# Long Overdue: Bipolar II (Hey that kinda rhymes)



## A Sense of Purpose (May 8, 2011)

So although some of you may know me and associated symptoms (from PM's), for the most part i had never received an official diagnosis (in 3-4 years of treatment). As a result, I had been given treatments that were in most cases inappropriate. 

Today i was informed of the highly probable diagnosis of
Bipolar II.
More recently i have been displaying the 'hallmark' signs of this condition (much to my surprise and inability to notice).

There tends to be reluctance in diagnosing people with a 'label' here in Australia (or at least thats what Ive noticed) unless you are obviously psychotic etc. For this reason its probably taken time to piece it all together.

I mistook the recent positivity and productivity for actually 'feeling better' because i was so low prior to it. However, its been brought to my attention that these behaviors are definitely well above the 'normal' spectrum.


Anyway, the purpose of this post is not to brag or seek sympathy.


I have been involved in a few threads (ones Ive started and others such as Kehkorps') detailing my treatment that had essentially 'no direction.' 

This is because each symptom was being treated individually as opposed to a spectrum that belongs to a specific disorder.

I still suffer anxiety related symptoms such as agoraphobia, panic attacks general apprehension, but also the mood based crashes and peaks of hypomania and prolonged periods of agitation and restlessness.

For this reason i plan to stay on this forum as opposed to switching to something like Depressionforums.org as well as i feel i have a few friends here that i would like to stay in contact with.


My treatment plan currently is to lower Zoloft to 75mg and begin Olanzapine 5mg immediately and titrate the dosage up until stable. Valium Prn for agitation/anxiety.
For some reason he didnt want to give me lamictal (because of the rash maybe?) or an anticonvulsant like Valproate (because im already highly prone to migraines).

This will be my focus thread that wont necessarily be updated on a daily basis, but will aim to log changes and help me keep track of everything.

Cheers


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## jim_morrison (Aug 17, 2008)

So our prediction was right? Cool! Glad you've finally got the right diagnosis, hope the new treatments work well!


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## GotAnxiety (Oct 14, 2011)

That awesome the new treatment sounds good.


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> So our prediction was right? Cool! Glad you've finally got the right diagnosis, hope the new treatments work well!


It appears so. Its both a blessing and a curse (when he told me today i had a panic attack immediately, in fear of how it may compromise my vocation. He reassured me that if managed appropriately, ill be able to choose what ever career path i desire).

I was highly anxious about the topic pm'd to you and have been going through the motions up till the appointment today.
So the result is mostly a blessing i suspect.



GotAnxiety said:


> That awesome the new treatment sounds good.


I hope so. Ive put in plenty of patience and med juggling so far on something we (doc + I) didnt know we were medicating for.

So i can at least do myself the favor of trialing the treatments pertaining to the condition with a bit more confidence. I dont deny there may be difficulties finding the right med or dosage, but at least ill be manipulating the RIGHT meds which im hoping, will improve the results dramatically.


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## A Sense of Purpose (May 8, 2011)

Interesting link between Bipolar II and migraines.
I have suffered from migraines since age 19. Chances are some of the meds i was on at one point or another may have helped my mood as well.

http://www.everydayhealth.com/health-report/bipolar-depression/bipolar-disorder-and-migraines.aspx

I know topamax isnt approved solely for BP or mood stabilisation but it sure as hell slowed my brain down.

Amitriptyline has strong antichollinergic properties so that sedation may have been beneficial and stopping hypomania.


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## cafune (Jan 11, 2011)

A Sense of Purpose said:


> For some reason he didnt want to give me lamictal (because of the rash maybe?) or an anticonvulsant like Valproate (because im already highly prone to migraines).


My psych didn't put me on lamictal because I was on the hypomanic/manic side of the illness and apparently lamictal acts similarly to antidepressants and doesn't have strong anti-manic properties (so perhaps that's why your psych ruled it out as well).



> Its both a blessing and a curse (when he told me today i had a panic attack immediately, in fear of how it may compromise my vocation. He reassured me that if managed appropriately, ill be able to choose what ever career path i desire).


I remember I completely _flipped out_ when my psych told me my tentative diagnosis because of all the implications. It came as a shock and blew my mind.

Anyway, it's definitely good that your psych knows what to medicate for now. I'll be interested to see how your meds work out for you.


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## A Sense of Purpose (May 8, 2011)

Solar Eclipse said:


> *I remember I completely flipped out* when my psych told me my tentative diagnosis because of all the implications. It came as a shock and blew my mind.
> 
> Anyway, it's definitely good that your psych knows what to medicate for now. I'll be interested to see how your meds work out for you.


I know right!?!?! I was so excited about feeling good again that when he said it (because he has been observing me/my behavior for over a year now)
i freaked.

Heart rate shot right up, brain felt like it had live electricity charging through every neuron. I said "i think im having a panic attack".

Talked me through breathing techniques and then went on to console me about work and the rest.

Thanks, i look forward to updating. The only thing im phobic about is losing my drive and functionality. I dont want to be depressed again


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## riptide991 (Feb 1, 2012)

Cool! I got migraines from the age of 5! And had them really bad up until college. They just went away one day. I also was an extremely happy kid but at the same time very violent/irritable. I wonder if that's why Abilify works so well for me heh.


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## ricca91 (Mar 11, 2012)

A Sense of Purpose said:


> I know right!?!?! I was so excited about feeling good again that when he said it (because he has been observing me/my behavior for over a year now)
> i freaked.
> 
> Heart rate shot right up, brain felt like it had live electricity charging through every neuron. I said "i think im having a panic attack".
> ...


Don't worry, I know it's difficult to receive such diagnosis... But in my experience if you find the right combination of meds you'll be able to live a (almost) normal life.

It may take some time but eventually you are going to feel better. Much better. I know what you are going through, the only thing I can say is hold on! But it will get better, I promise!


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## A Sense of Purpose (May 8, 2011)

ricca91 said:


> Don't worry, I know it's difficult to receive such diagnosis... But in my experience if you find the right combination of meds you'll be able to live a (almost) normal life.
> 
> It may take some time but eventually you are going to feel better. Much better. I know what you are going through, the only thing I can say is hold on! But it will get better, I promise!


Hah yeah i hope so.

Started Olanzapine (Zyprexa) 5mg last night. I presumed it would act in a similar time frame as seroquel...

Well, boy was i wrong. I took it at 10pm expecting to feel tired within 30-45 mins.

This was not the case. I ended up going to bed at around 12:30 (not feeling tired but figuring i should at least give it a shot) and then gradually drifting off.

I woke up at 9:30 and turned my alarm off without even being conscious of doing so. Then woke up at 12pm lunchtime.

Man was i crazy tired in the morning. I had a strong coffee and a cigarette and definitely noticed the dizziness/ortho hypotension effect.

Within an hour i felt more awake and now feel ever so slightly tired.

Olanzapine is like seroquel on steroids. Usually seroquel would put me out and leave me quite perky in the mornings.

Ill take Olanzapine at a much earlier time tonight and see if this makes a difference.


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## rawrguy (Mar 29, 2008)

I have bipolar I with psychosis and I think bipolar II is less severe. I also got inappropriate treatments for it and it was horrible what I have been through. I take risperdal for it and will be taking it for the rest of my life. I took zoloft in the past also and it helped me pretty well. Good luck!


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## ricca91 (Mar 11, 2012)

A Sense of Purpose said:


> Hah yeah i hope so.
> 
> Started Olanzapine (Zyprexa) 5mg last night. I presumed it would act in a similar time frame as seroquel...
> 
> ...


Yeah, olanzapine has strong sedative properties which may or may not diminish with time. Watch out for sugar cravings and excessive eating, since olanzapine can give you a very big hunger.

I consider olanzapine to be a much stronger antipsychotic than quetiapine, but maybe quetiapine is a little more sedating, I don't really know.



rawrguy said:


> I have bipolar I with psychosis and I think bipolar II is less severe. I also got inappropriate treatments for it and it was horrible what I have been through. I take risperdal for it and will be taking it for the rest of my life. I took zoloft in the past also and it helped me pretty well. Good luck!


Yes, BP I is much more problematic than BP II regarding mania, but the latter may have deeper and longer depressive spells. Both are very messed up...


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## A Sense of Purpose (May 8, 2011)

ricca91 said:


> Yeah, olanzapine has strong sedative properties which may or may not diminish with time. Watch out for sugar cravings and excessive eating, since olanzapine can give you a very big hunger.
> 
> I consider olanzapine to be a much stronger antipsychotic than quetiapine, but maybe quetiapine is a little more sedating, I don't really know.


The appetite problem (aside from diabetes) is fine. Im below the average BMI for my age and height so gaining some weight would be good.

Also i go to the gym 5 days a week doing weights and cardio, so im hoping the gain goes to muscle and less to fat.

Seroquel at the max dose i took it for (150) doesnt even NEARLY compete with Olanzapine 5mg. The difference is so disproportionate.

Zyprexa is strong, but i dont mind it so far. Im not getting any restlessness or dystonia yet. And im also not getting the hive/rash problem like i did with seroquel.


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## cureyfreri (Jan 20, 2013)

Glad you've finally got the right diagnosis, hope the new treatments work well!


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## A Sense of Purpose (May 8, 2011)

I have the strong urge to self medicate still. Had a great day yesterday at the tennis in Melb. Drank a fair bit last night before bed. Hoping that once the Olanzapine reaches steady state that i wont be as inclined to do that.

Feel less sedated this morning, even a little stimulated. This is confusing but i like it.


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## whattothink (Jun 2, 2005)

So what prompted the bipolar II diagnosis? Clear-cut hypomania?


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## A Sense of Purpose (May 8, 2011)

whattothink said:


> So what prompted the bipolar II diagnosis? Clear-cut hypomania?


Spending large amounts of money on myself and others ($1700 over christmas), 2-3.5 hours sleep and waking up feeling amazing, impulsive (leading to coke use and being very forward with someone i liked),
heightened sexual desire and reward from stimulation.

Oh and agitation. Between being exceedingly happy and productive, i'd have 2 day bursts of sheer frustration and irritability.


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## whattothink (Jun 2, 2005)

A Sense of Purpose said:


> Spending large amounts of money on myself and others ($1700 over christmas), 2-3.5 hours sleep and waking up feeling amazing, impulsive (leading to coke use and being very forward with someone i liked),
> heightened sexual desire and reward from stimulation.
> 
> Oh and agitation. Between being exceedingly happy and productive, i'd have 2 day bursts of sheer frustration and irritability.


Fair enough. Sounds like your typical hypo-mania.


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## A Sense of Purpose (May 8, 2011)

whattothink said:


> Fair enough. Sounds like your typical hypo-mania.


To be honest, apart from the spending and the illicit stuff, i dont really regret the rest. Feeling irritable for a couple days is worth how awesomely functional i am as a person during the other time.

I just need to watch it i guess because if ive lapsed with drugs then im just asking for mania...?


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## ruiomichlet (Jan 21, 2013)

That awesome the new treatment sounds good.


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## A Sense of Purpose (May 8, 2011)

Update:

Filled out the paperwork for my course and prepared all other important documents!
Usually i avoid doing things like the plague that take that kind of attention/effort, but these days i seem to proactively do them.

Sedation in the AM is becoming less prominent which is nice. I still feel quite energised from the zoloft though.


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## A Sense of Purpose (May 8, 2011)

Hey guys. Sorry I haven't thrown an update down in a while.... I'm quite busy getting things done!

This week has been really good. Ended up going to big day out in melbourne for free as my friend had 5 spare tickets.

Saw one of my most favorite all time DJ's - Pretty Lights.
Had genuine good old fashioned fun. Felt no need to 'boost' the experience with anything recreational. Was so naturally energised and elated that my friends really got into the music. 

Really positive overall and definitely in the top 2 music experiences. 
Was really nice to go there and have a few drinks and enjoy Crystal Castles as well (although the sound wasn't as great for their set).

More updates soon. I physically file my course paperwork on Tuesday. Excited!


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## A Sense of Purpose (May 8, 2011)

Physically filed my enrollment in Paramedicine today 

Rocked up and proactively started chatting with a few different girls (the course seems to be 75%-25% female to male ratio.

It was really exciting, I got to suit up in my paramedic outfit and order my gear. Super stoked and cant wait for the 25th of feb to start the course.

Feel like im just killing time until then. Its been great to have a year off study, but im ready to get my brain firing again and working towards a satisfying career at the same time.

Concerning meds, im feeling no fatigue any more from the Olanzapine. Im starting to notice the mood elevating effects similar to how seroquel aided me. Only this time im not getting horrendous allergic rash break outs which is quite nice.

Im currently taking Olanzapine 4-5 hours before bed, as for some reason my body metabolises it quite slowly it seems. My doc seems to think that its a bit unusual that it takes that long to knock me out (apparently its used for manic patients at 10mg and usually calms/sedates them within 45 mins), but im not really all that fussed. 

More updates soon. Im going to head out and try to purchase some of my course books tomorrow so i can get a head start on the reading


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## riptide991 (Feb 1, 2012)

So wait you would never proactively speak to chicks? I wish that zyprexa does that for me. I mean I usually am the one approached by girls, I never really do it myself so a lot of missed opportunities.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> So wait you would never proactively speak to chicks? I wish that zyprexa does that for me. I mean I usually am the one approached by girls, I never really do it myself so a lot of missed opportunities.


Not off the bat no... But i think its more the zoloft stimulating me to go and do it, and the olanzapine is keeping me calm and my thoughts in order so i dont sound like an idiot.

Synergy is a wonderful thing.


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## bazinga (Jun 9, 2010)

Speaking of rhyming, do you ever do clang associations?
I uses to do that a lot before medication.

See three cops treetops he hops


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## A Sense of Purpose (May 8, 2011)

bazinga said:


> Speaking of rhyming, do you ever do clang associations?
> I uses to do that a lot before medication.
> 
> See three cops treetops he hops


No, but sometimes i leave words out of a sentence i write/speak because my mind goes faster than my ability to converse or physically write.

My lexicon is not bad, so its this weird combination of sounding eloquent and stupid/clumsy at the same time.


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## A Sense of Purpose (May 8, 2011)

I <3 Olanzapine.

I'm now at a stage where i can drink a cup of coffee and be completely alert and functional. It still puts me to sleep at night too.

Otherwise, irritability has dropped to 1-2 days a week, with the rest being very functional.


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## riptide991 (Feb 1, 2012)

I'm going to ask my doctor to add the zyprexa in early, though she wants me to get used to Effexor first. My anhedonia has just gotten pretty bad since Abilify left my system. The worst is I bought so many games and I go to play a game and it's like a chore. At least abilify let me enjoy it. Now I set aside an oxycodone day or 2 just to play games as it gives me my interests back.


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## riptide991 (Feb 1, 2012)

This sort of seems promising.



> *Effects of chronic administration of olanzapine, amitriptyline, haloperidol or sodium valproate in naive and anhedonic rats.*
> 
> Orsetti M, Colella L, Dellarole A, Canonico PL, Ferri S, Ghi P.
> *Source*
> ...


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> This sort of seems promising.


Chronic amitrip caused some depression in me. Or at least apathy.
But everyone is different. I hope Zyprexa works for you.


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## A Sense of Purpose (May 8, 2011)

I'm terribly sorry for the lack of posting as it has been few and far between.
I'm doing fantastically well and couldn't hope for a better scenario.

For a long time I was so desensitised and demoralised that I thought I'd be stuck with my problems.

Since this thread I've had none and am excelling in all aspects of my life that I feel are valuable to me (social, positivity, engaged, more confident, vocational direction, hobbies and the only thing missing now is that special someone).

Blah. Sorry. Anyway, thumbs up 

This is how I feel....


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## riptide991 (Feb 1, 2012)

That's awesome dude, have you noticed any side effects yet like weight gain, tiny peen syndrome, appetite, sleepiness?


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## loophole (Apr 15, 2012)

Good luck. It took 14 years to get labled bp for me.. there was a high point (manic) when they diagnosed me thinking all the troubles would go away.. and they certainly have for my family and wife. Lamictal is great.. I'm on that klonopins for a year now . Just added wellbutrin in there in the hopes of clearing my foggy head and lethargic feelings all the time. Good luck.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> That's awesome dude, have you noticed any side effects yet like weight gain, tiny peen syndrome, appetite, sleepiness?


Negative and negative  all works well (due to zoloft boosting it actually) and weight gain does not appear to be occuring.


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## riptide991 (Feb 1, 2012)

Cool man I got my prescription for 2.5mg of olanzapine and will be starting it tomorrow. She wanted 5mg but I said I rather start low. I like my new psychiatrist she's like "you tell me what you want since you know psychopharmacology and we will prescribe that way". haha


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> Im currently taking Olanzapine 4-5 hours before bed, as for some reason my body metabolises it quite slowly it seems. My doc seems to think that its a bit unusual that it takes that long to knock me out (apparently its used for manic patients at 10mg and usually calms/sedates them within 45 mins), but im not really all that fussed.


Well it took long for me too. In fact last night I took it 2 hours before bed but was still awake and had to take some zopiclone to even fall asleep. Then I woke up and was a bit sedated and took another nap after eating breakfast. I read that olanzapine takes 5-8 hours to reach peak time, so you're bang on with taking it 5 hours before bed. I will do the same tonight!


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Well it took long for me too. In fact last night I took it 2 hours before bed but was still awake and had to take some zopiclone to even fall asleep. Then I woke up and was a bit sedated and took another nap after eating breakfast. I read that olanzapine takes 5-8 hours to reach peak time, so you're bang on with taking it 5 hours before bed. I will do the same tonight!


Yeah, its often best to take it when you get back from uni (in my case) and no later than 7pm. Otherwise you wake up a bit out of it and get significantly more tired as the day progresses. Thats at least what ive found. Now im trying to reach a balance between its benefits and some minor sedation issues as im now a uni student with assignments and deadlines.


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## riptide991 (Feb 1, 2012)

Yah I took it at 6pm last night and woke up and am feeling pretty normal right now, not sedated. So that is probably the right time for me hehe. I did get a bit of restless legs yesterday at around 10pm but it was very light.

I woke up with very dry mouth though which I didn't enjoy. It's weird because the affinities for the muscarinic receptors are high enough that 2.5mg shouldn't affect it. It could be a transient effect though as it's fine now just overnight/morning. I do feel oddly more chipper today than usual.

*UPDATE:* crazymeds is not kidding about this drug working fast. They mention "some can feel better the next day". While i'm not 100% I do feel pretty good today. In fact, I'm planning and excited about making my own hummus. WTF? haha either way it's pretty cool.


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## riptide991 (Feb 1, 2012)

Also noticed my appetite is much lower since starting olanzapine. I just don't feel like eating and normally I eat every 2 hours.


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## A Sense of Purpose (May 8, 2011)

My appetite is slowly increasing (which is a good thing). Its been over a month now on this combination and I'm feeling great still. 

I have the slightest tremor in my hands but for the most part everything is side effect free. My doc thinks its just Zoloft reaching a steady state (since upping it) but nevertheless I'll monitor it to see what happens.

All in all, productive and engaged. Good stuff.


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## riptide991 (Feb 1, 2012)

I've been on the olanzapine for 5 days and already noticing interests coming back. Much quicker than any other drugs I took. It's also a much longer lasting impression. Like with past drugs I would have moments where I had interests but they would be like "windows" so to speak. Today I've been interested all day in doing things. A lot of the past drugs also gave me windows but during these windows the interests were those which provided quick reward such as gaming, it was always tough to get back into tasks where it takes some hard work before getting reward such as programming. I'm happy to report olanzapine/effexor arge giving me windows where I actually want to program. It's not yet 100% but it's good to even experience this in windows. I may raise the olanzapine to 5mg which is what my doctor initially wanted. I just don't want the higher dosing to give the opposite sedating feeling. I know that 2.5mg hasn't caused any sedation, it's just when I go to bed I can sleep normally. Remeron for instance when it hit histamine I would be crawling to get into bed I was so sedated hehe.


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## jimmythekid (Apr 26, 2010)

kehcorpz said:


> I've been on the olanzapine for 5 days and already noticing interests coming back. Much quicker than any other drugs I took. It's also a much longer lasting impression. Like with past drugs I would have moments where I had interests but they would be like "windows" so to speak. Today I've been interested all day in doing things. A lot of the past drugs also gave me windows but during these windows the interests were those which provided quick reward such as gaming, it was always tough to get back into tasks where it takes some hard work before getting reward such as programming. I'm happy to report olanzapine/effexor arge giving me windows where I actually want to program. It's not yet 100% but it's good to even experience this in windows. I may raise the olanzapine to 5mg which is what my doctor initially wanted. I just don't want the higher dosing to give the opposite sedating feeling. I know that 2.5mg hasn't caused any sedation, it's just when I go to bed I can sleep normally. Remeron for instance when it hit histamine I would be crawling to get into bed I was so sedated hehe.


Be careful when you go to 5mg. On 2.5mg I gained no weight, on 5 I gained lots super quickly. Probably weigh yourself everyday and write it down once youre on 5. Maybe keep a food diary if you can be bothered.


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## riptide991 (Feb 1, 2012)

jimmythekid said:


> Be careful when you go to 5mg. On 2.5mg I gained no weight, on 5 I gained lots super quickly. Probably weigh yourself everyday and write it down once youre on 5. Maybe keep a food diary if you can be bothered.


Did you notice the difference between the 2 doses other than weight?


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## jimmythekid (Apr 26, 2010)

kehcorpz said:


> Did you notice the difference between the 2 doses other than weight?


It was a long time ago now but I'm not sure whether I did. It didn't really help me with the problem I took it for. I remember feeling like a zombie but I don't know whether that was the whole time or just at 5mg.


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## A Sense of Purpose (May 8, 2011)

Brief update time!

So its been just over 1 month now on the new regimen.
Zyprexa is definitely granting me antidepressant properties! More so than when I was on Zoloft alone.

I got bumped up to 100mg of Zoloft and kept the Zyprexa at 5mg.
I'm definitely doing very well in all areas (anxiety low, motivation high, depression non existent).

Irritability seems to be dropping down to 1-2 days a week, and the episodes are much less intense and prolonged.

Only negative thing I can say for the moment is getting a chest infection on the first day of Autumn! Ironic really, but nothing that a course of antibiotics wont fix. Hopefully that's me done and dusted with sickeness for the whole winter period!


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## riptide991 (Feb 1, 2012)

Great to hear man! I've been doing awesome on Effexor/olanzapine. I'm actually seeing anhedonia improving much more than it has in a while. I've been doing things constantly so I even forget about this site. Yah so I'm at 3.75mg right now I'll be going to 5mg next week. The only thing that I have noticed in dry mouth overnight. I wake up with a very dry mouth and chug tonnes of water. I also don't poop as impressively as I used to. I haven't noticed any weight gain but my guess is less pooping and more water would on its own end up in weight gain. How's the 5mg doing for you? You don't get the dry mouth side effect at all?


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## gilmourr (Nov 17, 2011)

I'm on zoloft 100 mg. Though I'm getting seizures atm to try and treat the depression/anxiety. Might do this olanzapine thing if they don't work. Did you start at 2.5 mg and work up to 5 mg?

Was zoloft losing it's efficacy for you? For me it just keeps me out of major depression that's it. But I feel like I have no interest in anything whatsoever--or motivation.


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## A Sense of Purpose (May 8, 2011)

gilmourr said:


> I'm on zoloft 100 mg. Though I'm getting seizures atm to try and treat the depression/anxiety. Might do this olanzapine thing if they don't work. Did you start at 2.5 mg and work up to 5 mg?
> 
> Was zoloft losing it's efficacy for you? For me it just keeps me out of major depression that's it. But I feel like I have no interest in anything whatsoever--or motivation.


My diagnosis was changed from depression with anxiety to bipolar 2 with anxiety and agitation. Zoloft played a role in making me hypomanic but has been the only antidepressant to drastically improve my mood/concentration.
So instead of axing the zoloft, my psych and I decided that we'd cap off the mania with Olanzapine, and now I have the right balance of activation without being too high.

I started at 2.5 for the first 5 days then went to 5mg. I can even drink alcohol on top of the olanzapine and it doesnt cause problems.

Having said that my drinking has dropped and I don't feel the need.


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## gilmourr (Nov 17, 2011)

A Sense of Purpose said:


> My diagnosis was changed from depression with anxiety to bipolar 2 with anxiety and agitation. Zoloft played a role in making me hypomanic but has been the only antidepressant to drastically improve my mood/concentration.
> So instead of axing the zoloft, my psych and I decided that we'd cap off the mania with Olanzapine, and now I have the right balance of activation without being too high.
> 
> I started at 2.5 for the first 5 days then went to 5mg. I can even drink alcohol on top of the olanzapine and it doesnt cause problems.
> ...


Sounds like you just had to tweak it a bit with the antipsychotic so that it capped your highs. Not sure if it's then worth it to try olanzapine or if it makes sense for my condition since I still need to be higher in mood. Probably will either try nardil again after the seizures or nortryptiline with zoloft to possibly augment it. Zoloft alone is really not enough, just barely enough to get by.


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## riptide991 (Feb 1, 2012)

I haven't drank on it yet but will once things have stabilized. I actually took my first 5mg dose. I'm combining my 2.5mg pills and they will last me exactly till the day I have my appointment with psyche. Hopefully nothing weird happens where she skips out and I'm left without it heehe.

What most people don't know is that olanzapine is actually GABAergic in that it significantly increases a neurosteroid which is a GABAa agonist.



> Allopregnanolone induction may contribute to olanzapine and clozapine anxiolytic, antidepressant, and mood-stabilizing actions. Alterations in this neuroactive steroid may result in the modulation of GABAergic and dopaminergic neurotransmission, potentially contributing to antipsychotic efficacy.
> 
> http://www.ncbi.nlm.nih.gov/pubmed/12496935


There's many studies on this fact.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> I haven't drank on it yet but will once things have stabilized. I actually took my first 5mg dose.
> 
> What most people don't know is that olanzapine is actually GABAergic in that it significantly increases a neurosteroid which is a GABAa agonist.
> 
> There's many studies on this fact.


The addition of Olanzapine has really helped me open up. More so than I had even realised it would. I'm now starting class discussion, asking questions and not second guessing myself. This even translates through to assignments and such at uni where i use to over analyse and procrastinate because I could never come to what I felt was the correct conclusion that was expected of me.

Over all it has been a fantastic enabler along with Sertraline.


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## boomshakalaka44 (Mar 11, 2013)

Has anyone actually had any luck with Zoloft? I took it for about 4 months, and it turned me into a zombie. No SSRI's have ever worked for me. I'm diagnosed with Bipolar II and Social Anxiety Disorder, and I'm on 225 mg Effexor and 100 mg Lamictal. The Lamictal has evened me out quite well, and the Effexor has helped tremendously with my anxiety, but we're still chasing the anxiety with higher and higher doses of Effexor because it just refuses to become manageable. Has anyone else had good/bad experiences with either of these?


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## A Sense of Purpose (May 8, 2011)

boomshakalaka44 said:


> Has anyone actually had any luck with Zoloft? I took it for about 4 months, and it turned me into a zombie. No SSRI's have ever worked for me. I'm diagnosed with Bipolar II and Social Anxiety Disorder, and I'm on 225 mg Effexor and 100 mg Lamictal. The Lamictal has evened me out quite well, and the Effexor has helped tremendously with my anxiety, but we're still chasing the anxiety with higher and higher doses of Effexor because it just refuses to become manageable. Has anyone else had good/bad experiences with either of these?


