I have a question I hope some of you can help me with because it's one that I'm confused about.
How do you know when the right time is to contact your pdoc?
For example, do you contact them if you're showing early signs of hypomania or mania or do you wait until your symptoms are moderate or severe?
The reason I ask this question is because I made the mistake of calling my old pdoc to tell him my tdoc said I was manic and I was starting to hear voices again.
Now that I'm seeing a new pdoc, I'm confused as to when the right time is to call him for a med adjustment.
I feel like I'm between a rock and a hard place since I'm a rapid cycler and my moods change often because of it.
How do I guage when to call my pdoc vs. when not to?
I don't want to call my new pdoc needlessly, but at the same time, I don't want to suffer uneccessarily either.
Any thoughts?
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN
I so feel responsible for your confusion, I am sorry my friend.
My tdoc alwasy says I am to call my pdoc at the first signs of when I start to feel manic, now whether this is because I rarely ever get manic or not and it's usually because of a major med change I don't know. but between tdoc and pdoc that's the rule.
As for med changes my pdoc would not let me just call and suggest a med change, that would only happen during an appointment in his office.
If you were hereing voices or psychotic I would call the pdoc immediatly. Remember you talked to your new pdoc about that and he said to call when this happened. So Call.
I know Kat, but thanks to my old pdoc, I'm always going to have the fear of being deserted by another pdoc. I've never had that fear before, but I do now.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN
Part of me wonders too if I could learn how to control my rapid cycling through DBT or CBT. This is something I plan to discuss with my tdoc at our next appointment.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN
Last edited by dreams in neon; 03-24-2009 at 12:22 PM.
It's very difficult for me to know the right thing to do since I'm a rapid cycler who experiences hypomania and mania 95% of the time. If my bipolar fell more on the depressed side, it would be easy for me to know when I need to call my pdoc.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN
Last edited by dreams in neon; 03-24-2009 at 12:25 PM.
Yeah we depressed peeps tend to never call our pdocs! *L*
I would definitely talk to your tdoc about them. What method of therapy does your new pdoc use? Like my pdoc is grounded in CBT as far as his practice goes. So he works on that type of therapy.
You might also talk about EMDR with your tdoc. That's what I've started with my tdoc. I do know that DBT centers on whatever specific "problem" you want to work on and correct. The one thing though it's not a slow process, my program is a 17 month program.
I don't think you can go to DBT for rapid cycling alone, but you could go to it for underlying issues that may contribute to the rapid cycling.
I can assure you it's not DBT, that is a totall different program all in itself, you'd know if the tdoc was using it on you, it's very different and would include a workbook that you had to do daily 'homework' in.
CBT is the most general therapy I think that pdocs/tdocs use. I know that my pdoc's general practice is psychodynamic psychotherapy and then uses CBT where needed. My tdoc also starts out with a form of CBT.
I have no idea if my tdoc incorporates CBT into my sessions or not.
I used to work with a tdoc many years ago who used CBT and it was a complete failure.
Of course, the tdoc left alot to be desired.
For example, she blamed me for the ambivalence I have about a certain taboo subject despite the abuse I experienced during my childhood and teenage years.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN
Last edited by dreams in neon; 03-24-2009 at 04:23 PM.
ummmmm...yeah she really sound like she knew what she was doing.
My tdoc questions it sometimes, but only as a means to an end. She wants to know if I've just given up of if I'm still using the alt. coping techniques, etc. Sometimes I just get tired of it all and have a "who cares" attitude. But she's never mean about it, it's more of a if she senses that attitude then she try's very hard to steer me back to a more proactive way of dealing.
My tdoc is the same way. He allows me to have my moments where I moan and whine about having bipolar, but he also encourages me to problem solve and think positively.
For instance, if I mention something negative about a given situation, he'll tell me all of the good things which I like because as you know, when you're depressed, it's difficult to look on the bright side.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN
It really depends. Depression, as soon as I recognize I am starting to get depressed, I call the next business day. I know depression will always, only get worse without adjustment.
Hypomania, only if it goes on a couple days or seems to be worsening, because that doesn't tend to get out of hand.
I've never called my pdoc when I'm hypomanic unless it has turned into mania.
As far as depression is concerned, if I feel suicidal, I call my pdoc right away no matter how long it has been since I rapid cycled.
If I cycle from mania to extreme anger to severe depression, I call immediately since I'm prone to psychotic depression.
