Bipolar Manic Episode

[Eileen455]

I am totally against making my daughter take Depakote to manage her manic episodes. The side effects and long term side effects are just awful and my daughter agrees about the effects on her body. My question is what other medications have been successful in mananging and slowing down the manic episodes and depressive as well?

[Eileen455]

Thanks! When my daughter was hospitalized for the first time the end of February it was same way for her. The Dr. had her on depakote, zyprexa, a couple other things. She was pretty doped up too and could not hardly do anything but sleep and eat. I hurried up and got her off of that depakote. I'm really not fond of zyprexa either. So...what 2 medications ended up working for you? Are you on a mood stabilizer? My daughter has been taking the lithium 450mg along w/ her anti-psychotics the past 4 or 5 nights.When she kept refusing the 450mg as prescribed by the day, we left it alone. Hopefully, the night dose will be enough to keep her stable. Thanks again.

[Eileen455]

Hey! My daughter had an appointment w/ her Dr. today and she again told me that the lamictal in most people helps those who have the depressive state more. She said that she does not think that would help prevent a mania episode. However, I've heard different on here, but that is what she insists... Now that my daughter is out of her manic state she is taking the lithium 450mg at night, along w/ 200 seroquel, 2.5 zyprexa and .05Risperidone 2x a day. Of course now she is kind of in a melancholy mood/ indifferent mood as she described it and really tired, which is typical for her after a manic episode. I know one thing is for sure, she has got to give this some time to work b/c we (me and her father and grandmother cannot handle a 3rd manic episode (for 7 or 8 days in a row) and keep her from being hospitalized. It is extremely exhausting and sooo hard when she flys into rages b/c she cant get her way or someone tells her no about going places and doing things. This last time was so rough, i know I can't do it and continue to work at my job and keep my sanity. I have to lie to her about numerous things to keep little peace and her screaming and cussing at me it's just wild. Anyway, thornis keep me posted... how long did your last manic episode last? (if I may ask)

[thornis]

The Lamictal does seem to help a lot and although the side effects haven't gone away like they are suppose to they are mild. They did take a few weeks to even have a noticeable effect. I stopped taking the anti-psychotics may start again if I start to slip, but overall the last episode is becoming just a memory.
But to be honest I think simple life style changes I made once I came down worked even better. Such as I cut out alcohol completely, I try to exercise more, spend much more time outdoors (even if it's just to eat lunch) and I take a good walk before bed. Simple stuff like that helps to maintain a much more positive attitude. And at least I don't dwell or fear the next episode.
Good luck.

[cmrichardson1013]

I am new to the site however I have manic episodes as well and i am 29. From experance let the doctors know how the side effects are effecting your daughter. I would stick to what is working for her. when i had my first manic episode and hospitalized they had me on so many meds i could not even stay awake long enough to eat a full meal. then the other meds such as depokote made me gain so much weight and i was losing my hair it was not good. I took myself off and the doctor was upset but she said if it is making me feel worse then do what i think is best. i was on 5 differant meds and now 3 years later i am only on 2. just keep listening and talking with your daughter like you have been doing cause support is all she needs. Good luck with everything.

[Eileen455]

Thanks thornis. Will you please keep me posted on how the Lamictal is working for you. I'm going to really push that to try next, after my daughter is out of this manic state.

[Eileen455]