Fortunately for me, I have not had to take an SNRI (as im quite sensitive to medications and their side effects). Having said that, if my regimen is to fail me in any way, I will end up going for Effexor or some other combined dual acting therapy.

At this point I'm floating along happily.


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## riptide991 (Feb 1, 2012)

boomshakalaka44 said:


> Has anyone actually had any luck with Zoloft? I took it for about 4 months, and it turned me into a zombie. No SSRI's have ever worked for me. I'm diagnosed with Bipolar II and Social Anxiety Disorder, and I'm on 225 mg Effexor and 100 mg Lamictal. The Lamictal has evened me out quite well, and the Effexor has helped tremendously with my anxiety, but we're still chasing the anxiety with higher and higher doses of Effexor because it just refuses to become manageable. Has anyone else had good/bad experiences with either of these?


Zoloft and Remeron worked well for me for a few months and then pooped out. Zoloft was always good at keeping me calm though even after poop-out.

So anyways, to update the thread I am now on 300mg of Effexor and 5mg of Olanzapine and things are going well. I still get occasionally anxious but it's not that bad. I talked to a pretty hot chick the other day which I normally wouldn't do. It definitely removes the strong inhibitions I always had.


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## gilmourr (Nov 17, 2011)

Olanzapine sounds like a really awesome drug..

I think I'll try out Nardil 30 or 45 mg after my seizures are over with 2.5 mg of olanzapine.

Do you guys see any problems with this? Sometimes nardil is actually too activating so maybe olanzapine will help?

It's either that or zoloft with olanzapine (though zoloft causes apathy and disinterest for me even though its a good AD, I think olanzapine would make it worse) or a complete long shot with a TCA and olanzapine.

I really need to get a grip on my atypical anxiety that causes me loads of nausea.


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## A Sense of Purpose (May 8, 2011)

gilmourr said:


> Olanzapine sounds like a really awesome drug..
> 
> I think I'll try out Nardil 30 or 45 mg after my seizures are over with 2.5 mg of olanzapine.
> 
> ...


I can highly recommend Olanzapine as a fantastic addon to an antidepressant, especially those prone to mania or hypomanic symptoms. Indirectly it may also be useful as an addon for depression.

Come to think of it, since Kehkorps jumped ship with abilify and joined Olanzapine with zoloft, ive hardly seen him even online. This is something i can personally attest to as since going on this combo, i have been super productive and am now team leader for a large Uni assignment


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> I can highly recommend Olanzapine as a fantastic addon to an antidepressant, especially those prone to mania or hypomanic symptoms. Indirectly it may also be useful as an addon for depression.
> 
> Come to think of it, since Kehkorps jumped ship with abilify and joined Olanzapine with zoloft, ive hardly seen him even online. This is something i can personally attest to as since going on this combo, i have been super productive and am now team leader for a large Uni assignment


Fo shizzle. Although I'm taking it with Effexor XR at 300mg. This combination is great as the Effexor gives me a good calm energy. Olanzapine is a bit sedating but taken at the right time before bed and you will have a great energized day the next day. To me that's usually 6pm and I'll go to bed at around 10:30-11pm.

I've been on it for a month and my blood tests all came back fine. I think while it has a high chance of side effects I don't think that doses of 2.5mg -5mg will cause them so much. It definitely does make food taste amazing so it could make those who are weak pig out. A lot of fear mongering on this drug when it's one of best for treatment resistant depression. I definitely notice the gabaergic effect from the allopregnanolone as i'm not as inhibited.


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## bazinga (Jun 9, 2010)

I might have to switch from Saphris to a preferred medication (Zyprexa, Risperidone, Geodon, Seroquel). I'm kind of afraid to try Zyprexa, Risperidone, and Seroquel due to weight/hunger issues. I don't have much restraint when I have a big, constant appetite.

What's the risk of developing diabetes on these medications for a person who has a family history of diabetes.


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## riptide991 (Feb 1, 2012)

I went drinking the last 2 days and man I've had a case of anhedonia today. I just don't feel like doing much. I guess drinking and anhedonia don't mix well. Hopefully it's gone by tomorrow.


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## A Sense of Purpose (May 8, 2011)

I dont find drinking makes mine worse, but it definitely screws my concentration up.


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## riptide991 (Feb 1, 2012)

Yah I'm back to normal today. It was maybe just a hangover type deal hehe.


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## A Sense of Purpose (May 8, 2011)

Hi all. 
Checking in. 

Havent slept in 2 days and experiencing a manic/hypomanic episode. Cant sit still and am immensely restless.

Cracked about 3 hours ago. Called my psych centre and they put me through to my doc. I have an appointment tomoorrow but wasnt sure i;d keep my sanity till then without sleep.

Writing my thoughts down now so i acn remember in the morining at the appointment.

Got into contact with him and was told to take 20mg olanzapine and 15mg valium. 
Assures me this will take the edhge off.
Very very unpleasant feeling, racing thoughts and a lot of pacing.


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## A Sense of Purpose (May 8, 2011)

Having a lot of circular thinking. Repetitive thoughts and intrusive ideas asl well. Feel very 'fight or flight' and not the slightest bit tired yet.


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## jim_morrison (Aug 17, 2008)

Do you take regular tablet form or Zydis (orally dissolving form) zyprexa? I've heard Zydis kicks in quicker in these situations. :stu


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## A Sense of Purpose (May 8, 2011)

I have the regluar tablet s.
I chewed them up into power and drank it all down. Im still dealing with restlessness and racing thoughts.

If i dont sleep tonight im going to ED. Like before midngitt


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## A Sense of Purpose (May 8, 2011)

Having microsleeps at the desk. But i still feel like my skin is crawling and i cant stop moving my feet. Going to try and lie down.


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## A Sense of Purpose (May 8, 2011)

Slept about 2-3 hours and the rest was wired and awake. Still feel quite restless but the racing thoughts have subsided somewhat.

Going to the appointment now.


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## A Sense of Purpose (May 8, 2011)

Just got back from the Docs. Confirmation of what i suspected.

I slept for about 3 hours last night after the 20mg olanzapine and 10mg valium. Thats still no where near enough. So, we changed it up.

Been bumped to Olanzapine 10mg in the morning at 20mg at night.
Also started 900mg of Lithium taken at night.
Bumped Valium up to 10mg at night
Also given a script of Imovane 7.5mg provided the above doesnt make me sleepy.

If this combo doesnt bring me down to earth, i dont know what will.
Ill post updates and try to log my mood regularly again and hopefully the racing thoughts will subside.

Peace


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## A Sense of Purpose (May 8, 2011)

Feeling a lot more settled today. Have a funny metallic taste in my mouth, i think its from the lithium.

Racing thoughts have subsided somewhat and feel a bit tired. Still trying to catch up on the sleep side of things.

Mood: indifferent, mostly a bit blunted, but not as irritable.

I cant remember if i took Zoloft today yet... Just got back from having breakfast out and not sure whether i took it or not.


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## A Sense of Purpose (May 8, 2011)

Had my first night of semi-reasonable sleep. 6-7 hours

Feeling incredibly depressed though. Mania/racing thoughts gone but i've definitely crashed which sucks.

Still have that metal taste too.


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## A Sense of Purpose (May 8, 2011)

Mmm. Such a shame. Feeling incredibly unmotivated and down. 3 weeks ago everything was running smoothly. Mood stable, not tired and motivated.

Not quite sure how it all fell to ...t but i've been trying to nut it out.
Maybe this is just a worse/rapid cycle going down that i haven't experienced before.


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## A Sense of Purpose (May 8, 2011)

Not sure about this lithium right now...

Cant tell what its actually doing to me. All i know is i have a foul metallic taste in my mouth and the world feels 'pointless'. Apathy is at a maximum.

I was under the impression lithium has antidepressant properties. Does it take 4 weeks like ssri's do? Or is it faster

Does anyone know how lithium works?


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## jim_morrison (Aug 17, 2008)

The high dose of zyprexa might be contributing to the apathy, are you at 30mgs for acute mania, then back down to 10-15mg for maintenance? That seems more common I think. 

If you ended up taking zopiclone that would explain a metallic taste, lithium might do it too, not sure. Lithium's mechanism of action is pretty elusive btw, harder to define than for other meds. Has a good track record at treating bipolar 1 though. 

Did your Dr suggest lowering Zoloft after your recent period of mania?


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> The high dose of zyprexa might be contributing to the apathy, are you at 30mgs for acute mania, then back down to 10-15mg for maintenance? That seems more common I think.
> 
> If you ended up taking zopiclone that would explain a metallic taste, lithium might do it too, not sure. Lithium's mechanism of action is pretty elusive btw, harder to define than for other meds. Has a good track record at treating bipolar 1 though.
> 
> Did your Dr suggest lowering Zoloft after your recent period of mania?


I believe that is the plan with zyprexa. I dont really notice any extra sedation during the day, but it could indeed be the cause of the apathy.

I havent taken any zopiclone and when i do i get the worst metallic after taste. Worse than now with the lithium.

Doc hasnt dropped the zoloft im guessing out of fear that ill crash and burn. Thats the direction i was heading before this mixed episode hit me.

I think he plans on lowering the zoloft and switching to something like Pristiq or Effexor.

Zoloft has a proven track record for me, but im worried that its going to fade out and become useless. Its the only med in the past that has pulled me out of depression.


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## A Sense of Purpose (May 8, 2011)

Woke up today with slight headache. In much the same headspace that i was in yesterday.

I have a lot of uni work piling up but i dont have the focus or concentration to get any of it done. It feels pretty futile.

I have another appointment with the doc tomorrow. Hopefully he has some idea as to an alternative to this. I'd like to potentially drop the lithium, lower the olanzapine and add lamictal. 

Perhaps i need to change zoloft to an SNRI. I fear that it has pooped out on me


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## jim_morrison (Aug 17, 2008)

Did he consider Prozac? Given it's generally considered the most stimulating SSRI, has clinically proven efficacy in combination with olanzapine (symbyax), and so on.


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## A Sense of Purpose (May 8, 2011)

He didnt go into details as to what he planned provided this dose increase doesnt help.

I presume ill be kept on a mood stabiliser regardless of whether im manic, depressed or stressed. Its probly for the best too, as im more likely to slip into bad habits.

Im not entirely sold on the Symbyax combo though. The prozac raises the olanzapine levels and im guessing only amplifies the side effects.

I guess i just want to find the combo that keeps me slightly up, but not too much.
I think ill request Lamictal over lithium, and effexor over pristiq or cymbalta. Hopefully i can also lower the Olanzapine to 15 or maybe 10mg.


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## A Sense of Purpose (May 8, 2011)

Saw the doc today. He told me that this was a textbook "Mixed State" and that a mood stabiliser will be most beneficial to my overall outcome.

From what i know of the mood stabilisers, they are quite well known for being harsh with side effects.

At this rate, i can switch lithium to Lamotrigine if i like (but thats going to cost about $200 even here is Australia / month).

Anyway, back on track. Mixed state. I didnt truly understand what was going on until i looked it up (a little bit ago). It does make a lot of sense now. Extreme irritability along with depressive thoughts, inability to sit still (went 42 hours without sleep), anxious and that general feeling that something bad is about to happen.

Plan is to keep lithium (had to have a blood test today) at 900mg pending the results of my levels. Reduce zoloft to 100mg (which i should have been doing from last visit but didnt). Continue taking 20mg of Olanzapine at night time and get rid of the 10mg in the morning.

Going back in to see him on friday (thats like 3 times in 1 week), to monitor mood and discuss lithium results. If this depressive/anxious period lifts ill be extremely happy to return to normal.

If not its going to be one step at a time tweaking each med until it works. Which might mean coming off zoloft and switching to Effexor/Cymbalta, and trading lithium for Lamictal (if i can afford it).

I feel physically exhausted, but mentally it feels like an electrical storm coursing through my CNS. So much energy, with quite often agitated and depressed mood. Anxious even.


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## A Sense of Purpose (May 8, 2011)

So as a result of Lithium side effects, I have rationalised and made a decision that i want to swap to Lamictal. I value my clear skin (which is starting to break out on lithium), not having a metallic taste in my mouth, and not being constantly thirsty too highly at this stage. Its also difficult to write with the tremor it has caused.

Ive worked out that to afford Lamictal, I could either Quit smoking and use that as motivation to quit. Or, alternatively i could work 3hrs casual work per week while studying. This is much more viable and something i will follow up with on Friday.

Its funny, even after a 6 fold increase in olanzapine, as well as lithium and valium... I still feel as though my brain is overflowing and constantly trying to defy whats thrown at it.


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## A Sense of Purpose (May 8, 2011)

So Lamictal was a hard sell. Doc feels its more important to use a 'faster' stabilising agent like Sodium Valproate before rushing to lamictal.

Very frustrating. Titrating off Lithium and straight on Sodium Valproate 1000mg.
Also given Imovane to be taken on top of the night meds if i have trouble sleeping.

I hope that Epilim stays true to its side effects so we can dismiss it rapidly and be done with it. Im counting on Lamictal to work for depression as well as mania prevention.


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## A Sense of Purpose (May 8, 2011)

I must say, this is only day 2 on Sodium Valproate 1000mg, however im feeling so much better compared to when on the Lithium. For the first time in about 2-3weeks i actually feel calm, collected and not oozing with anxiety and racing thoughts.

I can definitely feel Valproate GABAergic effects. Similar feeling to valium but smoother and seamless.


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## jim_morrison (Aug 17, 2008)

Hows your weight going so far, much change from baseline?


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> Hows your weight going so far, much change from baseline?


No net gain whatsoever from the several months on Olanzapine.
My appetite has changed in that.... i'll wake up and not feel the slightest bit hungry. Same goes for lunch, but by dinner im ravenous. I may have converted some of my muscle mass to fat but thats to be expected when you stop going to the gym.

No man boobs yet either, thankfully.

I plan to get back to the gym soon now i can afford it.

Too early to tell with the Sodium Valproate and its effects on weight.
I just hope my hair doesnt start falling out, because i need to find a mood stabiliser that can be used long term. Lithium was pretty pathetic at controlling racing thoughts. My doc isnt comfortable keeping me on Olanzapine for maintenance due to its potential metabolic side effects.


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## jim_morrison (Aug 17, 2008)

Oh so your doctor doesn't plan to keep you on zyprexa long term, is he considering a metabolically neutral AP such as Saphris in it's place, or does he want to switch you over fully to valproate as your sole mood stabilizer?


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> Oh so your doctor doesn't plan to keep you on zyprexa long term, is he considering a metabolically neutral AP such as Saphris in it's place, or does he want to switch you over fully to valproate as your sole mood stabilizer?


Im happy as hell on Olanzapine. If im permitted to use an AP its what i would want. Although now that we have a handle on my diagnosis, i think he feels more comfortable getting me on to a mood stabiliser.

Im still slightly hypomanic, and high doses of Olanzapine have hardly put me to sleep in conjunction with 20mg valium and 15mg of Imovane.

Thats why the mood stabiliser comes into it. I'd love to get my Olanzapine dose back down to 5mg, but ill happily take the trade off of a valproate+olanzapine combo though.

I think this mania/energy is still slowly dieing down since jumping on Valproate on Friday.


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## jim_morrison (Aug 17, 2008)

It's a bit perplexing that he wants to take you off Zyprexa for metabolic reasons when your not actually gaining any weight. I'm aware that not all of zyprexas metabolic effects are purely weight related, but wouldn't periodic monitoring of fasting glucose, lipids, triglycerides and such be enough to monitor if anything negative is beginning to occur? 

As for the mania, are you still at 200mg of zoloft? Seems it could be a trigger as much as anything.


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## A Sense of Purpose (May 8, 2011)

Yeah, i know right. I presume that while he didnt say (any time soon) he'd like to get stabilisation from more than 1 med. At this stage its just managing the current state which has been acute.

I will suggest monitoring to him of the olanzapine.

Zoloft is back down to 100mg as of 2 appointments ago. Need to update my sig.


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## jim_morrison (Aug 17, 2008)

A Sense of Purpose said:


> I will suggest monitoring to him of the olanzapine.


Not sure if the research/marketing is to be 100% believed, but the sublingual form (Zydis and generic equivalents) is said to cause less metabolic complications and weight gain, maybe he'd be open to that.


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## A Sense of Purpose (May 8, 2011)

Hi all,

Had yet another blood test this week, this time for Sodium Valproate levels and LFT.

I had another strong 'episode' of agitation whereby i didnt get to sleep at all on sunday night. Spent around 35 hours awake and then was at the point of micro sleeps whereby i got 3 hours sleep.

Since that i've also had about 3 panic attacks (thats a new addition to the symptom family).

All in all pretty frustrated and annoyed that this isnt slowing down at any rate.
See the doc on friday.


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## jim_morrison (Aug 17, 2008)

Could zoloft still be contributing to the episodes?


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> Could zoloft still be contributing to the episodes?


Possibly however i was on 100mg for about 3 months with no trouble whatsoever. I then titrated to 150 (still no problems) then 200 and signs of it started then.

Reducing by 50% down to 100mg one would think that any activation that would induce mania would subside somewhat.

I on the other hand have experienced little to no reduction.

If it was an antidepressant problem, what do you think my options are? Would i be able to try an SNRI or is there a more logical med that would work for the lows?

Im starting to get the itch of old habits again, and they aren't healthy. I want to sort it out before something silly happens


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## jim_morrison (Aug 17, 2008)

Some would say lamictal, though dosing get's tricky when you're on valproates. Do you become depressed when you remove ssris all together even with mood stabilizers in place?


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> Some would say lamictal, though dosing get's tricky when you're on valproates. Do you become depressed when you remove ssris all together even with mood stabilizers in place?


Yeah unfortunately i do. Right now i feel like zoloft is failing me. 4 months ago was a different story. At this stage its a tough see-saw between getting a good antidepressant response without the potential hypo/mania.

Perhaps once valproate kicks in he'll be more inclined to address the mood. It just sucks alternating through all the emotions in one day. It becomes tiring, yet the brain still wants to fire off constantly.


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## jim_morrison (Aug 17, 2008)

A Sense of Purpose said:


> Yeah unfortunately i do. Right now i feel like zoloft is failing me. 4 months ago was a different story. At this stage its a tough see-saw between getting a good antidepressant response without the potential hypo/mania.
> 
> Perhaps once valproate kicks in he'll be more inclined to address the mood. It just sucks alternating through all the emotions in one day. It becomes tiring, yet the brain still wants to fire off constantly.


Your hypomania sounds on the severe side tbh, could it be bordering on full blown mania? I mean the fact that your still getting manic symptoms on such a whopping combo. If not Lamictal, maybe low dose Abilify augmentation for the antidepressant effect, 2 atypicals is less common but can be done.


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> I mean the fact that your still getting manic symptoms on such a whopping combo. If not Lamictal, maybe low dose Abilify augmentation for the antidepressant effect, 2 atypicals is less common but can be done.


Downers dont really affect me that much. I can drink like a camel. Stimulants (cocaine) really push my buttons in a good way (at the time of use) but over all they are counter-intuitive.

The fact that the restlessness is out of control and my sleep is F.....kt im left with few options.

I dont see how paxil would help as its extremely serotonergic. Im curious as to what he suggests tomorrow as ive had little remission of any symptoms.

Is it possible to take 2 mood stabilisers? As in Lamictal AND sodium valproate?

Also, is there any particular AD changes that might help? Celexa? or Cymbalta? Ive heard anecdotal evidence that Cymbalta is particularly numbing.

I guess i want to emphasize the mood boosting. An AD with mood boosting properties. Stabilisation is sort of in process, but i fear when i come out of this ill crash really badly (as i usually do) and zoloft wont help me.


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## jim_morrison (Aug 17, 2008)

I don't see any point in taking paxil either, did he mention it? Or did you mean abilify, which is serotonergic but doesn't have the risk of increasing mania which is what puts it in a unique position for bipolar depression.

It is possible to use two anticonvulsants but it's second or third line due to compounding side effects and because most of them interact with eachothers metabolism, so for example only half the usual dose of lamictal is taken when on valproate, but almost double is needed when on tegretol. So it's really much simpler to not take 2 at once. 

As for celexa or cymbalta, not sure, it's just trial and error really. Pristiq is a weaker SNRI so might be slightly less likely to trigger a manic episode, but considering some people can't even handle the mild snri effect of geodon it's hard to say.


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## A Sense of Purpose (May 8, 2011)

Yeah the paxil was just something came to mind.... Sedating etc (however very serotonergic).

I understand the complication of mood stabilisers on each other. I suppose all i can do is wait and see. Maybe a dose bump of Sodium Valproate will help. I think im noticing slight positive effects in the racing thoughts. Sleep still an issue.

I have enough downers to tranq an Elephant or Small water hippo.


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## A Sense of Purpose (May 8, 2011)

Today was the first noticeable day where i didnt feel tweaked out of my brain. Kind of feeling like when you have been running at a high anxiety level for so long that the mind just shuts down completely and nothing really seems to affect you.

I didnt care for Uni work that was due, i felt no desire to do anything apart from like in bed and just be. 

This was for the majority of the day. Either my body has exhausted all its energy and stress, or this is me crashing into the typical anhedonia mixed with depressed mood.

After talking to the doc today, once my sleep is on a semi regular basis we will address the antidepressant aspect of my med regimen. I will be curious to see what is suggested. As for now, im left guessing whether it will be another ssri or perhaps an SNRI. Either way i want to experience a positive baseline that is border hypomanic but not all the way there... Somewhere similar to when i started zoloft for the first time at 50mg. 

I guess if i had a preference it would be Pristiq or Efexor.

At this stage i cant tell whether this IDGAF attitude is due to sodium valproate reaching a steady state or if im just crashing. I guess the next few days will shed some light as to which one.


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## A Sense of Purpose (May 8, 2011)

Failed to feel fully 'awake' yet again today. Some kind of strange fog whereby i cant place whats happened during the day in coherent order as well as confusing reality with dreams.

Still dont have an overwhelming care for any aspect of the world. Finally off Lithium (last pill was last night) so hopefully things will improve.

I did get quite agitated last night around 8pm (the most awake i felt all day) and had the compulsion to move.

Sleep is still hit and miss. Some nights 6-7, others 3.


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## A Sense of Purpose (May 8, 2011)

Exhaustion, Avolition and extreme apathy for the past few days. Suicidal ideology but not at attempt stage or anything. Just thinking about death a lot.


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## riptide991 (Feb 1, 2012)

Wow dude, that really sucks about your situation right now. I think your doctor should be treating the depression at the same time because if it creeps up it could take a long time to get out of it even with meds, but preventing it seems to be much easier. 

That's a fairly high dose of olanzapine. I've been at 2.5mg recently. I must say im a bit less motivated than I was at 5mg but it could be an adjustment period. Reason i'm on this dosage is because I had some blood work done and it messed with my triglycerides. I'm still within the normal range just my previous blood work showed me in the low normal area and now i'm high normal. So we lowered it and will do blood work again. I haven't seen any weight changes though. At 20mg, I would have your blood work done after about a month to see how things are going. Wish there was something like olanzapine but not as controversial. Abilify was good but not as good as olanzapine. Once you go olanzapine you taste the power of a good drug and don't want off it hehe. Anyways, as someone on Effexor I recommend it. Zoloft is indeed more likely to make you irritable and manic. I'm on 375 and never had that problem.

I'd actually consider bringing up clozapine at my next doctor meeting. Olanzapine is closely related but clozapine comes with many advantages like d2,d3, o-opioid, gabab, 5-ht1a agonism. Although from what I hear you need to get a blood test done constantly to monitor for agranulocytosis.


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## A Sense of Purpose (May 8, 2011)

Yeah i hope this is a transient thing. After being up (but agitated, which wasnt fun) comes the down.

I just always pictured bipolar as up and fun/great times vs depressed non functional times. I had no idea there was a mixed state of everything at once. Boy was i wrong. You can have a horrendously painful mania.

But, what goes up must come down, and so i must push on and hopefully address my mood tomorrow at yet another appointment.

Side note:* Does anyone know if Sodium Valproate has antidepressant effects similar to that of Lamotrigine? Im feeling super flat at the moment.*

Glad things are working out for you


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## jim_morrison (Aug 17, 2008)

kehcorpz said:


> Wish there was something like olanzapine but not as controversial. Abilify was good but not as good as olanzapine. Once you go olanzapine you taste the power of a good drug and don't want off it hehe. Anyways, as someone on Effexor I recommend it. Zoloft is indeed more likely to make you irritable and manic. I'm on 375 and never had that problem.


That would be Saphris, it's likely the closest thing on the market you're going to get to olanzapine without the metabolic issues. It retains activity at most of olanzapines binding sites minus the muscarinic ones. and plus 5ht1a partial agonism, and 5ht1b antagonism which disinhibits serotonin release. Saphris/olanzapine/clozapine are the only atypicals with broad spectrum D1-D4 blockade, IMO this makes them special.



kehcorpz said:


> I'd actually consider bringing up clozapine at my next doctor meeting. Olanzapine is closely related but clozapine comes with many advantages like d2,d3, o-opioid, gabab, 5-ht1a agonism. Although from what I hear you need to get a blood test done constantly to monitor for agranulocytosis.


Clozapine has too many issues associated with it IMO, agranulocytosis risk, potent anticholinergic and antiadrenergic effects, metabolic profile on par with olanzapine, and so on.

Granted it has the additional benefits of gabaergic, opioideric effects as-well as NMDA receptor enhancement but it it's still usually reserved for treatment resistant schiz.


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## jim_morrison (Aug 17, 2008)

A Sense of Purpose said:


> Side note:* Does anyone know if Sodium Valproate has antidepressant effects similar to that of Lamotrigine? Im feeling super flat at the moment.*


Nah it seems to only help the mania portion. It's a bit of a mystery as to what makes Lamictal 'different' from standard sodium channel blockers, for example why it's generally stimulating and helps depression rather than being sedating and helping mania. Both can mess with memory though. Lamictal has the rash risk, depakote doesn't because it's not an aromatic anticonvulsant.


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## riptide991 (Feb 1, 2012)

jim_morrison said:


> That would be Saphris, it's likely the closest thing on the market you're going to get to olanzapine without the metabolic issues. It retains activity at most of olanzapines binding sites minus the muscarinic ones. and plus 5ht1a partial agonism, and 5ht1b antagonism which disinhibits serotonin release. Saphris/olanzapine/clozapine are the only atypicals with broad spectrum D1-D4 blockade, IMO this makes them special.
> 
> Clozapine has too many issues associated with it IMO, agranulocytosis risk, potent anticholinergic and antiadrenergic effects, metabolic profile on par with olanzapine, and so on.
> 
> Granted it has the additional benefits of gabaergic, opioideric effects as-well as NMDA receptor enhancement but it it's still usually reserved for treatment resistant schiz.


Yah too bad for the agranulocytosis, as otherwise it seems like a miracle drug. I read that it works on the negative effects of schizophrenia which would of course be relevant for anhedonia.

I actually decided to up my dosage back to 5mg last night as my anhedonia was slowly creeping back, not full blown but noticeable to me. My problem with saphris is that it is not generic here in Canada so it would cost a fortune. It would simply bring back the same old problem that I had with abilify, and that's price.

There is no doubt that olanzapine at 2.5mg doesn't alter my appetite. As soon as I go to 5mg I want to eat everything in sight. I have been decent about what I eat, but I still do indulge more than I normally would. This coupled with the drug is probably behind the higher trigs. Maybe for the time being i'll control my urges and stick to olanzapine until Saphris goes generic which is 2015. There's also one called Latuda that apparently works great but it also causes more EPS than say olanzapine. Olanzapine actually has a good rep with not giving EPS.


