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Switching from Depakote to Lamotrigine?

Wishbone

Wishbone

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Is that last quote him blaming you or him blaming himself?
 
H

HisWife

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Is that last quote him blaming you or him blaming himself?
So, at the height of the mixed episode, everything was, according to him, my fault. So, for example, when his work put him on leave it wasn't because of how he behaved at work, it was because I must have told them he is bipolar (I didn't). When a family member stoped visiting, it wasn't because he screamed at their kid, it was because I must have poisoned them against him. Because, according to him, there was nothing wrong with him, and his behavior wasn't the problem.

Now, he's no longer blaming me, but he's still not ascribing things to illness. Instead he feels awful and guilty, and everything (e.g. the fact that he's not working, or that the kids are very nervous around him) is his fault because he just didn't do the right things and he's a terrible person. If, I tell him it's not his fault, that he was ill, he says that's making excuses, and tomorrow he's going to pull it together and do better. He also says that since he's going to pull it together, we should plan as if he'll be 100% back to normal.

So, he's still not really accepting that something is wrong, or able to problem solve rationally, but he's no longer blaming me, and the rage has been replaced by deep sadness, which breaks my heart but does have the advantage of being less scary to the kids.
 
H

HisWife

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To add, despite continuing to believe he is not ill, he is taking the meds. In part because he's miserable and at least on the meds he can sleep, but mostly because he knows I will kick him out and keep the kids with me if he doesn't. He doesn't want to separate. He gets anxious if I leave for a few hours to go to the store and cries, although now he has started telling me that I should kick him out because he doesn't deserve me.
 
Wishbone

Wishbone

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Ugh! It reads so close to home. I was just the same in pointing the finger elsewhere when I was like that, but at the time I genuinely believed it was other people and that they were working against me etc. A horrible thing to happen to someone and understandably horrible to be around, but always remind yourself that he simply isn't well and he'll return.

He still sounds a bit mixed to me. I know you say he's taking the meds, but are you 100% certain he's taking them? All of them? All of the time? He's high dose Quetiapine right? That's usually pretty damn effective, although I appreciate there are still changes afoot, and believe me, they really can mess with you! What you've got to watch out for is people being left to their own devices with regards to meds who think they aren't ill: they simply won't take the meds, why would they! They aren't ill! Something to keep an eye on, if you can somehow monitor his pack or something without bringing it up, that may be the best route to take. But then, if you're sure he's taking them as he should, it's just a matter of time before things settle.

It's a really delicate time though. With all that's gone on, for you both, to effectively have temporarily lost your mind too is no place anyone wants to be. If his mood is swinging still he'll switch from pointing the finger, maybe even glimpses of feeling/looking well, to guilt, and back again. I said it before about the dangers involved and I know you don't need reminding, but do keep a close eye on things, try and notice the little things even more just in case. But also look after yourself and try to find time, somewhere, to relax, or you'll be posting here as an inmate instead of a visitor yourself!
 
H

HisWife

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Ugh! It reads so close to home. I was just the same in pointing the finger elsewhere when I was like that, but at the time I genuinely believed it was other people and that they were working against me etc. A horrible thing to happen to someone and understandably horrible to be around, but always remind yourself that he simply isn't well and he'll return.
Because I have years of history with him, it's really obvious he's not well. He genuinely believed that I was ill and all of this was a figment of my imagination. So, it's easy to have compassion, although it's harder to be confident that he'll return. The mixed episode is relatively new, it's been about six weeks, but before that he was profoundly depressed for months.


He still sounds a bit mixed to me. I know you say he's taking the meds, but are you 100% certain he's taking them? All of them? All of the time? He's high dose Quetiapine right? That's usually pretty damn effective, although I appreciate there are still changes afoot, and believe me, they really can mess with you! What you've got to watch out for is people being left to their own devices with regards to meds who think they aren't ill: they simply won't take the meds, why would they! They aren't ill! Something to keep an eye on, if you can somehow monitor his pack or something without bringing it up, that may be the best route to take. But then, if you're sure he's taking them as he should, it's just a matter of time before things settle.
His Dad is still here, and one of us goes to him, hands him the meds, and stands there until he swallows them. So, I'm sure he's taking them. I hate doing that. It feels super controlling. But I don't feel like I have a choice. If I don't know 100% that he's taking them, I can't let him be with the kids, both for their emotional safety, and because I want them to have a relationship in the end.

He is on a high dose of Seroquel. His doctor said to expect it to work fast on the agitation and insomnia, and to take up to 6 weeks to address other symptoms. He's been on it for 3.5 weeks. So, hopefully it will work better.

I would say that he's definitely still got some mixed features, compared to when he was so depressed in the first few months after my son's death.

It's a really delicate time though. With all that's gone on, for you both, to effectively have temporarily lost your mind too is no place anyone wants to be. If his mood is swinging still he'll switch from pointing the finger, maybe even glimpses of feeling/looking well, to guilt, and back again. I said it before about the dangers involved and I know you don't need reminding, but do keep a close eye on things, try and notice the little things even more just in case. But also look after yourself and try to find time, somewhere, to relax, or you'll be posting here as an inmate instead of a visitor yourself!
I am very aware of the danger, and part of my grief is that I have enormous anxiety about losing someone else I love. So, he's not neglected. He's got lots of eyes on him.
 
H

HisWife

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im entitled to post on this thread as is anyone

:hug:
I didn't mean you as the person with more experience. I meant more experience than me. That this is a brand new diagnosis, so I need to hear from people who have lived with the diagnosis longer than a few weeks. i absolutely consider you one of the people I need to hear from. I'm not wanting you to go away. It's just that I've already received the particular message that you think I shouldn't be here.
 
