The Right Treatment Plan

My Therapist keeps telling me that bipolar disorder is one of the most treatable of all mental health illnesses, and that it is possible to maintain a healthy life with the right combination of therapy and medications.  I don’t know about being the most treatable, but I know enough people who are able to manage their disease that I believe that is possible.  I’m just not there yet.

Therapy is going well.  I love my therapist and the way she helps me deal with my illness.  She rarely gives any opinions or insights that she has, but leads me through a self discovery where I come to my own conclusions.  I’m not exactly how she does it, but I’ve learned more about myself and gained more insight into what I’m dealing with through her counseling techniques.  And since I see it for myself, I believe it more than if she just told me what she thinks.  I meet with her once a week and have come to rely on these sessions to cope with the day to day issues.  They are always intense, and I’m usually exhausted, but I almost always feel better about myself by the end of the session.

But therapy alone isn’t going to maintain my illness.  This is a physical disease, and, for me at least, requires medications to control the physical symptoms.  Here is where I’ve had the most problems.  For whatever reason, my body just doesn’t seem to tolerate these meds, and I’ve either had serious side effects, or they are just not effective.  When I was first diagnosed (Okay, when I first accepted my diagnosis) a year ago, my Doctor started me on a combination of Lamictal and Seroquel.  Of course it took a while to build up to a therapeutic level on the Lamictal, but once I did this seemed to be a workable approach.  The Seroquel left me somewhat sedated, but it was manageable.  Then, for some reason my Insurance Company refused to pay for the Seroquel and I had to look for an alternative.  For a while I just stayed only on the Lamictal.  But before long I could feel the mania returning, and we had to add something else before it got out of control.  So the next was adding Trazodone.  I don’t know how well that would have worked, but it was so sedating I couldn’t stay awake during the day and had to discontinue.  Next was Depakote.  I tolerated it okay, but after several weeks I couldn’t tell any change or improvement in my mood.

I don’t even remember what we tried next.  All I can say is it must have had some severe side effects because I was only on it a week.  So we moved on.  Perphenazine was the next attempt.  No side effects, but after a month it was obvious that it wasn’t making a difference.  Next on the list was risperidone.  This seemed to be it!  The feeling of mania began to reduce, and I had a period of more or less stability.  But I continued going down.  Instead of stopping the mania to a manageable level, I started getting depressed.  So we went on to the antidepressants.  Celexa was added to the mix.  It seemed to do okay at first, but then I began to develop sexual side effects that eventually became enough of a problem that we decided to discontinue.  That’s when I tried Wellbutrin.  Initially it didn’t seem to be working, and after about a month I was ready to try something else.  We had been through so many changes my Doctor decided that I needed to stay on this a while longer to make sure it wasn’t going to work.  I didn’t recognize them as possible side effects but started having other problems.  My anxiety level started rising.  I was having repetitive, extremely negative thinking.  I attributed it to my growing depression, and didn’t report it to my Doctor.  Then I had an overdose on Ativan that I had been prescribed for sleep.  I really don’t think it started as an active suicide attempt, but once I had taken a little more than usual my memory is gone, and I can’t say that it didn’t turn into one.  That resulted in a weeklong stay in a mental hospital.  I was released, but the depression was still there, and my anxiety was increasing.  Now I was into full blown panic attacks.  It didn’t take long before this became unbearable, and I finally talked to my doctor about the way I was feeling.  The anxiety, panic attacks and possibly even the feelings of suicide are documented side effects of Wellbutrin, and I was immediately taken off.

Now I’m back at square one.  I was still taking the Lamictal and risperidone, but I needed something to help with the depression.  Since I seemed to be doing well on the Celexa, and the side effects were more annoying than anything, my Doctor asked me to restart on it.  This time I wasn’t showing any improvement after a couple of weeks and just couldn’t shake the depression.

I met with my Doctor again last night and he doubled my dosage on the Celexa.  Of course I’m hopeful that this will be the right combination, but only time will tell.  Not trying to create a self-fulfilling prophesy, but somehow, I suspect that either the side effects will become a problem again, or my mood will continue to fluctuate and we’ll have to continue searching.  But there is the chance that these are the ones that work, and I will do all I can to remain positive about them.

I do want to believe that I’m going to be able to manage my illness and have a happy, normal life.  It’s been a year that I’ve been working my way through medication after medication to find that magic bullet, and has been a frustrating experience. But I do have a wonderful Therapist, and a good Doctor who I’m very comfortable working with.  They both tell me it can take time to find the right treatment, and I need to trust them and be patient.  But it’s hard.  I’m really struggling with the ongoing depression and it takes more energy to fight then I seem to have.  But I really have no choice but to fight.  I’ll continue on with the regimen I have until it proves unsuccessful.  If not, I do take comfort in knowing that there are a multitude of medications available, and that it is possible to find the ones that work.  It just takes a lot of trial and error.   Sooner or later there has to be a treatment plan that is going to work for me to maintain this disease.

There has to be.

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4 Responses to The Right Treatment Plan

  1. Bipolar Wife says:

    I think it depends on your type of bipolar. It is really hard to get the right med mix and sometimes one works for a while then quits. Unfortunately my husband cannot tolerate any anti-depressants. He became very violent every time. Lamictal and klonopin work the best, but neither help with his depression. Seroquel did, but gave him diabetes so for now he’s just living with the depression. I wish I could get him to go to therapy. He refuses. I hope you find the right combination for you! *hugs*

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    • You are absolutely right, it depends on the individual. I’m sorry your husband (and you) have had such a difficult time. I do give you a lot of credit for sticking by him throughout his struggles. If only my Wife had been so committed. She kicked me out within a month of my diagnosis. Best of luck to you both.

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      • Bipolar Wife says:

        I’m so sorry. That’s not fair. She wouldn’t have kicked you out if you had diabetes or MS or something. To me it’s the same. I know it’s hard. It takes the right type of person to overlook and quickly move on from what one says in a manic or depressed mood but it can be done. I hope you find that right person for you.

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  2. Norelle says:

    I have been diagnosed for 3 1/2 years and am still looking for the correct medication or combo of medications. I have tried more than 20 different medications either alone or in combination with other medications. My latest trial started a month ago. I was feeling much better until suddenly side effects set in and I had to wean off of the new medication. Now I have to start all over again. I’ve tried anti-depressants, anti-psychotics, anti-seizure medications & combinations of each. I know it can take a long time to find the right combo of meds to get the point where we are regulated. It sounds like you are doing the best you can. I know how hard the fight is, as I am in the middle of it myself. Don’t give up. We will find the answer someday and it will be worth the struggle.

    BTW – Not certain what the commenter above is trying to say……..it does sound like you are taking responsibility for finding the right medication. It is just taking a long time for you as it is for me. Also not certain what is wrong with having a good relationship with your therapist. I know I have a great therapist and would have a hard time understanding anyone saying it’s a bad thing.
    Perhaps J. can explain why this is a problem.

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