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Old 5 November 2017, 17:24
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Bi-Polar-II

So, can anyone recommend a newer medication that may manage this better than Lamictal? Lithium is not an option. Symptoms are just not well managed. Sleep is so-so, and Seroquel 100MG is used for sleep. No other psychotropic meds are taken.

They also deal with General Anxiety, unipolar depression, Insomnia. PTSD is suspected but has not been diagnosed.

I want this person to be well informed when their next appointment comes up.
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Old 5 November 2017, 18:18
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Expat, Lamictal is normally good with bipolar "lows", not so much the highs. That is likely why the high dosage of Seroquel, in addition to being a sleep aide. Typical response to Lamictal not being effective is a slight increase in the dosage.

Is the Lamictal not working? Is the common rash not going away? As for a "better" med it depends on what the problem is. If it's not stabilizing the mood properly, Effexor may be a good alternative. Abilif is also newer alternative but normally dosed with Lamictal, not instead of. Depakote is not new but very effective.
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Old 15 November 2017, 02:29
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Bipolar in the setting of generalized anxiety, PTSD, and insomnia? Rather than scope out medications in detail, I'd push for a better diagnosis. For many of us in the field, a diagnosis of Bipolar II is suspicious in the setting of all those comorbidities. It's a diagnosis that gets thrown around a lot in people with mixed anxiety, depression, and mood control.

All that said: what medication depends on what you're trying to treat. If it's the mood lability of Bipolar Disorder, Lamictal is a good one but can be insufficient for severe cases. Lithium is a good choice. Depakote is as well. If the symptoms of Bipolar are predominantly depressive (instead of manic), Latuda has a good evidence base with less side effects than almost any mood stabilizer or antipsychotic used as a mood stabilizer.

With due respect to ramzmedic, Effexor is NOT a mood stabilizer and should be avoided for suspected bipolar disorder in the absence of one. Antidepressants like SSRIs and SNRIs (Effexor is the latter) can trigger manic episodes in the absence of a mood stabilizer. Definitely bad juju.

This is not meant to be medical advice, just considerations for the patient to have when getting actual medical advice from their professional. My biggest piece of advice would be to push for a solid diagnosis, then ask to address symptoms by taking one medication at a time until symptoms are in remission.
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Old 15 November 2017, 02:40
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While this is not a question of medicines to treat this disorder, it is a question of what can a layperson (loved one) look for to see if there IS a Bipolar condition that is yet undiagnosed or even recognized as the person who has having it? If that makes any sense?
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Old 15 November 2017, 02:53
notdeadyet notdeadyet is offline
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I usually direct patients to NAMI (National Association of Mental Illness). If you google that name with Bipolar Disorder, the first results are web pages that describe symptoms of the disease with a good bit of background with enough science to educate but without so much to overwhelm. It's a good first pass to determine if there is enough concern to seek out professional help.
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Old 15 November 2017, 06:43
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Unusually severe mood swings, from very high manic to low low state of depresssion. The highs are the worst in my experience. My mother was severely Bipolar until her death. I knew it was going to get bad when she would start raging at neighbors, spending wildly, act out sexually, stay up all night "cleaning" the house-creating piles of junk everywhere, empty out the house into the yard, etc. It usually ended with Police intervention and a inpatient visit to a mental ward.

But she was a severe case who reacted poorly to meds so didn't want to take them. There are plenty of people who have less severe forms and they function fine (provided they are self aware and willing to do treatment)

I'm only speaking from experience and not a medical person.
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Old 15 November 2017, 09:49
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After talking with them, and gathering a bit more info. Bipolar-II really does not fit. The highs and lows are just not there, grandiose plans, hypersexuality are not there either.

The symptoms of Aspergers do fit but not completely as well as other closely associated diseases. But, psych is not our area. We also understand that Aspergers has been removed from the DSM and rolled into Autism.

The have an appt on 11/30 with a Pyschiatrist.

Purple, WRT your mom, was she diagnosed late in life? My mother had a slow decline after 50 and was DX'd with everything from Paranoid Schizophrenia to depression, Bipolar-II and sometimes everything at once. She never got the help she needed and was poorly managed.

I have immense empathy for the mentally ill and those close to them.
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Old 15 November 2017, 18:17
notdeadyet notdeadyet is offline
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Originally Posted by Expatmedic View Post
After talking with them, and gathering a bit more info. Bipolar-II really does not fit. The highs and lows are just not there, grandiose plans, hypersexuality are not there either.
Yeah, Bipolar II is one of the more over-used diagnoses. True Bipolar isn't usually mistaken for much else.

