• Welcome! It’s great to see you.

    If you'd like to talk with people who know what it's like

    Our forum members are people, maybe like yourself, who experience mental health difficulties or who have had them at some point in their life.

Tips for bad anxiety and depression...

K

keith74

Well-known member
Joined
Sep 14, 2020
Messages
316
Location
Canada
Hello folks,
My wife had an intense manic episode last fall (full details in some of my earlier posts) which she came out of by mid-November. She was recovering well to the point that she was excited about going back to work just a few weeks ago. Unfortunately it was likely too soon to return and that did not go well. She started to get anxious at work, which I was a little worried about because she is a healthcare professional working in a hospital and the hospitals are being overwhelmed with COVID. Anyway that anxiety got more intense and spiralled into depression. She is off work again but is struggling with a lot of anxiety in addition to depression. Her logical mind knows that she has nothing to be anxious of right now but she cannot help it. She currently takes Depekote/Epival 500mg and transitioning from Olanzapine (which was used to treat her mania) to Seroquel (currently 150mg) since Seroquel historically has a very sedative effect on her. The Seroquel is helping a little but her sleep, while a little better, is still poor and her anxiety is still high. It seems especially bad in the mornings, where she can get the shakes. She seems to calm down more in the afternoons after doing some activities to distract her from her constant ruminations. We found certain activities in the afternoon that she enjoys (yoga, meditation, walks, some games) help a lot and by evening her mood can be actually ok. Just the mornings are always rough. She tries some of the same activities in the morning with more limited effect. Because of COVID and the cold weather here we are limited in other activities she can do. I play a lot of calming music for her which helps a little while she lies down. I wonder if she will need to try something like ativan for a few days, though I don't like those types of meds.

Any other suggestions I can try?

Thanks
Keith
 
OmniscientNihilist

OmniscientNihilist

ACCOUNT CLOSED
Joined
Dec 9, 2020
Messages
1,779
Location
Canada
Hello folks,
My wife had an intense manic episode last fall (full details in some of my earlier posts) which she came out of by mid-November. She was recovering well to the point that she was excited about going back to work just a few weeks ago. Unfortunately it was likely too soon to return and that did not go well. She started to get anxious at work, which I was a little worried about because she is a healthcare professional working in a hospital and the hospitals are being overwhelmed with COVID. Anyway that anxiety got more intense and spiralled into depression.
worrying about covid not only solves nothing but will actually make it worse. so just pretend it doesnt exist yet continue to follow external guidelines; like staying at home as much as possible but if you have to go out then wash hands, wear mask, social distancing, etc... but on the inside your acting like it doesnt exist. your not thinking about it, your not worrying about it, etc... just be free on the inside and be diligent on the outside.
 
HLon99

HLon99

Well-known member
Joined
Apr 15, 2020
Messages
703
Location
London, UK
I used to have terrible anxiety which coincided with my bipolar episodes. Quite a common feature. Manic episodes can be so physically and psychologically overwhelming to the point that even after the episode passes, many people find that their nerves are just totally shattered. But don't worry, the human mind has an excellent capicity to heal itself, given time and effort. I would often get panic attacks post mania, but with time and through periods of relative stability they passed.

In terms of meds, Seroquel should help with the depression and anxiety, just give it a few weeks. All mood stabilisers have whats known as a 'polarity of effectiveness', i.e. some treat bipolar mania (Depakote, Olanzapine), but not depression, some treat depression but not mania (Lamotrigine), some treat both (Lithium, Seroquel). The old meds your wife was on only really help with mania. Seroquel should treat both depression and mania, so give it a few weeks. If it doesn't work, consider adding Lamotrigine, excellent mood stabiliser for depression with very few side effects and something I am personally taking.

In terms of self-help, if yoga, meditation etc work for your wife I would recommend that you stick to that religously. If mornings are rough, perhaps some moderately intensive cardio exercise, such as running can help. If runnings not her thing, then you can buy these home step machines which are a great substitute. Try and cut out caffeine as well, as that's bad for anxiety.

