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Question Dec 09, 2019 at 05:08 PM
  #1
I am having some hypomanic symptoms such as overspending, excess energy (while awake,) and pressured speech. I would like to reduce my antidepressant, though will wait until I see my pdoc on the 20th unless it gets worse.

I want to talk to my pdoc about having the freedom to increase or decrease my antidepressant a predetermined amount upon noticing symptoms rather than waiting until I see him next, or talk to him on the phone. He only works 2 days a week, so it would take a long time to get ahold of him.

Has any had/does anyone have an arrangement to make small medication adjustments themselves when symptoms change?

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---"Address before the Wisconsin State Agricultural Society". Abraham Lincoln Online. Milwaukee, Wisconsin. September 30, 1859.
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Default Dec 09, 2019 at 05:15 PM
  #2
I have permission to use certain medications prn. I used to call my pdoc and just say, please reduce or please increase my dosage and he didn't make me come in first. Perhaps if you call, your pdoc could call in a new prescription and use the meeting on the 20th to check to see if the change worked.

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Default Dec 09, 2019 at 05:24 PM
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Hmmm... the 20th is pretty far away.

Could you go to the hospital (regular admission, not inpatient) and ask for an assessment? I think Canada has socialized medicine, right? If you don't have to pay for the hospital, it may be worth the trip. You don't want to enter psychosis, but you also don't want to experience brain zaps, severe depression, nausea, vomiting, headaches, etc from reducing your antidepressant dose too much or too fast. So, I really, really think you should get a dr's opinion to be safe, if that makes sense.
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Default Dec 09, 2019 at 05:29 PM
  #4
My pdoc should be in the office on Thursday and Friday. Maybe I'll ask him to call me then. I don't need a new script since I take both 80mg and 40mg capsules of the medication, and I'd like to reduce it to just the 80mg. The hypomanic symptoms aren't that severe yet, so I don't think a couple of days will hurt.

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It is said an Eastern monarch once charged his wise men to invent him a sentence, to be ever in view, and which should be true and appropriate in all times and situations. They presented him the words: "And this, too, shall pass away." How much it expresses! How chastening in the hour of pride! How consoling in the depths of affliction!
---"Address before the Wisconsin State Agricultural Society". Abraham Lincoln Online. Milwaukee, Wisconsin. September 30, 1859.
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Default Dec 09, 2019 at 05:45 PM
  #5
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Originally Posted by Merlin View Post
I am having some hypomanic symptoms such as overspending, excess energy (while awake,) and pressured speech. I would like to reduce my antidepressant, though will wait until I see my pdoc on the 20th unless it gets worse.


I want to talk to my pdoc about having the freedom to increase or decrease my antidepressant a predetermined amount upon noticing symptoms rather than waiting until I see him next, or talk to him on the phone. He only works 2 days a week, so it would take a long time to get ahold of him.


Has any had/does anyone have an arrangement to make small medication adjustments themselves when symptoms change?


Yes I have fiddled with med doses with my Pdocs blessing .. he would rather me catch things quickly. If the changes we agreed on didn’t help then I would go in for an appt.

But some Doctors just freak out about it and want an office visit to make even small changes.

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Default Dec 09, 2019 at 07:50 PM
  #6
I left a message with my pdoc's office. If it gets bad within the next couple of days, I will contact urgent services.

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It is said an Eastern monarch once charged his wise men to invent him a sentence, to be ever in view, and which should be true and appropriate in all times and situations. They presented him the words: "And this, too, shall pass away." How much it expresses! How chastening in the hour of pride! How consoling in the depths of affliction!
---"Address before the Wisconsin State Agricultural Society". Abraham Lincoln Online. Milwaukee, Wisconsin. September 30, 1859.

Last edited by Merlin; Dec 09, 2019 at 08:03 PM..
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Default Dec 10, 2019 at 10:38 AM
  #7
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I left a message with my pdoc's office. If it gets bad within the next couple of days, I will contact urgent services.
That sounds like a good plan!

My doctor prescribes "prn" medications. He allows me to take them at my discretion, but not more than a certain amount of each. He also wants to know if I've been using my prn medications on a very regular basis. That helps him know if perhaps my BASE medications need adjustment.

In the case of my "prn" medications, it's only me adding them or not using them. If I ever want to reduce one of my BASE medications, my psychiatrist wants to have a say in it. He is very good about making occasional decisions over the phone, but he wants veto power. I have reduced my base meds in the past without checking with him. When I told him in person, he scolded me about not calling him.

As a side note, my prn medications are not meant for depression as much as developing mania, agitation, anxiety, and/or insomnia. They are usually my main issues that require quick action. I know that different people with bipolar disorder have different situations.
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Default Dec 10, 2019 at 11:07 AM
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Originally Posted by BirdDancer View Post
That sounds like a good plan!

My doctor prescribes "prn" medications. He allows me to take them at my discretion, but not more than a certain amount of each. He also wants to know if I've been using my prn medications on a very regular basis. That helps him know if perhaps my BASE medications need adjustment.

In the case of my "prn" medications, it's only me adding them or not using them. If I ever want to reduce one of my BASE medications, my psychiatrist wants to have a say in it. He is very good about making occasional decisions over the phone, but he wants veto power. I have reduced my base meds in the past without checking with him. When I told him in person, he scolded me about not calling him.

