☼ Tiggy: Is it withdrawal or bipolar depression?

[DoctorMussyWasHere]

I saw your edit, scallywag. Thanks, understood.

 

hi mammaP,  I hope you are well..

 

I hope it's only a week. My knowledge is based on a 3rd person account.

She's been in there as a voluntary submission for a bit longer than that - maybe two, or even three weeks.

 

So the risperidone could have been started earlier than a week ago, but I'll make sure I know before suggesting anything.

The risperidone certainly isn't helping - no surprises there.

 

I'm updating Tiggy's thread now.

 

thank you..

[DoctorMussyWasHere]

Hi All. Just a follow up:

 

It's been stressful, but we're out of the worst of the recent scare, which is to say actual suicide is off the table, although anxiety remains.

 

We have been following Breggin's "Psychiatric Drug Withdrawal", and the turbulence towards the end of a taper - risperidone in Tiggy's case - is mentioned there, and well-known here.

 

At each 10% drop she has exhibited high irritability in exactly 3 days after the drop.

The irritability, or a disembodied state then persists for 2 days.

Then she returns to her old self - before the anxiety - for half a day to a day.

Then it's back to high-baseline anxiety for three weeks, with a window if we're lucky.

 

So it's almost like I have her back for one day, every three weeks.

 

This brief turbulence/window is very predictable.

It does seem to coincide with the half life of Risperidone - 20 hours - which means it takes 4 days + 4 hours to stabilize completely.

 

The silver linings here are:

- underneath the anxiety she's still there.

- the fact that she reacts to drops, even though her dose is so low, means the risperidone is still having an effect

which means that much of her anxiety could probably be the end-of-taper effect.

- which means that there is hope that once clear of it, she'll improve

 

 

Breggin describes the turbulence at low doses due to medication spellbinding, which makes sense.

 

Before I read that I tried to visualise stray risperidone molecules floating around in the blood, and occasionally making it past the blood brain barrier into the synapse.

Seeing as there isn't an army of them to hold fort, these stray molecules tend to get into skirmishes with dopamine over who owns a particular receptor, of which there are now a few too many after the recent war.

And while they're squabbling, there's a human trying to make use of their services to resolve anxiety, some of which is well-founded in reality by now.

[nz11]

22 minutes ago, DoctorMussyWasHere said:

Breggin describes the turbulence at low doses due to medication spellbinding, which makes sense.

DMWH I'm not sure where you are getting this from...I think you may be misreading Breggin. Do you have a reference for this?

 

My understanding is the turbulance at low doses (or any dose for that matter ) is due to acute adverse withdrawal reactions from dose change,  it is not due to MS on the contrary..MS is the tendancy to render a person unable to perceive the harmful effects of the drugs even thinking they are doing better on the drug, any emotional distress that is recognized is blamed on themselves ie their "M.I.", other people or stressors. 

MS basically clouds the judgement of the severity of the adverse drug effects both during treatment and in withdrawal.

 

 

Well done on buying that Breggin book. Tiggy is lucky to have you as her support person. 

 

[DoctorMussyWasHere]

I stand corrected nz11. Thanks : )

 

About the closest I could find was:

“The medication spellbinding is more acute or dramatic when starting the medication, or during drug dose changes up or down, but it is almost always present to some degree if the drugs are having a clinical effect”

 

So Breggin doesn't associate spellbinding with "low altitude turbulence" (for want of an analogy) - the increase in negative side effects when approaching the end, and the doses are paradoxically small. As far as I understand it, these side-effects go beyond just mental states, so to associate them with spellbinding would be problematic in association and usage.

 

 

I was reading about akathisia, and the fact that it doesn't always manifest physically, causing an experience of the most searing internal trauma imaginable. It was one of things I wondered about in relation to Tiggy and her low altitude turbulence. Not akathisia, but a degree of? .. if it exists in degrees. And hopefully it isn't that.

 

I also read that Risperidone is tranquilizing at standard and high doses, but activating at low doses, and some reports of intense anxiety, one person saying - in terms of the anxiousness - he'd had the 7 worst hours of his life after trying Risperidone only once. Tiggy quipped "now try 7 months".

 

 

My own attempt at understanding why the anxiety is still so intense now - though it is qualitatively different now - is based on hearing about that effect of activation at low doses. I related it to my own experience of hallucinogens like LSD which Breggin mentions as being spellbinding.