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## A Sense of Purpose (May 8, 2011)

Dropping Olanzapine down to 10mg at night and keeping the valproate the same.

Just down and out but he;s confident ill bounce back.
I really want to change my AD but hes going away and isnt confident changing my meds up before/while hes away.


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## jim_morrison (Aug 17, 2008)

kehcorpz said:


> There is no doubt that olanzapine at 2.5mg doesn't alter my appetite. As soon as I go to 5mg I want to eat everything in sight. I have been decent about what I eat, but I still do indulge more than I normally would. This coupled with the drug is probably behind the higher trigs. Maybe for the time being i'll control my urges and stick to olanzapine until Saphris goes generic which is 2015. There's also one called Latuda that apparently works great but it also causes more EPS than say olanzapine. Olanzapine actually has a good rep with not giving EPS.


Is the sublingual form of olanzapine generic in canada yet? Supposedly it's favourable metabolic profile may have something to do with it being transported to the liver in lower amounts.



> [Update 10/2007: the rumor is that a special form of Zyprexa may not cause weight gain like the regular form does. At least two studies so far do indeed support this idea and were not produced with support from the manufacturer.
> 
> Why would a wafer approach make a difference? The idea is to let the Zydis wafer melt in your mouth, which it does almost instantly, then not swallow it, but rather let the medication be absorbed across the membranes of your mouth wall, which does work (it's called "buccal absorption"). Because your stomach is not exposed to Zyprexa this way, the idea is that this does not stimulate some of the stomach serotonin receptors that are thought to be responsible for appetite increase. The older "antidote" idea for Zyprexa was related, using Pepcid or similar medications. I think there might be more to the story than this stomach serotonin receptor idea; I think it might also have to to with the direct transport to the liver of high levels of Zyprexa, when swallowed, versus very low levels when absorbed in the mouth -- but first we can wait and see if there's any truth to this story in the first place!]


http://www.psycheducation.org/hormones/Insulin/weightgain.htm


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## A Sense of Purpose (May 8, 2011)

@ Jim

My doc didn't have too much to say about Asenapine. I don't think he prescribes it often/is comfortable using something so 'new'. The game plan as stated above is to sit tight for the next month and contact my GP if any dramas occur.

I feel like a sitting duck but oh well, psychiatrists need lives too I suppose.
He said when he's back we can address my antidepressant and review whether switching to something else would be beneficial.

I think each gets a little bit better. I think i like Sodium Valproate. It has a super subtle benzo-ish feel to it, but not so drastic that it takes over and blocks your thoughts.


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## jim_morrison (Aug 17, 2008)

Regarding Saphris it's likely as you said, he's uncomfortable with it as it's relatively new so he hasn't had as much experience prescribing it, though in your case it may also be due to your migraines because it has 5-HT1b antagonism, which could work in the opposite way to triptans which are 5-HT1b&d agonists.


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> Regarding Saphris it's likely as you said, he's uncomfortable with it as it's relatively new so he hasn't had as much experience prescribing it, though in your case it may also be due to your migraines because it has 5-HT1b antagonism, which could work in the opposite way to triptans which are 5-HT1b&d agonists.


Luckily i avoid the triptans all together now. Ant\ything ending ERTON is amazing


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## riptide991 (Feb 1, 2012)

jim_morrison said:


> Is the sublingual form of olanzapine generic in canada yet? Supposedly it's favourable metabolic profile may have something to do with it being transported to the liver in lower amounts.
> 
> http://www.psycheducation.org/hormones/Insulin/weightgain.htm


Heh funny you should mention this, I started taking my olanzapine sublingually just for the hell of it. They don't have this version, at least not generic, here in Canada, but I just cut the pill in half and let it melt under my tongue. I basically hold it for 10 minutes and then swallow. I started doing it when I was on 2.5mg because I was cutting the pill in half. It's possible that olanzapine itself is not responsible for the metabolic issues but maybe one of its metabolites. The sublingual version will minimize the conversion to different metabolites. I just hope that the metabolites aren't also responsible for some of the benefits you get from the drug. Anyways, after being back to 5mg, I am already starting to feel better.


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## jim_morrison (Aug 17, 2008)

kehcorpz said:


> Heh funny you should mention this, I started taking my olanzapine sublingually just for the hell of it. They don't have this version, at least not generic, here in Canada, but I just cut the pill in half and let it melt under my tongue. I basically hold it for 10 minutes and then swallow. I started doing it when I was on 2.5mg because I was cutting the pill in half. It's possible that olanzapine itself is not responsible for the metabolic issues but maybe one of its metabolites. The sublingual version will minimize the conversion to different metabolites. I just hope that the metabolites aren't also responsible for some of the benefits you get from the drug. Anyways, after being back to 5mg, I am already starting to feel better.


Do you think that letting a regular pill dissolve in your mouth actually undergoes proper/significant buccal absorption though? I think sublingual based pills used a freeze dried formula which is designed especially so the chemical can break down into a small enough size that it can properly be absorbed in this manner. I could be wrong about this, just curious.


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> Do you think that letting a regular pill dissolve in your mouth actually undergoes proper/significant buccal absorption though? I think sublingual based pills used a freeze dried formula which is designed especially so the chemical can break down into a small enough size that it can properly be absorbed in this manner. I could be wrong about this, just curious.


I'd be curious to know this also. Im struggling to find the best time to take my Olanzapine in the evening. I dont get home till round 6pm and find that if i take it then i get too tired to be productive. Half of me goes f-it ill use daylight to study and just relax in the evenings....

But if the wafer has fast acting effects... i could potentially study and drop the wafer 1hr before bed instead of 4-6hrs

@Jim
Do you think the Zydis would be covered under the PBS or concession card scheme?


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## jim_morrison (Aug 17, 2008)

A Sense of Purpose said:


> I'd be curious to know this also. Im struggling to find the best time to take my Olanzapine in the evening. I dont get home till round 6pm and find that if i take it then i get too tired to be productive. Half of me goes f-it ill use daylight to study and just relax in the evenings....
> 
> But if the wafer has fast acting effects... i could potentially study and drop the wafer 1hr before bed instead of 4-6hrs
> 
> ...


Yep it's covered by the pbs for exactly the same indications as zyprexa tablet form. Or do you pay full price for the tablets since it's subsidized for BP1 but not BP2? At any rate there's also a sandoz generic olanzapine orodispersible/sublingual for cheaper.


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> Yep it's covered by the pbs for exactly the same indications as zyprexa tablet form. Or do you pay full price for the tablets since it's subsidized for BP1 but not BP2? At any rate there's also a sandoz generic olanzapine orodispersible/sublingual for cheaper.


I get the pbs phone up discounted one but its Zyprexa branded. Will ask my doc for it.


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## riptide991 (Feb 1, 2012)

jim_morrison said:


> Do you think that letting a regular pill dissolve in your mouth actually undergoes proper/significant buccal absorption though? I think sublingual based pills used a freeze dried formula which is designed especially so the chemical can break down into a small enough size that it can properly be absorbed in this manner. I could be wrong about this, just curious.


Well from my understanding drugs with a low molecular weight like olanzapine can be used sublingually. If you don't account for PH then you need to leave it sitting in your mouth for longer. Some drugs simply take longer to diffuse and most people won't wait long. Any of the changes made are typically to increase diffusion via ph or additional carriers as patients are less likely to adhere to their drug schedule if it is a pain in the ***. They don't actually change the drug itself, the molecular weight will always be the same. Drugs with too high of a molecular weight will never be made into sublingual versions.

I've used many drugs in this method and quick acting ones you can tell kick in right away while they sit under there. Hell, I've even used supplements in this way.

Whatever doesn't get through I swallow so either way I get it all. I will see if my intense cravings come back. Thus far I haven't been getting them which is either a coincidence or who knows.

While the group of patients was small, I still think it's crazy that the difference in weight gain is so vast between the 2 groups.



> Substantial weight gain (SWG) (> or =7% increase from baseline weight) was noted in 84.2% (n = 16) of the olanzapine tablet patients and in 31.6% (n = 6) of the orally disintegrating olanzapine patients, with the olanzapine tablet group showing a significant increase in the mean percentage of weight gain (F = 4.0; p = 0.014).


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> I'd be curious to know this also. Im struggling to find the best time to take my Olanzapine in the evening. I dont get home till round 6pm and find that if i take it then i get too tired to be productive. Half of me goes f-it ill use daylight to study and just relax in the evenings....
> 
> But if the wafer has fast acting effects... i could potentially study and drop the wafer 1hr before bed instead of 4-6hrs
> 
> ...


Did the 5mg make you tired? I don't even get tired when I take it. I take it at 5pm now and I'm still fine at night time. I assume that there has been some desensitization at histamine receptors as initially it did make me tired.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Did the 5mg make you tired? I don't even get tired when I take it. I take it at 5pm now and I'm still fine at night time. I assume that there has been some desensitization at histamine receptors as initially it did make me tired.


Yeah pretty much, however at 20mg plus for that stint when i was also taking 10 in the morning, it really started to add up.

@kehcorps
I need an AD similar to zoloft, as im partially responding to it. What would you recommend? 150 works a little but no where near like 50mg use to the first time round.


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> Yeah pretty much, however at 20mg plus for that stint when i was also taking 10 in the morning, it really started to add up.
> 
> @kehcorps
> I need an AD similar to zoloft, as im partially responding to it. What would you recommend? 150 works a little but no where near like 50mg use to the first time round.


SSRI's, i'd probably think paxil would be similar as the affinity for SERT is much stronger than the others. Paxil also has sigma-1 activity, though it's agonistic instead of antagonistic like Zoloft. Though agonistic activity could make it more anxiolytic. Zoloft is a unique breed in that it doesn't impair mental vigilance and well it's the only one like that. It's even possible that the reason Zoloft raises dopamine is not because of DRI capabilities but because it antagonizes sigma-1. I find that venlafaxine doesn't impair mental vigilance for me at least when combined with olanzapine. Venlafaxine is definitely anxiolytic for me.


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## A Sense of Purpose (May 8, 2011)

@ Jim

So ive switched to Zyprexa Zydis dissoluble 10mg wafers.

I must say they seem very different to Olanzapine tablets.
The tablets seem way more intense and have greater orthostatic hypertension as well as more sedation than the wafers.


Still feeling pretty down and depressed. Sleeping a lot and eating hardly anything


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## jim_morrison (Aug 17, 2008)

Interesting that it seems so different, maybe it's smoother so has seemingly less side effects, dose may also need to be increased/decreased depending on the phase you're in. :stu


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> Interesting that it seems so different, maybe it's smoother so has seemingly less side effects, dose may also need to be increased/decreased depending on the phase you're in. :stu


yeah im starting to think the 20 mg dose may be required. Or an wafer 5mg with a 5mg pill


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## riptide991 (Feb 1, 2012)

I've actually upped my dose to 7.5mg the last few days. I must say last night I had some akathisia. It started in my right leg and I would get this weird feeling where my shin is and I'd have to move my leg to make it go away. After about 30 minutes it went away on the right leg and started happening on the left leg. It then went away after about an hour. It was quite unpleasant but I must say since going to 7.5mg I've been feeling much better. I hope the restless leg problem is transient. If not I'm willing to deal with an hour of that for the benefits I achieve. I will continue to test it for a while longer and may get it officially prescribed. I'm still doing it sublingually. I haven't had the insatiable appetite, but we will see after about a week.


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## Boulder257 (May 9, 2013)

kehcorpz said:


> I've actually upped my dose to 7.5mg the last few days.


DOes Akathasia only happen in the legs, or can it happen in the arms too? Is yours only in your legs?


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## riptide991 (Feb 1, 2012)

Boulder257 said:


> DOes Akathasia only happen in the legs, or can it happen in the arms too? Is yours only in your legs?


Well I think I should have called it Restless Leg Syndrome rather than Akathisia. Akathisia is just restlessness in general I think and RLS is very specific with legs but can happen with arms too. For me it was just legs, it was my first time experiencing it. Well when I took Remeron ages ago I had it too at the beginning a bit. My guess it will go away. Hopefully I don't get it today.


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## A Sense of Purpose (May 8, 2011)

Boulder257 said:


> DOes Akathasia only happen in the legs, or can it happen in the arms too? Is yours only in your legs?


Akathisia can happen anywhere. This time two weeks ago i was so tormented by the compulsion to move that i was pacing my room, moving my arms and constantly trying to keep myself physically occupied.

This differs from Tardive dyskinesia because the inner restlessness cannot be sated in TD because its automatic, but can be ameliorated in akathisia by moving. With akathisia you can try and sit still, but i guarantee you it will be the most horrendously difficult thing you could possibly do


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## A Sense of Purpose (May 8, 2011)

Today i upgraded my personal health insurance to include psychiatric care.
My doctor told me it would be an exceptional thing to do, because he wants to do a major med shuffle as soon as my exams are over (in 4weeks).
Beds and meds for a day cost ~$600, so getting the cover upgrade for an extra $570 was a no brainer.

Only problem is, there is a clause saying that i must wait 2 months before private healthcare will cover it.

All in all i think its better to be covered since having mania/anxiety and depression.


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## riptide991 (Feb 1, 2012)

So last night I didn't get the restless legs! woot! Seemed like a one time thing. I'm pretty glad because that feeling was so horrible. I may ask my doctor to make the 7.5mg change permanent since I am finding things much more exciting since increasing. Will just have to monitor blood closely.

Cool about the insurance upgrade. If I had no choice but to take brand name stuff like Saphris i'd probably get drug insurance too. Luckily everything else is covered here hehe.


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## riptide991 (Feb 1, 2012)

Last night I didn't feel like holding the drug under my tongue and just swallowed it. This morning it was tough waking up and i'm super sedated. I haven't felt any sedation yet since the 7.5mg raise as I have been doing it sublingually, but man did it hit me today. It could also be a coincidence who knows. But yah olanzapine is heavily metabolized at first pass.



> OLZ was subject to substantial first-pass metabolism; at the tmax, OLZ accounted for 19%, 18%, and 8% of the radioactivity, in mice, dogs, and monkeys, respectively. The ratio of AUC OLZ to AUC radioactivity was, respectively, 10%, 14%, and 4% in mice, dogs, and monkeys. The principal urinary metabolites in mice were 7-hydroxy OLZ glucuronide, 2-hydroxymethyl OLZ, and 2-carboxy OLZ accounting for approximately 10%, 4%, and 2% of the dose. Metabolites that were present in urine in lesser amounts were 7-hydroxy OLZ, N-desmethyl OLZ, and N-desmethyl-2-hydroxymethyl OLZ. In dogs, the major metabolite accounting for approximately 8% of the dose was 7-hydroxy-N-oxide OLZ. Other metabolites identified were 2-hydroxymethyl OLZ, 2-carboxy OLZ, N-oxide OLZ, 7-hydroxy OLZ, and its glucuronide and N-desmethyl OLZ


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## A Sense of Purpose (May 8, 2011)

Hi all,


Have had a really rocky week. Spent monday-monday in the psych ward in Melb due to intense and insatiable restlessness.

I voluntarily admitted myself after not sleeping for 2 days and feeling like my skin was crawling. The ward was a real eye opener to how the system works/fails in some areas. I was taken to the ward and was the youngest there by far. The closest person to my age was maybe 36 (im 23) and the majority had schizophreniform disorders. I had no one to talk to or anyone that was non threatening with the exception of 1/2 people.

The medication dosing aspect was just ridiculous (getting sedating meds too early, getting other meds too late). Furthermore they switched my meds up something strange.

Im now on Prozac 60mg, Olanzapine 20mg, Sodium Valproate 1000mg, Valium 20mg.

Discharged yesterday and will be seeing my psych when he gets back from holidays on Friday.

Over and out


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## riptide991 (Feb 1, 2012)

How you liking the Prozac? I've been at 7.5mg olanzapine, thus far all is good. After getting all my test results back everything was fine minus my blood sugar was low. Reference range 3.6-6.0 and I was at 2.3. We will be taking regular blood tests to see how things are going.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> How you liking the Prozac? I've been at 7.5mg olanzapine, thus far all is good. After getting all my test results back everything was fine minus my blood sugar was low. Reference range 3.6-6.0 and I was at 2.3. We will be taking regular blood tests to see how things are going.


Prozac feels less stimulating/anxiogenic than Zoloft. Im only 3 days in on Prozac and it was to ween off zoloft and hopefully to start effexor.

I've still needed Olanzapine at rather high dosages to remain calm.
I think ive gained about 1-2kg but thats cos i was binging on unhealthy food


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## A Sense of Purpose (May 8, 2011)

So i guess im currently on what would be Symbyax (Fluoxetine + Olanzapine) with my own unique dosages.

20mg olanz and 60 prozac.

Felt very strange the past few days post being in the psych ward. Still feel quite restless and nothing sates the urge to constantly be doing something.

Even when i actually DO do something, my brain gets bored and switches off or races onto other things.

Impossible to study for exams...


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## A Sense of Purpose (May 8, 2011)

Felt incredibly vague the past two days. Nothing matters at all.

No sure if this is because im going into a depressive cycle or if its the prozac starting to kick in, but something will need to change.

This is making life so difficult right now.


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## A Sense of Purpose (May 8, 2011)

Quick update. Captain Vague is still here. Mostly unfazed by anything right now.

Not sure if its because of Zoloft withdrawals or because of the Prozac but something still seems odd about the world.

My doc wants to get me off antidepressants all together and just try a mood stabilizer.

I start 40mg Prozac from today and 10mg Olanzapine.


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## A Sense of Purpose (May 8, 2011)

Interesting few things about this new combination.

Sexual aspects such as desire, orgasm intensity etc have increased to my surprise.
I think there is some nice synergy between these meds, but im still feeling really vague and tuned out.

Im hoping its just the fluoxetine reaching its steady state and motivation comes back.

Also, i seem to slowly be *gaining weight*. At first i believed that i wasnt because i didnt really pay much attention to my appearance, however the other day i saw some scales and jumped on to my surprise i have gained about 10kg since starting Zyprexa.

Seeing as its been probly over 3 months and ive had a sedentary lifestyle, its not that surprising. I will renew my membership at the gym to combat the weight gain and hopefully turn it all into muscle.


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## A Sense of Purpose (May 8, 2011)

Anyone know much about Lithium low dose in conjunction with another mood stabilizer like Sodium Valproate?

Is there an augmenting effect from the combination? Also im guessing the Lithium dosage would be lower than if it was for monotherapy.

At the moment im quite sluggish and constantly tired, but its hard to tell who is doing what


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## A Sense of Purpose (May 8, 2011)

So its come to my attention that the synergy of both olanzapine and fluoxetine combined is in favor of boosting olanzapine levels.

I do not feel anywhere as stimulated as i did when i was on olanzapine and sertraline.
Im curious as to why the sedation is more prominent even though ive switched to arguably the most stimulating SSRI...?


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## riptide991 (Feb 1, 2012)

The tiredness may be from the extra olanzapine. Keep in mind that it has a strong affinity for Histamine.



> histamine H1: 2.2


Granted I've been taking 2.5mg in the morning and 5 mg at night, and I haven't really been tired, just very relaxed. Although I just added Mirtazapine 30mg to my cocktail to see if it can improve my motivation a bit. I enjoy things and get reward now, but I need to be more motivated to actually pursue my career. Right now I just feel happy and care free. It's kind of an awesome feeling, but at the same time i'm not used to it. I mean it's good to have a bit of anxiety for the future, but I have like 0 anxiety. I can talk to people I normally wouldn't talk to, I am not scared of anything. This could be the propranolol which I take twice a day, who knows. Anyways, I'm hoping the mirtazapine helps with a bit of a motivation boost.


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## A Sense of Purpose (May 8, 2011)

Hi all. I have a new plan...

I'm washing out all of my medications with the exception of Sodium Valproate and Valium.

My doc and I both feel its important to work out just exactly what baseline for me is.
Once that is established we can medicate on that basis.

So far i have received good/partial response but relapse and anhedonia also. Starting 40mg Prozac and 10mg Olanzapine at night and reduce dose by 10 every week (for prozac).


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## A Sense of Purpose (May 8, 2011)

Waiting for a medication wash out is one of the most frustrating things. Im on so may drugs (which do work -however weight gain) that this process is going to take ages.

Im thinking about calling my psych up and going in as a voluntary patient so i can have my meds titrated and monitored

I want an SNRI. Whichever one i havent quite decided yet however most likely effexor.
Furthermore i want to use lamictal as a mood stabilizer instead of olanz/valproate.


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## CD700 (Apr 22, 2010)

A Sense of Purpose said:


> Waiting for a medication wash out is one of the most frustrating things. Im on so may drugs (which do work -however weight gain) that this process is going to take ages.
> 
> Im thinking about calling my psych up and going in as a voluntary patient so i can have my meds titrated and monitored
> 
> ...


Why are you washing out just for a crappy SNRI


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## A Sense of Purpose (May 8, 2011)

blakeyz said:


> Why are you washing out just for a crappy SNRI


Not sure tbh.

Zoloft worked amazingly well the first time.... but was crap the second time.
Im hoping that a new class of med will make me feel better and ill have learned a lesson for going off in the first place


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## CD700 (Apr 22, 2010)

A Sense of Purpose said:


> Not sure tbh.
> 
> Zoloft worked amazingly well the first time.... but was crap the second time.
> Im hoping that a new class of med will make me feel better and ill have learned a lesson for going off in the first place


What about Reboxitine+ Lamicital ?
Did topamax have the dopamax effect ? 
SNRI i would go Effexor. The Psychiatrist I used to go to who did a magic trick at the end of every appointment and made my wallet disappear used to cream his pants over Effexor


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## CD700 (Apr 22, 2010)

Plus at high doses Effexor boosts dopamine which is what zoloft works on yeh ?????


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## A Sense of Purpose (May 8, 2011)

blakeyz said:


> What about Reboxitine+ Lamicital ?
> Did topamax have the dopamax effect ?
> SNRI i would go Effexor. The Psychiatrist I used to go to who did a magic trick at the end of every appointment and made my wallet disappear used to cream his pants over Effexor


My docs not extremely open to 'radical' regimes and has knocked my request for reboxetine twice now. Ive also did get stupid while on topamax.



blakeyz said:


> Plus at high doses Effexor boosts dopamine which is what zoloft works on yeh ?????


Im guessing so, but with more adrenaline.


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## A Sense of Purpose (May 8, 2011)

Still not over the hump of vague-ness that I thought would have subsided by now. Everything seems bleh and i cant focus on my studies for exams in 2 weeks.

See the doc tomorrow. I really do hope he changes something drastically because each time its tiny/insignificant and time consuming.

If I had it my way; I'd have Effexor 300mg, Sodium Valproate 1000mg, Olanzapine 5mg, and valium 5night/20mg for panic attacks.


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## A Sense of Purpose (May 8, 2011)

Signing in,

So I've been quite vague and spaced out / disconnected with my body and world. To begin with i was ecstatically happy but after 2 weeks of unwavering melancholy / vague-ness something has to change.

Also, ever since starting fluoxetine i have been waking up 2-3 times a night.
I *NEVER *awake for anything once im asleep. The only times are if im sick etc.

I really really want to try Effexor + Lamictal with PRN Valium. Gah


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## A Sense of Purpose (May 8, 2011)

Saw the doc today.

We reduced the valium down to 10mg and kept the rest the same. He wants to give it 1 more week before we start experimenting with things.
Im really hoping to give Effexor/Saphris combination a go. Or even Lexapro with Saphris.

Im not interested in Ap's that cause weight gain/diabetes etc.
(Not ragging on Olanzapine. Its saved me, for sure but now it a better head space i shouldnt need as much)


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## riptide991 (Feb 1, 2012)

I actually have been noticing weight gain with zyprexa now. It makes no sense because ive been eating well and nothing has changed. I'm seeing my doc tomorrow and will work on getting rid of it. I think the biggest factor is it lowers my blood sugar pretty badly. 

I'm going to add Mirapex (dopamine agonist) and possibly change Effexor to clomipramine.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> I actually have been noticing weight gain with zyprexa now. It makes no sense because ive been eating well and nothing has changed. I'm seeing my doc tomorrow and will work on getting rid of it. I think the biggest factor is it lowers my blood sugar pretty badly.
> 
> I'm going to add Mirapex (dopamine agonist) and possibly change Effexor to clomipramine.


Well the thing is, i didnt THINK i was gaining weight, however i recently jumped on the scales and found out that in 2 months of olanzapine caused 
12kg of weight gain!!!

I actually have a small but noticeable pot belly now, when in the past ive always maintained an athletic appearance.


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> Well the thing is, i didnt THINK i was gaining weight, however i recently jumped on the scales and found out that in 2 months of olanzapine caused
> 12kg of weight gain!!!
> 
> I actually have a small but noticeable pot belly now, when in the past ive always maintained an athletic appearance.


I'm in the same boat! I've always had abs, but I just have been so happy and enjoying the drugs that I didn't even notice. It's like it made me completely oblivious. Then my parents mentioned I have gained weight and I was like "really?" and then realized it. I don't even look in the mirror anymore and when I shower I just wash myself. I am not as OCD over my appearance so just didn't notice.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> I'm in the same boat! I've always had abs, but I just have been so happy and enjoying the drugs that I didn't even notice. It's like it made me completely oblivious. Then my parents mentioned I have gained weight and I was like "really?" and then realized it. I don't even look in the mirror anymore and when I shower I just wash myself. I am not as OCD over my appearance so just didn't notice.


Me too! Its been a gradual thing so its hard for one to notice! But ive had friends ask me if ive gained weight as well as my parents.

I also used to have a 6pack and now its more like a 4pack with rounded bits.

Kinda depressive and makes me want to go on Saphris ASAP


----------



## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> Me too! Its been a gradual thing so its hard for one to notice! But ive had friends ask me if ive gained weight as well as my parents.
> 
> I also used to have a 6pack and now its more like a 4pack with rounded bits.
> 
> Kinda depressive and makes me want to go on Saphris ASAP


Yah Saphris is apparently similar to olanzapine but name brand only here.

This is why I want to switch to a TCA like clomipramine, it has very similar receptor antagonism to zyprexa, minus the dopamine blockade.


----------



## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Yah Saphris is apparently similar to olanzapine but name brand only here.
> 
> This is why I want to switch to a TCA like clomipramine, it has very similar receptor antagonism to zyprexa, minus the dopamine blockade.


Effexcor + remeron + olanx not working out for you?


----------



## A Sense of Purpose (May 8, 2011)

Another thing that i have noticed is dose timing of these meds. I take prozac in the AM and Olanzapine in the PM.

But, knowing about Symbyax i wanted to see for myself what it would be like. Boy it made me into a zombie alright. So surprising how important dosage timing is.


----------



## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> Effexcor + remeron + olanx not working out for you?


It is but because it affects my blood sugar doctor wants me off it. I'm meeting with her tomorrow and the reason I chose clomipramine is because it resembles quite a similar profile for antagonizing receptors. Zyprexa just also antagonizes dopamine receptors.

Clomipramine


> 5-HT2A receptor (Ki = 36 nM)
> 5-HT2C receptor (Ki = 65 nM)
> 5-HT3 receptor (Ki = 85 nM)
> 5-HT6 receptor (Ki = 54 nM)
> ...


