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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Christ_empowered on April 12, 2011, at 2:46:44
My big problem has always been agitation, anxiety, and semi-regular fits of psychosis with sadness ("psychotic depression"). I've had 1 episode that could have possibly been relatively mild mania (with psychosis, of course) and 1 episode that was a sort of months-long nervous breakdown that ended up being diagnosed as psychotic mania, but honestly doesn't seem to fit in with anything I've seen in the DSM-IV (weight loss, looking younger, high blood pressure, dissociation, auditory hallucinations, visions).
Here's the thing: when I think "Bipolar," I think someone whose mania is largely biologically based and who has to take an anti-manic on a regular basis. I've taken antidepressants before w/o going manic, I've even taken amphetamines w/o mania (until the dose was ramped up too high...), and I don't have a problem with regular (hypo)manic activation. My "manic episode" was more of a nervous breakdown, the result of years of social isolation, stress, and untreated psychotic depression. The dissociation happens, sometimes, under severe stress and as a reaction to psychosis.
Anyway, here's the question> am I really doing the right thing taking 30mgs Abilify? I mean, its great, I only take 2 meds, Celexa and Abiliy, and I'm functioning. That said, the Abilify (at least @ 30mgs) does precious little for the depression; it really seems to function mostly to take the edge off of the psychotic depression. The Celexa doesn't so much lift my mood as it does relieve remaining tension, agitation, and paraoia; together, the combo works well, but I'm feeling a bit...tranquilized.
My doctors have always been either quick to smack a severe label on my problems (its schizophrenia! bipolar I!) or quick to call it some sort of psychological problem. My current doctor is great, but he's public health, and they're even worse about calling everything bipolar (or worse...) and then putting people on antipsychotics, usually at pretty high doses.
I know I should be thankful that I found something that works and that I'm able to function, but I have a shrink appointment coming up, and every time that happens I get to thinking about my meds and my diagnosis. I can't help it.
Plus, I don't understand what's going on in my brain. If neuroleptic=reduced agitation, paranoia, and overall anxiety, then why do I still get psychotic depression on a full dose of Abilify? What's so special about Celexa that this little $4/month pill did something that Abilify wasn't doing?
Any input is greatly appreciated, even if you're just going to tell me to take my pills, pray to avoid TD, and live my life.
Thanks.
Posted by emmanuel98 on April 12, 2011, at 3:06:29
In reply to am I really bipolar?, posted by Christ_empowered on April 12, 2011, at 2:46:44
30 mg of abilify is a very high dose and there's no evidence that doses higher than 10mg are effective or useful. Asking to go down to 10mg might be the first step with your p-doc. Check out rxlist.com. It's like a PDR on line.
Posted by Phillipa on April 12, 2011, at 11:20:14
In reply to Re: am I really bipolar?, posted by emmanuel98 on April 12, 2011, at 3:06:29
Didn't you write was it this weekend? That your parents stopped by and said how great you were doing? Was it on social? Anyway that seems like kind of a cue. As for the celexa same as me with the generic luvox that tiny dose of 50mg does something. Not make feel better but stable I guess. Meds are wierd. Phillipa
Posted by mellow on April 12, 2011, at 12:42:41
In reply to am I really bipolar?, posted by Christ_empowered on April 12, 2011, at 2:46:44
I also worry about TD dude, but my doc seems to think that years of added stability from the medicines will lend themselves to learning life lessons and get me to a place where I will actually be taking fewer meds. I've been doing a lot of exercise and eating really healthy and my doc is impressed by that so he says we should just keep going.
As far as the bipolar stuff throw the DSM away, it doesn't do justice to a very complex condition and it leaves many people a back door to escape by rationalizing thier way past the mania stuff. Look for the obvious stuff. You have had an episode of major depression, you've been psychotic. You have also been very motivated here lately to go back to school. Look at that a little. Maybe you are functioning very high right now and this could be an up tick from a lower cycle from a month or even a year ago.
Do you ever find yourself very motivated and kind of happy and then cry or just get watery eyes later that same day? Do your thoughts ever scream at you...like obsessions but they take the form of annoying jingles or commercials? Like imagine some problem or even something you are excited about is running through your head but at the intensity of a used car sale commercial! Those along with irritability can be signs of mania just as much as the hyper-sexuality or spending sprees.
There are all sorts of little subtleties to the mood spectrum you have to look at. It's nothing to be ashamed of having either a diagnosis of Schizophrenia or Bipolar I. You write well and function quite high so don't let that stuff hold you back. I did for years and I can't get those years back especially the ones when I was too proud to admit I needed therapy and drugs.
