very happy for you kay...progress is progress. I am hoping that hubby sees a good difference in you.
bizi

I'm sure he will see a big difference!

But I just had to take a prn.

I'm going to have a hard time figuring out how much goal-directed behavior is appropriate...

Hi, Kay,

I just woke up.

'Want to let you know that I keep hoping for good things for you.

M

My husband can tell that I'm much better than I was yesterday, and better than I was when I was when I was on Lithium, but he can't help me with the gray areas.

It's rather an arbitrary thing to wake up in the morning and know whether you're feeling like yourself or not (and I bet most people can trust their own judgement)...
But for 7-8yrs on Lithium I was either hypomanic, depressed, or flat and
I don't know exactly what I'm looking for now.
It's frustrating.

Last night taking 600 vs. 400mg made a huge difference.
I still have med to play with (650 today, I can take up to 750, max is 800mg).

I don't know now if I should have taken that 50mg prn dose earlier than I did today (I took it at 3) or at all because it made me tired. I felt better before I took it... But was it a healthy kind of better? And how much energy is too much energy?

Tomorrow's plan: No plan. Fly by the seat of my pants per usual.

You are an inspiration, Kay!
 

Hi Kay,

You are doing well. One sign of this is the amount of insight you have into yourself and into your daily life right now.

Simply asking the questions you are asking shows insight. :)

It makes sense that you are not sure of what you are looking for as an emotional "norm," the target you are trying to define and trying to achieve.

Medical conditions, as well as the effects of medications, can, over time, cause us to loose a sense of what feels "normal" for ourselves. We can also lose self-confidence and no longer trust ourselves, our own perceptions.

I like how your doctor is handling allowing you to find the doses and times of daytime meds which suit you best. I feel she is showing confidence in you, in your judgment and is helping to restore your self-confidence. :)

You are very highly motivated to bring your life into balance. It's inspiring to witness someone so motivated! :)

I believe you will have an increasingly accurate sense of what's just fine for you, as for energy levels, goal-directed behaviors, and more.

Self-compassion and patience help us so much in our finding balance in our lives.

You are working hard to heal, Kay. Not everyone works so hard at this. I have a lot of faith you will find the balance which serves you best.

You are truly doing an amazing job of caring for yourself. :)

:hug:

DejaVu

Seriously, I lost my post.:confused:
It was the most beautiful and thought full post I have ever written. :cool:

Kay,

Even someone like me who has been in the bipolar game since 1988 and who is mostly depressed now both due to side effects and to lack of sleep, has to adjust pills during the days sometimes and weekly via the pill minder.

You daily plan/system will eventually settle into something more of a routine.
It might feel like hard work right now. I can promise you that it gets easier because you and the meds / amounts / times will get used to each other.

Take good care.

Mari

Yes,

You are right, DejaVu,

What makes these things especially
hard is that we have to ignore our own self-perceptions /self-trust.

We have to trust that we made the right decisions about the process-- finding a doc, getting on the meds, . . .
And we have to accept that we are not in control because we handed control over to the meds.


M

Thank you both so much! :grouphug:

I still have the same pdoc I was bitching about 2mo ago. I think she's a hero now. Two major changes: 1) I became more proactive in my care 2) I became much more insightful after I discontinued Lithium.

I suffer from a general lack of self confidence. I question everything. Why should this be any different? I certainly have good reason. For example: am I questioning the 50mg prn dose because I over-medicated? could it have been s/e of the drug? or is it because I am really only missing the energy/productivity?

At some point last night, I remembered I have MS :rolleyes:
Sure, meds are going to effect me differently at different times. But I guess that's where the prn's will really come in handy.

In a perfect world I'd like to get away from prn-dosing, but I realize that might not be a realistic goal. Thank you, Mari, for letting me know that it's okay. I grateful to have the option, instead of having a pdoc insist on snowing me 24/7.

Kay

Kay

Keep up the good work.

Donna :hug::grouphug:

At 11 this morning I thought I might be having some rapid thoughts, but I held off on taking any med until I was sure...
The next thing I knew, it was 1 and I was in the middle of another massive cleaning mission.
So I took 50mg of Seroquel.
An hour later, I was less motivated but still too racy, so I took 50mg more.