 

When the dose is too low one finds oneself stuck in the passage between the foyer and the movie theatre, metaphorically speaking.

One can hear the audience enjoying the movie, but cannot see the movie, and one can't leave and go back to reality either.

 

There's just a feeling of inexplicable restless, a feeling that goes beyond just a conscious awareness of it. Nor merely the frustration that it's not "kicking in", however tending as it does towards wanting to be bound in the drug's spell, to reach the tipping point where it's not competing so much with your own neurotransmitters.

 

So I concluded that since risperidone is a psychotropic in that it creates a spell, perhaps the nature of being released from its spell has an anxiogenic effect that is much more extreme than that of more benign molecules, and agressive to the point of physically-detectable brain alteration.

 

As far as I understood it, it was the binding to receptors that created the experience of spellbinding via a psychotropic effect, and the subsequent detaching from a now-increased number of receptors which caused not only anxiety issues, but extrapyramidal symptoms etc. on the way down.

 

I just noticed the close proximity of my usage of "receptor binding" and "spellbinding".

For the record, I am aware that spellbinding refers to a psychological phenomenon 8¬]

[DoctorMussyWasHere]

After writing all of that I still managed to omit the crux of what I wanted to say.

 

A "mental illness" or an episode is usually a reponse to unresolvable internal factors and external stressors.

Tiggy's particular response was what is referred to as dysphoric mania.

 

Mania is a state which is usually characterized by a break from self-awareness, as are neuroleptics.

 

In fact I just found this statement from Breggin:

"Mania – whether or not it is medication induced – illustrates profound spellbinding."  (ref)

 

So it's not a stretch to surmise that the drug hinders the ability to resolve the issue, thereby sustaining it.

And I can see how returning home from being spellbound might create anxiety.

 

 

This, aside from, or perhaps related to the fact that her nervous system is out-of-whack in relation to cortisol.

 

 

Oh, an important thing happened last week: as per the above, she has been unable to take in information, particularly in relation to her state of being.

But after the last dosage drop, she was able to pick up "Psychiatric Drug Withdrawal" and start reading it.

 

It's pretty heavy going, and can seem dire for someone who is negatively disposed, but she handled it fine.

 

For the first time she took the reigns and explained her withdrawal plans to family members.

This is important because i've come under fire, and I need to step out of the picture.

 

More importantly she needs to become autonomous, which is happening.

She really needs to put her foot down regarding me talking about her online like this, though.

[DoctorMussyWasHere]

Quick Question

(with longer explanation)

 

What to do in the case of "crotchety", irritable feelings, and a feeling of sub level mania?

It doesn't feel like an emergency, but it is uncomfortable, and of concern.

 

 

 

 

Summer has arrived in the southern hemisphere, and we are approaching the anniversary of the "manic" episode of last November.

 

The usual pattern to a Thursday taper is a reaction on Sunday: less anxiety, less spellbinding, more irritability.

On a Monday there's a brief window of clarity, then back to being anxious.

 

After the last 10% taper, almost 3 weeks ago (1 Sept 2017), there was indication that we may have been breaking through the anxiety layer.

Tiggy accidentally missed a risperidone dose a week ago on Thursday, 15 September.

 

 

On Monday night, after an afternoon where she seemed "flat" emotionally there was an alarming very much "out-of-the-blue" attack of .. not sure what to call it: crying, screaming, anger, poor logic. I called her sister in San Diego who expertly soothed her, and she was fine after 30 mins.

 

She described the usual early-morning anxiety horror as being less, but a new terrifying planet rising: depression.

Over the past week the tight anxiety seems to be waning, and the wide-open depression, which brings more mania potential, is more present.

 

 

Something we added a week ago is 300mg of phosphatidylserine, which could be responsible for the anxiety lifting.

 

On the positive side, her personality is back.

It had been suppressed and replaced by an anxious person,

so it's good to you again my darling, and sorry to have to track you objectively like this, which won't be forever.

[DoctorMussyWasHere]

Question: What to do in the case of "crotchety", irritable feelings, and a feeling of sub level mania bubbling up?

 

Answer: Diazepam, maybe.

I know, right?

 

It began to feel serious so she took what I thought was 1mg - her own choice and action - but I looked at the box and it was actually 5mg (half of 10mg tablet).

A little high for my peace of mind, but boy did it work.

