Bipolar Depression & Hibernation

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kellyinCali
Regular Member


Date Joined Apr 2009
Total Posts : 292
   Posted 9/11/2017 3:05 PM (GMT -7)   
I saw the P-doc today. While my blood will be tested for anything and everything that causes fatigue, he thinks what I describe as "excessive sleep" is bipolar depression. He said that typically the "hibernation" time is Fall & Winter. I have never heard of this before but it certainly helps me understand why he is treating me for Bipolar II (w/ hypomania).

Perhaps since my Circadium Rythm is "upside down" this explains why I'm "hibernating" Spring and Summer.

Those of you with Bipolar, have you heard of this before? When do your depressive episodes strike the most?

theHTreturns...
Elite Member


Date Joined Mar 2009
Total Posts : 19942
   Posted 9/16/2017 1:41 AM (GMT -7)   
if ya have mania, hypomania, yeah.....and with type 11 being the depressive this may well be how ya mind body is expressing this.

kellyinCali
Regular Member


Date Joined Apr 2009
Total Posts : 292
   Posted 9/16/2017 3:23 AM (GMT -7)   
Hi Turtle, I had 5 good days without depression but still slept crazy number of hours which just confuses me. sadAt this point, I'm feeling concerned. I think I read that you have Sleep Apnea. How did you get diagnosed? I am sleeping waaaaaay too much. I do not wake up feeling refreshed no matter how much sleep I get.

theHTreturns...
Elite Member


Date Joined Mar 2009
Total Posts : 19942
   Posted 9/16/2017 11:46 PM (GMT -7)   
yeah i do. severe. need a sleep study. get ya wired up with the pony tail. referral to a sleep dr....respiratory doc. go to a sleep centre. get all wired up. not that bad, i have had 2!! when rep[ort is back ya can discuss what ya need. cpap maybe.

Tim Tam
Veteran Member


Date Joined May 2016
Total Posts : 1084
   Posted 9/17/2017 11:28 AM (GMT -7)   
You said you have "excessive sleep" and the doctor thought it might be "bipolar depression" which I guess he means you have the depressive side of manic depression.

You also said, "I had 5 good days without depression but still slept crazy number of hours which just confuses me."

I just got through six days of no electricity, no computer, no telephone, no television.

Since I don't drive, either, there was basically nothing to do all day.

Thank goodness, I never did get depressed, because of my anti-depressant Mirtazapine, or manic, because of my Lithium.

But there was just nothing to do.

What I would do is, after breakfast, I would go back to bed. I would also be tired, because I was so bored.

As soon as the devices came back on, I wasn't tired and I didn't go back to bed right after breakfast.

So, the question is, do you have anything to keep you occupied? Are there things you're interested in?

Is that what is making you sleep all the time?

UserANONYMOUS
Forum Moderator


Date Joined May 2011
Total Posts : 4409
   Posted 9/18/2017 7:16 AM (GMT -7)   
Hi kellyinCali,

This sounds like you are experiencing hypersomnia which usually occurs during the periods of depression in bipolar disorder.

Are you on any meds for your Bipolar. Sometimes, it can be a side effect of the meds.

I hope you find some answers and feel better.

UA
Moderator - Bipolar

kellyinCali
Regular Member


Date Joined Apr 2009
Total Posts : 292
   Posted 9/18/2017 10:24 AM (GMT -7)   
TimTam: Are you in an area affected by the hurricanes? I am so thankful that you are okay and of course posting with us again.

You wrote: /So, the question is, do you have anything to keep you occupied? Are there things you're interested in?//

I think boredom is part of the problem. I lost interest in things that used to bring me pleasure. Which comes first? The chicken or the egg? I was also put back on Latuda at 20mg. I am learning that most A.P.'s, hypersomnia, somnolence and sedation is a side effect. I've decided to not fight it. I had Ovarian Cancer on top of many other health and financial challenges for years. Perhaps my body needs a chance to relax. Even though I am not as productive as I'd like to be, there is an upside in that it may be producing healing from long term stress.

kellyinCali
Regular Member


Date Joined Apr 2009
Total Posts : 292
   Posted 9/18/2017 10:31 AM (GMT -7)   
UA: I was given "Latuda" which is an A.P. that has been FDA approved for "Bipolar Depression." I recently came across a letter from Department of Health and Human Services to Sunovian Pharmaceuticals coming down on them for failing to disclose information from trials.