Then I became dull, flat and tired. I know I over-medicated.

Lesson 1: I should have trusted my instincts and taken the Seroquel at 11.

Lesson 2: Give the 1st prn more time to work.

Kay

kay you are so insightful, and are doing a great job being careful.
I wish you much luck in this journey.
bizi

Mari
 

Mari,

I am sorry you lost your post. :(
I enjoy your writing so much! You clearly hit the nails directly on the heads whenever you write. I am always very enlightened by your written offerings.

:hug:
DejaVu

Hi Kay. That's part of the side affects of Seroquel. I feel dull,flat,and tired a lot of the time,but it's helping me with my panic attacks,OCD,depression,and etc.

At one time my mind was buffeted with sharp,and painful tormenting thoughts all of the time. I was on the edge of panic attacks allot of the time,and stress,and high anxiety. It is so aggravating. Less then one half of one percent of people understand it. There has been so much misunderstanding from the people around me.

I found out that one of my first cousins had panic attacks. These things come down the family tree somewhere. BF:hug::hug::hug:

Mary I agree with DejaVu. It is such a painful experience to loose a well thought out post. I'm sorry. BF:hug::hug::hug:

Thank you for posting Steve.

Understandably, I don't like that feeling. And it's making it hard for me to tell when I've taken too much med because the s/e can feel so similar to over-medication.
I don't know if these prns are being prescribed with the intent to stabilize my mood or sedate me? Or if it really makes a difference?
I'm afraid of being completely snowed like I was when I was on Lithium. To be completely honest, I'm afraid I might end up under-medicating because of it and end up high on the spectrum. I'd rather be higher. Who wouldn't want to be? But I know that's not healthy for me.

When I got out of the hospital after my s/s attempt I started having very disturbing memories/images and a lot of panic attacks, usually in the morning when my anxiety is at its highest. I have fewer now. I take Xanax when it happens, but the Seroquel seems to be helping me have less of those thoughts and anxiety.

Thanks to all! :grouphug:

Kay

To My Dear Friends,

It's been such a hard two months.

I can't thank you all enough for all the wisdom, support, and encouragement you've given me. You've carried me on your shoulders while sometimes bearing the weight of your own problems. You're strong and amazing people.

It has meant the world to me. I don't think I say thank you enough.

:grouphug:

Kay

I think I got it right today :)

I took 50mg at 11 as soon as I realized I was racing, then another 50 2hrs later when I still was. I had been waiting too long to medicate.

I slowed down, was able to sit down and relax. I did do some cleaning, but I didn't go overboard.
I'm tired, but I don't feel dull or flat :)

700mg yesterday, 700mg today, with the freedom to go 50mg higher. And 800mg is the max.

I hope it goes this well tomorrow.

Kay

I am glad that you got it right kay.
You are so strong....
bizi

Kay, I agree with mymorgy- definitely see your psychiatrist face to face.

I have no direct experience of Seroquel but when I was a voluntary patient in a private psychiatric hospital it was handed out PRN with no follow-up. This concerned me.

I hope that your psychiatrist can help.

All the best.

I did end up seeing my pdoc the next day. I was escalating at that point.

She increased my nighttime dose, but she prescribes medication to be taken prn (as needed) during the day because the amount I need varies.
She said this sometimes happens with patients who take Seroquel.

Other patients take small doses (usually 50mg) off-label (accepted and widely used by medical professionals but not approved by FDA) prn for sleep.

Kay

Are you able to get a good nights sleep?
bizi

Saturday night: I got very lightheaded and learned the hard way not to take Xanax and 600mg of Seroquel too close together. 700mg for the day.

Sunday: I only needed 650mg to keep me grounded. I was exhausted, but not dull/flat.

I left the house to run errands both days. I only leave the house to go to the grocery store, pharmacy, or doctor so it was a pretty exciting weekend for me :)

-------

I've been keeping notes:

A couple of days ago I was dismissing symptoms that might be hypomania at 11am until about 2pm.

Until today I've been blaming all my early morning hypo symptoms on anxiety. That is when my anxiety is at its height, but it usually responds to Xanax. It hasn't been responding to Xanax... and it doesn't seem to become clear to me that I'm hypomanic until hours later. I should know better.

