Any one ever felt this way??
 

Is it possible to be both depressed and manic at the same time??

Has anyone else ever felt this way??

This is how I feel... both at the same time.... :thud::Sigh:

Frustrated...
Abbie

Guess not...

thanks anyway
:(:(:(:(:(:(:(:(:(:(

Absolutely Abbie
 

That is called a mixed state. Dysphoria. They are defined by the DSM in brief in your exact words practically.

If you are on an antidepressant (other than Lamictal which is a stabilizing agent) generally it is safer to lower them, because they are activating. Usually the treatment is to up the moodstabilizer you are on, add a stabilizer, or add an antipsychotic. the latter option works the best for me ... calms me right the heck down. the sooner you are treated, the faster you will respond.

The best stabilizers for mixed states are Depakote and Trileptal. Lamotrigine is a good adjunct also because of its antidepressant properties.

Fewer individuals in mixed states respond to lithium than to the above two agents, however, per my reading, those few who do respond to lithium fare better - symptoms are resolved faster.

As far as AP's... my standby is olanzapine (Zyprexa) for a short term treatment, but it should not be given if you are already at a risk for diabetes, and as it is, i only use it for brief periods because it does make me gain weight fast. Seroquel also works but not as well. in both cases, moderate to high doses are needed for acute and breakthrough dysphoria typically (15-20mg Zyprexa, 600mg Seroquel given at night, or 400 at night 200 am). Here Geodon is not available but i would think it should be effective and does not carry the high diabetic risk Zyprexa does. I don't know the dosages offhand.

I would discuss these various options with your doctor if you are not on such a regime already, or if you are on lower doses.

i do hope you feel better soon. Mixed states are the worst of bipolar. Be safe. Post when you can if you need to vent. I can appreciate the frustration... an understatement even? :hug:

~ waves ~

p.s. looks like we cross posted... sorry i wasn't faster... trying to give you some info here.... chin up... it WILL resolve. it WILL, ok?

mixed moods /mixed states
 

Abbie,
What's happening today?
Did you call the pdoc?
Sometimes I used to call to INFORM my pdoc that I had made an adjustment.

I can't believe that I accidently deleted my post from last night.
I'm a moron.

Here's what I said last night.


Have you made a recent med change?
I remember that mixed is horrible.
I used to describe it as the energy of mania combined with the low of depression.
Often, as Waves suggests, it is caused / aggravated by antidepressants.
It is a dangerous state.
Get a hold of the pdoc or make adjustments.

Mari

Yes
 

I have this problema nd have been diagnosed as having Bipolar I, mixed, etc. What usually happens is that I get so many thoughts and ideas in my head that I can't think of things outside ofmy own head, it almost seems like a berserk TV going on and on fromc hannel to channel. I won't be able to sleep, I will feel hypersexual and try to do many things at one time, but never what I am really supposed to be doing. I get irritated with everyone around me very easily. At the same time I will start to cry for no reason, feel no energy at all - then lots of energy. Feel sad and like have a preoccupation with dying, and then suddenly feel like I could do anything.
It makes me feel crazy - except for when ithappens and I don't notcie the episode ocming on (like I didnt this time). It also happens a lot. I am now on Lamictal, wellbutrin, abilify and risperdal. I am wonder if I shoudl get my doctor to stop the wellbutrin, I wonder if its causingme problems. I also tend to get on forums and also e-mail people long e-mails. I dont usually ever go on forums...unless I'm mixed or manic... so I guess y'all can guess where I'm at today

You have a good description here.
 

Hi,
Abilify can do that too.
I think it can be dose dependent.
Have you called the pdoc.
A mixed state counts as an emergency as far as I am concerned.
M.

Abbie, would you check in?
 

Abbie,

How are you doing? Any better?

would you check in if you can please?

I am worried. Mixed moods while varied in their severity and characteristics, can escalate rapidly into dangerous situations. I believe Mari was thinking of the "strict" Mixed Episode definition... with full blown mania and deep depression... depending on features it can certainly be a medical emergency.

I do hope you are ok. Would like to hear from you. Even just a little peep if you can manage it... or let us know how you are, if you can manage that.

have you talked to your pdoc about this (pdoc himself, that is, as opposed to his office personnel or answering machine)?

Here's hoping you are better, or at worst, holding your own.

:hug: ~ waves ~ :hug:

my computer keeps knocking me off of here...

