Medication question for Bipolar I

[crOOk]

Hi people!

I've had one manic episode last year which doesn't fully qualify due to it's short duration, but I'm experiencing (ultra-)ultra-rapid cycling between hypomania and major depression and frequent mixed episodes and I just cannot take it anymore. If I stop taking everything altogether, I will go into a stable hypomania than drop down into major depression after a month or so. I am at a loss. The only medication that's ever made me feel sane is olanazpine which I self medicated with. The problem is that it will not do shit for my depression and I just cannot be studying medicine and care for my daughter adequately while I am depressed. My life will go to hell if I go on olanzapine.

So I thought about suggesting Lamotrigine and Olanzapine to my psychiatrist. Has anyone made experiences with this combination? I have never tried the former myself, but have heard great things. How were the dosing schedules or can it be used as needed? My brain is torturing me and I need a break, I jsut don't know who I am anymore, my affections are all fake and have been for an eternity. Olanzapine makes me feel so damn sane, so healthy, it is lovely. But if I'd take that outside of a hypomanic state I'd surely get stuck under my blanket for an eternity. During hypomania it doesn't even fully alleviate my lack of urge to sleep, it really just evens me out to a state that feels perfectly right. Right now I'm in a hypomanic state and cannot wait to leave the house, but tears have been streaming since last night. What is this fucking shit, I hate my fucking brain, sometimes I just wanna tear my head apart and get in there to fix things. :/

Please give me some advice what to do!

 

[Vaya]

crOOk, can you clarify one point? You write,

My life will go to hell if I go on olanzapine.

But then you write,

Olanzapine makes me feel so damn sane, so healthy, it is lovely.

So is it that you do, or do NOT, want to be on Zyprexa?

Also, I have never found SSRI's/SNRI's/AAP's to really work for me, personally, but I, like you, vacillate between manic and depressive states and have found lamitrogine (Lamictal) to be a god-send. It is currently the only medicine I'm on right now for mood disorder NOS, and I'd recommend it to most anyone struggling with depression. A good starting dose is typically 25mg; I was just bumped up to 37.5mg/day after about two months on 25mg after 0.5mg Risperdal for 2 months made me have thoughts of self-mutlilation (which I've never had before in my life; it was rather startling and disturbing).

This is only my experience with Lamictal, though, and so I urge you to definitely consult with your doctor regarding beginning treatment with it. Also, why not mention Zyprexa to your doctor if it makes such a significantly positive (?) impact on your life? Honesty will get you far, and you're showing some great insight with the following statement:

I just cannot be studying medicine and care for my daughter adequately while I am depressed.

Keep us informed of your progress and good luck to you!!

~ Vaya

 

[crOOk]

crOOk, can you clarify one point? You write,



But then you write,



So is it that you do, or do NOT, want to be on Zyprexa?

Also, I have never found SSRI's/SNRI's/AAP's to really work for me, personally, but I, like you, vacillate between manic and depressive states and have found lamitrogine (Lamictal) to be a god-send. It is currently the only medicine I'm on right now for mood disorder NOS, and I'd recommend it to most anyone struggling with depression. A good starting dose is typically 25mg; I was just bumped up to 37.5mg/day after about two months on 25mg after 0.5mg Risperdal for 2 months made me have thoughts of self-mutlilation (which I've never had before in my life; it was rather startling and disturbing).

This is only my experience with Lamictal, though, and so I urge you to definitely consult with your doctor regarding beginning treatment with it. Also, why not mention Zyprexa to your doctor if it makes such a significantly positive (?) impact on your life? Honesty will get you far, and you're showing some great insight with the following statement:



Keep us informed of your progress and good luck to you!!

~ Vaya

Thanks for your understanfding, I'm very glad someone replied. Right now I am completely manic again and I know that a few mg of olanzapine would alleviate that and let me find some very natural feeling sleep for at least 4h. More if I increase the dosage. On the downside it will not do much for my depressive symptoms so I will simply not be able to (I hope noone tells me "mind over matter" now) get my ass up to do a good job at uni (only barely pass instead with little to no work and always live with the uncomfortable feeling of not knowing shit about what exactly I'm doing to your patients). The same goes for my daughter. While I manage to have her with me 2 nights per week, every weekend, I still feel this will have to increase if she so desires eventually (she's barely 3yrs old). In a depressed state I will also tend to pacify her with tv before going to bed which can easily be avoided altogether when I'm not depressed. I know the depression will take over with a vengeance when I'm on zyprexa eventhough it is of great help in my hypomanic and manic states which so dominate my life in a way that can be observed by an outsider (the inside is much much darker). The hypomania alone has severe social costs and makes life feel like a constant lie, the realization of which hits me severely in mixed or depressed episodes. These episodes can change twice within the same day which can be pure torture not knowing where they came from. I have managed to self medicate myself to a relatively constant hypomanic state with amphetamine, but I'm extremely afraid of the social costs which felt immensely threatening after 18 months of use and have diminished my sense of self worth to nil at times.