I think it's possible that I was just unwilling to admit to myself that those hypo symptoms are going to be there when I wake up everyday.

I took 50mg when I got up. And I just took 50mg more.

Kay

Most nights I sleep pretty well thanks to the Seroquel, but some nights MS sx act up and I lose a couple of hours.

I am glad that most nights you get good sleep.:)
bizi

Just a thought right now. An unpleasant thought...

Because my symptoms have been feeling so much like anxiety lately, could I be slipping into dysphoric hypomania?
Or do mixed episodes only occur during mania?

I wish waves were here to answer your question.....
bizi

My last hospitalization was for dysphoric mania. I'm familiar with the overlap of anxiety/inner tension with manic symptoms, but only at that level...

I've really only been noticing this for the last 2-3 days. Yesterday I only had to take 50mg of Seroquel (650mg/day) along with my regular doses of Xanax, but I had to take 150mg today. It helped, but that put me at my max of 750mg/day. Max for Seroquel is 800mg.

At least I'm not manic, and I'm medicating for all this, but I'm worried that I'm escalating again and I'm going to reach the point where I'm maxed out on Seroquel soon.

I see my pdoc on Wednesday. I'm sure I can hold on until then.

Tomorrow's another day. Hopefully it's more of a 650mg day than a 800mg day.

Kay

Dysphoric Hypomania / Mixed States
 

Hi Kay,

Dysphoric hypomania is written about and is a possibility at any time.
Please see the symptoms and definitions for various categories of experiences, as discussed in this pdf, if interested:

https://www.icgp.ie/assets/10/41D0B4...olar_37-38.pdf

I hope this information helps to answer your question.

I hope Tuesday is a calm day for you.

:hug:
DejaVu

OH, dear god --
That is where I lived for many years:

http://www.mcmanweb.com/bipolarii.html

(The DSM does not appropriately enough address this as far as I am concerned.)

-------
Anyway, even if you do have it, it might be only be a transition stage for you on a way to a more friendly mood.
Keep your eye on what is happening.

M

Thank you for the articles.
I have no doubt now that this is what's happening. I remember the feeling of "inner-tension" and the psychomotor activity I was experiencing prior to being admitted for dysphoric/agitated mania. It's just happening to a lesser degree.
I'm only feeling these symptoms in the morning. I doubt I would be feeling them at this point at all if I was one of the patients who responded to only a nightly dose of Seroquel. But so far, the prns are doing the job.

I hope this is just a shift to a positive mood, but I escalated into a more pronounced euphoric hypomania during the middle of last week, requiring my meds to be readjusted. When I was in the hospital, they treated the dysphoric mania like mania. There is little room (50mg) to adjust the Seroquel again if I escalate.

I'm worried that I may max out on Seroquel and require an additional drug, posing more problems. The only drugs I found commonly used with Seroquel are Depakote and Lithiium. I cannot take Depakote, and would only even entertain the idea of taking Lithium at a very low dose.

Both my pdoc and the psychiatrist in the hospital told me I'm "running out of drugs." And that's not a comfortable thought to have right now.

Kay

Gabapentin?
 

Kay,

I take 200 mgs Gabapentin at night.
It is a low dose but seems to help with depression and anxiety.

My old pdoc's plan was to get me to 600 mgs but I was overwhelmed with the brain fog / sleep affect -- can't explain exactly but two to or three times tried to increase the dose.

M

Thank you for mentioning that Mari!!!

I was taking a very hefty dose (totalling 2400mg/day) of Gabapentin for years for neuro pain d/t MS. I stopped it a while ago because it wasn't working for me anymore. I forgot it was a mood stabilizer too...
Maybe that's another reason why I've been harder to control recently.

I'll have to mention this to pdoc tomorrow.

Man oh man, You are a wise one!

Thank you, thank you, thank you!!!

Kay

Good luck.

I hope that it helps.

M

I saw my pdoc today...

I had been slowly tapering off Gabapentin for several months because it's an anti-convulsant and I was on such a high dose. But I came off the last of it (300mg) a couple of days before I was discharged from the psych hospital 8/2. I honestly didn't think 300mg was a big deal. Apparently the psychiatrist didn't either.
I thought when I was discharged that I had reached my baseline, but I was still hypomanic and I'm obviously still struggling with that.

