Abilify dose reduction and mania

[scochran]

Over the past three years or so, I was on up to about 25-30mg Abilify.  I have been slowly brought down, where I am now taking 3mg.  I think I am starting into a manic episode.

My question is, could I have reached my lower threshold for the Abilify, maybe at about 7-10mg, or could it be something else?  I am under a lot of stress right now with school.

Thanks

[scochran]

Sounds like that coming off of the med maybe something.  Back when I was first diagnosed Bipolar is when I first started experiencing all of my nasty migraines.  (I just realized this.  It was sort of the migraines came when I was being experimented on with all of the mood stabilizers.)  Back then I was too stupid to realize that they could have something to do with one another.  But, that's water under the bridge.  Hopefully things will work out for you, I know from first hand experience that those headaches can be debilitating.

I saw my Psychiatrist today (yesterday).  He's keeping things the same, and I will see him in about a month.  I asked him about my theory with the reduction in the Abilify causing the manic symptoms.  He told me that with Bipolar Disorder, it is not the same as any other illness, it's trial and error with the mood stabilizers.  When you find "the" combination, you are considered stable, and then it is the outside factors that may cause the mood swings.  He said that there is no way to tell exactly what causes the moods to go one way or another, you just have to catch it early enough to do something about it.  Basically, he blew my theory out of the water, but what he said makes complete sense.  Looking back on it, we lowered the Abilify dose in very small increments, and kept it there for a descent length of time.  I am thinking now that it wasn't the lowering of the Abilify dose, it was probably the stress from school and work that caused the episode.  I am still a little irritable and agitated, but that will probably pass with time.

[llamasmellfunny]

I've never had to do the injections for migraines.  When I got them as a teenager after a while they just chalked it up to a behavioral issue (military doctors suck) so I stopped going to the doctor and dealt with it myself, although when I started mood stabilizers my migraines stopped.  I can't tell if the Indomethacin is working for me because now I'm on the Seroquel and going off the Lexapro so my zaps and headaches might just be related to SSRI discontinuation.

[scochran]

Sorry I haven't posted in awhile.  Started back to school, and I have alot on my plate.  I think I am starting to get headaches again, though they are few and far between.  I use Relpax, which is a pill, and I also have DHE-45, which is an intramuscular injection (I give it to myself - only hurts about 1/2 the time, I go for the hip).  The DHE-45 is an old, not very much used, migraine abortive.  One of my old Neurologists started me on it quite some time ago.  I have an upcoming appointment with my current neurologist, and I will tell her about the very few headaches coming back.  I really don't want to go back on any preventive at this time, so I will discuss the options with her when we meet.

[llamasmellfunny]

It takes a lot to offend me so don't worry about it!

I don't usually have a migraine type headache when I get the brain zaps which I thought was weird, but I have noticed an increase in headaches over the past few weeks so I feel like that kind of confirmed the diagnoses.  I started the medication this week and I didn't get any yesterday and haven't gotten any today yet (although I slept most of the day so there's still time!).

[scochran]

Sorry to bug you again....Those brain zaps you get, do they occur before, during, or after a migraine happens.  I'm thinking the brain zaps could possibly be an Aura, which is something that happens that will tell you a migraine is coming.

BTW, if I pry too much or insult your intelligence by telling you something you already know, please tell me, and I will stop.  I don't want to come off sounding like a know-it-all.

[scochran]

I used to get migraines alot.  I used to live with them for days on end.  These days I only get a few strikes here and there.  (What I call a strike is when you get the pain of a migraine that kind of "sparkles" on the side of your head for just about five minutes or less.)  Indomethacin is a non-steriodal anti-inflammatory drug (NSAID) in the same class as Ibuprofen and Naprosyn.  It is mainly used for gout and arthritis.  I can see where it would benefit a migraine sufferer.  I really feel for you, because I know first hand how migraines can disrupt your life.  Add Bipolar into the mix with migraines, and it can get pretty ugly.  I started my bouts of bad migraines right before I was diagnosed with Bipolar.  It really *****.  But, look on the bright side...maybe they'll just stop one day.

