Hi - my son is 17 years old and has been diagnosed with bipolar ll about two years ago. He was put on Lamictal at that time which helped to bring his severe mood swings into order. Before the medication, he would go high for about 2 weeks, and then low for about two weeks, with a lot of anxiety. He was able to make it through grade 10 on the Lamictal. About a year ago, he began to not do so well again. The doctor kept increasing his Lamictal, and got him on the brand name, instead of the generic to see if he would do better. He is on 300 mg. of Lamictal currently.
His main symptom is exhaustion and depression, with a great lack of motivation. Some days he does not manage to accomplish much of anything - he is not attending school. The doctor has added 50 mg. of Seroquel at night as he was having trouble sleeping. She also just added Abilify about 3 weeks ago - just a small dose of 5 mg., and now he is up to 10 mg.
He is still very depressed and fatigued. He is sleeping better at night. Do you have any suggestions as to what is happening, or what could be done to help him to have more energy and have better feelings? Thanks!
Well, not being a doctor I can only tell you what I have been told by doctors and what others with bipolar have told me. Bipolar is actually exhausting. I do experience a lot of fatigue. Depression is not just a mood. It also has a lot of physical characteristics, such as needing more sleep. I have heard two things about sleep and bipolar. The first is that people with bipolar require more sleep in general. The second thing being that when bipolar people sleep, they do not rest. I know personally that both are true for me. I can sleep for eight hours and feel like I only slept for ten minutes or didn't sleep at all.
Also, depression can put you to bed for days at a time doing nothing but sleep. Depression drags ever last bit of desire out of you. For me personally, when I'm depressed the whole world is weighing me down. My arms and legs feel heavy. My chest feels heavy. My spirit feels heavy, even. I don't want to do anything but maybe sit and watch t.v. because it is so brain dead and passive.
You say that he has been on meds but you don't say anything about talk therepy. Does he have a psychologist or therapist who specializes in bipolar to talk to? Sometimes that is helpful. Also, bipolar is such a complicated illness. I've known a lot of people who have to switch their meds over and over because things stop working. There are 400 combinations of meds for bipolar, so it isn't easy.
Also, exercise is really good for depression. Getting out of the house is good. It is hard to do since you don't even want to move when it gets bad, but it is worse to just sit there and let it swallow you up. If he wants to get better he's going to have to try to fight it and get himself out of the house, and not just to a doctor visit, but like walk the dog or go to the park. Just get out and move around. Also, when I was a teen I forced myself to watch comedy shows, because I didn't laugh any more. Although I wasn't laughing I watched the shows anyway. I did this on my own, and I think it did help me in the long run.
Anyway, hopefully that helps and he gets through his episode soon.
i wish i could be of any help. this is strange what your son is passing through. for me it doesn't make sense since both lamictal and abilify should up him and not to get him depressed. sleeping better at night is due to the seroquel. sometimes there are some adverse effects for a few weeks which will soon disappear. sometimes, he suffers from other symptoms, like being anemic or deficiency in iron, etc...
i wouldn't rush for a change, BP is not like a flu that you take antibiotics say and it disappears in a few days, no it needs time to act.
some pts don't tolerate anticonvulsants, but your son did well for a year.
your question is difficult for me to answer really, i suppose you can take another opinion. the problem with these drugs is that people react differently to them. it isn't like 1+1=2. your pdoc thought correctly and put him on 2 new and potent drugs.
the problem is that nobody prescribed antidepressants for its danger, but could be that he needs it, i myself took them and yet warn people about them. they complicated life for me tremendously.
am very sorry, i made some thoughts about your question but couldn't find a way out not being a doctor. have you thought of consulting a doctor specialized in medicine i suppose he is called internal medicine, but not GP, these are useless. why don't you do some tests like thyroid, CBC, minerals, liver enzymes,...
The doctor who specializes in medicine for mental illness I believe is called a psychopharmichologist. Or something like that. They are both psychiatrists and specialists in all of the psychiatric drugs, more so than a usual psychiatrist.
