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I am just exhausted with the medication changes

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Kimin661

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I was diagnosed with Bipolar I about a year-ish ago (im 32). I didn't have any mental health issues until I had my second child in 2012. Since then I have had so many stupid medication changes and it makes me insane. I am currently on 20mg of Paxil, Tegretol, and 500MG of Depakote. I guess my question is... Has anyone been on this combo before? It seems like it's working a bit, but it's still not where id like to be. I feel like my psychiatrist just throws me on random medications and hopes for the best. I am switching doctors at the end of the month because of insurance issues.

Just hoping someone had any kind of input or advice. My main symptoms on this combination are moodiness (I get very snappy, especially before my cycle), slight anxiety, and SOMETIMES mania, but that's not as often anymore.
 
Tawny

Tawny

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It is different where you live compared to here as many people take just one medication like Lithium. Were you ever given that?

For 3 months after an episode, i have taken Fluoxtine, Olanzapine and Lithium. After 3 months the Olanzapine was stopped. After 6 months Fluoxetine was stopped. Then i continued on Lithium. This was pre-planned, i was told this when i was discharged.

We all have different symptoms but for my psychiatrist, the goal is the less medication the better, the lowest does the better.

Your symptoms would be a sign for me i was not on a high enough dose though, or that life was stressful.
 
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Kimin661

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Oh...Is this a forum that is outside of the United States? I can't seem to find anything in the states. :(
 
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keith74

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My wife is diagnosed with bipolar I. She was on 500mg Depakote (or Epival as it is known in Canada) and 100mg Seroquel. Currently she is on just Olanzapine 15mg as she is coming down from a manic episode. Her doctor hopes to eventually wean her off Olanzapine and back on to some mood stabilizer (though right now she is reluctant to go back on one for various reasons). It can take a long time to find the proper med combo that works well for you.
 
Tawny

Tawny

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Oh...Is this a forum that is outside of the United States? I can't seem to find anything in the states. :(
No, members are from all over the world. Lots of different countries and lots in yours too. 😀
 
HLon99

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Dear Kimin,

There is a lot of trial and error when it comes to selecting bipolar medication. My suggestion would be to have a word with your psychiatrist about coming up with a long term game plan to specifically tailored to your needs than quick fixes and shots in the dark and to simplify for medication regiment as much as possible

For instance if your predominantly a depressive type, ask for mood stabilisers targeted specifically at depression such Lamotrigine or Symbyax. If you are mania predominant ask for Lithium, Depakote or Antipsychotic. If your a rapid cycler, avoid all antidepressants. If you have psychotic features ask for an antipsychotic. If you have classic bipolar disorder and require long-term stabilisation ask for Lithium. Research your illness and research the meds and so that you are well informed and clued in on your treatment. In the US, there tends to be no clear universal framework and psychiatrist pretty much try meds at their own discretion. I will list a link down below to the prescribing guidelines used to treat bipolar here in the UK. Here there are very clear methods by which drugs are selected and in my experience it tends to work very well.

 
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Failing Heart

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I was diagnosed with Bipolar I about a year-ish ago (im 32). I didn't have any mental health issues until I had my second child in 2012. Since then I have had so many stupid medication changes and it makes me insane. I am currently on 20mg of Paxil, Tegretol, and 500MG of Depakote. I guess my question is... Has anyone been on this combo before? It seems like it's working a bit, but it's still not where id like to be. I feel like my psychiatrist just throws me on random medications and hopes for the best. I am switching doctors at the end of the month because of insurance issues.

Just hoping someone had any kind of input or advice. My main symptoms on this combination are moodiness (I get very snappy, especially before my cycle), slight anxiety, and SOMETIMES mania, but that's not as often anymore.
I am in the states and completely understand how frustrating it can be to find the right meds! I’m famous for finding a medication cocktail that doesn’t make me want to kill myself and I stop there! So I am always just fine or just barely able to cope but never sure if I could do better. Too scared to keep trying bc I end up being completely miserable for weeks on end. It’s GREAT when you finally find something that works. But yeah, it’s a crap shoot until they guess the right one for you:( sorry friend, hang in there
 
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keith74

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Hi Tawny,

For 3 months after an episode, i have taken Fluoxtine, Olanzapine and Lithium. After 3 months the Olanzapine was stopped. After 6 months Fluoxetine was stopped. Then i continued on Lithium. This was pre-planned, i was told this when i was discharged.
Regarding your Olanzapine treatment, how was it to come off Olanzapine? Did you experience any withdrawal symptoms? And how slowly did you ramp down? My wife is still on Olanzapine (10mg) following her discharge from the hospital for a manic episode. It has been 6 weeks on it so far but the plan is to start weaning off it as she goes back on her main mood stabilizer (Depakote/Epival). I hear that the withdrawal symptoms can be bad for some people.
 