//Bridget Walton, MS, RAC
Director, Regulatory Affairs
Sunovion Pharmaceuticals, Inc.
One Bridge Plaza, Suite 510
Fort Lee, NJ 07024

RE: NDA 200603
LATUDA® (lurasidone HCl) Tablets
MA #86

Dear Ms. Walton,

This letter notifies Sunovion Pharmaceuticals, Inc. (Sunovion) that the Office of Prescription
Drug Promotion (OPDP) of the U.S. Food and Drug Administration (FDA) has become aware
of oral statements made by a Sunovion sales representative on May 17, 2011, to a
healthcare professional regarding its drug, Latuda® (lurasidone HCl) tablets (Latuda). The
sales representative’s statements are false or misleading because they promote an
unapproved use and minimize the risks associated with Latuda. Thus, this promotional
activity misbrands Latuda in violation of the Federal Food, Drug, and Cosmetic Act (FD&C
Act), 21 U.S.C. 352(f)(1), (n).

Background

Below is a summary of the indication and most serious and most common risks associated
with the use of Latuda.1

According to its FDA-approved product labeling (PI) (in pertinent
part):

Latuda is indicated for the treatment of patients with schizophrenia.
The PI for Latuda includes a Boxed Warning regarding increased mortality in elderly patients
with dementia-related psychosis. Contraindications for Latuda include known hypersensitivity
to lurasidone HCl or any components in the formulation, and strong CYP3A4 inhibitors and
inducers. The PI also contains Warnings and Precautions regarding: cerebrovascular
adverse reactions; neuroleptic malignant syndrome; tardive dyskinesia; metabolic changes,
including hyperglycemia and diabetes mellitus, dyslipidemia, and weight gain;
hyperprolactinemia; leukopenia, neutropenia, and agranulocytosis; orthostatic hypotension
and syncope; seizures; potential for cognitive and motor impairment; and suicide.

The most commonly reported adverse reactions for Latuda (incidence ≥5% and at least twice
the rate of placebo) were somnolence, akathisia, nausea, parkinsonism, and agitation.
Promotion of Unapproved Uses

On Tuesday, May 17, 2011, at approximately 1:40 PM, a sales representative from
Sunovion made a sales call to a psychiatrist at his office. During this sales call, the sales
representative indicated that Latuda is only approved for schizophrenia use, but studies for
use in bipolar disorder are being done and it is only a matter of time before it is approved for
bipolar disorder. The sales representative continued the discussion of the unapproved use
of Latuda for bipolar disorder by pointing out that two other psychiatrists in the area are
using Latuda for the treatment of bipolar disorder, and both are pleased with the results in
these patients. Overall, the sales representative spent a considerable amount of time during
the sales call discussing the off-label use of Latuda in the treatment of bipolar disorder.
According to its PI, Latuda is only indicated for the treatment of patients with schizophrenia.
Therefore, the oral statements made by the sales representative misbrand the drug by
suggesting a new “intended use” for Latuda for which the PI lacks adequate directions for
use.2

OPDP acknowledges that the sales representative stated that Latuda is only
approved for schizophrenia and that use of Latuda for the treatment of bipolar disorder is
off-label; however, these statements do not mitigate the misleading overall impression
created by the sales representative during the sales call that Latuda is safe and effective for
the treatment of bipolar disorder.

Minimization of Risk Information/Unsubstantiated Claim
During the sales call, the sales representative minimized the risk of common adverse
reactions associated with Latuda treatment. For example, in this discussion, the sales
representative indicated that somnolence can occur during the beginning of treatment;
however, it usually goes away after a week. FDA is not aware of substantial evidence or
substantial clinical experience to support this claim. The PI does not include any information
indicating a decreased risk of somnolence over time. In fact, we note that the PI includes a
WARNING AND PRECAUTION regarding the potential for cognitive and motor impairment,
which states the following (in pertinent part):

LATUDA . . . has the potential to impair judgment, thinking or motor skills.
In short-term, placebo-controlled trials, somnolence was reported in 22.3% (224/1004) of
patients treated with LATUDA compared to 9.9% (45/455) of placebo patients,
respectively. The frequency of somnolence increases with dose; somnolence was
reported in 26.5% (77/291) of patients receiving LATUDA 120 mg/day. In these short­ term trials, somnolence included:



hypersomnia, hypersomnolence, sedation and somnolence.