Well sometimes (it happened to me) Lamictal or another mood stabilizer will stop working after a while. Lamictal generally is known as a mood stabilizer that specifically works best on depression so it should help on that. Abilify is an antipsychotic that for some people is activating but can be sedating. Seroquel is an antipsychotic that is generally sedating. There is a concern when one medication doesn't work to keep adding others and unless there is a specific reason the psychiatrist states, because taking more than one antipsychotic at a time can put a person further at risk for some long term side effects such as long term movement disorders. Perhaps you could speak to the psychiatrist about having the Lamictal itself replaced with another medication (certainly 3 medications at once of that nature will be sedating to a person). This is a list of available mood stabilizers:
If the psychiatrist doesn't have any further ideas I would agree about the idea of a psychopharmocologist. I have one and have found them to be of great help. They have extensive knowledge of medications and would also be able to use medications that are FDA approved but used off label for bipolar (within their discretion) that someone who was not a specialist of this nature might not be familiar with.
no i don't mean psychopharmacologist, i mean the doctor who is not a surgeon. you know in england surgeons are called Mr so, whereas who you call doctors are like you have problems of liver or gastrointestinal, i mean medicine while excluding surgery these we call in our country internal medicine. in england they are called doctors. if you suffer from anemia where would you go, you don't go to a gynecologist for example, but you go to internal medicine but he is not a surgeon, gynecology, ENT, oncology, renal all are surgeons, for example neurology is internal medicine so is psychiatry but the latter is a specialized branch of internal medicine, whereas internal medicine in the large involves diagnosis for flu, typhoid, contagious disease. for osteoporosis you go to an orthopedist . perhaps the branches in the USA are different than over here. IMO I count them all as shoemakers. never trust them. half are ignorant whereas the other half dishonest. The best who combines both because being dishonest he may prescribe the right drug.
off point but funny. They asked a philosopher which you think is the worse out of the four classes: an intelligent and innovative, an intelligent but un-innovative, an ignorant and innovative or an ignorant and uninnovative. the answer is the ignorant who is innovative because most likely his innovations will be catastrophic
Well, here where I live an internal medicine doctor is one who will see you when you are sick, test your blood, and generally be your general practitioner. Also, they only see adults and not children, where a family practitioner does the same thing but sees both adults and children, and a pediatrician only sees kids. Here for psychiatric problems they generally don't like to see you unless you are sick with a problem they understand and they don't know anything about psychiatric medicines. They just put you on them at random.
I see what you mean now though because I re-read taht part of your post. Maybe he is sick and it isn't his bipolar making him sleep. In that case, yes he should see his regular, general doctor.
in egypt there is no such thing as GP. In my view and as far as i remember, a GP in the west seems to be a little better than a nurse, i.e. a good nurse. western Films show them doing all sort of things from helping a woman deliver her baby to amputate legs to cure somebody from a fever etc...they used to exist though in rural areas in egypt, in British films they are the family doctors in the small villages, where the film shows a woman screaming in late pregnancy so they call him. In britain until now, universities have a clinic where you find a general practitioner, he gives the students contraceptive pills, do some psychiatric help, somebody who got harmed in an accident, you name it
Now we have specializations, doctors are divided only into 2 categories: surgeons which we call doctors still (in britain they call them Mr) and non-surgeons, this last category was the one i meant we call here internal medicine meaning anything inside your body, be it chest, cardiac, stomack,etc... but they prescribe drugs only and don't do operations. a psychiatrist is one. So if you have diabetes you go to one of them and they are subdivided also into several types, so you have a doctor of diabetes only, another one for chest, etc...psych etc.. a pediatrician etc..
so my view about what is called a GP is someone specialized in everything, so he must be ignorant of the details, and you just call him in emergency, until you call a specialist because he may be able to save your life though
so you are right i meant perhaps it isn't bipolarity rather another internal cause and needs to check with a general doctor.
