It's very unfortunate that you are feeling bad. I really wish I would be instead in your place so that your mind is free to help others. You are the "pheonix de ce bois" like La Fontaine said in his fables. I can't really advise about family relationships but I am sure that marriage is a problem whether for BP or not.
Consider Lamictal. Leftcoastchick said "if you titrate the drug slowly, 12.5mgs at a time". This means not augmenting 12.5mg daily but every week, i.e. one whole week at night 12.5mg then increase to 25mg the next week. so it takes 9 weeks about to reach 200mg the therapeutic dose. But you can end at 100mg only I suppose depernding on the person. I heard very successful stories with lamictal. In egypt people don't know the difference bertween AC and AD so they use it as AD. The rash as it's mentioned is 1 in 1000. Titration makes it very rare.
I wish you try to calm down (easily said than done) however think about when you had the previous episode and you came out of it. I think it isn't the depression which you suffer but the panick itself which horrifies you. I am sure if you can hang on for a while things will always improve. This is how nature develops. Ups then downs etc...
Calm down just for a while and the tempest will pass away. Wish you all the best
I was put on Lamactil as an AD, it has worked far better for me then any ssri or tryclic - a world of difference, when they augmented that with Lithium, it seemed to to do the job.
AD's made me hypomanic and terribly anxious, now my anxiety is controlled, and my drops in moods aren't as severe (except pms) . I've started to get my energy back that's been lacking for over 10 years, I don't have to force myself to do errands, I just do them. Since August I've only cancelled 2 appt's, and that's a darn miracle. The side effects on these drugs are pretty rare, and you would really have to be at max dose before it might even happen. See your GP if you can't get into your pdoc,s/he will also have an update on what meds you are on, and at least start you off.
I wish you a bit of piece, you are so valued not just to me, but so many here,
You are in my prayers, Jane
Well as I said Lamictal has strong anti-depressent properties and even though that's not a concern of yours, anti-psychotic properties as well. Obviously you can't make changes without speaking to your psychiatrist but sounds like the Remeron is making things worse. You may not need an anti-depressent but you need relief from depression. A mood stabilizer when working is supposed to work on both mania and depression. Psychiatrists generally try and add another working mood stabilizer as an adjunct when there is remaining depression because of the risk of emergent mania from the anti-depressent. I'm sure they will consider Lamictal but because by FDA regulations (I'm not sure if those are worldwide but those are probably standard guidelines) Lamictal can only be raised at 25 mg. per week and 150 mg. is a starting dose it wiil take a while for you to see an effect. Most probably the Remeron is making things worse and should be changed and I'm reading through the posts and I believe you hadn't tried Wellbutrin so as you would need an adjunct anti-depressent that would be the safest and if the Lamictal starts working on the depressive aspect of bipolar they could titrate that down.
Lamictal takes a couple of months to build up build up to a proper dose so it will be a while you are on a lot of medication before they titrate you off the other medications. But at the end it will be worth it. But if anything is clearly worsening things such as the Remeron and doing more harm than good you need to call that to their attention. And certainly as new classes of anti-depressents come out if they are less likely to induce mania and that's been confirmed that's worth asking about as well as you stated. No one is on the same medications for life. A medication update is needed from time to time in a person's life as things get adjusted and new medications are developed.
I wish the Remeron made me manic. Its just making me sick and im more depressed than before.
I will discuss Lamactil with my pdoc when I see him in january, just dont think I need another MS - I need a working AD right now like no toomorrow.
Mind you thats just one of the many things I need..