Well...I think the lithium is going to be a NO go for now. My daughter started taking it on Monday April 12, 2010. She is complaining so much about the side effects and how it is making her body feel by Wednesday she started to refuse the lithium very emotionally, crying, screaming and complaining about being so doped up that she can barely stand and/or walk straight. Her father physically forced her to take it, which is probably not right. I don't know. We really don't know what to do when she is in such a manic state. On Thursday morning she refused again and I was not about to have that "fight" with her trying to make or coax her into taking it. I know her mind was made up. Thursday night it was the same thing a huge scene about the medication, crying, screaming, yelling and arguing about the medicine. (She is also upset about me not letting her have her phone) I'm just trying so hard to protect her and do damage control, I'm starting to realize that I can't without causing her to become so irate and angry. Anyway, I know she is in a manic/ slightly psychotic state but I think she has a point when she says that she can't handle the way it is making her feel. And I don't think she should be staggering around and so off balance to the severity it is happening and she should have a big say in her TX 17 or not.  Although, she has been sleeping through the night, she is still up and raring to go by 6:30am. I think I am done with the lithium fight for now and she can just continue with the seroquel, zyprexa and risperidone. She has another Dr. appointment, next week and I just put a call in to the Dr. to let her know what is going on. I also made sure to mention that I want her to try the Lamictal even though I was told by her that it is not helpful for acute mania. However, from what I'm getting from this forum from different people is that once she would start taking it and it builds up in her system, maybe then it would help prevent these back to back manic episodes and help her to be stable for a much longer period of time.  I really appreciate all of you who have taken time to read and comment on my posts, it is all helpful and very supportive to me. Thanks...

[thornis]

I've been given Risperidal (Risperidone).
Your daughter is on a very mild doze which is good. It doesn't sit well with me. I'll probably only take when absolutely necessary.
It makes me really drowsy with almost no ability to sleep and I get sleep paralysis when on it. Also anxiety. Makes you a little hungry too.
I know some people who are on it though with no side effects and 0.5 is very mild, but some side effects you might wanna watch out for.

[LostGrrl]

From what I know, pdocs really prefer to avoid Topomax, especially since it's been marked as as weight loss drug. That shouldn't be the reason why you'd choose it. My pdoc won't give it to me for that reason.. I could use to lose a few pounds too!

[thornis]

I've just started Lamotrigine with anti-psychotics when I need them. I don't know the effectiveness since I just started. But I could say there's little side effects. Dizziness and drowsiness, especially if you stand up quickly. Dry mouth in the morning, and there is a rare allergy that only effects 1 percent of the population that you have to worry about. Basically if you get a skin rash you have to stop taking it.
Also the effects are worse when you first start, actually it zonks you out at first, but my doctor eased me into it - 25 mg, 50, 75, till you get 100 mg. After a couple of weeks I've been stable, but to be honest Im not sure if that's the meds or the natural process of coming down.
Good luck

[wj74]

I would have her try the lithium. If that works and she is stable, you can always talk to the doc about dropping one of her meds...

[Eileen455]

Thanks for the information! I will definitely keep Lamictal on the list to try next. My daughter's doctor just prescribed her 450mg of Lithium 2 times a day. I did not want that. That is along with the 200 Seroquel, .05 Risperidal 3 times a day and 2.5 Zyprexa which seems excessive to me. And 900mg of lithium does not seem like a low dose to me. Anyway, at this point, I'm just about willing to try anything. She has had three manic episodes regularly the last 3 months which lasts about 7 or 8 days. I just wish that something would work and work fast b/c she needs to be stable for more than 3wks at a time. She has her 18th birthday coming up, graduation and not to mention, she needs to choose her college and her stabilization or lack there of is going to affect all those things. So here it goes....

[Seph1212]

For what it's worth, my doctor has told me that Topamanx (and Neurontin) are nearly worthless for bipolar. I have also read elsewhere that they are not (usually) good as a first line of defense, but rather as an adjunct for other symptoms.

I have good success with Lamictal alone. Side effects were (for me) mild at first and remitted. Although when I was put on it I also required Seroquel.

When the doctor says that Lamictal doesn't work for acute mania, I believe he may mean initiating that drug when the person is in an acute manic episode (especially due to the slow titration schedule) isn't helpful without an adjunct. If your daughter isn't currently manic this may not be an issue.

