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Can't function without medication

U

Underdog21

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Joined
Mar 26, 2021
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196
Location
Oxford
Hi all,

I just wanted to vent a little because I see a lot of people in general who are able to manage their bipolar with little medication or even can afford the luxury to pick and choose what meds they take ( after taking into consideration the nasty side effects).
I feel like I personally can't afford that luxury. I am on Risperidone 3 mg and that has caused my metabolism to slow down hence I am overweight and I am also on Lithium 900 mg and my thyroid seems to have started to malfunction. I wish I could drop the anti-psychotic or at least be on a low dose and perhaps change Lithium to maybe valproate or something else that isn't so severely adverse on kidneys and thyroid. The problem is that I don't know if I suffer from mixed episode or simply severe depression (no one has told me yet). I am concerned that if I mention this to my psychiatrist or dare to switch to new meds I will experience instability and potential other side effects. My bipolar is severe, I've experienced severe psychosis where I completely lost touch with reality and also severe depression where I felt suicidal, low, agitated and many other symptoms. I don't even know if my last mood episode was a mixed episode (that's what they wrote on the letter) or purely severe depression. If it wouldn't be for the meds I would probably be locked up in a hospital or die of suicide depending which mood episode I am in.
 
Wishbone

Wishbone

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England
If they wrote it on the letter then take that as being a yes, it was mixed. The treatment for mixed is usually the same for Bipolar 1, with some meds being better at dealing with the mixed side of things (basically acknowledging that you need something that will work against mania and work against depression and not just one pole).
When I was majorly trawling through studies a while back I noted down some of my findings, these are the ones relevant to mixed that I found:

Lithium - not particularly good for mixed (some conflicting reports)
Risperidone - good for mixed
Quetiapine - doubts about mixed (conflicting reports)
Valproate - Marginally
Aripiprazole - good for mixed and rapid cycling
Ziprasidone - good for mixed

It's probably best you do your own research into meds, maybe having a look through some studies and seeing what you find regarding mixed states/episodes/features and then with what you find you can approach your doc and maybe suggest something. They won't always say yes (I didn't get exactly what I wanted the last time I had a review but I did get one that I wanted, which was good enough). So just put it to them and see what they say.

Try here:

1.) The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 2: Review, Grading of the Evidence, and a Precise Algorithm
2.) Evidence-based guidelines for treating bipolar disorder: revised third edition Recommendations from the British Association for Psychopharmacology
3.) Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder
4.) bipolar disorder - PMC - NCBI
 
U

Underdog21

Well-known member
Joined
Mar 26, 2021
Messages
196
Location
Oxford
If they wrote it on the letter then take that as being a yes, it was mixed. The treatment for mixed is usually the same for Bipolar 1, with some meds being better at dealing with the mixed side of things (basically acknowledging that you need something that will work against mania and work against depression and not just one pole).
When I was majorly trawling through studies a while back I noted down some of my findings, these are the ones relevant to mixed that I found:

Lithium - not particularly good for mixed (some conflicting reports)
Risperidone - good for mixed
Quetiapine - doubts about mixed (conflicting reports)
Valproate - Marginally
Aripiprazole - good for mixed and rapid cycling
Ziprasidone - good for mixed

It's probably best you do your own research into meds, maybe having a look through some studies and seeing what you find regarding mixed states/episodes/features and then with what you find you can approach your doc and maybe suggest something. They won't always say yes (I didn't get exactly what I wanted the last time I had a review but I did get one that I wanted, which was good enough). So just put it to them and see what they say.

Try here:

1.) The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 2: Review, Grading of the Evidence, and a Precise Algorithm
2.) Evidence-based guidelines for treating bipolar disorder: revised third edition Recommendations from the British Association for Psychopharmacology
3.) Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder
4.) bipolar disorder - PMC - NCBI
Hi WIshbone,

I just don't understand. Why isn't Lithium effective for mixed episodes (I have heard this from other sources as well) if Lithium seems to treat both mania and depression. I just had a look at my letter dating January this year and it says I am likely to experience suicidality given a mixed episode. I take lithium and it seems to be working. Risperidone wasn't strong enough even at 6 mg to regulate the mood hence they added Lithium.
 
Wishbone

Wishbone

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And to help you search through the studies, if you aren't already aware, hold down the ctrl key and hit the F key and that will open up a box. Just type in there any medication name or 'mixed' or something like that for all of the relevant results to save you time.
 
Wishbone

Wishbone

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I honestly don't know. There have been more than enough studies done on Lithium over many years now so it should really be concrete that it either works or doesn't, I assume it's down to patient presentation or maybe even study design rather than the drug itself, but I'm not sure. It is known to be good for keeping suicidal feelings at bay and yes that's right about mixed being the biggest risk factor for such feelings so if it does keep those feelings away it's something to consider.
 