[llamasmellfunny]

Glad to hear the doctor was able to adjust things.  Hopefully it all works out.  I just started a medication called Indomethacin?  It's for migrains because that's what they've been attributing my brain zaps too.  I had them last night, but that was my first night on medication so I'm hoping that it starts working.

[scochran]

Here's an update.  Had my Lithium level done on 8 Sep 2009.  Went to the Psychiatrist on 16 Sep 2009.  He said that my Lithium level was 1.6.  Theraputic range is 0.5 - 1.5.  He said normally he would leave it alone, and use the "Treat the patient and not the number." metaphor, but I was symptomatic with a tremor.  I also felt sick to my stomach (slightly), and had some cognitive issues.  The stomach and cognitive stuff I attributed to the insomnia, but he didn't seem to think so.  We backed off the Lithium to 1200mg, and increased the Abilify to 15mg (ruining months of hard work, ha ha).  He also added Seroquel, 50 to 150mg, for the sedative effect.  He said Seroquel had anti-depressant & anti-manic effects also, but we were targeting the sedative effects of it.  Thus far, I have only been able to tolerate 25mg of the Seroquel, but I tried 50mg and was a hung-over zombie.  I am still hypomanic, which is better than I was.  Hopefully, things will get even better with time, as I start back to school on 23 Sep 2009.

[scochran]

I used to play with my own medications - adjust the dosages, stop them, etc. until I made the mistake and told my therapist in one of our sessions.  Boy, did she tell me a thing or two.  Needless to say, I haven't done anything like that since.  She looks at Bipolar as the brain being at the point just below a seizure.  That analogy is not too far off in my opinion.

Lithium has been about the only medication other than Abilify that my body has responded to.  As far as toxicity, it scares the hell out of me, but as long as I know the signs and what to watch out for, I really trust my psychiatrist to keep his end of the bargain.  If he messes up, I will drop him like a hot potato, and find someone else.  (Which would not be easy, since there are so few psychiatrists around the city in which I live.)  I really don't see that happening, because I have been seeing him for quite a while now, and he has proved himself so far.

Anyhow, I hope your new psychiatrist is doing you justice.

[llamasmellfunny]

No no!  No offense taken.  I've been busy.

My last psych was trying to put me on Lithium, but it would have required me to go off my medication that I'm on now and I'm pretty sure that is virtually impossible.  I tried reducing my dose a little and my mood flew off the handle.  It would take me over a year to go off of it and to me its just not worth it.  That and I'm terrified of the toxicity. I don't take very good care of myself so that would be a big issue.  I just recently switched psychs actually because mine was kind of a douche bag.

[scochran]

Hey,

I am sorry if I offended you with that last comment.  That was not my intent.

[scochran]

About the Lithium dose, I have read where people have been on as high as 2400mg per day.  I take my Lithium (which is extended-release) at night.  My last level (on 1200mg) was 1.0, and the toxic level is about 1.5.  I trust this doctor - he wasn't afraid to do the Lithium with all of my complex medical history.  Other psychiatrists would not have anything to do with Lithium for me, and basically (over the long run, and my history with Lithium), I think I am doing well on it.  I go for a level on Tuesday, 8 Sep.  I guess we'll see.  I am sorry if I am sounding harsh or anything, I don't mean it.  Before this psychiatrist, I had a really good one that was a resident.  She had a dual specialty of Internal Medicine & Psychiatry.  I really liked her, but she bucked the Lithium.  My current psychiatrist said "A lot of the new kids don't really know how to use Lithium, and I have been using it for over 20 years".  He also said that there is alot of newer stuff now, and that is what they become comfortable with.

Thanks for your input, and I will keep you posted.

[llamasmellfunny]

I'm glad you made it to the doctor.  The increase in Abilify should help out and I hope things work out for you.

I ended up stopping the Abilify because it made me gain 7 pounds in 2 weeks.  Well, it made me hungry enough to eat enough to gain that much.  I've already got a bit of a weight problem so I figured the risks didn't outweigh the positives.  It wasn't really working with my mania anyway.