P.S. Don't personally recommend Ativan. Benzos do nothing to heal long term anxiety and often do more harm than good. A psychological study conducted on Benzodiazepines (e.g. Valium, Ativan etc), shows that when given to people undergoing significant mental distress for instance grieving widows, it calms them down for its duration of action, but then the grief returns twice as bad afterwards. It basically delays the onset of anxiety, rather than treat it and it eventually snowballs into higher levels of anxiety which is why often people find that they quickly need to take more and more of it to feel better. Have known people who have been addicted to tranquilisers and believe me it is not a happy life. Better stick to other remedies.

Also is your wife on the Immediate Release or the Extended release preparation of Seroquel. The immediate release formulation lasts only 8-12hours and often causes a 'stop-gap' in the morning until the next dose is taken. If so, consider speaking to your doctor about switching her to the extended release formulation.
 
K

keith74

Well-known member
Joined
Sep 14, 2020
Messages
316
Location
Canada
I used to have terrible anxiety which coincided with my bipolar episodes. Quite a common feature. Manic episodes can be so physically and psychologically overwhelming to the point that even after the episode passes, many people find that their nerves are just totally shattered. But don't worry, the human mind has an excellent capicity to heal itself, given time and effort. I would often get panic attacks post mania, but with time and through periods of relative stability they passed.

In terms of meds, Seroquel should help with the depression and anxiety, just give it a few weeks. All mood stabilisers have whats known as a 'polarity of effectiveness', i.e. some treat bipolar mania (Depakote, Olanzapine), but not depression, some treat depression but not mania (Lamotrigine), some treat both (Lithium, Seroquel). The old meds your wife was on only really help with mania. Seroquel should treat both depression and mania, so give it a few weeks. If it doesn't work, consider adding Lamotrigine, excellent mood stabiliser for depression with very few side effects and something I am personally taking.

In terms of self-help, if yoga, meditation etc work for your wife I would recommend that you stick to that religously. If mornings are rough, perhaps some moderately intensive cardio exercise, such as running can help. If runnings not her thing, then you can buy these home step machines which are a great substitute. Try and cut out caffeine as well, as that's bad for anxiety.

P.S. Don't personally recommend Ativan. Benzos do nothing to heal long term anxiety and often do more harm than good. A psychological study conducted on Benzodiazepines (e.g. Valium, Ativan etc), shows that when given to people undergoing significant mental distress for instance grieving widows, it calms them down for its duration of action, but then the grief returns twice as bad afterwards. It basically delays the onset of anxiety, rather than treat it and it eventually snowballs into higher levels of anxiety which is why often people find that they quickly need to take more and more of it to feel better. Have known people who have been addicted to tranquilisers and believe me it is not a happy life. Better stick to other remedies.

Also is your wife on the Immediate Release or the Extended release preparation of Seroquel. The immediate release formulation lasts only 8-12hours and often causes a 'stop-gap' in the morning until the next dose is taken. If so, consider speaking to your doctor about switching her to the extended release formulation.
Hi H,
Thanks for the excellent and insightful reply (as always). Her condition got even worse yesterday morning as her thoughts went to even darker places. Her sleep was also worse. She basically slept a total of 2 hours max and just laid in bed for most of the night in anxiety. Her lack of sleep likely attributed to her really rough morning. It was disappointing because her mood was pretty decent Sunday evening. Fortunately she had appointment with her psychologist in the afternoon where we all came into agreement that she has slipped into a bipolar depression coupled with extreme anxiety. In addition to upping her Seroquel dose to 200mg (150mg IR at night and 50mg XR in the morning to help with the anxiety), we also agreed that she MUST start getting some sleep. Hence she was prescribed clonazepam (0.5mg) in the short term so she could get some sleep. I agree about being really careful regarding the benzos but we felt that she needed something ASAP to help with the anxiety and sleep. It seemed to have helped last night as she fell asleep pretty quickly and was able to get about 6-7 hours of (i think) decent sleep. She still woke up with some anxiety but it was much less than the day before. Her mood was still not good but it wasn't at the horrible level it was yesterday morning. in 3 days, her Seroquel will be increased another 50mg. I am hopeful since in 2015 she had a major depressive episode with anxiety and she was taking the same med combo she is now (Depakote and Seroquel). Her Seroquel was eventually increased to a max of 300mg so I think that is the plan again. She also took a benzo (Antivan) for a few days when she could not sleep at all. She was on it for maybe a week before weaning off it (she recalled that while the first few days knocked her out, the effectiveness dwindled over time). The interesting thing this time vs 2015 is her mood fluctuation during the day where AM is horrid and PM is decent (in 2015, she was just bad the whole day). Her psychiatrist says as she gets a better night sleep, her AM mood should get better (though shouldn't she be tired in the PM also?). Have you experienced this mood change where the anxiety/depression is horrid in the AM but much better in the PM (and then repeat cycle)?

