Question:
History: I experience mixed episodes that occur every few days, at
least that's the closest the doc has come to a name. I describe these
episodes as being stuck in 'stare' mode - sort of like when you catch
yourself staring at something ("earth to John") and you don't feel like
snapping out of it - except I can't snap out of it. I lose all
focus/concentration and feel terribly uncomfortable with no concept of
the past or future. These seem to be triggered at random, or often due
to exercise, stress (even healthy) or even eating. I've learned since
childhood to snap myself out of these episodes by self medicating
w/alcohol, overeating, gambling (mind intense), etc, otherwise the
episode does not go away on its own - even over days/weeks. I have to
set out to self mentally exhaust myself through intense/hyperfocusing
behaviour to snap out of it. I also experience hypomanic behaviour from time to time resulting in
poor impulsive decisions. The major issue for me, however, are the
mixed episodes. Over the years, I ended up with severe depression due
to the guilt of self medicating (after years of recovery programs and
no mental health treatment).
After several medications and diagnosis (bipolar, anxiety/OCD,
depression, ADHD and back to depression) I was placed on Effexor at
112.5mg. This triggered full mania, including euphoria (which sure was
a welcome change to be honest), hyperactivity and an insane gambling
debt after a year of sobriety. I dropped the Effexor to 75mg and was
then placed on Lamictal and worked up to 100mg. This stopped the
Effexor mania but anymore Lamictal brought on more mixed
episodes/anxiety and hypomania.
Doc prescribed Risperdal for the mixed episodes. It kicks in and works
sometimes, but I can only tolerate .25mg because it exhausts me. I
sleep about 16 hrs a day on and off. I also feel much more depressed
lately, so she had me increase the Effexor back up to 112.5. No change
yet (and no mania yet). I need a Risperdal alternative. I'd love something I could take *just*
when I snap into one of the episodes but I'll take whatever on a
schedule if needed. Risperdal would probably solve the problem if I
could tolerate more than .25mg but anymore and I'm never waking up.
Secondly, being tired all the time is clearly making me depressed. I
don't want to do anything at all, and prefer sleeping. In my 15 minute visits to my doc, it's usually more helpful for me to
go in with what I want to try vs let her diagnose 6 weeks of my life in
15 minutes, so I need some suggestions this round. Thanks all. Here's the pro/cons in a nutshell. Effexor 112.5mg: Combats Depression but causes Mania. Lamictal 125mg: Stops the Effexor Mania. Doesn't do much else. Can't
tolerate more than 125mg w/out anxiety/mixed episodes and hypomania. Risperdal: Stops the hypomania 80% of the time. Stops mixed episodes
50% of the time. But makes me dead exhausted (and gain weight, ick).
Answer:
I would suggest you re-post this in alt.support.depression.manic as
well, for feedback from more people with first-hand experience. Risperdal is an "atypical antipsychotic," meaning it blocks both
serotonin and dopamine receptors. The dopamine "blockade" suppresses
positive psychotic symptoms (e.g. hallucinations) and helps with
mania, but can also cause fatigue, dullness, weight gain, and a host
of other problems. The serotonin blockade alleviates the undesirable
side effects to some extent (which is why the atypical antipsychotics
are more easily tolerated than the older, "typical" antipsychotics),
but not perfectly.
It's hard to say that a particular drug will be better for you. I can
think of three strategies worth investigating.
1) Replace Risperdal with another atypical antipsychotic, such as
Abilify or Zyprexa.
2) Replace Risperdal with another mood stabilizer, such as Depakote or
Topamax.
3) Try to combat fatigue and lethargy by taking Strattera or
Wellbutrin, along with your current medications.
These are options to discuss with your doctor. I hope something works
for you.
I am always amazed that Effexor is used to treat people with anxiety
problems. I was put on it to treat depression but it spaced me out and made
me more anxious. I then then read up on SNRI's and came to the conclusion
that increasing NORADRENALINE would increase anxiety not fight it. I'm
certainly no doctor and may well have missed something here (someone please
correct me if I'm wrong) but I would suggest an SSRI over an SNRI for
anxiety related depression. I'm suggesting canning the Effexor and trying something like Paxil or Zoloft
(which have their own list of side-effects)
Talk with your pdoc about Ativan (Lorazapam). My brother used to get
into the condition you describe and it helps him within 10 minutes. It
is in the benzo family of drugs with Valium but acts over a shorter
time. These drugs are not given out like they used to because they are
pretty addictive if taken on a regular basis and have been abused. You
doctor may not want to prescribe them because of this but they should
not be denied to someone if they will help. not much med advice, but have you been to a neurologist? your "stare
mode" sounds an awful lot like temporal lobe seizures. BP and epilepsy
can go hand in hand, which may be why the same meds are used for both.
you might want to get an epilepsy evaluation and an MRI, just to check
it out. I had mixed episodes in the past, and they were *nothing* like
you describe, rather i was agitated, angry, unable to stop moving,
unable to stop the anger and/or depression. not a good combo.
Lamictal has helped me a lot though, it just takes a while to ramp up,
and kind of sucks for the first month or so. I've been on one or the other of these meds since 1977, right along
with my friend who suffers from the same symptoms (panic disorder with
its bedfellow know as depression). Since my body learns rather quickly
how to become tolerant of the andipressant groups, I've had to change
meds every two-three years. I tried effexor which acts on serotonin,
norepinephrine and dopamine. I could not tolerate it because of my
anxiety disorder -- the initial side effects were too scary for me to
continue (felt like crawling the walls). The bottom line, IMO is that
the pdocs really don't have a clue how these medications work and I
know for a fact they work differently on different people (hence my
friend can take 250 mgs of effexor without a problem and it helps her
anxiety). So, I long ago concluded that we are works in progress for
the pdocs. It is clear to me, after 30 years of suffering, that meds
work differently on every one of us, so until you take them, you really
don't know what to expect.
