertive in making sure it is treated as soon as possible. It can take a long time to arrive at the best med combo, make sure you are comfortable with and fully trust your pdoc and have patience w/ the meds many times we notice the side effects and not the benefits. Don't underestimate the value of exercise,diet, proper sleep, friends, and prayer. Good luck and know that there is a light at the end of your tunnel. dan

[vacantangel]

Sorry, I didn't mean to scare anybody. I'm not feeling depressed right now or suicidal. I'm on fairly high dosages of Ads and they usually work pretty good. I also have a friend who is really good at pulling me up from the abyss. I wasn't questioning my meds per se, just wondering why most mood stabilizers seem to concentrate on the manic/hypomanic end of the spectrum as opposed to the depression end as well as pdocs doing the same. I'm being treated for both but I prefer most of my treatment to be for the depression because it is so much harder to handle. I seem to be doing much better lately even though I'm still very much rapid cycling several times a day. My cycles are very easily triggered but I'm doing fine. Thanks everybody for all your concern, very much appreciated.