Thanks again for listening and sorry about ranting a little, "it's on" again after a 4-6 week break from amphetamine with zero productivity. Uni was non existant during this time, but I managed as always. The loss of hypomania was a huge relief until depression kicked in though. I hope I sort of made clear what the problem is, I'm afraid of becoming very depressed with olanzapine, since I have only ever taken it "on demand" when mania was threatening me (which works like a charm!!). I'm very curious about what lamitrogine might do for my depression. I've tried some tricyclics and ssri's and they all made me very hypomanic and a lot of them brought on the darkness (the more tiring tricyclics as well as pure ssri's) which is very very scary. I have high hopes in lamitrogine and will most definitely check if I can get ahold of it through the psychiatrist who first prescribed me ssri's and noticed poor compliance and substance abuse.

 

[Mariposa]

crook, I'm not bipolar but my best friend is. He is experiencing hypomania at present; I imagine he would tell you something similar. He was prescribed lamitrogine and is now going to talk about upping his dose; also when he tries to take breaks from his Adderall (for ADHD) he gets into some pretty dark places in his mind. This said, he has not self-harmed since before he went on the lamitrogine and he is doing much better in both work and social situations. Other than the hypomania (which he almost enjoys until it devolves into a mixed state) he's doing OK.

Used appropriately, lamitrogine seems to really work for some people. You'll need to work on compliance (set a timer on your phone to remind you to take your meds maybe?). It's not a drug of abuse at all, so I can't imagine an understanding psychiatrist would deny it to you based on a history of substance abuse. Lastly, a sleep specialist and a comfortable bed will be fine.

My best.

 

[Vaya]

Yes, Mariposa speaks the truth. Compliance with lamitrogine is very important, especially because it is an Anti-Epileptic Drug (AED) that can have some pretty severe withdrawal effects if you were to just suddenly discontinue it due to a psychotic episode or even mere forgetfulness. I keep my bottle of it next to my toothbrush so that I always remember to take my dose in the morning, and so that there's no excuse for forgetting.

 

[crOOk]

Again, thanks a lot for the insights. It really helps to see I'm anythign but alone with this. I'm in full blown hypomania despite killing that bottle of wine left over from cooking last night... Enjoying myself a lot right now... I will call the psychiatrist in a minute an get an appointment. This has to be addressed or I cannot see myself turning out to be a functioning member of society (yuk the term makes me wanna puke). Hopefully the olanzapine can be added on an "on demand" basis. I've read a study yesterday testing coadministration of the two and it seems to go together well despite both of them being metabolized by glucoronation.



Oh and I don't think dosing on a schedule will be a big problem for me, I've been polytoxicomanic and self medicating for 13 years and if there's anything I enjoy thinking about is how to modify my mind or body. The timer idea doesn't sound bad though.

edit: damn its a holiday, cant reach that psychiatrist. hopefully i wont have changed my mind for another year by tomorrow.

 

[Vaya]

Hey crOOk, just a friendly reminder that moderating alcoholic intake is extremely important if expecting psychiatric medications such as lamitrogine and olanzapine to work properly; also, alcohol really, really intensifies the sedating properties of atypical antipsychotic (AAP) meds such as Zyprexa, Risperdal, et al.

I don't mean to call you out - rather, I hope this course of action works for you, and I wanted to suggest moderating it.
Good luck!!!! I'm so glad you're gonna give it a try...

~ Vaya

 

[Ms.Martini]

the only time i ever felt okay was when i was on risperidone. well, actually, it just caused that zombie affect, but i rather have no emotions than be bipolar, right? unfortunately, i do NOT enjoy the weight gain that comes with bipolar meds, so i stopped taking them. rather be crazy than overweight, that would just make me more depressed. get medicated soon, this is a terrible way to live.

 

[crOOk]

Hey crOOk, just a friendly reminder that moderating alcoholic intake is extremely important if expecting psychiatric medications such as lamitrogine and olanzapine to work properly; also, alcohol really, really intensifies the sedating properties of atypical antipsychotic (AAP) meds such as Zyprexa, Risperdal, et al.

I don't mean to call you out - rather, I hope this course of action works for you, and I wanted to suggest moderating it.
Good luck!!!! I'm so glad you're gonna give it a try...

~ Vaya

Yeah thanks for the reminder, I've found out alcohol seems to be by far the worst of all substances for my brain chemistry. It'll reliably trigger depression in me within a couple of hours after consumption. I hate the stuff. I keep it to a single occasional drink now when I know I'll be in good company and that seems to work out. As soon as I start using it to regulate my emotions it backfires very quickly.

@ Ms.Martini
The weight gain is what I'm most looking forward to. I just hate being skinny. I'm pretty hot shit I hear, but with arms like matchsticks noone takes you entirely serious. It really reflects back onto how people react to you and has some influence on how I feel about myself. 5 years of therapy taught me not to rely on external feedback to supply my narcism and rather try to reach a healthy self image through intrinsic mechanisms, but it simply cannot be denied that these things have some degree of influence on me. My weight has fluctuated between 130 and 200 lbs (at 176cm/5'10"), I have lost 20lbs within two weeks before due to loss of appetite and gained twice that weight in half a year, so I kinda know what it feels like to loose/gain weight.

edit: yay i got an appointment in late august... lol