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Grand Member
Member Since Nov 2019
Location: In my head, mostly
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#1
Hi all,
As some of you know I've been going through a mixed episode for close to 6 months now, which worsened because I didn't have access to my regular therapist for over 2 months because of covid-19, right when things were at an all-time low. After things escalated and I overdosed I ended up getting extra help from my local crisis team and getting extra meds, which helped a little, but only enough to get me from "crisis" to "really depressed." In hindsight I should have asked for the extra help way sooner. Next time I hope I will. I thought it was starting to get better, so I tried to come off my Seroquel, but almost immediately I started to get impulsive and suicidal and extremely irritable again, to the point that I'm getting into fights with strangers (luckily only verbal so far). Needless to say I'm upping my meds again, but all this has me feeling really hopeless. I feel like there's no way to win. If I stay on my meds I can't concentrate and I'm anhedonic and unmotivated, so I can't do any of the things I love. If I try to reduce my meds, I can't function because of the depression and irritability itself. To make things worse I think I'm still feeling angry and betrayed by my therapist because of the lack of help when I was at my worst, so I can't benefit from my therapy like I usually could. I'm doing my best to salvage that relationship, but I just don't know how to recover from this episode. And I feel like even if I do recover, it will just be a matter of weeks before I get worse again because I've been unstable ever since I had kids. I want to give myself time to get better, but I can't because I have twin babies and a four year old that require attention, and I want to be responsible and take care of them like I should, not slack off and leave everything to my wife. Long story short, I just don't see a way out of this episode and at this rate I feel like I'll never be able to be myself again and I can't really see a reason to carry on living. Any advice as to how to break the cycle and recover? My Pdoc has suggested different meds (for instance upping the lithium and trying Lamictal instead of Seroquel) but for the above reasons I'm kind of hesitant to change meds again. At least on Seroquel I know I won't get into a fight or do something else that will get me in trouble. I'm getting more exercise but the results of that have been mixed. I'd like to get enough sleep but unfortunately I'm sleeping horribly unless I'm on Seroquel. I'm even considering ECT if there's a good chance that it will get me stable long enough to really recover and get back some of my strength. However, I'm hearing really mixed stories about that and it would be great if there were a less drastic approach... Anyway, sorry for the rant and thanks for any advice. Last edited by bluekoi; Jun 02, 2020 at 08:29 PM.. Reason: Add trigger icon. |
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*Beth*, Anonymous46341, bpcyclist, fern46, Fuzzybear
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*Beth*, bpcyclist, Fuzzybear
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Legendary
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#2
I am very sorry you are struggling. What are your current symptoms and meds and doses?
Mixed episodes can be quite tricky, as you know, but I really do believe there is a combo out there that will work much better for you. Truly. What about a new therapist where there can be trust and no trauma? Sending you strength and hope and love. Hang in there. This will turn around. __________________ When I was a kid, my parents moved a lot, but I always found them--Rodney Dangerfield |
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Anonymous46341, Fuzzybear
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#3
Long-running mixed episodes are the worst. In the past I have had episodes that have lasted over a year, and then came back again after a short break. In fact, I was pretty much in a near constant mixed episode for over nine years until March 2019. I totally understand how hopeless it feels, but I urge you to hang on and keep trying new options. What stopped my mixed episodes was Ziprasidone (Geodon). I had tried dozens of combinations of meds to no avail until I was given Ziprasidone. That was my wonder-drug. There may very well be one, or a combo, for you out there. It helps to have a pdoc you trust who you can work with closely to find the right fit. Changing meds too often can send us off balance, but it is also pointless staying on meds that aren't working. My heart goes out to you as mixed states are pure hell. Stay in treatment and don't give up. There is hope.
__________________ Bipolar 1 with psychotic features PTSD "Phew! For a minute there I lost myself." 'Karma Police' by Radiohead |
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Anonymous46341, bpcyclist, Fuzzybear
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Grand Member
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#4
@bpcyclist: Thank you! I'm currently on 1000mg lithium and 150mg Seroquel (at least I was before I tried reducing it).