Z

Zoe1

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I didn't mean you as the person with more experience. I meant more experience than me. That this is a brand new diagnosis, so I need to hear from people who have lived with the diagnosis longer than a few weeks. i absolutely consider you one of the people I need to hear from. I'm not wanting you to go away. It's just that I've already received the particular message that you think I shouldn't be here.
I have given no indication that you shouldn't be here HisWife

I was just giving my perspective from the patients point of view
 
K

keith74

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To add, despite continuing to believe he is not ill, he is taking the meds. In part because he's miserable and at least on the meds he can sleep, but mostly because he knows I will kick him out and keep the kids with me if he doesn't. He doesn't want to separate. He gets anxious if I leave for a few hours to go to the store and cries, although now he has started telling me that I should kick him out because he doesn't deserve me.
It sounds like he went from a dsyphoric (mixed) mania to more of a pure depressive episode (there is also type of depression that can have elements of aggression). My wife's recent swings were like that. She was dysphoric manic for a few months and then slid into a deep depression where she was horribly depressed/anxious and felt terrible about herself (and life in general). It is quite common for to fall into a depressive episode after the manic one. In is important that he has something for depression. 800mg Seroquel should help with depression in addition to mania. A switch to lamotrigine from depakote would also help with depression (at the expense of some protection against mania)
 
K

keith74

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Because I have years of history with him, it's really obvious he's not well. He genuinely believed that I was ill and all of this was a figment of my imagination. So, it's easy to have compassion, although it's harder to be confident that he'll return. The mixed episode is relatively new, it's been about six weeks, but before that he was profoundly depressed for months.




His Dad is still here, and one of us goes to him, hands him the meds, and stands there until he swallows them. So, I'm sure he's taking them. I hate doing that. It feels super controlling. But I don't feel like I have a choice. If I don't know 100% that he's taking them, I can't let him be with the kids, both for their emotional safety, and because I want them to have a relationship in the end.

He is on a high dose of Seroquel. His doctor said to expect it to work fast on the agitation and insomnia, and to take up to 6 weeks to address other symptoms. He's been on it for 3.5 weeks. So, hopefully it will work better.

I would say that he's definitely still got some mixed features, compared to when he was so depressed in the first few months after my son's death.



I am very aware of the danger, and part of my grief is that I have enormous anxiety about losing someone else I love. So, he's not neglected. He's got lots of eyes on him.
He'll return. That is what I have learned recently. Even if it seems so permanent. Don't give up hope about that.

Do not have any guilt at all about ensuring that he takes his meds. That is one of the key things you can do to help him get better. In every blog/article I've read about helping someone go through a mood swing, ensuring med compliance is always on the list.

It was 6 weeks minimum before the Seroquel really started to kicked in to alleviate the depression. And then another 3-4 weeks after that to really resolve it. My wife started Seroquel at the end of January when in the throes of a deep depression and she is nearly back to baseline now. It was probably only earlier this month that she herself started to feel hopeful and saw the light at the end of the tunnel (~9 weeks of Seroquel)
 
H

HisWife

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It sounds like he went from a dsyphoric (mixed) mania to more of a pure depressive episode (there is also type of depression that can have elements of aggression). My wife's recent swings were like that. She was dysphoric manic for a few months and then slid into a deep depression where she was horribly depressed/anxious and felt terrible about herself (and life in general). It is quite common for to fall into a depressive episode after the manic one. In is important that he has something for depression. 800mg Seroquel should help with depression in addition to mania. A switch to lamotrigine from depakote would also help with depression (at the expense of some protection against mania)
Yeah, I feel like he's still sliding, but that's where he's heading. I don't think the Depakote does anything for him. He was steadily getting worse until they added the Seroquel, even though his bloodwork showed therapeutic levels of Depakote.
 
Wishbone

Wishbone

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I posted in another thread about meds as maintenance drugs and those for acute cases. Depakote as maintenance will keep mixed/mania at bay in the most part but it won't do enough when someone is actually in a manic episode; you need antipsychotics for that acute treatment. Same goes for depression. Depakote is more aimed at keeping the higher end under control and isn't that effective for keeping depression away, it won't do much if anything to get anyone out of a current depression, again, antipsychotics and other mood stablisers that are more aimed at the lower end of the mood scale would. So the drugs he's on now/going to be on (Quetiapine and Lamotrigine) should be bang on for what he's got. You'd still have to hope that the Quetiapine does enough to keep any future mixed episodes at bay though. And going forward the med compliance will be something that always needs to be ensured as many of us think we no longer need them after a while, which we soon regret.
 
H

HisWife

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I posted in another thread about meds as maintenance drugs and those for acute cases. Depakote as maintenance will keep mixed/mania at bay in the most part but it won't do enough when someone is actually in a manic episode; you need antipsychotics for that acute treatment. Same goes for depression. Depakote is more aimed at keeping the higher end under control and isn't that effective for keeping depression away, it won't do much if anything to get anyone out of a current depression, again, antipsychotics and other mood stablisers that are more aimed at the lower end of the mood scale would. So the drugs he's on now/going to be on (Quetiapine and Lamotrigine) should be bang on for what he's got. You'd still have to hope that the Quetiapine does enough to keep any future mixed episodes at bay though. And going forward the med compliance will be something that always needs to be ensured as many of us think we no longer need them after a while, which we soon regret.
Thanks! It's good to know what to look out for.
 

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