 

Apart from being a little "drugged", she got everything back: her old self without anxiety or depression, and subjectively I can confirm this.

..which is obviously a problem since it's NOT an option for anything other than emergencies.

 

We've set a limit at 10mg per 4 week period, but preferably not at all. By preferably I mean that we acknowledge that it's potentially hugely problematic, even to the point that it could be the cause, and that even selective usage is simply prolonging and worsening things.

 

Whatever the diazepam is doing to her GABA, it very directly targets what she has been suffering from, which could be a result of any combination of:

diazepam withdrawal,

diazepam withdrawal syndrome,

risperidone effects/side effects,

risperidone withdrawal,

risperidone withdrawal syndrome,

lithium,

hormonal issues*

 

* the HRT has had no effect, despite low estrogen being a factor in her episode.

Estrogen rapidly dropped causing mood swings, but not resolved by HRT is understandable.

 

 

After about 2.5 days the original diazepam dose wore off, so there was a bit of a low,

but it coincided with the start of a risperidone taper drop: 0.0738mg, which brought a positive energy bounce.

 

Today she anxious again, however lately given the shifts, I am positive.

Primarily, the fact that risperidone is still having a detectable and changeable influence means that it could be a cause.

 

Like anyone, we would prefer something we can work with.

(while acknowledging that the need to have something to work with is part of the mistake psychiatrists make,

medicating their hopelessness by creating disorders in others)

 

 

Tiggy says she'd like me to add that prior to the most recent drop, she was having heavy night sweats.

They lifted the night before last, coinciding with the drop.

Last night they were back, but to a lesser degree.

 

I looked online for the lowest possible doses of risperidone, and found these doses for unfortunate children:

0.01mg titration dose

0.05mg lowest dose

 

If one takes these as theoretical end points, then Tiggy has anything from 3 months to over a year to go.

Noted theoretical, and that's ok.

 

 

She's been finding that with some of the shifts in anxiety moving to depression, the depression responds to personal factors, like her connection to her sister.

Although a huge potential stressor, their bond is non-negotiable, which I support.

 

However the sister is still of the belief that involuntary restraint is an option, and although she endorses the Icarus Project's Harm Reduction Guide which advocates free choice, it seems she thinks that extends to choosing whether to apply force or not, which really doesn't make any sense at all.

 

Thankfully Tiggy is aware of the risks, and being extra careful about what she says, while enjoying her sister's company.

[DoctorMussyWasHere]

Correction to:

 

Lowest prescribed doses of Risperdal (risperidone)

Note: these are per kg of body weight doses *

 

Titration (start) dose: 0.01mg/kg

Maintained Dose: 0.02mg/kg

 

Source:

RISPERDAL® 1 mg/mL oral solution

 

 

* Also noted that these are prescribed for "Conduct and other disruptive behaviour disorders in children 5 -12 years of age".

But seeing as the doses are per/kg, one might expect there to be a degree of correlation when body mass is taken into account.

However body mass is not an effective measure for the most part, given metabolic differences.

Pediatric doses are generally higher per unit of body weight.

Pediatric Dosing and Body Size in Biotherapeutics

Factors and Mechanisms for Pharmacokinetic Differences between Pediatric Population and Adults

 

 

 

I understand and concur with the position of this forum, which is not to speculate on the final jumping-off point beyond advising the individual to decide.

I am therefore cautious to speculate or draw conclusions either generally, or specifically in our case.

 

I am noting the following:

• Tiggy is currently just above a 0.075mg dose
• This corresponds to 1/10th of a 0.01mg/kg dose
• Taper drops are having less of an effect
• Anxiety still comes, but thankfully goes sometimes.
• General mood is:
  • more fluid.
  • open to external psycho-stimulus:
    • negative aggravation
    • positive nurture (preferred, advised)

[DoctorMussyWasHere]

To the esteemed moderators:

Can we get input on whether you think the new schedule is a good idea or not?

Thank you.

 

New Schedule

Given that the changes in dose don't seem related to certain symptoms, and that the drops have stopped affecting her mood which seems to be following a natural course now,

she had decided to start a linear 25%-of-start-dose taper at a rate of two weeks per level off the risperidone last Friday.

 

That was delayed that until the following drop, which will be in 10 days from now: 9th December, 2017.

Instead she dropped by the usual 10%, which is from 0.0544 to 0.049mg.

So when she drops down to 0.0408mg it will be a 17% drop.

