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Bipolar son possibly entering depressive cycle?

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Posted 11/16/2017 7:21 PM (GMT 0)
Hi

My son is a 20 year old who was diagnosed with BiPolar I July 28, 2017. He had a psychotic break July 28, 2017 and another one October 4, 2017. He is curently taking abilify 20 mg and zoloft 100 mg daily. He takes trazodone 150 mg as needed for sleep.

For the past 3 days, he has been very lethargic, super sleepy, and not interested in things. I am letting him sleep as much as he likes. I do not think that illegal drugs are involved. I am concerned that he is going in to a depressive cycle. He sees the psychiatrist on Monday, the 20th. He says he is not hallucinating and has no self harming/suicidal ideation. He is safe and is at home.

I know that one can get psychosis both with the mania and with depression. Would it be plausible that he is a cycler with a 1-2 month duration? Other than asking about a mood stabilizer or other meds, what questions do you think would be good to ask the psychiatrist? I understand that it takes a while and tweaking of the meds to find a good fit.

Thanks

Pedi
Posted 11/17/2017 12:31 AM (GMT 0)
I'm sorry to hear of this latest situation.

I was hoping with the job at the fast food restaurant that he was going to continue doing OK.

Do you think there was anything that brought this on?

Was he complaining about anything at work?

You said, "For the past 3 days, he has been very lethargic, super sleepy, and not interested in things."

Was he still working when he started into the depression?

You said, "He says he is not hallucinating and has no self harming/suicidal ideation." So it sounds like the meds held to a certain degree.

Was he able to see a psychiatrist within a short period of time? Did they increase his medicine?

You said you will see the psychiatrist on the 20th, and note "Other than asking about a mood stabilizer or other meds, what questions do you think would be good to ask the psychiatrist."

Was he on a mood stabilizer before this situation happened?

When you first wrote, you said his meds are Abilify (net says anti-psychotic also used for bipolar) 15 mg, and Zoloft (net says for depression and panic attacks) 100 mg daily and trazodone (net says for depression, anxiety and insomnia) 150 mg at bedtime.

Above in this most recent post, you said about his meds after the October 4th situation, "He is curently taking abilify 20 mg and zoloft 100 mg daily. He takes trazodone 150 mg as needed for sleep."

So the only change in meds after the latest situation is a 5 mg increase in Abilify, which is an anti-psychotic for bipolar.

So that sounds like a small increase since the latest situation. I'm on a mood stabilizer (Lithium, 675mg. at night) rather than an anti-psychotic, and I'm also on an anti-depressant, Mirtazapine.

At his doctor's appointment they might increase his present meds or, put him on a new med or two. I think that's probably right, that they will change and alter medicines until they can get him stable.

How are his spirits holding up, and yours?

You say, "Would it be plausible that he is a cycler with a 1-2 month duration?

As a bipolar myself, there probably are cycles, but I only get onto those cycles before I am put onto medicine. Prior to being put onto medicine, I'm usually very depressed.

I've also had the cycle of mania, with rapid thoughts and probably so many ideas I couldn't keep up with them. We think it's better than the depression, we usually think we're cured when prior to that we've been depressed awhile, and we don't want to be told we're still sick, but in another way.

So, come to think of it, I usually go to a psychiatrist on a depressed cycle, but in that condition, we're usually so low and negative, we don't think anything will help, and we have low energy and it's hard to get us off square one.

It is good that he has a place to go to when something happens.

It's also good that we live in an era when they do have medicine for emotional problems. As I think I mentioned, my grandmother, my mother's mother, had Bipolar, back in the 1930s and 1940s, and they didn't have anything for that.

They didn't even know what you had, they labeled it as schizophrenic, even in the early 1960s, when it was a new, undiscovered condition called manic-depression.

You didn't get to lay down on your mother's couch in between doctor visits, you got sent to the state hospital a long distance away.

So we can be thankful that they have a variety of medicines for this.

