I just received this question from Eileen:
Julie,
It seems that I am having a very rough time managing my bipolar type 2 when my life is turned upside down and had to take a temporary leave of absence from work to take care of my Mom and spend time with her in her final stages of terminal cancer.
I am not functioning well at all.
Suggestions ? I am going to re read some of your books that I have but am not going to do everything at once. Fortunately my Mom has 24 hour paid caregivers around the clock and is receiving Hospice care.. Yet, my emotions are all over the wall and I am on a low dose of Lamotrigine at 25 mg and wondered if I should up the dose .
Thanks
Hi Eileen,
First off, 25 mg. of Lamictal is a very, very low dose. That is basically what people start at in order to slowly go up and avoid side effects. I am not a doctor- but I talk to my co author Dr. John Preston regularly. My mother, brother, friend and myself are on Lamictal. Our doses are 125mg, 400 mg, 500 mg, and I take 700 mg.
200 mg is the basic therapeutic dose. If you go to the category list on the right, I have many posts on Lamictal and other medications.
I doubt very much that 25mg is having any effect.
You have to keep going until the Lamictal works. This is well known in the health care profession.
I think that this is the best place to start.
I am very sorry to hear about your mother. It would affect anyone’s bipolar.
Start with meds and go from there. I think a grief counselor is the best next step.
Julie
Hi Julie,
Your advice to Eileen is spot on. I was taking 50mg of Lamictal with no other meds over the winter. In March I started what turned out to be a pretty severe depressive episode. When I finally got to a Psych. Nurse Practitioner, the first thing she did was say I was drastically under-medicated and has upped me to 150mg. That’s still on the lower end of dosage amounts, but it’s working for me and we’ll go up more if I need it. I can’t tell you what an amazing help it’s been in getting more stable.
Everyone hates taking meds, and I avoid them and try to take as little as possible. But, if something’s not working you’ve got to be willing to try a higher dose. I’ve learned how important that is.
Lamictal is a great mood stabilizer when used in conjunction with drugs. I take 300 mg of Lamictal since 2005. I agree with Julie we all need a team of caregivers who help of find that creamy middle that is normal for each of us. I have refractive depression and so take Mirapex in conjunction with my other meds. Mirapex was my miracle drug as it brought everything together and in a period of about 2 weeks I was well and functioning on a not depressed nor high level of functioning.
I disagree.
In fact, the drugs may be part of the problem:
http://www.psychintegrity.org/pamphlet_on_informed_consent.php
There are ways besides psychiatric drugs that work well.
They are much safer and far more effective.
A non-commercial site (links on where to begin):
http:/discoverandrecover.wordpress.com
Duane Sherry, M.S.
Retired Counselor
Dear Julie,
I have been diagnosed with depression since my 20’s, had severe post-partum depression and now am in the beginning stages of peri-menopause. This current stage of the peri-menopause have been almost a complete switch of mood disorder symptoms, namely: agitation, too much energy, wired but tired and for the first time ever, very dark suicidal thoughts. Is it bi-polar now or peri-menopause?????
Hello Shelley,
At age 49,I went from mild depression to severe depression with suicidal ideation. I turned 49 and found I I was in perimenopausal. My sleep is so bad and I have severe insomnia every night and my moods are very dark. Hormones, or lack there off can be very serious. I like you had severe post partum as well. I hope things get better for us on the other side of menopause and soon!
Hello to both Shelly’s,
We still don’t know enough about the role of reproductive hormones and bipolar disorder. This is not an estrogen illness-and yet estrogen can cause mood swings in people who don’t have bipolar. I’ve been lucky as I stayed stable throughout menopause and have had little symptoms- at least one thing I can be thankful for! I will write more on this topic in the future- for now my best advice is getting the sleep under control- especially if there are a lot of hot flashes. I will keep you posted when I do write about menopause – please sign up for my newsletter if you want to see my latest work. Thank you for writing and sharing your stories with each other. Julie
I am a nurse and also diagnosed with Bipolar 2. Lamictal needs to be increased every 2 weeks until reached a therapeutic dose, 200mg for me, apparently. I started off with 25mg twice a day, then 50mg, then 75mg, then 100mg which equals 200mg a day. Not sure why my doctor got me to take it twice a day, it is usually taken once a day, but everyone is different.
After about a week I started noticing I wasn’t feeling as energetic and happy as I was when I first started or increased the dose, and that’s how I knew it was time for me to increase it again.
Hope this helped some.
Thank you Taylor. This is very helpful. Julie
I was diagnosed bipolar 2 in 2012. I refused to go on meds because I have anxiety when it comes to taking new pills. I have been on a horrific rollar coaster ride pretty much the last year and a half. I now see a counselor and she has encouraged me to see a psychiatrist and get on meds. I dont have insurance and am trying to figure out how to do what I need to do. I have severe night sweats due to menopause and have disrupted sleep. Im trying to tough it out everyday, listening to pisitive biblical teaching gives me my most peace. Im very thankful I came across your book, loving someone with bipolar disorder, it led me to your website. Thank you for being a voice for me when I cant find words to descibe to people what im going through. You are a Godsent
Thank you Sheri. We really do all go through the same thing when we have bipolar disorder. It’s as though we are all related. This is an illness that can be managed. I do understand your reluctance to get on medications. There is so much misinformation about psychiatric meds in our society. I have a very simply policy- if a person who has bipolar disorder can manage this illness without medications- which means being able to work, have strong relationships and reach your goals, then I say go for it! The majority of us can’t do this. It is possible to find the right medications at the lowest dose needed- along with what I write in my books- you can find a balance. I hate to see people suffer. I suffered way too much myself to want anyone to go through this pain of this illness when it has its jaws around us!
Here’s what I would do. Start with sleep. My coauthor Dr. John Preston helped me get out of a ten year sleep nightmare where I couldn’t even close my eyes without heavy medications. I now take .5 mg of Melatonin ( that is .5 not 5!) four hours before bed and then I take 150 mg of Trazadone one hour before I want to sleep. I go to sleep and wake up at similar times. I’m sleeping like a regular human being again! Yes, hot flashes will still wake me up, but I can always go back to sleep. That was never possible before. I had a huge amount of fear around my sleep problems. Melatonin and trazadone is a very common sleep regime for people with bipolar disorder. It works because it allows for deep sleep. This will help with your anxiety and will create a foundation for trying a new medication for the bipolar itself. Melatonin is in stores- and trazadone is a very, very inexpensive generic medication. As for the bipolar meds, talk with your therapist about over the counter lithium orotate. My dear friend and colleague Dr. Jay Carter is a big proponent of this type of lithium for people with bipolar disorder and you can find it for a low cost in stores. I’m not a doctor, so these are just suggestions – but they are something you can do right now in order to start feeling better. Then you can move forward with the psychiatrist. I highly recommend Lamictal- the generic is lamotrigine as it works exceptionally well for bipolar 2 and if you start with very small doses and work your way to a therapeutic dose- with is usually around 200 mg, you can get relief often with few side effects.
These are just my opinions, but we can’t always just get in to see a psychiatrist quickly- we can do things on our own that work. Small doses of lithium orotate and a small doses of Melatonin are cheap and if carefully monitored can work wonders to hold you over until you have a full evaluation from a psychiatrist.
I can tell you are ready to get better Sheri. Give it time- it can happen! Julie