Posted by blueboy on June 28, 2008, at 11:25:42
In reply to mania???, posted by sunnydays on June 24, 2008, at 23:44:00
> So I finally got to talk to my T. He encouraged me to make sure I give my pdoc all the information (I tend to get really scared when I'm there and despite however confident I was suddenly start hiding stuff). He also asked if I was feeling manic-y? I said I don't think so. But he said, "Well, I know you don't want to [long story], but I think you're probably on the continuum at least if you truly don't feel like you need sleep at all."
>
> Do you guys agree? He may be right - my brother has bipolar I and so I probably have some predisposition as I have a serious family history of mental illness. Anyway, see pdoc tomorrow, so hopefully I can get off this Effexor.
>If you are bipolar and taking Effexor, there is a high likelihood of bad reactions.
I tried Effexor, prior to the time I was diagnosed BP, and I had a horrible experience at higher dosage, ending in seizures/convulsions. And, it did no good.
Your extreme insomnia is a symptom I share. Yes, it could easily be hypomania induced or aggravated by Effexor. I am especially reminded of my own problems by the lack of response to "normal" doses of Xanax.
If you are in fact bipolar, you need to get off Effexor and the last thing in the world you need is to take Xanax every day. Bipolar patients are especially susceptible to getting addicted to depressants. I had a horrible time with alcohol.
The one thing I have really been successful with is Use of a benzo for hypomanic or mixed-state insomnia. (In my personal lexicon, if it feels good, I call it hypomania; if it feels bad, I call it "mixed state".)
I have a high body weight (225-230 pounds) but for mixed state insomnia, or when I feel agitated and unpleasant in the evening, I take 2.5 to 3 times the "normal" dosage of clonazepam (Klonopin). I think Klonopin is better than Xanax for hypomanic relief. (Xanax is great for fast-acting relief from primary anxiety.)
However, I limit myself to two doses of Klonopin a week and, after four years, I have no habituation or craving for the drug.
Ambien and Lunesta are effective for sleeplessness but if you are having a mixed-state episode, you might wake up still having the episode and will possibly have some very weird and unpleasant dreams. Or at least, I do. Again, I need 2.5 to 3 times the suggested dose of Ambien/Lunesta to get me to sleep if the insomnia is bipolar related. (And it is difficult to tell the difference sometimes, although it gets easier over time.)
I occasionally use both Klonopin or Ambien to reduce simple anxiety: Klonopin primarily for social anxiety, i.e. I want to stay awake and go to, say, a dinner party; Ambien if I am having anxiety or feel okay but just can't get to sleep. In those cases, the normal dose of 10mg Ambien to sleep or 1mg Klonopin when I'm going out for the evening works great.
Ambien (available in generic) is really good for waking up in the middle of the night, since it only lasts about five hours. On occasion, when I have gotten to sleep but wake up at 2 or 3 a.m., 10mg of Ambien works very well.
If your pdoc is prescribing daily Xanax along with high doses of Effexor, without taking a total history and making an informed decision about the possibility of bipolar disorder, you need to either confront him with the possibility or see someone else. This is a very bad drug combination for someone with Axis I Bipolar. It probably wouldn't help the condition at all and would leave the patient worse off than before.
Since you have difficulty describing your symptoms in person (and let me tell you, I have symptoms I find extremely embarrassing to tell even a psychiatrist in a private setting protected by legal privilege), here is my suggestion:
Write them down and let him read them. I did two such documents. First, a life history (which is very helpful in seeing longer cycles in bipolar type disorders, especially if you have periods of success in school or work followed by periods of inexplicable breakdown). Second, a description of symptoms broken down by type.
If you have embarrassing symptoms (sexual obsession or conduct, eating disorders, self-mutilation, etc.) and don't want to put them in writing, you might characterize it generally. Say, for example, you are bulemic and eat a lot of food, then vomit it up. Yeah, I can sympathize, you might find it just to embarrassing to tell even a doctor. But maybe you can write down "an eating disorder" and tell the doctor that it is too embarrassing for you to give details. Or if you spent hours obsessively looking at men's penises on the internet, you might write down "problem with a sexual obsession that goes on for hours" or, if that is too much for you, just "an obsession that takes up hours of time".
I realize these may not be problems you have, I just want to say that your doctor needs some clue about your symptoms. Even if you generalize them beyond recognition, it's better than leaving him clueless.
Also, caveat: I am not qualified to diagnose mental problems in person, much less from an internet post! I just hope I can give you some help from my own experiences and perhaps a bit of perspective about one possible problem. That said, my own opinion would definitely be influenced by your brother's condition. Have you thought about talking to him, if possible?
poster:blueboy
thread:836059
URL: http://www.dr-bob.org/babble/20080626/msgs/836970.html