Zyprexa


> serotonin 5-HT2A: 3.7
> serotonin 5-HT2B: 8.2
> serotonin 5-HT2C: 10
> serotonin 5-HT3: 57
> ...


obviously affinities are different. I am almost convinced that the biggest contributor to my response to zyprexa is the 5-ht2c antagonism which raises dopamine in prefrontal cortex. This means I would probably have to take a bit of a higher dose of clomipramine to get that effect. Possibly something like 150mg. I'll start low though 75mg and see what I get. That's if the doctor agrees hehe.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> It is but because it affects my blood sugar doctor wants me off it. I'm meeting with her tomorrow and the reason I chose clomipramine is because it resembles quite a similar profile for antagonizing receptors. Zyprexa just also antagonizes dopamine receptors.
> 
> Clomipramine
> 
> ...


Its funny you should say that about 5-ht2c antagonism. Since titrating onto fluoxetine, my sex drive has been through the roof and orgasms amazing.

Does Effexor have any 5-ht2c antagonist properties?


----------



## jim_morrison (Aug 17, 2008)

kehcorpz said:


> I actually have been noticing weight gain with zyprexa now. It makes no sense because ive been eating well and nothing has changed. I'm seeing my doc tomorrow and will work on getting rid of it. I think the biggest factor is it lowers my blood sugar pretty badly.


Unfortunately the weight gain with zyprexa seems to differ from other weight gaining meds (eg:mirtazapine), because it's not simply based around increased appetite or excessive somnolence, but rather an alteration in how the body processes calories, namely it makes the body burn fat instead of carbs.



> *IV. Zyprexa Makes Your Body Use Fat, Not Carbs, As Fuel*
> 
> Normally, after eating, your body uses carbohydrate as the main energy source. After a long time hungry, it switches to fat.
> 
> ...


Why Zyprexa (And Other Atypical Antipsychotics) Make You Fat



kehcorpz said:


> obviously affinities are different. I am almost convinced that the biggest contributor to my response to zyprexa is the 5-ht2c antagonism which raises dopamine in prefrontal cortex. This means I would probably have to take a bit of a higher dose of clomipramine to get that effect. Possibly something like 150mg. I'll start low though 75mg and see what I get. That's if the doctor agrees hehe.


Cyproheptadine seems pretty close receptor-wise too, probably closer than Clomipramine.


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## A Sense of Purpose (May 8, 2011)

Top notch info once again Jim. Thanks for that.

Im definitely going to push hard for saphris because I don't want to gain any more weight (not that its problematic).


----------



## jim_morrison (Aug 17, 2008)

No worries, I guess until then a low carb diet like atkins, paleo, etc., might be useful for controlling weight.

Regarding your question about effexor, I don't think it does any 5-ht2c antagonism, but both prozac and saphris are potent blockers of this receptor type.


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## riptide991 (Feb 1, 2012)

jim_morrison said:


> No worries, I guess until then a low carb diet like atkins, paleo, etc., might be useful for controlling weight.
> 
> Regarding your question about effexor, I don't think it does any 5-ht2c antagonism, but both prozac and saphris are potent blockers of this receptor type.


And here I thought my oatmeal was a healthy choice hehe.



A Sense of Purpose said:


> Top notch info once again Jim. Thanks for that.
> 
> Im definitely going to push hard for saphris because I don't want to gain any more weight (not that its problematic).


Have you considered a drug like Lamictal instead of antipsychotics?

Also I have been researching Mirapex which is a dopamine agonist and there seems to be a lot of studies for bipolar.



> *Preliminary randomized, double-blind, placebo-controlled trial of pramipexole added to mood stabilizers for treatment-resistant bipolar depression.*
> 
> Goldberg JF, Burdick KE, Endick CJ.
> *Source*
> ...





> *Pramipexole for bipolar II depression: a placebo-controlled proof of concept study.*
> 
> Zarate CA Jr, Payne JL, Singh J, Quiroz JA, Luckenbaugh DA, Denicoff KD, Charney DS, Manji HK.
> *Source*
> ...


Although this puppy is a hard start as it relies on autoreceptor desensitization to start working. So you get about a week or 2 of not feeling so great before it kicks in.


----------



## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> And here I thought my oatmeal was a healthy choice hehe.
> 
> Have you considered a drug like Lamictal instead of antipsychotics?
> 
> ...


I have considered Lamictal but my doc wanted to trial me on Lith and Sodium Valproate first. Lamictal isnt covered on the PBS here so it would be around $200 a month, which is a shame.

If its the unique to saphris, fluoxetine and such then ill be happy to try it.


----------



## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> No worries, I guess until then a low carb diet like atkins, paleo, etc., might be useful for controlling weight.
> 
> Regarding your question about effexor, I don't think it does any 5-ht2c antagonism, but both prozac and saphris are potent blockers of this receptor type.


Can saphris be used in combination with fluoxetine / and or Effexor?

Are there potential interactions that may raise the dosage of one or the other?

Thanks


----------



## CD700 (Apr 22, 2010)

A Sense of Purpose said:


> I have considered Lamictal but my doc wanted to trial me on Lith and Sodium Valproate first. Lamictal isnt covered on the PBS here so it would be around $200 a month, which is a shame.
> 
> If its the unique to saphris, fluoxetine and such then ill be happy to try it.


I'm from AUS and it works out cheaper to buy it online from India noscript


----------



## A Sense of Purpose (May 8, 2011)

blakeyz said:


> I'm from AUS and it works out cheaper to buy it online from India noscript


Im extremely wary of imported stuff tbh. I don't know for sure if the XR technology is up to scratch, if the medication is the correct dose and if its the medication I actually ordered.

Im more than happy to pay for psych meds. I feel its important to get quality.


----------



## jim_morrison (Aug 17, 2008)

A Sense of Purpose said:


> Can saphris be used in combination with fluoxetine / and or Effexor?
> 
> Are there potential interactions that may raise the dosage of one or the other?
> 
> Thanks


The monograph mentions Luvox, Paxil and Prozac.



> Coadministration of a single 75-mg dose of imipramine with a single 5-mg dose of Saphris did not affect the plasma concentrations of the metabolite desipramine (a CYP2D6 substrate). Thus, in vivo, Saphris appears to be at most a weak inhibitor of CYP2D6. Coadministration of a single 20-mg dose of paroxetine (a CYP2D6 substrate and inhibitor) during treatment with 5 mg Saphris twice daily in 15 healthy male subjects resulted in an almost 2-fold increase in paroxetine exposure. Asenapine may enhance the inhibitory effects of paroxetine on its own metabolism.
> 
> Saphris should be coadministered cautiously with drugs that are both substrates and inhibitors for CYP2D6.


http://www.drugs.com/pro/saphris.html#footnote-reference-11

So basically paxil and prozac levels may be increased..at-least if this one study is correct. Which I guess could mean that halving or at-least lowering the dose of prozac may be necessary. Effexor doesn't seem to interact as it's only a substrate of this enzyme, much like desipramine.


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> The monograph mentions Luvox, Paxil and Prozac.
> 
> http://www.drugs.com/pro/saphris.html#footnote-reference-11
> 
> So basically paxil and prozac levels may be increased..at-least if this one study is correct. Which I guess could mean that halving or at-least lowering the dose of prozac may be necessary. Effexor doesn't seem to interact as it's only a substrate of this enzyme, much like desipramine.


How does saphris relate to prolactin levels? Olanzapine seems to be giving me the start of man boobs (not majorly) but still, fat seems to attract to the nipple area and stomach.


----------



## jim_morrison (Aug 17, 2008)

According to the same monograph sheet prolactin elevation from saphris is rare:



> In Saphris clinical trials, the incidences of adverse events related to abnormal prolactin levels *were 0.4% versus 0% for placebo*.
> 
> *The effects on prolactin levels in the short-term schizophrenia and bipolar mania trials revealed no clinically relevant mean changes in baseline.* In short-term, placebo-controlled schizophrenia trials, the mean decreases in prolactin levels were 6.5 ng/mL for Saphris-treated patients compared to 10.7 ng/mL for placebo-treated patients. *The proportion of patients with prolactin elevations ≥4 times ULN (at Endpoint) were 2.6% for Saphris-treated patients versus 0.6% for placebo-treated patients.* In short-term, placebo-controlled bipolar mania trials, the mean increase in prolactin levels was 4.9 ng/mL for Saphris-treated patients compared to a decrease of 0.2 ng/mL for placebo-treated patients. *The proportion of patients with prolactin elevations ≥4 times ULN (at Endpoint)* *were 2.3% for Saphris-treated patients versus 0.7% for placebo-treated patients.
> 
> *In a long-term (52-week), double-blind, comparator-controlled trial of patients with schizophrenia and schizoaffective disorder, the mean decrease in prolactin from baseline for Saphris-treated patients was 26.9 ng/mL.


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## A Sense of Purpose (May 8, 2011)

Thank you muchly


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## A Sense of Purpose (May 8, 2011)

Small update:

Had one of my better days lately with the feeling of being connected to my body and the rest of the world. I dont feel as withdrawn as i have felt over the past few weeks.
I have a scenario skills exam tomorrow and im quite nervous about it. I can see myself getting very little sleep tonight.

Still there is a long way to go and i have some proposals for my psych on friday.
Mainly:
Saphris, Effexor and Lamotrigine.


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## A Sense of Purpose (May 8, 2011)

The past 3 weeks have been hectic.
So much so that i feel i should withdraw from my current study/course and give myself a bit of time to sort my brain out.

I feel a range of emotions limited to but not entirely zombification, mania, derealization, anxiety and panic attacks. Very rarely do i get an "up" that is... well... "up".

Seeing the doc on friday as i stated yesterday and will strongly encourage that something drastic/efficacious is done to relieve these symptoms


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## jim_morrison (Aug 17, 2008)

You study EMT right? That would be a pretty hectic, high stress course I'd imagine.


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> You study EMT right? That would be a pretty hectic, high stress course I'd imagine.


Indeed, however im very capable and good at helping others with their phys/psych problems. It seems i neglect myself to some degree without realizing it, but i do the work because i find it rewarding.

Im lucky that once my symptoms are under control, ill have full autonomy and be capable of working in this particular industry. I just need to take a bit of a time-out and sort myself out before i can help others again.


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## A Sense of Purpose (May 8, 2011)

Had to drop a lot of sleeping meds to get to bed last night. Ended up somewhere round 30 Olanzapine, 40 Valium and 1.5g Sodium Valproate.

I did sleep through the entire night for the first time in weeks which was nice, but this morning i've had the worst post depressant hangover.

Also feel a bit more depressed (psychologically) maybe due to the olanz or valium. Wish i could just see my doc now. Waiting til Friday is so frustrating.


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## A Sense of Purpose (May 8, 2011)

Recovered from the sedation of that rather large and irresponsible dosing to get to sleep. Woke up today feeling a lot more fresh.

Think im going to talk to my doc about venlafaxine/pristiq tomorrow and see what he says. I do really also want to try lamotrigine instead of Sodium Valproate


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## A Sense of Purpose (May 8, 2011)

Back from the docs today.

Looks like we are keeping things simple for the time being and letting time take its course.

We removed Olanzapine daily and made it PRN and dropped Valium to try and aid in concentration boosting. Keeping Prozac at 40 and going to keep Sodium Valproate at 1000mg.


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## riptide991 (Feb 1, 2012)

let me know how it goes with going off the olanzapine. I had a nauseous day today and it's my 2nd day without it. Feeling like crap whole day.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> let me know how it goes with going off the olanzapine. I had a nauseous day today and it's my 2nd day without it. Feeling like crap whole day.


Interesting. Is it the cholinergic rebound? Or something else do you think?


----------



## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> Interesting. Is it the cholinergic rebound? Or something else do you think?


Well it blocks a lot of serotonin receptors, some which are responsible for bad side effects. So now these receptors are no longer blocked and I have tonnes of serotonin because of Effexor. This is the only thing I can think of. I'm sure they will downregulate eventually but they have been blocked this entire time, could have even upregulated.


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## A Sense of Purpose (May 8, 2011)

ick


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## bazinga (Jun 9, 2010)

A Sense of Purpose said:


> My treatment plan currently is to lower Zoloft to 75mg and begin Olanzapine 5mg immediately and titrate the dosage up until stable. Valium Prn for agitation/anxiety.
> For some reason he didnt want to give me lamictal (because of the rash maybe?) or an anticonvulsant like Valproate (because im already highly prone to migraines
> 
> Cheers


 Sorry man, I haven't followed your forum post at all, but I am curious. What prescriptions did you end up with? Obviously they should've given you a mood stabilizer, but why not lamictal or valproate? Anyway, I was just curious as to what meds you are taking for your bipolar.

My main medications for bipolar are Lamictal (for mood swings/agitation/etc.) and Saphris (which works to stop my racing thoughts and calm my mind.

What do they have you on now? Do you have an official diagnosis?


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## A Sense of Purpose (May 8, 2011)

bazinga said:


> Sorry man, I haven't followed your forum post at all, but I am curious. What prescriptions did you end up with? Obviously they should've given you a mood stabilizer, but why not lamictal or valproate? Anyway, I was just curious as to what meds you are taking for your bipolar.
> 
> My main medications for bipolar are Lamictal (for mood swings/agitation/etc.) and Saphris (which works to stop my racing thoughts and calm my mind.
> 
> What do they have you on now? Do you have an official diagnosis?


I was undiagnosed manic for a long time. Due to my solitude (even when living at home with parents) no one noticed the times that i was sky high.

They definitely knew about the lows. As a result they adapted their behavior as to how they would communicate with me.

Firstly i got scripted Olanzapine. 10mg.
My mania continued whilst on olanzapine so it was bumped up to 10mg in the morning and 20mg at night. Yep thats right... 30mg Olanzapine per day.

Since then i have put on 12kg which is relatively significant and im in the process of trying to see if Sodium Valproate is good enough as a monotherapy to handle the mania.

Once this is established, im hoping i can try an SNRI or Lamictal if i get another wave of mania. I currently take 1000mg Sodium Valproate, 10mg olanz prn and 40mg prozac

Another reason that lamictal wasnt the first choice is because our government hasnt got it listed on the pharmceuticals benefit scheme which means it costs round $300/30days to use as opposed to* sodium valproate 100 tablet box for $5*


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## CD700 (Apr 22, 2010)

"Another reason that lamictal wasnt the first choice is because our government hasnt got it listed on the pharmceuticals benefit scheme which means it costs round $300/30days to use as opposed to sodium valproate 100 tablet box for $5"

Is it on the list if you tell some BS and say you suffer epilepsy ?
I know topamax is


----------



## A Sense of Purpose (May 8, 2011)

blakeyz said:


> "Another reason that lamictal wasnt the first choice is because our government hasnt got it listed on the pharmceuticals benefit scheme which means it costs round $300/30days to use as opposed to sodium valproate 100 tablet box for $5"
> 
> Is it on the list if you tell some BS and say you suffer epilepsy ?
> I know topamax is


Yeah, you need to be epileptic or some kind of seizure sufferer.
Aus doesnt deem it useful for bipolar or psych for that matter.

Pathetic really.


----------



## bazinga (Jun 9, 2010)

A Sense of Purpose said:


> Another reason that lamictal wasnt the first choice is because our government hasnt got it listed on the pharmceuticals benefit scheme which means it costs round $300/30days to use as opposed to* sodium valproate 100 tablet box for $5*


Is the generic, Lamotrigine, not available there?


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## A Sense of Purpose (May 8, 2011)

bazinga said:


> Is the generic, Lamotrigine, not available there?


Ill look into it but i recall only ever seeing brand name lamictal in pharmacies here. My psych also told me that it costs an arm and a leg for me due to the fact that im not epileptic. This suggests to me that its not generic. Same with the pricetag.


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## bazinga (Jun 9, 2010)

I'm not sure what pricing in Australia is like or if you have or need insurance, but with insurance, I pay $12 for 30 day supply.

I don't think the generic is all too expensive. I think it's about $22 if you use mail order. But, Jesus, I didn't realize how expensive Lamictal is. $467 for 30-day supply.


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## bazinga (Jun 9, 2010)

https://en.wikipedia.org/wiki/Lamotrigine

"Lamotrigine is also available in generic form[47] in the United States, the United Kingdom, Canada and Australia."


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## A Sense of Purpose (May 8, 2011)

bazinga said:


> https://en.wikipedia.org/wiki/Lamotrigine
> 
> "Lamotrigine is also available in generic form[47] in the United States, the United Kingdom, Canada and Australia."


Then my psych was either flat out Bs-ing me or genuinely has no clue.

Its still only indicated for epilepsy though


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## bazinga (Jun 9, 2010)

A Sense of Purpose said:


> Then my psych was either flat out Bs-ing me or genuinely has no clue.
> 
> Its still only indicated for epilepsy though


What does that mean. Does that mean you are not allowed to buy a generic because you are not epileptic?


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## A Sense of Purpose (May 8, 2011)

bazinga said:


> What does that mean. Does that mean you are not allowed to buy a generic because you are not epileptic?


I think it means that legally he cant write me a script for it regardless of whether its generic or not, because i dont suffer epilepsy.


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## bazinga (Jun 9, 2010)

Oh I see. That's a damn shame.


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## A Sense of Purpose (May 8, 2011)

bazinga said:


> Oh I see. That's a damn shame.


Same goes for Wellbutrin. Here you can only get it if you are a smoker.

But if you are a smoker with a mental health condition, they will not prescribe it to you.

Makes me so mad because i want to quit but am denied the right medication because our FDA doesnt want people with psychological disorders on stimulating meds.


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## A Sense of Purpose (May 8, 2011)

Feeling quite clear headed today. Quite a pleasant change from the past week or so.
Im hoping to get some exam study done as they are fast approaching and i dont feel prepared.


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## jim_morrison (Aug 17, 2008)

Generic Lamotrigine (100mg) was costing me about AUD$30 a month if I recall correctly and I'm not epileptic.


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> Generic Lamotrigine (100mg) was costing me about AUD$30 a month if I recall correctly and I'm not epileptic.


Really? Then ive been led astray this whole time... Misinformed even.


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## riptide991 (Feb 1, 2012)

Hey man how are you doing off the zyprexa?


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Hey man how are you doing off the zyprexa?


I have had no longer than 2-3 days at a time off Zyprexa due to using it prn for sleep. All in all the lowered dosage and less frequent use is boosting my mood which is nice.

Im not suffering any w/d symptoms like nausea which i'm really happy about.


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## A Sense of Purpose (May 8, 2011)

I've recently noticed a trend in my sleep process that ive yet to figure out the cause of. 

Ever since getting out of the psych ward i have been waking up in the middle of the night and eating (not a lot) or drinking some form of food/beverage. This time, for example is now after going to bed at 8pm and waking to do this routine.

The only thing i can link it to is either the reduction in dose of the olanzapine/valium OR perhaps its a side effect of the sodium valproate sedation wearing off.

Its quite strange as i always wake up quite 'with it' and mentally sharp with memory of any current dream. Although tonight is an exception, i usually rouse between 1-4am.

Will continue to keep a log of this additionally to the thread.

Cheers


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## A Sense of Purpose (May 8, 2011)

Drank far too much alcohol last night during a party for the moon being close.
Felt incredibly lethargic all day but no headache which was a pleasant surprise.

I definitely realize how much drinking negatively affects my overall mood.


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## riptide991 (Feb 1, 2012)

Heh humans love to celebrate everything. I mean the super moon? Gee. Any chance to get drunk really hehe.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Heh humans love to celebrate everything. I mean the super moon? Gee. Any chance to get drunk really hehe.


It is Australia. Biggest binge drinking culture on the planet...


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## riptide991 (Feb 1, 2012)

Ahh must make it hard to quit alcohol hehe


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## jim_morrison (Aug 17, 2008)

A Sense of Purpose said:


> It is Australia. Biggest binge drinking culture on the planet...


It's funny coz it's true lol.


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## riptide991 (Feb 1, 2012)

jim_morrison said:


> It's funny coz it's true lol.


You guys should drink to agreeing.


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## A Sense of Purpose (May 8, 2011)

Watch this space ...... (Australia) for the next generations of kids growing up with more anxiety disorders, alzheimers, and a bunch of other brain based impairments.


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## A Sense of Purpose (May 8, 2011)

Not sure if its the after effects of the boozy night a few days ago but my mood has been absolutely atrocious. Very self deprecating and negative. Feel like the life force has been sucked out of my very bones.

Im also skeptical as to whether Prozac is doing anything positive for me at all. If it isnt then that would explain why i feel so terrible, as Zoloft was keeping me going.

Hoping for it to do a drastic 180 so i can get some study done.


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## A Sense of Purpose (May 8, 2011)

Immensely restless and feeling down. The combination has me pacing with no relief. Ive downed my permitted meds (30mg Olanzapine, 20mg Valium and 1000mg Sodium Valproate) right now to try and quell this unrelenting urge to move whilst feeling horrible.
Feels like im going to struggle to sleep tonight...


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## A Sense of Purpose (May 8, 2011)

Still up and bouncing around off the walls. Feel really frustrated and incredibly agitated even after meds. I wish my doc could spend 5 mins in my shoes. I think then he'd be more inclined to listen to me when i talk about medication changing requests.


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> Still up and bouncing around off the walls. Feel really frustrated and incredibly agitated even after meds. I wish my doc could spend 5 mins in my shoes. I think then he'd be more inclined to listen to me when i talk about medication changing requests.


Man setup and appointment, go in there and say that your current meds are not working. They are just making you want to seek out self medication and you're even considering marijuana. Tell him while sure things may look good to him on paper, but you're living proof that they are not working and you want to try something else that may work.


----------



## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Man setup and appointment, go in there and say that your current meds are not working. They are just making you want to seek out self medication and you're even considering marijuana. Tell him while sure things may look good to him on paper, but you're living proof that they are not working and you want to try something else that may work.


I know. The reality is, he's been seeing me every tuesday/friday for the past 4 weeks and im stressing each time that improvement is non existent. On friday i will go in with a mission to get asenapine instead of olanzapine, and if that doesnt work ill try for lamictal over sodium valproate. If that doesnt work ill go for Effexor over my prozac. Something HAS to change!!


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## riptide991 (Feb 1, 2012)

Man wish you had a doctor like me. This guy just sounds like he has an ego. I think you really need to push for lamictal. If not then memantine as it's an nmda antagonist. But seriously do not leave without lamictal. Do everything in your power, beg him! Tell him you'll suck his dick haha. Tell him you feel this is your only chance at getting better and you're getting even more depressed that you can't even try it. Tell him you're thinking of going for street drugs for relief. At least my doc knows I used to do marijuana and I tell her if I get cravings hehe.


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## riptide991 (Feb 1, 2012)

Found an interesting link that pertains directly to treatments used in Australia.

http://www.australianprescriber.com/magazine/30/3/70/3


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Man wish you had a doctor like me. This guy just sounds like he has an ego. I think you really need to push for lamictal. If not then memantine as it's an nmda antagonist. At least my doc knows I used to do marijuana and I tell her if I get cravings hehe.


I do have a history of substance abuse with harder drugs. Perhaps i might have to use it as a segway into an additional reason for the need of a med change.

We all know how well cocaine helps bipolar spectrum disorder! Something a little like this....

:rain:argueopcorn:flush:bash

I just wish my pdoc was more into his drugs as therapy. He is great for cbt based therapy and changing the way i see things... Just less reluctant to take on board med published articles and radical treatment strategies.


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## A Sense of Purpose (May 8, 2011)

New day. Same headspace. Tomorrow needs to be now! My doc's gonna get it.

Forced myself out of the house to do work at uni today. It was cringe-worthy. The people everywhere, feeling anxious and depressed and agoraphobic.

Slept a total of 2 hours and 23 minutes.


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## A Sense of Purpose (May 8, 2011)

I have started getting micro sleeps (although with restlessness) but not enough to put me under. Trying to tranq myself again with olanzapine. Hope i get some decent rest!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Considering throwing some of that old Seroquel thats still lying around to see if that helps


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## A Sense of Purpose (May 8, 2011)

Getting to the point of complete physical exhaustion and wanting to crash but my brain/cns is just going haywire. I feel like valium should come in 50mg tablets. Even then relief is still marginal.


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## riptide991 (Feb 1, 2012)

You read that website I linked? Some good info there, you may choose a different drug just based on the info provided. It actually shows lamictal good for depression but not as good for bipolar. They have charts with ratings and stuff.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> You read that website I linked? Some good info there, you may choose a different drug just based on the info provided. It actually shows lamictal good for depression but not as good for bipolar. They have charts with ratings and stuff.


Im taking it printed with me to the Pdoc. Its going to be my evidence and sway for it he tries to deny me any changes. Its incredibly helpful.

Thank you


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## A Sense of Purpose (May 8, 2011)

Home from the anticipated appointment. So the plan is... start from scratch.
Doing a titration off all antidepressants (Fluoxetine goes to 20mg tomorrow) and using Olanzapine PRN for sleep in addition to valium.

Boosting Sodium Valproate to 1500mg pm to cap myself from becoming manic (as we will be changing antidepressants in the near future / SNRI).

For the meanwhile, this means i have to deal with the pacing/gym/sleeplessness/irritability/restlessness and maybe if im really lucky... hospital (again). /facepalm

Once fluoxetine is out of my system for long enough something will take its place. I hope the washout period doesnt drag on and leave withdrawal symptoms (nausea/dizziness).


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## A Sense of Purpose (May 8, 2011)

Passed out at about 7 pm for 3 hours. Guess thats better than nothing. Now what to do with the rest of the night/early morning....

Either take more sleeping meds or try and do something productive like study. Either way ill be restless doing them both.


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## riptide991 (Feb 1, 2012)

Man this guy loves his Sodium Valproate. Well hope it works out for you. What he say about Lamictal?


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Man this guy loves his Sodium Valproate. Well hope it works out for you. What he say about Lamictal?


He says one step at a time. Doesnt want to change my meds around too quickly right now because im not exactly the poster boy of stable.

He didnt rule it out for the future though. Sodium Valproate is hardly noticeable. I dont have 1 side effect at all and potentially any benefits either as im still quite agitated. Who knows?!


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## A Sense of Purpose (May 8, 2011)

I have began to notice two types of restlessness that i experience. Maybe its just one type but the day seems to vary from the night type.

During the day i can do physical things and for the most part, ill still be irritable as all hell, but the compulsion to move is sated for the most part.

Come night time irrespective of what i do, the restlessness is bad (yes i have run the block at 2:30am, gone for a drive, etc) without any relief.

I think perhaps its linked strongly to my Nervous system, because as i have explained before, i can feel relief from physical work during the day but come night my brain seems to take over and go haywire. Feels like there are things inside my body pulling in opposite directions and chaos.

I dont know if im making all that much sense. Its very difficult to describe.


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## A Sense of Purpose (May 8, 2011)

Oh and i think i've taken enough valium/olanzapine to tranquilize a small rhino in the past 48 hours. 15V/10 Olanz night 1 20V/20 Olaz night 2 30V/20 Olanz night 3.

Tonight i plan on having 50 valium and 40 olanzapine. I suspect that my body will crash horridly at some point after this cycle ive been on, (not to say that ive been up in a good way). It would be superawesomecoolfun if i could get more than 4 hours sleep!

Its so frustrating because ive had to push my exams back due to hospitalization a few weeks ago so now my supplementary exams are coming up. I guess ill have to kiss the next day or so goodbye as any form of productive study.

Ill also have that extra 500 Sodium Val*NO*ate (i feel it does nothing, hence the pun).


