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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 35. This is the beginning of the thread.
Posted by HenryO on August 27, 2003, at 5:40:02
Please share experiences and ideas about trying to remain clean and sober while experiencing mania. I'm convinced this mental illness is integral to his lack of success with staying permanently clean.
Sobriety hasn't been working after many tries. We have to get some new ideas.
He's given AA a thorough and dedicated try, repeatedly. (I know the difference, I've got twenty years) But the mania has never been adddressed. I never understood what I was looking at before I learned more about my own mental illness. (depression)
This is a heartbreaking situation.
Got any thoughts? I sure would like to hear anything relavent. Thanks
Posted by jay on August 27, 2003, at 12:57:36
In reply to Sobriety and Mania- related to above post, posted by HenryO on August 27, 2003, at 5:40:02
> Please share experiences and ideas about trying to remain clean and sober while experiencing mania. I'm convinced this mental illness is integral to his lack of success with staying permanently clean.
>
> Sobriety hasn't been working after many tries. We have to get some new ideas.
>
> He's given AA a thorough and dedicated try, repeatedly. (I know the difference, I've got twenty years) But the mania has never been adddressed. I never understood what I was looking at before I learned more about my own mental illness. (depression)
>
> This is a heartbreaking situation.
>
> Got any thoughts? I sure would like to hear >anything relavent. Thanks
>Hi: That's super-nice of you to advocate for your friend. Just my own thoughts....if it's a cyclical type of possible bipolar depression, one of the more calming atypical antipsychotics like Risperdal and (if he can afford it) Zyprexa are good places to start. Starting also with a possible lower dose anti-depressant, it's hard to say which ones will work until tried. There is controversy over their use in cycling bipolar disorder. It may require a combination of antidepressants. I hear Neurontin is being used in addictions, and have heard expert psychopharmacologists say that benzodiazepines are warrented even in addictions as long as the use is controlled.
There is a new, once-a-day form of Depakote (Epival in Canada) that looks good in combinations with the above medications. (I found Depakote to be very fast in calming during a cyclic episode.) I'd think that the less sedating antipsychotics like Geodon might not be a good choice for rapid-cycling depression.
Just my thoughts..anyhow...and I hope the best for your friend. Take good care.
Jay
Posted by HenryO on August 28, 2003, at 1:32:42
In reply to Re: Sobriety and Mania- related to above post » HenryO, posted by jay on August 27, 2003, at 12:57:36
Well your right on the money as far as what's been prescribed to date, Depakote and Klonopin. Geodon was too much of a buzz. Zyprexa is on the list of stuff to try.
I just am not sure that I am in any position to be of long term help, or even intermediate help. A regular drunk is a known quantity to me, I can handel that, but this I think is a brain malady and may need specialized care.
His emotions just roll through with this overwhelming intensity and then its on to something new. This oddly optimistic OK what's next attitude. And always this bigger than life attitude/energy that infects the people near by. He's attractive as hell, until people just have to get off the ride.
I call it mania, but I'm starting to wonder about a more sophisticated diagnosis. Something is going on, on top of the other standard addict rap. The suffering has been costly, longterm and bewildering. His family is cooked.
I feel sort of lucky for the first time to be a depressive.
Posted by Larry Hoover on August 28, 2003, at 7:05:16
In reply to Re: Sobriety and Mania- related to above post, posted by HenryO on August 28, 2003, at 1:32:42
I'm going to offer up my musings on this, Henry. I don't know if I've got any good advice. This is a difficult case, seeing it from here.
> Well your right on the money as far as what's been prescribed to date, Depakote and Klonopin. Geodon was too much of a buzz. Zyprexa is on the list of stuff to try.
What was his response to these meds? I know many doctors who will not treat mental illness until the addictions are under control, but this man seems to require getting the mind stabilized as a first course of action.
What I fear is, that if you find something to rein in his mind/behaviour, that he's going to have a sense of loss of self. I've seen that happen, in a similar case. He may have some mourning to do, as he comes to terms with drug-induced changes. He's been the focus of everyone's attention for a long time.
