Controlling psychosis and antipsychotics withdrawal symptoms

[Stefn]

Hi, I'm bipolar 1, diagnosed when I was 17. I had one really intense first manic episode,  with a psychosis that lasted more then a month before I voluntarily went to emergency. Than I was so depressed that I asked to go back to the hospital, and then I had another manic episode because I took antidepressants. From then on it went better and better, until recently, when I got completely stable.

I am perfectly fine, like I was before I got this illness. So we are lowering my medication, because I am afraid I will get tardive dyskinesia. I am currently taking Seroquel 700 mg and Lamictal 250. I have previously been on several antipsychotics, and that is what scares me. Less than a year ago, I was also taking 4 mg of Risperdal. I'm scared that I will get antipsychotic-withdrawal-induced tardive dyskenisia. What are the symptoms of withdrawal and how would withdrawal TD manifest itself? Can anyone who has tapered-off antipsychotics tell me about their experience?

I am also afraid that I might not be stable enough with only lithium, which would make my psychiatrist want to put me back on Seroquel, which I DO NOT want. I have read a lot about these drugs (researches and resumés and articles on reputed sites about these drugs and tardive dyskinesia) and I don't want to take any risks.

I don't know if this is  unusual, but I want to establish some kind of contract in case I get psychotic again, so that antipsychotics are used only in small quantities and for minimal durations of time by any psychiatrist that would be treating me. But now that I'm thinking of it, that would mainly be my actual psychiatrist. I any case, I do not want to let some very powerful medications harm my life.

And do you know anything that would treat psychosis besides antipsychotics? Can psychosis be controlled by augmenting mood stabilizers? Can it go away by itself? Can it be that in my future manias I will never reach the level of psychosis?

Thank you, I am counting on your personal experiences and advice.

[therese83]

You sound great and i wish you luck with this.

I had psychotic depression and i gave up  a low dose of Zyprexa because i didnt need it any more.  With your Doctors help you sound on the right track.

[freddie8605]

Omega 3 (fish oil) has been shown in tests that can help with psychosis and mood disorders. but if you want to take it in the large grams that is needed by those who have mental illness, i would check with your doctor first and get a dosage from them. also if you get it, get the filter fish oil because some of it has mercury as fish has a lot of mercury can build up and be toxic.
so fish oil (Omega 3) mercury free.
I take about 6 g although i can take up to 12 grams a day. It does not have side effects
good luck  

[Stefn]

Thank you for your advice Iladvocate, I am certainly doing this under my psychiatrist's supervision.

And the thing is that I might not need this medication, since I am bipolar and not schizophrenic, and I could maybe manage on mood stabilizers alone. I am working on my lifestyle and other aspects of my treatment so that I do not need to take much medication. As for the TD, it is just me who is worried, not my psychiatrist, and because I might not need Seroquel, I am stopping it.

[ILADVOCATE]

  As regards tardive dyskinesia it would depend if you have the signs of it or not or if your psychiatrist is just concerned. The best thing to do if they have specific concerns is to obtain a referral to a neurologist who is a movement disorders specialist. If tardive dyskinesia is diagnosed, Clozaril is an option as regards antipsychotics that will not cause or worsen tardive dyskinesia. The website "Patient Education Tardive Dyskinesia" (note as the website itself says "these medications may be medically neccessary) is one helpful site. There is also a fully informative website on Emedicine on tardive dyskinesia that could be discussed with a psychiatrist or neurologist.
   However its essential to understand that they are just concerned and can follow up by doing regular movement disorders tests. If you don't have the signs of it then the best thing to do is work with them and stay on treatment. Also note as they are researching new treatment modalities as regards antipsychotics there will eventually be whole new treatment modalities in the coming years that won't cause tardive and there are certainly new options as regards mood stabilizers that have been brought into use on a regular basis. Best to work with your psychiatrist as regards concerns regarding side effects both long term and short term as well as beneficial effects of medications.