 

Then the next one will be 25%, and so on.

0.0408
0.0272
0.0136

0

 

We have backup doses so she can reinstate if needed at any point.

 

Any cautionary words or do we get the green light to proceed?

Thanks!

 

After that - unless otherwise-advised - we will wait two weeks, then begin a linear taper of the lithium at 10% every two weeks.

It seems lithium may be a candidate for a linear taper due to the absence of receptor over-compensation.

Again we have backup doses.

 

 

Update: Tiggy's Self-Assessment (reported)

 

Tiggy weighed up whether what she was experiencing was either:

• original issue
• being on the drug
• withdrawal (coming off the drug)
• withdrawal syndrome (having initially come off the drug too quickly)

Tiggy felt that the original issue, and being on the drug seemed the most likely causes of her current depression.

This was concluded by the slight improvements she experienced shortly after a drop.

 

The anxiety, or what of it remains may or may not be withdrawal-syndrome-related, although that's the most likely explanation.

 

Based on her assessment, she shortened the taper-drop-period to 2 weeks per level on 2 October, 2017.

At each drop the mood-fluctuation was less than the previous one.

 

The most recent one was notable by its lack of anything notable.

 

 

Physical Symptoms

Her persistent night sweats have remained the same since the start, and have been unaffected by anything, including the HRT, which as far as I know doesn't definitively say it isn't menopausal.

 

This, taking into account that the weather is becoming warmer, and accounts for adjustments to bedding (duvets, blankets and a sleeping bag).

 

It also accounts for the fact that she was experiencing cold patches * on her skin due to anxiety, requiring more bedding.

The cold patches seem to have improved as the anxiety moved into depression.

 

* Risperidone causes actual temperature regulation disturbances up to a critical level, including actual hyperthermia and hypothermia, but only at much higher doses, so Tiggy's cold patches were more likely as a result of risperidone-induced anxiety.

 

There have been no new physical or nervous system symptoms.

 

 

Mood Observations

Her depression has shifted somewhat from feeling suicidal to the point of planning it.

She has shifted to a general existential conundrum now which is not entirely unusual for her.

 

There is some hopelessness at having had a breakdown with resulting after-effects, much of which references the label of "bipolar disorder".

Some notes on this are at the end.

 

Yesterday she completed an entire day of missions which I would have found stressful,

but which was normal for her prior to her breakdown last November.

She was most-decidedly not manic or anxious.

 

Today she is not feeling particularly great after another night of changing bedding,

but she's painting right now, and generally her art career is doing better than it ever has been.

 

 

Personal Notes

I occasionally have to work hard when an alarmist "supporter" reacts to her comments on Facebook.

Without even a consultation, the most recent one diagnosed her as "definitely bipolar".

 

They were able to ascertain that her anxiety and depression is a result of not being on meds.

They concluded that she must be made an example of in public online despite her private-messaging requests for them to stop.

 

They prescribed an antidepressant which apparently works for them, although presumably not when it comes to having empathy regarding someone else's psychological state.

They went silent when it was pointed out that antidepressants are not an option for a person with a propensity for mania.

 

I can only advise against posting in public, but not necessarily influence it, recognising that she has always felt lonely, even when in the company of friends.

Call me overly-practical, but I'd rather "work" with that than add something which makes it worse into the mix.

 

[DoctorMussyWasHere]

We found a maverick psychiatrist who subscribes to Mad in America and expressed approval about Peter Breggin's methods.

He intends to withdraw Tiggy from the lithium, and institute dietary changes.

 

 

I'm a little concerned with his advice regarding the risperidone.

He says that at 0.05mg the dose is practically homeopathic, and she should just stop taking it.

 

Not according to my calculations which place D2 receptor occupancy at 5%.

That's very much an average with many, many influencing factors meaning it could be, say between 1 and 10% (? .. I made that up)

 

Tiggy honestly doesn't know what's causing what,

which by all accounts sounds like it's the meds to me.

 

If she did decide to take his advice and not mine, would she at least be below risk of EPS at that dose?

I'll see if I can dig anything up, but potentially quicker to ask.

 

I could possibly get him to participate in a discussion here.

[nz11]

Morning DM 

Well that 0.05mg certainly sounds very small to me. 

May I ask how on earth do you measure such a dose. Maybe you already posted previously but I haven't read back too far.

