Help/panic and fear

[adel_ezz]

Hi

it's time I seek help now from the kind people here although my last experience with the group was a mistake I did towards the nicest lady and our leader

I am supposedly BP1 since 2 years only (got 1 mania for sure, although 4 years before an OCD person only). I was stable since then more or less on Ap's only:

seroquel 25mg
risperidone 1mg
stelazin 2mg
xanax 0.375mg

the last 2 months I began to go down so i added lexapro/cipralex 5mg every other day, then everyday now. But the last 3 days i have panic and fears. I was cautious with cipralex as it may bring mixed episodes or rapid cycling which in fact didn't occur at all because i am watching myself thoroughly not to exceed any dose. But as i said the last few days in the morning to come out of bed is impossible having great fears and i have to go to work. I remember many years ago when this occurred my pdoc (who is away right now) said adding an antidepressant must accompany adding benzo too, i.e. i should give it with an extra benzo. So this afternoon i added a 0.125 mg xanax (i am sensitive to drugs) and i calmed down. So do you think panic and fear can be an extra side effect of cipralex and i should increase the above doze of xanax. Finally does benzo removes panic and fear or there is a special drug for this

many thanks and grateful

ezz

[zzzmykids]

Dear adel_ezz,
My goodness you have been through sooo very much in your young years!
First, with bp1,2 or any of the others we are inclined to have other malllodies. The only time I was in a psych area of the hospital, the psych said he was suprised I did not have other mallodies besides bp2.  So the ocd or adhd or any of  these can coincide with the bp.
I take diazapam, seroquel and lithium for the bp2.  Seems to be the best combo for me in years.  I have never been numb but have had tremors, odd thoughts and all over body pain from meds.  The tremors wasn't the lithium but another med effexor which when taken off of the drug, they went away.
Why not lithium, yes there can be side effects as well as with any of the bizzare drugs we all take.  But lithium has kept me level on the manic side for years.
I just mainly wanted to write you and say, good luck and we are all pulling and praying for your stability.
zzzmykids

[adel_ezz]

Thank you all dear friends

Yesterday evening i went to see a new pdoc with my parents. This is the 1st time the guy convinced me. The point is you may not be convinced with the precedent ones but you have to go with them because they are pdocs. The nice thing he diagonsed the case directly. He is licensed from the canadian council of medicine whatever this is and is a psychopharmacologist contrary to the others psychiatrists. He dx BP1 yet he said we'll see exactly about that. He also asked why taking like Bastet said stelazin and risperidone I was glad to hear it from him. I know stelazin is typical with risk of TD in the long run and i asked this to my original pdoc who said since it works with me then it's OK, wrong of course but i am not a pdoc to decide on the meds.

To be frank with you the true reason why I was sticking to my pdoc who put me on antipsychotics and yet i know i must be on an MS is that I don't want to cross the barrier to anticonvulsants or lithium. Usually I rank the meds going upwards as follows: tranquilizers (xanax, ativan, ...) then AD (SSRI, Tricyclics,...) then AP (typical and atypical) then AC (lamictal, depakine, tegretol, topamax,...) then lithium. So so long i am in the lower end it's better with the side effects, each time i cross to an upper level i run the risk of more side effects. So i was happy with my meds fooling myself of course and suffering much until yesterday i couldn't take it any more. The guy seems very convincing. He said stop the cipralex, of course i am aware that an AD without an MS is risky I knew this very well that but I thought i could control it by watching myself and let my parents watch me as i live with them until I took a daily 5mg which drove me - not manic thanks God - but in panic and fear. I thought it was my illness but the guy said it's from the cipralex so that was good news and he upped the seroquel to 50mg.

Now this i need your view on it: one of the reasons my original pdoc didn't put me on AC say, he said a long use of them will mke me numb and dysphoric, is this true? Perhaps I should post this independently to see your views

I'll keep informed
thanks a million
ezz  

[bastet56]

yes, ezz, the cat goddess is a lucky symbol for me. I know that your meds seem to be working for you right now but I agree with ILADVOCATE that taking 3 anti psychs seems a bit much and that 1 at a safe level would be better. Do you live near a University that has a mental health clinic in it? You might be able to find a psy doc there that could help you better than the drs you have found so far. Many of the psy docs there also teach and leacture on the subject as well as keep in touch with other psy docs around the world. I too have had trouble with psy docs here in the US so don't get discouraged. Keep trying. Keep reading on the subject. Don't give up.

