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Can't function without medication

U

Underdog21

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Mar 26, 2021
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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 :).
Unfortunately I live in the UK and adult mental health services are underfunded and short staffed. To get an appointment with a psychiatrist you have to jump hurdles and getting regular reviews is difficult. Lithium seems to work, I am just concerned about the severe side effects. But if I would request a med change I am not sure they would agree and if they do agree they tend to forget about you once you are on the medication unless you complain and phone Pals which is the place you complain if you are unhappy with the services provided. I don't want to bad mouth NHS but unfortunately this past year I have been let down after they put me on Lithium and the dose was not in the therapeutic range and nobody bothered to request a blood test or check the levels. So I am reluctant to ask for a different review because I am worried that if it doesn't work I will be left hanging or should any side effects arise it will be hard to chase them.
 
S

SFGuy

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The U.S. system is bad, too. To get the level of care I've had, I've gone private because I've been lucky to have a supportive husband. It's expensive. If I used my private insurance, the best clinicians would be unavailable -- they won't take the low reimbursements insurance offers.

I hope someone here who knows NHS can give you some tips.
 
Wishbone

Wishbone

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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.
I wouldn't forsee either of those doing too much for depression. I'm in a similar boat in that depression keeps coming back to me and I'm now thinking that maybe the Valproate isn't the way to go, almost as if it's keeping too good a lid on the higher end and not letting me get into the realms of happiness, or at least, not for long. 8mg of Risperidone is pretty damn high for outpatient care and Bipolar maintenance, it seems they're more concerned with you going too high they're forgetting about allowing you to experience happiness too.

Take a look here, I posted this before. It's Canadian in origin but pretty good tables for info:

 
Wishbone

Wishbone

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I think I'm gonna see about trying Quetiapine again, only this time without the antidepressant ruining it! :rolleyes:
 
U

Underdog21

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I think I'm gonna see about trying Quetiapine again, only this time without the antidepressant ruining it! :rolleyes:
Hi Wishbone,

When I first experienced psychosis they put me on Quetiapine, however the side effects were tolerable but for someone who isn't necessarily functional in the society. What do I mean by that... I was sleeping 18 hours a day, was eating a lot and was left zombified. I am not exaggerating when I say I did experience those three side effects. I am not sure if it was a dose related thing or just my body getting used to the medication in the begining . Who knows if Lithium is going to affect my kidneys at some point, I might try quetiapine as well again. I am not sure how severe your depression is. Mine was so severe I couldn't brush my teeth, run to the shop, even getting words out of my mouth was difficult. Is valproate and lamotrigine a soultion to cover both ends?
 
Wishbone

Wishbone

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I found this for Lithium and Lamotrigine:

"The addition of lamotrigine to lithium proved effective in bipolar depression in an independent European study. This combination would have the additional theoretical benefit of combining two drugs with positive long-term data and complementary polarity indices."

Some other things I found:

"In bipolar I disorder, lamotrigine will usually require combination with an antimanic long-term agent (IV)."

"When the burden of disease is mania, it may be logical to combine two predominantly anti-manic agents (e.g. lithium, valproate, a dopamine antagonist or a dopamine partial agonist) (IV). When the burden is depressive, a combination of lithium, lamotrigine, quetiapine, lurasidone or olanzapine may be more appropriate (IV)."


This recommendation regarding bipolar depression:

"Consider initial treatment with lamotrigine, … usually as an addition to agents preventing recurrence of mania"

But I'm not seeing any mention of Valproate and Lamotrigine together so maybe as two anticonvulsants (And I believe Lamotrigine has a different mode of action if I'm not mistaken) it might be that they clash and/or aren't safe to take together. That's all I know from that quick look.
 