Look I do post about side effects both long term and short term but Stephen's Johnson syndrome from Lamictal is extremely rare. The chances are 1 in a thousand. And after six month that risk goes down. The basic rule with Lamictal is if you get a rash of any kind see your doctor immediately. And they will decide what to do. When I was on Lamictal the problem I ran into was that at higher doses it made me manic. My psychopharmocologist says that can happen to some people. That's not common but not unheard of but at lower doses and when used as an adjunct it would be less of a problem. Lamictal is better at treating depression than mania though so as adjunct it might be more helpful than an anti-depressent which unlike Lamictal can easily push a person into mania, Wellbutrin aside (and its still a possibility with that). And remember from that website which is run by a mood disorders specialist (whom I'm not affiliated with) the quote "any medication can cause any side effect". That doesn't mean it will. I had extra-pyramidal side effects from Lamictal and that was so rare it was reported to the FDA. Its a statistic. Its common ones to be concerned about and with Lamictal I see no reason not to try it.
But with Remeron yes for a person with bipolar mania is a strong possibility. I was on Remeron as an experimental treatment for tardive dyskinesia and it made me wildly manic, overeat to the point where I got sick and sleep all day. It most likely wouldn't cause extreme mania in a person with depression. But people with bipolar run a risk when using anti-depresents so the best thing is the usage of an adjunct mood stabilizer that has a good effect on depression which Lamictal does. Speak to your psychiatrist with any changes at all times. But don't take my word. The sites I provide that are clinically accurate would provide more information that you could use to inform yourself and bring to your psychiatrist and discuss.
I hope by the time you see this this post the "bleeding" will have eased some. That was always my ex-husband's line..."Right now, we need to stop the bleeding."
This may be repititous, but I just wanted to tell you that I take 1200mg Li and 400 of Lamictal. The Lamictal was added for depression after my last hospitalization three years ago.
I've not had any problems with Lamictal. It helped my depression - not a ton, but I was able to go back to work.
And I haven't had SJS or any other problems. This is just my experence, but I wanted to let you know as you're considering it with trepidation.
I really feel for you - I was suicidal most of the Ssummer here in the US (and hadn't found this site, yet).
I'm glad you've managed to get an appointment for Monday and yes being able to have a chat with your wife is a step forward and I hope she gives you your alone time while you get through this.
An update, still cannot get into my pdoc, one of my psychologists is missing in action as well (im a bit worried about her as she had a heart attack earlier in the year) but I am seeing my clinical psych on monday.
Ive been thinking a lot about the advice some of you have given and my wife and I have discussed some of the things I am feeling and the problems we have, thats got to be a step forward - my mood has lifted a little but it tends to mid week, however I still feel deeply depressed and I hate that.
I hear you, guess im just so worried right now about it getting worse. Warm and happy perhaps who knows.
This is the worst I have been in 15 years, thats the scary thing
Sweetie, compared to the side effects of other MS's, they're pretty minimal with Lamactil, especially if you titrate the drug slowly, 12.5mgs at a time. I am truly amazed this works as I have refractory depression. I now have a libido, I don't get as hypomanic or dizzyness, dry mouth or constipation that I felt on most of the SSRI's and trycyclics.
It's a first line drug. I had a slump when still titrating up on the Lamactil, and was placed on 150mgs of Lithium, between the two, I'm pretty much back to norm, and I was happy as a clam today, first time in months. I also have more energy, a feeling I haven't had in 10 yrs. I have 2 other chronic health issues, and I haven't had any reactions because of this drug. It's not as bad as it sounds. I just want to see monkey even keeled again, you're in my prayers. Jane
I know more about mixed episodes than I ever wanted to. SSRI's are not the only AD that can cause them BTW - so can MAOI and Tricyclic AD's - SSRI's are the most commonly prescribed now which is the major risk profile.
My last mixed episode almost cost me my life (thank you Prozac).
I appreciate the advice on lamactil - its one a number of people have given me but I am extremely hesitant to insert another drug into the mix and Lamactil has some nasty side effects I am not very thrilled about included SJS and TEN not to mention some of the other side effects - I would need to be very convinced by a doctor to take the drug as Lithium is working as an MS and adding another AC or MS or AP into the mix is something I would need some serious guarantees on at this point.