Glad your person has an appointment scheduled with a psychiatrist. Hopefully a good one, but God knows it's hit and miss. Ask lots of questions and if given a diagnosis, ask how they arrived at the diagnosis. Ask about what treatment alternatives there are to the ones being offered (for almost any mental disorder, medications and therapy offer the best results if used together). Take notes, because the individual in question has a habit of remembering the things that are most in line with their beliefs (not a feature of mental illness, when I go in for a physical and hear that I need to lose 10#, drink less, and keep running to keep my lungs working well, I walk away remembering being told my lungs work well).

And be very cautious with what you read on the Internet. People have very skewed visions of mental illness based on personal experience or observing symptoms in someone close them. People who may not be the best sources of information post all kinds of bad info about medications and outcomes. Best to listen to a professional and always feel free to get a second or third opinion.

Best of luck and hope the visit goes well.
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Old 15 November 2017, 19:14
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Originally Posted by notdeadyet View Post
Yeah, Bipolar II is one of the more over-used diagnoses. True Bipolar isn't usually mistaken for much else.

Glad your person has an appointment scheduled with a psychiatrist. Hopefully a good one, but God knows it's hit and miss. Ask lots of questions and if given a diagnosis, ask how they arrived at the diagnosis. Ask about what treatment alternatives there are to the ones being offered (for almost any mental disorder, medications and therapy offer the best results if used together). Take notes, because the individual in question has a habit of remembering the things that are most in line with their beliefs (not a feature of mental illness, when I go in for a physical and hear that I need to lose 10#, drink less, and keep running to keep my lungs working well, I walk away remembering being told my lungs work well).

And be very cautious with what you read on the Internet. People have very skewed visions of mental illness based on personal experience or observing symptoms in someone close them. People who may not be the best sources of information post all kinds of bad info about medications and outcomes. Best to listen to a professional and always feel free to get a second or third opinion.

Best of luck and hope the visit goes well.
Thank you all for taking the time to post.

You are right, talking about this stuff is scary because you never know how people will respond. There can be such a social backlash. But I would be lying by omission if I didn't fess up.

But, with that I hope people can learn from this thread.

The person is me.
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Last edited by Expatmedic; 15 November 2017 at 19:25.
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Old 15 November 2017, 19:26
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The person is me.
Brother, fear not! Believe me, we all have issues of one kind or another and the "judgment" factor doesn't exist here. We have to help each other.

I have no doubt you will get what you need and drive on successfully!
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Old 15 November 2017, 19:33
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Originally Posted by Expatmedic View Post
After talking with them, and gathering a bit more info. Bipolar-II really does not fit. The highs and lows are just not there, grandiose plans, hypersexuality are not there either.

The symptoms of Aspergers do fit but not completely as well as other closely associated diseases. But, psych is not our area. We also understand that Aspergers has been removed from the DSM and rolled into Autism.

The have an appt on 11/30 with a Pyschiatrist.

Purple, WRT your mom, was she diagnosed late in life? My mother had a slow decline after 50 and was DX'd with everything from Paranoid Schizophrenia to depression, Bipolar-II and sometimes everything at once. She never got the help she needed and was poorly managed.

I have immense empathy for the mentally ill and those close to them.
My mom had a traumatic unstable childhood-which I believe contributed. She was bipolar as long as I can recall along with being an alcoholic. She also had psychotic breaks.
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Old 15 November 2017, 19:40
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Originally Posted by Expatmedic View Post
Thank you all for taking the time to post.

You are right, talking about this stuff is scary because you never know how people will respond. There can be such a social backlash. But I would be lying by omission if I didn't fess up.

But, with that I hope people can learn from this thread.

The person is me.
Thank you for your courageous vulnerability. The brain is simply an organ like any other of our organs and it can suffer illness, disease and injury. It can be terribly scary to deal with mental health issues and it can take time and experimentation to figure out what medication is best. It's not easy at all, I know that for certain.
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Old 15 November 2017, 19:51
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... The person is me. ...
My gut thought it might you.

Doesn稚 matter. Please continue to take care of yourself.

All my best,

S
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Old 15 November 2017, 20:24
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Expat, PM sent
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Old 18 November 2017, 17:28
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Originally Posted by MilkBoneSkivies View Post
While this is not a question of medicines to treat this disorder, it is a question of what can a layperson (loved one) look for to see if there IS a Bipolar condition that is yet undiagnosed or even recognized as the person who has having it? If that makes any sense?
From what little I know, often the first sign of bi-polar rather than just depression is a manic period. I know from personal experience how much personal/relationship/career/ financial damage can be done with just one manic episode. Once you have seen one first hand, you recognize it when you see it again.
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Old 18 November 2017, 22:26
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From what little I know, often the first sign of bi-polar rather than just depression is a manic period. I know from personal experience how much personal/relationship/career/ financial damage can be done with just one manic episode. Once you have seen one first hand, you recognize it when you see it again.
Some one very close to me suffers from depression, bi-polar, and occasional psychosis/ psychotic "episodes". Over the years I've learned to read certain indicators, that are specific to this person, that give me a heads up on what is coming. In my experience they are specific to this person. I speculate that each person suffering from this will have their own 'tells"

I know that when this person starts to read their Bible a lot, like all day, that I need to start paying attention. They will also start to journal, page after page, usually prayers written out begging for salvation. The books they read change and all have the same certain theme of "how do you know if you are "saved", does God forgive sin, etc. Then the music they listen to will change. Normally this person likes country music, a little pop, and contemporary Christian. When they start the downward spiral that changes to some almost underground, obscure Christian music. I know that when they start listening to this its coming.