I had quite a bit written.... short story... I'm still here... not any better but holding on.

:hug:

:hug:

You know I'm having modem problems, get knocked off all the time.

If you can Abbie, just hit the Thank You, so we know you have been here.

:hug:

( I keep writting out my replies on notepad, then copy and paste..then..whoosh...offline I go......)

Hi, Abbie,
I'm concerned because I remember mixed being positively awful.

I'm glad you say that you are a bit better and I appreciate your posting.

I hope that you get "more" better very soon.
Call one of the docs giving you the meds. One or two of your meds is ramping you up. Your pdoc is your best bet.

Mari

Hi Abbie, really good to hear from you!
 

Hi Abbie!

Thanks for checking in! I'm so relieved to hear from you... wish you were doing better, but holding on is good. If you have not talked to your pdoc, even if you have an appointment soon, i would call and ask to speak to him directly - or have him call back. he may want to direct you to make a med adjustment right away.... as you had mentioned in earlier threads you were working on your meds to counteract your depression... sounds like one o those counteractions might have gone haywire.

Sorry we didn't get to read your story... :(

ack!!! darn internet! my usb port is a bit flakey so that occasionally knocks me off... but not often. i have also noticed that NT doesn't keep one logged in very long, while inactive (which includes while typing a post)... i have had my session expire while typing a message... and if one just logs in again as requested, it still won't let you submit, complaining that you have "logged in after" initiating the reply. ack!!!! this foils an old trick of mine when, after typing a long post, i pretty well expected my session to be expired: the trick was to open the forum in a separate browser/tab, log in, then go back to the browser/tab where my post was ready to go, and hit submit. It used to work... but no longer! hmmph! :mad:

i do copy and paste a lot. if i am prompted to log in when i hit submit, i go ahead and do so.... then, i use the back button to return to my typed-in reply (i do not get redirected back regardless if i hit the specific link to do so... i get a blank page:rolleyes:). at that point, since i cannot submit due to the fresh login, i do a select/copy of the reply. then, i page back further to the thread itself and hit refresh so it refreshes my session id. (opening the thread in a new window works too). then hit reply again, and paste. the title and icon need to be set manually of course. sigh. irritating. functional but irritating.

of course typing up in notepad or another editor is even safer coz then you can save it locally... regardless if your whole internet connection has gone poof. arggh.

i do wonder why the session thing is the way it is. it used to work here. could be the vbulletin version??? but why? i dunno.

Well, Abbie, you hang in there and pop in and either paste a pre-typed post, or two words or whatever. Just the Thanks button works too, if you are not in shape to type, at least we know you're out there, lol... but personally, i was really glad to hear from you that you are holding on. darn shame your "story" got e-munched, but we'll live with that.

the reason i still would like for you to hear from your pdoc is that the longer these states persist, the worse off you are in the long run... they train your brain... you are more likely to end up in similar states in the future than if it gets nipped in the bud.

but i will shut up now. before my session expires... if it hasn't already! :p

You take care now, Abbie. ;) And a big thanks again for the post!

:hug: ~ waves ~ :hug:

Just wanted to update everyone...

YES, I am indeed in a very mixed state!!!

Pdoc and Tdoc are both VERY concerned!!

They are adjusting my medicine---decreasing one and increasing a couple of others... but if that doesn't work I am to call the clinic and may have to go to hospital. :(

I go back to Pdoc in two weeks but have to call Tdoc in one week to check in.

Right now... I'm just very tired but can't get my brain to shut down...even when I am able to sleep a little my brain is very active.

:(:o:(
Abbie

Hang in there sweetie.
I hope they can get a good balance worked out soon.:grouphug:

Have they ever suggested or tried hypnosis or something along those lines?
For overall help?

dear abby,
I am so sorry that you are in this mixed mood....I have had them before and they are awful.
thank you for checing in...and know that we are here if you want to come and jsut psot/ check in/ stay in touch until you get more stable.
We are here for both ups and down times.
((((HUGS)))))
beth

Sending hugs and thinking of you.

Donna

hi Abbie
 

good to know your pdoc was responsive and tdoc is looking out for you too.

i hope the med changes work

but if you see little or no improvement, please DO go call clinic to be safe.

best wishes :hug: for the med changes to help.

~ waves ~ not doing so great myself, so i might not be around too often :(

I don't know what's happening....