Post Edited (Tim Tam) : 11/16/2017 5:58:53 PM (GMT-7)

Posted 11/17/2017 10:23 AM (GMT 0)
a mood stabilizer is imperative and a requirement for a dx bi-polar disorder.!! a psychiatrist who specialises in the treatment of bi-polar disorders also is a must. keep strong.
Posted 11/18/2017 8:39 PM (GMT 0)
Thanks for responding.

Have you guys heard of this testing? I am going to ask the psychiatrist about it. Basically, it is a genetic test obtained via cheek swab to assess what meds may work best. Here's a list of some of the meds it tests for: https://genesight.com/product/ My other son (Joseph) has intractable seizures--I am going to ask his neurologist about it, too. He is on 3 anti seizure meds.

Now for the questions:

1)The fast food job fell through. Adam has been looking for other jobs, so far--no takers. I brought up the idea of volunteering. I am not sure what triggered this depressive cycle. He adopted a dog and has been taking the dog for a walk and to the dog park, so he and the dog are getting out for a bit. That is good. Both Adam and the dog get to interact with other people and dogs at the dog park and it is good to be outside for a bit.

2) We see the psychiatrist on Nov 20th. We had last seen the psychiatrist Oct 20th. At that time he increased the abilify to 20 (was 15),left the zoloft at 100, and kept the trazodone at 150 as needed.

3) No mood stabilzer has been prescribed--only the abilify, zoloft, and trazodone.

4)My spirits are good. I was having a great deal of anxiety--so I was started on Lexapro and trazodone. I am sleeping better and anxiety is better. Joseph has been seizure free for 6+ months (12/1 will 7 months)--longest time in >5 years. My rheumatoid arthritis is responding nicely to the plaquenil (I was diagnosed 8/15/17) and husband (Joseph's and Adam's dad) is good. Dog and cat are doing well; although they do not really like each other too much---hopefully that will get better; we have only had the dog for a week. The dog did have a tick borne illness that caused him to have anemia. We have started the dog on proper medication and he is much more active and feeling better. It's just that Adam is lethargic, cranky, irritable, not wanting to shower, etc--depressive symptoms. He will not share about his psychotic break, so I do not know what precipitated it. He says that he does not feel like he is having racing thoughts. He does not have grandiosity.

I know that it takes a while to get meds tweaked. It is hard to be patient. That is why I think that this genesight.com thing may be helpful.
Posted 11/19/2017 3:43 AM (GMT 0)
Sorry to hear about the latest difficulties.

You mentioned, genesight.com. (where you said they send off a cheek swap to determine what meds you should take for your condition).

I'm glad you heard about that somewhere. I first heard of that perhaps on this website some six months ago. But it's not something that's generally on my mind so I didn't mention it because it's so new to me I never thought of it.

But that does sound like a good technique. Do you think you're going to try that? It would be interesting to see how that goes if you do.

I've always been used to whatever the psychiatrist recommended.

And, you said, you're might try such a test for you other son.

So the fast food job never materialized? So he got into a depressive cycle?

I think the adopting the dog is a good idea, and the taking it to the dog park. I just got finished walking my dog a couple of hours ago.

We picked up trash, we recognized some neighbor's cars, we get to dodge some cars because most of the streets around here have no sidewalks, but they do have curves, so we get to test our alertness skills, so it is an adventure I wouldn't get from lying on the couch.

Just the day before yesterday, I picked up trash, stuffed it into my pockets, partway through, emptied the trash into a trashcan or two, got back home, emptied other trash into my kitchen trashcan, then couldn't find my $150 reading glasses that I had put into my pocket before we left.

Life as an adventure, not just a walk around the block. I looked into the kitchen trashcan and couldn't find them. I'm having a stress test, to see how I handle this. Close to freaking, but not full. I go back down the street and look in a couple of trash cans that I dumped trash into, not there.

I finally found them in the trashcan in my kitchen when I looked more closely a second time. I mean, a walk can give you a chance to test your skills, and again, can be an adventure.

The best venture today on the walk was I got to talk to a guy on a neighborhood street for about 20 minutes. He reminisced. Really nice, so walking the dog can be very therapeutic. Dogs are not judgmental, they like you anyway as long as you take them for a walk.