I am curious about the Lithium.  Is it scary to be on such a high dose?  I know the risks are pretty extensive.

[scochran]

Update:

I saw my psychiatrist on Sept. 1, and he thinks I am having significant symptoms.  He raised my Lithium to 1500mg, and bumped up the Abilify to 5mg.  I know it takes time, but I haven't noticed any difference yet.

[llamasmellfunny]

Sounds like you have a lot on your plate.  I'm happy that the mania is starting to subside.  Make sure you contact your psychiatrist ASAP so they know what's going on and they know how to treat you when the crash comes.  It's better to notify them now instead of when you're depressed because you will be less inclined to do so then.  It's all about preparedness...if you know what's coming, do what you can to make it easier on yourself.

And you're welcome for my concern and my comments.  I've felt alone for a very long time because I didn't have anyone to talk to who actually experienced the same things as me.  Just a whole bunch of friends with psychology degrees!  I think sometimes they learn more from me just by seeing what I go through than they would in any classroom.  But I'm glad I found this forum because there are a lot of people with insightful advice and who also just know what it feels like.

[scochran]

About the school thing...This time around it is more stressful than ever, meaning the material is harder.  I already have a BS, an MBA, and I am currently working on an AAS for Medical Records.  I am for sure taking more classed than I can handle.  I really need to finish sooner rather than later.  I only have two more quarters to go (I will finish in March of 2010), and if I opt to not take some of the classes now, they won't be offered for another year.

My wife is a diabetic (she has had diabetes for over 30 years), with a host of problems related to that, and she also has problems completely unrelated to the diabetes.  It's the problems unrelated to her diabetes that is bringing her down.  She has stenosis of the cervical spine, and may have to have surgery to correct it.  We see the surgeon on the 31st of August.

I have a call out to my therapist, but I haven't called my Psychiatrist yet.  Things seem (I say that with great reservation) to be getting better over the past few days.  Some of my manic-like symptoms are still there, but others have lightened up a little.  My thoughts aren't racing as fast, and I don't feel quite as invincible.  I still do have the racing thoughts and feeling of invincibility, just not as strong as earlier in the week.  I also still have the increased sex drive, the desire to spend money, the taking chances (like on the road), no appetite, irritability and agitation, and decreased need for sleep (I do sleep, just in spurts of 3-4 hours at a time.

I have always told people that a manic episode is a lot of fun, but the crash at the end really hurts.  I could keep going, but I have probably bored you enough already.  I really appreciate your concern, and thank you for your comments.

[llamasmellfunny]

Yeah the school thing will get ya every time.  I just got my bachelors but it took me 8 years of going to school part time (sometimes even only one class at a time) while I worked full time.  I'm not mentally stable enough to do more than that.  Sometimes I'd feel really great and I'd register for 3 or 4 classes and then when it came down to it I would freak out from the stress and just completely shut down.

Just remember that if you can't go to school full time, even if it will give your wife a break, it's not the end of the world.  If your wife has medical problems as well then hopefully she can understand that it can be dangerous for you to take on more than you could handle because your mood could spiral out of control.  It might make things more difficult for a while, but your brain is a pretty important organ in your body and people like us have to struggle for a bit longer than others in order to acheive some of our goals.

[scochran]

Thanks for your input.  I have been on the 3mg for about a month.  Before that, I was on 7mg for a couple of months, and 10mg before that, so on, so forth.  I also take Lithium ER 1200mg at night.  It seems to me that this started a few weeks ago, and I really didn't think anything was wrong.  My therapist suggested I track my moods, and then I signed on to this site.  When I took a look at things over the past week, it started making sense.  The stress with school has been an ongoing thing, for about the past few months.  I am going to school full-time and working full-time.  (I know that's bad, but I need to finish school as quick as I can, so I can get a better job, that will give my wife a break.  She has medical problems as well.)

[llamasmellfunny]

If you're under a lot of stress with school then that could very likely be the reason you're starting into a manic episode.  How long have you been on the 3mg?  If it's only been a few days then I would wait about 1-2 weeks to let your body adjust to it.  Otherwise I would talk to your doctor and have them bump them up to 10.