I forgot to take my AD yesterday.... and today I feel like wonder woman on speed!!! It doesn't make sense!

:(:(:(:o:o:o:(:(:(

Hi,
Call the pdoc and the tdoc right now.
This is serious stuff -- to have a reaction to skipping a med when you are already in a mixed mood.

What AD did you skip? Someone here might have experience with it.
You could also call a pharmacist and ask about the ramifications of skipping that AD.

M.

I agree with mari,
abby what is your mixed mood like for you?
hope you stabilize as soon as possible.
beth

Sending hugs, and good thoughts.

And warm fuzzies.

Donna

Abbie, i am very concerned
 

It is unusual (tho it seems to be a bug going around, coz it bit me too:rolleyes::confused:) to have increased agitation when decreasing or due to skipping an AD. indeed, skipping just a single dose is unlikely to produce any reaction. but if it did, one would expect reduced agitation.

i agree with Mari to talk to your pdoc ASAP - i.e. call the office, and if he is not available right then, get them to have him call you back.

My suspicion is there is a coincidence here. That the skipped dose is fortuitous and that the manic-side sx are still on the increase, despite the dose adjustments. Am i right though in "hearing" that you are feeling less depressed? it was the "wonderwoman on speed" phrase that made me think that, but i'm not sure... wonderwoman could be feeling cruddy and on speed, i suppose.

you may also be having a paradoxical reaction to one of your meds.

Would you like to share what meds you are on?

Could you try to describe how you feel overall... i don't know if you can; i realize it is tough.

in any event. please call pdoc asap, ok?

:hug:

~ waves ~

Mostly lately I feel like WonderWoman---talking a million miles a second making no sense... was driving like a mad woman in the Indy 500 when I went to the doc this week... BUT... at the same time I was feeling hopeless, worthless, very empty, and staring over the edge at the very dark place with now bottom.

Yesterday I woke up feeling like I was DRUNK.... I don't drink. I could barely walk, my head was spinning.... I hated the way I was feeling and "IT" was a very very prevalent consistant thought.

I keep my medicine in a daily dispenser thingy.... My AD (Cymbalta) was not in the case. I don't know now if I forgot to take it.... or if I double dosed....the AD and forgot the Seroquel.

I have taken the medicine today as prescribed and am feeling a bit better...

I didn't call doc... was too afraid...

I need to get off of here...the battery on my laptop is about dead.

Hugs to all,
Abbie

Dear Wonder-Abbie... it's ok... it can happen
 

OK. This confirms it, still mixed. you also got quite manic. It is excellent that you are able to write - that is a good sign, hopefully by now your speech is also more coherent. Your writing is coherent. The "IT" thoughts are a problem, and a bunch of mania plus that, plus those feelings of malaise can get you in bad trouble. Moving on...

if you double dosed the Cymbalta it could certainly rev you up like that. And cause you to feel drunk.

Ok, this is positive, and you were smart not to try to self-adjust since you aren't sure what happened. Do continue as prescribed, do not change an iota unless you hear from your pdoc. Still, i would like to hear you doing a lot better ... that would be a lot safer.

awwwww, hon, i'm sorry. i know how that can be coz i screwed up my meds totally right after i got stabilized as an inpatient. :(:o i know. but no fear. no fear.

right now, it is not so important what happened, but that something DID go awry with your dosing, and that you got more manic as well as some weird symptoms.

upshot... if tomorrow
- you are feeling giddy still (that drunk feeling)
OR
- you have not slowed down SIGNIFICANTLY and still have pervasive thoughts of "IT"

do please call and talk to your pdoc. one of the symptoms of mania is DISTRACTABILITY lol!!! so i think he will understand... and if he doesn't - point that out to him like i just did to you. ;):cool::p
i'm thinking he might have you take a smidgeon more seroquel even for just a couple of days or until the mania is quieted. but even if not, it will be best for him to know, especially about "IT" in this situation.

It's OK that you made a boo boo with your meds. Even on our best days, we don't do everything perfectly, let alone on days like you are living now!!! :hug:

i'm so sorry this happened. i hate that this happened. but stuff like this... :Sigh: ... happens.

it can happen to you
it can happen to me
it can happen to everyone
eventually

- YES... It Can Happen


hang in there, and please try to check in with us tomorrow and let us know how you are doing.