K

keith74

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Hi Wishbone,

When I first experienced psychosis they put me on Quetiapine, however the side effects were tolerable but for someone who isn't necessarily functional in the society. What do I mean by that... I was sleeping 18 hours a day, was eating a lot and was left zombified. I am not exaggerating when I say I did experience those three side effects. I am not sure if it was a dose related thing or just my body getting used to the medication in the begining . Who knows if Lithium is going to affect my kidneys at some point, I might try quetiapine as well again. I am not sure how severe your depression is. Mine was so severe I couldn't brush my teeth, run to the shop, even getting words out of my mouth was difficult. Is valproate and lamotrigine a soultion to cover both ends?
Yeah many people get that "zombie" feeling when on higher doses of an antipsychotic. But again, everyone is different. My wife has been on 300mg quetiapine for about 10 months now and fortunately doesn't have that side effect. She does like to sleep a lot but once she is up, she is up - no feeling sluggish or numb. And if she needs to get up early for something, she will. She is slowly tapering off it however (just dropped to 250mg) now that it has been awhile since her last depressive episode. Her maintenance dose is typically just monotherapy valporate, with the quetiapine added only in times to deal with acute depression. But I am wondering if she needs something more permanent to guard against depression since the data on valporate for depression is sparse.
 
K

keith74

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But I'm not seeing any mention of Valproate and Lamotrigine together so maybe as two anticonvulsants (And I believe Lamotrigine has a different mode of action if I'm not mistaken) it might be that they clash and/or aren't safe to take together. That's all I know from that quick look.
I have read that it can be ok to take valporate and lamotrigine together. But it is very important to lower the dose of the lamotrigine since the way they interact with each other can greatly increase the potency or duration of the lamotrigine. I don't recall if the same is with the valporate. In any case you would need to work with a psychiatrist who is familiar with the interaction of the two.
 
U

Underdog21

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Oxford
Yeah many people get that "zombie" feeling when on higher doses of an antipsychotic. But again, everyone is different. My wife has been on 300mg quetiapine for about 10 months now and fortunately doesn't have that side effect. She does like to sleep a lot but once she is up, she is up - no feeling sluggish or numb. And if she needs to get up early for something, she will. She is slowly tapering off it however (just dropped to 250mg) now that it has been awhile since her last depressive episode. Her maintenance dose is typically just monotherapy valporate, with the quetiapine added only in times to deal with acute depression. But I am wondering if she needs something more permanent to guard against depression since the data on valporate for depression is sparse.
I guess i
Yeah many people get that "zombie" feeling when on higher doses of an antipsychotic. But again, everyone is different. My wife has been on 300mg quetiapine for about 10 months now and fortunately doesn't have that side effect. She does like to sleep a lot but once she is up, she is up - no feeling sluggish or numb. And if she needs to get up early for something, she will. She is slowly tapering off it however (just dropped to 250mg) now that it has been awhile since her last depressive episode. Her maintenance dose is typically just monotherapy valporate, with the quetiapine added only in times to deal with acute depression. But I am wondering if she needs something more permanent to guard against depression since the data on valporate for depression is sparse.
I guess it depends on the severity of one's Bipolar. If I had to rate the intensity or severity of my Bipolar I would rate it as a 10.I experienced both poles of the illness and found them to be painful and debilitating. On top of that went severely psychotic.
 
K

keith74

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Perhaps. My wife is bipolar I also and while her manic and depressive episodes can be very intense, she doesn't really get full on psychosis (though she can get quite paranoid).
 
S

SFGuy

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I have read that it can be ok to take valporate and lamotrigine together. But it is very important to lower the dose of the lamotrigine since the way they interact with each other can greatly increase the potency or duration of the lamotrigine.
My psychiatrist said she often uses lamotrigine as the antidepressant half of a valproate/lamotrigine combo but, as you say, the lamotrigine dose has to be individualized because valproate affects it somehow.
 
Amazingly

Amazingly

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I too suffer from severe bipolar and need my meds.
I can become psychotic when manic or mixed.
Currently I am on Risperdal and Lamictal and take PRN clonazepam as needed.
 
C

Comorbidity

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Jul 19, 2021
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London
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.
Keith is absolutely right, I am fortunate enough to be able to control my environment, I don't actually have nay other option as I am the opposite to you, I cannot function at all with meds
 
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