Keeping my job is vital and I cant do that with some side effects of some drugs.
I really appreciate all your help guys, truly its so valuable. I do have a routine and a plan, have had for 10 years now, without it I am lost and if i was not working right now I think I would be in serious trouble.
I havent tried Yoga yet, my psychologist swears by it but the problem I have is pure depression, I cant get energy and feel sick all the time, motivation to do something new is low.
Looking back the Mirtazapine (Remeron) have been a disaster - they have not lifted my depression at all and have mad it worse but thats only part of the problem, the other stuff and a pile of things I am not so comfortable talking about in the open are just so hard to work through, my mind is full of wire some days.
Trying to get into my pdoc. Hopefully soon.
As far as meds go, ADs, especially SSRIs, have the risk of inducing a mixed episode. Perhaps adding Lamictal to the Lithium would be something to consider. Lamictal has strong antidepressant properties and can be taken with Lithium.
I know how difficult bipolar is in a marriage. Marriage without bipolar is really hard too. You and your wife have to talk about what you and what you just cannot do at this time in your illness. You have to letter her know what your needs are. I have three non medication suggestions.
The first one is simple yoga. It gives you the quiet time, meditation, deep breathing and stretching your body needs. You can ask your wife to join you or atleast give you one uninterupted hour twice a week to take care of just you. My second suggestion developing a plan for each day. Your expectations for yourself minimal day, okay day and good day. I have had to have plans that were as simple as getting out of bed and brushing my teeth. Depression is so tough and personally defeating. My third suggesting is to use your mood tracker. You may be having bad day after bad day, but it helps to put it all into perspective.
You sound pretty desperate, so I hope that you have been able to speak with your wife. I have to have time alone and the fact is that although it is poor timing for her, the situation with her family has apparently been very hard on you as well. I was not here when that was happening, but my personal experience has been that any loss will bring up memories of my most meaningful loss - and that can caused a marked deterioration in my ability to cope.
This may sound odd, but my husband has been resistant to "marriage counselling", but when the psychiatrist suggested "family therapy", it was a different story altogether. Perhaps a little twist in the wording might help bring her around, too?
Please hang in there. I hope you can talk to your psychiatrist about medications and also a therapist about your present situation - soon. It's Monday in Australia now, right?
Monkeyc - you have also been very helpful to me - and my wife when she has posted here. As I read this, every word you said would be the same coming from me. I am facing the exact same trials and depression only a daily - if not hourly - basis some times. Many times my wife has suggested hopitalization when I reach this point - and for the same reasons as you, i can't afford to do that.
I too am struggling with this in out marriage - what I should because I'm tired of hurting her and others. My thoughts of leaving have nothing to do with not loving her or our family. So many times I have thought about just renting an apartment where I have a place to escape when in this state.
I can tell you - like others - you need to try and find some way to breath right now. I know this isn't wasy in the place you are at...believe me I have been there so many times. On thing that helps me is to just go for a drive, to give me soime time to settle/think, and to her some time to do the same without me there pushing back.
The medications i'm on are cymbalta, lamictal, trazadone and ambien.
The other thing I would suggest is to get yourself your own therapoist/counselor. This was extremely tough for me to do or to give in too - and I really don't use it to the advantage I know I could because I don't tell them everything. However, I do tell them enough to at least have someone to talk to - to talk things out with. My best advice would be to find someone you can talk to friend. I'm sure, from the advice you have given me, you know you can't do this on your own.
This is a long road we're on remiond yourself that you don't have to have the answers today. Remind yourself of the reasons you should not do anything rash. Take a long drive...go out and get a coffee or something. Give yourself some distance and don't forget to breath...but also find someone in person to talk to and talk to your health care provider about the medication. Use the tracker to monitor your swings so you can identify any patterns.
Above all...just hang in there...we won't leave you alone here...don't isolate us or your wife. We will get each other through this.