Last saw the doctor on Oct. 20, next is Nov. 20.

Net says Lexapro is for anxiety and depression and that Trazodone is an anti-depressant, and another site says it's an off brand used for insomnia. You say, "I am sleeping better and anxiety is better."

I take Lithium for mania and as a stabilizer, and Mirtazapine for depression. For sleep, I take Melatonin from the health food store, for I don't want to get on any sleeping pills if I can help it. You're supposed to check that with your doctor or druggist to make sure it doesn't interfere with your meds, but my psy. says its OK for it's been out a long time.

Someone else on this website recommended "Knock-Out" which is Melatonin and Varlarian Root combined, which is supposed to be better for sleep. That's also sold at the health food store, or on the net.

I also use a heating pad at night when I lay down. It expands the blood vessels, thus making it easier on the heart, which I think is stressed more when laying flat, than if we were sitting up, which is the position of hospital beds.

It's also like a child's teddy bear, it's warm and comforting. It helps me get to sleep faster, and better, and longer between wakeups.

It's good about Joseph.

You say, "It's just that Adam is lethargic, cranky, irritable, not wanting to shower, etc--depressive symptoms."

Yeah, those are my symptoms when depressed. Seems like the anti-depressant would stop his depression. I'm sure he's on a good one, but it's just a question.

You say, "He will not share about his psychotic break, so I do not know what precipitated it. He says that he does not feel like he is having racing thoughts. He does not have grandiosity."

The plot thickens. What is going on? He won't talk about it, whoa.

How are his spirits? I mean, he has the trouble, but is he generally feeling good, bad? Of course, you said he entered depression, but before that, was he watching his favorite TV shows, things like that.

Can he watch and enjoy a TV show now, or is he too depressed to watch TV? Does he enjoy walking the dog?

You say, "It is hard to be patient." I can be impatient, also.

Aer you generally positive? I learned that by accident some time ago, but it really helped.

You said, "I brought up the idea of volunteering." That's good. Would he consider dog walking at a kennel so he could be around more people? Or volunteering at a hospital, or senior citizens home?
Posted 11/21/2017 2:38 PM (GMT 0)
Hi Tim Tam

the job(s) did not pan out. Not sure why. Adam does enjoy a movie/TV show and seems to be following that. That and taking the dog to the dog park are the only things that he enjoys. brought up volunteering--he did not want to do it. His spirits were generally pretty good prior to last week--he was active, good hygeine, not irritable, not excessively sleeping.

Saw his doc. The doc was not too impressed with the genesight testing. I shared with him my observations and concerns about Adam entering a depressive cycle. He asked me if it could be just apathy. I suppose so, but along with excessive sleeping, irritability, not wanting to do anything, and poor hygeine? Anyway, I did ask about a mood stabilizer as he had mentioned it (as well as Wellbutrin) when we first saw him in August. We decided to switch the antidressant to Lexapro, come back in a month. (The reason for the Lexapro is that it seemed to help me when Zoloft did not and perhaps there is a genetic/familial tendency for different meds to work better than others.) In the future, perhaps go to Lamictal +/- wellbutrin. Adam does not want to see another psychiatrist for a second opinion.

Tim Tam, this shotgun approach is a pain. Other medical specialties use objective data--physical exam findings, lab tests, imaging. Seems like the pharmacogenetic technology would be useful. If I were a psychiatrist, I think that i would utilize it. Oh well.

Additionally, Adam has way overdrawn his checking account. He will not give us his debit card. We are not on his account--so we cannot close it. Any suggestions?

It is always something, 'eh?
Posted 11/21/2017 2:39 PM (GMT 0)
Tim Tam, glad that you found your glasses. Good luck with your stress test. I like to cufddle with warm things on my tummy---so comforting.

Take care!
Posted 11/22/2017 12:52 PM (GMT 0)
Hi pedidiva,

When you think Adam is in a calm state, try talking to him about the overspending. Be sure it is the right moment, and ensure it does now sound like a scolding as he may take it the wrong way.