Another issue, with respect to the alcohol use, is coming to understand why he used it. No matter how bad it got, we all chose alcohol to achieve something, as it gave us benefits. Once you understand that better, you can perhaps have more success in finding non-drug alternatives for those benefits. (I hope I'm not presumptuous about the depth of your involvement.) If he's used it to pass out, then he may need a sleep aid. If he's used it to forget, then he will benefit from counselling (and, firm application of the steps, of course). There may be many reasons why he drank, and I've known manics who drank because it "set them off". So, they were, in a sense, addicted to their own mania. That's complicated behaviour.
> I just am not sure that I am in any position to be of long term help, or even intermediate help.
I also wonder if you're not a little emotionally involved in this one, too. Finding some measure of success here may border on the impossible, and will certainly require a hefty investment in effort. I'm just suggesting, "Be careful".
> A regular drunk is a known quantity to me, I can handel that, but this I think is a brain malady and may need specialized care.
In my area, there are a number of specialized dual diagnosis (i.e. addiction/mental health) programs, with specialist counsellors and pdocs. Maybe you can get a referral through local substance abuse treatment centers?
> His emotions just roll through with this overwhelming intensity and then its on to something new. This oddly optimistic OK what's next attitude. And always this bigger than life attitude/energy that infects the people near by. He's attractive as hell, until people just have to get off the ride.
It could be pure mania. There could be some ADHD. One thing to also consider is the impact on his body from all his activities. Alcoholics are notorious for nutritional deficits. Alcoholics, bipolars, and ADHDers, as classes, tend to respond to nutritional supports. His meds may not work well if his body remains in defecit conditions.
> I call it mania, but I'm starting to wonder about a more sophisticated diagnosis. Something is going on, on top of the other standard addict rap. The suffering has been costly, longterm and bewildering. His family is cooked.
I'm glad he still has family. But, I hear you loud and clear.
> I feel sort of lucky for the first time to be a depressive.I'm afraid I understand that comment very well, too. ;-)
Lar
Posted by HenryO on August 28, 2003, at 9:25:19
In reply to Re: Sobriety and Mania- related to above post » HenryO, posted by Larry Hoover on August 28, 2003, at 7:05:16
Larry, what a post, every comment was wise and helpful. This board is a great service. You put some thought into that, thank you.
His response to the meds seems like they help, I'd increase the dose quite a bit. There is a chicken and the egg aspect to this. Which issue has more influence on the other. I don't know if the answer matters.
I've decided I am not equipted to nor ready to try to solve him. I can offer a bed for a while but the instaibility I'm not going to have around me for too long.
It looks like pure mania, how rare is that? I didn't know if that was really possible. I think he uses to stay sane. He eats as much as two men. He's not heavy. And he sleeps like the dead, at least right now. Maybe he's making up for lost time. This is the first good place to crash for a while.
The program works for a 18 months or so, then this other condition comes in over the top. He feels it comming, starts going to two then three meetings a day. People give up on him like he's insincere. But I'm starting to see this other illness is making it so that thinking is not always in the picture. Indeed several days may go by while he is clean and manic that he doesn't remember.
I've know him on and off since high school, he has always been high voltage.
I worry, maybe even starting to think, the prognosis isn't good. I wish he and I could leave him in some good hospital setting for a long time.
Posted by HenryO on August 28, 2003, at 9:28:56
In reply to Re: Sobriety and Mania- related to above post » HenryO, posted by Larry Hoover on August 28, 2003, at 7:05:16
I took it once for a few weeks did nothing for my mood but gave me a lump in my throat.
Any experiences out there?
Posted by KimberlyDi on August 28, 2003, at 10:29:19
In reply to Re: Sobriety and Mania- related to above post » HenryO, posted by Larry Hoover on August 28, 2003, at 7:05:16
I was a pressure cooker of anxiety. Alcohol was my release valve. 3 of my 4 grandparents were alcoholics so I guess I was also doomed from the first drink.
