I know well you are not doctors, so don't feel responsible about answering imprecisely, only that I am thinking loud so perhaps your feelings and experience can help.
Someone said that MS can be : either lithium or AC or low dose AP. Alright this is a classical info. I take seroquel 25mg right now along with stelazine 2mg and risperidone 1mg because I was dx OCD at first before an AD turned me manic thus classified BP (monkeyc objects here that I must have been BP all along). So I preferred to keep the 2 AP's along with the seroquel. Now
1. In many forums people tell me it's crazy to be on 3 AP's (monkeyc is one), yet my doctor says the doses are small so they work more as sedatives. I am not convinced this is why I am with a new pdoc, still perhaps you can tell me that in general: DO AP"s SUBSTITUTE ONE ANOTHER. i.e. suppose I get rid of the stelazine say (typical AP) does my seroquel contain the same substance - so to say - of the stelazine or risperidone, because I realized that most people are on one AP only along with one AC. The reason why I kept the risperidone since the onset of my disease of OCD 6 years ago is that I felt it organizes my mind, whereas stelazine is to remove my nervous pressure. So my question would the seroquel substitute them so that if I cut them I can get the same feeling with the seroquel?
2. the 25mg I believe is not a low dose AP. I believe it should be 400mg or more which I can't tolerate. My mother who is helping me with the meds increased it to 50mg so after a while I became a bit depressed. So I removed 25mg. Now how come removing 25mg makes me less depressed although seroquel is an MS and it should work more like an AD. OR perhaps along with the other 2 AP's I became depressed and I should have cut the stelazine instead of reducing the seroquel.
3. The manic state in my view is hidden i.e. covered beneath my seroquel. Why? because the reason why I took 50 mg was that once I was on 25 mg like now and I started to become angry so my mom increased it to 50mg and I became fine. But then after a while I started to become depressed so now I am back again on 25mg. My question is: Once I am depressed like I am in a way now, does it mean the mania is gone completely or that only covered by the seroquel i.e. if I stop my seroquel it will come again. I think this has to do with what is called complete episode, so perhaps I stopped my episode in the middle !! using the seroquel ?
4. I heard that if you intervene after one mania only, your stand a better chance of recovery in my case I intervened during the 2 manias to stop them. Does it mean, I didn't exhibit complete episodes ? OR that the manias once they happen there are counted as one complete episode
One last question: Sure our group is over a few hundreds members, yet the people who post are countable. Does this mean the MAJORITY recovered so not interested anymore to read or post
From what I have seen OCD is often a gateway diagnosis to BP in adults as is ADHD as well.
No you cant get bipolar, you have it or you dont;) The thing is getting the right diagnosis.
As to 1 and 2 - I cannot comment on the AP drugs as I have not taken them, based on what I have read the dosages seem low yes.
3. Interesting thought on Seroquel however it might not be hidden as not there unless you are one the seroquel. Its very effective against anger - the whole point of bipolar is there are 2 states if you like and mania and depression are the sides of the coin - most of us cycle and I think your problem (personal opinion) is you are not getting an effective dose of a mood stabiliser - you dont want an MS to act as a sedative because there are sedatives that can do that a lot cheaper than 3 AP's - an MS is a mood stabiliser and your moods are not stable.
4. Ive read many things, Im not sure what that one refers to - most of us have manic episodes on many occasions, for me theyre cyclical, severe manic episodes are rarer and once on an MS should be impossible without other factors but complete episodes of not im not sure unless you mean the criteria for diagnosis - I know that DSM-IV-TR criteria for BP 1 is one or more manic episode with or without major depressive episodes but the DSM criteria for mania is what most people would call severe mania - the term tends to be a catch all - for example Type 2 is defined as being more hypomanic with a major depressive episode and BP2's are not supposed to suffer the extereme mania's that 1's get however Ive had some pretty extereme manic episodes - and thats before you get into criteria where psychotic behaviour is manifest or other artifacts are present such as hallucinations or voices.
In the end you can overthink this stuff sometimes. I think right now you really need an effective MS - once you have one your moods settle down and the lows and highs even out - its not a bad place to be.
As for posting numbers, well a lot of people are shy and I guess Bipolars might tend to be as well, every now and then you see people pop up and make a post and go off again - in my mind if someone makes one post asking for help on the worst day of their lives and gets help then does it matter if they lurk all the other days ?
Although adjunct mood stabilizers are often given, multiple antipsychotics are generally not a good idea except during the specific period of titration. The best thing is to discuss this issue with your psychiatrist and find the one most effective (the atypical antipsychotics from Risperdal onwards have the safest long term side effect profile) and build that up to a clinical dose and see if that is effective in combination with a mood stabilizer.