You have always been so insightful, and you've helped me with your posts. My pdoc told me sometimes meds might not work after a while, and sometimes you have to try a different cocktail. I've tried most of the SSRI's, and they have actually made it worse at times. Have you thought about adding a mood stabilizer like Lamactil, don't worry about that rare rash warning, if you are put on it slowly you won't have issues. I have severe reflux disease so that's something I have to consider when taking meds. Like I posted before, when you get stable, get some counselling, meds are only part of your stability.
If you can't tell your wife what you are feeling, write it, draw it - do jello sculpting, just something to let her in on what's going on. You are a strong person. Do you have insurance. I would suggest going into hospital if you can, it's not that bad. I went in, and at first, I was thinking, what am I doing here? I'm finally feeling better.. there is light at the end of the tunnel. You can do it, hugs Jane
I think the one thing I know is I am not leaving my wife. I love her and I don't run from things - never have really which is a good and bad character trait to have but its mine.
I think couples counselling is the answer to some of the relationship issues - my private psychologist does it a lot and she is willing to do it for us but its getting us both in a room and my wife is being somewhat resistant I thing - therese is right in the dealing with a lot right now and I feel I am adding to that - I have to get myself sorted.
In the morning I am going to call my clinical psychologist at the hospital and see if it can get in to see my old pdoc - I truly hate doing it because of various reasons not least of which is an ability to commit me if she fears I will harm myself but I have no options as I need off these drugs, I think the depression is ripping me apart here, I dont have manic energy which is a good sign but im crushed by this pain in my head and my heart.
Sigh. One easy day. Id kill for that right now.
I just go do a quick p-doc when I feel the need to answer my inquiries.Though I do post so often that I worry that I am a pain?
Take the best of care my friend! Tres
Remember your wife just lost her father and it would be very unfair to leave her now.
Just stay calm. Repeat yourself clamly. "I want you to leave me alone right now please"
You should get into couple counselling and the counsellor will tell her to "listen" to what you are saying. To respect your request to be alone at times etc.. She will take more notice if someone else tells her.
It is a very uneven field when you are in a relationship and you have an illness, because the other person can write off anything you say as being a symptom. I find this most unfair. Like she always has the upper hand because she has a 'healthier mind' my husband thinks this too, in an argument he will say i'm being 'irrational'.......grr........I get soooooooooo f -ing mad......LOL have a sense of humour.
There are new anti depressants coming along , Valdoxan, which increases deep sleep and helps with depression in a different way. I have a feeling this will help people with bipolar without making them manic.
I have psychotic depression, Remeron and Wellbutrin were hopeless for me, I mean they did nothing - but cymbalta works brilliantly. But I will be taking Valdoxan in the spring when it comes out here in Austria.
I know i've suggested a spell in hospital to you through PMs, but if you feel this would be a backward step then I fully understand your reluctance, all I shall say on that subject is keep it there as an option.
Trying to cope with grief and relationship problems is hard enough and even harder when you are BP. Are you able to see your therapist on a more regular basis whilst you are feeling this way? It may also be worth considering that the mirtazapine may in fact also be making you feel worse - I reacted to citalopram this way and became more depressed and angry. I know they are different types of meds but it is certainly worth looking into. I can feel your frustration regarding not getting into see your psych and as much as you feel like you are beating your head against a brick wall, ring everyday damn day until you get that appointment through.
I agree with what the others say about trying to get through to your wife that you need some alone time. This may sound a bit twee, but have you thought about writing it down like a letter for her to explain exactly how you are feeling, that it is in no way her fault and that you are scared of damaging the relationship further which is why you need to be left alone. I imagine that she is probably blaming herself (as we all do) and is feeling helpless as well as coping with her own grief of losing her dad. Relationship counselling sounds like a good idea but perhaps not until you are feeling stronger emotionally.
I'm glad you put this out onto the open forum, you give so much to everyone on here and take very little back. Giving everyone a chance to help support you is good for you as you are a much valued member of this community and we all want to support you as best we can.