Speaking for myself, I am CONSTANTLY exhausted. I've kind of always had a lower than average energy baseline, but being on medication and being depressed make it much worse. Fatigue and exhaustion are really big problems for me, because it makes it hard to do everyday things sometimes. Xila mentioned that exercise is really great for depression, and this is true. However, I find it virtually impossible most days to exercise because I just don't have enough energy to get out the door, let alone walk or run. I do try to do ashtanga yoga when I can, because while it can be an intense and grounding workout, I still have that energy barrier to hop over to get to the studio. Depression just really makes everyday living hard for many reasons, fatigue being a big one (at least for me).
The role that medication plays in fatigue depends on the specific type. For example, anti-psychotic meds often have very profound fatigue as a side effect. You mentioned that he takes Seroquel, which is an antipsychotic; as you know, this is used as a sleep aid, but not because it was originally designed for such a purpose. The sleepiness that results is a side effect. I was briefly put on a different antipsychotic that I was told causes drowsiness at first. I could barely stay awake while walking down the street or having a conversation. It did certainly help me at night to knock me into a drugged sleep, but during the day it was really difficult to deal with that side effect. I ended up sleeping constantly. This drug was added to stop rapid cycling, so while it took away the swings up to the highs, it left me back in a deep depression. This I am sure only added on to the exhaustion.
Many, many other medication used to treat psychiatric disorders can cause fatigue, including Lamictal. I am currently on this, but I'm only up to 150mg right now. 300mg is a fairly high dose from what I've discussed with my doctors, so side effects might be presenting more strongly.
I wish I had a good suggestion for how to help your son gain a little more energy, and some leverage to push past the depression right now. However, as you can probably tell from my response, this is still something that I'm struggling with. Some days will be better than others, so maybe helping him take advantage of those days will help? Maybe doing something that doesn't require a lot of energy to be expended, but is enjoyable?
Oops, wanted to add something at the end but pressed "post" too soon.
Once the depression lifts, the energy will start to follow. And this may also become less of a problem once he adjusts to the new medication dosage, which may take a while. Good luck!
I think all bipolar people experience the kind of depression u describe in your son. I recently was diagnosed and have already been on 3 different meds and Iv got a total of four I take every day just to keep me stable as I'm not very stable yet. I think that getting out and getting some sun and exercising are great ideas. It may take a few combos of meds to help lift the depression. Good luck I hope that his depression will lift soon.
I get even more tired when I'm depressed, so that is certainly a possibility.
However, just to rule out other issues, have you thought about seeing a neurologist for his sleep issues? They can do sleep studies to make sure he's getting sleep, and the sleep he's getting is quality. That way you could eliminate sleep apnea or other sleep disorders/issues from the mix. Of course, getting a general workup (blood drawn, physical) would be a good way to rule the other health issues out as well...
Good luck, and I'm so sorry your son is going through this, and sorry that the solution is taking so long to find. Have faith, though - you will find something that helps! These meds are so difficult to get *just* right, but a good doctor will get it right over time :)
The question of fatigue and Lamictal piqued my curiosity. I take 150 mg both at 8 AM and PM, which I don’t find sedating or fatiguing at all. This is all I take. However, in the late afternoon I crash. Some days I have to leave work an hour early, because all I want to is take a nap. I’m almost too fatigued to make it home, let alone go to the gym after work, which I would like to.
My sleep on Lamictal has never been better. I fall asleep as soon as I go to bed, and wake up 6 to 8 hours later after a very solid and restful sleep.
I wonder if the crash is do to a low of the Lamictal during that time of day. Perhaps I should take my two doses at 8 AM and 3 PM…or 100mg at 8 AM, 2 PM, and 8 PM. I don’t think there is an extended release formula.
I'm diagnosed Bipolar and I'm 17 also. I can tell you for sure that his doctors need to do a lot of adjusting towards the milligrams. They had me on way to high of dosages of Depakote, which basically acted as a horse tranquilizer for me. They finally realized I wasn't going to agree to keep taking this drug in such high amounts and they lowered me from about 1,080 mg to about 325 mg. I feel great now, I'm just worried because the Doc says he wants to put me on that Lamactil. Just by hearing your son's story I'm not too excited.
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