Patients should be cautioned about operating hazardous machinery, including motor
vehicles, until they are reasonably certain that therapy with LATUDA does not affect
them adversely.

Additionally, as noted in the ADVERSE REACTIONS section of the PI, somnolence was
reported as one of the most common adverse reactions associated with the use of Latuda
during clinical studies. If you have any evidence to support such claims, please submit it to
the FDA for review.

Conclusion and Requested Action

For the reasons discussed above, the oral statements made by the Sunovion sales
representative misbrand Latuda in violation of the FD&C Act, 21 U.S.C. 352(f)(1), (n).
OPDP requests that Sunovion immediately cease violative promotional activities/materials for
Latuda such as those described above. Please submit a written response to this letter on or
before December 28, 2011, stating whether you intend to comply with this request, listing all
promotional materials (with the 2253 submission date) for Latuda that contain violations such
as those described above, and explaining your plan for discontinuing use of such violative
materials. Please direct your response to the undersigned at the Food and Drug
Administration, Center for Drug Evaluation and Research, Office of Prescription Drug
Promotion, Division of Professional Promotion, 5901-B Ammendale Road, Beltsville,
Maryland 20705-1266 or by facsimile at (301) 847-8444. Please note that the Division of
Drug Marketing, Advertising, and Communications (DDMAC) has been reorganized and
elevated to the Office of Prescription Drug Promotion (OPDP). OPDP consists of the
Immediate Office, the Division of Professional Promotion (DPP) and the Division of Direct-toConsumer
Promotion (DDTCP). To ensure timely delivery of your submissions, please use
the full address above and include a prominent directional notation (e.g. a sticker) to indicate
that the submission is intended for OPDP.

In addition, OPDP recently migrated to a different tracking system. Therefore, OPDP letters
will now refer to MA numbers instead of MACMIS numbers. Please refer to MA# 86 in
addition to the NDA number in all future correspondence relating to this particular matter.
OPDP reminds you that only written communications are considered official The violations discussed in this letter do not necessarily constitute an exhaustive list.

It is your responsibility to ensure that your promotional materials for Latuda comply with each
applicable requirement of the FD&C Act and FDA implementing regulations.

Sincerely,
{See appended electronic signature page}
Jessica N. Cleck Derenick, PhD
Regulatory Review Officer
Division of Professional Promotion
Office of Prescription Drug Promotion

Tim Tam
Veteran Member


Date Joined May 2016
Total Posts : 1084
   Posted 9/18/2017 12:13 PM (GMT -7)   
Kelly: Thank you for asking about the hurricane situation.

You're worried about me, I was worried about forum moderator, UA, out there near the Atlantic Ocean below Cuba where the storm might have been somewhat nearby.

We were hit by 60 mph winds and a lot of rain which uprooted trees which knocked out power lines, which knocked out my electricity, my TV, my computer and my phone.

Since I don't drive, I'm just sitting here, sleeping. Finally after 6 days it came back on.

I think Florida had millions without power, and it could have been a couple of weeks or more before they got power back.

But enough about my troubles, now I want to talk about yours so I can forget about mine.

OK, where were we? Your Pdoc said what you describe as "excessive sleep" is bipolar depression."

Well if it's depression, why doesn't he give you an effective anti-depressant?

I'm giving this guy 3 more weeks, no, actually 4. I mean, I've had it with this guy.

You say, "Those of you with Bipolar, have you heard of this before? When do your depressive episodes strike the most?"

I'm bipolar, and all through the summer, and here at the start of the fall, I have not been depressed. I haven't been depressed in 10 years, probably 20, once on an anti-depressant (sinaquan and not for last 3 or 4 years, Mirtazapine).