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## CD700 (Apr 22, 2010)

A Sense of Purpose said:


> Oh and i think i've taken enough valium/olanzapine to tranquilize a small rhino in the past 48 hours. 15V/10 Olanz night 1 20V/20 Olaz night 2 30V/20 Olanz night 3.
> 
> Tonight i plan on having 50 valium and 40 olanzapine. I suspect that my body will crash horridly at some point after this cycle ive been on, (not to say that ive been up in a good way). It would be superawesomecoolfun if i could get more than 4 hours sleep!
> 
> ...


kudos for being able to go to UNI with this ****

Can't remember if I said before but have you tried melatonin for sleep ?

It really works well. No way is it a placebo effect either because I don't suffer from that awesome placebo affliction


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## A Sense of Purpose (May 8, 2011)

CD700 said:


> kudos for being able to go to UNI with this ****
> 
> Can't remember if I said before but have you tried melatonin for sleep ?
> 
> It really works well. No way is it a placebo effect either because I don't suffer from that awesome placebo affliction


Cheers. Each day is a battle right now, but i do know things can be better, because they have been.

If melatonin mixes with the bundle of stuff im on then im more than happy to throw it in the mix. I think half my sanity is lost because of the crappy sleep cycles ive been in the past 4 weeks


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## jim_morrison (Aug 17, 2008)

A Sense of Purpose said:


> Oh and i think i've taken enough valium/olanzapine to tranquilize a small rhino in the past 48 hours. 15V/10 Olanz night 1 20V/20 Olaz night 2 30V/20 Olanz night 3.
> 
> Tonight i plan on having 50 valium and 40 olanzapine. I suspect that my body will crash horridly at some point after this cycle ive been on, (not to say that ive been up in a good way). It would be superawesomecoolfun if i could get more than 4 hours sleep!


Maybe Seroquel is a better fit than Zyprexa, the bipolar dose of seroquel (400-800mg) seems to put most people to sleep.


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> Maybe Seroquel is a better fit than Zyprexa, the bipolar dose of seroquel (400-800mg) seems to put most people to sleep.


Unfortunately i share a sensitivity to seroquel that appears as a hefty rash. It took me a while to discover it was the seroquel causing it. It was more like hives actually.

Remeron on the other hand might be an idea


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> He says one step at a time. Doesnt want to change my meds around too quickly right now because im not exactly the poster boy of stable.
> 
> He didnt rule it out for the future though. Sodium Valproate is hardly noticeable. I dont have 1 side effect at all and potentially any benefits either as im still quite agitated. Who knows?!


I don't know, to me it already sounds like you're unstable, so changing meds can make you even more unstable? How can you become more unstable than that? hehe

I'm just saying if you're not the poster boy for stable then your meds are obviously not doing anything so to keep them on is just beating a dead horse. This guy just sounds like a stubborn C-sucker.

My doctor would change meds right away if they weren't working, she wouldn't try to stabilize me on the ones that are doing nothing.

Your body is obviously not responding to these meds, they must as well be a bag of flour, but he doesn't seem to understand that. You don't just magically start responding after being on them that long.

Typically doctors raise dosage if you are showing at least some signs of response and increasing the dose may give you more response. Like when I first took Zoloft at 50mg I noticed some things pretty early on, it wasn't complete remission but it was noticeable to me, which means it's doing something. But you don't seem to have even the slightest bit of any response to these ones.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> I don't know, to me it already sounds like you're unstable, so changing meds can make you even more unstable? How can you become more unstable than that? hehe
> 
> I'm just saying if you're not the poster boy for stable then your meds are obviously not doing anything so to keep them on is just beating a dead horse. This guy just sounds like a stubborn C-sucker.
> 
> ...


I can fully understand and support what you are saying.... Its a strange relationship because he does give good advice (as in talking) focusing on other things like mindfullness and meditation (which i do). The thing is, i feel he thinks this is all because of my exams. He has been seeing me well over a year however, and has been treating me for anxiety and depression so i dont see what the difference is now.

I have tried to state to him that yes although exams and performance anxiety does affect me, this current state is still not the reason im so all over the place.

I presume he is waiting to see how i fare post exams (which is unfair as hell on me) but gives him the impetus to treat me with more specificity.

You may be entirely right in that i need to find a new psychiatrist. It just seems like an impossible mission right now with everything going on.

Its a thought that has crossed my mind though. Ive seen him bi-weekly for about 4 weeks, im not sure how i'd back out of the treatment process. I guess i could just cancel an appointment and then never show up or get back to them.

*Then there is the financial component. Currently i do not pay a single $ for a consultation. It is bulk billed even though he is a private psychiatrist. He started doing it when i ran into financial trouble which makes me think he does give a S*&^ about my wellbeing. *Im just so torn about it all and probably not in the best headspace to make a decision.

Sidenote: after that dosing of meds this evening you'd think i'd get a good nights rest.... Sigh.


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## riptide991 (Feb 1, 2012)

Oh hey, if he's saving you lots of money then that's cool stay with him. Just be more assertive with him. I know it's easy to become submissive at the doctors office. I used to be like that but now I don't take no for an answer(well sorta). I'll sit there arguing with them until they fold hehe.

And I will only fold if they make a good point. And trust me i'm not stubborn I have folded before because they brought up good points to me. So there's gotta be a bit of flexibility but with assertiveness. 

Stick with him if he's doing you the favours. Possibly be really open with him and tell him you are grateful for everything he is doing but he's not placing himself in your shoes.


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## A Sense of Purpose (May 8, 2011)

Well my argument this time was complaining of the restlessness and not getting proper sleep, but focusing on the fact that prozac seems to be doing sweet FA along with sodium valproate. This prompted a prozac ween (hopefully to an snri or zoloft+abilify) and a valproate boost. I still think the most primarily important part is getting me on a decent antipsychotic thats calming. 

I wish i coulda walked out with saphris and lamotrigine.


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## A Sense of Purpose (May 8, 2011)

About to head out into the world. Melbourne CBD. I made a pact with a friend who is helping me study that i would meet them at the state library. 

Its like PEOPLE EVERYWHERE YOU LOOK kinda thing. If i wasnt so highly strung about exams there is no way in hell i'd be leaving the house. I'd be hiding in my olanzapine and valium cave.

Then again, if i wasnt so highly strung... then i'd be a happy person. Gah.


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## A Sense of Purpose (May 8, 2011)

And while i was out studying... I went into Off Ya Tree and *got my nose pierced.*

What am i doing? I like it though.

I've added it to my tragus, an industrial and two upper ear ones.


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## riptide991 (Feb 1, 2012)

Tell your doctor that the mania makes you do things like get your nose pierced. And you were strongly thinking about buying hookers and coke.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Tell your doctor that the mania makes you do things like get your nose pierced. And you were strongly thinking about buying hookers and coke.


The funny thing is, 2 out of 3 have been done in the past 3 months. And ive never seen a prostitute. He will probly notice at my next appointment on friday.

The piercing doesnt hurt that bad. Its cartilage but still not as bad as the Industrial on my right ear.

I must admit though, i didnt have any premeditated thoughts to go and get a piercing. It kind of just happened as i walked past the shop. I didnt even give thought to what my parents would think (not that they have a problem with it).


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> The funny thing is, 2 out of 3 have been done in the past 3 months. And ive never seen a prostitute. He will probly notice at my next appointment on friday.
> 
> The piercing doesnt hurt that bad. Its cartilage but still not as bad as the Industrial on my right ear.


It's funny because buying coke is not considered the lowest common denominator, it's once you involve hookers that people look down on you. haha


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> It's funny because buying coke is not considered the lowest common denominator, it's once you involve hookers that people look down on you. haha


Sometimes i dont make the best choices. I know this. Impulsivity is strongly a part of my character, but right now there doesnt seem to be any borders.

I have abstained from the c even though at times i have considered having it. Plus im not too sure how well it mixes with antipsychotics.


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## GotAnxiety (Oct 14, 2011)

Why not getting a hooker would have a more immediate antidepressant effect then taking these med's! Go lay some pipe : D

Hookers and blow!


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## A Sense of Purpose (May 8, 2011)

Probably right in saying that. But im pretty picky so im doubtful i'd ever find one that i liked. lol


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## GotAnxiety (Oct 14, 2011)

Yeah man I just wanna get my dink suck I'm sure that will make me happy lol.

Happiness in the good ol fashioned way.


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## A Sense of Purpose (May 8, 2011)

So after 2g of Epilim last night i didnt really notice much of a difference today (with regard to restlessness). At least i dont regret my piercing....yet. 

Feeling very tingly in the brain today... kind of like what i imagine a seizure to actually feel like if one was about to start..

Sapped of energy in my periphery but my trunk/spine/brain feel like they are on a battery charger.


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## A Sense of Purpose (May 8, 2011)

Exam in 1 day and i barely know the content. Ive been revising like mad (or trying to concentrate) and even caught up with a study friend but i have zero confidence in this.

There is so much to know and im not going to be able to cover it. There are criteria that pass or fail you because it is a scenario exam. Its not your 'walk in and get 51' kinda thing. 

Starting to feel nauseous as a result of being in fight or flight mode for so long.

%*^&
$^%$
&*%$


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## A Sense of Purpose (May 8, 2011)

Just took two Anagraine tablets in hope that it quells the nausea.

Not too sure how good it is for you while taking an antipsychotic though...


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## riptide991 (Feb 1, 2012)

Just relax with the valium for exams as I hear it can mess with memory. Propranolol may even help with keeping you still heheh.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Just relax with the valium for exams as I hear it can mess with memory. Propranolol may even help with keeping you still heheh.


If i dont dose _some_ valium i wont sleep the night before (not that im really sleeping properly anyway) but i feel it will be even worse quality.

Losing a losing battle at the moment. I guess i can be happy i dont have a cold. That would just top it all off


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> If i dont dose _some_ valium i wont sleep the night before (not that im really sleeping properly anyway) but i feel it will be even worse quality.
> 
> Losing a losing battle at the moment. I guess i can be happy i dont have a cold. That would just top it all off


Oh the night before is probably fine, I meant like during the exams hehe.


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## A Sense of Purpose (May 8, 2011)

So im now just shy of 24hours before this exam and im so nervous. Before i was just restless, agitated and depressed, but now im actually feeling nauseous, jittery and shaking.

I dont know how to pass the hours, because i have huge anticipatory anxiety about looking over my notes for revision because it will just prove to me how much i dont know.

So im left with time to kill and nothing to do. This is the worst combination of feelings/mental/physical status i think i have ever had.

I just want to quit, leave uni and run far far away somewhere


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## gilmourr (Nov 17, 2011)

A Sense of Purpose said:


> So im now just shy of 24hours before this exam and im so nervous. Before i was just restless, agitated and depressed, but now im actually feeling nauseous, jittery and shaking.
> 
> I dont know how to pass the hours, because i have huge anticipatory anxiety about looking over my notes for revision because it will just prove to me how much i dont know.
> 
> ...


This is essentially why I've told fam that I know when I'm good to go back to school. To go through university with an untreated mental health disorder is so stressful. I had a huge tax exam postponed 3 times and my prof didn't understand how I never had the time to study even though I told him I had major depression. It's torture. To try and be mentally alert and focused when you have such ****ing issues is ridiculous.


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## A Sense of Purpose (May 8, 2011)

gilmourr said:


> This is essentially why I've told fam that I know when I'm good to go back to school. To go through university with an untreated mental health disorder is so stressful. I had a huge tax exam postponed 3 times and my prof didn't understand how I never had the time to study even though I told him I had major depression. It's torture. To try and be mentally alert and focused when you have such ****ing issues is ridiculous.


I feel so much pressure to perform at a high level and carry my Distinction/HD average from my previous course. Im in no state to do it. Im literally so scared about tomorrow i _feel_ unwell.

I know if i run away from it then ill hate myself for not giving it a shot. Im stuck in a vortex of catch 22.

Also if i do not pass tomorrow, i have to wait until this time next year to resit the exam, as well as do the subject again. So much time hinges on this too. /huff


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## A Sense of Purpose (May 8, 2011)

So i've managed to spend the day doing some exercise and maybe 30 minutes of actual study/looking at notes. Im dosed up and hoping to get a decent nights rest for the exam. Im worried because im so tempted to walk out of the exam room and not sit the scenario. Its at the forefront of my thoughts. 

I also keep ruminating about catastrophic events that might delay or remove me from the condition of sitting the exam. So much so that i want my mum to drive me in so i dont have any impulsive or risky temptations to do something silly.


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## riptide991 (Feb 1, 2012)

Dude hold in there, you will pass the exam and do a good job! Once you're doing it you will be like "oh hey I know this" and before you know it you're handing it in and getting ready to go home.


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## Coontra (Jul 2, 2013)

My doctor put me on Lamictal because he thought I may have some symptoms of bipolar II, however, I don't think the medication does much for my anxiety.

Last time I went in, he upped my dosage from 100 mg to 200 mg. I asked him if he had heard of Nardil (I've heard nothing but good things, sans the side-effects). He told me he had heard of it, and he would be willing to consider it if the Lamictal still did nothing for me after upping the dosage. Here I am a month later, and still no noticeable changes.

Any thoughts?


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Dude hold in there, you will pass the exam and do a good job! Once you're doing it you will be like "oh hey I know this" and before you know it you're handing it in and getting ready to go home.


Its a 3 person live scenario that takes 1.5 hrs. You work as a group of three to assess an accident and how you would respond as the paramedic. Thanks for the positive vibes though



Coontra said:


> My doctor put me on Lamictal because he thought I may have some symptoms of bipolar II, however, I don't think the medication does much for my anxiety.
> 
> Last time I went in, he upped my dosage from 100 mg to 200 mg. I asked him if he had heard of Nardil (I've heard nothing but good things, sans the side-effects). He told me he had heard of it, and he would be willing to consider it if the Lamictal still did nothing for me after upping the dosage. Here I am a month later, and still no noticeable changes.
> 
> Any thoughts?


I myself am not familiar with lamictal as i've yet to try it. Its on my wishlist however. There are a few members on here that use it and may be able to inform you of its therapeutic action time and if it does do anything for anxiety.

My understanding is that it works to prevent the depressive phase of bipolar, without affecting manic or anxious tendencies. You may need an antidepressant as well or another mood stabilizer like lithium or sodium valproate to get anxiety relief.


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## A Sense of Purpose (May 8, 2011)

I have some (surprisingly) fantastic news. Top 3% for the scenario exam i did today. Still feel like balls, but im just blown away that i was able to perform on the spot.

I guess this is the impetus i need to confirm to my doc that its not exam related and actually is confirmed that i am in a mixed state.


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## jim_morrison (Aug 17, 2008)

Congrats on the exam results! Regarding the restlessness, I forgot to ask, did your Dr suggest Cogentin? Usually one of the most effective treatments as far as I'm aware.


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> Congrats on the exam results! Regarding the restlessness, I forgot to ask, did your Dr suggest Cogentin? Usually one of the most effective treatments as far as I'm aware.


Thank you. The examiners were aware of my condition and said "well if this is you operating at 60% capacity we will be extremely interested to see how you go when you feel better".

I think he feels its triggered by exam study (but i know its not because this all started way before exams were even a conscious thought) and doesnt want to add too many things to the mix.

He saw me tapping/shaking in his room, decrease to tears, and also have pressured speech. This exam hasnt changed my symptoms, so i think he will now understand that some pharmacology has to change. Cogentin is something i will bring up, or trihexyphenidyl.


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## riptide991 (Feb 1, 2012)

Told you you'd ace it!

Man I know how you feel like with your episodes, this morning woke up at 4am and have not been able to go back to sleep. Hopefully this is a temporary adjustment as I upped the dose to 50.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Told you you'd ace it!
> 
> Man I know how you feel like with your episodes, this morning woke up at 4am and have not been able to go back to sleep. Hopefully this is a temporary adjustment as I upped the dose to 50.


I hope all goes well with your titration phase. Don't be too hasty or slow


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## A Sense of Purpose (May 8, 2011)

Finally crashed out yesterday at about 12am. Think my body was so fatigued due to adrenal overload and previous bad nights sleep that everything just shut down.

Feeling really restless again today, not nervous but still agitated. This needs to be fixed and im going to explain this to my doc tomorrow. Im going to flat out tell him that something needs to be changed because i cant continue on feeling like this. Its perpetuating self harming thoughts and is preoccupying every minute that im conscious.

I just feel like i need to move, drive a car at high speed, ride my motorbike, do something that is energising or that can convert this restlessness into something.


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## A Sense of Purpose (May 8, 2011)

Going to the psych today. Ill be requesting Pristiq and/or Lamictal for both mood and restlessness. Perhaps maybe abilify but im unsure whether it will agitate me further or relax me. Failing that, ill ask for Saphris.

Hope the meeting is worth while and i walk away with something


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## riptide991 (Feb 1, 2012)

Hey, hope it goes well. 

I think if it was between abilify and saphris, I would go with saphris. I wanted to switch zyprexa to it but it was too expensive. Abilify did make me restless, and it's done so to many others as well so it could make your current symptoms worse.


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## A Sense of Purpose (May 8, 2011)

Just got back from the docs. We have decided to wash prozac out, therefore i will no longer be on an antidepressant for the next two weeks.

After that time i presume he will let me try a SNRI or other medication. It seems vary clear to me that he wants to cover his *** by not scripting something now after being on prozac because of its super long clearance time.

More agitated waiting for me which is always a whole bunch of fun.


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## riptide991 (Feb 1, 2012)

Man I want to smack your doctor. It's not like you're going on a MAOI haha, unless that's what he plans. But yah most doctors just switch you from one SSRI to the other with no issues. Next time ask for some propranolol, like at least 40mg pills to help with the physical portion of restlessness. It will really calm your body down if you feel restless. At least, it should hehe.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Man I want to smack your doctor. It's not like you're going on a MAOI haha, unless that's what he plans. But yah most doctors just switch you from one SSRI to the other with no issues. Next time ask for some propranolol, like at least 40mg pills to help with the physical portion of restlessness. It will really calm your body down if you feel restless. At least, it should hehe.


Its really frustrating considering that when i was in hospital, then took me off 200mg of Zoloft and put me on to 60mg of Prozac within 1 day. That was fine and i didnt have any issues!


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## A Sense of Purpose (May 8, 2011)

Still not sleeping at all. Its getting to the point where im having micro sleeps and dreams are getting confused with reality. Its very disconcerting and strange.

Just need to survive this prozac washout and then i can start Pristiq.


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## A Sense of Purpose (May 8, 2011)

Feeling pretty vague today. Rather a strange feeling. I feel like i should be doing something but cant muster the energy into a useful productive task.

Im guessing its because prozac is helping me wash out from zoloft, and prozacs metabolite is helping me wash out from prozac. So its a double action thing i guess.

Nose piercing is starting to calm down and isnt swollen any more. Yay.


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## A Sense of Purpose (May 8, 2011)

Still in a very vague state of mind. Tried to get some sleep as i thought i might be crashing from this perpetual insomnia. Got a few hours down which is better than none. 

I find it frustrating though because if i cant study productively and try doing something else i feel guilty. Right now for example, im running out of ways to kill time until i regain focus so i can concentrate.


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## A Sense of Purpose (May 8, 2011)

Feeling quite nauseous again today. Im having trouble working out whether its due to anxiety or if i have a cold/virus. Im inclined to think that its anxiety because its transient.

Trying to concentrate on studying for exams is just the worst. I know this is not news to everyone but when you are compromised to begin with its just the worst.


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## riptide991 (Feb 1, 2012)

Yah that blows man. Thought you were done the exams? I would not be able to study or remember anything in the state I am now.

Ugh i'm not sleeping either and it's getting to me. Been up since 3am, going to take Remeron tonight.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Yah that blows man. Thought you were done the exams? I would not be able to study or remember anything in the state I am now.
> 
> Ugh i'm not sleeping either and it's getting to me. Been up since 3am, going to take Remeron tonight.


No, you see i was hospitalized in week 9 of the semester and fell too far behind. They didnt even let me use a pen in the ward.

I got approval for supplementary exams which are 1month after the proper ones. So ive got 1 down and 3 to go. Im so close to breaking point. I go for mid night drives, pace around. *I AM the definition of restless.*


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> No, you see i was hospitalized in week 9 of the semester and fell too far behind. They didnt even let me use a pen in the ward.
> 
> I got approval for supplementary exams which are 1month after the proper ones. So ive got 1 down and 3 to go. Im so close to breaking point. I go for mid night drives, pace around. *I AM the definition of restless.*


Ahh well good luck! Seriously man try propranolol for the restlessness. Ask for 40mg twice a day!



> Motor restlessness has been proposed as the possible result of an imbalance between the central dopaminergic and β2-adrenergic systems. The improvement in akathisia from propranolol could thus be due to the β2 blocking property of propranolol.
> A blinded study has shown propranolol to be more efficacious than lorazepam in neuroleptic-induced akathisia.
> Furthermore, the low doses of propranolol used to treat akathisia do not significantly affect blood pressure
> 
> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1192441/


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## A Sense of Purpose (May 8, 2011)

Will do. I have an appointment on thursday so ill bring it up then. Ill also try and persuade him to let me start pristiq a week early.


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## A Sense of Purpose (May 8, 2011)

So after rummaging through my medications bag from a while ago i found some propranolol that my neurologist prescribed me when i had a bad bout of migraines.

Im going to try some today to see if it helps with the restlessness.


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## A Sense of Purpose (May 8, 2011)

Unfortunately my trial with propranolol has seemed ineffective so far. No marked improvement on the restless side of things. I have taken 80mg today (40 morning, 40 afternoon).


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## riptide991 (Feb 1, 2012)

Damn that sucks 

BTW have you tried low dose remeron just for sleep? I took 15mg last night and it knocked me out. I slept 14 hours and im still sort of tired and out of it hehe. I mean this stuff is great if you want sleep.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Damn that sucks
> 
> BTW have you tried low dose remeron just for sleep? I took 15mg last night and it knocked me out. I slept 14 hours and im still sort of tired and out of it hehe. I mean this stuff is great if you want sleep.


Yeah i have some remeron left over from when i was on it. I have tried it but it seems to make little difference. Ive discovered that seroquel is a no no because of this strange rash i get from it.

Im going to ask him for some more Zopiclone when i see him thursday. Maybe that will do the job


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> Yeah i have some remeron left over from when i was on it. I have tried it but it seems to make little difference. Ive discovered that seroquel is a no no because of this strange rash i get from it.
> 
> Im going to ask him for some more Zopiclone when i see him thursday. Maybe that will do the job


Zopiclone may help but if not maybe combine zopiclone with Remeron 7.5mg - 15mg. Man if remeron can't get you to sleep it must be bad. I mean this stuff knocks me out. I also have the disintegrating type that you hold under your tongue and then swallow.

Edit:

Oh yah I also take 3mg of melatonin every night, so could be the combo of melatonin/remeron works well who knows.


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## A Sense of Purpose (May 8, 2011)

Its time to find a new doctor. Im sick of this Bullsh!t


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> Its time to find a new doctor. Im sick of this Bullsh!t


Fill us in on the story!
What happened?


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Fill us in on the story!
> What happened?


So ive walked out (yet again) with no changes to my medication regimen, and told that i need to exercise more and practice more 'mindfullness' techniques.

I said i wanted a change to x,y,z (asenapine, lamotrigine, maybe pristiq) and he told me i need to stop looking things up and reading into medications. Said that i focus too much on it and all the literature on the net is 'bs'.

He said in 1 weeks time he'd consider changing something as that will be a complete 2 weeks of washing out from prozac. I dont think im going to return.

Man im p'd off.


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## jim_morrison (Aug 17, 2008)

A Sense of Purpose said:


> So ive walked out (yet again) with no changes to my medication regimen, and told that i need to exercise more and practice more 'mindfullness' techniques.
> 
> I said i wanted a change to x,y,z (asenapine, lamotrigine, maybe pristiq) and he told me i need to stop looking things up and reading into medications. Said that i focus too much on it and all the literature on the net is 'bs'.
> 
> ...


Sorry to hear that, you were obviously suffering and he should have done more. Maybe he doesn't like x,y,z, but he should have offered a solution beyond behavioral modification tips.

Sometimes I don't understand psychiatry, they seem to either want to load a person up on 800mg of seroquel or else they suggest yoga and relaxation (hyperbole), it's like there's no middle ground left.


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> Sorry to hear that, you were obviously suffering and he should have done more. Maybe he doesn't like x,y,z, but he should have offered a solution beyond behavioral modification tips.
> 
> Sometimes I don't understand psychiatry, they seem to either want to load a person up on 800mg of seroquel or else they suggest yoga and relaxation (hyperbole), it's like there's no middle ground left.


I feel so frustrated and that im not being taken seriously. I also feel as though he is intimidated by the fact that i can rattle off drug names and their mechanisms. Even so that should not impact a proper therapeutic relationship. I dont know what to do.


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## A Sense of Purpose (May 8, 2011)

So im fighting on a daily basis with my parents. This just seem to be at the lowest of lows in forever. Im feeling pretty helpless on top of all the other crap thats going on. 

Valium and sleep (when i get it) are my most favorable periods of existence. I just want it all to go away.


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## gilmourr (Nov 17, 2011)

A Sense of Purpose said:


> So im fighting on a daily basis with my parents. This just seem to be at the lowest of lows in forever. Im feeling pretty helpless on top of all the other crap thats going on.
> 
> Valium and sleep (when i get it) are my most favorable periods of existence. I just want it all to go away.


I hear you there. Sleep is the best part of my day atm until something kicks in. It sucks that you have to fight people off constantly. Have you not tried Lamictal yet?


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## A Sense of Purpose (May 8, 2011)

gilmourr said:


> I hear you there. Sleep is the best part of my day atm until something kicks in. It sucks that you have to fight people off constantly. Have you not tried Lamictal yet?


I want to try it desperately yet have been knocked back on several occasions, just like with the saphris. :sigh


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> I want to try it desperately yet have been knocked back on several occasions, just like with the saphris. :sigh


Continue going to him see what he will do, and in the meantime look for a new doctor. Google doctors around your area, call/email them with your situation and see what they say. He can at least continue giving you the current meds while you look for a new one.


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## A Sense of Purpose (May 8, 2011)

I have some good news finally.
I think i've found my new psychiatrist! After a few hours of sifting and searching through lots of different and dead ended sites i found a very promising one.

As read from his profile 
_
'BioAdult psychiatrist with a special interest in bipolar disorder, difficult to treat depression, ADHD and psychopharmacology.
I am a strong believer in trying to minimise medication side-effects to enhance compliance. I also advocate exercise, good quality fish oil, and where appropriate other vitamins and light therapy (phototherapy) in combination with the lowest possible doses of standard psychiatric medications .
I am also interested in the interface between general medicine & psychiatry in particular how mild thyroid disease can affect mood symptoms.'_

Interestingly from my mothers side, there has been a long lasting issue with thyroid dysfunction. However, this has yet to show up in any of the formal tests that ive had in regards to its function.

This really makes me feel a little better about the situation.


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## CD700 (Apr 22, 2010)

" lowest possible doses of standard psychiatric medications ."
That bit would turns me off


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## A Sense of Purpose (May 8, 2011)

CD700 said:


> " lowest possible doses of standard psychiatric medications ."
> That bit would turns me off


I think he means greatest therapeutic level with the lowest possible dose and thus minimal side effects. I wont know till i meet him however.


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## A Sense of Purpose (May 8, 2011)

Brief update time.

Headed for my potentially last appointment with my current psychiatrist. I am awaiting ANY change to the BS he's been recommending me (meditate more, mindfullness, exercise) instead of changing the medication which is doing nothing for severe restlessness, agitation, irritability, insomnia, rapid mood changes (none good) and decreased appetite.