I would be one of those who quietly watches and occasionally posts. I may have a specific problem or concern and wonder if anyone out there has a good answer. They usually do.
Sometimes a question is asked and I feel I have useful experiences to share. Then I will.
Mostly, I read what's going on and often educate myself in the process; but you have to bear in mind this is never professional medical advice; it's all subjective. There are two sides to everything.
I mostly feel that my thoughts are either very similar to the regular posters (in which case repetition is needless and not particularly valuable), or that my knowledge is inferior and therefore less valuable.
Occasionally the "regular" posters do rather "take over" a thread; this can be good or bad. When the original question/thread gets lost into some esoteric debate I get discouraged/frustrated and stop reading that particular thread. (the same old discussions do seem to come up time and again)
The great thing about this forum is its depth and the variety. There's almost always good advice and even more support. It's fantastic when people can end their lonely struggles and feel cared for and no longer alone with their problem.
Now I've gone off subject myself, so will wish all a Happy Christmas and end my post.
Everyones knowledge is valuable don't forget - even knowledgable people do not know everything so I would encourage all posters to jump in now and then and say what they feel or have experienced - it can be very helpful and useful for people to hear many views from varied areas of life and age and experience.
Never hesitate to jump in and especially when some of us take over as I know I have done sometimes; we do tend to go over the same things over and over and thats when we might need someone new to jump in and remind us of it.
If you would mean myself I went through the threads and was looking for ones dealing with lack of healthcare coverage and disability discrimination issues as those are not often answered. There should be some centrally located resource lists for those issues (such as the independent living centers or the Medicare Rights Center) so that it would not be available to everyone. I believe in this one (which was a different topic) you did provide a cogent answer so I understand your perspective as per each person voicing their opinion and I'll be more judicious but as for the other issue (which often is the main thing in between a person's health care and prescription coverage) I think its that should be addressed. I did start this thread a while back here:
I feel embarassed to keep posting to you since my questions are rather trivial w.r.t the issues you are raising which seem more complicated or say more professional.
I am on 3 AP's yes, yet small doses : risperidal 1mg, stelazine 2 mg and seroquel 50mg (2 atypicals). Some of you say life will be much nicer had I been on an MS and that the AP's are only convenient during titration and are not welcomed in the long run.
However now I feel stable and feel I recovered. True I stayed like this for 2 months then I raged for two days only but then I became stable again when I increased my seroquel to 50 right now as I was on 25 before. I discussed this with my ignorant pdoc, he said the AP's I am taking are more of a sedatives because of their doses and better to go this way to control my fluctuations than to take the AC (lamictal, tegretol,...) or lithium because they can hurt me on the long run. This is what he said. I remember I sent a letter to a kind professor of psychiatry in Buffalo called Dubovsky who said that if I am BP then I need an MS. Now what makes him think that I may not be BP, probably because he didn't see me personally. However another one in New York is convinced that I am one.
I know everybody thinks that BP is in the genes. Let it be, but in my view it just means that my thermostat is broken so the highs get higher and the low can get pretty low. What the hell did this to me except through a trauma, an AD and the like... True they say OCD and ADHD are gateways to BP but why only those. Can one be born odd with BP without knowing he is one, then all of a sudden the thermostat gets broken ? Once it's broken it's broken and this I agree with everybody on this issue and from there on one needs for sure an MS to regulate oneself. But God doesn't create a person with a broken thermostat !!
On the issue of the definition of an MS that it should be an AC or lithium. But why not abilify or seroquel ? people tell me you should consider an MS. Alright seroquel yet an AP is considered an MS. OK for larger dose but is an MS. The proof is when I used before the typical AP's I fell into depression, however with this one I never felt depressed only lethergic at most. So why not consider living on it if I can. Forget about tardyve dyskenia, cataract, diabetes.... But the other AC also have their side effects. The lithium also needs regulation. It needs a strong personality like monkeyc to be in the middle of a mania with its psychosis and is able to think to monitor the toxicity.
On a 2nd thought, I think BP is the devil in me. I need an exorcist instead of an MS
have a good day
I hope you have a good christmas, My advice still stands - In my opinion you need to see a new doctor - I do not believe you are getting good treatment from your current one and I believe this is harming you.
Whatever the belief on what causes BP, medical science and study not withstanding, you need and deserve adequate care which you are not getting.
I am really concerned my friend - you see to have constructed a line of reasoning which will keep you locked in this path - I am sorry but you are not stable on the drugs - if you are on a Mood Stabiliser and an Anti Depressant you should not be having episodes every 2 months - you should be able to manage better than that if you are stable.