Do you think therapy once a month is sufficient for Adam? It sounds like he may need to visit his psychiatrist probably twice a month if possible. The meds usually work together with therapy to help.

I hope things get better soon.

UA
Posted 11/22/2017 2:54 PM (GMT 0)
Hi UA

Thanks for the response. He is not interested in talk therapy sad I did ask him what his plans were with the bank and his overspending. He didn't say anything.

Time will tell.
Posted 11/25/2017 8:38 PM (GMT 0)
OK, right when we have things worked out, something else occurs.

So, is Adam’s activities seem to be at about the same level as they were before he had his difficulties at school. So, is he getting back to where he was?

His psychiatrist did not like genesight.com which, at a cost, tell you which meds you need for which illnesses, including emotional problems.

What you might consider is doing the test anyway. Getting the results, showing them to the psychiatrist, or not, as you choose. But, especially if his meds don’t seem to be working out, perhaps then showing the genesight.com results to the psychiatrist.

If he will not consider giving that a try you could think of changing doctors.

But I think your genesight.com idea is a good one. What he thinks and what you do can be two different things. You don’t want to slow down your thinking because it not just like his.

You can be using this time to start the process, which may take a month or more, and have the results, rather than losing this time by doing nothing.

You can do a dual tract situation, do what the doctor says, then if that’s not working, do what genesight.com says.

I’ve been thrown off by other people’s opinions, some of which were right and some of which were wrong, and I have been thrown off by my own inaccurate thinking.

I thought I needed some help by a professional one time in recent memory, and I did not follow through with that and I paid the price.

Some time we need a boost from somebody else to do something like that, but sometimes there is no nobody there, or there is no boost from someone who is there.

It is at such times that we have to rely on ourselves. I kinda had something like that not too long ago, so I hope I learn from that to do better in the future.

So you both have some depression, so they may be some inheritance of emotional problems, as was mentioned before. Genesight.com could perhaps help with both.

You say, “Additionally, Adam has way overdrawn his checking account. He will not give us his debit card. We are not on his account--so we cannot close it. Any suggestions?"

Oh, right, suggestions. Well, uh, it's his card, but do you have to pay any unpaid bills? Or, after 18, he has to pay. If you have to pay, I don't know, or if merchants are going to be ripped off, I would consider asking him for the card.

You are giving him free room and board, you could use that as a wedge, saying, we're helping you, you need to help us by giving us the card.

When I was in a bipolar group we had some people who over spent. But I would think that if he gets on the right meds that could improve or stop.

As for your son still seems to be depressed, it may be the medicine has not had enough time to take effect.

You said that Joseph has been free of seizures for six months and 12/1 will be 7. So that sounds good. Does he like to watch TV? How does he like the dog?

Does Adam get a kick out of walking the dog at the dog park? Are there any streets in your area that are good for walking the dog? I walk my dog every day, so he’s a vital part of my program.

Only had the dog for a week. Is he a puppy?
Posted 11/26/2017 2:17 AM (GMT 0)
i'd change dr's. abilify useful fror disorganised thoughts so good. but it needs a foundation med like lamictal; which i use in combination with a anti dep. i agree with the leverage ua has suggested. he 20, needs to put his big pants on.
Posted 11/26/2017 7:22 PM (GMT 0)
H, agreed. He did say that he would give his debit card to his dad. We will see. I hope that he will follow through. Plan is for this to happen tomorrow. We wait, we watch, we see.
Posted 11/27/2017 4:22 AM (GMT 0)
good. keep vigilant and strong.
Posted Yesterday 12:35 PM (GMT 0)
Hi pedidiva,

I'm now catching up on posts on the forum...

Great to hear he agreed to give up his card. This is a first step. I hope he followed through, and things get better.

UA
Posted 12/10/2017 4:15 PM (GMT 0)
HI

The Lexapro has really helped. Adam found a job at a local fast food restaurant. The depressive symptoms have disappeared. Nothing to suggest a SSRI induced mania. Adam was able to get his banking situation cleared up and did give his dad (my husband) the debit card. Adam says that he feels pretty good and his sleep is good.

