Seroquel: A Bipolar Patient’s Opinion

As I’ve mentioned in previous blog entries, my educational background is in psychology. I also have been previously employed as a pharmaceutical representative (for oncology and neurology drugs). That’s the professional stuff. The personal part of the story is that I am diagnosed Bipolar II and have been on Seroquel (aka Quetiapine, say kwe-TIE-a-peen) for the past four+ years. Seroquel is an atypical antipsychotic medication used to treat bipolar disorder and schizophrenia.

My opinion of the drug…LOOOOOVE IT!!!!

When I Went on Seroquel

I was previously on Depacote and the antidepressants Wellbutrin and Zoloft for management of my bipolar symptoms. Then I went off meds during a pregnancy and was put on some entirely inappropriate meds by a new (quack) psychiatrist I was trying out after my pregnancy. Big mistake. Ended up undergoing a week of psychiatric day hospitalization, which, thankfully resulted in my being prescribed Seroquel for the first time.

Why I Almost Wasn’t Put on Seroquel

I don’t remember what the quack doc had me on, but I do remember him talking to me about Seroquel and dismissing the drug due to his concern that I would gain weight. I am not obese or even significantly overweight, but this bad doc took it upon himself to decide that, after a pregnancy I would prefer to be slim instead of sane. Bad call. The size of my ass is just not as much of a priority as is my mental health.

What I Like About Seroquel

Now there are several different drugs used for the management of bipolar disorder, and different patients respond to different drugs. I am certainly not recommending that all bipolar patients run out and get some Seroquel, but the drug is certainly something that I would recommend any patient struggling with bipolar symptoms at least discuss with his or her psychiatrist.

You Can Feel Its Effects Right Away: Compliance (a patient taking meds as prescribed) is a huge issue for most patients, particularly those with bipolar disorder, since some of the symptoms, at least of hypomania, can be downright pleasant. Even knowing better, I’ve had lots of problems staying on meds, mainly because the effects of antidepressants and other drugs used to manage mood take so long to build up to therapeutic dose (meaning that there is quite a delay between when you take the drug and when it works). Seroquel, at least for me, is somewhat sedating. I take it at night and it helps me sleep and helps to quiet the ‘chattering’ in my head that often keeps me awake. The instant effects of the drug help me stay compliant.

Seroquel Helps With Insomnia: I know that I just mentioned this effect, but it is important enough to stand alone. Many bipolar patients have trouble sleeping, and lack of sleep can precipitate a manic episode—a vicious cycle. Managing sleep is extremely important.

Dangers of Seroquel

Seroquel is not recommended for elderly patients with dementia-related psychoses. And certainly if you are pregnant or considering having a baby, you need to discuss your mental health and medications with your doctors. Recently, some of the people who develop diabetes while on Seroquel have been suing AstraZeneca, but the lawsuits have been dismissed. Bottom line--Any drug has risks, and psychiatric patients are a high risk population. You don’t get somethin’ for nothin’. Sit down with your psychiatrist and discuss whether the possible benefits of taking a med outweigh the risks.

Mooday

One and a half hour phone call with lawyer (cost: ~ $375) regarding ongoing custody crap with ex-husband (a 52-year-old man who wants support for his part-time care of our one child. Support from me, a part-time employed mother of 2 additional children under four years of age). For $%#& sake! This and writing deadlines have help to put me all over the bipolar landscape today. Mixed episodes! But played with my little ones this evening and delighted in their adorableness. Priorities. Remember what is important.

Moo-di-Meter

Manic 10 ... MIXED... 1 depresseD

This blog is for informational purposes only, it is not intended to be used for the treatment of mental illness. If you are having emotional troubles, please see a mental health professional.

Bipolar Disorder & Psychiatric Day Hospitalization

As mentioned in my blog entry “Bipolar Disorder and Pregnancy” I went in for a week of voluntary hospitalization shortly after my son was born. It was a difficult decision to make, and I was pretty scared, but I was also extremely sick…severe depression mixed with some of the less pleasant manic symptoms, such as problems filtering stimuli, incessant chattering in my head, insomnia and irritation.

I approached my hospitalization in kind of a detached, clinical way, since my Master’s is in psych. I am sure that I tried to maintain this perspective to make the experience seem less scary and more controlled. And I did learn a lot, and got enough of a peek into a psychiatric hospital to know that this was one place I didn’t want to spend much of my future.

So here’s what happens when you check into a psychiatric hospital on a 9 – 5 basis:

1. Entrance interview: Some guy asked me a bunch of questions, most designed to gauge how much of a suicide risk I was. I was not a suicide risk, and all my cynical mind could think during this interview was “They are sure covering their lawsuit-vulnerable asses!”

