I'm sorry I haven't checked in in so long. I know that you would have been a great comfort to me, and your knowledge and experience would have helped guide me and better advocate for myself. But I couldn't type.

I'm BPII. I was on a daily dose of 1800mg of Lithium for about 5 yrs. off of it for about 4 (not without its issues). Hospitalized once for toxicity, but pdoc restarted me back on 1800mg the next day because she said the levels were "borderline." I had been unable to reach her in the ER or hospital.

I'm not going to get into it, but I just went through toxicity again, this time SEVERE and it went on for months because one hand doesn't know what the other is doing. (I have MS but please, please, please don't ask me any questions about it right now because it will only muddle me). I WILL cut the docs some slack because MS is a disease that effects the brain and all psychotropic drugs effect it, too. If I wasn't so snowed I would have caught on to it sooner.

I stopped lithium a little over a month ago and enjoyed a wonderful period of more clarity. I was able to reflect on things and put some things into perspective. I haven't felt that good in years. I think lithium was snowing me to some degree all along.

But I know I need to be on a mood stabilizer long term!
This is why:

My hypomanic episodes increased over the last 2 yrs, so did my drinking.

Over a period of 4-5 mo I was hypomanic (or mostly?). The last 2-3 I was off Lithium.

In December, I tried to commit suicide.** I'm VERY, VERY, VERY lucky to be alive.

On the 8th of this month I started noticing signs of what could be signs of mild hypomania. I saw the pdoc on the 10th, but we decided to start Latuda at 20mg because I need that mood stabilizer.
Due to issues with prior authorization, I didn't start the Latuda until this past Friday the 17th.
Yesterday, the 19th, I knew I was hypomanic. Today it's full-blown and I have akathisia.

I spoke to the on-call nurse about this, but a BIG CONCERN FOR ME is that I am critiquing my own suicide attempt. It's not "what I would do next time," but "what I should have done." It pops up. It's extremely disturbing. She said it's the hypomania.
I'm not suicidal. I don't want to die. I don't have a plan. If any of that changes, it's to the ER I go. I don't have a problem with that- I don't want to hurt myself again.

She told me to stay on the Latuda, which is approved for bipolar depression. I had reservations about taking it in the first place because last time on the seesaw I was on the air not on the ground? But I will do it.
And she told me to keep taking the xanax. It does nothing for akathisia. I have an expression for that, but it's not appropriate for the forum.

My pdoc will not be in the office until Wednesday (2 days from now). I have an appointment with her Friday.

I think I'll take ANOTHER shower.

Kay

i am so sorry you are going through all of this....thank God you are alive.
I thought lithium wasn't used for bipolar II because it didn't work. I think i tried latuda but it wasn't successful. I have tried so many. How bad is your depression? or are you just worried about your hypomania?
Bobby

Kay,

Very sorry for the lithium and what happened.

M

Kay

You do not need a mood stabilizer for long term. You need one for right now.

(I read the Wikipeida entry for Latuda.)
Have you already tried all / enough of the anti-Psychotic meds? Did you have akathisia on them?
Why would she go with a brand new drug for you , esp one that works for depression?
I do remember that you are on other meds that potentially react/interfere with your bipolar meds.

These are your options as I understand them. My explanations are somewhat non-linear due to massive sleep deficit.
I do understand that you are dealing with A) mania with bad thoughts and B) akathisia.

1. Call the pdoc's number for whomever is on call until you see the pdoc on Fri. Ask for a different med -- one that you know will bring you down ---- you have to make this call even though you are not optimistic about getting help.

2. Keep taking the Xanax and the Latuda as directed until Friday -- a bad option but an option.

3. Go to the ER. The ER will be most concerned about bringing down the mania and they will be able to do that. You might present as o.k. enough to be treated without being locked up.
You might have a suggestion for a med that you know will bring you down without the akashisia.
The ER trip has a very good chance for relief/ success even if it risks a lock up.

4. On your own, increase the Xanax (for the mania). Lower the Lutuda for the akashisia and the mania --- a possible option.

5. On your own, see what other meds you have that you can take for the mania --- a possible option only if you are in a good head space to prescribe for yourself. And if you have enough meds that can get you through to Friday.

Talk to us.



M

oh kay, sorry that you are haiving these difficulties. I am grateful to you for posting to us. keep coming back we can be another set of eyes and ears for you, you need all of the support you can get.
bizi

Kay!!!!

I haven't read your post yet but as it is long it will take me a while to read and reply "properly". Meantime, just want to say I am happy to see you!



waves

I think it would be better if you went to the ER if you are that uncomfortable.

The only DIY alternative I can see is:

-- suspend Latuda (pdoc will prolly d/c it anyway -- at least halve it if you don't want to skip it)

-- take Benadryl, provided the pharmacist confirms it is compatible with ALL your meds. This drug is used in emergency treatment of akathisia.

Benzos are unlikely to help with akathisia -- different neurotransmitters involved. Not much is likely to help unless the Latuda is at least reduced if not stopped.

======= BENADRYL DOSING

If you have taken Benadryl before, and know that your body finds it sedating, then take a 50 mg first dose, otherwise just take 25 mg.

