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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by minisnow on August 9, 2002, at 8:15:59
I had my first acute manic episode at the age of 38. That was last year. I am now taking Zoloft, Trileptal, and Omega 3. I have read numerous books on bipolar disorder and I am trying to figure out when it would be safe for me to go off mood stabilizers and how to determine when I could have another episode. I would like to think that I might never have another episode. At this time I am doing very well, not depressed and satisfied with medicine though I have gained thirty pounds, due to Depakote I guess. I embrace life after two suicide attempts during the depression phase. I have a wonderful family, many ambitions, and financial security. In other words, I was able to recover everything after seeing so many people in the hospital who lose it all. I am grateful for good health but I do fear another episode.
Posted by Ritch on August 9, 2002, at 11:14:38
In reply to bipolar cycling, posted by minisnow on August 9, 2002, at 8:15:59
> I had my first acute manic episode at the age of 38. That was last year. I am now taking Zoloft, Trileptal, and Omega 3. I have read numerous books on bipolar disorder and I am trying to figure out when it would be safe for me to go off mood stabilizers and how to determine when I could have another episode. I would like to think that I might never have another episode. At this time I am doing very well, not depressed and satisfied with medicine though I have gained thirty pounds, due to Depakote I guess. I embrace life after two suicide attempts during the depression phase. I have a wonderful family, many ambitions, and financial security. In other words, I was able to recover everything after seeing so many people in the hospital who lose it all. I am grateful for good health but I do fear another episode.
Minisnow,It is recommended to maintain some level of antimanic medication indefinitely (that is if your diagnosis is for real and undisputed). If you are having some tolerance problems with the Trileptal (ie.-high dosage), you might ask your pdoc about a dose reduction. There are some folks that seem to become manic only in the presence of antidepressants, and may do OK if they just avoid antidepressants (of course if they feel well). There are some others that go long stretches of time (several years) between manic episodes and stop and start their antimanic medication. That is a controversial topic. What does your pdoc think about it?
Mitch
Posted by inertia on August 9, 2002, at 14:58:06
In reply to bipolar cycling, posted by minisnow on August 9, 2002, at 8:15:59
>I have read numerous books on bipolar disorder and I am trying to figure out when it would be safe for me to go off mood stabilizers and how to determine when I could have another episode.
I think that's a really tough decision. From what I have heard, no one can predict if someone will have a relapse and, if so, when.
I'm not an expert, so I can only speak from my experience. I went off my meds because I was in total remission for 2 years. As soon as I went off, I relapsed. Since then it has been harder to control my bipolar disorder.
So from my experience the only advice I would give a friend is this:
1. If your side effects on your current regimen are not bothering you - Stay On Them! I've lost so many important things in my life because I went off meds. I'd hate to see that happen to you.
2. Whatever you do, I would stay on the Omega-3 since it has few side effects. (I've found certain brands have fewer side effects than others. OmegaBrite is best for me.) In addition, it keeps your LDL cholesterol down and your HDL up. It's also supposed to be good for joint problems. So I think staying on Omega-3 is a win-win situation.
I hope this helps.
Posted by oracle on August 9, 2002, at 18:34:03
In reply to bipolar cycling, posted by minisnow on August 9, 2002, at 8:15:59
Forever, as we cannot "cure" BP. Also one cycle
kindles another, and left untreated BP spirals
into "rapid-cycling" BP. This is where the cycles
can be measured in hours/days/weeks. Going from depressed to manic in a short time does not sound like fun.The more cycles you have, the more you will have in the future, and the shorter the length between cycles. (If untreated)
Posted by minisnow on August 9, 2002, at 19:03:39
In reply to Re: bipolar cycling, posted by oracle on August 9, 2002, at 18:34:03
Thanks Mitch, inertia, and oracle for your responses. I have to hear the same stuff over and over again to believe it is true, especially because last year I didn't even know a thing about bipolar disorder. This is all new to me and very scarey. My pdoc advises me to stay on the anti-manics. I get a bit rebellious because at times bipolar illness seems almost unreal. I want to forget I have it and since I rarely encounter anyone who has had my experience it is easy to kid myself. Thanks for reminding me that I have to be careful.
