Hypomanic- new to Latuda- other concerns
 

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! :):)

:heartthrob: :trampoline: :heartthrob:

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.

Kay,
We completely understand you. You are very clear.
It is going to be easier for me to post to you in small pieces because of my own issues. (I have multiple issues right now and I apologize.)

That is flat out not true.
The drug, as far as I know, was approved in the US in 2013.


You do not need a mood stabilizer long term. You need something for right now.You are getting a head of yourself with your thinking.


I really and truly understand what you are saying about hypomania and MS.
That really really stinks. You need a pdoc sensitive to this.

The pdoc practice is not appropriate for you. They do not have the expertise or the stamina to deal with your type of mania.

Your very best bet is the ER although it can be a crap shoot because depending on what you reveal, what is in your record, and which pdoc you get, you could be locked up.
The good thing is that while you are locked up, you should have access to a social worker who can find you an appropriate placement for a pdoc when you get out.

Criteria for getting locked up varies by state.
It is usually something like this:
>>harmful to self or others.

In some states there is an another component more vaguely worded having to do with being able to take care of yourself. Find out which state here.

http://www.treatmentadvocacycenter.o...Procedures.pdf

http://www.treatmentadvocacycenter.o...-in-your-state

Depending on the law of the state, a pdoc can usually hold you temporarily for 72 hours. After that a judge can keep you in longer. Most states want you out as fast as they can (that initial 72 hours or so) due to shortage of beds and other costs but you could get unlucky / lucky enough to stay longer.


If you have access to a therapist, put in an emergency call now about possible hospitalization. You need to reach out to all your support people.

Refuse the med. Do try to keep a relationship with her for now until you get someone else.


M

Kay,

I see that Waves has posted. She is more knowledgeable than I am.

D/C-ing the Latuda is a good idea.

Decrease the Zoloft for tonight and tomorrow,
========
Call your MS doc to leave a message that you are at / very close to an emergency situation.
If you trust that office to care for you, reach out to them (1) in order to be on record and (2) with the hope that they can help you now and (3) with the hope that they can help you from the hospital after you are in-patient.

That office needs to have information regarding the degree of your hypo-mania right now.

===
In case your husband does not already have all doctor names and phone numbers and a list of your drugs, give him those now.

I send my very best thoughts for your safety, well being, and comfort.

M

Akathisia is no freaking joke, and it seems pretty clear it's med induced. If your pdoc doesn't respond by reducing or suspending the offending med, see a different doc, even if that means going to the ER.

Do you have any other extra-pyramidal symptoms? If so you should report those too....

I am angry you didn't get a better response from the sub-pdoc. :mad:

:hug:

waves

p.s. I've read that benzo's sometimes do give benefit as well... I'd be careful increasing those though... but maybe an occasional dose can serve as a pad if things are particularly bad.

That's actually a very good idea, given the hypomania. Zoloft can be activating ... especially if one is already activated, and will not help with the akathisia either. (SSRI's can actually cause it, even if that does not seem to be the case here if you were on it already.)

Thank you Waves and thank you Benadryl!!!

50mg and I can sit still (to some degree)! But it's not helping the hypo, of course. I told my sister the pdoc should have suggested it, she responded that some people have "a bad reaction to it." LOL Let's start comparing benadryl to anti-psychotics now.

If that (expletive) thinks I'm going on a 6th psych med to counter-act akasthisia caused by a drug that's likely wrong for me in the first place, she's got another thing coming.

I've only had one appointment with my new neurologist, the next one is in August. Although BP is very common in MS, I doubt he would be of any help here. But I should make an appointment with my PCP. He's wonderful. My husband knows I keep a list of all my current meds on my computer desktop. I also keep a copy in my wallet along with business cards for all my doctors.

I'm not going to the ER unless I'm s/s...
My local is where they took me after my s/s attempt, I had to stay in the cardiac unit there for a while after I did it, and I went there for a severe anxiety attack about a month after I came home. So there's history.
Also, even though I'm not s/s, I'm critiquing my own s/s attempt. If I'm 100% honest, this will no doubt raise flags of some color or another. Vague. Depending on who I get for an MD, I could very well get locked up.

I'm safe right now, and much more comfortable thanks to Waves' advice re:Benadryl.

I am going to take the Latuda and Zoloft tonight
since I am much more comfortable because of the Benadryl and don't want to screw around with too much on my own...
I see the therapist on Thursday, pdoc on Friday.No doubt there will be news.

Kay

So glad the benedryl helped.

Donna :hug::grouphug:

glad it worked, for some they have the exact opposite reaction. It is like gambling....
bizi

Dear Kay,

You have a lot of courage. :hug::hug::hug:
Do call the PCP.


Very glad that Waves's Benedryl suggestion is helping you.

Mari

The paradoxical reaction you are referring to is possible, but improbable, and it is more common (less uncommon) in children than adults. Most adults find first-generation antihistamines sedating, and Benadryl specifically very sedating. It is even sold as a sleep aid.