((( Wonder-Abbie )))

:hug: ~ waves ~ :hug:

Dear abby,
HOw are you doing sweetie?
beth

Just thought I would share...

Doctor has lowered my Cymbalta back to 90mg -- taken mid day
Upped my Seroquel to 500mg -- 50mg in morning, 450 at bedtime.
Upped my Klonopin to .5mg 3 times a day

I am still feeling pretty much the same.... I was supposed to check in with Tdoc on Monday but panic set in and I still haven't been able to call... I go back to see her on Monday... I also see the NEW Pdoc on Monday...I am not looking forward to this at all...everytime I think about it...it literally makes me sick to my stomach.

:(:o:(:o
Abbie

Hi Abbie
 

Dear Abbie,

Thank you so much for taking the time to check in with us. :)

The med changes sound good.... overall. 500mg seroquel is decent. I took 600 for dysphoria & mania... plus a benzo in equivalent potency to what you are taking. however i also had sublingual lorazepam PRN for acute anxiety/panic attacks. Also, that is a real high dose of Cymbalta. i can't figure how you would have been scripted an even HIGHER dose!!! Scary.

from RxList - Cymbalta
(Select page 2 - Dosage and Administration - from the page menu)
but that stuff is activating.... lets see how you do and what the new pdoc says. i do hope you like him. ordinarily i would say what a time to be switching pdocs but perhaps it is a good thing everything considered.

i am glad you will be seeing your T. don't worry about not having called, you have enough to deal with than worry about having been too anxious to do something. if you get the whim, go ahead and call. but i am glad you will see her monday as well as the new pdoc. :)

hang in there! :hug:

~ waves ~

Dear abby,
glad to hear that you/will be seeing your team on monday.
I am hoping that you have their support and expertise to help you thru this transition.
I agree that is a high dose of cymbalta for being in a mixed state...but I don't know alot about cymbalta....and how stimulating this to you.
beth:hug:

Cymbalta was originally prescribed for RSD (Reflex Sympathetic Dystrophy) Pain. 60mg did absolutely nothing for the RSD or Depression. They then upped it to 90mg with what I call wonderful results... where I was for a long time but that level too quit working. At 120mg I was getting some pain relief again for the RSD but it did nothing for the depression.

Oh...In case I haven't posted yet.... I am SEVERELY allergic to ALL narcotic and opiate pain killers. I have nearly died each time they tried a different one.

The Pdocs in the past have mentioned stopping the Cymbalta all together so that may be what happens.... that scares me as it is the only thing that even takes a small edge off of my RSD pain.....

We'll see what happens on Monday....

:(:(
Abbie

Dear Abbie,

I'm sorry that you are in a med mess at the moment. The new pdoc should be able to get you out of the mixed mood.
He / She might even be able to help you with something for the pain.
Some docs are geniuses. I've run into one or two. But even those kinds need lots of input from us to help them get the right answers.

Keep trying.

M.

Ooohh Abbie!
 

Dear Abbie,

I'm sorry to hear about the Reflex Sympathetic Dystrophy... i just googled it to see what i could find medication-wise. Found a NINDS site info sheet on it - they call it CPRS - Complex regional pain syndrome. anyway it sounds just horrible. that and bipolar too. my stomach sank down into my shoes. it does state that no single medication has been found to relieve the condition but says that lots of drugs are used symptomatically... not just opiates or steroids either.

Notably i see that AEDs are mentioned and i am aware of some, including new ones, which may help with pain control. I am thinking gabapentin but more specifically its newer cousin - pregabalin. Also tricyclic ADs like amitriptyline or nortriptyline could help. the latter is often used for fibro. Amitriptyline howver is unique in pain treatment, in that it has been found, even in low doses, to help with pain of diverse origin... even psychogenic pain (i am not suggesting that yours is) but it seems to be a particularly interesting drug insofar as pain control. This i was told by my pdoc - i am not in the US.

I just thought i'd toss a few non-opiate names at you... of course i don't know what you've already tried... but anyway...

There are many meds out there. i hope your new pdoc will find something that works for you. :( i really hope this new pdoc is the genius kind!

let us know how things go.

:heartthrob: ~ waves ~ :heartthrob:

oh yaeh
 

i get it all the time depresion is somtimes a part of beeing manic

Hi all...

