case study on aripiprazole, valproate, olanzapine treatment, compliance, and recreational drug interactions from a patient point of view (bipolar I diagnosis)
Subject : male (me), 31 years.
The first episode in life being major depressive for 6 months without treatment, starting during first college year in France at Paris VI (who on earth can not be depressed by pacing in this architectural asbestos laden nightmare campus, seriously ! ) escalating to a moderate/severe depressive episode requiring 150 mg venlafaxine daily (3 * 50 mg divided in the day, XR was not available in France at this time).
Diagnosis : unipolar depression
Revised diagnosis : bipolar I, current episode depressive
2002 Was a turning point since it was the year (in december, 7 2002) of a first mixed episode with psychotic/delusional features triggered by a burnout work condition (worked already as an IT engineer, self-educated by absorbing thousands of IT network admin books), receding into depression since olanzapine 2*10mg + 3* 20 mg prazepam were added and venlafaxine withdrawn (the olanzapine antidpressant effect being to weak to compensate the venlafaxine withdrawal and resultant depression)
The 2002-2008 period has seen a compensated phase without any kind of official treatment,guidance, and compliance, but including substance abuse (weak opioids - codeine) as a coping mechanism. This was later switched to buprenorphine (self-medicated) for it's emotional/blunt affect properties and antidepressive properties (based on high baseline reward and euphoria) rather than SSRI stimulation. dosage was 0.3 mg daily, which is low and at the border between pain relief dosage and opiate dependance maintenance dosage.
Recreational use of other substances included cannabinoids (some experiences creating a decompensation potential for a mixed state)
benzodiazepines (long half life bromazepam to a dosage of 18 to 24 mg per day at peak usage, in a 2 week acute use/ 2 week abstinence patttern. Physical BZD withdrawals symptoms were never observed)
No further professional diagnosis were made.
2008 Has seen an hypomanic phase during 1 month triggered by positive affective events reinforced by buprenorphine withdrawal, creating a sensory; affective, cognitive overload; escalating to an acute manic phase : psychotic/delusional persecutive and "impeding doom" ideation. These elements where non congruent with the manic phase, but too short lived to call it a "mixed state" At this time the diagnosis of bipolar I was officially done. the manic phase was treated with olanzapine 10 mg/day + 20 mg very weak BZD (prazepam)
Since 2008, my compensation mechanisms have greatly increased since it did not require any hospital commitment (commitment by request of a third party in 2002, commitment by choice in 2008) The treatment consisting of valproate 2*500mg and aripiprazole 20mg decreased over 3 years to 5 mg.
sometimes, aripiprazole is discontinued for 2 weeks to reduce the plasma concentration and during treatment the dosage strategy is a completely day by day tuned dosage (sometimes 5, sometimes, 10 mg, sometimes 20 mg) in order to explore the dose response stimulation/sedation curve of aripiprazole.
Cocaine hydrocloride and cocaine base (inhaled) were shown to have a diminished reward and euphoric effect during the 2009-2011 time line. probabbly because of the dopamine receptors blockade by aripiprazole and natural tolerance creating a dampening effect. runaway cocaine occured for the first 5 months with a peak use of 1g every 3 days, to a low of 1g every 3 weeks. slight depression symptoms emerged and were treated with venlafaxine 75mg XR. cocaine use decreased in 2011 Q4 and 2012 Q1
later, Venlafaxine was introduced at a range of 37.5 to 75 mg, dose-modulated each month by self-assessment and doctor guidance.
feb. 2012 has seen a protracted and incomplete burnout syndrome managed entirely with rest caused by acute use of ethylphenidate and intensive night work for the end of 2011 (3 weeks of 100+ hours of work/week, mainly IT cognitive intensive tasks)
I will update soon. take care !