Cautiously optimistic. Meds right now: Abilify 20 mg daily, Lexapro 20 mg daily. Psychchiatrist visit 12/18/17.

I am still going to the monthly Depression/BiPolar support group. I find it helpful.

Thanks for all of your support.

Pedi
Posted 12/10/2017 4:45 PM (GMT 0)
Hi Pedi,

Happy to hear that the Pedi is helping. Congrats to Adam on his new job. I am glad he got his banking situation cleared up. Things sounds like they seem to be going good, and progressing well. I am really happy to read this.

Be sure to monitor him. Depression has its ups and downs. The symptoms can come back, but once he continues with meds and therapy, things will go positively.

Group helps. Good that you will be continuing with it.

Know that we are always here for you.

UA
Posted 12/10/2017 7:57 PM (GMT 0)
Thanks. Will keep you posted.


Pedi
Posted 12/11/2017 11:28 PM (GMT 0)
You said:

1. "The Lexapro has really helped.”
2. “Adam found a job at a local fast food restaurant.”

3. “The depressive symptoms have disappeared."
4. “Nothing to suggest a SSRI induced mania.”

5. “Adam was able to get his banking situation cleared up and did give his dad (my husband) the debit card.”
6. “Adam says that he feels pretty good and his sleep is good.”

Is this the same person who wrote on Oct. 8 on another thread by pedidiva,

“My son is 20 years old and is a college student. I was notified on 10/4 that he was acting strange and had been self cutting. I drove to his campus and he was acutely psychotic. He was medically cleared in the ED; however, no psych hospital beds were available. He refused psych hospitalization in our hometown--2 hours away.

“I was in contact with his psychiatrist and took him to the hotel where I made sure that he took his meds and added Seroquel 400 mg nightly. Additionally, Abilify 15 mg and Zoloft 100 mg daily. He was diagnosed with Bipolar July 28th after a psychotic break.

“He is much less agitated. Still grandiose (IMO) wanting to start a website fashion company and still fixated on numbers and their special/spiritual significance."

“How long after 2 psychotic breaks basically 6 weeks apart does it take to stabilize. I am thinking a year?”

I’m wondering, what could have possibly led to such improvement, and not in a year, but in two months? Wait a minute, it says here,

““providing shelter, food, and love”

By jove, I think we’ve found it!
Posted 12/12/2017 3:57 AM (GMT 0)
i think ped attending support group is helping,
esp understanding her son, and for ped to speak
and have support with others in the same boat.
strategies are out there. a good med combo,
shrink and self awarness by adam is excellent.
this is positive...watch for changes, they happen quick.
having a job and giving up card shows he is stepping up.
love positives....and family support too. most people give up.
Posted 12/12/2017 6:42 PM (GMT 0)
Hi Tim Tam, yes it's me. The same one that wrote the post on October 8th. I feel hopeful and continue to be cautiously optimistic.

Thanks H. I am pleased that Adam is stepping up to the plate.

Keep on keepin' on. The support group is very helpful for me. It is nice to see folks who are doing well, even with being diagnosed for 20-50 years with BiPolar.

Thanks for the forum and the virtual support.

Pedi
Posted 12/27/2017 6:45 PM (GMT 0)
How is Adam doing? Is he still working his job?

Did you all have a good Christmas?

His last appointment was on December 18. How did that go? So, his next appt. is on Jan. 18.

How is your anxiety?

I have some anxiety with the upcoming Jan. 1 event. With the festivities.
Posted 12/27/2017 7:10 PM (GMT 0)
Hi Tim Tam

Adam is still at his job. He Likes it. He was hesitant to work there as he had worked there a year ago and found it stressful and anxiety inducing. This time he says that he feels pretty good about it and doesn’t find it stressful. He is looking into a phlebotomy course at the local junior college this January.

