Flatness/loss of personality on bipolar medication

[mycatunderstandsme]

My DD has recently been diagnosed with bipolar after a severe psychotic episode where she spent 6 months in hospital. She started off on quetiapine and was left on this for 14 weeks and it did not work.

When we complained she was started on olanzapine which started to work straight away and she is now taking olanzapine and lithium.

She has been on the Olanzapine and lithium for 10 weeks and has had the olanzapine dose reduced to 10mg daily but she is flat and quiet for most of the day. Her personality only comes back at 6ish in the evening and she is so tired she goes to bed at 8.

I know the Drs don't want to reduce the dose in case she relapses but I am scared she'll be like this forever. I can't see her being able to have a normal life and she was so vibrant before.

Has anyone any advice? Does this lack of personality ever get better?
I am finding it hard to cope with. She is only in her teens and had everything going for her before this happened.

I had my first major episode in my teens too. I was misdiagnosed though and given the wrong treatment. I have been on olanzapine and personally found it very helpful. I came off because of weight gain. I personally would ask for her meds to be changed if she is suffering from over sedation then arpiprazole does not often cause sedation yet works as a anti pych like olanzapin.

This is very hard for you and her. I am a mental health nurse btw.

Sometimes people can experience oversedation, others describe it more like being a bit flat, not having any spark, or it can be a mix. And of course this can seem worse if the person has been through a period of elation and has come back 'down'.

Does your daughter have input from a CPN or early intervention team or similar? It sounds as if she was unwell for a long time and the doctors understandably want to be cautious. Especially if she did not respond to quetiapine, they won't want to make sudden changes. They may also be trying to get your dd on a consistent lithium level.

Perhaps try and discuss with a CPN, or ask for her to be referred if she doesn't have this. The doctor may consider a small decrease initially, maybe down to 7.5mg. What time does she take it? If late evening/bedtime some people find the side effects less sedating if they it early evening, but best to check with your dd's team.

All the best.

To add to what Crawling said, some doctors will also try risperidone, some find this less sedating.

OP you could also ask for a referral for Carer's support for yourself. I know you are her mum and not just a carer, but this is what to ask for and you may find it helpful. Worth a try anyway?

Thank you all for your speedy replies..

She has already had her dose reduced form 15 to 10 as we explained about these symptoms. I am not happy with the way she was treated in hospital. She just got worse and worse and she was left on the quetiapine far too long IMO.

She eventually became so ill the Consultant just put her on 15mg olanzapine straight away so we don't know if maybe 5mg might have worked. It worked amazingly well although she has put on over a stone in weight. Her Lithium levels are stable at 0.5 which I believe is fairly low. We are trying to stop any more weight gain by diet and exercise and it is slowing down.

I feel angry because if she hadn't been allowed to get so ill maybe something with less side effects could have been tried. My DD and I are both too scared to try anything else at the moment and they wouldn't agree to it anyway. She wants to go back to school to restart her A levels in September but she is only able to concentrate properly when the effects of the medication are wearing off.

We are with the EI team but the impression I get is that they would prefer to keep her overmedicated. They see school as something to keep her occupied rather than actually achieving anything. They don't know how she was before. She was intelligent and creative and enthusiastic and she gets that back later in the day so I know it can't be the illness, it has to be the medication.

I do feel very tearful about it all most of the time. It feels like a huge loss but I don't really see what anyone can do to help.

Oh mycat, sorry to hear that her treatment hasn't always been good. It is like a loss really, certainly you and she have "lost" the last few months, and as you say, she is still not her usual self. Is it worth asking for a second opinion, and/or is there perhaps one or more staff with the EI team that may be more understanding?

The weight gain is such a common side effect, really hard for some people, she is doing well to slow it down.

I think and I know its hard that you need to givve it a bit more time. I take it your dd is recently diagnosed they will get her meds sorted and she will be able to lead a almost normal life but right now she is vulnerable for relapses particularly if her meds are reduced to quickly give it time. She will get back to being the girl you know.

Thank you crawling. I do know I have to give it time and I know she needs to stay on this dose for now.

I am scared she'll never be the girl she was but she does seem stable and reasonably happy. She has gone out for a picnic with her friends today which is something I thought she'd never do again.

I am also angry with the hospital and myself as I feel I should have spoken out more early on in her treatment to move things along.

You have given me some hope actually as I have read quite a few of your posts before posting myself.

I am very pleased you have found my posts helpful. I hope your dd is feeling better soon. But you must not blame yourself for not acting sooner as a first episode is very frightening and confusing for family members and it sounds like you did your best.

Did you have severe psychotic episodes Larahusky?

My DD was very psychotic and the initial diagnosis was thought to be schizoaffective which was changed to bipolar. She started off manic, then had psychotic depression. I think they are amazed at how well she is doing now really as she has no mood symptoms at all.

We will stick with the meds she's on. Being on the olanzapine long term worries me in terms of her self esteem and general health. I am providing a healthy diet and DH and myself have lost half a stone to the point where I'm almost underweight! She is still gaining weight, although at a much slower rate.

I don't know if this helps but my actual diagnosis is scizoaffective. Before my illness kicked in I wanted to study medicine and had the grades to do this. But now my illness is settled I plan on going back to study. Starting at G.C.S.E hopefullly this September. So while I've needed a few years there's no reason your dd cannot return to her previous self.

Good luck Crawling. Really hope everything works out for you.

Thank you