I'm going to approach my pdoc on Sept 4th about the possibility of being bi-polar and ADHD. Before I had even heard of bi-polar, I had learned to be aware of those moments when I'm "just so darn happy to be alive". They were always followed by a period of major depression. My ability to focus at work has been reduced to zilch. nada. nothing. My son is ADHD and I've often thought that I had a *touch* of it too.
I'll post on what she says. It might help with your situation.
I drank because I despised myself. I also drank to shut up my mind (racing thoughts). I also drank because of inability to sleep.
KDi in Texas
Posted by jemma on August 28, 2003, at 11:27:31
In reply to Mania- what about Lithium? experience, posted by HenryO on August 28, 2003, at 9:28:56
I have bipolar one - no psychotic manias for twenty years, but occasional hypomanias - and I'm also a recovering alcoholic - ten years sober. I have a pretty good idea of how easy it is to reach for that first drink at the best of times, and how irresistible it is when manic. I've been very, very lucky to reach a place where I'm sober and more or less stable and functional.
I've found one supplement that will stop hypomania in its tracks for me - inositol. I swear, 500 grams three times a day will calm me right down and get my feet on the ground when I feel myself getting up there. I think of myself as a blender, with various speed settings. Inositol brings me down at least one, even two settings, from high to medium-high to medium. Now if only I could find something natural with few side effects that could get me to medium from low :>).
If you do a web search on inositol and bipolar, you'll see it's had proven results in various studies. I'm not sure why it works. Larry, could you shed some light?
Best of luck with your friend. If you've been in recovery all these years, I'm sure you understand the importance of detachment when dealing with the alcoholics we're close to. I found alanon to be a great help once when I got a little too enmeshed in someone else's illness. Not that I'm saying you're enmeshed - in fact, all I see in your posts is thoughtful concern.
- Jemma
Posted by Larry Hoover on August 29, 2003, at 11:06:20
In reply to Re: Sobriety and Mania- related to above post, posted by HenryO on August 28, 2003, at 9:25:19
> Larry, what a post, every comment was wise and helpful. This board is a great service. You put some thought into that, thank you.
Thanks for acknowledging the content. I have considerable experience around addiction and recovery (I'm qualified as an addictions counsellor).
> His response to the meds seems like they help, I'd increase the dose quite a bit. There is a chicken and the egg aspect to this. Which issue has more influence on the other. I don't know if the answer matters.
Stability has to come first, though usually that comes through abstention from the substance(s) of abuse. This case is an obvious exception to the general pattern. Cognitive issues can only be addressed once stability is achieved.
> I've decided I am not equipted to nor ready to try to solve him. I can offer a bed for a while but the instaibility I'm not going to have around me for too long.
That's wise, to assert boundaries. Otherwise, you can get sucked into "giving a little more help", over and over again. Moreover, he has to take responsibility, somehow. Maybe, get him a referral to an inpatient program, even drive him there, but then it's up to him.
> It looks like pure mania, how rare is that? I didn't know if that was really possible.It's common enough.
> I think he uses to stay sane. He eats as much as two men. He's not heavy. And he sleeps like the dead, at least right now. Maybe he's making up for lost time. This is the first good place to crash for a while.
Pure manics do eventually crash. The body has limits the mind can't supercede.
> The program works for a 18 months or so, then this other condition comes in over the top. He feels it comming, starts going to two then three meetings a day.
That pattern should be emphasized to him. If he can feel it coming, he ought not to be relying on more meetings. He should be heading straight for a doctor's office. Recovery is where you find it. He's looking in the wrong place, to solve the mental issues.
> People give up on him like he's insincere.
That's common in AA, IMHO. Psychiatric dysfunction is often attributed to a failure to fully adopt the program, to reservations. I know of one residential program that has a counsellor (nick-named Gestapo Al) who keeps all psych meds under lock and key (that's the good part), but then refuses to give them out as prescribed (via various subterfuges). I had to take one poor guy to the emergency department for an injection of Haldol, because he had been denied his Zyprexa for about a week. He had been advised to increase his efforts in prayer.
> But I'm starting to see this other illness is making it so that thinking is not always in the picture.
He has to heed his own warning signs. A sponsor may help with that, via feedback, but it is his task to change his behaviour. "If you keep on doing what you always did, you'll keep on getting what you always got."