The Seroquel seems to take away most of the manic features, and it takes the edge off the despair, but it still leaves me feeling tired, empty, unable to concentrate, and unable to enjoy anything. I'll try to feel better by listening to music, reading a book, watching a movie, but then I end up just stopping after a few minutes because I don't feel any joy from it, it's just a chore. Also, all media (entertainment as well as news) are like a minefield of triggers for anxiety right now. The anxiety seems to be a constant regardless of meds. If I try to taper off the Seroquel, the depression gets worse and the despair and SI start to come back. Also, some of the manic symptoms start to return. The first ones I noticed were insomnia, impulsiveness, and irritability, which resulted in reckless driving, starting fights, and so on. Also, I started to get things like "feeling presences" again. I started to increase the Seroquel again before the agitation got too badly out of hand so I don't know how far it would have gone if I'd gone completely off the Seroquel. I'm hoping a new therapist won't be necessary and that it will start to feel normal again after a while. I'm trying to focus my anger on the policy of the practice where she works rather than on her personally. I really used to love her and I would hate to give that up and have to build up a new relationship all over again. Hopefully in a few weeks/months I'll get some of my confidence in mental health care back and it will stop feeling like quicksand. I've heard that higher doses of Seroquel can actually be less sedating than lower ones, so maybe I can still try going above 150mg to see if I'll get some of my energy and motivation back. |
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Anonymous46341, bpcyclist, Fuzzybear
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Grand Member
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#5
@Wander: Thank you, and I'm sorry to hear that your episodes have lasted that long. I thought six months was bad but nine years really sounds like hell. I definitely know what you mean about episodes coming back after a short break. I've been experiencing the same for the past few years, but luckily they're not always mixed for me.
I'll look into Ziprasidone, thanks for that! One of the things that makes it so frustrating is that it's so hard to find the right med combo because it's different for everyone. It would be so nice if certain meds were known to "just work" for different kinds of episodes and it wasn't such a crapshoot. |
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Anonymous46341, bpcyclist, Fuzzybear
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Wisest Elder Ever
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#6
Hi, I was on seroquel for a few months but stopped it due to very severe side effects. I don't know of much that helps severe depression or mixed episodes except for meds Someone said exercise can help as much as meds for depressive episodes but I don't think for mixed episodes (that hasn't been my experience either)
I also feel angry about a therapist. I wonder if some of what he did was due to the policy of the practice, I don't know. He was very cruel and dumped me with no referral (i did nothing wrong). Even now the ''policy'' seems the same. Not that I have contacted any of them for quite some time __________________ |
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bpcyclist
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#7
Mixed episodes have been a major feature of my bipolar 1 disorder. Or what would often happen was that I'd have an elated mania or a pure depression that would transition to the other "pole" in the form of a mixed episode, often doing so at the peak of the type of original episode. In my case, the right medications were crucial in easing the mixed episode. Sometimes I was lucky to reach baseline stable, but other times I'd switch to a more "pure" form of depression or mania. It depended on the medications. I have found that some medications are a bit better for handling mixed episodes than others. Some medications as part of my cocktail, were for me no-nos. I'm a little reluctant to declare what I believe are the "good medications" or bad ones for mixed episodes, because we're all different.
I do think that therapy and practice of coping skills/methods have been important adjuncts to the medications. I guess I've used ones for both depression and mania at the same time, as the medications do their work. |
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Legendary
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#8
Well, Fluffy, I just don't think you guys are going after this as hard as you could be, med-wise. Just my opinion. I hope you feel better soon, whatever you decide to do. Many patients with severed bp 1 require way more than two meds. Way more.