As i have completely washed out of prozac by now, im going to ask him what his 'master plan' is for me pharmacologically. If he has nothing useful or anything to come up with i will be making a swift transition to a psychopharmacologist/psychiatrist i have already sourced but need a referral to.

Im crossing my fingers he pulls his finger out and actually grants me some sort of therapeutic treatment for this *hypo/mania that i've been in for close to 2 months now. *

Its destroying my friendships, preventing relationships and f'ing up my home situation.

Regards,

ASOP


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## A Sense of Purpose (May 8, 2011)

So i guess i can say that ive had partial success. After months of battling for a change my doctor finally prescribed me *Lamictal* in hope that it will help level me out.

He really strongly wanted to put me on Lithium again but i told him i wasn't going to take it as the side effects i experienced from a prior trial were unacceptable.

Im to start at 25mg and slowly titrate up. Ill also use Olanzapine 10mg wafers for acute agitation, but not daily due to its weight gain effects.

Im hoping that the Lamictal daily in combination with PRN Olanzapine will be enough to keep me grounded and sane. I also will still be taking 10mg valium and valium prn for panic attacks.

We decided due to edema, that sodium valproate (as well as the fact that it was doing sweet FA) will be stopped.

If depression is still an issue in months to come we will look at reintroducing Zoloft at a low to medium doseage (75-100mg) as it has worked well for me in the past.

Overall i guess im happy with the outcome and will continue to update regularly.

ASOP


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## riptide991 (Feb 1, 2012)

Woo finally man. I hope this one works for you.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Woo finally man. I hope this one works for you.


It is a positive step forward i feel.
I'm going to titrate very slowly and try not to tax my body with too many prescribed drugs and do my best to qualitatively evaluate the effects (hopefully positive) that it will have on me.

Failing Lamictal i can always go back to the dreaded Lithium and Olanzapine combination, however its effectiveness was not optimal and the side effects were out of control.

Either way, i feel like an actively positive process is underway, that i have SOME mastery over my therapy and hope it brings relief.


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## A Sense of Purpose (May 8, 2011)

Feeling extremely hypomanic right now. SO excited but confused and very nervous. Im going out tonight to celebrate finishing some tough exams (or at least this period).

I feel so...... strange. Like a Good storm is happening inside my whole body.

Im currently on NO medications except valium because my doc wants me to wash out the Sodium valproate before starting lamictal. Maybe this is why im feeling really good.

Hoping to pick up tonight XD in this mindset im extremely prosocial because everything feels great. Feels like im on the class A's again!

I start lamictal in 3 days time. Till then i guess rock n roll with it. Not complaining


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## A Sense of Purpose (May 8, 2011)

In a complete 180 from yesterday, im starting to feel rather ill.

I think it is because the half life of prozac is so long, that only now its starting to clear my system. Im feeling dizzy, sweating, stomach issues and nausea. Possibly mixed state still but im not sure. Its been about 3 weeks since my last Prozac dosage.

Ugh. Just let me start lamictal already and post ssri use side effects f... off.


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## A Sense of Purpose (May 8, 2011)

Day 2 of the same thing. Seems now i can completely say its the prozac withdrawal. Coming off 200mg of zoloft that was then switched to 60mg prozac will do that to you i spose. Hoping this wont last longer than a week but im a bit pessimistic from what ive been reading about w/d length on the net.

O well. Just have to sit and wait till i feel good enough to start Lamictal.


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## A Sense of Purpose (May 8, 2011)

Took 10mg of Olanzapine last night with valium in hope to get a decent nights sleep.
It also has serotonergic 5ht-2a properties so i presume it would help with the prozac withdrawals.

Needless to say i feel a lot better this morning. No nausea or dizziness yet and dont feel as irritable.

Still going to wait a few days to start Lamictal just incase the withdrawals come back.


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## A Sense of Purpose (May 8, 2011)

Decided to start dosing Lamictal now. I know i said that i wanted to wait for the side effects/withdrawals to stop from the other drugs, but im losing time.

Semester 2 starts in 2 days and i cant afford to hold back on treatment as Lamictal can take up to a few months to start working let alone it has to be slowly titrated from 25mg to 100-200mg.

Hoping nothings going to go wrong. Might continue to take small amounts of olanzapine if i get the waves of nausea/dizziness.

Wish me luck on my lamictal journey! Its pretty much my only mood stabilizer hope apart from high dose lithium (yuck).


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## anxietyhater (Jul 21, 2013)

*I just joined this SAS Forum. First post, and I've never joined a forum before!*



A Sense of Purpose said:


> I have some good news finally.
> I think i've found my new psychiatrist! After a few hours of sifting and searching through lots of different and dead ended sites i found a very promising one.
> 
> As read from his profile
> ...


IT'S GREAT TO KNOW I'M NOT THE ONLY ONE STRUGGLING WITH ANXIETIES,, BOTH SOCIAL AND PANIC ATTACKS. I'VE NOW BEEN DIAGNOSED AS ADD. AND BIPOLAR. No one was surprised that I was BIPOLAR. Ive always had anxiety -I remember hating school. I never felt like I fit in. I always just thought I was weird.

But now anxiety has taken over my life. I was learning to deal with some of my anxieties and paranoia when I broke down years ago and was put on Paxil. But it didn't change how worthless I felt. Now I have a choking disorder that causes anxieties of dying. I almost died in front of my two girls, and I couldn't function after that anxiety attack.

The doctor put me on clonazepam (similar to xanax ), and I have now become addicted to it. And I want to stop abusing the medication, but then part of me doesn't, because for the first time, I can feel better...other times I just feel worse. I hate myself even more for being a drug abuser.

I also take Adderal and Effexor and they want me to take Risperdone, but it makes me feel even weirder...if that's possible. Thank you to everyone who shared their heartache. (wanting to die rather than feel like this... But I'm a mother. of a 17yr old and a 24yr old in grad school.... My 17yr old has this same disorder. But I wld never do that to them. That's the only reason I go on living this prison like life.

Anyway thank you for letting me know I'm not just a lonely freak....lol
Kathy


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## loophole (Apr 15, 2012)

Prozac scares the crap out of me... Reg Dr gave that to me. And I went psychotic on it.... Literarly... Dr said that's a tale tale sign of having a possible disorder.... Was put on Kpins and Lamictal... And now I've not been a complete a hole to my wife. Which is good but I'm in a hole of manic depression.. Dr. Added serequel. Starting to take that is like being dropped into a coma... That should only last a few weeks supposedly then it should be an uplifting experience... I really hope so.... On day 6 now at 150 moved up from 50 mg on day 5...


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## A Sense of Purpose (May 8, 2011)

anxietyhater said:


> IT'S GREAT TO KNOW I'M NOT THE ONLY ONE STRUGGLING WITH ANXIETIES,, BOTH SOCIAL AND PANIC ATTACKS. I'VE NOW BEEN DIAGNOSED AS ADD. AND BIPOLAR. No one was surprised that I was BIPOLAR. Ive always had anxiety -I remember hating school. I never felt like I fit in. I always just thought I was weird.
> 
> But now anxiety has taken over my life. I was learning to deal with some of my anxieties and paranoia when I broke down years ago and was put on Paxil. But it didn't change how worthless I felt. Now I have a choking disorder that causes anxieties of dying. I almost died in front of my two girls, and I couldn't function after that anxiety attack.
> 
> ...


Thanks for your input. Days ...weeks...months can be very difficult with this disorder. I cant imagine the stress of being a parent, i can barely look after myself at times. You must have a decent bit of inner strength to be in that situation.

I can definitely relate to the school situation. I never belonged to a click or group but seemed to float between lots of different ones. Never had any solid friends until school finished which is quite ironic in itself.

Take care.


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## A Sense of Purpose (May 8, 2011)

loophole said:


> Prozac scares the crap out of me... Reg Dr gave that to me. And I went psychotic on it.... Literarly... Dr said that's a tale tale sign of having a possible disorder.... Was put on Kpins and Lamictal... And now I've not been a complete a hole to my wife. Which is good but I'm in a hole of manic depression.. Dr. Added serequel. Starting to take that is like being dropped into a coma... That should only last a few weeks supposedly then it should be an uplifting experience... I really hope so.... On day 6 now at 150 moved up from 50 mg on day 5...


Hopefully the seroquel will settle in your system and allow you to wake up less tired. It did for me which was great. The only reason i went off it was because it was giving me a rash/hives the longer i was on it. At first it looked like mosquito bites but then went more towards full blown hives. Wasnt that pleasant.

I too can become very difficult to live with when im hypo/depressed. Countless fights with my parents at home over stupid things... Some felt very justified to me, others were irrational now that i look back. Its a rollercoaster of sometimes good and a lot of bad (at least for me).


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## A Sense of Purpose (May 8, 2011)

So after a very short holiday break between semesters (3 days as opposed to the 3 weeks everyone else got) due to supplementary exams (delayed exams because i was unwell) i had my first day back for semester 2.

I had 3 panic attacks today at uni. I feel this overwhelming sense of impending doom and have been incredibly anxious and worried. I still hold the contention that its prozac withdrawals, however it may also be because i reduced my valium dosage at night. 

Today was so stressful i cant begin to describe it. I feel like i havent had enough time to wind down from exams (3 days isnt enough of a break) and all the assessments that i was told about today for the upcoming semester just made me freak. It still feels like exam mode to me so everything has a huge value of importance that i cant seem to rationalize. 

Even small tasks like online quizzes we have to do have sent me into a spin, let alone the essays and placement that we will get given and be due shortly.

All i can say is i hope to hell lamictal starts kicking in or i fear that im going to have to get back onto olanzapine or up my dosage of valium.

In and out

ASOP


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## riptide991 (Feb 1, 2012)

Damn man, I wouldn't be able to pull off what you are pulling off so you're definitely stronger willed than I am. heh

Are you supposed to raise your dose of lamictal eventually? Are you taking standard or extended release? 

I may add this one eventually so want to know as much as possible about it.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Damn man, I wouldn't be able to pull off what you are pulling off so you're definitely stronger willed than I am. heh
> 
> Are you supposed to raise your dose of lamictal eventually? Are you taking standard or extended release?
> 
> I may add this one eventually so want to know as much as possible about it.


Im not going to lie. Its been pure hell. I thought once those exams would be over i'd get a sense of accomplishment and confidence boost. Unfortunately it hasnt been that way. Im going to take it day by day and promised myself that im going to stay in the course until week 3. If still by that time im still suffering as much or there has been little improvement ill most likely consider deferring my course and taking some time off.

Im registered with the disability service at my uni for having bipolar depression and am able to take special consideration for things like assessment and leave (if i am suffering medication side effects, panic attacks, or dysphoric mood.

Im currently on 25mg of the standard Lamictal and will be seeing my psychiatrist for (most likely) a dosage increase to 50 (he's conservative) but if 75 is possible ill shoot for that.

Ill keep you posted. Right now i think im going to just suck up any potential addiction to valium and use it when needed during the day. I can always slow taper at some point as i dont see any harm in trying to improve the current situation even if that means taking more valium.


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## A Sense of Purpose (May 8, 2011)

After a 2 weeks of pure hell (nausea, irrational and overwhelming anxiety, panic attacks etc) while being at uni, ill get to see my psych tomorrow.

Something needs to change. Im either withdrawing from prozac...olanzapine...or sodium valproate. I dont know which it is but i feel f..... awful.

Im guessing he'l either throw me back on a low dose of Olanzapine as it acts well for the nausea and seems to make my symptoms better, or get me to take a very low dose of prozac to see if these symptoms abate.

Im also likely to get a lamictal dosage raise.

Will update tomorrow.


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## A Sense of Purpose (May 8, 2011)

Saw the doctor. What a relief. He recognized all the signs and issues ive been having and was able to offer a plan.

I have been dealing with:

-nausea
-panic attacks
-excessive sweating
-no appetite (lost 4kg in less than 1 week)
-extreme and persistent anxiety
-constant heart rate of 110+
-Blood pressure over 140
-Feeling of extreme terror / feeling like something bad is about to happen
-Insomnia

These all may be a result of prozac withdrawals or Olanzapine withdrawals. Im about to go into second week uni and need to be as functional as possible.

The plan is as follows:

-Prozac 20mg AM
-Valium 10mg AM + 10mg PM
-Lamictal 25mg PM
-Olanzapine 5mg PM

He said this should combat the nausea, reduce the withdrawals, and allow me to function under less stress. It will also reduce my base anxiety and should allow me to regain my appetite so im not eating 1 meal a day.

I see him again in 3 days time for a review.


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## riptide991 (Feb 1, 2012)

I had pretty bad nausea during my olanzapine withdrawal. So that could be it! It is after all an antiemetic.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> I had pretty bad nausea during my olanzapine withdrawal. So that could be it! It is after all an antiemetic.


Yeah i feel as though coming off 10mg with no taper wasnt the smartest choice by my doc. Im feeling way less horrible today. Little bit anxious and zoned out.

Had a decent nights sleep so that was brilliant.


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## A Sense of Purpose (May 8, 2011)

Its nice to feel functional again!
The nausea, sweating and headaches have gone since 2 days of dosing.

Still a little anxious but much better than i was 2 days ago. I cant quite work out where my mood is, but im definitely better off with these medications. 

My next appointment is tomorrow to evaluate how the changes have affected me. I may possibly stay on this combination until Lamictal gets raised to its max potential.

Until then im content with being able to eat food again and feel a little less stressed.


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## A Sense of Purpose (May 8, 2011)

Small update:

Im feeling so much better since being on the meds. The withdrawals seem to have dissipated and im actually noticing a significant mood boost. Im not sure if its the addition of prozac to the regimen again or if its the olanzapine but something is working wonders for my system.

Im now on 50mg of lamictal and going to titrate up to 200-400mg. Im really excited about feeling 'well' again and things seem a lot less stressful. 

In a few weeks time ill swap the prozac for Zoloft and probably be on 100mg soon.

#tag Feeling great


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## A Sense of Purpose (May 8, 2011)

A little update:

Things have been going really well as of late. I have been able to get out of bed and go to uni without feeling depressed or anxious to the point of feeling sick.

Im getting a lamictal dose bump on monday and am looking forward to hitting the therapeutic dosage of 150+. My doc mentioned that i could go as high as 400mg/day if need be.


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## riptide991 (Feb 1, 2012)

Freaking awesome. Hope it continues to go good and remain stable. Then you can say to the doc "told you so".


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Freaking awesome. Hope it continues to go good and remain stable. Then you can say to the doc "told you so".


I tell you what. Its been a war and a half to get this regimen prescribed (especially lamictal) and several months of sheer horror, but yeah what goes down must come back up at some point, and i finally feel that im hitting that correct balance between being too low or manic.

Closest to baseline ive felt in probably 4 months.


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## loophole (Apr 15, 2012)

Yr and a half and still haven't gotten it right on meds. Lots of patience. Takes some 5 to 7 years...


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## A Sense of Purpose (May 8, 2011)

loophole said:


> Yr and a half and still haven't gotten it right on meds. Lots of patience. Takes some 5 to 7 years...


Sorry to say but i hope you're wrong...
I've probably had bipolar since i was 19 when things started to go wrong, but my mood swings and mania were so far apart and i wasnt cycling half as fast as i have been lately that it was difficult to diagnose and thus, get the right treatment for it.

I think I was a critical capacity just last month. Very close to hospitalisation (in hindsight it may have been a better idea than suffering intensely for 2 weeks).

Right now Im feeling really good. Im currently on 75mg Lamictal with 5 olanzapine and 20 prozac. I dont have any sexual dysfunction and my anxiety is under control with valium. Right now i cant ask for much more. 
I have also noticed being much more articulate with my words and sentences form seamlessly in my head as im talking to people. I actually feel cognitively enhanced.

I am very content.


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## A Sense of Purpose (May 8, 2011)

Currently suffering from a seasonal cold. Bought some Pseudoephedrine 30mg tablets from the pharmacy but im unsure whether or not i should take them.

I dont want to mess up this good streak of feeling well by risking hypomania/mania, but this cold sucks!!!

Hmm decisions decisions.


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## loophole (Apr 15, 2012)

Take the meds. You'll be fine. Not a whole lot of interaction in most cases... Just stay positive. Don't let us mind drive ya down with a negative thought.. Easier said then done I know


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## A Sense of Purpose (May 8, 2011)

Turns out taking pseudoephedrine wasnt such a good idea after all. I feel like im crashing majorly today... Dysphoric, anxious and irritable. Hope this is just a 1 day side effect and that i havent screwed my meds ability to work.


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> Turns out taking pseudoephedrine wasnt such a good idea after all. I feel like im crashing majorly today... Dysphoric, anxious and irritable. Hope this is just a 1 day side effect and that i havent screwed my meds ability to work.


That sucks, i'm sure you'll be fine. Stick with an analgesic like ibuprofen for any pain and just sit colds out. Let your immune system do its job.


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## A Sense of Purpose (May 8, 2011)

Small update:

I seem to have leveled back to my original self after 4-5 days of feeling crap due to the pseudoephedrine. 

I saw my doctor on monday and we decided that its best i stop taking Prozac as i have NO appetite and can barely eat anything. I can go the whole day without feeling the slightest bit hungry. Im losing weight quite rapidly even with Olanzapine.

Next monday ill be starting Zoloft again, as its the only med that has had potent effects on my depression.

Ill also be escalating the dose of lamictal to 50mg twice a day. I look forward to reaching a therapeutic threshold for lamictal (200+ range).


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## A Sense of Purpose (May 8, 2011)

Weighed myself today. Its scary because when i was on Lithium/Sodium valproate just 4 weeks ago, i weighed in at 83kg. Im now sitting at 70kg, with the majority of the weight loss occurring in the last 1-2 weeks (about 8kg).

For the next few days i've been told to bump olanzapine up to 10mg as i have ZERO appetite whatsoever. Will re-evaluate the olanzapine dosage on Monday when i get my Lamictal bump.


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## riptide991 (Feb 1, 2012)

8kg in 1-2 weeks? whoa, must have been some water weight too. Either way it's a good thing when you don't gain on olanzapine as you can get its benefits without some of its worse side effects hehe.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> 8kg in 1-2 weeks? whoa, must have been some water weight too. Either way it's a good thing when you don't gain on olanzapine as you can get its benefits without some of its worse side effects hehe.


Yeah this is true. I gained pretty fast when i was on 20mg Olanzapine, 2000mg Sodium Valproate/900mg Lithium. Ended up putting the weight on then. Water weight was definitely prominent with Lithium as i was always thirsty.

I think once Olanzapine goes above 10mg i start to notice weight gain.


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## A Sense of Purpose (May 8, 2011)

Back from the docs! Excited to say that I've had Lamictal bumped to 100mg/day without any signs of rash. Also, I'm back on Zoloft 50mg so that should be great for depression and anxiety.

Keeping the Olanzapine at 10mg for now. 
Now I just need to get my appetite back and everything will be sweet.


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> Yeah this is true. I gained pretty fast when i was on 20mg Olanzapine, 2000mg Sodium Valproate/900mg Lithium. Ended up putting the weight on then. Water weight was definitely prominent with Lithium as i was always thirsty.
> 
> I think once Olanzapine goes above 10mg i start to notice weight gain.


I didn't even notice weight gain because I was just not paying attention due to enjoying things. But then one day I noticed my abs were disappearing, so it kind of just hit me and that was at 5mg hehe.



A Sense of Purpose said:


> Back from the docs! Excited to say that I've had Lamictal bumped to 100mg/day without any signs of rash. Also, I'm back on Zoloft 50mg so that should be great for depression and anxiety.
> 
> Keeping the Olanzapine at 10mg for now.
> Now I just need to get my appetite back and everything will be sweet.


Sweet I think if you can handle 100 then you're pretty much set. The rash usually starts even at the lower doses from my understanding.


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## loophole (Apr 15, 2012)

Your fine on the lamictal . Try not to over think things.... Bad habit for bipolar. This forum. Can be a great coping mechanism. Very helpful. But if your getting too involved and worried and pushing the forum to hard it can be toxic.. This came from my therapist.. So just be careful. Don't over think stuff.. That's a path for doom a lot.. Let the meds have plenty of time to sink in. Take it one day at a time... All you can do.


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## A Sense of Purpose (May 8, 2011)

loophole said:


> Your fine on the lamictal . Try not to over think things.... Bad habit for bipolar. This forum. Can be a great coping mechanism. Very helpful. But if your getting too involved and worried and pushing the forum to hard it can be toxic.. This came from my therapist.. So just be careful. Don't over think stuff.. That's a path for doom a lot.. Let the meds have plenty of time to sink in. Take it one day at a time... All you can do.


Yeah this is true. Its just that when i cycle i have a really hard time remembering how im feeling, so this log aims to create a chronological sequence of thoughts. My psych has warned me of spending too much time on forums. But overall, I think the level of involvement hasn't been too overboard and i try to make 1 entry a week. This week is going well.


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## loophole (Apr 15, 2012)

Good deal. Just trying to be helpful. I'm glad your psych advised as well. Keep us informed.


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## A Sense of Purpose (May 8, 2011)

Had a hectic day today. Had extreme nausea and a super migraine. Ended up in the hospital for 9 hours getting 3L of IV fluids, IV Metaclopramide, some kind of IV non steroidal anti-inflammatory and IV Diazepam.

Haven't been eating the past few days from anxiety so my body was just completely shutting down.

Hopefully feel like a human again tomorrow after some rest and a bit of food.


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## A Sense of Purpose (May 8, 2011)

Felt fantastic today. Such a 180 from yesterday. Had a warm endorphin like rush all day and got a lot done. I think lamictal might be starting to kick in. That or the IV diazepam has had some positive residual effect.


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## riptide991 (Feb 1, 2012)

Sweet such is the diagnoses of bipolar, one day you're on the top of the world and well you know the other days. Hope it continues.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Sweet such is the diagnoses of bipolar, one day you're on the top of the world and well you know the other days. Hope it continues.


I know right. Its f.....
Sometimes I just have no idea where my head is at. I have a bit of an appetite today so was able to manage some soup.

I think things will finally level out. Ill probly be jumping to 150mg lamictal next week. I really want this regimen to work after so many ups and downs in the past 6 months (in and out of hospital etc.)


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## A Sense of Purpose (May 8, 2011)

Felt pretty vague today. Not sure if its the increase in lamictal or just coincidental. Maybe it was due to starting zoloft at 100mg.
It wasnt a bad day, i just felt indifferent and not anxious.
Friday i move up to 200mg lamictal, finally the therapeutic threshold


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> Felt pretty vague today. Not sure if its the increase in lamictal or just coincidental.
> It wasnt a bad day, i just felt indifferent and not anxious.
> Friday i move up to 200mg lamictal, finally the therapeutic threshold


Sweet!

Isn't being non anxious a good thing? haha


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Sweet!
> 
> Isn't being non anxious a good thing? haha


Yes, its a great thing. But i draw the line at complete or partial dissociation. If i feel apathetic and not anxious, i still feel pretty crappy and drained. Sometimes i dont feel connected to my body physically or mentally.


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> Yes, its a great thing. But i draw the line at complete or partial dissociation. If i feel apathetic and not anxious, i still feel pretty crappy and drained. Sometimes i dont feel connected to my body physically or mentally.


Have you tried whipping it out in public and giving yourself a wank or two just to make sure you're still there physically?

I hear yah, one of my problems when I hit major depression is that I get derealization, nothing feels real, like literally! It's as if I'm floating out of my body. The thing is, I've heard that a combination of chlomipramine and lamictal actually help derealization. I read a paper on it and a few on the depression forums have attested. So it may be some transient thing who knows.


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## A Sense of Purpose (May 8, 2011)

First decent titration dosage. 200mg per day Lamictal starting now. Excited to see how it fairs.


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## A Sense of Purpose (May 8, 2011)

Heya, so this is a few days in on 200mg. I'm overall really happy and in a good mood. Things don't seem to make me irritable.

I'm definitely not hypomanic, but im certainly not feeling bad today.
Im guessing Lamictal is starting to kick in


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## loophole (Apr 15, 2012)

All very good. Just curious. Why didn't the Dr start with lamictal as a start by itself.? Lamictal is today's lithium.. Intended for BP... Just curious... Haven't read all the pages so don't know whole deal.. Lamictal does a lot on its own and the others may not be doing much of anything.. Could be way off. Just a thought


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## A Sense of Purpose (May 8, 2011)

loophole said:


> All very good. Just curious. Why didn't the Dr start with lamictal as a start by itself.? Lamictal is today's lithium.. Intended for BP... Just curious... Haven't read all the pages so don't know whole deal.. Lamictal does a lot on its own and the others may not be doing much of anything.. Could be way off. Just a thought


I was too unstable to start lamictal on its own. The time it would take to titrate up to a therapeutic dose would had meant that i'd have been manic for 4 weeks. I was on high dose olanzapine as well as 2 grams of Sodium Valproate.

Thats why i was on lamictal at the same time as im still on olanzapine.

Also, im his 20th patient ever to be prescribed Lamictal.


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## A Sense of Purpose (May 8, 2011)

Also, here in Australia it is not recognised as a medication for the treatment of bipolar disorder. It is used by some psych's for off label use for bipolar.


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## loophole (Apr 15, 2012)

Very cool. Yeah I did take Klonopin first to kill edge and end the insomnia. Not sleeping for 4 days can make u start to literally trip...


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## A Sense of Purpose (May 8, 2011)

loophole said:


> Very cool. Yeah I did take Klonopin first to kill edge and end the insomnia. Not sleeping for 4 days can make u start to literally trip...


It very much can. I have suffered from Auditory hallucinations when I hadn't slept for a few days.


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## loophole (Apr 15, 2012)

Meds cause me faults where I randomly will not remember stuff I did. Not fun..


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## A Sense of Purpose (May 8, 2011)

loophole said:


> Meds cause me faults where I randomly will not remember stuff I did. Not fun..


Yeah some meds are worse than others for me.

Mirtazapine, Lexapro, Lithium, Prozac and Sodium Valproate were the worst meds I've tried for cognitive impairment. I have no impairment on Olanzapine or Lamictal so far which I am very happy about.


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## A Sense of Purpose (May 8, 2011)

Few days in at 200mg Lamictal. 
No side effects that I can discern. Feeling pretty positive about this whole thing.
My only stress is Uni exams and small minor things.


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> Few days in at 200mg Lamictal.
> No side effects that I can discern. Feeling pretty positive about this whole thing.
> My only stress is Uni exams and small minor things.


Ahh don't get stressed out about your penis, you can't change it. Just kick *** on your exams!


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Ahh don't get stressed out about your penis, you can't change it. Just kick *** on your exams!


I know right? Exam stress is by far the worst trigger


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## A Sense of Purpose (May 8, 2011)

I've had a rough couple of days recently. I have been appetiteless for 3 weeks now and im starting to get nausea.

Furthermore I am trying to get a new psychiatrist. He has great credentials and seems like an open minded doctor when it comes to meds.

My current doc just tells me to exercise and do meditation/mindfullness.
I feel we have hit a brick wall and im sick of being in limbo


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> I've had a rough couple of days recently. I have been appetiteless for 3 weeks now and im starting to get nausea.
> 
> Furthermore I am trying to get a new psychiatrist. He has great credentials and seems like an open minded doctor when it comes to meds.
> 
> ...


Could it be the stress of exams?

I agree you should get a new psychiatrist. Any psychiatrist who tells you to do mindfullness and exercise during bipolar crisis is just insane.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Could it be the stress of exams?
> 
> I agree you should get a new psychiatrist. Any psychiatrist who tells you to do mindfullness and exercise during bipolar crisis is just insane.