I was depressed for a month or two, and an hour or two after taking my first anti-depressant (sinnaquan) I was no longer depressed and I haven't been depressed in 35 years, which is how long I've been taking anti-depressants.

So what is this seasonal depression in sunny California stuff?

Again, have you ever had mania? Or, hypomania? No, to all previous questions about mania, but yes to the one about going from topic to topic, or project to project.

You earlier said, "I am going to keep a journal of my sleep cycles and my mood cycles. If I start to "go down" again without a good reason, I will go back on the Latuda."

So you're now back on Latuda, which the net says is an anti-psychotic, althougth you said, "if at all possible, I want to avoid the anti-psychotics."

OK, anti-psychotics, I was on one, Stelizine (sp?) and all I wanted to do was keep walking, and it took away my emotions, good and bad. No doctor since has prescribed it.

Drugs.com says of Latuda side effects may include:

• • drowsiness;
• • feeling restless or being unable to sit still; or
• tremors, muscle stiffness, problems with muscle movement.
• inability to sit still
• incremental or ratchet-like movement of the muscle
• mask-like face
• muscle discomfort
• muscle trembling, jerking, or stiffness
• need to keep moving
• restlessness
• rigid or stiff muscles
• shakiness in the legs, arms, hands, or feet
• tiredness
• unusual tiredness or weakness

That's the ones I had, and you said tiredness. Do you have any of the above?

Could you get a 2nd opinion about what you might have and what meds might treat that?

kellyinCali
Regular Member


Date Joined Apr 2009
Total Posts : 292
   Posted 9/18/2017 3:50 PM (GMT -7)   
TimTam: I'm the one that got the "rash" from Lamotrogine. (It is still visible, possible scaring). I think he's prescribing Latuda as an "anti depressant" because it was approved by the FDA for "Bipolar Depression. I have come to accept that I am likely Bipolar II because I do have atypical depression in that I can come "up" from depression to what feels like the "normal me" but I've never had full blown mania. I wish I could get a proper diagnosis because I am just not sure. If P-doc thinks my hypersomnia is due to "bipolar depression" and "hibernation" (except the seasons are off???), I can't be confident that is it when clearly the med causes "hypersomnia, somnolence and sedation." Refer to the letter I posted in the above comment to U.A. I think it is more likely that the Latuda is causing my excessive need for sleep. I'm not nearly as depressed as I was when I started posting again but I don't want to go through "the longest and deepest depression of my life" again like that so I'm afraid to wean off of the Latuda. On the other hand, not being productive and sleeping excessively affects my mood and quality of life negatively because Major Depression put all aspects of my life on Hold for a while as I could barely function enough to take care of myself and my 3 fur-kids. I probably need a 2nd opinion to be certain but I'm at the mercy of my Health Insurance which leaves much to be desired. One day at a time and pick your battles b/c that's what needing health care feels like for me.d..battles. sad Sadly, I find my experiences with the medical community to be demoralizing. I also think PCP's tend to think Psyche patients all have "health anxiety" and don't take us seriously enough.

Tim Tam
Veteran Member


Date Joined May 2016
Total Posts : 1084
   Posted 9/18/2017 5:57 PM (GMT -7)   
Kelly: I went to the net and found some things.

1. On web.md, it said, “Signs It’s Time For a Switch” (of meds):

"It’s important for you to notice how you’re doing, too. Let your doctor know if you (one sign was): “Are running low on energy or feeling really sad or hopeless.”

When It’s Time for a Transition: “If you suspect your medication isn’t managing your bipolar disorder the way it used to, or you just don’t feel good, see your doctor right away,” says Michael F. Grunebaum, MD, a research psychiatrist at New York State Psychiatric Institute in New York City.

2. Bipolar Disorder: Ask the Expert (on web.md website)

"Bipolar disorder is often misunderstood. To help, WebMD’s health team takes your questions to leading experts on bipolar disorder. Bookmark this page and check back. We’ll be adding more of your questions and finding expert answers."

Sample questions:

•Is there a cure for bipolar disorder, or do I need to stay on medications for the rest of my life?
• Q: How stable should my moods be when I'm on medications? I don't feel like I'm improving much.
• Q: How can I tell if I'm going into a depression cycle, or I'm just in a bad mood?
• Q: I think someone I know has bipolar disorder. How can I tell? What should I do?