As for self care, she is doing her best sticking to her yoga, etc. But her motivation is so low in the AM (much much better in the PM). She did try some cardio in the AM but it is hard as our building gym is closed because of COVID and it is pretty cold out there. Maybe we should get some indoor exercise machine if you think the intense cardio will be helpful.
 
HLon99

HLon99

Well-known member
Joined
Apr 15, 2020
Messages
703
Location
London, UK
Hi H,
Thanks for the excellent and insightful reply (as always). Her condition got even worse yesterday morning as her thoughts went to even darker places. Her sleep was also worse. She basically slept a total of 2 hours max and just laid in bed for most of the night in anxiety. Her lack of sleep likely attributed to her really rough morning. It was disappointing because her mood was pretty decent Sunday evening. Fortunately she had appointment with her psychologist in the afternoon where we all came into agreement that she has slipped into a bipolar depression coupled with extreme anxiety. In addition to upping her Seroquel dose to 200mg (150mg IR at night and 50mg XR in the morning to help with the anxiety), we also agreed that she MUST start getting some sleep. Hence she was prescribed clonazepam (0.5mg) in the short term so she could get some sleep. I agree about being really careful regarding the benzos but we felt that she needed something ASAP to help with the anxiety and sleep. It seemed to have helped last night as she fell asleep pretty quickly and was able to get about 6-7 hours of (i think) decent sleep. She still woke up with some anxiety but it was much less than the day before. Her mood was still not good but it wasn't at the horrible level it was yesterday morning. in 3 days, her Seroquel will be increased another 50mg. I am hopeful since in 2015 she had a major depressive episode with anxiety and she was taking the same med combo she is now (Depakote and Seroquel). Her Seroquel was eventually increased to a max of 300mg so I think that is the plan again. She also took a benzo (Antivan) for a few days when she could not sleep at all. She was on it for maybe a week before weaning off it (she recalled that while the first few days knocked her out, the effectiveness dwindled over time). The interesting thing this time vs 2015 is her mood fluctuation during the day where AM is horrid and PM is decent (in 2015, she was just bad the whole day). Her psychiatrist says as she gets a better night sleep, her AM mood should get better (though shouldn't she be tired in the PM also?). Have you experienced this mood change where the anxiety/depression is horrid in the AM but much better in the PM (and then repeat cycle)?

As for self care, she is doing her best sticking to her yoga, etc. But her motivation is so low in the AM (much much better in the PM). She did try some cardio in the AM but it is hard as our building gym is closed because of COVID and it is pretty cold out there. Maybe we should get some indoor exercise machine if you think the intense cardio will be helpful.
Yes, I have experienced mood fluctuation during the day (ultradiem/ultrarapid cycling). Its horrible, there's no getting past that. Its an emotional rollercoater when your mood is changing at such a rapid pace. If she hasn't done so already, have her speak to her supervisor at work to give her some time off, at least until the medication kicks in. I'm a strong believer that working and keeping yourself busy is a key part of staying sane, but at this stage I doubt that she is any condition to do anything. I wish I could offer better advice but right now it would be best if rests up and takes it easy.

For sleep, try magnesium and Melatonin supplements and Valerian tea. Excellent non-narcotic alternatives to benzos. These were absolute lifesavers throughout my ultra-rapid phase They won't knock you out, but they will take the edge off enough so that you can sleep. I know she's in a crisis, but she needs to get good natural sleep. Another reason I'm against benzos, is that they eliminate what's known as REM Sleep. REM sleep is a phase of sleep where the brain consolidates memories; its also the part of sleep when most people have dreams. REM Sleep is vital to the process of the mind healing itself. People who are on tranquilisers long term, no longer experience this restful type of sleep and thereby walk around like zombies all the time. If its an absolute must then make sure to use it only short term, but I'm sure there are other things you can try before turning to sleeping pills.
 
