When we, people with bipolar disorder, are in a full blown manic phase or a severe depressed phase, the doses of medication we have to take to control those phases are astronomically higher than the doses of the same medicine we take when we are in a normal phase or euthymic.
I have been on as high a dose of Seroquel as 800 mg when I was in a full blown manic phase. If I were to take 800 mg of Seroquel today, I seriously think I would not wake up. My body at this normal phase would not be able to handle that large dose. Our metabolic rate increases a LOT when we are manic, therefore the weight loss and the staying awake all the time. So, our body, in that increased metabolic rate state, can metabolize al LOT more medication than it can in a normal or euthymic state. My lithium dose has been pretty large as well when I was in a full blown manic state, and without bad side effects such as loss of fine motor coordination, tremor, diureresis, even hair loss, and acne.
Many psychiatrists think that if I was on 800 mg of Seroquel when I was in a full blown manic state, that 800 mg is my maintenance dose. But they are WRONG! No one needs the high doses that we take in extreme phases as maintenance doses. Maintenance doses are much smaller. For example, I am currently on 75 mg of Seroquel, less than one tenth of the dose that I took in my severe phase.
I have been on such high doses of Depakote that literally half the hair on my head fell out, among other things, and still the doctor who prescribed it to me wanted to keep increasing the dose!
I’ve actually had arguments with previous psychiatrists about this, when they have tried to keep increasing my dose when I was normal or euthymic. Eventually, I would have to find a new psychiatrist and hope that they realized the dosage issue.
Thank goodness, I now have a doctor who realizes this fully, and was explaining it to me when I stopped him mid sentence and exclaimed “Hallelujah, finally, someone who understands this!!!”
These medications are powerful medications with awful side effects. The thing that is most beneficial is to use the smallest dose necessary to control our symptoms while having the fewest side effects. Of course the key is controlling your symptoms, so the dose has to do that adequately.
Just thought I would write about this because I have struggled a lot with this in the past. Now, I feel lucky to have the doctor I have.
And now my Seroquel is kicking in and I am about to fall into a deep slumber, so good night all!
2 thoughts on “Doses and Roses”
Very good point. I bet a lot of people don’t think about those dosage issues. Can’t believe that more doctors don’t. Makes total sense. Although once my antidepressant or mood stabilizer is increased for depression or cycling symptoms, respectively, it stays that way. I can see that for manic meds how you would need to decrease the dose after no longer manic though just because of their sedating effects.
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I understand what you’re saying about remaining on the high dose for maintenance 🙂 I also really think everything is sped up when you’re manic, your brain is certainly working like mad (haha) so you’re metabolizing and clearing those drugs out of your system. Once everything slows down, you’re not clearing them as fast, so then they can stay in your system at high levels and become toxic to you. Since I go between depression and mixed mood phases and now I am totally off Zoloft, I tend to increase and decrease my mood stabilizers.