My new treatment for my bipolar

[ellaowenmummy]

Hi all I was diagnosed with bipolar disorder a year ago after many years of mental health problems. I saw a private consultant psych who continued with the sertraline I was on and added lamotrigine. I've had a very difficult three months and my GP referred me to the cmht team. Last week I had my first appt with another consultant on the NHS. He has stated he doesn't understand why just the lamotrigine as it on it's own with an ssri is not the correct treatment or the gold standard. After a discussion he respected my wish to not be on lithium. I start quetiapine next week followed by weaning off the sertraline and then onto venlafaxine as I've been on too many ssri meds and he questions if they will work. Have been on sertraline for six years now was effective until last year. I am going to do the meds changes but it is hard hearing from one consultant that what I was on is not correct from a consultant I have seen for a long time who is in charge of perinatal care on the nhs also. The new consultant is middle aged and much more old school then her. Who on earth do I believe? I feel pushed into a corner being honest the expectation from the nhs cmht and psych is to do this new medication. Yes I'm not fantastic at the moment but I could be a lot worse if we get this meds combination wrong and changes have really fucked me up in the past. It scares me. I next go next week to see the nurse for a physical health check: i emailed the private consultant who said it sounds a good plan however I need to make sure I'm happy with it. Sorry for long post I feel so confused. Added to this I've been offered a new more challenging job I want to take but worried I won't cope had sleepless nights over all this making me stressed and down :( sorry for long post.

[fortifiedwithtea]

Hi I think each consultant has their ideas no matter what field they specialise in. Lamotrigine is a newer medicine used for a variety of conditions. I myself was on lamotrigine and Topiramate for years for my epilepsy. I was very distressed one night having been taken to a&e for seizures the doctors read my medication and assumed they should be talking to the mental health team.

Over the years I have also taken anti depressants. I have a disabled daughter coupled with my own ill health, life is pretty shit. I didn’t like Sertaline it made my seizures more frequent. I preferred. citalopram but haven’t taken it for awhile.

Try to be kind to yourself. If the thought of the new job is giving you sleepless nights maybe you should tell yourself it’s not your time for this role but maybe in the future it will.

Remember I said I have a disabled daughter, well late last year she was diagnosed as having Bi Polar. It’s the sort that makes her manic, she doesn’t get depressed . She is on risperidone and I think she is having a relapse.

Can I ask why you don’t want to be on Lithium? Any advice you can give me on the treatment of Bi Polar would be appreciated.

Sending you a cyber (((hug))) , hope someone can answer your question better than me

[ellaowenmummy]

Thank you for your lovely reply x
Sertraline has helped immensely but I suffer predominantly depression and my mania isn't obvious I get more energy I don't sleep etc mind racing. I have bipolar 2 which is more depression less mania. I don't want to go onto lithium because the side affects physically are not good within 10-20 years significant risk of kidney failure. It is also toxic and would require regular blood tests to check the levels. I said if I was 52 not 32 I would have it but I don't want to risk kidney failure in my fifties. I can't afford to go privately I need the support on the nhs so I'm going to go with the nhs consultant and trust them. Work wise Ive decided to accept the offer as it's a great opportunity I worked towards for years I can't let my mental health rule my life, I really enjoy work and it's important to me. I'm just being totally honest from the start with them. Xx

[ellaowenmummy]

Also the idea of treatment is to stabilise moods. So risperdone olanzapine quetiapine are all anti psychotics designed to reduce manic moods. The anti depressant to reduce depressive moods. Sometimes lamotrigine or some other anti epileptic drugs are added in addition as a mood stabiliser. You have to be careful with anti depressants as some can cause a manic period. HTH x

[ellaowenmummy]

Sorry also the consultant said lithium and I quote is the "gold standard" treatment for bipolar there are many combinations of medications the specialists use lithium is a mood stabiliser x

[Melliegrantfirstlady]

I’d go with the consultant who has the most experience.

[Bombardier25966]

Lithium is pushed because it dampens everything down, it subdues the patient, often to the point of causing difficulties with speech and concentration. It's also cheap compared to the alternatives. And it often results in weight gain. Isn't it sad that is classed as the gold standard?

If you're sexually active (or may be), have they checked that you're on reliable contraception? Hope you don't mind me asking, but both lamotrigine and lithium can cause birth defects.