> Indeed several days may go by while he is clean and manic that he doesn't remember.
Once the mania is fully active. He's missed the window of opportunity. He needs to formulate a plan of action when he's not manic, and pledge to put it into effect when he feels the warning signs.
> I've know him on and off since high school, he has always been high voltage.
I hung with a similar dude.
> I worry, maybe even starting to think, the prognosis isn't good. I wish he and I could leave him in some good hospital setting for a long time.That's really a fine idea. If you're in Ontario, I know just the place.
Lar
Posted by katia on August 29, 2003, at 14:20:38
In reply to Sobriety and Mania- related to above post, posted by HenryO on August 27, 2003, at 5:40:02
Which above post?
Posted by Jasmine Neroli on August 29, 2003, at 23:42:57
In reply to Re: Sobriety and Mania » HenryO, posted by Larry Hoover on August 29, 2003, at 11:06:20
Um Henry. I joined this thread part way through, but have you considered that this person has Borderline Personality disorder, which can have very manic-like and/or psychotic episodes? Sufferers very often get into big time substance abuse and other risky self-destructive behaviours. Basically BPD people have chaotic emotional lives and emotional dysregulation ( to varying degrees - it's the hingepin of their behaviour).
They are often very attractive and charismatic. It can be cyclical and seems to be sometimes co-morbid with bipolar or even maybe related to it- there's a lot of discussion around that in psych circles..
One of the things that makes me suspect this as a diagnosis with knowing so little, is YOUR response to this person. They drag you with them, boundaries become extremely blurred and you feel bound up with them. I suspect all this because it seems like a familiar situation to me, since I have a close relationship with a BPD person, and have worked closely with another. And BPD doesn't have to have the classic self-mutilating behaviour present.
If you want to check out more, try this site: BPDcentral.com or just do a search for Borderline Personality Disorder.
Good luck
Jasmine
Posted by galkeepinon on August 30, 2003, at 2:28:39
In reply to Mania- what about Lithium? experience, posted by HenryO on August 28, 2003, at 9:28:56
I took Lithium for about 3 weeks and it did wonders for me, but I couldn't take the side effects any longer so I went off-too bad, it was really doing well.
> I took it once for a few weeks did nothing for my mood but gave me a lump in my throat.
>
> Any experiences out there?
Posted by HenryO on August 30, 2003, at 4:11:07
In reply to Re: Sobriety and Mania- related to above post » HenryO, posted by jay on August 27, 2003, at 12:57:36
Isn't Lithium the classic med for mania? I haven't heard one of the state (AZ) doctors mention it.
I am certainly hearing some good ideas here. Thank you all for your time and concern.
I don't see any psychosis or much mood swing other than very brief and powerfull moments of sorrow, but they aren't depressive. They are still grand.
I have made it clear that he can't live with me. He is going into a treatment center which has an emphisis on the psychiatric. Then he is going to live in some kind of halfway house yet to be determined.
Posted by HenryO on August 30, 2003, at 4:12:45
In reply to Re: Mania- what about Lithium? experience » HenryO, posted by galkeepinon on August 30, 2003, at 2:28:39
Any other Inositol stories?
Posted by HenryO on August 30, 2003, at 4:20:54
In reply to Re: Sobriety and Mania- related to above post » HenryO, posted by katia on August 29, 2003, at 14:20:38
This above post:
Posted by galkeepinon on August 30, 2003, at 4:54:04
In reply to What are the down sides of Lithium?, posted by HenryO on August 30, 2003, at 4:11:07
Hi HenryO Yes, I believe Lithium is the all time old classic med for good ole mania!;) The reason you may not have heard the doc mention it is because there have been so many new meds come out since Lithium with less side effects, etc.
How are YOU feeling about all this?
Take Care:-)
> Isn't Lithium the classic med for mania? I haven't heard one of the state (AZ) doctors mention it.
>
> I am certainly hearing some good ideas here. Thank you all for your time and concern.
>
> I don't see any psychosis or much mood swing other than very brief and powerfull moments of sorrow, but they aren't depressive. They are still grand.