Adel please get some help here, see another doctor if only for peace of mind.
thank you very much for your concern and your sympathy. Alright would you kindly enumerate the MS available if you mean the AC: lamictal, tegretol, depakote, there are another 2 which i cannot remember or the lithium which this pdoc is afraid to put me on.
I understand your point. Perhaps my parents are afraid to bend in a new road which can be more harmful.
One point though I need to understand fully. Why AP are not considered MS if in
Antipsychotics were designed specifically to treat schizophrenia and other psychotic disorders. They have within relatively recent times (the atypical antipsychotics from Risperdal onwards) have started use as mood stabilizers because they have mood stabilization properties. I know when I was on Zyprexa although I would not suggest it because of weight gain (I myself gained 35 pounds) it had a strong mood stabilization effect. Seroquel had a good mood stabilization effect. Clozaril were it not for the severe side effect profile when I took it as an antipsychotic served as both a mood stabilizer and an antipsychotic. The concern is over the long term side effect profile of antipsychotics when they are used as mood stabilizers although for bipolar with psychotic features they are a neccessity. For bipolar a mood stabilizer may be enough and an antipsychotic helpful as well but if someone is off medication and in a hypermanic state an antipsychotic can knock out a manic episode cold and then as a mood stabilizer is added the antipsychotic can be lowered. I'll let the person you addressed answer it as well but this is my specific knowledge if not a problem. Thanks.
Adel I am not a psychiatrist and thats what you need, reading forums and writing letters to doctors is not primary care - you need a primary care psychiatrist who is willing to medicate you and not play games which is what your current doctors is doing in my opinion.
You should not be having the episodes you are having if you are stable.
As for Lithium its perfectly safe for most people as long as the required diet and treatment plans are followed and you do not have thyroid issues, ive taken it for nearly 2 years and some patients have taken it for more than 30 years contiunously without harm - its not popular now because its cheap but the other mood stabilisers all have side effects as well and some of them make lithium look like a walk in the park.
I grow tired of FUD and outright silliness surrounding Lithium which is still the most common approved first line mood stabiliser in most of the world today.
As for what doctor jones says, well you could ask him but actually he has multiple drugs there .
Lamictal and Depakote and Carbatrol are anti epileptics / anti convulsants
Seroquel, Zyprexa, Risperdal, Geodon and Abilify are atypical anti psychotic drugs
Lithium is the only true 'mood stabiliser on his list'
I think you have not understood what I meant BTW - the very fact that these drugs are anti psychotics is a clue to what i meant - none of these drugs were designed as Mood Stabilisers, its not their reason for existing or the primary reason they were first prescribed - reality is that the mood stabilising effects in the anti psychotics and ant epileptics are side effects, off label if you like, of the drugs. Sure they work and thus are MS drugs but theyre not mood stabilisers as such in real terms.
You could take any of these drugs. Youre not taking one - youre taking several but youre taking them at a level so low theyre not doing anything but sedating you.
Right now your psychiatrist is being paid to sedate you - something you could accomplish with Temazepam for likely 1/4th the price the cocktail you are on now is costing you and a crapload safer.
I ponder why your psychiatrist thinks you need to be sedated? Bipolar patients and in fact all mentally ill patients do NOT need sedation - the world has moved long past the point where mental patients should be whacked up on Haldol and stuck in the corner. How old is your psychiatrist? For some reason I suspect late middle age to early old age....
Tell me Adel does this doctor work for you or your parents?
I am concerned my friend, I truly am, I think you need real medical advice and you need to get it sooner rather than later, I really mean that because your parents are not the ones who matter here its you and I am afraid what lies down this road.
Hi monkeyc/ ILADVOCATE
I have discovered that my pdoc 63 years old is putting me on sedatives rather than medicine like monkeyc said. Upon discussing my meds with him lately he said that the lithium and AC can in the long run hurt.
I am on risperidal 1mg, stelazine 2mg, seroquel 50mg. I had always questioned why people take larger doses and I am on these. for the 1st time he confessed that he is putting me on sedatives. Apparently the older school. I am not sure whether my situation worsenned or not. But I remember when I turned euphorically manic in 2006 due to an anafranil only without the resperidone, that since then i had 3 manias dysphoric which I promptly aborted.
For the last 2 months I was very stable until I raged for 2 days . I was then on 25mg seroquel only. So I increased it to 50mg now. I know well that the 2 atypical AP risperidone and seroquel can work as MS but in higher doses.