As a side note, my prn medications are not meant for depression as much as developing mania, agitation, anxiety, and/or insomnia. They are usually my main issues that require quick action. I know that different people with bipolar disorder have different situations.
What are the prn meds you generally use for mania? I have some prn meds for sleep so I might have some tonight to make sure I get a full night's sleep.

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It is said an Eastern monarch once charged his wise men to invent him a sentence, to be ever in view, and which should be true and appropriate in all times and situations. They presented him the words: "And this, too, shall pass away." How much it expresses! How chastening in the hour of pride! How consoling in the depths of affliction!
---"Address before the Wisconsin State Agricultural Society". Abraham Lincoln Online. Milwaukee, Wisconsin. September 30, 1859.
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Default Dec 10, 2019 at 12:45 PM
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What are the prn meds you generally use for mania? I have some prn meds for sleep so I might have some tonight to make sure I get a full night's sleep.
I have both regular Seroquel and Ativan to work with as "prn"s in addition to my base medication mix, which includes Seroquel XR. I try to stay away from the Ativan, except for anxiety, but Ativan is sometimes helpful at getting me to sleep when other stuff fails.

All of my medications appear in my signature below.
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Default Dec 10, 2019 at 01:10 PM
  #10
Please stay on it--these things can change quickly. You don't want to end up having to be in the hospital over the holidays.

I have permission to make small adjustments, but I am supposed to call and tell him when I do. My only official prn is Zyprexa for emergencies.

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Default Dec 10, 2019 at 05:29 PM
  #11
It's good to have you posting, Merlin.

I think you have a great plan.

Yes, I am allowed to tweak my meds on my own. Once in awhile, she thinks I may have tweaked them too much. Oh well.

I hope you'll stick around!

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Default Dec 11, 2019 at 03:28 PM
  #12
Well, I decided to tweak my meds. I took my prn sleeping med last night, which I have discretion on, but I also took 80mg of my antidepressant rather than 120mg this morning. I talked to my mom about it since she works as a physician and she said it sounds like a reasonable change to make on my own if I keep my pdoc updated. I will keep taking the sleeping pill until, as well as taking the 80mg dose until I talk to him tomorrow or the next day. My symptoms don’t seem as intense today.

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It is said an Eastern monarch once charged his wise men to invent him a sentence, to be ever in view, and which should be true and appropriate in all times and situations. They presented him the words: "And this, too, shall pass away." How much it expresses! How chastening in the hour of pride! How consoling in the depths of affliction!
---"Address before the Wisconsin State Agricultural Society". Abraham Lincoln Online. Milwaukee, Wisconsin. September 30, 1859.
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Default Dec 13, 2019 at 10:10 PM
  #13
I talked to my psychiatrist today. I told him about my medication adjustment and he said that he probably would have made the same adjustment. We talked about the symptoms I had been having, though I forgot to mention the pressure to talk. The antidepressant reduction seems to have ended the hypomania and I haven’t swung into depression. I’m seeing him next Friday so I’ll keep him updated.

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It is said an Eastern monarch once charged his wise men to invent him a sentence, to be ever in view, and which should be true and appropriate in all times and situations. They presented him the words: "And this, too, shall pass away." How much it expresses! How chastening in the hour of pride! How consoling in the depths of affliction!
---"Address before the Wisconsin State Agricultural Society". Abraham Lincoln Online. Milwaukee, Wisconsin. September 30, 1859.
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Default Dec 14, 2019 at 06:38 AM
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I think this can be ok for as needed meds like stimulants, sleep meds or anxiety meds but I dont know how much I can get behind messing with your antidepressant or mood stabilizer or antipsy.

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Default Dec 14, 2019 at 12:45 PM
  #15
I believed I would become more manic without reducing my antidepressant. I was not able to speak with my doctor for a week. I talked with my mother who is a doctor. I made a judgment call and it worked out for me. I would prefer permission to increase or decrease my antidepressant slightly if my manic or depressive symptoms start interfering with my life one week is a long to tolerate severe symptoms. As I said, I would like to discuss a protocol such as increase by 40mg if depressed, decrease by 40mg if becoming manic. Leave a message with my pdoc.

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It is said an Eastern monarch once charged his wise men to invent him a sentence, to be ever in view, and which should be true and appropriate in all times and situations. They presented him the words: "And this, too, shall pass away." How much it expresses! How chastening in the hour of pride! How consoling in the depths of affliction!
---"Address before the Wisconsin State Agricultural Society". Abraham Lincoln Online. Milwaukee, Wisconsin. September 30, 1859.
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Default Dec 20, 2019 at 03:30 PM
  #16
I saw my psychiatrist today and talked about modifying my antidepressant dosage. He has given me permission to increase or decrease it between 40mg and 120mg. Right now I am taking 80mg. He also prescribed me a prn dosage of Ativan for my Social Anxiety, 10 pills.

I will take 1 pill to make sure that I don’t have an adverse reaction to it or am too impaired to drive. I plan to take it prior social events I intend to cancel on to see if reduced physical symptoms will help me out the door.

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It is said an Eastern monarch once charged his wise men to invent him a sentence, to be ever in view, and which should be true and appropriate in all times and situations. They presented him the words: "And this, too, shall pass away." How much it expresses! How chastening in the hour of pride! How consoling in the depths of affliction!
---"Address before the Wisconsin State Agricultural Society". Abraham Lincoln Online. Milwaukee, Wisconsin. September 30, 1859.
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