>
> I have made it clear that he can't live with me. He is going into a treatment center which has an emphisis on the psychiatric. Then he is going to live in some kind of halfway house yet to be determined.
Posted by HenryO on August 30, 2003, at 10:00:07
In reply to Re: What are the down sides of Lithium? » HenryO, posted by galkeepinon on August 30, 2003, at 4:54:04
I'm feeling several things, thinking actually. I'm greatful for the form of mental illness I've got for the first time. I don't like telling him he's too sick for me to let him stay for long. I'm happy I had the health to tell him that. I'm hopeful for him. I'm also thinking that this is a life long recovery he needs. Screwing up could cost him his life. If I my disease flares up I sleep for two weeks. He has a difficult road ahead if he doesn't get a handel on this. I'm worried I'll have to get really tough. If he were to mess up and get high or pull some stunt, I'd have to cut him loose completely. That would be very sad. I am seeing up close now what I was looking at for years but never recognized. In one way its fascinating. He is scarey smart but this illness has run his life since anyone can remember. Its like some Oliver Sachs essay and I don't know that it will have a happy ending. The horrible fact is, I don't like his odds.
Posted by katia on August 30, 2003, at 13:58:31
In reply to Re: What are the down sides of Lithium? » HenryO, posted by galkeepinon on August 30, 2003, at 4:54:04
Hi,
you mentioned about PCOS and Depakote? Why have I not heard this before, specifically from my own Pdoc???? How common is this?
Katia
Posted by galkeepinon on August 30, 2003, at 14:54:44
In reply to Re: What are the down sides of Lithium? » galkeepinon, posted by katia on August 30, 2003, at 13:58:31
Hi, I can't give you an explanation as to why you didn't hear it from your pdoc~sorry, but there has been controversy surrounding this issue. It is quite common, I have very mild PCOS.
Some (but not all) studies have found that PCOS is more common in those who have been taking Depakote than in those taking some other seizure/bipolar medicines.
A possible explanation for the effect of Depakote is that it is one of the few seizure/bipolar medicines that are not *enzyme-inducing*. Enzyme-inducing medications promote the liver's production of substances that lower blood levels of the male hormones involved in PCOS. In effect, enzyme-inducing seizure/bipolar medicines like Tegretol/Carbatrol treat PCOS but Depakote does not. Lamictal has been found to reverse the features of PCOS.
Here's a pretty good link with some great info: http://www.psycheducation.com/hormones/Insulin/polycystic.htm
Depakote also promotes weight gain, which is associated with higher levels of insulin and of active male hormones, both factors linked to PCOS.
Hope this helped:-)
> Hi,
> you mentioned about PCOS and Depakote? Why have I not heard this before, specifically from my own Pdoc???? How common is this?
> Katia
Posted by katia on August 30, 2003, at 15:29:25
In reply to Re: What are the down sides of Lithium? » katia, posted by galkeepinon on August 30, 2003, at 14:54:44
How many other women do you know who has this from Depakote? Did you get it from Dep.?
I already have a history of ovarian cysts.
I'll talk to my pdoc about it after this loonnnnnggg weekend. How long does it take for the onset?
I've been on Dep. for about two weeks.
thanks.
Katia
Posted by galkeepinon on August 30, 2003, at 15:55:55
In reply to Re: What are the down sides of Lithium? » galkeepinon, posted by katia on August 30, 2003, at 15:29:25
Hi Katia, I did get it from Depakote, and I knew 2 other people who did also. It may not happen to every woman though, please don't be alarmed. I know a lot of peole who do just fine on it~~in other words do not develop PCOS. My doctor told me that polycystic ovaries are more common in those with seizure disorders.
There is a GREAT book entitled "PCOS - The Hidden Epidemic" by Dr. Samuel S. Thatcher, you may want to check out.
As far as onset goes, I was on Depakote for about 2 months and my menses have been off ever since.
Hope this helped.
Take Care.
> How many other women do you know who has this from Depakote? Did you get it from Dep.?
> I already have a history of ovarian cysts.