Pdoc said this was "excellent information."

Rather than bump me up to 800mg of Seroquel, she's going to keep me at:
600mg at bedtime with 50-150mg prn during the day

and add:
300mg Gabapentin at night

Technically, I'll be on 4 mood stabilizers, but I guess I have been for 7-8yrs.

I don't know how it will interact with Seroquel, but:
300mg was not an issue when I was on Abilify, and I was taking 2400mg of it when I was on 1800mg Lithium, 400mg Lamictal, and 200mg Topamax.
So my body obviously has a high tolerance for it.

If taking it with 600mg of Seroquel becomes a problem, I can take it during the day instead.

If it works, I imagine my Seroquel dosage will need to be adjusted. Or at least I won't need as many prns.

I am experiencing dysphoric hypomania, and have been taking 750mg of Seroquel for the last 3 days.

Thanks again for sharing your experience, Mari. I had factored out the Gabapentin :hug:

Kay

Hi Kay. I usually take 600 Mgs of Seroquel before bed. If I start feeling to tired the next day over a period of time,I decrease my Seroquel dose down to 450 Mgs before bed. I stay at that dose for a week or two,and when I start feeling more panic/fear/OCD/depression,I go back up to 600 Mgs before bed. I've been doing that for several years.

I was cleaning a hand vac last night,and I started feeling a lot of anxiety that sometimes comes with doing to much cleaning,and having allergy attacks. I took part of a Seroquel,and some of my other meds, it was time for them,then I became less hyper, and less freaked out. I was getting hyper. I hate that fealing,but I'm taking the meds,and praying.

The Seroquel has been a really big help in reducing my mental health challenges,but it slows me down. I can accept this slow down because the meds combination are helping my anxiety problems. BF:hug::hug::hug:

Kay,

Good pdoc visit. :hug::hug::hug:

I am guessing on the fewer prns.

I was put on it by my pdoc/neuro for nerve pain but I could only get up to three hundred mgs before I was wiped out with sleepy side effects.
(Hard to deal with meds that cause sleepy affects when I am trying to go into work without enough sleep.)

If you have not seen it, here is a fun site run by a guy with more than one MI/personality disorder/something
http://www.crazymeds.us/pmwiki/pmwik...Meds/Neurontin

M

I've noticed the that I get that tired hang over if I medicate enough, too. I held back on some of the med Sunday to avoid it. I haven't been experiencing it the last few days though. It really is a trade off. :hug:

It stinks that you have to, but it makes me feel better that some of you have to play with your meds too, and have found ways to make them work better for you :hug:

Cleaning can really get me going too. I've been trying to stay away from anything more involved than vacuuming the last few days. I don't feel well right now and the last thing I need is to get wrapped up in something and rev myself up. My anxiety has been really high.

You warned me about the weight gain with Seroquel. I have gained 6-7lbs since starting. It's not unwelcome, but I don't want to gain much more than that.

Kay

How is hubby through all of this?
bizi

Once the prns kick in I appear to be more "normal" and that's what he sees when he gets home from work. He did notice a difference this weekend because he saw how I was in the morning before I medicated. And he saw the difference after I medicated. He said I wasn't off the wall, and it didn't seem to faze him.

He's noticed a drop off in productivity the last few days (I'm not scrubbing the walls anymore). Part of that is intentional, part of that is because the type of hypomania I'm experiencing now is less-goal-oriented (I left that part out). Yesterday I told him that "I'm not feeling well and am trying not to get myself worked up."

I like the fact that he's picking up on changes in my behavior, and is getting involved enough now to start asking questions.

I saw pdoc and I told him we are just adding back a drug I was taking before. He detests dose increases and drug additions, but he was satisfied with my explanation.

I try to tell him enough so that he understands what is going on without going into any detail. His responses to my explanations lead me to believe that he thinks I have things under control.

Sunday he told me he wasn't going to drink during the week anymore. Monday he came home with a 12pk. After that was gone, he got into some hard stuff. He didn't drink last night, but he did take an OTC sleeping pill.

No recent disagreements :)

Thank you for asking Bizi,

Kay