Could this be psychosis prodrome?

I don't know because I've never been psychotic before. It could just be because I'm severely depressed, but I'm a little worried. I will take this up with my Pdoc, but I wanted to get opinions here as well. I don't have any hallucinations but I think I do have a bunch of the "negative" symptoms that could be early warning signs. I think this has been building up over the past few months.

I can't sleep and I can't think clearly. Having a lot of derealization. Keep losing my train of thought. Having trouble spelling words though I used to be able to write entire essays without needing a spell checker. I'm having trouble thinking of the right words when I'm talking. I'm also very irritable and anxious. I can't muster the energy to behave normally around people anymore.

I'm losing my memory, both short term and long term. I can't remember what I'm doing or what I was about to do for longer than about 5 seconds, and I can't remember things I just did. I usually have great memory, but now I'm forgetting stuff like my passwords or the middle names of my kids, stuff that I would never forget normally. I've resorted to writing my passwords down on a notepad so I don't have to reset them all the time. I forget to take my meds, I forget appointments, stuff that never happens to me otherwise.

I zone out a lot and sometimes I hardly know where I am. I don't think I should be driving anymore. I feel like I'm kind of drifting in and out of consciousness. When people talk to me or ask me a question I sometimes don't register it for a few seconds. Sometimes I'm just "gone" for a while.

I'm having a lot of trouble thinking clearly and concentrating, and I have zero motivation. I don't feel able to do my job anymore but I'm afraid to tell them how bad I'm doing. I'm anhedonic most of the time and I'm too distracted to even read a book or watch tv. I'm severely depressed and I'm alternating between feeling empty and being unable to stop crying. I feel completely alienated from the world and I feel like nobody cares about me, not even my wife.

I keep wanting to say things and then immediately forgetting what it was. I think I may have been saying some weird or inappropriate things sometimes. This has been going on for a while but I thought it was the meds. But now I'm not on any meds anymore except Lamictal.

My entire life feels like a trap that I need to escape from. When I think about the future it makes me desperate and hopeless because I feel like this will never get better. I have a lot of thoughts about SI and hurting myself, but I don't think I'm at risk of doing anything because I couldn't do that to my family. Still, it bothers me. All I want is to be alone and for the days to be over as quickly as possible. But then I can't sleep at night, so there's no escape at all. I seriously wish I could just be put into an artificial coma until this is over. I don't know what to do about it.

Sometimes I feel like I'm about to go crazy, but sometimes I get lost in my thoughts and I think maybe it's the other way around, that I've been crazy and now I'm waking up and about to see my real life.

I'm so sorry you're going through this. Whatever the cause, however it would be described medically, it's clearly a problem for you. If recording your experience here helps to process it, please continue to do so. I know it's taken a while to get a response but that's no indication of the degree to which we care about you.

My knowledge of psychosis is minimal so I have little to offer in that direction.

This:

"I can't sleep and I can't think clearly. Having a lot of derealization. Keep losing my train of thought. Having trouble spelling words though I used to be able to write entire essays without needing a spell checker. I'm having trouble thinking of the right words when I'm talking. I'm also very irritable and anxious. I can't muster the energy to behave normally around people anymore.

I'm losing my memory, both short term and long term. I can't remember what I'm doing or what I was about to do for longer than about 5 seconds, and I can't remember things I just did. I usually have great memory, but now I'm forgetting stuff like my passwords or the middle names of my kids, stuff that I would never forget normally. I've resorted to writing my passwords down on a notepad so I don't have to reset them all the time. I forget to take my meds, I forget appointments, stuff that never happens to me otherwise.

I zone out a lot and sometimes I hardly know where I am. I don't think I should be driving anymore. I feel like I'm kind of drifting in and out of consciousness. When people talk to me or ask me a question I sometimes don't register it for a few seconds. Sometimes I'm just "gone" for a while."