Depression is very easy for me to recognize, but mania isn't. I need my tdoc's help in letting me know when I'm manic because I can't always tell the difference between feeling level and feeling really, really good. Sometimes they feel the same.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN
Last edited by dreams in neon; 03-24-2009 at 06:12 PM.
A friend of mine who has BPII suggested that I write down a list of my symptoms the next time I'm manic so I can better understand what's happening to me.
When I see my pdoc on Monday I also plan to ask him to write down some guidelines as to when I should call him so I can refer to this at a later time.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN
It interests me that you can't tell the different between your stable times and your manic stage.....when your stable are you generally in a pretty good mood?
Well, I should think the earlier the better. Do you keep a mood chart? Have a crisis plan, with a list of symptoms, some indicating early warnings, some for later on? And a list of what to do in each instance? Do this when you're feeling well, and then follow it when you're hypomanic, manic, or going into a depression.
I think you would benefit most from being very upfront with the new pdoc. Tell him of needing to know when to call him, tell him your fears about calling too often, and especially, tell him your fear about losing another doctor. You can get your boundaries set right from the beginning, and have the comfort of knowing it's okay (or not, as the case may be) to call in whatever situation.
If I were your doc, though, I'd want you to call ASAP when the early warning signals start. Easier to get this in hand than full-blown mania or severe depression, or even hypomania.
With your tdoc, ask for some specific coping techniques for the symptoms.
DBT is something everyone can use, bp or not. Mostly practical coping skills for the everyday. It can work really well on how we cope, how we can govern ourselves, how well we can manage our illness, deal with our relationships, navigate the world. I believe that in the DBT is the importance of the Crisis Plan and attention to the early signals.
Just be honest with the docs. I am sure they will appreciate it, too. It will help them know how to best help you. I call my pdoc whenever I start to go a little off. Sometimes just her all-back is what I need, knowing that someone is following me. She will listen to me, as usually I know what needs adjusting. But I always check it out with her.
However, I do not have the intense, rapid cycling you do, and I don't do SI or SH. I have tendencies, but have had enough years in illness now to be able to deal with them without acting on them.
****, am I going on and on, sound preachy? Forgive me if so. I am hypomanic, just now getting around to eating something for the first time today, and getting mighty wordy here. Yesterday I wanted not to exist. The carousel of bp.
I'm going to talk to my tdoc about trying DBT as a means of controlling my rapid cycling. I have other issues to deal with (such as PTSD and SH), so there is no rush as far as T is concerned.
My 2 sisters have the contact information for my tdoc (and soon, my new pdoc) as well as a list of warning signs for mania, depression and psychosis. I also keep the phone numbers of my doctors on my fridge in case a friend or family member visit. If I'm manic, depressed or psychotic, they have the means of getting in touch with them if need be.
I do write a mood chart. I bring it with me to my T appointments and my tdoc evaluates it to identify any patterns he notices in my cycling as well as any triggers that may be responsible for it.
I just need some coping strategies for when I'm manic, depressed or starting to hear voices. My problem is whenever I feel manic, severely depressed or I hear voices, I panic and don't know what to do -- even moreso now that my old pdoc deserted me when I needed his help the most.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN
Last edited by dreams in neon; 03-24-2009 at 08:40 PM.
Well, I should think the earlier the better. Do you keep a mood chart? Have a crisis plan, with a list of symptoms, some indicating early warnings, some for later on? And a list of what to do in each instance? Do this when you're feeling well, and then follow it when you're hypomanic, manic, or going into a depression.
If I were your doc, though, I'd want you to call ASAP when the early warning signals start. Easier to get this in hand than full-blown mania or severe depression, or even hypomania.
Seaturtle
For what it's worth, I think this is excellent advice. For me, it's much easier (and requires less medication) to nip these things in the bud before they get out of hand. Not to mention that depression for me is very dangerous, and hypomania makes me a miserable, grouchy mess.
I'm confused because I started hearing voices again last night. They sounded exactly the same way they did the other day -- many people talking at a moderate level, but I couldn't understand anything they were saying.
__________________
Atypical Bipolar I Disorder with Rapid Cycling
Meds:
Depakote 1500mg
Prozac 40mg
Risperdal 1mg titrating to 6mg/day
Klonopin .5mg (2x/day)
Trazodone 100mg or 200mg PRN
Last edited by dreams in neon; 03-25-2009 at 10:34 AM.
