Dear Renee, Studies show that it takes a good 3-4 months or more to recover from a manic episode. Cognitive symptoms are par for the course, just as you describe. In addition, 30-40% of manias are followed by a depressive episode in the subsequent 3-6 months. So, you are describing nothing odd, just the natural course of illness and recovery.
Treatment recommendations hinge on a thorough initial evaluation to make as clear a diagnosis as possible, and some of the symptoms you describe, such as cutting and mood swings, could suggest any possible number of diagnoses, some of which may be treatable with medicines and some of which may not be so clearly medicine-treatable. It may be worth trying to find a local or regional expert in mood disorders for a formal second opinion about diagnosis/diagnoses and treatment recommendations (both pharmacologic and nonpharmacologic). WebMD isn't set up to assist with making formal referrals but, apart from Googling or contacting a University medical center, you could try the websites for the American Psychiatric Association (www.psych.org ) or the American Society for Clinical Psychopharmacology (www.ascpp.org ) as well as Castle-Connolly Top Doctors (http://www.castleconnolly.com/doctors/ ).
Of the three FDA approved medicines for bipolar depression, Latuda is weight neutral (Seroquel and Symbyax are not, and can be sedating). May be worth discussing the evidence-based treatments for bipolar depression with your doctor.
Dr GView Thread
Dear emokid95, Bipolar disorder doesn't particularly involve minute-to-minute changes in mood. Instead, it has more to do with changes from your usual mood state that involve unusually high energy, not needing much sleep if any, and a fast rate of thinking and talking. An episode usually lasts for at least a few days if not weeks until then eventually going back to a normal state. "Mood disorder" is a non-specific way of describing a problem with moods (and includes all mood disorders, from unipolar depression to bipolar disorder to dysthymia to cyclothymia to other kinds of mood problems), but mood in and of itself is only a small portion of what defines bipolar illness. Temper, or temperament, is linked to personality and varies from person to person. It's "hard wired" and not so much altered by the environment. A careful evaluation by a psychiatrist should be able to help you better understand the nature of the mood changes you're experiencing, and whether they're linked to the high-energy symptoms that define bipolar disorder or else some other type of problem. Dr. G.View Thread
Dear Renee, Excellent questions. Drug dose has not been identified as a risk factor or contributor either to short-term changes in blood sugar or eventual diabetes. Atypical antipsychotics can oppose the action of insulin, whose job is to chaperone glucose from the bloodstream into body organs; over time, prolonged insulin resistance can lead to weight gain and other metabolic changes including diabetes. Diabetes in the progressive end result over time of the body's inability to manage blood sugar. The process, if it occurs, usually takes many years. Blood sugars can normalize if an offending agent is stopped, provided that a progressive chain of diabetes risk-factor events has not occurred (eg, weight gain, family history, prolonged hyperglycemia and insulin resistance). (If of interest, my book on managing psychotropic drug side effects covers these issues in more detail -- can probably find a used copy on Amazon for not too much.) Also after gastric bypass be sure you are only taking immediate release -- not extended release -- formulations of all medicines, since XR drug forms of drugs are more poorly absorbed after bypass. Dr GView Thread
Dear reneegigliotti, Many atypical antipsychotics can oppose the action of insulin (which is responsible for transporting sugar from the bloodstream into organs) which over time can result in both weight gain and high blood sugars with insulin resistance, posing a risk for diabetes. In someone who already has diabetes (as your numbers reflect), there is a risk-benefit issue regarding which atypical antipsychotic may be safest as well as most effective without further aggravating insulin resistance. An argument can be made for continuing the Seroquel is it is indeed helping and other agents that carry a lesser risk for diabetes have proven unhelpful. Two questions come to mind though: first, antipsychotics such as Seroquel are often used short-term when someone is in a manic episode but not necessarily kept long-term, for which mood stabilizers such as Depakote, Tegretol or lithium are more customary. If your doctors believe that psychosis occurs for you only when manic, then one or more mood stabilizers such as these may help prevent psychotic mood episodes without the need for any antipsychotic as a long-term preventative agent. A second question is whether you and your doctor have discussed (or tried) any of the atypical antipsychotics which appear to carry a lesser risk for metabolic side effects, such as Latuda or Saphris. Saphris may be especially worth considering since it is absorbed under the tongue through the musoca in your mouth, rather than through the gastrointestinal tract, meaning that it poses no issues for absorption after gastric bypass. Lastly, in the setting of diabetes, some authorities would recommend an older typical rather than atypical antipsychotic (eg, Haldol, Trilafon, Prolixin, Navane), agents which treat psychosis entirely as effectively as atypical antipsychotics do but without the metabolic risk.
Dear Dinaba, There are a number of medicines that can be used -- though frankly none with spectacular results -- for weight loss. Lamotrigine is one of them (it doesn't cause weight gain.) Effexor sometimes can. Phentermine is a Adipex, a stimulant-like medicine that is prescribed for morbid obesity. It wouldn't be a wise choice while someone was manic or psychotic, or who had heart disease or high blood pressure, but other than that, it may be one of several appropriate medicines a doctor could prescribe if they felt that a medicine was indicated to treat obesity. Diet and exercise still remain the first-line gold standard remedies.
Complex situation, would be hard to offer advice or suggestions without doing a proper evaluation. Anxiety is more common than rare in people with bipolar disorder. Atypical antipsychotics or benzodiazepines probably represent the best- studied treatments for anxiety. There's a little bit of data also with Neurontin or Lyrica for anxiety symptoms. Akathisia from antipsychotics can often mimic anxiety and it's sometimes worth adding a beta blocker like inderal to see if it might reduce akathisia -- but with heart disease that would require careful monitoring and assessment to assure safety. Also ssri's are sometimes used for anxiety but nobody has ever studied whether they work effectively to treat anxiety in people with bipolar disorder. Cognitive behavioral therapy is also a mainstay of treatment for anxiety.
Dr GView Thread