I could have written the same sentences about myself. I got goosebumps when I read your post. Now, it could be depression and of course, I cannot possibly tell you "for sure" what is going on for you. You might be in a mixed state of depression and dysphoric mania (for the most part, that's what your description sounds like, to me). I can, however, tell you that when I've described the same to my pdoc she says it's mixed-state with some psychosis. Although, the psychosis aspect usually involves a degree of paranoia.

Now, whatever is going on, whatever name it has, the bottom line is that FluffyD - I am deeply concerned about you. You've been going down for a long time, and you just keep going lower and now you are having more severe symptoms.

Furthermore, it sounds to me that you don't have a reliable support system at home. I'm sure that your wife has her side of the story and I fully understand that. But the fact is that you don't feel supported.

I don't know what to advise you to do except to keep posting here and/or the obvious - go IP. I am no advocate of that, but you are safe there, able to drop the stress of having to "be and do". Also, treatment is expedited when you're IP. I'm thinking that maybe a hospital stay would help to get you in more quickly for ECT. Also, there might be a medication that could help you until you do have ECT. What do you think?

I agree with everything said and Your and Bether's posts coulda been mine.

I could write a novel about you. Short version is, i agree this mixed state stuff slash dysphoric mania thst is getting worse. I also am concerned you are drifting to the psychotic side of the ledger. Badass dysphoric mania is not far at all from psychosis, take it from one in psychosis all the time. Months at a time. Your cognitive issues support my concerns.

So, yes, to me, you sound percolatingly psychotic without hallucinations--yet. It is misery and you have to get out of this or you will end up in the ER. Spent 6 yrs in the hopital. Trust me.

Is this an emergency? Yes, it is. And Lamictal is not your answer. Yiu need a bigtime antimania med like high-dose Depakote and a killer anti psychotic--just for starters. I like Zyprexa or Trilafon in these situations. You need it now.

I only know how derm surgery works in the UK. But no GP is your solution. You need a good pdoc.

I live where you are now much of the time. The best strategy forme has been: 1, knock the sh:@out of the mania, and 2, manage the psychosis your dysphoric mania has spun up. Depakote is likely to be your best sleep solution, in my experience. Sleep meds do not address the cause. Lowish dose Seroquel is a total joke for what you have.

Hugs and love. You must take action. PM me anytime. I have a schizophrenia support grp on snapchat. I cld chat there w you also.

Stay strong. Get meaningful help now.

I strongly second cyclist's post.

Where you are, Lamictal alone is like hitting a baseball with a popsicle stick.

I agree entirely with all of cyclist's assertions and suggestions. And I agree that the state you're in is an emergency.

Please let us know how you're doing tonight, if possible.

Just checkin' in...

Thank you for the concern everyone, it really means a lot to me. And sorry for the late reply.

I agree that the meds right now are not sufficient. I had been tapering off most of my meds in preparation for ECT, and was actually planning to stop Lamictal as well pretty soon. I don't know that that would make a difference anyway because it doesn't seem to be helping much. But as those of you who have been reading my ECT thread know, it now looks like it's going to be a few months before I can get into the hospital for ECT. I'm seeing my Pdoc tomorrow and I really really really hope he can expedite things somehow, because ECT is where I have my hopes set for a "real" solution. But if the wait can't be reduced then I guess maybe I can't avoid some temporary meds.

I do feel like things have been going steadily downhill for a long time, and I feel like it's accelerating now. I have been having trouble recognizing whether this is a mixed state or not, but since so many people here mention it I'm starting to think maybe it's true. I've been on the fence about asking for my crisis team because I feel like I would be wasting their time. I don't know if the lack of support thing is just in my head. Maybe it is, because I keep feeling like everyone hates me and I honestly can't imagine why anyone wouldn't. Even my therapist, I really look forward to seeing her but as soon as I leave her office I feel like she's thinking "phew, I'm glad that creep is gone for the week." I feel like she'd rather be rid of me but is just too polite to say anything.

I've been afraid to take more drastic measures because I don't want it to affect my job. I keep struggling to produce some tangible result every week so they don't notice what's going on. But since these symptoms are already affecting my job, maybe it would be better to try and get extra help. I don't know.