K

keith74

Well-known member
Joined
Sep 14, 2020
Messages
316
Location
Canada
Yes, I have experienced mood fluctuation during the day (ultradiem/ultrarapid cycling). Its horrible, there's no getting past that. Its an emotional rollercoater when your mood is changing at such a rapid pace. If she hasn't done so already, have her speak to her supervisor at work to give her some time off, at least until the medication kicks in. I'm a strong believer that working and keeping yourself busy is a key part of staying sane, but at this stage I doubt that she is any condition to do anything. I wish I could offer better advice but right now it would be best if rests up and takes it easy.

For sleep, try magnesium and Melatonin supplements and Valerian tea. Excellent non-narcotic alternatives to benzos. These were absolute lifesavers throughout my ultra-rapid phase They won't knock you out, but they will take the edge off enough so that you can sleep. I know she's in a crisis, but she needs to get good natural sleep. Another reason I'm against benzos, is that they eliminate what's known as REM Sleep. REM sleep is a phase of sleep where the brain consolidates memories; its also the part of sleep when most people have dreams. REM Sleep is vital to the process of the mind healing itself. People who are on tranquilisers long term, no longer experience this restful type of sleep and thereby walk around like zombies all the time. If its an absolute must then make sure to use it only short term, but I'm sure there are other things you can try before turning to sleeping pills.
She is already on sick leave again. Her psychiatrist feels she is in no state to go back to work in her present condition. The issue is that she is a healthcare worker in a hospital and her workplace needs her with a certain level of cognitive aptitude. Before she went on leave, her anxiety made her make some mistakes like forgetting to take the proper precautions (PPE) when treating a potential COVID patient. That was the eye opener that made her realize she may need to take off again. But I agree that keeping yourself busy is key to faster recovery and I wish she could be working. But it is for the best. If you have any ideas that work for you in keeping busy at home when in an anxious/down mood I would love to hear them. We are considering getting netflix

She was already trying melatonin for a few days with minimal impact. She was trying a few herbal teas but not Valerian. We'll give that a try, thanks. She already takes a magnesium supplement. We were using lavender sprays and special droney sleep music, which works for me but started to lose any effectiveness on her. Yeah we are both uncomfortable with the benzo but her sleep was getting so horrible that we (including her psychiatrist) felt it was important that she finds a way to calm down get any sleep asap. But yeah i really hope it is really short term. thanks for the reminder regarding the importance of trying to get off the benzo asap. Maybe in a few more days we'll try a night without the benzo and see how it goes.
 
HLon99

HLon99

Well-known member
Joined
Apr 15, 2020
Messages
703
Location
London, UK
She is already on sick leave again. Her psychiatrist feels she is in no state to go back to work in her present condition. The issue is that she is a healthcare worker in a hospital and her workplace needs her with a certain level of cognitive aptitude. Before she went on leave, her anxiety made her make some mistakes like forgetting to take the proper precautions (PPE) when treating a potential COVID patient. That was the eye opener that made her realize she may need to take off again. But I agree that keeping yourself busy is key to faster recovery and I wish she could be working. But it is for the best. If you have any ideas that work for you in keeping busy at home when in an anxious/down mood I would love to hear them. We are considering getting netflix

She was already trying melatonin for a few days with minimal impact. She was trying a few herbal teas but not Valerian. We'll give that a try, thanks. She already takes a magnesium supplement. We were using lavender sprays and special droney sleep music, which works for me but started to lose any effectiveness on her. Yeah we are both uncomfortable with the benzo but her sleep was getting so horrible that we (including her psychiatrist) felt it was important that she finds a way to calm down get any sleep asap. But yeah i really hope it is really short term. thanks for the reminder regarding the importance of trying to get off the benzo asap. Maybe in a few more days we'll try a night without the benzo and see how it goes.
Netflix is good. Reading is better, if she feels up to it. Something relaxing, nothing too dramatic or intense. I've been getting into books on philosophy lately, really helps me put my problems into perspective.
 
K

keith74

Well-known member
Joined
Sep 14, 2020
Messages
316
Location
Canada
Thanks H. Anything else you can think of, please pass it on.

btw - she tried sleeping without the benzo last night. She had some PM group therapy which she felt was good and was in a decent mood (as usual in the PM). She was able to sleep until 2AM, which gave her ~5 hours of sleep. Not bad. She did take the benzo when she woke up (which was the plan), which gave her another 3-4 hours of sleep. Basically we are trying to only use the benzo as needed.
 