[Eileen455]

Thank you for sharing and your encouragement. It is hopeful to me that maybe my daughters manic episodes can be managed and/or prevented with Seroquel. She is now taking 200mg of Seroquel, .05mg of Risperadal 3x a day and 2.5mg of Zyprexa. It can sometimes be challenging when it comes to the weekends as far as getting her to go to bed at the same time or from going to bed late. She is about to be 18 next month and she has always been rather independent which was okay before she started having these manic episodes. And now anytime she is in a good mood or excited about something I wonder is this the beginning of another manic episode. She had one in February and March and I believe she is right now in the beginnings of  a hypomanic phase if not the beginnings of a manic one. I really dont know what to do when this is starting and happening since she is never fully aware that she is in or about to be manic. I've done alot of damage control from her previous episodes,but deep down I know that I will be unable to continue to do so and that is scary to me. Anyway, i can't remember if it is Bipolar 1 that she is diagnosed with since this is all kind of new. I am going to get clarification at her next doctor's appointment. In the meantime, I am going to see what this next week brings......Thanks again for your encouragement and well wishes. I really appreciate that as I am really going through rough times in dealing with all of this.

[Athena_M]

Oh my goodness, Eileen.  Your daughter is so lucky to have you.  I was diagnosed when I was 23 and my poor mom was so overwhelmed.  I'm 38 now.  I can tell you there is hope.  As long as I stay on my medicine I don't have manic episodes. I've had some depressive episodes though, but once I start taking an anti-deppressant I usually feel better.
Why did the doctor stop her meds?  
I take 400 mg of Seroquel and I like it as it makes me sleep and there is virtually no way I can go manic if I sleep.  I also take Trazadone on an as need basis for those nights that I can't sleep.  The only problem with Seroquel is that I can't really work because of the daytime drowsiness.  The good thing about it, is that it's the only medicine I have been on that I can actually feel some normal feelings of happiness.  I tried to take a lower dose 300mg but I had so much anger.  When I went up to 400mg I'm more calm and mellow.  
I mentioned I was on Depakote and was able to go college, work, and got married.  
I was on Lithium for one year and that was one of the worst years of my life.  I was so suicidal that year.  Everyone is different, for some people Lithium is great.  
I've been hospitalized 5 times for mania.  Four of them was because my pdoc let me go off my medicine because I wanted to get pregnant.  I have 5 year old boy who is so joyful.  I was in the hospital for 6 weeks because I refused to take meds while I was pregnant with him.  After the first trimester it was OK to take meds.
I'm actually pregnant with my second baby, but this time I stayed on my meds.  The baby is due in a couple of weeks.
I'm just telling you all of this because I want to let you know that your daughter can still have a good life.  
Make sure she takes her meds at the same time each night and goes to bed within the hour.  When I was in college I took my meds at 9 talked to my boyfriend (who is now my husband of 11 years) on the phone for an hour and went to sleep at 10.  
Your daughter will be OK.  Some of the meds make us put on weight so we have to  keep a food diary and stay away from high fat foods.
I talk to my mom almost everyday and she really helps me out emotionally.
Usually when someone gets out of the hospital for mania they are really doped up.  After the body gets used to the meds and the outpatient psychiatrist adjusts the dose, things get better.  
Did they diagnose her with bipolar 1?  That's what I have.  
Best wishes to you and your daughter.  I wish all the best for both of you.

[Eileen455]