I'm sorry I'm late checking back in...:o

Met with new Pdoc... I think he had my case file memorized... he even said he researched RSD (Reflex Sympathetic Dystrophy)... It sounded like he did because he was asking me some questions about how I am dealing with it.

I was so nervous and scared to death of this guy that I can't tell you what he looked like... I don't think I ever looked up. Tdoc told me that the office staff told her that I didn't look too good that day.... said I was shaking, rocking, and was pale white/greyish

He kept all of my meds the same for now...will see me again first week of April.

Oh well... nothing has changed...guess I will just have to keep on keeping on with the mixed feelings until I can't take it anymore.

Thank you everyone for caring!!
:hug:
Abbie

hi abby, thanks for checking in.
what do you think he should have changed?
Maybe you can ask to see him sooner or talk with his nurse since you were flustered about being there. Unless you had questions written down I am not sure how you could remember the visit.
:o
beth

Sorry he wasn't more help on the changing of medicines.

But I'm hoping that you come up with a good medicine plan.

Donna

It's the fear of being around people I don't know... and the fact that the new Pdoc is male... long story. Plus the waiting room was a bit crowded and I don't do crowds... me plus one is a crowd.

I meet with Tdoc again soon..can't remember date but I have the card somewhere. I will ask her what he said in his notes.

I was hoping he would maybe change things around a bit to help with this mixed state.

:o
Abbie

I recently heard that abilify might be helpful in mixed states. Have you ever tried this med before?
beth

Dear Abbie,
Call that stupid pdoc's office and tell them you need SOMETHING changed because you are in a mixed state. What is he? A moron?

OK. Deep breath.
I promise to be calm.
Seriously.
Call somebody (tdoc or pdoc). Or get someone to make the call for you.
Or print out what you wrote here describing your mood and fax it to him.


Sorry that I am a bit moody tonight.
You have a pdoc. That is wonderful.
Now you have to kind of teach him to do his job. I know that that is a lot to ask of a patient, but that is what we do.

We help them understand us and we help them realize the difference between
our normal bad situation and
our very bad situation.

This guy does not know you yet and does not know the difference for you. You are going to just have to let him know what exactly is going on.

Or let the tdoc tell him.
Either way you need a med change now or later and now is better.

Here's the problem that I see. Mixed states are not stable. They don't usually stay mixed states. They can deteriorate and patients can end up in the hospital.


Abbie, I'm sorry that you are dealing with this now.

Mari

Dear Abbie... wanted to stop by before 'break'
 

Indeed. Yes. Thank you Mari! i wish i could have pressed the Thanks button multiple times for that!

And yes, "end up in..." is right... i.e. the last resort becomes the only resort... and not a deluxe resort either. Something must be done NOW, or at least tried.

Pdoc sounds conscientious... thoughtful. Maybe he focused so much on taking on the case he missed the main point?? i.e. to stabilize you asap!

However, i dislike his waiting room situation. Usually, and preferably - partly for confidentiality and partly to maintain "safe" therapeutic boundaries, the office/appointments are set up so as to provide for minimal or NO contact between patients. (i dunno - maybe it's a clinic and they're not all his though... :confused:)

He also does not match your gender preference. i do not discount this; it is part of your comfort zone.

i am usually reluctant to "throw out" something before it has been fully tried but with the above 2 isues, i wonder if a different pdoc/situation might suit you better. However, it may be best to try to work with this for now, than to try another new person ... stressful, and seems unlikely to get you help sooner.

I like the suggestions of printing this or parts of it out... and faxing it... documents things... you don't have to deal with ppl etc. Also....

YESS.... tdoc DOES know this difference in you.... if tdoc were willing to mediate/push concepts through to pdoc for you, being another professional AND one who knows you, it oughtta carry some weight. And, having just seen you, the pdoc may not require another stressful visit but perhaps be willing to call in a script. Talk to tdoc about the whole thing, anyway.

Well, Abbie, somehow, i do hope you can find a way to get meds adjusted, asap. Good luck. :heartthrob:

:hug: ~ waves ~ :hug: ... back to formerly scheduled 'break' now... :o

Hi Abbie, did you... perchance...
 

Other mondays i recall you have had appointments so i thought you might have got to see your tdoc today... did you?

If so, was she helpful? Can she help mediate things with the new pdoc for you?

I hope so.

Looking forward to an update.

When you can.

Take care of yourself, first.

:hug:

~ waves ~