K

keith74

Well-known member
Joined
Sep 14, 2020
Messages
316
Location
Canada
btw - she tried sleeping without the benzo last night. She had some PM group therapy which she felt was good and was in a decent mood (as usual in the PM). She was able to sleep until 2AM, which gave her ~5 hours of sleep. Not bad. She did take the benzo when she woke up (which was the plan), which gave her another 3-4 hours of sleep. Basically we are trying to only use the benzo as needed.
Also, she had a dream during that 5 hour sleep without the benzo. While it was nightmare, I guess that is a good thing since she may have been in REM sleep. Maybe we continue this strategy - sleep without the benzo (if possible) and take it if she wakes up in middle of the night and cannot go back to sleep (her psychiatrist also gave this as a viable option since she is not working). Maybe we also cut back on the dose also - to 0.25. See what is the absolute minimum she needs for sleep.
 
HLon99

HLon99

Well-known member
Joined
Apr 15, 2020
Messages
703
Location
London, UK
Also, she had a dream during that 5 hour sleep without the benzo. While it was nightmare, I guess that is a good thing since she may have been in REM sleep. Maybe we continue this strategy - sleep without the benzo (if possible) and take it if she wakes up in middle of the night and cannot go back to sleep (her psychiatrist also gave this as a viable option since she is not working). Maybe we also cut back on the dose also - to 0.25. See what is the absolute minimum she needs for sleep.
Seems reasonable enough, but as I said before, stay vigilant of dependancy issues. If her sleep and anxiety doesn't improve after 2 weeks, then you should perhaps consider sending her to a sleep specialist or speaking to your psychiatrist about alternative options. Taking care of the physical side of things is also key to good sleep. I was never a sound sleeper, but a few years ago I had a part time job doing manual labour in a warehouse. I would come home each day have dinner, conk out at 9pm and sleep like a baby after that. Obviously, this isn't the exact same case and I don't suggest your wife does any manual labour right now, but I seriously think that some cardio exercise will go a long way.

My mother also has issues with sleep and one of the techniques that her therapist suggested is something called 'blocking out thoughts'. Basically, what you do is pick a random word, which has no bearing or connotations to you such as 'paperclip'. Then, when you are lying in bed and start getting any distrubing thoughts that are keeping you up, you just repeat the word in your head, over and over again. The idea is that its a sort of a autotraining, a trigger that your mind will gradually associate with sleep and relaxation. It might not work the first few times, but eventually you will subconsiously form an association. Might seem strange but apparently it really helps.
 
K

keith74

Well-known member
Joined
Sep 14, 2020
Messages
316
Location
Canada
My goal is to cut out the benzo after a week. I agree with the cardo. We actually went for a solid 15 minute run that felt good for both of us. She felt tried enough to take a quick nap. We walk about 2 hours a day but it is a casual walk so we need something more intense. Unfortunately the weather gets really cold next week so getting out there will be a bit of a challenge.

I'll have to pass on that association technique. Thanks for the tip! Right now her anxiety has such a strong grip on her brain so it is tough for her to let things go.
 
I

itsmeagain

Well-known member
Joined
Dec 25, 2010
Messages
902
Location
england
HLon99.
Hi, You don't mention sodium valproate, Epilim. Often used in mood stabilising.
 
I

itsmeagain

Well-known member
Joined
Dec 25, 2010
Messages
902
Location
england
Does Epilim resolve manic episodes or is it to alleviate depression or both?
 
HLon99

HLon99

Well-known member
Joined
Apr 15, 2020
Messages
703
Location
London, UK
HLon99.
Hi, You don't mention sodium valproate, Epilim. Often used in mood stabilising.
Depakote is another brand name for Valproate/Epilim, which is what I said. Its only really useful in the manic phases and his wife is already on it.
 
I

itsmeagain

Well-known member
Joined
Dec 25, 2010
Messages
902
Location
england
As I understand it, depakote is valproate semisodium whilst Epilim is sodiu valproate.
The respective dosages look quite different in terms of mg too.
Hospital staff are vigilant not to get the 2 mixed up.
 

Similar threads

Top