How to recover from mixed episode?

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.

When I'm not stable on meds, mixed episodes are my norm, and they are a living hell. So first, I want to offer my empathy

We've discussed how betrayed we both feel by our therapists during the COVID crisis. So of course, you have my full understanding there, too.

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).

For me, getting in arguments with strangers is a clear symptom of a mixed state. Sometimes manic, but definitely mixed. The argument with strangers thing is potentially dangerous and really does indicate the need for medication intervention.

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.

Yes, that's the conundrum of medication, isn't it? Or maybe it's more accurate to say that mental illness itself that is the culprit. For most of us, accepting that we have a mental illness is a lifelong struggle...at least, for me it is. "Stuck between a rock and a hard place" is the phrase that comes to mind when I weigh the medication/no medication option.

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.

Yes. Like we discussed on the other thread that feeling of being betrayed and abandoned by a therapist...to me, it feels almost unbearable, like my very core is just curled up, sobbing in traumatic emotional pain. The feeling of broken trust and abandonment is traumatic, plain and simple.

Something I have been thinking about since this morning is that the COVID situation is affecting therapists, too. Hopefully, most of them are equipped emotionally to manage the sudden interruption of normal, in office therapy. Still, it has to be frightening and sad to therapists to lose the in-person connection with clients, especially long-term clients.

I've been reading some about COVID and how it's affecting traditional therapy, but one question I'm curious about that I haven't seen addressed is how many therapists are losing clients due to switching from in-office appointments to video? If therapists are losing clients they've worked with for a while, or for a long time, they must be going through their own grieving process.

Whatever the case, whether COVID is as much of a danger as we're being told by the medical community, or whether it's all overblown, these sure are difficult times. For many of us with mental illness these times feel overwhelming. We're overwhelmed, then the bad stuff (suicidal feelings, for example) amp up. But even for the most stable people, from what I'm hearing and reading this spring, all the stress is pushing many neurotypicals over the edge.

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...

I'm with bpcyclist on this. In my experience the meds you're on are not enough to provide stability for the episode you're currently in, also not enough to keep you stable, altogether. Also, your current meds don't sound like they're doing the job that meds should be doing.

I know that Seroquel helps a lot of people, and it sounds like it helps you with irritability and anger, which is great. Since sleep is so very important to help us remain stable I do believe that the low-dose Seroquel is beneficial.

Who am I to advise you, but...I strongly suggest Lamictal. It's so successful for those of us with bipolar disorder, and it's especially helpful for BD depression.

When I started seeing my pdoc a few years ago I was reluctant to mess around with meds, to try this, try that. I was sooo discouraged at that time. At one point I was very unstable and suffering severely. I told her I had decided to try ECT. She agreed, but she encouraged me to experiment just a bit more to find a med combination that worked. She told me then that if no med combination was effective we'd go ahead with ECT.

It took a commitment, patience, and adjustment, but I finally, finally am taking a combination of 4 meds (Lamictal, Trilafon, Pristiq, Klonopin, and I sometimes use melatonin for sleep) that is not only keeping me stable, but is truly helping my quality of life.

Anyway, sorry for the rant and thanks for any advice.

Aw, you're not ranting. You're trusting us to help you out and that's what we're all doing here...supporting each other.

.....

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.

@BethRags: I'm glad to hear you spoke to your therapist, and I hope that will make everything a little more bearable for you.

Thank 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.

I entirely agree with your therapist. In addition, I feel sure that BD and trauma do feed off each other until they're so blended that it becomes difficult to discern one from the other.

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!

Honestly, from everything I've heard (I mean from others with BD) Lamictal really doesn't have side effects. The only concern is going up too rapidly and acquiring the horrible rash reaction - but the answer is to take it slow at first, and besides, the skin thing is extremely rare.