 

I think it is fairly well established that the lower the dose the lower the risk of adverse events....so I think your risk would be a lot lower than most at 0.05mg. 

 

On ‎11‎/‎30‎/‎2017 at 11:44 PM, DoctorMussyWasHere said:

Tiggy felt that the original issue, and being on the drug seemed the most likely causes of her current depression.

This is only my opinion but in wdl push the delete button on all previous conditions or original issues. 

 

Go well

nz11

 

[DoctorMussyWasHere]

Re. measuring small doses, here's your answer : )

.. a compounding pharmacy, which is a wonderful thing.

 

They are super-efficient, extremely professional, and not expensive,

as in only a small markup on the meds themselves.

 

That's for South Africa, so here's the international site:

Fagron | Pharmaceutical compounding

 

Nothing in NZ, though, so here are some others:

Pharmaceutical Compounding | Leading Compounding Pharmacy

Custom Supplements | Pharmaceutical Compounding | NZ

Optimus Healthcare Compounding Pharmacy

 

 

Just for the record, I think we tapered too fast.. or something..

I couldn't help noticing that whatever's going on now

happened during an attempt at shortening the taper period to two weeks.

 

(The blue line is today. The yellow line is risp. The red behind everything is lithium. ignore the rest.)

 

The first two-week period-end was October the 25th.

Issues manifesting towards the end of December.

 

She says she's more broken than before, and I agree.

There have been some fairly extended implications.

 

It still seems very chemical to me.

Not mania at all, but fluctuating depression, anxiety and psychosis.

 

 

 

 

If the risperidone dose is homeopathic / placebo,

then there's no harm in continuing the taper.

 

If it is not,

then there is harm in going cold turkey.

 

But if it's causing this deterioration then we weigh up the lesser of two tapers.

(one of which is a turkey).

 

 

I'd feel more comfortable taking the leap knowing she's safe from EPS.

 

I'll take yours as a vote in favour, NZ11

(not that it's my choice)

 

.. thanks!

 

 

[nz11]

Not sure what I'm voting for here lol 

 

DM I think you one of the most conscientious symptoms reporters on this site but just wondering when the drug sig is next updated  the latest in the drug sig is 16 june 17 ....any update being worked on ? 

Yes I confess I'm lazy I like to look at drug sig rather than read 3 pages of posts. 

[DoctorMussyWasHere]

Yes, I added a whole lot which would affect the vote, didn't I?

Ok, the vote would be the same as before:

 

On or Off risperidone

but taking recent distress into consideration.

 

To condense my reply, if we tapered at that rate

and then after two months things suddenly started falling apart,

does that sound like side effects, withdrawal, or..?

 

She is hypersensitive to substances.

 

 

Sorry about the quantity. Someone mentioned data collection somewhere.

 

I tend to "go meta" on things, which is say get all possible angles

which seems to be how I gain an understanding.

 

Probably an aspergers / autism thing

(please read between the lines re. disorders)

but I collect gaps and fill them in.

 

So I was trying to complete our part of the map,

so others could get to theirs,

and then we find theirs when we need it,

and they find ours,

and like stepping on stones,

we all get home safely.

 

But then there's also reality, like that signature..☟..yes..

Not today, though. Major deadline..

[DoctorMussyWasHere]

Signature updated. This forum software accepts copy and paste from Google Sheets.

Looks alright to me. Acceptable to the mods?

[nz11]

DM everything you do is very impressive.

 

 

[DoctorMussyWasHere]

'cept modesty, which is paradoxical.

Interestingly Tiggy is downscaling, and clinging to simple truths.

I'm just tagging along - barely - or not, where appropriate at this stage.

[DoctorMussyWasHere]

Well she's been off the risperidone for 4 days, and not a blip.
She'd taken a valium a few days before that to face the film industry for work.

"I’m ok. Major fear still not fully returned after Valium. Thinking about life etc"

 

I suggested postponing the lithium taper until 3 weeks time to be sure.

Will update schedule shortly.

[DoctorMussyWasHere]

The risperidone drop off didn't go too well.

She had been becoming more suicidally depressed anyway, so whether or not the drop off was even related is questionable.

 

She went to see a psychiatrist. In Tiggy's words:

"The fast-acting one is called Physquet, and I was started off on 100mg a day for the first week, going up to 150mg for the following 3 weeks till I see the doctor again. 

