Q: Cycling & Internal Voice Monologue
I have (obvious now) had BP disorder my whole life but only diagnosed within the
last year. I currently take 200 mg Topamax, 150 mg Effexor, 40 mg
Geodeon and sometimes an "extra" 37.5 mg of Effexor at lunch. I am a mother to
a 4 year old and to 2 year old triplets and am married, happily. I experience
mixed states and rapid cycling. Lately I have been completely off-the wall
thoughts that I am processing as totally rational then getting into "fights"
with myself for a good hour or two trying to decide which "side" is going to
"win". Like, if the information is right or wrong. I know the the thought is
totally screwy (an example, my husnad is into telescopes big time, I wanted him
to stop using them so the "people" of Saturn wouldn't be so encouraged to
contact us). This is pure lunacy. I am highly educated and highly medicated.
This has NEVER happened before. I've always had the "internal voice monologue"
but never one that was totally and utteraly crackers.
Dear Jenn --
doc's about whether there might be a different medication regimen that would
be better, more able to control the cycling and the thoughts. I think most mood
experts agree that the key to bipolar control is to rely on mood stabilizers and
watch out for antidepressants, at least if when on them a person is cycling and
having mixed states. In that case it looks to me as though most mood experts
think it's a good idea to address the mixed states and rapid cycling by
gradually tapering off the antidepressants -- but don't do this on your own, it
needs to be an agreed-upon plan with your doctor; and there might be a good
reason in your symptoms or your history for keeping the Effexor where it is, for
all I know based on your paragraph.
Geodon may be a pretty good antimanic, that's not fully
clear yet. It's less clear whether this medication can prevent cycling, i.e.
keep a person well. And Topomax has not been shown to be a mood stabilizer at
all, though it can be pretty amazing for weight gain control. So you can ask
your doctors for the logic that leads to this current medication regimen; for
the plan on where to go from here if you're not doing well (e.g. see if that
includes consideration of tapering off the Effexor); and if you don't get a
pretty clear straight answer on why the doc' is not using your current approach
(e.g. compared to the
guidelines), then you might just get a second opinion about treatment
options and see how that sounds. There are a lot of
stabilizer options; here's a current list including a
table of them listed by the evidence supporting their use.
Published September, 2004