[ILADVOCATE]

Yes although of course only a psychiatrist can make a final decision general psychiatric thinking is that one anti-psychotic at a clinical dose is far safer and effective than 3 at a subclinical dose. Mood stabilizers could be added or adjusted but anti-depressents are of concern because of the risk of worsening mania. I know you had stated that they don't prescribe Lamictal except for seizures where you are but Lamictal has a good anti-depressent effect. Xanax is generally okay for short term use for anxiety. I understand that a psychiatrist's decision would take precedence over all of this but I believe you were thinking of transfering to one who would adjust your medications to a more effective regimen. If you got information from another psychiatrist that advised you that this combination might not be of use then I would believe they are right. Obviously we can't give specific advise but I would advise you to change to a psychiatrist who is more up to date in their knowledge. I know we've said this before but we are all concerned.

[bernie40]

Hi adel,

I wondered where you had been!  I missed you but was hoping it was because things were going well for you that you hadn't been on here.  

I really wish that you were able to find a good psychiatrist and I know how frustrating it is that this is not proving possible.  I have heard that cipralex can cause increased anxiety, agitation etc and as Narnia has said it really isn't good to take this without a mood stabilizer - I know you currently take AP's to manage your moods.

I always feel like I'm not really giving you much in the way of advice because I know that the healthcare system for you is so different to mine over here so the UK rules don't apply.  However I hope that at least I can offer support.

[Narnia41]

Hi adel, felt I had to leave you a message on this question about Cipralex.

I took Cipralex for around 4 months prior to my diagnosis of BP.  I think I was taking 20mg.  It made me terribly aggitated, more depressed, more anxious....it was after this horrible reaction that my pdoc started to think about Bipolar as a diagnosis, as the Cipralex actually made me alot worse!  It induced Rapid Cycling for me.  I would never take this drug again personally.

As for benzo's, they do help with the symptoms of anxiety and panic, though here in the UK they are not given as readily as they can be addictive.  I'm no expert on medications but I would say taking Cipralex without a mood stabiliser is not a good idea.

Hope this helps  

[adel_ezz]

I am extremely sorry i read your name wrong i didn't put my eyeglasses. You know Bastet is an old Egyptian god for wisdom (cat) daughter of Ra and protecting, see:

http://www.moggies.co.uk/bastet/bastet.html

also:

http://en.wikipedia.org/wiki/Bast_(goddess)

thanks ezz

[adel_ezz]

thanks
of course i am under a pdoc but a lousy one. Each time a person hears of my drugs laughs. Once i sent a letter to a pdoc in buffulo (USA) to enquire so he replied saying it's odd you are on 3 AP's. HOWEVER i function so i assume "if ain't broke don't fix it" like the americans say. During the last 5 years i consulted at least a dozen of arrogant filthy and ignorant pdocs. No 2 of them agreed on one combo. There was one who said lamictal being logical contrary to my current coktail which is illogic. You can say that i am aware of all the drugs, AP's typical and atypical, AD, AC's and read in all, but since the above combo works in low doses i feel safe better to take the classical MS (lithium, depakote, tegretol, lamictal, etc...) so i don't want to cross my barrier to go to AC's now unless my combo fails one day. You see. The FUNNY thing a BP pt must not take AD's, AP's unless with psychosis and Benzos yet i take the 3 of them and it's working. So i don't want to fiddle with my meds because i have a job. It's only that i am depressed the last 2 months so i added cipralex but it's now the panic and fear. I know xanax is addictive above 1mg mine is lower considering the transiant situation. As to side effects of AD's all of them have got all the side effects you can think of including depression !!!
thanks ezz

[bastet56]

ezz, are you taking all these meds under the care of a pdoc? I notice that you are on 2 anti psychotics, why? Why risperdone and stelazin? Are you adding and subtracting meds with your pdoc approval or on  your own? Xanax can be very helpful with panic as I have this problem and take it too but you have to be careful with it unless you want to become addicted to it. Have you looked up cipralex and it's side effects? I am not familiar with this drug. I find it impossible to function without my meds so I know where you are coming from. I just hope you are under the close care of a dr.