The slow-acting one is called Dyna-Lamotrigine, and I am starting off on 25mg a day for the first 2 weeks, followed by 50mg a day for the next two weeks, after which I will see the doctor again."

 

The "Physquet" is Syquet aka Seroquel (quetiapine). 150mg = 4mg risperidone, which is 8x her original dose of risperidone.

As predicted her depression is not much better.

 

Apparently the lamotrigine intensifies the quetiapine.

They are both notoriously difficult to withdraw from.

 

She has been on them for 20 days.

 

Best tapering advice please?

Thank you.

 

I've suggested 0.1mg risperidone as a "devil you know" solution once she's off the other stuff, assuming she accepts my advice.

 

Sorry for the poor "adherence". I can only "control" so much without being over-controlling.

[DoctorMussyWasHere]

Tiggy has decided to taper within the 3 week window, but the dose she chose to drop by may be too much.

 

She was started on lamotrigine 25mg, and Seroquel 100mg, both 9 days ago.

I will check the dates. I have it at the 6th which would make it 11 days.

 

Last night she dropped the Seroquel to 50mg (50%).

Lithium is being held at 375mg. I'll obtain dates for when she tapered that too.

Lamotrigine held.

 

I'm concerned 50% is too much for a sensitised person.

From other threads I've gathered a 25% drop might be more appropriate?

If so, for how long / what rate?

 

When should the lamotrigine taper start? At the end of the Seroquel probably I'm guessing.

Also, I guess by that stage it's going to be settled in, and looking at a long taper.

(lithium will remain held)

 

I've cautioned that's it's probably going to hurt a bit, but hopefully we'll not be in syndrome territory.

 

Thank you.

[DoctorMussyWasHere]

Signature update. 10 days on Seroquel / Lamotrigine.

She's agreed to add another 25% to make it 75mg Seroquel pending further advice.

 

Slight adjustments to lithium, and a slight drop on the 19th because of the doses we had made up.

But I'll recommend holding on that.

 

(feels like I'm reading a weather report)

[DoctorMussyWasHere]

On 11/09/2017 at 5:04 AM, scallywag said:

Before taking the risperidone, has this person taken any psychiatric or neuroactive medications?  If they were "psych drug naive" before the risperidone, they might try discontinuing in 25% steps while closely monitoring symptoms.

 

Hi Scallywag. I hope you are well.

re. your advice, what if they weren't psych drug naive?

- how does that change the landscape after 10 days on, in this case, 100mg Seroquel, and 25mg Lamotrigine.

Thanks!

 

ps. sorry for grabbing your personal attention with the tag / quote (assuming the forum notifies you).

[Altostrata]

Hi, DrM. If the person already had withdrawal syndrome or other neurological upset from going on and off drugs, adding and decreasing other drugs might be rocky.

 

But otherwise, if a drug was introduced only 9 days ago, as scallywag said:

On 9/10/2017 at 8:04 PM, scallywag said:

After only a week, someone might try a 50% reduction for a week, then cut that in half to 25% of full dose for a week.

 

[Altostrata]

I know it might be difficult for a third party to answer, but did Tiggy find the Seroquel or lamotrigine helpful?

[DoctorMussyWasHere]

Hi Altostrata,

 

Thanks!

 

No, meds not helpful. Same depression.

She said it made her sleepier, that's all, and lately just "doped up".

 

Seems insomnia is the top withdrawal symptom for seroquel,

apparently due to residual antihistaminic effects at low doses,

making that effect the longest-established.

 

I guess if the insomnia got serious then a slow-ish taper towards the end

would reap the "benefits" of the antihistamine.

(aka take care of its own mess)

 

Anyway, we will see.

 

Thanks again, as ever,

DM

 

 

 

The depression

My view on the origins of her depression are that it's not worth speculating once meds have been in the mix, for three months after she's clean. (Possibly beyond, but again not worth speculating now). But I am of the view it's primarily meds in origin. The subject matter certainly fits David Healy's description as "concern over a future devastated by illness".

 

The fact that it happens during the early part of the day, and carries on for a standard 5 to 8 hours almost suggests actual drug side effects, not even withdrawal, no? (It's not quite the same as her cortisol anxiety from before. She is more present.)

 

But side effects don't explain the persistence through various drugs, unless it's the lithium which has been the only constant, or a syndrome linked to circadian rhythms. Actually depression is linked to circadian rhythms. And there I was saying it wasn't worth speculating.

