I am replying to your post just for the sake of support. But your questions are always difficult to answer. Mixed states occur when one is depressed but also angry. He doesn't take an antidepressant which provokes this state, it could well be the disease.
I tried myself to function with no AD but failed. Now i am under stablon a French AD non-existent in Canada i am afraid but fantastic for anxiety and mild. There is the welbutrin they say doesn't bring mania. But your pdoc has to find something for his anxiety. You remember gabapentin (neurontin) an MS weak but excellent for anxiety.
I remember your 1st letter seeking an anxiolytic but not benzo because addictive. I am afraid you should resolve his anxiety
i am awfully sorry had really wished i can offer a sound advice
Usually pdocs don't recommend antidepressants for BP pts because it is full of controversy and side effects, but i can read between the lines in many forums that it helps and that a great majority of pts take them to function, especially if they are under a mood stabilizer. your son is already under 2, because zyprexa although an atypical AP yet very strong one.
Funny I can't explain why I hate both although neither tried them. I have no explanation for this but i hate the names: zyprexa, valproate. Yet i like names like abilify, lamictal, seroquel also with no explanation. Had I been a pdoc i would have announced my theory: The only pills I see suitable for BP pts are: lamictal+seroquel. I have many reasons for this although i didn't try this combination because i want to exhaust all other possibilities. The reason why i see they are the ONLY logical meds is that depression is the major issue in BP not mania (the latter easily extinguished by AP's) but it's depression which is responsible for the acknowledged 20% mortality in BP whether in BP1 or 2 especially the latter very pronounced. Now lamictal is good for depression so is seroquel which is often used as a monotherapy because it has an antidepressant effect. In mania seroquel is best, don't say lithium or tegretol, remember that in lithium NOT only drink a lot of water but plenty of water with flush it out, too cumbersome. Seroquel is best. Also the side effects of the MS are plenty too much involved. Seroquel you can withdraw easily (forget not to sleep well, not true...) you can always add one more seroquel when you feel manic like i am today, then subtract one, no worries. The 1st to have drawn my attention to this is LeftCoastChick which is true. Again lamictal works upwards and seroquel works downwards so equalising each other (my engineering sense not the clinical one). So i am positive that this the right combo. Finally if you consider the production dates of these 2 drugs they are the latest except abilify among all the bloody others.
I appreciate your well researched knowledge as always....seems I am askng the same questions repeatedly. His pdoc returns July 13th and has said he would than put him on seroquel as you mentioned, I look forward to this and hope it works for him....he was on it before the crash but not a high enough dose(only 100mg) I don't think the pdoc understood at that time the full extent of the ONSET of his problems.
I don't know if he will also change his MS at that time as well?....I only search for answers to ease my own mind since I am the third party I cannot suggest.
the knowledge of yourself and others who have walked the path of this ugly disease has proven to be very very helpful to me.
I remember he was on wellbutrin than tried gabapentin as well when he at one time was in the depressive state....and to my knowledge neither worked for him...thus he stopped on his own. there have been many drugs tried, when he has no relief he stops taking on his own, also when something works he also stops taking because he feels he is OK....so you can see the FRUSTRATION of the pdoc he has been seeing for 4 years......seems he only turns to him when there is a crisis.
He is soooo sure mental health is a form of weakness and can be cured by the strength of the mind....I think after this last episode he has finally come to the understanding its not in his control and must come to accept he has this condition.
How long have you suffered ezz?.............it is a mental torture and my heart breaks for anyone who has to live with this horrible disease
seroquel will do him good. contrary to all the meds that he had known this one isn't harmful at all. 100 is ok i take 50 or 75 now because i am manic due to an AD.
gabapentin won't lift his depression so he was right didn't make him any good.
seroquel has many advantages
1. good night sleep
2. can titrate up and down any time i.e. can add one more pill at your choice or remove one no withdrawal or side effect of that
3.somehow it lifts depression but not as strong
the problem with our illness is that we take wrong decision at times. like i did in 2006 when i stopped the meds and was catastrophic my disease took the ugly turn.
welbutrin an SSRI works differently good for stopping addictions but i bet like the others can indiuce manai.
good that he accepts he is ill this is the 1st step in the right direction. it is 7 years now from OCD to BP until in the family we decided after seeing a dozen of pdocs we admit i am bipolar. nevertheless a very complicated illness, i compare it to the lousy cancer and the other sevcere diseases. it needs a lot of management. what is worse the symptoms keep changing unfortunately not to the better. However the good news it's the final stop (terminus) . NEVER stop any meds except with the permission of the pdoc.
there is an Arabic say: the paradise is at the foot of the mother. Meaning to enter paradise it depends how good you are to your mother because poor her she is always the true sufferer
Valproate is better on mania than depression. That can be a difficulty of it. They could add another mood stabilizer or change it. As for Zyprexa its an antipsychotic so the pacing could be a temporary movement disorder such as akathesia and they could prescribe a side effect pill for it. Zyprexa does have strong mood stabilization effects though. Both of these are from general knowledge as well as my personal experience. Speak to his psychiatrist about all this.
the pacing was before the zyprexa, it has stopped now and the anxiety and racy mind has also lessened.
however the depression has remained constant if possibly even worse.
appears he has stabilzed in LOW mood.
Maybe the pdoc will add an AD along with the change to seroquel..something sure has to work.
seroquel will not worsen his depression for sure, he may only feel lethargic if he is given high dosage. But as IL said valporate is good for mania and weak for depression.
There is an alternativce to give him (ask your pdoc) an AD good for anxiety too like lexapro but for a short while only because all AD's run the risk of bringing mania, and stop. Already he takes zyprexa which is strong enough to cover the AD if given.
In my view at least the choice of seroquel is OK that's sure, now the turn comes for lifting the depression. Neither zyprexa nor the valporatye will do it. Apparently your son is BP2 and here lies the trick because it takes a while to elevate him. You know you will be surprised that simetimes you find the patient becoming better on his own and the meds are the same.
I bet an AD now is convenient. The problem which? citalopram/celexa/cipram is weaker than lexapro/escitalopram/cipralex (same company)., Don't use tricyclics though they fidel too much with many neurotransmitters, either an SSRI or SSRE or a stimulant. Have you tried st John's wart (it can bring mania after a long time) but some people tolerate it. I tried seroxat/paxil and i became manic after 20 days. The thing he has to find something to lift him up but maintain it due to BP2. Seroquel here helps also. I take stablon (tianeptine) ask your pdoc about it it's a new tricyclic very very good for anxiety and works late some american order it online.
I really wish i could find a clue, but had this been true i would have at least sorted out mine
If he hasn't tried Lamictal that has a good anti-depressent effect. That worked for me for me as a full mood stabilizer over a long time. I didn't find Neurontin and Topomax to be quite that effective but from what when I was put on them they are generally used as adjuncts. Risperdal, Seroquel and Zyprexa generally have the strongest mood stabilization effect out of the antipsychotics. Many people have had a bad experience with SSRI anti-depressents worsening mania so psychiatrists tend to use them with caution but you could to his psychiatrist more about that.