-- Subsequently, take 25 mg every 6 hours for a day.
-- Then try shifting the doses further apart -- 8-10 hours.


I am so sorry I didn't catch this yesterday!

My thoughts on being on a mood stabilizer long term come from concerns over the severity of my suicide attempt (it being my only one) and the frequency of these hypo episodes over the last 2 yrs. I'm an alcoholic, but a binge alcoholic, mostly associated with hypomanic episodes. The s/s attempt is clearly fresh in my mind, having only happened in December. Perhaps my perception will change when I can better digest things.
When do they decide to send you to a psychiatrist in the US?

Again, I don't want to delve into the MS arena in any detail, but it has to be mentioned. But the toll hypomania takes on my body is awful. My body can still feel it (but not so much if I'm drunk), nonetheless my mind drags that body a long. I guess how long I crash afterwards depends on how much damage is done, and how long the episode lasts.

I have experienced akasthisia before, caused by Zyprexa, prescribed for another intense hypo episode. I am NOT having fun!

The pdoc at the time (I've had a couple at that office)put me on a very low dose of Seroquol? to treat the akastisia the first time. And it worked very well.

Tried as mood stabilizer, I can't take Seroqoul because I hit the dirt at 150mg.
Lithium gives me moderate acne, but I didn't stop it because of that. I can't take the following drugs that I've tried because of side effects (and we're not talking Mickey Mouse stuff):

Lithium
Risperidone
Seroquol
Zyprexa
Depakote
Cymbalta
Ativan

The pdoc said she didn't want to have to put me on any "heavy-hitters" yet because of the side effects.
She said she has had a lot of success with Latuda. She said that there were very few side effects unless it was taken at high dosages. I was particularly concerned about neurological symptoms (Risperidone, ESPECIALLY Lithium), again only at high dosages).
I expressed my concern that Latuda was marketed for BP depression. She said it was a mood stabilizer and wasn't known to induce mania....
I was 3 days into what could (and was a hypo episode). But she put me on the Latuda anyway. The hope was to get me off one of my current meds if the Latuda is effective.
I know the akasthisthia is from Latuda. Maybe the hypo is fall-out from stopping the Lithium. I know that is common.

I know the pharmacist checks for drug interactions, but I did check myself. I didn't check myself. I didn't find any.

I'm on 5 different psych meds.
Pdocs add. They don't subtract:

Latuda 20mg
Lamictal 400mg (5yrs)
Topamax 200mg (5yrs)
Zoloft 100mg (2 mo for worsening OCD, helps, surely not helping with the hypo right now I bet)
Xanax 1mg 3xday (6 mo to replace Klonopin)

I'm leery of increasing the Xanax above 1mg.

I DID take the Latuda last night, but I struggled with the decision. The pdoc I have now is my 5th at that practice and I was never fired as a patient. 3 left the practice...
I FIRED the one I spoke to yesterday. That was the only time my husband stepped inside a pdoc's private office.
She is covering for my pdoc until she returns tomorrow.That's all I'm going to get if I call. If I call today it will be the same thing: suck it up, take meds as prescribed. If I call today, it will be, "your pdoc will be in the office tomorrow, suck it up, take meds if prescribed, if you're s/s go to the ER." I'm sure she's had patients who have experienced hypo+akathisia.

I will try to get my pdoc on the phone tomorrow. Maybe she'll prescribe something, maybe she won't. She'll keep me on Latuda. "You were already hypomanic. Give it time to work." LOL

It's important that you feel that your condition is being managed properly. It's important that you have faith in the professionals you call for help when you need it, and get help when you do. It's time for a change.

It's taken me 6 hours to write this because I can't sit still from the akasthisia, but my thoughts are racing because I'm hypo. I'm having long conversations with telemarketers.
I get off track, ramble, so I delete. I edit, cut, paste, write, re-write. But I think I'm fairly clear. I hope I'm fairly clear.

I'm sorry this is so long, but I swear it could have been a novel.

Kay

I wish I knew about the benadryl yesterday...

I was dry for 3mo following s/s attempt, then very rarely 1-2 beers thereafter.

Being absolutely miserable, having nothing to slow me down, knowing that my husband can drink an 18pk a night if he's in the mood (6 beers in the fridge) I texted him that he needed to pick up beer on the way home. I had taken down the sign on the fridge with big bold red letters reading "NO BEER!"

The poor thing! After a long hard day's work he comes home to THIS. It's GOT to be scary to watch someone with akasthisia. And I was talking ragtime. He needed the beer more than I did and he drank it.

I had 4 beers, slept for a little bit, but was back up around 2 or 3 cleaning the bathroom.

I will try the benadryl. I hope it makes a dent.

The sign is back on the frige.

Kay

Hi Kay,

I can assure you that you are writing clearly, your current situation tears at my heart. Nothing is worse than a trusted Professional disappointing us in the level of Care we need and expect.

I am not BP, having just the one side, Depressive Personality Disorder. I've been to that darkest of places, I live just above that level due to heavy doses of Mirtazapine now, but we can all slip.

While you are going through this difficult time please always hold in your mind that Friends and Family in the Real World and here care greatly about your wellbeing. Everything passes, you will be able to access your Dr very soon, hopefully that will produce the results you seek.

Dave.