Ask Your Question

-------------------------------------------------

(Kelly, if you want to ask them about Latuda or anything else, you can tell me the question(s), and I can type it in, or you can go to web.md, and look for their "ask the expert" section.

Maybe they have a "search for your topic" at top right of first page on their website) Or, just keep scrolling down on their "bipolar" section, and I found a "list of topics" and one of them was "ask the expert."
----------------------------

3. Doctors almost always prescribe medication for people with bipolar disorder. So your first step is to seek out a professional who has experience treating the condition. In most cases, this will be a psychiatrist.

Find someone you like and trust. Since you'll be seeing a lot of each other -- at least at first -- it's important to have a good working partnership. If you don't feel comfortable around your doctor, you might not be open about symptoms or side effects of your medication.

4. You should find a qualified therapist, preferably one who knows a lot about mood disorders and has experience treating them. Ask your doctor for recommendations. Or get in touch with an organization like the National Alliance on Mental Illness (NAMI) or the Depression and Bipolar Support Alliance (DBSA).

5. Reviews for Latuda to treat Bipolar Disorder

(below is drugs.com comments)

(On net search engine, I typed in “Latuda for bipolar disorder” and hit “go”. After several ads at top of list of some 10 such websites that talked about Latuda reviews, the first entry was “drugs.com, reviews for latuda”)

Reviews

"I took latuda for a little over a year and I had so many side effects. I was so tired all the time, I couldn't function at work and I was a cashier, my throat got smaller, I would gag brushing my teeth and I used to be able to take 3 pills at once without a problem. When I was on latuda I could barely swallow one and I still gagged. I had memory loss, weight gain. I was miserable and I couldn't figure out why. Then I realised that it was latuda. So, I got weaned off of it and I felt 10 million times better, I lost 50lbs since I've been off of it, I can function again, my memory is slowly coming back and I don't gag when I brush my teeth and I can swallow more than one pill without gagging."
1.0

(keep scrolling down until after the ads for the 2nd and 3rd etc. reviews of latuda)

"I've only been on this med for 5 days and I feel FABULOUS!!! On my last 40 mg dose today & then upping to 80. It's been a year of hell on my antidepressants with cycling up & down. I call it the the roller coaster of emotions. My depression would only improve for a short time & then I crashed back down. I can't believe how amazing I feel in such a short amount of time. So thankful!!!!"
10
JJinTX (taken for less than 1 month) September 1, 2017
4 users found this comment helpful.
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"I started on 20 mg of Latuda for bipolar and anxiety disorder. I felt the same as I always do during the first week of starting latuda. Then I upped it to 40 mg a week later and about an hour later I felt super tired , dizzy , confused , slow heart beat , and UN aware of what was going on around me. And to make it all worse I had trouble sleeping. But I felt so weak like I needed to sleep but couldn't. I'm unsure whether I should continue or discontinue it. Overall rating on this drug would be a 5. Those were terrible side effects and they hit me hard."
5.0
Annon11223 August 30, 2017

kellyinCali
Regular Member


Date Joined Apr 2009
Total Posts : 292
   Posted 9/19/2017 6:08 AM (GMT -7)   
Thank you, TimTam for your response. I will check out the WebMD site for questions. The reviews I've read for Latuda are very mixed. Some love it. Some hate it. The only mood stabilzer he has prescribed to me is "Lamotrogine" and he was really bummed I got "the rash." I guess Lithium is not the first choice for Bipolar II as it is mostly to manage "mania" and with II, depression is the primary reason for needing meds. I have to do a lot of self investigating because the Med Roulette route is destabilizing to an already unstable brain.

Glad you have your electronics back. I can't imagine 6 days without power.

theHTreturns...
Elite Member


Date Joined Mar 2009
Total Posts : 19942
   Posted 9/19/2017 6:21 PM (GMT -7)   
i did 3 months once without power!!!

and then again i was homeless on the streets at one point.

u learn to adapt.