Christmas went well

The psychiatrist kept the meds the same ( lexapro @ 20 mg and abilify @ 20 mg). The psych scheduled a flow up visit in March. As that psych is 2 hours away, we talked about seeing a psych in our home town and if Adam chooses to go back to uni, then the original psych ( the one 2 hours away) will see him. We have an appointment with the local psych in February.

My anxiety is up and down. Typical during the holidays. Overall, I think that things are going pretty well.

How are you holding up?
Posted 12/27/2017 7:58 PM (GMT 0)
Glad to hear from you. I was having a situation you weren't aware of. I was getting some feedback, hello, and I was having to go back on my heels, which you didn't know about.

So there was some hesitation and hold back, so that's what was going on.

That's why I said, "I'm glad to hear from you." I wanted to give you this message.

As the song says, "And I gotta get a message to you, hold on, hold on. One more hour and my life will be through, hold on, hold on."

"Well, the preacher looked at me and he smiled. He said, `Come walk with me, come and walk one more mile.' For once in my life I'm alone, I ain't got a dime, ain't got time for the phone."

That's a pretty song. It's about a guy going to the electric chair with the preacher. The Long, Green Mile. You can hear it on youtube.com.

Glad to hear Adam I doing well. Is it the same fast food restaurant? That's amazing, that he sees it a different way. That's good that he doesn't feel stressed.

So keeping the meds the same was his 12-18 appointment. And the next one is March. That seems well apart, but you said the distance was 2 hours.

A appt. with a local psychiatrist in February. That's good, also.

You said, "My anxiety is up and down. Typical during the holidays. Overall, I think that things are going pretty well."

Did you inherit your anxiety?

How are your other children? Is the puppy settling down? Does that help Adam and the others some?

As for myself, I've got Jan. 1 coming. Me and the post traumatic stress disorder people don't like this one. I'm going to be positive and I've thought of some ways to help the situation.

Are you staying positive? How about Adam?

It's good that he's looking to go to junior college for the phlebotomy course. Looks like his mind is growing stronger.

The fast food job probably helped to strengthen him. It's a stepping stone process.

If he goes back to uni, will he be majoring in the same thing?

So, like I say, I'm glad you wrote back.
Posted 12/27/2017 10:20 PM (GMT 0)
Hi Tim Tam

Sorry about the PTSD and Jan 1. Fireworks are not a big thing here on Jan 1--due to the arid conditions and fire danger. What will you be doing to cope better?

The dog is doing well. I signed him, Adam, and me up for an obedience course. I went to the first one with the dog. You know how there is always that one kid in the class who talks when the teacher is talking, wants to play with the other kids, and is highly distractible? Well, that kid is our dog. So any progress will look HUGE! We are crate training him so that he can stay in his crate when we are not home rather than the garage. So far, so good.

Joseph, my other son, had a seizure on Christmas day. It lasted ~5 minutes, but we were able to stop it using the magnet for the vagal nerve stimulator/rectal valium/clonazepam. He had gone almost 8 months without a seizure. I still think that is a success.

I hope that Adam likes the phlebotomy course. I am not sure what he will decide to do about Uni or is he will continue his Chemistry major. I hope that he likes the local psychiatrist. There are not too many psychiatrists in our city. I am thankful that Adam is liking his job and will hopefully make new friends. It is the same job.

I am staying positive. I think that many in my family have anxiety. I believe that I am only one who has sought treatment for it. I have been diagnosed with GAD/PTSD/Depression. Lexapro/Trazodone have been godsends. I like my counselor--I see him monthly. I remain cautiously optimistic about Joseph, Adam, and the dog.

Oh, I was playimg woith Adam's hair and I believe that he has psoriasis of the scalp. There are many psychiatric illnesses associated with psoriasis, including bipolar disorder. Interesting. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928455/

Take care Tim Tam--please keep in touch.
I will be thinkimg of you on Jan 1.

Pedi
Posted 2/1/2018 10:33 AM (GMT 0)
Keep strong. Soz about other son
Seizure...we have this in our family.
I am very slowly stepping away fron hw
To work on myself. Ua and tt still about.
Paid me dues...saying later real hard. Ht.
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