Thanks for the heads up on the medication mixing effects on birth control. It is a very scary thought because I have seen the recklessness and poor judgement. My daughter just had her first full manic episode approximately 1 month ago and had to be hospitalized because it became so out of control.(thinking and looking back I believe she experienced hypomanic phases but never a completely manic phase.  At the time, since I was only familiar with her bipolar depression, I was caught off guard and not really familiar with the manic phase. Had no idea, but learned so very fast. Before she was hospitalized I had to take her phone, car keys and computer because of how the things she did and said became more inappropriate. I was so thrown. Anyway, she was on Seroquel and Risperidone which she was stable for almost 2 1/2 years. The Dr. weaned her off of those meds and 6 wks later she had a BP depression episode. She went back on the meds but still had another BP depression the following 2 months and then she went into a manic episode. While she was in the hospital they changed her meds to Depakote & Zyprexa which she was on for just about the full 9 days she was there. It took awhile for her to get stable. When she came home she was okay and then after a day or two she would just sleep and eat all day, could not really fully function. I mean she was really doped up, lethargic and just blah. Dr. lowered the Zyprexa, I don't think she ever reached the therapeutic levels of the Depakote b/c I was not giving it to her like it was prescribed. I did not know what to do, I just wanted my daughter back. Went back to the Dr. told her I stopped the "emergency meds" and started her back on the Seroquel and Risperidone. I know, I am not  supposed to be playing Dr. but again, I did not know what to do, b/c she couldn't function on the other meds, she had already missed 2wks of highschool, plus she had 4 college classes that she had been missing and had to return to school fighting to save her grades. She is an A student who works very hard. Anyway, now the Dr. has her on a low dose of Zyprexa along with the Seroquel and Risperidone. I suggested Lamictal, Dr. says it does not work well for acute mania. She suggests Lithium if she cannot be maintained on the meds now without an episode. I'm so broke down, anxious and worried about what's going to happen next. Nevermind the hurt and pain I'm feeling for me and for mostly her b/c I cant imagine having to deal with regular teenage issues let alone BP as a teen or an adult for that matter. Didn't really mean to go on like this, I want to think about and focus on on other things but right now, I can't. I just need this to be figured out soon, so I can get off these pins and needles before I am unable to hold it together. Any suggestions from anybody who even read this far???

[bernie40]

I understand completely what you are saying.  My son was recently prescribed depakote for control of epileptic fits.  I was dead against it as this is med I have been on for my BP and I did not like the side effects.  However, they started him on it in the hospital without my consent!  As it stands, he's been on it about 5 months now and has not reacted to it in the same way I did at all.  I ended up saying he could stay on it BUT only if he was well on it and that at the first sign of adverse side effects I would be insisting on a change.  As I say 5 months down the line he has not had the same effects I did, however I do question the change in his moods and will be requesting a change at his April appointment.

There are many medications out there for the treatment of BP but as we are all different what works for one does not work for another.  Xila also made a good point about birth control, I think tegretol can also effect this so make sure you discuss this point with the Dr.

[Athena_M]

Depakote was a wonderful med for me to end the mania.  I was able to go to college, hold 3 part time jobs, get engaged, and get married.  What side effects are you concerned about?  The docs will do blood tests to avoid any liver problems.  
  I am currently taking Seroquel for mania.  It works very well.  The down part is the side effects of daytime drowsiness make it almost impossible to work.  
One year I took Lithium.  It left me feeling very depressed though.  

[Xila31]

Also watch for other things like drug mixing combination. I believe Topomax is one of those that actually causes birth control pill failure. I know you're a mom and maybe don't want to consider this, but bipolar people are not always the best with judgment and tend to be reckless. So, having your daughter on a good birth control is a good idea. I mean, your daughter has enough on her plate right now and better safe than sorry.

[Eileen455]

Thanks all! I will have to talk about other medicinal options with her psychiatrists. I've been researching Topomax so I think I'm going to make that suggestion. This is heartbreaking for me to watch and actually realize what bipolar really is and what it takes people through. I mean I've always known about it, but until you see it and/or go through that's when a true understanding is reached. I know you have to be strong so I definitely commend and respect those who have to manage this disorder along with all the other life issues that are thrown at you. I'm just trying to help my daughter as best I can and stay strong for her.....

[Xila31]

Right now I am taking Lithium which has relatively few side effects. The main thing about Lithium is you have to drink a lot of water because it is hard on the kidneys. Lithium not only helps to stabilize mania but is also helpful with depression.

But, as ILADVOCATE says, everyone is different and everyone responds differently to each treatment. There are tons of combination of  meds for bipolar. It can take a long time to find the treatment that works.

[ILADVOCATE]

I know out of all the different mood stabilizers Lamictal was the most effective and had the least problematical side effect profile for me but each person responds differently to each medication. This is a full list of mood stabilizers:
http://www.psycheducation.org/depression/meds/moodstabilizers.htm
It would be worthwhile to discuss available options with her psychiatrist.

[wj74]

There are lots of other options. I think you should talk to her doctor about it. Good luck!