[Altostrata]

There is also the chaotic and stressed family situation....

[DoctorMussyWasHere]

It's complicated. She's had a nature/nurture baseline anxiety / depression which she was always able to rise above, even utilise, but currently not. But currently she's living and connecting with her sister for the first time which is great for both of them.

 

But she feels resentful towards me at the moment for only presenting routes which seem hard. It only seems that way because she hasn't followed them, and made things worse for herself. I hope she sees a pattern and notices what she lands on when other things fail.

 

She will be dropping doses now because she hates these meds, but she's already booked an appointment with another highly-recommended psychiatrist who is apparently also a very good therapist. I've also heard she (the psychiatrist) is a big fan of lithium, so she can't be all that good : |

[DoctorMussyWasHere]

Tiggy only dropped to 75mg instead of 50mg Seroquel which was an error.

 

But she is doing surprisingly well.

It's the first day she could actually describe as "good" in a long time.

 

Now would this be going up ⬆︎ starting to settle-in?

(and doing what? seeing as they don't do much)

 

Or / and masking old syndromal withdrawal dysthymia?

(both of which bug me a bit)

 

Or could it be from going down ⬇︎ from 100mg to 75mg for a week.

 

(note: she lowered the lamotrigine too, slightly. Will update signature shortly)

 

She's going onto 50mg tonight..

[Altostrata]

On the basis of one data point, it's impossible to tell what's a real symptom from a drug effect or withdrawal and what's a passing mood or indigestion or whatnot. We look at the daily symptom pattern interleaved with the drug schedule over some days.

 

When a drug change is made, it takes at least 4 days to reach steady-state in the bloodstream. (If the drug has a very long half-life, the full effect of a decrease can take longer.) If the drug change is a decrease, the drug will be progressively metabolized and, if the symptom was an adverse effect, it should gradually lessen. That's how we tell if a decrease is the right direction.

 

If, after a decrease, symptoms get progressively worse, over, say, 10 days, that indicates the symptoms are due to withdrawal and the decrease was too much. We ask the person if, intuitively, they feel a slight updose is called for or if they want to wait and see.

[DoctorMussyWasHere]

Thanks Alto. I'll pass that along right away, and let you know later how today went.

[Tiggy]

Dear Forum

In 7 week's time I will be flying from Cape Town via London (they are in similar time zones) to San Diego (9 hours behind) where I will stay for 3 months and then fly back the same route. I am in recovery from a late-life onset of mania that occurred at the end of 2016, since when I have been suffering chronic depression and anxiety. 
During that time I tried tapering off the medication was put on in a state hospital, but in February this year I got so desperate I saw a regular psychiatrist where I was put on seroquil and dyna-lamotrigine and more recently (about 2 months ago) I started on the anti-depressant Sertra, which is finally starting to help, although I am still very up and down. 
I am worried about the time difference between Cape Town and San Diego setting me right back to hell again if the Sertra stops working because of the change in schedule. 
Suggestions and advice are welcome.

[Petunia]

Hi Tiggy,

 

You may find some ideas here in this topic: 

Adjusting doses for different time zones or daylight savings time ...

[Tiggy]

Dear Survivors

Four years later I seem to have recovered from my late-onset "bipolar" episode and finally got off all the drugs 2 months ago. I am so grateful to all of you for your advice and support, without which I would have remained in a terrifying, expensive limbo forever. My partner Dr Mussy found your site, read everything he could lay his hands on, and with your help guided me through this so that I knew what to do. 
My life has changed dramatically... Dr Mussy and I moved to a tiny country town here in South Africa where there is clean air and water, and barely any traffic. Here I was able to slowly come out of my seizure of fear. I have been going for bike rides in the country, growing vegetables, and finding life slowly growing on me again bit by bit. I am so grateful to you for giving me this time to be "back" and find joy. 

Yours, Tiggy

 

[ChessieCat]

Oh Tiggy that is such great news and thank you so much for coming back to let us know that you are doing so well.

 

Woohoo!!!!   

 

 

Edited November 1, 2020 by ChessieCat
change from animated gif to picture

[ChessieCat]

Because you're feeling better, I added our cheerful "here comes the sun" symbol ☼ to the title of your Intro topic, to show you're recovering.

 

Please continue to let us know how you're doing. I hope you will add your story to our Recovery Success Stories eventually!

[ChessieCat]

And thanks to Dr Mussy for taking such good care of you.