[Bombardier25966]

I’d go with the consultant who has the most experience.

That can also mean they're set in their ways and not up to date on more recent treatments.

[ellaowenmummy]

I'm just so confused quetiapine has weight gain too. Yes I have the coil in place thankfully. Having done all my research I can only see that quetiapine is the best option out of a fairly shit list. I really like my private consultant I can talk to her this one on the nhs seems very knowledgable but I couldn't feel all that comfortable. I think I'll go and see her and get her opinion then weigh it all up can't afford it but I'm not comfortable right now with the plan, it's my body I assume I can refuse treatment at this time?

[fortifiedwithtea]

OP thanks for explaining Lithium. My daughter was on Olanzapine when she was in hospital under section 2 and it didn’t really help. When she went on to section 3 her meds were changed to risperidone and she recovered quickly.

Her periods have stopped and she has gained a lot of weight. Waiting to get the result of blood test to measure her prolactin level. Do the other anti psychotic meds mess with prolactin levels?

[Embracethechaos]

Hi, slightly off topic. I have a diagnosis of episodes of depression and psycosis and general anxiety disorder. Noone has diagnosed me with bipolar but I think it's likely. I was on olanzapine for my psycosis which zombified me and i felt so much more myself off it. I trialled setraline but got psychotic so took an olanzipane I still had in the cupboard (not something I'd recommend but I was with my dh and too scared to leave the house) it made me sleep for 12 hours. I then was referred to psycatrist who put me on quetalapaine (after I turned Down cetralapram) which has been great for me. Really helped with sleep and stabilised my mood. I'm anxious as it's a new medication but it has really helped myself.

[Embracethechaos]

*it has really helped me feel more myself.

[ellaowenmummy]

Embrace that is so encouraging thank you and I'm so pleased you feel better x did you find weight gain a problem with quetiapine?

[Embracethechaos]

I did put on weight on olanzapine. I was put on quetalapaine when pregnant, so hard to tell. I had a difficult labour, at 36 weeks when I was on 75, my team had suggested I increase to 100 but I'd decided I felt stable on 75. After birth 75 did not cut it for a week in hospital so I met with a hospital psycatrist, agreed increasing to 100, 50/50 12 hours apart so I could sleep in the day. On discharge I saw my mental health team who said to go to 75 at night and 25 am. Then I saw my consultant, who had assessed me once before who recommended 100 at night, 25 in the morning and an optional 25 pm. My bmi is fine and post pregnancy I'm breastfeeding on it too. I've just had my 6 weeks I do crave carbs and have an increased appetite which again could be breastfeeding. 100 is a very low dose though. Tommorow I'm starting buggyfit, a park based excersise program which should help me lose some belly fat and strengthen the right muscles as well as improving my mental health, being outdoors with other mums. Personally I'd like to come off quetiapine eventually so I'm working on improving my mental health in different ways. I did cbt before meds, haven't bothered since starting them, so I should get back to it.

[Embracethechaos]

*I just had my 6 week checkup. I haven't weighed myself all through pregnancy as I had enough to be stressed about and didn't want to get hung up on weight. I was pleased to see I was just over 60kg on my 6 week check up, simular to my olanzipane weight which I lost by taking up long distance running and eating healthily. I only ha had the motivation to do that after I'd slowly come off it. That was 6 months feeling pretty numb so turned down a suggestion on olanzapine and setraline. I'm not the most compliant when it comes to psychoactive. Like you said, it's your body and you have a choice. My mental health was effecting my family and work, but I only went for medication as a last resort, feel pretty silly for being so stubborn, causing so much stress for everyone.

[inthekitchensink]

Hi, I’m bipolar type 2 and the combination of venlafaxine, lamotrigine and venlafaxine has been bloody brilliant for me. No weight gain, just a bit of tinkering with the dosage to get the right balance for me. I was on a much higher dose and now down to 150mg venlafaxine, 100mg lamotrigine and 25mg quetiapine- got lots more energy, feel much brighter and calmer and capable. Venlafaxine however is a real bugger to come off, and have to decrease it very very slowly, every other day, every few days and so forth. Good luck with it

[ellaowenmummy]

So reassuring these replies given me much comfort and food for thought thanks all xx