In any event, that is why I suggested Kay take 50 mg only if she had already used it before and found it sedating, otherwise 25mg.

I am so glad you are feeling better! The pdoc really could have suggested it rather than tell you to suck it up or go to ER. People have done bad things when suffering from akathisia. That stupid doc deserves a taste of it her/himself. Forgive me for saying that but it makes me mad how utterly unresponsive they were to your needs.

I had it once in reaction to an excessive dose of Paxil (my second failure on Paxil). It really, really, really BITES. I not have any Benadryl. I took another first generation antihistamine having anticholinergic properties -- this is what is thought to help control EPS -- but mine had much less of that than Benadryl does, and in fact it did not help me. It really is hard to think under those conditions too, isn't it.

Definitely yes to GP, but also, when you see your neurologist, bring any questions you have regarding whatever is on the table with meds. And if you are still negotiating over the Latuda by then (I hope not!) talk to him about it. As a neuro, I believe he will be aware of the meds somewhat, and as well as these side kinds of effects (EPS), so might be able to offer some input.
Ask your "real" pdoc (not the stupid sub) about reducing the Zoloft given the hypomania. I've always had SSRI's reduced or suspended when hypo.

It is a little sedating for me. I started at 50mg, withheld the Xanax because that was like doing something into the wind anyway and I didn't want to risk increasing the sedative effect.

I was able to sleep in pieces. The first time I had to get up, I stayed in the living room so I wouldn't disturb my husband... he has to get up at 4:30am.

Please be careful about with holding your xanax. I think you said that you take 1mg 3 x a day?
I am curious why you switched from klonipin to xanax?
Yes benadryl is most useful as a sleep aid!
bizi

[BThe Benadryl isn't working.

I don't know what is winning out: Hypo or Akathsisia[/B]

Now my behavior is a little more goal-directed (have laundry in the dryer), but I still can't (expletive) still. I'm more agitated, racing thoughts increased, writing prolifically (this is new to me), I'm talking to myself more (thank God not to anyone else), critiquing my s/s attempt and remembering it more.

[B]ALTHOUGH STILL NO S/S THOUGHTS.[/B]

Calling the office

I hope they don't lock me up

I'll keep you posted.

Kay

Kay,

I hope that you go through to the office and got some help.

M

Kay

Benadryl I've read will not work if you keep taking the antipsychotic, but beyond skipping/reducing for a day or two, an MD needs to call shots. I thought the issue was just for a one day and then your pdoc would be stepping in to make some decisions.

What if your husband took you to the ER and you told them (with his help if you have trouble) that you are having trouble with the akathisia? I doubt you'd present as dangerous to self and others if you are going there mostly because you feel uncomfortable. Your husband can probably attest that you are not giving signs of doing bad things.

I have some concern that you are seeing motor agitation from mania, not from the Latuda. However, it could truly be akathisia. It would be best for a doctor to check you out, and give you treatments in a controlled environment -- hospital/ER where they can check your reactions to what they give you and change course of therapy quickly, if need be.

If you really won't do the ER and can't get to your pdoc, maybe you can get to your GP? You need to see a doctor at this point.

WOW! (expletive!)

I called and paged the on-call physician, but got a call back from my pdoc about 4hrs later...

-No ER

-No office visit

-She's not concerned about 100mg of Zoloft

-Like Waves, not certain on akasthisia vs. hypomania

-Choice to stay on Latuda or switch to Abilify tonight. Worried about hypo fallout if a mood-stabilizer is withdrawn at this point.
Said it's hard because I've tried so many drugs (lithium, depakote, risperidol, zyprexa, seroquol. I'm on lamictal and topomax now).

-I mentioned the Benadryl. She said I could try to increase it to 75 or 100mg, but not above. It will have that sedative effect, but obviously will not treat the hypomania.

-"Call me tomorrow if you need to, go to the ER if you need to, see you Friday."
Hopefully, I'm not leaving anything out.


I was truthful with her and thorough. She makes some good points, but I was hardly satisfied when I hung up the phone.
I wasn't about to agree to switch to a new mood stabilizer that I know very little about-during an episode-over the phone.
I'm not confident with the bipolar-depression drug approach in my situation.

Benadryl increase, and with pdoc's blessing. Hopefully it helps. If I'm not better, or am worse, I may have to just sit in that office until SOMEONE sees me. I will go to the ER if I absolutely need to. But I'm not in a hurry.

So far I've done 2 loads of laundry, vacuumed my apartment, cleaned the bathroom, and popped up and down scattered a million times for no purpose today. Usually, I have to lay down after I vacuum my living room (and it's not that big).
All this is going on. I'm driven. But I'm exhausted... maybe that part is the MS.

I'm agitated. And I've been that nasty kind of agitated on and off today. I'm trying to keep my mouth shut for my husband's sake.