I cannot be sure about the psychosis. Mine presented very differently. I was very dialed in and hyperfocused. It was very emotional and spiritual. I felt ill physically. Paranoid thoughts and delusions started.

You seem to have great insight. Lowered insight is also a sign things are going downhill for me.

Regardless of whether or not psychosis is on the way, your symptoms are significant and impactful. Make a quick list and offer that to your pdoc so that you don't forget anything tomorrow. I agree with the others this is all quite serious and I hope you are given proper help tomorrow.

Thanks, and I agree that it's definitely nothing conclusive yet. I've just read a lot of things that say these "negative" symptoms can be one of the first signs, and it makes me worried about what might come if I don't do something soon. I will take your advice of making that list, and I agree; at this point it doesn't really matter what exactly is going on, I just know that it can't go on like this much longer. I'm really hoping I can have ECT as soon as possible and that it will finally give me my life and personality back, because I don't even recognize who I am anymore.

I hear you. I get schizo like psychosis, but none of the negative symptoms. Mine isn't conclusive either and I am without diagnosis.

I really hope you get the ECT or something that can help soon. It is very unnerving to feel on the edge of a complete breakdown. You're really doing all you can, so I hope you can take some comfort in that.

Don't get hung up on taxonomy, Fluff. Negative symptoms is just another term for all the same stufg found on the lower bipolar pole. We need to unify sz and bp language, since they are essentially just difft manifestations of the same basic neurochemical processes--in my view.

You're right, I'm beginning to realize more and more that the taxonomy doesn't really matter all that much. I've made a list for my Pdoc even though it feels a little awkward to hand him that. Hopefully it can get the point across.

I have my fingers crossed for you to be able to receive ECT much sooner. If there does end up being some time until the treatments, however, there's an upside. Being on meds (an AP, for example) for 2 or 3 months makes stopping the med much, much easier than being on it for a long time. Not having a difficult withdrawal would be a blessing.

Wise. You must treat the mania as well in my opinion.

You're both right. I still hope it won't be necessary, but if I do need meds it won't be for long. And even though the prospect of waiting longer than I would like for ECT is daunting, I have to say that it's the first thing in years that really gives me hope that I might become myself again.

So that you know, it's possible that your care team will want to keep you on your meds even while undergoing ECT. I have repeatedly requested stopping my meds to always get told no. Of course, if you take one of the anti-convulsants used for bipolar disorder as well, then you may need to stop. So I guess it depends on what you're taking.

Cyclist makes a very important point. Treating only the depression of BD is a mistake. At least, it was for me and for others with BD that I've learned from. For years I was treated with only SSRI's and the mania would go haywire - causing the plummet into depression to hit harder. And mixed states (the real bugaboo for me) were out of control, altogether.

BD requites treatment from all sides. I've mentioned before that I do know a few people who are BD2 and treat it with only Lamictal. But they do not have any psychosis. They're natural state is hypomania or moderate depression. Nothing way out there, no mixed states.

Thank you! Yes, the main one I'm on right now is Lamictal, an anti-convulsant, so they told me I have to stop that. I used to also be on lithium and Seroquel, but I tapered off those. I wanted my mind to be as "clean" as possible so nothing would interfere with the ECT, if that makes sense.

Yes, the mixed states are the worst in my opinion. My Pdoc did propose an SSRI at some point (Olanzapine + fluoxetine) but I said no because I heard SSRIs can make mixed episodes worse, so I didn't want to risk it. I've heard they are tricky to treat with meds, unfortunately.

Quote:

Originally Posted by FluffyDinosaur Yes, the mixed states are the worst in my opinion. My Pdoc did propose an SSRI at some point (Olanzapine + fluoxetine) but I said no because I heard SSRIs can make mixed episodes worse, so I didn't want to risk it. I've heard they are tricky to treat with meds, unfortunately.

They are tricky to treat, yes. My "normal" state is mildly mixed (mildly depressed, mildly manic). It doesn't seem that any meds pull me out of the mild mixed. Meds do, however, put the cap on going into moderate - for the most part. I still have a low degree of paranoia.