__________________ When I was a kid, my parents moved a lot, but I always found them--Rodney Dangerfield |
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*Beth*
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#9
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Thank you, I've also heard the part about exercise and I find that it sometimes works for mixed episodes if it's something where I can let out a bit of rage. If your therapist was personally cruel to you then I would definitely take that personally. For me, I think the situation is a little different because even though my therapist could have fought harder against the practice's policy (to ban all f2f meetings regardless of urgency) I do still believe she's well-intentioned and wants the best for me. (And like I said I really want to continue to believe that and hopefully start feeling it again at some point.) |
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Grand Member
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#10
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Yes, I've also noticed episodes sometimes changing character. I believe this current one started out as euphoric hypomania, which changed into depression, which turned into a mixed episode, which then went into overdrive when the covid-19 situation hit. For me, a major factor (maybe the most important factor) in coping well is having stability in my life. I need to have faith that I have my therapist, she's looking out for me, and I have those appointments no matter what. They're what I cling onto when I'm having a tough time. I need my own space to work where I work on my own schedule, things like that. Right now everything is disrupted and it's the worst. I just desperately need my therapy sessions to not only continue but to be there solidly and reliably. Right now I can't feel that kind of trust anymore and that saddens me a lot. |
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Grand Member
Member Since Nov 2019
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#11
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You may well be right. Part of the trouble is that not too long ago I wasn't on any meds at all. All the meds I have now were added while I was in crisis mode, and so I have no clue about the effects they have on my mood, which med does what, etc. So adding another med kind of feels like operating in the blind. One thing we've been considering is possibly adding an anti-depressant but I'm not sure yet about that one. |
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catches the flowers
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#12
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#13
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I actually regard my current cocktail (below) as relatively small. At one point I took Lithium, Lamictal, Tegretol Geodon, Navane, Seroquel XR, Klonopin, and Ativan all at the same time. I still want to cut out unnecessary medications even in my current smaller cocktail. I have always wanted to see a lecture by Kay Redfield Jamison. From what she has presented in other lectures, she is only taking Lithium, and a moderate amount at the most. Is that still true? I wish I knew. She says she has "classic bipolar type 1", and yet in her memoir she describes a couple major mixed episodes. Many of her lectures to the public are just her reading from her book(s). If I was there to ask questions, she'd have some unexpected ones to answer. Not Intro to Bipolar Disorder 101 stuff. |
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#14
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I, too, wonder about Kay R.J. Having BD and taking only lithium was a standard treatment (as I recall) back in the '70's. I was given that treatment for a while when I was an older teen. But lithium by itself is not really stabilizing. I've wondered about KRJ in many ways. Some of her story doesn't seem entirely believable...I've wondered about her diagnosis, how "bipolar" she really is. __________________ |
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Grand Member
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#15
@BethRags and @BirdDancer: Thank you both! It's true that I've found all the meds pretty overwhelming. To me it's scary every time I start a new med or adjust the dosage, not knowing what side effects I'll get and whether it will cause any long-term damage. I still have this hope that once I've stabilized I'll be able to function without meds again, but even if that's not possible I do want to keep meds to a minimum.
That said, I agree that the current med combo doesn't seem to be doing enough to really get me stable, it's only taking out symptoms here and there. @BethRags: I have heard Lamictal mentioned before by others, including @BirdDancer, and it sounds like a promising option. My Pdoc has also mentioned it. I think if I change anything that's probably the one I'll give a try first. The downside is the long buildup period but I guess I could do that alongside my current meds if need be. I wish there were some meds that work well that I can take only "when needed" instead of having to commit in the long term. I actually did ask my therapist how she was coping with the isolation. She said she was okay with it, but that not having face-to-face contact was highly undesirable for the therapeutic process (couldn't agree more on that). I didn't get the sense that she was losing a lot of patients, but then again I think most of her other patients have only "mild" issues and are stable enough to cope with the situation or even postpone their treatment for a few months if need be. For people with serious issues the situation is a lot different I think. |
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*Beth*
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catches the flowers
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#16
[QUOTE=FluffyDinosaur;6854432]@BethRags and @BirdDancer: Thank you both! It's true that I've found all the meds pretty overwhelming. To me it's scary every time I start a new med or adjust the dosage, not knowing what side effects I'll get and whether it will cause any long-term damage. I still have this hope that once I've stabilized I'll be able to function without meds again, but even if that's not possible I do want to keep meds to a minimum.