Its usually this formulaic progression, nearly every time, that takes place. The amazing thing is, this person, when they are right in the middle of an "episode" (which can last for weeks) understands and tells me that they know that what they are experiencing isn't "true". That they know that what and how they feel isn't normal and the thoughts they are having aren't true. They just cannot stop it. They can't help it and it is its own kind of agony. All that they want in the world is peace in their mind. But where do you go, and what can you do, to get relief from your own mind?

When this person is "normal" and not experiencing an episode you could never tell that they suffer these things.

When I was younger and a lot more ignorant I could not understand why this person couldn't just "shake it off", "get out of bed and do something", and "just enjoy life". It was maddening and frustrating to me and others around them. I've watched them courageously fight some epic battles within themselves and now, these days, I'm in awe of their sheer tenacity to just hang on and gut through it. This person is the strongest, toughest person I know.

Medication helps. Effexor, Seroquel, and another I can't remember the name of. It evens them out for the most part.

I apologize for the lengthy post. I just spoke to this person on the phone and they are in the middle of an episode right now. This thread hit me in the gut.
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Old 19 November 2017, 15:13
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Get your testosterone check. Walter reed put me on trt it was the biggest help.
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Old 27 November 2017, 13:52
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Quote:
Originally Posted by Group9 View Post
From what little I know, often the first sign of bi-polar rather than just depression is a manic period. I know from personal experience how much personal/relationship/career/ financial damage can be done with just one manic episode. Once you have seen one first hand, you recognize it when you see it again.
For me it started with me not sleeping for a month. That was thought to be a manic phase. Went and saw my doc and gave me a referral. But, as I know now, there were signs: Overspending, hyperfocused on an item, hobby etc, no real hypersexuality, if anything asexual.

I am trying to figure out if I was misdiagnosed, the meds are working, I have created coping skills all or none of the above.

Perhaps the downs did more damage, but the highs served me very well being a Paramedic. Sleep not necessary and I would work 3-4 24hour shifts in a row.
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Old 27 November 2017, 13:58
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Originally Posted by A191 View Post
Some one very close to me suffers from depression, bi-polar, and occasional psychosis/ psychotic "episodes". Over the years I've learned to read certain indicators, that are specific to this person, that give me a heads up on what is coming. In my experience they are specific to this person. I speculate that each person suffering from this will have their own 'tells"

I know that when this person starts to read their Bible a lot, like all day, that I need to start paying attention. They will also start to journal, page after page, usually prayers written out begging for salvation. The books they read change and all have the same certain theme of "how do you know if you are "saved", does God forgive sin, etc. Then the music they listen to will change. Normally this person likes country music, a little pop, and contemporary Christian. When they start the downward spiral that changes to some almost underground, obscure Christian music. I know that when they start listening to this its coming.

Its usually this formulaic progression, nearly every time, that takes place. The amazing thing is, this person, when they are right in the middle of an "episode" (which can last for weeks) understands and tells me that they know that what they are experiencing isn't "true". That they know that what and how they feel isn't normal and the thoughts they are having aren't true. They just cannot stop it. They can't help it and it is its own kind of agony. All that they want in the world is peace in their mind. But where do you go, and what can you do, to get relief from your own mind?

When this person is "normal" and not experiencing an episode you could never tell that they suffer these things.

When I was younger and a lot more ignorant I could not understand why this person couldn't just "shake it off", "get out of bed and do something", and "just enjoy life". It was maddening and frustrating to me and others around them. I've watched them courageously fight some epic battles within themselves and now, these days, I'm in awe of their sheer tenacity to just hang on and gut through it. This person is the strongest, toughest person I know.

Medication helps. Effexor, Seroquel, and another I can't remember the name of. It evens them out for the most part.

I apologize for the lengthy post. I just spoke to this person on the phone and they are in the middle of an episode right now. This thread hit me in the gut.
Good post. I suspect I was a child when all of this surfaced but did not know things were not supposed to be miserable until I was about 45, 5 years ago.

Sometimes the internal conflict within is worse than the other stuff.
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Old 27 November 2017, 21:13
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Here's a pretty decent article on mental health and nutrition.
Goof for everyone to consider.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2248201/
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