Tim Tam
Veteran Member


Date Joined May 2016
Total Posts : 1084
   Posted 9/19/2017 6:47 PM (GMT -7)   
Only the strong survive.

kellyinCali
Regular Member


Date Joined Apr 2009
Total Posts : 292
   Posted 9/20/2017 7:41 AM (GMT -7)   
Wow...you guys are strong.

I am sitting here in tears because I am soooooo TIRED of being TIRED (and in pain) and I can't seem to stabilize / normalize and I wish I could just give up. Of course, I know that I have no chance but to exist and hope for the best. At least I have a roof over my head for the time being.

Tim Tam
Veteran Member


Date Joined May 2016
Total Posts : 1084
   Posted 9/20/2017 10:20 AM (GMT -7)   
Kelly,

You said, "I am sitting here in tears because I am soooooo TIRED of being TIRED (and in pain) and I can't seem to stabilize / normalize and I wish I could just give up. Of course, I know that I have no chance but to exist and hope for the best. At least I have a roof over my head for the time being."

That's true, Kelly. Turtle said he was without electricity for 3 months, and for some of that he was homeless on the streets. So you've got no complaints.

Here's what it said on the mayoclinic.org:

"Is treatment for bipolar I different from treatment for bipolar II?
Answers from Daniel K. Hall-Flavin, M.D.

"Treatment for bipolar disorder, formerly called manic depression, generally involves medications and mental health counseling (psychotherapy) — whether you have bipolar I or bipolar II. Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis.

"While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.

"The types and doses of medications prescribed are based on your particular symptoms. Whether you have bipolar I or II, medications may include:

•Mood stabilizers. You'll typically need mood-stabilizing medication to control episodes of mania or hypomania, which is a less severe form of mania. Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro) and lamotrigine (Lamictal).

•Mood-stabilizing antipsychotics. If symptoms of depression or mania persist in spite of treatment with other medications, adding an antipsychotic medication such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help. Your psychiatric care provider may prescribe some of these medications alone or along with a mood stabilizer.

•Antidepressants. Your provider may add a certain type of antidepressant to help manage depression. Because an antidepressant can sometimes trigger a manic episode, it needs to be prescribed along with a mood stabilizer or antipsychotic in bipolar I disorder.

•Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer. Symbyax is approved by the Food and Drug Administration specifically for the treatment of depressive episodes associated with bipolar I disorder.
------------------

You said, "The only mood stabilzer he has prescribed to me is "Lamotrogine" and he was really bummed I got "the rash." I guess Lithium is not the first choice for Bipolar II as it is mostly to manage "mania" and with II, depression is the primary reason for needing meds."

So, I guess I'm wondering, are you on both a mood stabilizer and an anti-depressant? Or an anti-psychotic for both, I'll guess.

The one that you are on makes you so sleepy you can barely take care of your cats, which others have reported on your med.

Can you mention this to your doctor next time? When is the next appointment?

kellyinCali
Regular Member


Date Joined Apr 2009
Total Posts : 292
   Posted 9/20/2017 10:28 AM (GMT -7)   
Tim Tam, presently I am prescribed:

SSRI: Prozac 60mg (recently increased then decreased then increased again). I tolerate this med as I've taken it in the past.

AP: Latuda 20mg. This drug caused "hypersomnia, somnolence, and sedation." A lot of people comment with the same complaints. I started it on 7/30 and it has improved the "deep depression."

I am just so tired of being tired. Being tired "all of the time" is depressing! sad

Tim Tam
Veteran Member


Date Joined May 2016
Total Posts : 1084
   Posted 9/20/2017 10:47 AM (GMT -7)   
Anyway you can get off of the anti-psychotic that makes you so sleepy? Get another one, or just an anti-manic stabilizer like I'm on, Lithium? I take Mirtazapine for the anti-depressant side.

When is your next appointment?

What is your situation? Why are you about to lose your apartment in a few months?

kellyinCali
Regular Member


Date Joined Apr 2009
Total Posts : 292
   Posted 9/20/2017 3:30 PM (GMT -7)   
TimTam: I am going to ask my P-doc about Mirtazapine. Interesting medication. In seems to be in a class of itself. My next appointment is 3 weeks. I have decided to try to half my dosage (from 20mg to 10 mg.).