2. Group sessions: Most of my time that week was spent in group therapy. For bipolar patients, a group of us typically includes patient with a wide range of symptoms (some are manic, some psychotic, some depressed, some mixed) and many different levels of functioning (some folks in the group seemed very “normal” / high functioning, and other seemed…well…pretty crazy). I did not find the topics discussed in group to be all that helpful. It was very helpful, though, to see that I wasn’t really doing all that bad compared to some of the other patients.

3. Specialized group sessions: Based on the answers that you give in the entrance interview, the hospital may put you in special group sessions, outside of your diagnostic category. Since I admitted to drinking more than I consider healthy, they scheduled me in an addiction group in the resident part of the hospital. SCAREY!!! The group was interesting, and full of all kinds. I didn’t participate very much, because, at the time, I didn’t feel that I belonged in a group of patients this severe. The most memorable group member was a young woman who seemed very aggressive in her attitude and whose skin was entirely green! GREEN! WTF? Yellow / jaundice is from liver problems. What the heck makes you turn green?

4. Seeing a psychiatrist: It took, I think, a day or two for this to happen, but I did finally see an actual shrink. The bipolar problems that I had at the time were due to a combination of being post-partum and on the wrong medication (Went to a quack psych as my first post-preg psych evaluation). The doc at the psychiatric hospital put me on the right meds, which was what really brought me out of this episode, much more effectively than any of the other aspects of day hospitalization.

Moral of the story: Get and stay on the right meds for your bipolar. If you are pregnant work very closely with your OB and psychiatrist to avoid a manic or depressed episode during and after your pregnancy.

Mooday

Still realize I have made too many commitments, and feel severely overwhelmed. Something’s got to give. I have been considering quitting one of my writing freelance jobs, but need the $. Something in my schedule must go. I am just not sure what it is.

Moo-di-Meter

Manic 10 9 8 7 6 5 4 3 2 1 depresseD

This blog is for informational purposes only, it is not intended to be used for the treatment of mental illness. If you are having emotional troubles, please see a mental health professional.

What Is Hypomania?

Hypomania is a sub-manic state, which, along with one or more episodes of major depression, warrants a Bipolar II diagnosis (as opposed with Bipolar I -- full-blown mania with or without depression).

Symptoms of hypomania may include optimism, pressure of speech (talking fast), a high level of activity, and decreased need for sleep. Some people also experience increased creativity, but on the negative side, they can also display poor judgment and be very irritable. Hypomanics are usually able to function socially and in their work-life and do not manifest the psychoses that can be part of an all-out manic episode.

Many of the symptoms of hypomania are within the spectrum of 'normal' behavior, so the condition is tricky to diagnose, since the person who is hypomanic typically feels great and is very productive. This good feeling can, however, when not managed, spiral out of control and cause problems in a persons life.

Although for diagnosis, those classified as Bipolar II cannot have had a true manic episode prior to diagnosis, this does not mean that mania could not occur in the future, as untreated bipolar disorder tends to worsen and become more extreme.

The DSM-IV-TR definition of hypomania is: "A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non-depressed mood."

I am Bipolar II, so this all sounds very familiar.

Here is a link to that provides on-line free access to DSM-IV-TR disorder descriptions, from Behave Net Clinical Capsule.

MooDay

Home, work, kids, doctor appointments for kids...I feel the pressure building. When I start getting very stressed the hypomania begins to feel like a bad, chaotic thing, rather than a happy, productive thing. Gotta cut down on work somehow. How??

Mood-ie-Meter

Manic 10 9 8 7 6 5 4 3 2 1 depresseD

This blog is for informational purposes only, it is not intended to be used for the treatment of mental illness. If you are having emotional troubles, please see a mental health professional.

Comparison of Bipolar I and Bipolar II Diagnosis

When you look through the literature on bipolar disorder (manic depression) there are many references to Bipolar I and Bipolar II. What is the difference? Which do you have? Here is a very basic summary of the differences between Bipolar I and II.

Bipolar I : This manifestation of the disorder is diagnosed in individuals who have experienced one or more manic episodes, and who may or may not have experienced any episodes of major depression. The DSM-IV-TR, psychology's diagnostic bible, indicates that one or more manic or mixed episodes (manic and depressed) are required are required for this diagnosis.

Bipolar II : Patients diagnosed as Bipolar II have hypomanic episodes rather than full-blown manic episodes, and have had at least one bout of major depression. Hypomania is milder than manic, the prefix hyop- meaning "less than."

Here is a link to that provides on-line free access to DSM-IV-TR disorder descriptions, from Behave Net Clinical Capsule.

Mooday:

Since I posted so recently, the Moo-today is essentially the same as the Moo-yesterday ;)

Mood-ie-meter:

Manic 10 9 8 7 6 5 4 3 2 1 depresseD

This blog is for informational purposes only, it is not intended to be used for the treatment of mental illness. If you are having emotional troubles, please see a mental health professional.

Research on Bipolar Disorder & Addiction

In yesterday's posting, I said that I would look into current research and information on the relationship between bipolar disorder and addictive behavior, and I've found some great info and links.

