Doses

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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!

Words

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Some words that have the power to change your thinking, the power to pull you up by your bootstraps, the power to pull you out of the seemingly bottomless hole that is depression and anxiety:

RESILIENCE, that is what we have, what we are to recover over and over again from black depressions, from the mean reds. We get up over and over again and brush ourselves off and go on! How resilient is our spirit, how resilient are we! I marvel at this ability.

PLASTICITY, this is what our brains do in learning or after any experience. An experience leaves a mark on our brains, good or bad. But this is not permanent. Our brains have the ability to form new connections and lose old ones. This happens between neurons. Once it was thought that an adult brain is like a structure made of stone. There is nothing further from the truth, the brain is undergoing changes all the time, whether it be in repair, or neuronal cell growth or growth of axons and dendrites. This all makes our brain very adaptable and repairable and changeable! So if we have undergone bad experiences, our brain can recover from those through plasticity!

HOPE, well what can I say about this word? This is the little, four letter word my world rests on. It is so powerful that even in the darkest of circumstances, just say it and things will get brighter. Your heart will get lighter. You will breathe easier. Take it away and , oh no I can’t even fathom taking it away. Always have hope, as long as you live and breathe!

STRENGTH, we with mental illnesses all have to be strong. We go through hell so many times that the word hell sort of loses its meaning. My muscles are getting stronger because I have a FaceTime personal trainer and that is just fab. But my mind has to be strong, my heart has to be strong, my will has to strong to withstand this sick disease. We all do. And we all are, that is why we are still here. We are strong for our children, for our friends and loved ones and we are strong for ourselves!

OVERCOME, when I am in a very depressed state or manicky phase, I do have lucid moments when I tell myself that I will overcome this too, just like I have been doing since 1985, yes I will overcome.

and a sentence: THIS TOO SHALL PASS, everything passes, good, bad, indifferent things pass. So of course whatever phase you’re in, it will pass.

Take heart my friends and stand tall and strong, easier times are ahead. I am sure of it!

Impulsivity is a symptom of mania or hypomania!

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One very important reason to take the correct dose of the correct medication is shown below from the article:¬†“Impulsivity and Risk Taking in Bipolar Disorder and Schizophrenia”¬†published in Neuropsychpharmacology in September 2013. Here is the reference if anyone would like to read the whole article:¬†http://www.nature.com/npp/journal/v39/n2/full/npp2013218a.html

Basically what this article is saying is that impulsiveness, which is defined as risky decision making, high risk attitudes, acting without planning, poor inhibition of risky actions, high risk attitudes, and rapid decision making (which basically means making decisions without thinking them through). Please understand that these are symptoms of mania. Once you are in a manic phase, you are going to do this. In a hypomanic phase, you are also going to do this but to a much lesser degree, your actions will not be as risky to your life or health. Please also understand that the only way to stop this from happening is to NOT go into a manic or hypomanic phase. The way to do that is to take the right amounts of the right medication as you doctor had prescribed. And if you feel like your mood is slipping towards mania or depression, to call your doctor and let them know. This is a BIOCHEMICAL disease involving levels or metabolism of neurotransmitters. All these neurotransmitters have certain effects on the brain. When their activity or levels of these neurotransmitters are high, we become impulsive. So, just take the right dose of your medication and head these problems off at the pass, nip them in the bud, stop them before they happen. If you don’t, this disease WILL¬†ruin your life, it will destroy your peace of mind, it will destroy your relationships, it will destroy your friendships, it may even take your life. That is as bluntly as I can put it. I am definitely on the therapeutic dose of lithium and I’m staying on it for the rest of my life, I am¬†not allowing this mood disorder to control my life or take days away from me or most importantly take my family or beloved friends away from me.

Not me, not now, not ever again! I hope you too will make a commitment to your health and sanity and your life, and follow your doctor’s advice to the letter.

Below in quotes are passages from the above mentioned article.

“Impulsiveness is a clinical feature of bipolar disorder.¬†Broadly, impulsivity refers to a predisposition toward unplanned reactions without consideration of consequences and can include risky decision making, self-reported high-risk attitudes, poor response inhibition, and rapid decision making.¬†

Bipolar disorder is often characterized by impulsive behavior and increased tendency to work toward a reward, often without sufficient planning. Although risky-impulsive behavior is a diagnostic criterion for mania and bipolar patients consistently show abnormalities on self-report measures of impulsivity, they do not consistently show deficits on behavioral tasks that require planning and forethought. These differences may reflect the multi-faceted nature of impulsivity, or the measurement tools used to assess the construct.

Finally, some of the mixed findings in bipolar disorder and schizophrenia regarding impulsivity and risk taking may be attributable to the types of medications patients are taking. The neurochemical basis of impulsivity and risk taking involves dopaminergic, serotonergic, and other neurotransmitter systems, and these systems are affected by antipsychotic (AP) medications. Some studies find a reduction in impulsiveness associated with AP medications, whereas others find no such effect in psychotic samples. Thus, it is important to consider the role of AP medications on measures of impulsivity and risk taking.

This is one of the first studies to examine both self-report and behavioral measures of impulsivity in bipolar disorder and schizophrenia. The study had two goals. The primary goal was to conduct a careful analysis of impulsivity using multiple approaches across three groups: bipolar disorder patients, schizophrenia patients, and healthy controls. The secondary goal was to compare subgroups of bipolar disorder patients who differed in terms of AP medications and history of psychosis on measures of impulsivity and risk taking.”

 

 

Bipolar Post 1: Mixed Phase Rapid Cycling Bipolar Disorder.

One thing not commonly known about BPD is that it comes in many varieties. There is the straight mania/depression variety. There is the “Mixed Phase Rapid Cycling” variety. This is the one I suffer from so I can be the most informative about this one. In this mixed phase rapid cycling type, you can go through many cycles of manicky/normal/depressed in one day. When you are manicky, you can be talkative, take risks you wouldn’t normally take, don’t sleep, have lots of energy and lose weight. It can be exhilarating, but it also comes with a LOT of anxiety. I know, sometimes I feel like my heart is going to burst out of my chest or I am going to die. In the normal phase, you are perfectly normal, no one looking at me in the normal phase can say I am cycling. The only bad thing about the normal phase is that you realize all the crazy things you have been doing in your manic phase and it can be quite devastating. In the depressed phase, you have no energy, you cry a lot, the bottom just falls out from under your feet. I just stay in bed. Can’t function. So no one knows what I look or act like when I’m depressed. It’s kind of like like being a yoyo whose strings are controlled by someone else. Imagine you not being able to control your thoughts and emotions. Just going on this involuntary, sometimes devastatingly painful emotional roller coaster ride. Until finally either you realize in one of your normal phases what’s going on and call your psychiatrist to prescribe you some extra lithium or one of your loved ones does. The increased dose of lithium miraculously brings you out of this mixed phase and gives you back normal. And you have never been so glad of that six letter word than the day you aren’t cycling anymore!!! So this is one of the things that happen to people who have bipolar disorder.