//Mirtazapine, sold under the brand name Remeron among others, is an atypical antidepressant which is used primarily in the treatment of depression.[7] In addition to its antidepressant properties, mirtazapine has anxiolytic, sedative, antiemetic, and appetite stimulant effects and is sometimes used in the treatment of anxiety disorders, insomnia, nausea and vomiting, and to produce weight gain when desirable.[7][8] It is taken by mouth.

The drug acts as an antagonist of certain adrenergic and serotonin receptors, and is also a strong antihistamine.[7] It is sometimes described as a noradrenergic and specific serotonergic antidepressant (NaSSA),[7] although the actual evidence in support of this label has been regarded as poor.[9] Chemically, mirtazapine is a tetracyclic antidepressant (TeCA), with four interconnected rings of atoms, and is a relative of the TeCA mianserin (Tolvon).[10][11]//

This med sounds good to take at night as you do. I take the Latuda at night now and you must eat a 350 calorie meal with it. Most people dislike that requirement because they fall asleep just a couple of hours after taking it. Unfortunately, it causes me to feel tired ALL DAY. I'm in bed way too many hours but I'm not sure how much quality sleep I am getting after about 6 hours.

I will not lose my apartment until the end of January. I am on Fed Disability. The cost of living is too high in California. It's a "Landlord's Market" in every sense and I've been struggling for a long time. I finally had to move out to the High Desert. It would be better if I could relocate but the cost to relocate is a factor. I'm thankful for what I have but I'm at that age where thoughts and regrets pop into my mind frequently. I wish I had made better choices but I didn't know then what I know now. Life goes on and we must play the hand we are dealt.

Tim Tam
Veteran Member


Date Joined May 2016
Total Posts : 1084
   Posted 9/20/2017 4:14 PM (GMT -7)   
1. If you take an anti-depressant, let's say, Mirtazapine like I do, as a bipolar II, as I believe you think you are, don't you also need a stabilizer, like I'm taking (Lithium in my case) so that the anti-depressant doesn't throw you into mania?

2. You say, "I have decided to try to half my dosage (from 20mg to 10 mg.)."

I think that's great. Except, you know, doing that without consulting your doctor has to be taken into consideration.

Through a series of errors, some mine, some the doctor's, I did that and it was a huge mistake.

So, I would use caution, to say the least.

My mirtazapine was causing me bad side effects (causing my toes, muscles, to twitch 15-30 minutes after I took it, and causing a huge increase in appetite. I didn't connect that to taking the Mirt, for some reason, and I went a couple of years like that, as I recall.

I told my psychiatrist about that, and she cut the Mirt in half, and those side effects disappeared immediately.

That's one reason I had concern about your being very sleepy all day long. I was thinking, that's from the medicine. That's either the wrong medicine, or too much medicine, because I've gone a long time with what turned out to be bad side effects.

I was thinking, there is no need for her to be in that all day sleepy state.

So my doctor cut me back to half and it worked like a charm. Realize, you could go back to whatever your original condition was before you started taking the med.

Also, I've finally learned, another way to cut back on pills is to:

1. last night you took your full pill.
2. Tonight, cut back to one half.
3. Tomorrow night, take you full pill again.
4. The next night take one half a pill.

Keep doing that as long as you think you should.

That way you are tapering more slowly.

Might look on the net to see what they say about going off of your medicine.

Again, you should also consider asking your doctor about cutting your dosage in half. These are all my opinions as a bipolar person.

My psychiatrist is a good psychiatrist and she recommend Mirtazapine to me.

I take 7.5 mg a night. I was 15 mg. and she cut it in half because of the side affects.

Mirt does help you go to sleep, I'm told. I also take 1 mg. of Melatonin from health food store for sleep.

You say, "I'm thankful for what I have but I'm at that age where thoughts and regrets pop into my mind frequently. I wish I had made better choices but I didn't know then what I know now. Life goes on and we must play the hand we are dealt."

Once we get unsleepy, maybe we can get on with our life. Can you go forward? Can you put your energy into other things?

I have things I regret, also. But the anti-depressant helps me get over that. I hope the Mirt will do the same for you.