I'm still here for you as always, and you know I will continue to PM you. Take care and for once be kind to yourself, you are definitely NOT a selfish guy but the complete opposite.
Yes Wellbutrin is the least likely of all anti-depressents when used in bipolar to push a person into a manic state but its still a possibility. But I agree it makes the most sense.
First of all thanks you all for your thoughts and for the kind words - this site never ceases to amaze me with how wiling people are to help when you need it.
Drugs : From what we can tell mood stabiliser is working fine, I have been stable on 1250mg Lithium for over 12 months and it works well for me
The problem started when my wifes father was dying and her family were ripping at each other like wild dogs the doctors put me on Mirtazapine (Avanza in AU and Remeron in the US) and its not been a fun ride really. I resisted an Anti Depressant for a very long time as I have had bad experiences in the past with them.
From what I am told MAO drugs are not used much anymore here - they are too touchy and dangerous and the potential side effects outweigh the benefits - My pdoc wont use them at all. I am very worried to take an SSRI due to my last ride on Prozac (suicide attempt) but may have to go that way.
Wellbutrin is prescribed here mainly for smoking cessation but I may be able to move to it my pdoc told me, its my preference as the SNRI drugs appears safer than Tricyclics and SSRI's for bipolars based on reading.
The Remeron is causing weight gain and it appears stomach problems (My diverticulitis symptoms have returned less than a year after a fairly big resection) but coming off an AD isnt easy and ive been trying to get into see my pdoc for a month now with no luck ( he has been sick himself) and finding another one.. it took me 6 months to find a slot with this one.
Couples counselling was something I pushed for 6 months and it was always too hard or no time or etc etc : my fathr in law took 18 months to die and our lives ran on hold that whole time and members who were around when he was dying might remember the ride i took then - I know there are deep problems in my marriage due to the family situation and theyre not easily fixed, there are other things as well - My wife is infertile and my illness has killed adoption which is another thing to deal with.
My worry is that I am crossing the line from being angry into being abusive and I do not want that - I cannot control the feelings I am getting of anger and depression and the lack of any desire to do much grows - im finding it hard to get out of bed and I do not see a point to life right now. This all terrifies me because my last depressive episode lasted nearly 3 years and cost me my career and almost my life.
I am terrified basically.
hospital sounds so nice but the price is so big I think I would have to be right on the edge to do it - the damage it would do to everything I have worked for.. Incalculable.
just4shanell you put your finger right on it - thats my wife to a T - she does feel shut out and helpless and watching someone go through this is hell, I know she loves me but she likes to get her own way - we have had times where I have literally had to pick her up and move her to get away - she stands in the door or my office and keeps talking until I just panic and have to get away before I hurt her - my brain locks up. I am about the least violent person around and yet...
Its the anger that i hate, I dont have a hair trigger I have no trigger, it just comes screaming out of me at the slightest touch.
Maybe i just need a few days away on my own? How do you tell your wife that?
I think couples counseling could be beneficial. You have both been seeing your own therapists, I think seeing one together might be helpful in having an unbiased mediator to help sort through your issues. It is never just one person's fault and you cannot place all of the blame on yourself. I have a problem with "snapping" when I become upset and I have learned to just say nothing, walk out the door and take a long walk to clear my head or even a car ride.
You didn't mention whether you have tried a mood stabilizer such as Lamictal. There are so many different options out there besides ADs.
Yah, what she said! I don't mean to sound cruel or uncaring. You are a bright star on this forum. I would vote for you as a leader without a thought. I just think we all need more than tea and sympathy some times. I also like to think we are talking about real world issues not just seeing a nirvana life through our B.P. eyes. What are your real options? If your wife is driving you crazy then leave the house. The voices in your head are enough for you to be dealing with. But DO tell her you care and you just need to sort things out. We care about you. Be careful.