We are still fairly young folks you and I. Lots of life to live. Keep it simple. It's not really important what you call it as long as you and your doctor are on the same page to get you treated.
mellow
Posted by morgan miller on April 12, 2011, at 13:29:42
In reply to Re: am I really bipolar?, posted by mellow on April 12, 2011, at 12:42:41
Bipolar has a fairly wide spectrum, and no one truly understands exactly what is going on in the brain to cause the reactions and behaviors people with bipolar disorder experience.
I've also done very well on just an antidepressant, though I did experience hypomania at times on it. I am bipolar for sure, there is no doubt in my mind.
Abilify at the dose you are taking is going to have stabilizing effects without antidepressant effects. The lower doses of Abilify, like 2 or 3 mg, are the ones that have antidepressant effects, especially when used as an adjunct to an antidepressant.
Celexa and other antidepressants are powerful drugs. Selective serotonin reuptake inhibition along with other mechanisms, like boosting brain antioxidants and impacting sigma 1 opiod receptors(in Celexa and Lexapro's case likely Sigma 1 agonism), have a profound antidepressant and anxiety reducing effects, much more so than any antipsychotic has potential for. Sigma 1 agonists may be responsible for the calming impact that some antidepressants have. There is also some evidence that sigma 1 agonists may improve neuroplasticity. So, there are other mechanisms than selective serotonin reuptake inhibition by which drugs like Celexa exert therapeutic benefits.
Right now, your "mood stabilizer" is Abilify. This was chosen at the dose it has been used because your condition manifested in psychotic symptoms. Otherwise, if you had just experienced agitated mixed states, you may have only been prescribed depakote, with possibly a low dose of Zyprexa, depending on the severity of the episode.
It is possible, you could slowly transition from the dose of Abilify you are on, to a 5 mg dose plus a moderate dose of Depakote, maybe 750 to 1000 mg, and a smaller dose of lithium, maybe 300 mg, and of course keep the Celexa on board. I know this is more medications, but the combination at these doses may be much less likely to cause any long term health issues that you might be concerned about.
If you are really doing well right now, there is probably no reason to change anything until everything in your life is going the way you want it to-job, social life, and overall strength and independence. Even then, you would want to be extremely careful about making any changes in medication.
I agree that talking to your doctor about lower the dose of Abilify to 15 or 10 mg and staying on Celexa might be a good idea.
If you start a religious workout and diet lifestyle(for life!), and keep up with supplements you know help, your chances of success in all areas of life, including medication changes, will be that much greater.
Morgan
Posted by floatingbridge on April 13, 2011, at 5:22:59
In reply to Re: am I really bipolar?, posted by morgan miller on April 12, 2011, at 13:29:42
CE,
Let me echo the other posters. Don't stress the labels nor the meds now. Enjoy your stability and give yourself the strength stability gives you to make positive changes. You are young. After some stability, reevaluate.
Ask your pdoc if you need 30mgs. Find some documentation of what Emmanuel says about the 30mg Abilify. Work with pdoc. That two meds have brought you this much clarity, to the point that you can question whether you need them, is really amazing(!).
I mucked around with my meds so stupidly at the beginning of my treatment, possibly (most assuredly) ruining some really alright treatments and putting my body through the stress of med changes and trials.
Advice from and old crone :-) is don't do it. Stay on it and get some fun and good work done.
You rock. Don't forget that.
fb
Posted by B2chica on April 15, 2011, at 7:54:16
In reply to am I really bipolar?, posted by Christ_empowered on April 12, 2011, at 2:46:44
my docs have always seemed to go back between psychotic depression and bipolar. but the bipolar ALWAYS presents itself as mixed states. i never get the happy, productive hypomania, and not truly bipolarI with dilusions of grandure and such.
always aggitated, always geared inward spiraling depression and then going into auditory, visual stuff.as long as the doc is treating symptoms and not based on your label then you're ok.
i totally understand the frustration with labels though.
Posted by floatingbridge on April 15, 2011, at 12:20:55
In reply to Re: am I really bipolar? » Christ_empowered, posted by B2chica on April 15, 2011, at 7:54:16
B2chica, you sound stronger. Hope you are mending....
fb
Posted by B2chica on April 21, 2011, at 12:07:19
In reply to Re: on beyond labels.... » B2chica, posted by floatingbridge on April 15, 2011, at 12:20:55
slowly. the anxiety is finally subsided. but the low is starting to creep in. doesnt help that theres no sun around here lately :(
Posted by floatingbridge on April 21, 2011, at 13:26:21
In reply to Re: on beyond labels.... » floatingbridge, posted by B2chica on April 21, 2011, at 12:07:19
Oh. That nasty low. Anxiety, however unbearable is lots of energy.
West coast. We've had days of fog :(
Today proves to be brilliant.
Hang tough.
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