Tawny

Tawny

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Hi Tawny,



Regarding your Olanzapine treatment, how was it to come off Olanzapine? Did you experience any withdrawal symptoms? And how slowly did you ramp down? My wife is still on Olanzapine (10mg) following her discharge from the hospital for a manic episode. It has been 6 weeks on it so far but the plan is to start weaning off it as she goes back on her main mood stabilizer (Depakote/Epival). I hear that the withdrawal symptoms can be bad for some people.
I was given Olanzapine because it works quickly, and the other medication was going to take a bit longer to work at full strength. I think the psychiatrist said Lithium would take 3 months to work fully and that is why i had to take the Olanzapine until then.

My illness is more depression though. Severe mania, many people take Olanzapine for longer.

It felt ok to come off of. I don't remember any physical withdrawal but as you would expect, my mood went up, but not that much because the Lithium was there. I lost weight gradually too.

I do feel that Lithium was more sedating than olanzapine. I think if it weren't for the weight gain, i would take Olanzapine. Also, antipsychotics are much more 'heavy duty' than Lithium so that is another reason why i was keen to come off it. Longer term potential problems made me think i would have to be extremely unwell to accept it again.

The hardest to come off, always for me, is the antidepressant. Mood goes straight down. When i stop the Lithium, or Lamotrigine, mood goes straight up.
 
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keith74

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I was given Olanzapine because it works quickly, and the other medication was going to take a bit longer to work at full strength. I think the psychiatrist said Lithium would take 3 months to work fully and that is why i had to take the Olanzapine until then.

My illness is more depression though. Severe mania, many people take Olanzapine for longer.

It felt ok to come off of. I don't remember any physical withdrawal but as you would expect, my mood went up, but not that much because the Lithium was there. I lost weight gradually too.

I do feel that Lithium was more sedating than olanzapine. I think if it weren't for the weight gain, i would take Olanzapine. Also, antipsychotics are much more 'heavy duty' than Lithium so that is another reason why i was keen to come off it. Longer term potential problems made me think i would have to be extremely unwell to accept it again.

The hardest to come off, always for me, is the antidepressant. Mood goes straight down. When i stop the Lithium, or Lamotrigine, mood goes straight up.
Thanks Tawny. Yes my wife was given Olanzapine because it is effective at bringing down acute mania fairly quickly. But like you said, the long term effects are a little troubling and we both would rather have her back on Depakote/Epival than stay on Olanzapine long term.

I'm glad to hear that you didn't experience too many issues with going off Olanzapine. I have heard of some people going through serious withdrawal issues. But they were on it for a lot longer (most were on it for many years), and I know the longer you are on it, the harder it is to stop.
 
Tawny

Tawny

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Thanks Tawny. Yes my wife was given Olanzapine because it is effective at bringing down acute mania fairly quickly. But like you said, the long term effects are a little troubling and we both would rather have her back on Depakote/Epival than stay on Olanzapine long term.

I'm glad to hear that you didn't experience too many issues with going off Olanzapine. I have heard of some people going through serious withdrawal issues. But they were on it for a lot longer (most were on it for many years), and I know the longer you are on it, the harder it is to stop.
I think the problem with coming off any mood stabiliser, maybe especially an antipsychotic mood stabiliser, is mania. I have certainly gone higher when coming off an antipsychotic than a non-antipsychotic mood stabiliser. I'm not sure why and i don't know if that is common.

I have heard many times people say they have to take the antipsychotic for 6 months but for me it was 3 months but i was probably not as unwell as your wife has been.

If psychosis is involved, i think it is a whole different thing.

Can she not have Lithium?
 
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keith74

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I think the problem with coming off any mood stabiliser, maybe especially an antipsychotic mood stabiliser, is mania. I have certainly gone higher when coming off an antipsychotic than a non-antipsychotic mood stabiliser. I'm not sure why and i don't know if that is common.

I have heard many times people say they have to take the antipsychotic for 6 months but for me it was 3 months but i was probably not as unwell as your wife has been.

If psychosis is involved, i think it is a whole different thing.

Can she not have Lithium?
As she lowers her Olanzapine dosage, she is ramping up on her mood stabilizer (Depakote/Epival). Epival is good for mania so hopefully that should keep things in check. I know her doctor is planning on a very slowly getting her off Olanzapine so it may be close to 6 months by the time she is completely off.

She has never tried Lithium but is very reluctant to try it for various reasons. Epival has been an effective mood stabilizer for her in the past so we (and her doctor) are comfortable as long as she is on that.
 
Zero One

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I'm on the same dosage of depakote ( 500 mg) and it helps my what you would call snappiness and it really works. It made me feel like I was on a high for the first three days then I just felt normal for the most part.
 

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