Possible exam stress, however i constantly feel on edge. Adrenally fatigued.
Exercise and meditation is not working for BP1 at this stage.

The new doc has a great resume and seems down to earth and actually cares what you have to say

Edit: i havent seen him yet but his credentials were on the website for the specific hospital


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## A Sense of Purpose (May 8, 2011)

So I had a good conversation with the new psychiatrist. He was wanting to know some general background information about my past mental health history.

He is interested in seeing me and he highlighted the fact that his main goal will get me functional and back into work (as in a job).

I hope he is open minded about allowing me to try a stimulant.
I have written up a document that discusses current medications I'm on, Previous useful meds, previous unsuccessful meds, my goals for getting better, and a small list of meds that I would like to try.

Looking forward to the appointment. Its 12 days away.


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## A Sense of Purpose (May 8, 2011)

I have struggled with the past week or two. I have been self medicating with codeine and pseudoephedrine, and it appears to have made my symptoms worse.

I know i need to stop it, but when im so low it feels like my only option. Hopefully my new psych will be able to help with these issues


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## riptide991 (Feb 1, 2012)

I think it's time for a MAOI! hehe

Although if you look up Parnate on wiki it seems to talk about it being used for bipolar disorder.


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## jim_morrison (Aug 17, 2008)

Have you considered Valdoxan for the depression portion? It seems to be slightly stimulating for some people & supposedly it's as effective as SSRIs for treating depression in clinical trials - time will tell if this correlates with real world experience. 
If I recall correctly there's also some research suggesting that circadian rhythm abnormalities may be positively correlated with bipolar disorder.


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## riptide991 (Feb 1, 2012)

jim_morrison said:


> Have you considered Valdoxan for the depression portion? It seems to be slightly stimulating for some people & supposedly it's as effective as SSRIs for treating depression in clinical trials - time will tell if this correlates with real world experience.
> If I recall correctly there's also some research suggesting that circadian rhythm abnormalities may be positively correlated with bipolar disorder.


Wouldn't agomelatine help with this too? Although honestly no one on here has had much luck with it.


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## jim_morrison (Aug 17, 2008)

kehcorpz said:


> Wouldn't agomelatine help with this too? Although honestly no one on here has had much luck with it.


Yeah, agomelatine (valdoxan) should help with the circadian rhythm issue if present.


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## riptide991 (Feb 1, 2012)

jim_morrison said:


> Yeah, agomelatine (valdoxan) should help with the circadian rhythm issue if present.


Ahh didn't know the brand name! Thanks lol.


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> Have you considered Valdoxan for the depression portion? It seems to be slightly stimulating for some people & supposedly it's as effective as SSRIs for treating depression in clinical trials - time will tell if this correlates with real world experience.
> If I recall correctly there's also some research suggesting that circadian rhythm abnormalities may be positively correlated with bipolar disorder.


Sounds pretty good. Im a bit concerned with the impact that Valdoxan would have on my liver with all the other meds ive tried.

Ill speak to my new psych about it


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## A Sense of Purpose (May 8, 2011)

So out of all the anticonvulsants I have tried (topamax, sodium valproate, Lyrica) which were all mind numbing and made me stupid, Lamictal on the other hand seems to show no cognitive impairment at all. Recently I've been hardly at all depressed, but incredibly anxious / on the verge of panic attacks. I do however have exams coming up so that isn't to be unexpected.

I just need to get through 4 more weeks of very intense uni / exams and then Ill have over 4 months to get my meds right.

I'm considering hospitalisation in a private facility for as long as need be (2 months?) to washout inappropriate meds, or add meds (like a stimulant for a possible ADD inattentive, with a mood stabiliser to cap it off) and prevent mania.


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## infinityplusone (Jun 5, 2011)

I just recently came off Lamotrigine because it causes that panic like anxiety in me - and extra itchiness in spring. Works pretty well for depression and energy but not always helpful with anxiety. I found anything above 200mg left me grasping for words, otherwise not too bad cognitively.

A Sense of Purpose how did you find Topamax in relation to anxiety and depression? My psych has suggested this or Valdoxan as last resorts since I've tried about 30 other meds over the last 16 years.


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## A Sense of Purpose (May 8, 2011)

infinityplusone said:


> A Sense of Purpose how did you find Topamax in relation to anxiety and depression? My psych has suggested this or Valdoxan as last resorts since I've tried about 30 other meds over the last 16 years.


For depression/anxiety, they were completely obliterated on Topamax (100mg). However i was also on high doses of Amitritpyline (150mg) and completely off the planet. Complete space cadet. Who knows what topamax on its own would have been like to be honest. Hope this helps.


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## A Sense of Purpose (May 8, 2011)

Okay Guys. Big update time.

So my family, friends and acquaintances have all told me how out of control I am right now. Ive been in a hypomanic state without realising it. I haven't eaten in 2 days nor have i slept a wink (durrr thats a give away). I have a really big call to make.

Take time off uni, get my sh!t together and go to hospital... Or keep pushing on. I feel trapped between what i WANT and what i SHOULD do. For my health, then hospital is the best option. But to be satisfied and relatively happy (the only happiness i have) is to be with my uni friends and complete the course. Im so torn.

Im currently having
-issues eating
-panic attacks
-headaches
-stomach aches
-profuse sweating
-extreme anxiety
-elevated and intense/racing thoughts
-cold peripheral extremities
-pulse no less than 120bpm

After discussing all this with my doctor, telling him how I've never been this unwell in my entire life, he has prescribed me Mirtazapine and Zopiclone to take along with everything else. He thinks that its a combination of an elevated mood state and intense GAD.

I'm now on.....
-Zyprexa
-Lamictal
-Zoloft
-Mirtazapine
-Valium (20mg/day+5-10 if needed)
-Zopiclone (7.5-15mg)

I see him again in a few days. I also told him that I'm going to get a second opinion because I seem to be getting worse each week.


Sigh.......................................


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## riptide991 (Feb 1, 2012)

That really sucks man! I know what it's like making these big decisions. I quit my job 2 years ago to get better. I didn't even quit in a proper way that would let me come back. But then again I was at my worse back then so didn't think straight. You still have the opportunity to think straight about the issue so make the decision while you can! I mean i'm not saying you're going to get worse but just think about what things could be like if you got worse, would you be able to handle uni? It sucks leaving friends and then going back to strangers that's for sure. I mean even at my work I left a lot of good friends. I even broke contact with all of them hah. Hell I broke contact with everyone. I was just doing soo bad. But i'm sort of glad I made the decision as getting better is my priority. It's been a rough time but I have high hopes that parnate will get me back to normal. At least feels like things are making small progress towards the light side.

If you have trouble sleeping i don't think you can survive zopiclone and mirtazapine together lol. They should knock you the hell out.


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## GotAnxiety (Oct 14, 2011)

Can ya say dra dru drug addict!.

That must be like some kind of record your on like 5 different kinds of downers.

All those could probably produce some kinda rebound super sensititizing recepters.

How can you handle being on that much medication! Kinda makes me angry a docter has the power to over medicate a person like that.


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## infinityplusone (Jun 5, 2011)

Thanks, very helpful hearing your experience on Topiramate. And that's a hell of a combo you're on, take care.


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## loophole (Apr 15, 2012)

Yeah do be careful I may be wrong in my statement but it seems like the psych is throwing stuff at you when most if not all these meds take at least a good solid month to start to settle in.... We are obviously all very different but I'm on 3 meds and I'm quite stable for the time being.. Obviously not perfect... But no one is. Have to remember that...


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## loophole (Apr 15, 2012)

My opinion. Get off the valium.... Drop a couple of those meds. Live life for a few months.. I'd personally recommend staying on the lamictal.. It's a wonder drug for many.. BP people..... The valium I think is ridiculous and a lot of those other meds just don't make sense... Your cognitive movements must be extremely fudged... Get a different psych... I'm on 1mg Klonopin 4 times daily(too much. I usually only take 2 but the extra is nice for times when I may have an anxiety attack.) lamictal 200mg once a day and seroquel


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## GotAnxiety (Oct 14, 2011)

Sorry for being rude. I'm a bit hypocritcal since I dug some adderall xr outta my grandmas shed. I know it's bad lol.

That many downers can't be good. Serioius. Get the hospital to reduce your med's


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> That really sucks man! I know what it's like making these big decisions. I quit my job 2 years ago to get better. I didn't even quit in a proper way that would let me come back. But then again I was at my worse back then so didn't think straight. You still have the opportunity to think straight about the issue so make the decision while you can! I mean i'm not saying you're going to get worse but just think about what things could be like if you got worse, would you be able to handle uni? It sucks leaving friends and then going back to strangers that's for sure. I mean even at my work I left a lot of good friends. I even broke contact with all of them hah. Hell I broke contact with everyone. I was just doing soo bad. But i'm sort of glad I made the decision as getting better is my priority. It's been a rough time but I have high hopes that parnate will get me back to normal. At least feels like things are making small progress towards the light side.
> 
> If you have trouble sleeping i don't think you can survive zopiclone and mirtazapine together lol. They should knock you the hell out.


Yeah. I hear you man. I'm a walking pharmacy and I dont know my left from right. I hope I make the right decision when it comes down to the crunch.

Even with Mirtaz and zopiclone added i got 1.5 hours sleep last night. That brings me to 3 days with 1.5 hours sleep cumulatively. I feel so tweaked out.



infinityplusone said:


> Thanks, very helpful hearing your experience on Topiramate. And that's a hell of a combo you're on, take care.


No worries at all. Glad it was useful.



loophole said:


> My opinion. Get off the valium.... Drop a couple of those meds. Live life for a few months.. I'd personally recommend staying on the lamictal.. It's a wonder drug for many.. BP people..... The valium I think is ridiculous and a lot of those other meds just don't make sense... Your cognitive movements must be extremely fudged... Get a different psych... I'm on 1mg Klonopin 4 times daily(too much. I usually only take 2 but the extra is nice for times when I may have an anxiety attack.) lamictal 200mg once a day and seroquel


I would like to reduce my drugs, but im going through such a rough time at the moment that I need any relief I can get. Ironically, my thoughts are racing and I'm hyper vigilante. I feel like all my senses are in overdrive.



GotAnxiety said:


> Sorry for being rude. I'm a bit hypocritcal since I dug some adderall xr outta my grandmas shed. I know it's bad lol.
> 
> That many downers can't be good. Serioius. Get the hospital to reduce your med's


I know. It should be enough to tranquilize a horse, but they dont seem to be effecting me greatly in terms of sedation.


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## jim_morrison (Aug 17, 2008)

A Sense of Purpose said:


> Okay Guys. Big update time.
> 
> So my family, friends and acquaintances have all told me how out of control I am right now. Ive been in a hypomanic state without realising it. I haven't eaten in 2 days nor have i slept a wink (durrr thats a give away). I have a really big call to make.
> 
> ...


Why did he add more meds rather than upping the doses of what you're already on? like pushing Zyprexa to 20mg instead of adding mirtazapine for example.


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## basuraeuropea (Jul 25, 2012)

yeah, you need to push for that second opinion - admit yourself to hospital if you feel you need to as uni friends will be waiting for you when you are released and have been stabilised.


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> Why did he add more meds rather than upping the doses of what you're already on? like pushing Zyprexa to 20mg instead of adding mirtazapine for example.


I really don't know to answer your question. I'm not in the best head space to be arguing or pushing for something because I genuinely don't know whats wrong/going on with me. He said that mirtazapine will stimulate my appetite and help with sleep. That's all I was told.



basuraeuropea said:


> yeah, you need to push for that second opinion - admit yourself to hospital if you feel you need to as uni friends will be waiting for you when you are released and have been stabilised.


The way it's going I'll be in hospital before the week is out. I cant physically nor mentally continue to function/malfunction like this.

I've got an excruciating headache right now probably from lack of eating and not having sleep. You should see my hand tremors.

I'll bring up the Olanzapine thing on Friday if I don't go in before that. I just want to make it to Thursday's exam. That's my primary goal right now. Hospital immediately after...?!?


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## GotAnxiety (Oct 14, 2011)

The zopiclone and valium are cross tolarent. The zope may make the valium less effective.

Same with the remeron and zyprexa for some recepters. That like doubling up on the antagonism.

I hate zopiclone with a passion I stopped that med ct I never had the shakes that bad in my life. Not even off of alcohol. Thank god it only kept me awake for 2 days. Crappy way to start the new year lol.


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## loophole (Apr 15, 2012)

A Sense of Purpose said:


> Yeah. I hear you man. I'm a walking pharmacy and I dont know my left from right. I hope I make the right decision when it comes down to the crunch.
> 
> Even with Mirtaz and zopiclone added i got 1.5 hours sleep last night. That brings me to 3 days with 1.5 hours sleep cumulatively. I feel so tweaked out.
> 
> ...


 U need to read what people are telling you. U may be stressed but that's cause the meds aren't helping. Your psych is a dope. Start wheenin off some of that. Your think u gotta be o this stuff to deal with life. When I reality your just getting messed up... That not what diagnosis is all about. These are the people that abuse drugs and see how far down the rabbit to hole they can get. Now honestly reading your posts you don't seem like the type at all.. But what you say and what you do are two different things.. If this whole thread here is a stretch of a journal to see what you can get to get screwed up the that's pretty bad. If it's not you need to take some advise we are throwing at you because we are worried. Your at a crossroad.. Go for the numbing dope me up stuff or get real on it. I seriously think u need to stop popping valium. That's just beyond me&


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## T800 (Jun 13, 2013)

@ sense of purpose

20mg valium per day? Are you sure? 
This sounds like a ridiculous dose. Are you addicted to it?


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## A Sense of Purpose (May 8, 2011)

loophole said:


> U need to read what people are telling you. U may be stressed but that's cause the meds aren't helping. Your psych is a dope. Start wheenin off some of that. Your think u gotta be o this stuff to deal with life. When I reality your just getting messed up... That not what diagnosis is all about. These are the people that abuse drugs and see how far down the rabbit to hole they can get. Now honestly reading your posts you don't seem like the type at all.. But what you say and what you do are two different things.. If this whole thread here is a stretch of a journal to see what you can get to get screwed up the that's pretty bad. If it's not you need to take some advise we are throwing at you because we are worried. Your at a crossroad.. Go for the numbing dope me up stuff or get real on it. I seriously think u need to stop popping valium. That's just beyond me&


I understand what you are saying, however this is such a critical point in my course that i cant afford to be suffering the effects of GAD/Bipolar because they outweigh the side effects of trying meds to get relief (at least in the short term).

Hospital will be a serious consideration after the exam...


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## A Sense of Purpose (May 8, 2011)

T800 said:


> @ sense of purpose
> 
> 20mg valium per day? Are you sure?
> This sounds like a ridiculous dose. Are you addicted to it?


20 mg is hardly a high dose. Go and look at benzodiazepine comparison charts and you will find that its quite low if compared to xanax etc.


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## A Sense of Purpose (May 8, 2011)

Hey all...

Haven't been able to do any updates because I ended up is hospital :/
Last Thursday I lost it completely. Hadn't slept in 3 days and this caused auditory hallucinations and extreme irritability/anger. I have seen a new psychiatrist who seems very switched on.

He recommended dropping mirtazapine and upping Zyprexa to 20mg. Basically he was saying that the nature of my bipolar (with mixed features) needs to be treated with a mood stabiliser primarily before considering antidepressants.

Currently I'm experiencing extreme anxiety (GAD 80%) with panic attacks and generally feeling on edge. The remainder is 20% depression. The priority is to get the GAD under control.

He specialises in Bipolar and basically said that the symptoms I am experiencing are classic hallmark signs of mania triggered by AD's (much worse than someone without bipolar would experience).

I discussed with him how Valproate and Lithium were crappy side effect ridden horrible meds. I also expressed my dissatisfaction with them. He didn't seem offended when I stated my stance on them and replied saying that they can be last resort meds if other ones fail. I appreciated the fact that he was accommodating and actually listened to what I thought about the crappy meds I've tried. 

Right now we are going to change one thing at a time and see how it pans out. He did mention Ziprazidone as a potential medication that I could try next, if 20mg Zyprexa messes with my triglycerides or weight gain. However, I'm lucky to eat 1 meal a day even when I was on Mirtazapine AND Zyprexa.


Does anyone know much about Ziprazidone? I have never taken a "done" antipsychotic before, (taken Seroquel, Olanz and Thorazine). 
Is it well tolerated? I was reading its wiki and it looks like an extremely dirty drug based on the receptors it hits. If anyone could shed some light on it that would be great.

Peace


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## riptide991 (Feb 1, 2012)

Wow sorry to hear about your situation. At least good that your psychiatrist is listening.

I don't really know too many people who have done Geodon, I know that there used to be at least one person who came around here who has done it. I forget his results. I would search the forums for either Ziprasidone or Geodon to see reactions. It is a fairly newer med. It's weird that it also seems like a serotonin/norepinephrine inhibitor.

I wonder what something like Clonidine would do for you where it lowers norepinephrine and typically has a calming effect.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Wow sorry to hear about your situation. At least good that your psychiatrist is listening.
> 
> I wonder what something like Clonidine would do for you where it lowers norepinephrine and typically has a calming effect.


Okay, thanks. I just feel a little bit funny about taking something that hits so many receptors. Plus I don't know how well the dones work on me.

Clonidine added to my current regimen? Or with Ziprasidone?


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> Okay, thanks. I just feel a little bit funny about taking something that hits so many receptors. Plus I don't know how well the dones work on me.
> 
> Clonidine added to my current regimen? Or with Ziprasidone?


Just clonidine alone.

Yah it's not really that it hits so many receptors. In fact it's like any other antipsychotic if you look at the affinities. The only thing is it does the serotonin/norepinephrine reuptake so it sort of acts as an antidepressant too.


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## A Sense of Purpose (May 8, 2011)

I see. So not as sedating as Olanzapine but with Olanz's antidepressant effect?


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> I see. So not as sedating as Olanzapine but with Olanz's antidepressant effect?


I didn't really know it has an antidepressant effect. I mean I combined it with an antidepressant. It could I guess due to the 5-ht2c/5-ht6 antagonism. Geodon does have that, probably need higher doses for 5-ht6 though. Not sure what doses would be required as would need to see studies hehe.


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## A Sense of Purpose (May 8, 2011)

3rd Day of Olanzapine @ 20mg.
Feel somewhat more relaxed but still have waves of anxiety and racing thoughts. Hopefully this all goes away once 20mg reaches steady state. I've managed to cut my smoking down from a pack a day to 1-2 cigarettes which is pretty nice. Have slept pretty solidly even while discontinuing Mirtazapine.


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## jim_morrison (Aug 17, 2008)

A Sense of Purpose said:


> I discussed with him how Valproate and Lithium were crappy side effect ridden horrible meds. I also expressed my dissatisfaction with them. He didn't seem offended when I stated my stance on them and replied saying that they can be last resort meds if other ones fail. I appreciated the fact that he was accommodating and actually listened to what I thought about the crappy meds I've tried.


Did he bring up Carbamazepine? It seems to be used in BP as an alternative to Valproate and Lithium as far as I'm aware. It's supposedly weight neutral and sedating.

As Keh mentioned, Clonidine tends to be calming, sedating &reduces irritability. It's sometimes used in the treatment of anger disorders, so it may be a useful adjunct to mood stabilizers for mixed or irritable symptoms though I can't see it being powerful enough to be a stand alone treatment for BP.

At any rate, good luck with Ziprazodone & your new/modified combo.


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> Did he bring up Carbamazepine? It seems to be used in BP as an alternative to Valproate and Lithium as far as I'm aware. It's supposedly weight neutral and sedating.
> 
> As Keh mentioned, Clonidine tends to be calming, sedating &reduces irritability. It's sometimes used in the treatment of anger disorders, so it may be a useful adjunct to mood stabilizers for mixed or irritable symptoms though I can't see it being powerful enough to be a stand alone treatment for BP.
> 
> At any rate, good luck with Ziprazodone & your new/modified combo.


Thanks for the insight. I didn't get too far into discussing various mood stabilisers. I just told him the ones I had been on (lithium, Sodium Valproate and Lyrica) and how bad they were. I guess I could bring myself to try another anticonvulsant, but the want isn't very strong :/

Ill be seeing him again in a few days and will mention clonidine for the irritability. It sucks how my mania is ruined by crippling irritability. Rarely I''l get this clear insight, euphoria and intense focus. That's the part I guess I can enjoy. However when the agitation sets in, its extremely uncomfortable.

I'll also bring up the Geodon thing and possibly try it instead of Olanzapine for a few nights to see if its any good. Since ramping up the dose of Olanzapine to 20mg I've started getting tremors in my hands and fingers. Every now and then my leg muscles will contract and 'jolt'. That's another thing that sucks when you are super restless and irritable.


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## loophole (Apr 15, 2012)

What happened to the lamictal?


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## A Sense of Purpose (May 8, 2011)

loophole said:


> What happened to the lamictal?


Still on the lamictal. At 300mg split into 100 in the am and 200 in the pm


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## loophole (Apr 15, 2012)

Man ur docs just go off the hook. Shooting you up way to quick... Should be on no more then 200... Starting out. Crap my Dr started me after the initial test on 100... Now on 200


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## A Sense of Purpose (May 8, 2011)

loophole said:


> Man ur docs just go off the hook. Shooting you up way to quick... Should be on no more then 200... Starting out. Crap my Dr started me after the initial test on 100... Now on 200


Oh wait a sec. I've been on lamictal for at least 6 weeks. I started off at 25, then 50 then 100 the 200. I've been on it for a while. The only thing added recently was the mirtazapine and the zopiclone. My new doc has stopped the Mirtazapine so I'm now on the stuff thats it my signature.


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## A Sense of Purpose (May 8, 2011)

Hey all,

Decided to spend the weekend up at the country and just try and chill out. Went fishing, had a few drinks and cruised around on my boat in the sun. Everything was great Friday/Saturday.

Sunday comes round and I'm irrationally angry, frustrated and racy in thoughts. Not sure if its to do with having to go back to the city or my brain going crazy town again.

Seeing my new doc again tomorrow.. He said that if olanzapine doesn't calm me then Geodon would be something to look at. I'm also considering asking about Saphris and Latuda. 

Anyone know which might be better suited to racing thoughts, anger and irritability?


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## loophole (Apr 15, 2012)

A Sense of Purpose said:


> Oh wait a sec. I've been on lamictal for at least 6 weeks. I started off at 25, then 50 then 100 the 200. I've been on it for a while. The only thing added recently was the mirtazapine and the zopiclone. My new doc has stopped the Mirtazapine so I'm now on the stuff thats it my signature.


6 weeks is not a while :/ I recommend reading wiki. Webmd. Www.crazymeds. Us
And other site.. A while I would say is at leat 12 weeks and your doc. Is changing stuff every 6 weeks? Psychiatrist get their license revoked.. It happens more then people realize. Many forums that our base on bipolar alone will tell you it's a long ride to find the correct med. 99 percent of the time. You gotta be patient and let meds go through their cycle. Level out. Then make an I formed decision. Only time I'd say cut it off quick is if the stuff is making you go nuts. Or causing other physical issues. You simply gotta slow down. Be patient.. It's almost impossible I know... I'd give a med 3 months before I really made an informed decision.. And at least 2 months if your feeling nothing from the medicine. Your Dr. Should of started u out on 1 to 2 meds tops. 3 or more I'd say he's a whack job and run as fast as you can.. I'm not trying to beat a dead horse but at this rate ur gonna end up in the hospital again... Let the meds settle in and the old ones get out. Sorry maybe I should get on my computer and read your signature.. Not sure what all your on..... Good luck and for the sake of all of us here take it slow. Not sorta slow I mean slow slow. It takes some people 7 years or more to get the right meds sometimes.. And if you don't have the time to be patient for that your gonna end up in the hospital or end up causing yourself serious health issues..... Be careful


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## riptide991 (Feb 1, 2012)

Loophole, oh shush. The internet is there for guidelines. Doctors make decisions based off their patients needs. Stop trolling and let him deal with things with his doctor. He obviously had it under control before and he went into a bad manic episode. Taking your slow time with a serious manic episode is actually the wrong thing to do as he can end up getting arrested or killing himself or who knows. It's his doctors decision so just stop playing armchair doc who read something online with no real world experience.


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## A Sense of Purpose (May 8, 2011)

loophole said:


> 6 weeks is not a while :/ I recommend reading wiki. Webmd. Www.crazymeds. Us
> And other site.. A while I would say is at leat 12 weeks and your doc. Is changing stuff every 6 weeks? Psychiatrist get their license revoked.. It happens more then people realize. ..... Be careful


As I have said many times, all of these medications were added over the course of months. None of them were started together at the same time.
I've discontinued the Mirtazapine and bumped the olanz to 20. We are testing whether or not Olanzapine is potent enough to prevent mania/irritability.

Depression is not my main problem at the moment. Its skewed heavily in the way of GAD and mania (20% dep 80% mixed state mania). So my priority is to find any anti-manic agent that will bring me to a much more calm and less anxious person.

If not then its time to try Ziprasidone or Asenapine.


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## loophole (Apr 15, 2012)

Good to hear. Have you tired an anti psychotropic?


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## A Sense of Purpose (May 8, 2011)

loophole said:


> Good to hear. Have you tired an anti psychotropic?


What exactly is an anti psychotropic? If you mean lifestyle enhancements like gym and eating healthy, I already do those.

I also do progressive muscle relaxation/meditation when I can get a sliver of clarity on some days.


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## A Sense of Purpose (May 8, 2011)

So I saw my new psych for the second time today. I'm really impressed with his reasoning and questions he asks. One of the first times I've ever been asked "hows your sexual function on this cocktail" and "when was the last time you felt genuinely happy".

We are sticking with the 20 Olanz for the time being and keeping the valium at 20. He feels that if Olanz doesn't help in the next week or so it might be time to consider another mood stabiliser (Geodon/Saphris).

All in all I hope I get some sleep and make it through the next couple of weeks with uni and crowds etc without losing it. Fingers crossed.


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> So I saw my new psych for the second time today. I'm really impressed with his reasoning and questions he asks. One of the first times I've ever been asked "hows your sexual function on this cocktail" and "when was the last time you felt genuinely happy".
> 
> We are sticking with the 20 Olanz for the time being and keeping the valium at 20. He feels that if Olanz doesn't help in the next week or so it might be time to consider another mood stabiliser (Geodon/Saphris).
> 
> All in all I hope I get some sleep and make it through the next couple of weeks with uni and crowds etc without losing it. Fingers crossed.


Sweet!

You should have said "kehcorpz has enough sexual functioning to go around for the both of us! high five!"

Did you ask him if he knows much about clonidine? Just out of curiosity not like you want to take it, you just heard it can calm a beast on amphetamines even hah.


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Sweet!
> 
> You should have said "kehcorpz has enough sexual functioning to go around for the both of us! high five!"
> 
> Did you ask him if he knows much about clonidine? Just out of curiosity not like you want to take it, you just heard it can calm a beast on amphetamines even hah.


I did mention this! He said that its something that we can try in the future if Olanz doesn't help me chill out.

Lol @ your sex drive. Wish I had one right now.


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> I did mention this! He said that its something that we can try in the future if Olanz doesn't help me chill out.
> 
> Lol @ your sex drive. Wish I had one right now.


Meh when you don't have a gf it's sort of a time waster, a time waster that feels damn good, but still haha. Cool that he was open to the clonidine!