U

Underdog21

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Joined
Mar 26, 2021
Messages
196
Location
Oxford
I honestly don't know. There have been more than enough studies done on Lithium over many years now so it should really be concrete that it either works or doesn't, I assume it's down to patient presentation or maybe even study design rather than the drug itself, but I'm not sure. It is known to be good for keeping suicidal feelings at bay and yes that's right about mixed being the biggest risk factor for such feelings so if it does keep those feelings away it's something to consider.
Unfortunately no doctor has told me exactly what my illness is. They just threw the term mixed state in there and that's about it. Even my diagnosis says Bipolar Affective DIsorder (pretty vague if you ask me) and that has been a working diagnosis for a year now. Last time I asked the Junior Doctor about my symptoms she said I have depressive symptoms, she didn't mention anything about mixed episodes which is probably what I have now looking back. I can't reasearch medication and illness if I don't know the specifics of my illness. Probably because they aren't sure exactly what I suffer from, but Lithium seems to be working though.
 
K

keith74

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Sep 14, 2020
Messages
650
Location
Canada
I just wanted to vent a little because I see a lot of people in general who are able to manage their bipolar with little medication or even can afford the luxury to pick and choose what meds they take ( after taking into consideration the nasty side effects).
Don't be hard on yourself. The people who can manage with minimal (or no meds) are fortunate to be able to put themselves in an environment where they can avoid most stress/triggers. Most people do not have that option. And everyone is different. Unfortunately some people are more med "resistant" or more vulnerable to side effects. I hope you find something that works well for you long term
 
U

Underdog21

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Joined
Mar 26, 2021
Messages
196
Location
Oxford
Don't be hard on yourself. The people who can manage with minimal (or no meds) are fortunate to be able to put themselves in an environment where they can avoid most stress/triggers. Most people do not have that option. And everyone is different. Unfortunately some people are more med "resistant" or more vulnerable to side effects. I hope you find something that works well for you long term
Thank you Keith.
 
S

SFGuy

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Mar 28, 2021
Messages
346
Location
California
I need an enormous number of different drugs to function reasonably well. It has taken years of trial and error to get the mix as good as it is now. And it gets switched up often.

People are different — and it’s ok to need a lot of meds or none. Whatever works, right? For the moment, my mix works well enough to keep me stable, calm, and even happy most days. The meds are worth the trouble for me.
 
Wishbone

Wishbone

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Unfortunately no doctor has told me exactly what my illness is. They just threw the term mixed state in there and that's about it. Even my diagnosis says Bipolar Affective DIsorder (pretty vague if you ask me) and that has been a working diagnosis for a year now. Last time I asked the Junior Doctor about my symptoms she said I have depressive symptoms, she didn't mention anything about mixed episodes which is probably what I have now looking back. I can't reasearch medication and illness if I don't know the specifics of my illness. Probably because they aren't sure exactly what I suffer from, but Lithium seems to be working though.
'Bipolar affective disorder' is how we diagnose it in the UK, same as other countries that follow the WHOs ICD-10 guidelines. See here: ICD-10 Version:2019

I believe they went this way because of the changeable nature of the presentations. You could first appear to have 'bipolar 2' but that could become 'bipolar 1' with a manic or mixed episode. You could see your doc and be currently well, or you could see your doc and be currently depressed. As you can see from that link it assesses how you are each time you have an appointment (the F codes) so better tracks your mood status rather than saying you have this particular rigid diagnosis or that one, because Bipolar 1 can have mania, mixed, hypo, depression and they can also have spells of rapid cycling but you wouldn't know where someone was without it. This way gives better insight into where you are within that. You still have Bipolar disorder no matter where you currently are moodwise. So while on the other side of the pond they use their own DSM-V guidelines, we use the larger ones used by more countries in the ICD-10. So just like me you have 'bipolar affective disorder' as your diagnosis and if we lived in america we'd be diagnosed as bipolar 1 because of the mixed state presence. I hope that clears up some of the confusion.
 
S

SFGuy

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Underdog, I've had great results with Depakote for my mixed states, but it doesn't help with depression. Lithium is supposed to do that, but I can't take it because of my kidneys.

My favorite source of info about all things bipolar is here (especially the stuff by Jim Phelps):

 
U

Underdog21

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Oxford
Thanks a lot guys. I am so glad to find support on this forum from people like you.
 
Wishbone

Wishbone

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I've had great results with Depakote for my mixed states, but it doesn't help with depression.
I've found something similar, studies are a bit undecided, but my psych swears that it does. Maybe it's another one of those 'for some people'.
 
U

Underdog21

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Messages
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Oxford
I've found something similar, studies are a bit undecided, but my psych swears that it does. Maybe it's another one of those 'for some people'.
Before putting me on Lithium my psychiatrist suggested that the alternative would be to put me on sodium valproate and increase risperidone to 8 mg if I am not mistaken. I don't now how efficient risperidone is in treating depression. I think it works well against mania.
 
S

SFGuy

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346
Location
California
Before putting me on Lithium my psychiatrist suggested that the alternative would be to put me on sodium valproate and increase risperidone to 8 mg if I am not mistaken. I don't now how efficient risperidone is in treating depression. I think it works well against mania.
Do you have access to your psychiatrist for another med review? They could probably change things up to address the mixed states, anxiety (?), depression, and psychosis risk you face.

I'm a tricky customer because I have a complicated mix of symptoms, so my psych. and I have had to work closely to manage mixed states, hypomania, depression, severe anxiety, ADHD, insomnia, depression, and probably other stuff I've forgotten. The meds have made each set of symptoms better and we've made tolerable tradeoffs.

Until tomorrow when I could go off the rails :).
 
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