> I'll talk to my pdoc about it after this loonnnnnggg weekend. How long does it take for the onset?
> I've been on Dep. for about two weeks.
> thanks.
> Katia
Posted by katia on August 30, 2003, at 20:47:42
In reply to Re: What are the down sides of Lithium? » katia, posted by galkeepinon on August 30, 2003, at 15:55:55
Do you have a seizure disorder? Are you able to have children b/c of it?
> Hi Katia, I did get it from Depakote, and I knew 2 other people who did also. It may not happen to every woman though, please don't be alarmed. I know a lot of peole who do just fine on it~~in other words do not develop PCOS. My doctor told me that polycystic ovaries are more common in those with seizure disorders.
> There is a GREAT book entitled "PCOS - The Hidden Epidemic" by Dr. Samuel S. Thatcher, you may want to check out.
> As far as onset goes, I was on Depakote for about 2 months and my menses have been off ever since.
> Hope this helped.
> Take Care.
>
>
>
>
>
>
> > How many other women do you know who has this from Depakote? Did you get it from Dep.?
> > I already have a history of ovarian cysts.
> > I'll talk to my pdoc about it after this loonnnnnggg weekend. How long does it take for the onset?
> > I've been on Dep. for about two weeks.
> > thanks.
> > Katia
Do you have a seizure disorder?
Posted by galkeepinon on August 30, 2003, at 20:53:16
In reply to PCOS » galkeepinon, posted by katia on August 30, 2003, at 20:47:42
No-I don't have a seizure disorder. Yes, I am able to have children as far as I know. Somewhere, something goes wrong with our reproductive systems and it starts this process of PCOS. When I tried to conceive, I was put on Clomid.
> Do you have a seizure disorder? Are you able to have children b/c of it?
>
>
> > Hi Katia, I did get it from Depakote, and I knew 2 other people who did also. It may not happen to every woman though, please don't be alarmed. I know a lot of peole who do just fine on it~~in other words do not develop PCOS. My doctor told me that polycystic ovaries are more common in those with seizure disorders.
> > There is a GREAT book entitled "PCOS - The Hidden Epidemic" by Dr. Samuel S. Thatcher, you may want to check out.
> > As far as onset goes, I was on Depakote for about 2 months and my menses have been off ever since.
> > Hope this helped.
> > Take Care.
> >
> >
> >
> >
> >
> >
> > > How many other women do you know who has this from Depakote? Did you get it from Dep.?
> > > I already have a history of ovarian cysts.
> > > I'll talk to my pdoc about it after this loonnnnnggg weekend. How long does it take for the onset?
> > > I've been on Dep. for about two weeks.
> > > thanks.
> > > Katia
> Do you have a seizure disorder?
Posted by katia on August 30, 2003, at 21:01:35
In reply to Re: PCOS » katia, posted by galkeepinon on August 30, 2003, at 20:53:16
Why clomid? And what is it? Is it b/c you have PCOS?
Posted by galkeepinon on August 30, 2003, at 21:28:58
In reply to Re: PCOS » galkeepinon, posted by katia on August 30, 2003, at 21:01:35
I needed Clomid to ovulate. I used it for about a year.
Clomid stimulates the pituitary gland to secrete the hormones LH and FSH, which in turn stimulate the ovaries. When we have PCOS, it makes it hard to conceive. Clomid helps us to conceive. I was on Clomid when trying to conceive, due to PCOS. Chemically, Clomid looks somewhat like estrogen. Like all hormones, estrogen works by occupying a receptor in different parts of the body. This occupied receptor then sends a signal telling that organ to do something. For example, in the brain estrogen directs the release of FSH, which controls the ovary's development of a mature egg. In the uterus, estrogen directs the thickening of the lining. Clomid blocks estrogen's attachment to its receptor.
Clomid affects fertility in a positive way by tricking the body into thinking that less estrogen is present than there really is. The body responds by releasing greater amounts of FSH. Since I wasn't ovulating, this extra stimulation caused me to ovulate. It worked pretty good.
>
> Why clomid? And what is it? Is it b/c you have PCOS?
>
>
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