Kay

Kay,
Your choices as I see them are

1 Stop taking the Latuda. Start Abilify.

2 Keep taking the Latuda with the increased Benendryl.

3 Go to the ER.

Abilify has been around a few years longer than Latuda. Abilify has been prescribed off label for sleep. How is your sleep?

Have you been taking Latuda with food as the manufacturer says? Take it with protein if you want absorption.
Here is the Latuda P.I. sheet if you have not already seen it:
http://www.crazymeds.us/pmwiki/pub/d...s/Latudapi.pdf

M

you are so resourceful mari.

I took 75mg of Benadryl and it's been a lot easier to sit still. And I'm a little calmer. :)
WOO-HOO!
Oddly enough, it didn't help the runny rose I have from the cold I'm still getting over.
And I'm still manic.
You can't have everything.

My husband is now 14 beers into the 18-pk he brought home (and whatever was left in the fridge). But I haven't had a drop. Just Monday night.

Plan is:
1. Stay on the Latuda (at least until Friday)
2. Keep taking the Benadryl
3. Don't take Zoloft tomorrow morning
4. Research Abilify
5. Pray for sleep

Kay

p.s. Now I have diarrhea

Good luck Kay.

Sending good thoughts and hugs.

Donna :hug::grouphug:

I hope that you sleep, Kay.

Good luck tonight and tomorrow.

Get back to us Thursday.

M

I think that stopping the zoloft is a good idea.
I hope you sleep well tonight if you can.
bizi

Mari,

I forgot to let you know that I do take Laduta with food. They say at least 350 calories. I finish dinner an hour before I take my pm pills (including Latuda) but I eat a twinkie beforehand for good measure (roughly 350 cal).

Despite eating well (ignore the twinkies), often, and a lot, it's been a struggle to gain weight and keep it on. I have blood work drawn more often than most people because of that, and it's all normal. I'm 5'8" and went from about 140+lb 1.5-2yr ago to a low of 113lb 2-3mo ago. Monday I was up to 120!!! :):):)

I know it's not particularly good for me, but for right now, I'm sticking with the 3-twinkie-a-day diet. They're just adjunct therapy, and right now I'm reading the results on the scale.

The weight loss began slowly around the time the hypo episodes became more frequent. I figured it had been the drinking, but I lost weight after I left the psych ward even though I was dry for 3mo after I left, then had only 1-2 beers every month or two after that, and still lost weight instead of gaining it.

I'd be a liar if I said I wasn't worried that I was going to lose more weight now that I'm manic. Now I have a "NO BEER!" sign on my fridge and a "DON'T FORGET TO EAT!" sign on my freezer.

I slept for 6 hours straight!!! :)

But then I popped right out bed, peed, and started cleaning the kitchen floor.

Not out of the realm for me to crash in the middle of an episode. But this morning, everything's still there but much more bearable.
Hopefully this means this is event is coming to a close.

Whatever it is, I'll take it. :)

Thank you for sharing kay and I am glad that you got 6 hours of sleep.
good luck today.
(((((HUGS)))))
bizi

Kay,

I hope that the episode is coming to a close and that you are getting a break from all of that.

You probably have a very clean apartment.:):):)

M

Yeah...

Spoke too soon- hypo is worse now. Sleep just helped recharge it.
I think Waves' and the pdoc's suspicions that the akasthisia-like symptoms might be from the hypo are probably true. STILL NOT S/S.

I had an appointment scheduled with the therapist for today, the pdoc suggested I cancel it. VERY good call. I'm SO agitated. NOBODY could tolerate being in such a small office with me for 5 minutes right now. Therapy would be helpful with the thoughts I'm having, but not in this state...
Now dwelling on before, during, after s/s attempt.

Although I'm not paranoid now, I'm remembering that I was very paranoid and labile in the psych ward.
I did do more research on Abilify and I'm going to remind the pdoc of that when I see her tomorrow and we can talk about if it would be more appropriate....
This is a different animal, but I think most of that has to do with the fact that this is my first hypo episode since my s/s attempt.
She said I should see results from the Latuda in a week. It will be a week tomorrow- that would be magical. I'm obviously not seeing ANY results. Maybe I'm burning through yet another drug, but she comes across as thinking this is very difficult and unusual.

Kay

Kay

That is not good at all. :(

Yep. I hope that you and your doc get this worked out very woon.

It might be better than what you are on now that is for sure.

Mari

just sending some hugs your way.
good luck tomorrow.
(((((HUGS))))
bizi

Last doses of 100mg of Benadryl and 1mg Xanax coincided perfectly and proved useful in calming me down for a little while.

My therapist called me and she was concerned. I appreciate that, and told her so. She said I should have still come in. I know she is experienced, but in the calmest way possible made it clear to her that she was greatly underestimating the level of my agitation. It was very kind of her to call.

My appointment is tomorrow afternoon.

Thank you for all the love, hugs, and support :hug:
Kay