That's a realistic goal, I think (keeping meds to a minimum). The more quickly you get stable, and stay stable for some time, the sooner you can minimize the number/amount of meds your on. That said, I agree that the current med combo doesn't seem to be doing enough to really get me stable, it's only taking out symptoms here and there. @BethRags: I have heard Lamictal mentioned before by others, including @BirdDancer, and it sounds like a promising option. My Pdoc has also mentioned it. I think if I change anything that's probably the one I'll give a try first. The downside is the long buildup period but I guess I could do that alongside my current meds if need be. I wish there were some meds that work well that I can take only "when needed" instead of having to commit in the long term. I don't know why, but I refused Lamictal for a couple of years before I finally agreed to it. Turned out it is an excellent medication. It's helpful to treat symptoms and it has no side effects that I have noticed. The most difficult part is, as you've posted, the build-up period. That does take some patience, although the time goes by so quickly. Also, at least for me, there was already noticeable benefit at 50mgs. I hear you on the "as needed" wish. Lamictal is not one of those, but there are some, you know? Even most of the AP's can be taken as needed, to some extent. As I understand it, the goal is to become stable and remain stable for some time. Once that point is reached there are so many med options to use. I actually did ask my therapist how she was coping with the isolation. She said she was okay with it, but that not having face-to-face contact was highly undesirable for the therapeutic process (couldn't agree more on that). I am so glad you spoke with her about it! I have a video appointment with my therapist this afternoon and I absolutely have to work something out with her so I don't feel as upset and generally messed up as I do feel. Thanks for sharing your experience...it gives me courage. I didn't get the sense that she was losing a lot of patients, but then again I think most of her other patients have only "mild" issues and are stable enough to cope with the situation or even postpone their treatment for a few months if need be. For people with serious issues the situation is a lot different I think. Okay, yes! I strongly believe you have hit on the main point of why you and I and many of us with mental illness are struggling with teletherapy. I know that the level of therapeutic care I need is higher (maybe even much higher) than what is needed by someone who does not have a mental illness and trauma history. I'll bet there are loads of clients who don't feel like teletherapy is that big a deal - or who even prefer it because they don't have to leave home, etc. And many of those are probably okay with taking a break from therapy, whereas for us a break can be potentially dangerous because of being tossed into a state of instability. __________________ |
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catches the flowers
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#17
I also spoke with my therapist (video) today. I laid it all out. Told her how betrayed and abandoned I feel...all of it. It was either tell all or quit. No grey there.
We also discussed how rotten she feels, not seeing clients in her office. There was a tremendous sense of relief to me to go over the subject. I am also relieved to hear that she does not intend on doing teletherapy any longer than necessary, although it sounds to me we'll be doing video sessions at least until the beginning of 2021. I'm trying to be creative with background and lighting. Something. Anything. Pretend I'm in a movie. FluffyD, you are in my thoughts. Please keep us posted on how you're feeling, and what your plans for meds are. __________________ |
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Grand Member
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#18
@BethRags: I'm glad to hear you spoke to your therapist, and I hope that will make everything a little more bearable for you. I agree that those of us with a history of mental illness and trauma likely need a much higher level of care, at least I know I do. My Pdoc thinks the feelings of betrayal in this instance tie into some trauma from the past and this amplifies the impact of the situation. I think that could be true, although I haven't worked out the details yet. I do kind of feel like the bipolar and the trauma are somehow "feeding on" each other, especially in dysphoric/depressed states of mind.
Being able to take it more or less "as needed" was one aspect I liked about Seroquel, although now it turns out it's not enough. I will speak to my Pdoc about Lamictal next week. Like you, there's something about it that makes me reluctant to try it, but now that I've heard so many positive experiences it kind of pushed me over the edge to try it. I did read that it has relatively few side-effects, although I don't know whether that's just because it's a pretty new medication so not all side-effects are known yet. I guess we'll find out! |
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#19
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FluffyDinosaur
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FluffyDinosaur
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#20
Have you guys ever experienced any of your episodes as traumatic? Now that my meds are back up the worst manic and depressive symptoms are under control, but I have this kind of lingering sadness that I can't really explain. It doesn't really feel like a depressive symptom, more like I'm sad and preoccupied about everything that happened. Maybe part of it is needing to accept the whole situation that I need meds just to function, I dunno. Another part is maybe finding a way to deal with all the anger I have. I just feel weird. Is this something you guys commonly experience in the aftermath? Is it part of recovering from the episode? I've never paid much attention to this part before. I'm also really tired and feel like I have to take it easy, like I've been sick. I just hope these really are the first steps towards recovery and I won't just relapse again.
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