Now I fear from the long term use of AP (tardyve dyskenia, cataract, diabetes,.....) usually AP are used during titration only of an MS. What is the implication of what he is doing. Is BP gets worse with age. Suppose I stay like this time without raging, is it OK. my pdoc say lithium monitoring is complicated, AC makes one dysphoric and numb after a while.
So what is the implication of my medicine in the long run. I remember another pdoc wanted to put me on abilify because it's 2nd generation regulating rather than suppressing the dopamine. What about glycene as you mentioned the other day.
Don't bother yourself by long writing just tell me the implication of my med in the long run
I have my own biases, especially towards SNRI's, because of my awful experience, but some folks here are doing well on them.
Seroquel is a good drug in the sense that you can tweak it when you need to, normally I take 50mgs morn/afternoon, the 100mgs at night. I've been slightly hypomanic the last couple of days, so I've been taking 75 both morn and afternoon. I was told not to change my main dosage if I'm bottoming out. My pdoc have given empowered me to get to know my cycles and augment when I need to. Education is key though.
Brains are incredibly complex organisms, hard to understand by the medical community.
Getting the right combination can be tricky. I'm actually going to ask my pdoc for an add on med, as I'm getting hypomanic more often. I know that can be adding another AP, as long as it works, I'm not drooling or tripping over myself, I'm game for whatever can make me functional in society
Empowering yourself and understanding your mood swings so you can catch the swings before they get bad can really go a long way.
Adel my comment still stands. Why is this doctor sedating you?
The answer is in his age. The old school approach was sedation for mental illness. This is 2008. I again suggest that you seek another doc - I do not think this med combo is working as its not controlling your mania's - but I am not a doctor.
The problem is as you have already pointed out other drugs send you manic - anafranil is an old school tricyclic anti depressant which has a black box warning of suicidality and mania in bipolar's - now ask yourself what sort of a psychiatrist can prescribe that to you? You cannot take anti depressant drugs safely as a bipolar without a mood stabiliser - its russian roulette with your brain.
You need to see a competent psychiatrist in my opinion if only for a second opinion - ive read about the cocktail and I dont think its doing anything BUT sedating you and you are on the rollercoaster right now with little mood control - anything new in your system risks something else happening to my mind but I am a layman - a mood stabiliser does not have to hurt you.
This is the problem with the damn internet - people read about worst case scenarios like tardive dykenisia and thyroid damage and assume thats going to happen to them - these are risk factors yes but the incidence of most of these side effects is so small they are not major issues providing you have adequate care and medical advice.
Right now you do not - I get the impression this psychiatrist has no idea how to treat a bipolar patient.
I say this again to everyone - THE DOCTOR WORKS FOR US. its important. We pay the bills in most cases and even when we do not they STILL work for us. Its up to us to make sure we get the best care and if the doctor you are seeing is not giving it to you seek a second opinion. Doctors can and do kill patients every day through lack of care,education or interest - there will be people in hospital beds right now because their doctor did not listen or care - I have seen 2 suicides in the past decade caused by GP's prescribing drugs they should never have given had they taken more than 5 minutes to speak to the patient and actually listen - this is number one reason why a growing groundswell of patient advocate groups and Medical groups has started to rise to remove the abiliy of GP's to prescribe certain classes of drugs.
Sigh. Adel im worried ok, I do not know you but I feel you are not getting help and that worries me because I do not want you to just disappear from here one day and never be seen again - too many bipolars kill themselves every year and we all say it wont be us but if we are not getting adequate treatment how can we say that.
BTW Lithium has been used for over 30 years by some patients without issues. Id say thats long run from anyones point of view
Adel do you parents have legal consent to make medical decisions for you? As an adult you have the choice on what medications you take.
Stelaziine is a hard core drug they give to schizophenics mostlywho aren't controlled by other drugs. Why are you on that? That's a seriously sedating drug with many side effects! It's a serious AP, do you have major psychotic episodes?
Do you know it was orginally a horse traquilizer?
I know this might be off topic but I have always wondered just why you would need to tranquilise a horse? I thought you were supposed to make them go faster not slower?
I just got this mental picture of Wilbur shooting Mr Ed up with Stelazine and him getting that look on your face you get when you take a big valium dose.. sort of geeee wilbur that suurrre feels goood..
* Monkeyc notes he is hypomanic right now and apologises if this off topic post causes issues for anyone or any horses reading who need tranquilising.