It appears that about 60% of those with bipolar disorder will have problems with substance abuse at some point in their life. This problem actually has its own term, "dual diagnosis", meaning a combination of mental disorder and addiction. Many people with mood disorders tend to self-medicate. Seems there is still less shame associated with being an alcoholic or drug abuser than with having a mental disorder.

A very recent study from January 2009 in the European Psychiatry (referenced below), had preliminary results showing "a strong relationship between Bipolar II Disorders and Alcohol Addiction: hypomanic states induce high risk behaviours which may become responsible for relapse and increased alcohol consumption".

Below are a few recent studies and helpful web articles that I found. Beware when you do mental health searches on search engines. Many of the results that come up are sites trying to see you something.

• Everyday Health Website - "Bipolar disorder and addiction: The dual diagnosis"
• J of Clin Psychiatry, 2006 - "Management of comorbid bipolar disorder and substance abuse"
• European Psychiatry, 2009 - "Alcohol addiction and bipolar disorders"
• Organized Wisdom Website - "Bipolar disorder and addiction"

MooDay

Busy week at work. It is start of the summer semester and I teach. So although I realize that I am hypomanic right now, slowing down is not an option. Maybe next week. Taking meds as I should, but already thinking about having a drink when I get home.

Mood-ie-meter
Manic 10 9 8 7 6 5 4 3 2 1 depresseD

This blog is for informational purposes only, it is not intended to be used for the treatment of mental illness. If you are having emotional troubles, please see a mental health professional.

Bipoar Disorder and Addiction

Bipolar, alcohol abuse and other addictions...OH MY!

I'm back! Confused? Read my November 2007 entry on Bipolar Disorder and Routine. There has not been a new entry to this blog for more than a year. Case in point. :)

The topic today is the relationship between addiction and bipolar disorder. I would love to start a comment-conversation on this one with other bipolar folk, so please leave a comment if you have something to contribute.

Alcohol: Although, after being diagnosed with this disorder for many years and learning the hard way the importance of medication compliance (taking your meds on schedule, day an and day out), there has been one request my psychiatrist has repeatedly made that I have never been able to adhere to. "Stop drinking."

I am not a falling-down-drunk-everclear-fifth-finishing-passed-out-in-a-pool-of-my-own-vomit alcoholic. I am probably more of a functioning-3/4-bottle-of-wine-most-evenings alcoholic. But being bipolar, perhaps my version is just as bad.

My psychiatrist always expressed exasperation with my drinking; seemed unable to understand why I couldn't just stop, since drinking while bipolar was clearly not logical..."It's not a good idea to drink with your meds and with having bipolar disorder." Duh! Don't you think I know that? If stopping were easy, it wouldn't be called an addition, Dr. Spock!

The ONLY time that I don't drink in the evening is when I am sick with a cold or some type of immune-bashing illness. The best way I have been able to try and reduce the amount of alcohol I consume daily is to make a point to have my first drink as late in the day as I can, and then switch to hot tea as at another time marker later in the evening.

Smoking: My history of smoking is much like my history of drinking. Not too heavy, but consistent. (Momentary digression...Isn't is bizarre that one of the few consistent things about a bipolar person is the long-term support of an addiction...whatever it may be...shopping, drinking, drugs, bad relationships. It's like excelling at the 'dark side' of routine.)

But listen to this...I quit smoking! So, for all of you bipolar smokers. It is possible. I just had to find a way to make quitting sound appealing. This was my ridiculous, but effective, reasoning, "If you chew Nicorette, you can essentially partake in your addiction anytime. Whereas with smoking, there are only certain paces and times you can do it." Twisted logic, but honestly it worked for me. One month so far sans cigs! Woohoo!

This entry has been more conversational than my past blog topics. I will be doing some research on bipolar disorder and addiction, and will share what I find regarding the latest studies. I plan to resume making regular contributions to this blog. I'll try to start posting something every couple weeks. How 'bout some of you out there begin posting some more comments and we'll get some conversations going?

MooDay

I have been over-committed/scheduled, busy beyond belief for the past year. That's why I have not been posting to the blog. Although not being able to slow down is a sign that something is wrong, I have had very few problems with severe depression during that time. A full in-box seems to help me have direction and purpose. And when I stop to rest, I fall into a mild to moderately depressed funk. This hypomanic 'need to live life at high speed' is certainly relevant to being bipolar. I will also look into this phenomenon more closely and report what I find. I have spent the past year+ being hypomanic. As far at the Mood-ie-meter goes, I'd say an 8 most of the time, except when the bottom occasionally falls through and I plop to a 2 or 3.

Mood-ie-Meter
Manic 10 9 8 7 6 5 4 3 2 1 depresseD

This blog is for informational purposes only, it is not intended to be used for the treatment of mental illness. If you are having emotional troubles, please see a mental health professional.