Posted by Lorelai on August 10, 2002, at 16:57:40
In reply to bipolar cycling, posted by minisnow on August 9, 2002, at 8:15:59
> I had my first acute manic episode at the age of 38. That was last year. I am now taking Zoloft, Trileptal, and Omega 3. I have read numerous books on bipolar disorder and I am trying to figure out when it would be safe for me to go off mood stabilizers and how to determine when I could have another episode. I would like to think that I might never have another episode. At this time I am doing very well, not depressed and satisfied with medicine though I have gained thirty pounds, due to Depakote I guess. I embrace life after two suicide attempts during the depression phase. I have a wonderful family, many ambitions, and financial security. In other words, I was able to recover everything after seeing so many people in the hospital who lose it all. I am grateful for good health but I do fear another episode.
**Thought I'd add my experience. I was first officially diagnosed bipolar 8 years ago (I'm 43). I've suffered from full blown manic attacks since high school (my first involved voices and paranoia to the point I dropped out of high school in my senior year, sure my entire school was "out to get me"). I "self medicated" all the way from jr. high to my mid-twenties, not knowing what was wrong, but knowing I preferred being high to being in my moody, messed up reality. Prior to the diagnosis I'd been given such anti-depressants as Prozac for depression (not a good idea--SSRIs trigger extreme mania in me). I had no idea I was bipolar and didn't believe the pdoc when she diagnosed me. I didn't believe the second pdoc either, or the third. It didn't occur to me that I fit what my latest pdoc calls "the classic symptoms." Sexual promiscuity (only while manic), rampant spending sprees (I had to file bankruptcy about 5 years ago and I never will have another credit card as long as I live), wildly manic and productive times (I'm a writer) which fizzle and die and turn into suicidal depressions. I moved to the country in an attempt to change my lifestyle, thinking a move from the city would mellow me out and I'd be fine. Wrong. My extreme manic episodes and depressions caused me to lose a very wonderful man. I've lost several relationships over the years (one woman's husband, after witnessing a particularly hyper manic episode, made her stop being my friend) and have only recently begun to realize that my behaviors are so extreme I can't possibly manage them without meds. I gained a lot of weight on depakote too and am currently trying to work with my pdoc to figure out what type of meds to take (also will start DBT--a type of therapy--soon). I'm only on Wellbutrin now (for depression resulting from the suicide of a friend last month) as I'd gone off meds months ago only to nearly lose yet another relationship because of my erratic behavior. I guess what I'm trying to say here is that even though I'd convinced myself I wasn't bipolar and that I could handle my moods, I was so wrong. Manic depression--bipolar disorder--whatever you call it--is a major player in my life and I'll always have to be on some type of medication. I've had a few psychotic episodes in my life and don't care to repeat them. Of course, I don't know your situation and I'm no expert. I'm just hoping it helps to know you're not alone. That if your pdoc decides you need to stay on meds, and if you're really honest with yourself and see that you can't handle your moods without them, well-- there're a lot of us out here who simply can't function on a "normal" level without meds. All the best to you.
Posted by katekite on August 11, 2002, at 21:44:43
In reply to Re: bipolar cycling, posted by minisnow on August 9, 2002, at 19:03:39
Well, since there have been 4 people say to stay on meds, I'll step out on a limb and say that with only one manic episode there is a chance that you might never have another, in which case it would be a shame to stay on unneeded meds for life.
A couple of situations where you might consider going off altogether just to see:
1. an inciting factor with the manic episode that is no longer present. For example, did you take any medication (cold medicine, allergy meds, antibiotics, herbal combos) just prior to the manic episode?
2. If you were actually hypomanic and not manic going off just to see might be more ok. Since you would be more likely to be able to be rational about going back on medication quickly.
If going off altogether is not a good idea there is perhaps a middle ground: reducing the Depakote dose to a moderately lower level, for, say, a year, and seeing if you had any hypomanic type symptoms. If none, then you could consider reducing it further.
There are some really good mood charts available over the internet (sorry have not kept track of where) that might be helpful if you do reduce the dose.
Others will say this too, that bipolar 1 disorder is like diabetes: if controlled you don't know its there but if it gets uncontrolled you have no idea what will happen or how quickly.
Take care -- kate
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