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## A Sense of Purpose (May 8, 2011)

He also said that he may ween me off zoloft and replace it with prn Clonazepam. Something that I am open to with sexual side effects and all


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## loophole (Apr 15, 2012)

Anti psychotic is a med. I'm on one. Didn't mean any disrespect


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## A Sense of Purpose (May 8, 2011)

loophole said:


> Anti psychotic is a med. I'm on one. Didn't mean any disrespect


None taken.

So I've been on Olanz @ 20mg for over a week now. I'm really noticing the benefits of taking it for anxiety. I wake up completely engaged with the world without feeling tired or any form of sugar cravings.

I have a mild tremor in both index fingers but I'm not that fazed by it. Who knows, maybe I'm a bit hypomanic. We shall see in the next week or so whether I crash hardcore or remain stable.

If not, then its time for Geodon + Clonazepam.


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> None taken.
> 
> So I've been on Olanz @ 20mg for over a week now. I'm really noticing the benefits of taking it for anxiety. I wake up completely engaged with the world without feeling tired or any form of sugar cravings.
> 
> ...


Well olanzapine is an antipsychotic. An Atypical Antipsychotic. hehe


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## A Sense of Purpose (May 8, 2011)

kehcorpz said:


> Well olanzapine is an antipsychotic. An Atypical Antipsychotic. hehe


I know this. I was just a little confused what an anti-psychotropic was. To me that sounds like not taking an AP


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## riptide991 (Feb 1, 2012)

A Sense of Purpose said:


> I know this. I was just a little confused what an anti-psychotropic was. To me that sounds like not taking an AP


haha yah


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## A Sense of Purpose (May 8, 2011)

Well its 3am and I'm wide awake. Got a solid 4 hours but theoretically i should be sleeping longer after a night time dose of Olanz 20 and Zopiclone 7.5mg.

Hopefully this isn't the start of another manic episode. Sleeplessness is usually the first sign and symptom preceding a manic reaction in me.


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## AlexP7 (Apr 5, 2013)

Hi, A Sense Of Purpose, thanks for sharing your journey with anxiety & bipolar. I know it's not easy! I have a lot in common with your experience. I have suffered moderate to severe anxiety for years, with panic attacks. For years I was told my problem was just anxiety. But I knew there was more going on. After my first session with a therapist recently, he told me he thinks I have bipolar. Not a big shock. I haven't yet been told which type of bipolar I have. But I suspect Bipolar I.

I get these periods of feeling extremely amped up, wired, restless, having compulsive casual sex, over-shopping, compulsions, paranoid racing thoughts, bursts of intense anger, irritability, euphoria, bouts of fast heart rate (which Propranolol helps) trouble sleeping. In the past I even used illicit drugs. My most recent one lasted several weeks. When the mania ends, I feel totally exhausted and drained. I have periods of somewhat normalcy in between, but the anxiety never totally leaves. I tend to get depressive/down periods in winter time where I feel totally unmotivated/tired/down.

For me the mania has always seemed much more prominent than the down periods which makes me think I have Bipolar I, not II. My down periods are more rare while mania seems much more common for me. I've never been to the psych ward thankfully, and never had a psychotic episode. But my therapist said there are tons of variations of bipolar and thinks I have it.

I'll probably be starting on a mood stabilizer soon. I'm not dreading it, but I hope I can stay on an anti-depressant or benzo for my anxiety (since I already have an underlying anxiety disorder). Anxiety plus bipolar is challenging indeed.

So thanks again for posting about your journey, I really related to your story! Much of it sounds exactly what I've gone through!


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## A Sense of Purpose (May 8, 2011)

AlexP7 said:


> Hi, A Sense Of Purpose, thanks for sharing your journey with anxiety & bipolar. I know it's not easy! I have a lot in common with your experience. I have suffered moderate to severe anxiety for years, with panic attacks. For years I was told my problem was just anxiety. But I knew there was more going on. After my first session with a therapist recently, he told me he thinks I have bipolar. Not a big shock. I haven't yet been told which type of bipolar I have. But I suspect Bipolar I.
> 
> I get these periods of feeling extremely amped up, wired, restless, having compulsive casual sex, over-shopping, compulsions, paranoid racing thoughts, bursts of intense anger, irritability, euphoria, bouts of fast heart rate (which Propranolol helps) trouble sleeping. In the past I even used illicit drugs. My most recent one lasted several weeks. When the mania ends, I feel totally exhausted and drained. I have periods of somewhat normalcy in between, but the anxiety never totally leaves. I tend to get depressive/down periods in winter time where I feel totally unmotivated/tired/down.
> 
> ...


I'm really glad that it has helped you somewhat. I started the thread initially to record fluctuations in my mood. Since then several people have said that they resonate on the same frequency and experience similar things to me. Since then I've tried to express any insight that I get on this forum; through the ups and downs.

Your episodes ring true to mine... Everything you have said I can also relate to. I'm not jumping the gun and labeling you, just saying we seem to have a few traits in common. I hope you get the relief you need from therapy/meds. Its a long, windy, steep and narrow road. Once you know your environmental triggers, it becomes slightly more bearable to manage. That said, even when I have noticed them, I have still spun out of control on more than one occasion.

Best of luck and feel free to post your progress here!


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## AlexP7 (Apr 5, 2013)

Reading your story did help me. I related to it. Have you ever tried Seroquel or know anything about it? My psych prescribed me some to try. He thinks I have a mood disorder probably bipolar but guess he wants more sessions with me before he makes a firm diagnosis. I saw him today for my 2nd visit & he wants to see me back in 2 weeks. Hopefully the Seroquel will stop some of my manic feelings/thoughts. I may get a second opinion just to see what they say.

One more question for you, how do pdocs typically diagnose bipolar, does it take one session, two, or more?


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## hworth (Mar 31, 2013)

It's good to hear all this information on Bipolar and the medications that go along with it, very helpful thread! I have a feeling my psychiatrist will probably diagnose Bipolar II at our first time meeting judging by the huge list of meds I've been on and my symptoms. Olanzapine/Zyprexa seems like it would be a very good choice for me as I also have always been diagnosed as being anxious and having G.A.D. along with depression, so I think it would definitely benefit my anxiety immensely but I'm afraid that it will take away my personality or change it in some horrific way! Along with all the other mood stabilizers/atypical antipsychotics. I'm also worried that it will make me (more) socially anxious, as I read in one study the blocking of dopamine led to social anxiety in some patients who previously had none at all.. when I'm in a good, energetic, probably hypomanic mood I barely feel anxiety but then when the depression and self-esteem drop come into play it's hard to socialize so I think if I fix my mood problems the social anxiety will mostly disappear, but bipolar meds as a whole worry me about that issue and also cognitive dulling.. don't want to suddenly become a constantly zoned-out tired lifeless zombie..!

What would you consider the best combos for bipolar meds if it's generally depressive state 80% of the time and bad anxiety? Zyprexa + an SSRI like Lexapro? I tried Lyrica but it just makes me stupid and spacey, didn't like it at all. Lamotrigine also seemed to make me spacey and anxious the few days I spent on it, alone and in combo with 20mg Celexa.


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## A Sense of Purpose (May 8, 2011)

AlexP7 said:


> Reading your story did help me. I related to it. Have you ever tried Seroquel or know anything about it? My psych prescribed me some to try. He thinks I have a mood disorder probably bipolar but guess he wants more sessions with me before he makes a firm diagnosis. I saw him today for my 2nd visit & he wants to see me back in 2 weeks. Hopefully the Seroquel will stop some of my manic feelings/thoughts. I may get a second opinion just to see what they say.
> 
> One more question for you, how do pdocs typically diagnose bipolar, does it take one session, two, or more?


Seroquel is a fairly good medication. Doses at 300+mg are useful for bipolar depression. Unfortunately I cant tolerate Seroquel because I break out in hives and a rash. I was on it for under a month before I started getting those side effects.

Secondly, I've been Bipolar since I was 20. I'm now about to turn 24 and its taken about 3 years to get my diagnosis right. For a long time my psych was treating me for individual symptoms instead of taking the whole cluster and turning it into a bipolar diagnosis. If we had realised that the cluster of symptoms equated to Bipolar I wouldn't have had bad bouts of sleeplessness, racing thoughts, impulsive thoughts, suicidal ideation, restlessness and anger. All in all its been a pretty bumpy ride. Now however, I think things are looking up.



hworth said:


> It's good to hear all this information on Bipolar and the medications that go along with it, very helpful thread! I have a feeling my psychiatrist will probably diagnose Bipolar II at our first time meeting judging by the huge list of meds I've been on and my symptoms. Olanzapine/Zyprexa seems like it would be a very good choice for me as I also have always been diagnosed as being anxious and having G.A.D. along with depression, so I think it would definitely benefit my anxiety immensely but I'm afraid that it will take away my personality or change it in some horrific way! Along with all the other mood stabilizers/atypical antipsychotics. I'm also worried that it will make me (more) socially anxious, as I read in one study the blocking of dopamine led to social anxiety in some patients who previously had none at all.. when I'm in a good, energetic, probably hypomanic mood I barely feel anxiety but then when the depression and self-esteem drop come into play it's hard to socialize so I think if I fix my mood problems the social anxiety will mostly disappear, but bipolar meds as a whole worry me about that issue and also cognitive dulling.. don't want to suddenly become a constantly zoned-out tired lifeless zombie..!
> 
> What would you consider the best combos for bipolar meds if it's generally depressive state 80% of the time and bad anxiety? Zyprexa + an SSRI like Lexapro? I tried Lyrica but it just makes me stupid and spacey, didn't like it at all. Lamotrigine also seemed to make me spacey and anxious the few days I spent on it, alone and in combo with 20mg Celexa.


I cant say for certain that an SSRI + Olanz will give you an antidepressant effect, however I have benefited from the combination of Zoloft and high dose Zyprexa. Furthermore, my depression is at about 20% with the remainder being agitated and manic. Lamictal is a wonder drug for me as I've not had hardly any depressive episodes.

Its a bit of trial and error. but zoloft/olanz/lamictal have been very effective.


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## AlexP7 (Apr 5, 2013)

Glad your doing better Sense of Purpose, someone told me that it's actually a good sign if a psychiatrist doesn't diagnose something like bipolar too quickly, because a good one wants to be thorough & make sure they know what's going on. I suspect I am on the brink of being diagnosed Bipolar I because I have so much manic periods & the stuff I mentioned in my earlier post.

He is starting me on Seroquel in addition to my Paxil & Xanax (Xanax is amazing). I'm looking forward to seeing how seroquel affects me if it helps me feel more stable.

For me the mania/compulsions/euphoria/hypersexuality is about 70%, while the depressive periods I get are much less prominent at about 30%. In between I am fairly normal.


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## A Sense of Purpose (May 8, 2011)

Howdy all 

I'd just like to do a small update on things.

Everything is brilliant! I'm more focused than ever and functioning at a really high level. The dosage increase in Olanzapine has been amazing for my agitation/frustration and furthermore, it hasn't impacted my cognition or sleep at all.

I feel very engaged and switched on with uni and my anxiety about things is entirely diminished allowing me to get decent study done. I'm 3 weeks from exams and I've never been is such a calm and content state in my whole entire life.

All is good! Woo


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## loophole (Apr 15, 2012)

I'm on seroquel and it's fantastic.. I'm also on lamictal and Klonopin.. The seroquel really helped me to not having racing thoughts.. Being able to focus. And be a little more laid back and even somewhat social. Something I thought I could never ever do. It will take you for a ride starting out. In knocked me flat on my butt. But you'll eventually get to your correct dosage.. The meds I'm on. Are working great together for me. Best I've felt in years. Literally


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## hworth (Mar 31, 2013)

loophole said:


> I'm on seroquel and it's fantastic.. I'm also on lamictal and Klonopin.. The seroquel really helped me to not having racing thoughts.. Being able to focus. And be a little more laid back and even somewhat social. Something I thought I could never ever do. It will take you for a ride starting out. In knocked me flat on my butt. But you'll eventually get to your correct dosage.. The meds I'm on. Are working great together for me. Best I've felt in years. Literally


What dosage are you on now..? And the Seroquel helped that much huh? I tried Lamictal at one point but it didn't quite seem to agree with me.. did you start it before or after you got on Seroquel?


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## A Sense of Purpose (May 8, 2011)

Hi all,

So as I stated earlier in the week, everything is going really well.
However, I've started noticing the prolactin side effect of Olanzapine.

I have started realising that its changing the upper chest area and around my nipples. Its quite insignificant at this stage, however i feel it may get problematic.
*
I'm stuck in this catch 22 situation where i really like what Olanzapine has done for me mentally, but at the same time i dont want to end up with man boobs.*

*So my question to you all is, which Atypical Antipsychotics have a less pronounced effect on prolacin when dosed medium to high strength?*

Also, are there any AAP's that are closely related to Olanzapine in terms of positive effects? I don't want to switch to a sub-effective med to only relapse.

Thanks,

ASOP


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## VERBW (Jul 23, 2013)

A Sense of Purpose said:


> Hi all,
> 
> So as I stated earlier in the week, everything is going really well.
> However, I've started noticing the prolactin side effect of Olanzapine.
> ...


I don't know what drugs are available in your country, but you should consider trying a typical antipsychotic.

Now that the risk of tardive dyskinesia has been understood, they aren't usually dosed high enough to prompt that risk. And besides, most atypicals haven't really been around for long enough to judge on that front. And you've seen yourself what they do to your weight gain. Type 2 Diabetes, here I come.



Dr. Ken Gilman said:


> Coming to a conclusion about 5-HT2A receptors and schizophrenia it is useful to step back and remind ourselves again that many drugs, including many FGAs, possess clinically relevant 5-HT2A receptor affinity in humans and have been in use for over half a century. All the following drugs have 5-HT2A Ki values more potent than quetiapine and several other "SGAs": amoxapine, chlorpromazine, chlorprothixene, droperidol, flupenthixol, fluphenazine, fluspirilene, perphenazine, prochlorperazine, thioridazine, thiothixene, trifluoperazine (data from PDSP data base).
> Two specific examples, chlorpromazine CPZ (Ki 2-5 nM), chlorprothixene (Ki 0.4-2.0): more potent than many SGAs!


If the above is true, I would have thought Perphenazine would fit the bill. I can vouch for Chlorpromazine, but it can be a bit sedating.

In any case, your choice of AAP is limited. It's really just Olanzapine or Asenapine in the same boat. I wouldn't touch Aripiprazole or Risperidone with a barge pole.

Edit: If you want to avoid Prolactin related side effects, I suspect you're equally screwed with regard to typical / atypicals. I suspect you'll just have to accept a lower dose and hope for the best.


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## A Sense of Purpose (May 8, 2011)

VERBW said:


> I don't know what drugs are available in your country, but you should consider trying a typical antipsychotic.
> 
> Now that the risk of tardive dyskinesia has been understood, they aren't usually dosed high enough to prompt that risk. And besides, most atypicals haven't really been around for long enough to judge on that front. And you've seen yourself what they do to your weight gain. Type 2 Diabetes, here I come.
> 
> ...


Well SH..

:/

I guess i could try asenapine. The thing is, i think the reason olanz works so well is because it takes away negative side effects of zoloft and increases the efficacy of both.

Going by that, i think i need a serotonergic antipsychotic.

I guess that leaves Asenapine, then Ziprasidone. The latter being a sub AP for what i need as it doesnt touch 5ht6. I want 5ht6. No / little prolacin.

Maybe i need to try a lower dose of Olanz again, however from experience its not enough to control my mania.


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## VERBW (Jul 23, 2013)

A Sense of Purpose said:


> Well SH..
> 
> :/
> 
> ...


Have you considered raising the Lamotrigine further? My psychiatrist said it could need to be 600/800mg +.

Apologies if you've answered this earlier.


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## A Sense of Purpose (May 8, 2011)

VERBW said:


> Have you considered raising the Lamotrigine further? My psychiatrist said it could need to be 600/800mg +.
> 
> Apologies if you've answered this earlier.


Nah all good. I'm currently on 400mg Lamictal a day.

I feel that it is helping, but it doesnt stop the mania. Only the depression


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## VERBW (Jul 23, 2013)

A Sense of Purpose said:


> Nah all good. I'm currently on 400mg Lamictal a day.
> 
> I feel that it is helping, but it doesnt stop the mania. Only the depression


I feel the same way about 250mg, but I'm going to try 400-600 before I try something else.

I might ask to be put back on Flupentixol. Can't get that in the US, though. I don't remember Chlorpromazine being particularly effective for mania, but the doses I have tried are relatively low. At an equivalent dose of 20mg Olanzapine, it would probably be quite good.


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## A Sense of Purpose (May 8, 2011)

So it looks like I have several options regarding changing my antipsychotic.

Olanz is a fantastic medication and I love it. Its really worked wonders for me and improved my concentration and focus. I've never felt better.

Problem is, as ive stated before, Man boobs are starting to show. My nipples are sensitive and there seems to be a slight change in the shape of my pecs.

This leaves me with a few options... in order of most favourable to least.

1) Try saphris (asenapine) with hope that its close in effects to Olanz, but without the prolacin increase. Mainly because it hits 5HT-6 receptors as I believe this is the mechanism of action behind clear thinking and focus.

2) Try Geodon (Ziprasidone) to see if it can stop mania. Im worried that it wont have the clarity and focus that i have from Olanzapine (no 5HT-6 action).

3) Try a typical antipsychotic like Flupentixol or something potent enough to prevent mania. I would also boost my antidepressant to Zoloft 150mg or 200mg in hope that it will mimic Olanz's clarity and focus.

Also, the last thing I want is to go back on Lithium and Sodium Valproate. The side effects outweighed the benefits 10fold. I was unable to tolerate them at all.


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## A Sense of Purpose (May 8, 2011)

Yep. I've decided that I'll be shooting for Asenapine.
Its the most logical step before Clozapine.

I wonder if i need to titrate off olanzapine while starting Saphris?

4 days more of 20mg Olans, then hopes to walk out with asenapine and Clonazepam.


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## VERBW (Jul 23, 2013)

A Sense of Purpose said:


> So it looks like I have several options regarding changing my antipsychotic.
> 
> Olanz is a fantastic medication and I love it. Its really worked wonders for me and improved my concentration and focus. I've never felt better.
> 
> ...


I can recommend Flupentixol. It's a great drug. I don't know how good it is for mania, but it's a good 5HT2A antagonist, and licenced for treatment of depression.

That said, I only tried 3mg, and I don't think it did much for mania.

Same story with Chlorpromazine, but again, I was only on a low dose (50mg). Probably better with bigger doses.

And Asenapine might be worth a try, but my intuition tells me it will be pretty much the same as Olanzapine.


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## A Sense of Purpose (May 8, 2011)

VERBW said:


> I can recommend Flupentixol. It's a great drug. I don't know how good it is for mania, but it's a good 5HT2A antagonist, and licenced for treatment of depression.
> 
> That said, I only tried 3mg, and I don't think it did much for mania.
> 
> And Asenapine might be worth a try, but my intuition tells me it will be pretty much the same as Olanzapine.


Yeah, I'm going to try another atypical (Asenapine) and if that still causes problems then ill give Flupentixol a shot in conjunction to Lamictal and Zoloft.


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## AlexP7 (Apr 5, 2013)

I am supposed to start Seroquel soon..Just a a trial run..Does it totally knock you out? Like, sometimes I need help sleeping at night, but at the same time I don't want to be totally out of it during the day to the point I can't function..Maybe that will go away after I get used to it..I'd like to try Lamictal or Lithium just by themselves or together with low-dose xanax, and see how I do on them, since my possible bipolar seems to be much more manic than depressive. Plus I just feel uneasy about ssri's based on what I've heard about them. I have generalized anxiety and panic disorder & possible bipolar. So I'm wondering if I can try a mood stabilizer with xanax (as needed) and see if that alone helps my moods since I don't have much depression, mostly mania/anxiety.


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## VERBW (Jul 23, 2013)

AlexP7 said:


> I am supposed to start Seroquel soon..Just a a trial run..Does it totally knock you out? Like, sometimes I need help sleeping at night, but at the same time I don't want to be totally out of it during the day to the point I can't function..Maybe that will go away after I get used to it..I'd like to try Lamictal or Lithium just by themselves or together with low-dose xanax, and see how I do on them, since my possible bipolar seems to be much more manic than depressive. Plus I just feel uneasy about ssri's based on what I've heard about them. I have generalized anxiety and panic disorder & possible bipolar. So I'm wondering if I can try a mood stabilizer with xanax (as needed) and see if that alone helps my moods since I don't have much depression, mostly mania/anxiety.


Really depends on which dose of Seroquel you're on. I was on 50mg and it made my anxiety significantly worse. If I took it in the day, I was too tired to function. If I took it at night, it gave me panic attacks.

I told my last psychiatrist I was on Seroquel at 50mg, and he winced. Personally? I would choose Chlorpromazine over Seroquel.


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## A Sense of Purpose (May 8, 2011)

Heading to my appointment today. Wish me luck.

I'm shooting for Clonazepam and Saphris to replace Valium and Olanzapine respectively. This is due to prolactin issues with Olanzapine and also due to valium having a shorter effective action than Clonazepam.

I wouldn't be taking clonaz every day like I am with Valium. This should reduce my tolerance and treat GAD/SAD more effectively.


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## A Sense of Purpose (May 8, 2011)

Good news guys. My psych appreciated the fact that I shouldn't have to put up with man boobs just to treat bipolar. He agreed that Asenapine would be the best next med to try and manage my symptoms.

In 2 weeks I'll be getting clonazepam bd and switching from Valium.

Woo


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## A Sense of Purpose (May 8, 2011)

Hoping that the Zyprexa discontinuation isn't going to cause cholinergic rebound. Don't think I'd manage the hectic nausea and vomiting associated with it.

Saphris isn't very anticolinergic from my understanding so the titration will still need to occur while I start Saphris.


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## VERBW (Jul 23, 2013)

A Sense of Purpose said:


> Hoping that the Zyprexa discontinuation isn't going to cause cholinergic rebound. Don't think I'd manage the hectic nausea and vomiting associated with it.
> 
> Saphris isn't very anticolinergic from my understanding so the titration will still need to occur while I start Saphris.


I discontinued 20mg Olanzapine cold turkey. I had a very mild headache on the first day, which I don't believe was from the Olanzapine.

I felt no side effects whatsoever, but this may have been because the Clomipramine masked them.


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## A Sense of Purpose (May 8, 2011)

3rd day on Olanzapine @ 15mg. No chollinergic rebound yet. Hopefully this discontinuation doesn't screw me over.

Lamictal is a fantastic med and its treating me very well. Glad I pushed my psych to let me try it.


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## AlexP7 (Apr 5, 2013)

Good luck with your new regimen A Sense Of Purpose, I hope it works for you! I can really relate to your story. My psychiatrist just told me that I have Bipolar I. Not a surprise. I take Paxil, Xanax as needed, Seroquel, & he is now starting me on Abilify to try and keep me stable. I asked him about Lamictal because I heard good reviews on it, but he said he wants to try me on the Abilify first because my symptoms are mainly manic periods with much less prevalent than depression. The manic periods are exhausting and not altogether unpleasant while they last, but they are a bit unsettling so I need to get them under control. 

He had me on up to 600mg of Seroquel but that was way too sedating so I have to keep it at 150-300mg in that range until I get used to it better. Hopefully the Abilify will help, he said it is very good for Bipolar I in preventing manic episodes. He told me the Lamictal tends to work better for Bipolar II people who have much more serious depression than manic episodes. If the Abilify doesn't work, I may ask about Lithium in future. So wish me luck, and best of luck to you on your continuing journey.


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## gilmourr (Nov 17, 2011)

Saphris is a good med on paper. I'm not sure if it's been that helpful to me. So far I just feel zoned out until 3-4 pm, have crazier dreams and that's it.

I also had a huge depressive dip yesterday from it which was uncomfortable to say the least.

I think because of it's strong effect on 5HT2C. NRI's make me suicidal and antagonizing 5HT2C increases NE and DA which is basically like an NRI. If you tolerate small amounts/moderate amount of NE then you may be fine. 

Also since you're manic/have manic bouts, you'll probably tolerate this better and feel less tired than me because of your excess energy.

Going to my psych tomorrow, telling her I felt majorly majorly depressed yesterday and going from there. I might take it for a few extra days just to make sure it's not a 1 day dip. It was a severe dip though.

What's unfortunate is I'm not sure I can use geodon since it's a slight NRI and NRI's like I said make me crazy...

I like Clozapine a lot. I might go with lithium since lowering NE would potentially make me less depressed if raising it makes me suicidal.

Good luck with Saphris man, it really seems like a good med in us crazies arsenal. I want more meds to make it onto the market with affinity with 5HT2A and 5HT6. and some partial 5HT1A agonism!


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## gilmourr (Nov 17, 2011)

BTW, even though my weight gain has stopped on saphris, I have yet to lose much weight. It's still a pretty weight gain pill with the dopamine antagonism. And my boobs are still moobs. Not super big just very supple and unusually sensitive/hard sometimes. 

Way TMI, but you're in my situation so **** it haha.


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## A Sense of Purpose (May 8, 2011)

Brief update:

So I'm really noticing the dosage change to olanzapine (lowering it).
I can feel my GAD and panic slowly coming back into the mix after lowering it by 5-10mg 

I hope that when I see my psych he'll script me clonaz to try and make up for asenapine's lack of sedating properties.

Olanzapine is by far the best medication I have ever been on. Just sucks about the prolactin stuff :/

Will see how it goes.


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## A Sense of Purpose (May 8, 2011)

Hi guys. Time for an update!

So I've been weaning myself off Olanzapine and I'm down to 5mg. My anxiety and panic attacks have been through the roof. It's amazing how well Olanzapine killed my anxiety.

However, I'm now taking Saphris 10mg / day to replace the Olanzapine.
I'm hoping once I get it to a steady state it will be as effective as Olanz.

Today I was also prescribed Clonazepam 2x .5mg / day. I'm allowed to take 5-10mg valium with this if I need and apparently its going to be much better for treating GAD.

All in all I'm going through a fair few changes. I hope things will work out like they were a month ago. 

I'm a bit of a walking pharmacy right now... but soon I'll have 1 less (olanzapine)

Peace


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## A Sense of Purpose (May 8, 2011)

I must say.... Clonazepam works exceedingly well!
I plan on taking it 3 days on 4 days off.


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## riptide991 (Feb 1, 2012)

Sweet man! Yah take it on the days you really need it while you wait for something else to kick in. See you've been going through some bad times. Well i'm sure they will pick up.


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## A Sense of Purpose (May 8, 2011)

Clonazepam is really is fantastic! It neutralises the huge anxiety because i dont have a proper dosage mood stabiliser yet. We are working on that after bumping Saphris to 10mg.

But yeah, the clonazepam gave me relaxation and slower thoughts. It also doesnt have the euphoric effects that valium induces. This means it plateaus slowly and with more longevity.


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## A Sense of Purpose (May 8, 2011)

Update:

So my psychiatrist believes I have ADD and wants to treat it with psychostimulants in conjunction with treating Bipolar 1. I'm not sure if its going to work or make my bipolar symptoms worse.

So far im still down to 5mg olanzapine and on 10mg Saphris. I still dont feel as good as i did when i was on 20mg olanzapine. So im quite skeptical as to how this will work.

He plans to start is on Wednesday with Dexamphetamine or Ritalin and see how i respond.

As i said, im not sure what to think regarding that.


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## loophole (Apr 15, 2012)

Any news. I'd be extremely iffy on this. Personally I'd get a 2nd opinion.


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## gilmourr (Nov 17, 2011)

I'm interested as well to know how this is going. Any news Sense?


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