I've post more about glycine when public statements are made which they will be. How about that? I don't want to be responsible for people trying to take it on their own. As for long term side effects of any medication, we should be aware of them and be monitored for them. That's why we get bloodtests for a variety of mood stabilizers. Each bloodtest is to prevent something that could happen. And to prevent it. And it is important to be aware, just not to let things frighten you away from treatment. I find it distressing that as a person with advanced tardive dyskinesia, that anti-psychiatry groups have spammed up the internet using my disability to frighten people off medication and create irrational lawsuits. When I look back the two factors that happenned were that it probably was not a good idea for me to be given two antipsychotics at once (in 1997) and also because I had some undefined minor motor movements as a child (although a normal CT scan) although the movement disorders specialist is doing tests to figure out what, that made me unusually suspectible. I got extra pyramidal side effects from Lamictal which was a statistical rarity. And from fish oil. And Lecithin. Please don't use me as an example. As for that, a standard movement disorders test should be done regularly by a psychiatrist to monitor for it. For everyone.
The important thing is not to put long term side effects out of mind but to address them factually. I had a friend who said "I don't read the package inserts as regarding side effects of medications. I don't want to worry I'll get them". He developed gastritis from Topomax which turned into Barrett's esophogitis. Yes this is extremely rare. And nothing that should make a person not take Topamax. But when I took Topomax and had sharp pains in stomach I stopped it asap. I knew. Information in itself is nothing that should frighten a person away from treatment. If he had been aware he would have stopped it as well. But this is extremely uncommon but keeping himself in the dark about any medication wasn't too sharp either.
People die from asprin each year. I don't know who hasn't taken Asprin. On the other hand people who take blood thinners can't take it and I can't because it could interact with some of my medications. Easy example. Educate yourself. Don't frighten yourself. And yes by all means get your treatment adjusted. And regardless of what I've posted about my physical disability if I hadn't taken anti-psychotics I would have cycled in and out of psychiatric hospitals or worse. It was neccessary. Right now priority number one is to get things stabilized. Then you can address long term side effects and other issues such as that more rationally.
And to put it simply you should be one antipsychotic. At a proper dose. And preferably an atypical (Risperdal, Seroquel, Geodon, Invega, Abilify, Zyprexa). Abilify has the best side effect profile out of what's out there but Seroquel and Risperdal are fine as well although it should be one or the other (with the addition of a mood stabilizer). Stelazine is hardly ever used. It knocked me out and I slept all day and I couldn't function. Among the older generation antipsychotics it is hardly ever used. I would suggest you change psychiatrists. 3 anti-psychotics at a sublinical dose doesn't make sense and I don't know of any psychiatrist that would disagree. But noting on your profile you live in Egypt if this is something you need advocacy as for changing psychiatrists contact "Mental Disability Rights International". They could advise you and despite the name, they are not anti-treatment (anyone reading this can look them up, I have referred people to them with success). But they do want everyone to have the proper treatment which by that combination is what you are definitely not getting.
Ironically on the aspirin my psychologist at the hospital and I were discussing panadol (I think its tylenol in the US) and how dangerous it is - she has been seeing the parents of a patient in Intensive Care who took 12 at once and is on dialysis and not expected to survive - she was not even trying to kill herself she hurt her knee at school...
The most common medications can be the most dangerous all to easily, aspirin inhibits blood clotting which can be deadly for example.
ILADVOCATE i do not think you have scared people, the fact is the internet is full of all worst case information - most of it anecdotal and based on no fact - for evidence look no further than the common claim some people trot out that Lithium destroyed their thyroid, its like folklore and misses the important fact that they would have had thyroid issues anyway and the proper work ups were not done.
This is the problem with family docs and meds also - they do not do proper blood work - before i started lithium i had to have full thryoid and liver function tests to ensure all was well - yet I see GP's hand it over.
I have seen GP's hand over AD drugs to suicide risks, Ive seen them hand out valium to alcoholics. Doctors are no better than the internet sometimes.
So what we do and have to do is educate ourselves carefully but not scare ourselves - sure you look at the common list of side effects and make sure you know interactions but what matters most is understanding the major risks such as black box warnings and interactions and actually following instructions and telling your doctor if you notice anything.
A study I read not long ago on Lithium pointed out that in almost 95% of toxicity cases in Lithium patients the cause was patient behaviour related : drinking alcohol heavily, not eating the right diet, not drinking enough water, becoming dehydrated, failing to get blood tests done, not telling doctors until it was too late. This is a condition that can lead to renal failure and people still cannot do what they are supposed to.
All drugs have side effects, all drugs can in the right circumstance harm or kill you - however that does not mean all drugs are bad - it means like anything you need to do what is required. I think of a new drug like learning a new piece of software - you can really make a mess if you don't pay attention and learn the commands.
Dont be afraid of the meds and the side effects - get well first.
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