Why will you lose your apartment in January? What are you going to do then?

kellyinCali
Regular Member


Date Joined Apr 2009
Total Posts : 292
   Posted 9/22/2017 1:26 PM (GMT -7)   
TimTam:

Re:

1) I have been taking 60mg of Prozac and 300mg Wellbutrin (this one for 13 years). I do not experience "mania" as it is described. I come up to what feel "normal and good" and sometimes I do get irritable and have racing thoughts. Most of the behaviors listed for "mania" do not fit me.

2) Thank you for your advice about "weaning." I will not be able to see the Pdoc for 2 more weeks, so I am going to half the dosage tonight. The worst thing that can happen is that I get "more depressed." Since I've been taking it since 7/30, why am I still getting depressed? I tried a "higher" dosage and there is just no way I can tolerate it. Latuda is a 2nd generation anti-psychotic. I do not have full blown mania OR any psychotic features. My biggest complaint is depression, however, I admit I do not experience it at the same level every single day which is why they probably suspect I am bipolar II. I relate a lot to the descriptions for "atypical depression" which as it turns out is actually more typical of depressed patients.


You wrote: //Once we get unsleepy, maybe we can get on with our life. Can you go forward? Can you put your energy into other things?//

Precisely! I know that I am supposed to be proud of myself for doing the bare minimum but I've reached my end for patience with this hypersomnia, somnolence and sedation. I am the type of person who feels good when I "check something off of the list."

I have no idea where I will end up living. I would like to relocate out of Cali for financial reasons, but the cost of relocating myself and 3 pets is more than I can afford. A catch 22. Thinking about it makes me very anxious. Another reason I need get "unsleepy." I have some big things to face and I can't do it with brain fog and depression. sad

theHTreturns...
Elite Member


Date Joined Mar 2009
Total Posts : 19942
   Posted 9/22/2017 8:52 PM (GMT -7)   
yep we deal with the cards we are dealt with, this our way of being in the world, and gives us all our unique qualities. tim tam has been giving you some good insights.

o/t. i was homeless for 3 months on the streets, then crisis accom, dirty hostels and a mens refuge for 2 and a half yrs. this is because my family kicked me butt out. had no contact for 3 yrs. first night at the mens refuge i had my wallet, meds, tape recorder and my tobacco stolen. since then i have been stable, relatively....a few lengthy admissions and ect and some hard hardships along the way. but these are my cards, you can change the sequence, this is the key. i have learnt soooo much and yes stronger.....wiser. it is the learning of lifes experiences that fosters growth and perspective. as a dear friend said to me, u are enough.

kellyinCali
Regular Member


Date Joined Apr 2009
Total Posts : 292
   Posted 9/23/2017 9:30 AM (GMT -7)   
You have given me good insight too, HT. I am sorry that you had to go through that.

We play the cards we are dealt and we can change the sequence. I like that. So true!

I am not on a "mood stabilizer" b/c I got the Lamictal Rash. However, I would really like to try it to see what happens 'long term' on a mood stabilizer. I read an article about how strict adherence to the DSM prevents P-docs from dx bipolar but it is actually much more of a SPECTRUM and the more I think about it, the more I think I have it. Good grief, there are even "mixed states." Yuck! At this point, I do have good days in between the mostly bad days.

Yesterday, I got my blood drawn for everything under the sun that can cause fatigue. R.A., Lupus, full thyroid panel. I know I will have to "fight" hard for a sleep test if it comes to that. I have lived alone without a partner for 10 years. Nobody is there to observe my sleep. Do I snore? Do I stop breathing? Do you sleep with the alien? smile

theHTreturns...
Elite Member


Date Joined Mar 2009
Total Posts : 19942
   Posted 9/23/2017 8:12 PM (GMT -7)   
the alien is my friend. he hated me at first and i he. soz that i am not as with it, tim tam doin' good, bad concentration and reading large content i find hard these days with my dickie eyes!! eye, 1 is blown. yes, i need to see me eye man, been tardy there.

yep mixed states. i know all about em. and in the past i was rapid cycling with them. and still do have rapid cycling dreams, which i will trade mark one day!!
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