Massive high

[Russell]

Okay guys, you're all brilliant! I have made a few life changes. I have volenteerd as a tour guide for a Victorian tour guide, been invited to join the Buddhist order and started my teaching degree in the past 7 dayo. I am now on such a massive high it actually hurts! How do I handle this? I know this will lead to the inevitable low. Is this the other side of venlaflaxin? Or should I just go with it? Feel like I could go for 10 days without sleep.

[SteveW]

While the idea of a Buddhist guide to Victorian England appeals to me and I favour teachers getting as far as they can with qualifications, I think we'd have to admit that Venlafaxine isn't proving to be a run away success. Your mood is still cycling and this high seems to be higher than you have experienced before. You haven't done anything disastrous but that is more by luck than judgement.

Maybe it is time to get a definite diagnosis of Bipolar and more effective medication than Venlafaxine. GP's are very variable in their
willingness to make psychiatric diagnoses. Some are happy to do it, others prefer a referral to a specialist agency which is usually
your local Community Mental Health Team. I would return to my GP and say I think I am definitely Bipolar and need different medication. If he will do that, great. If he won't then you ask for a referral to your CMHT.

That can take a while so you might need to ask for something to tide you over until your CMHT appointment came through.

You probably could go 10 days without sleep.I had the misfortune of being on a psychiatric ward with a guy who went night after
night without sleep.


Love

Steve

[Russell]

Thanks for that Steve!
I totally agree,this high is almost physically painful. Yet last Thursday,I thought my suicide was inevitable. Venlafaxine seems to amplify my moods and increase the frequency of swings.I have a follow up appointment on Wednesday morning,in which I will give your suggestions to my GP. I have no doubt that I am bipolar and can only emphasise how frightening the lows are.

[Pip]

Good news that you are happy.  Volunteering does help as it keeps your mind occupied on something constructive.  If someone had told me three years I would be helping out with a lunch club I would have laughed.  I started at one that's on a Friday then we moved to another town so I only continued until last Christmas.  By that point I was helping out at another one twice a week which is virtually on my doorstep so gave the first one up.  The lunch club I still do twice a week also does meals on wheels as well.

[Russell]

What medication should I be expecting from GP,if they take me off venlaflaxin?

[Grace]

I presume you need a mood stabilizer and Venlafaxine (Efexor) is an SNRI
There are a few alternatives for mood stabilizers depending on your particular kind of Bipolar, whether you tend to go more on a high mood or on the depressed side. This has to be properly diagnosed by a specialist.
I would certainly wait for the day after tomorrow to see the GP, but as Steve said you may have to take the initiative to go see a psychiatrist who can make this kind of diagnoses.
My best wishes Russell ..... with the right medication you will certainly feel better!

Grace

[SteveW]

What you might be prescribed depends on a couple of things. The first is whether you are still cycling or if you have settled into a high and are staying there. If your high is more or less there all the time a doctor might want to bring you out of it before attempting long term stabilization. There are a number of anti psychotics that would do that. Quitiapine was popular for a while but there are 4 or 5 choices at least.

If a doctor decided to go straight to mood stabilization I think Lithium and Depakote are the most common still but there are a good
few choices. Your GP might not want to start you on Lithium. You have to have various blood tests before you start and while you are taking it. My GP refuses to initiate Lithium treatment. He prefers to leave that to the Community Mental Health Team.
 
When I was in hospital I was amazed at the amount of benzodiazepine tranquillizer Clonazepam that people with Bipolar were on. This was to keep people calm while everyone waited for the mood stabilizer to kick it. Whether a GP would consider this use I am not sure.

[Russell]

Went to GP this morning,said I had been on this forum,and the intensity of the highs and lows I have been experiencing. The doctors answer-"Well what do you think we should do about it?" Not exactly helpful I have now been given Sertraline 50mg to take every other day witk venflaxin. Still no nearer a proper consultation. Still on a high which is good news,but what will the next low bring?

[Grace]

Dear Russell,

I really don't understand the rationale for this new prescription of Venlafaxine with Sertraline. Did the doctor make a diagnosis?
If I were you I would try to get an appointment with a specialist! I do not know anything about NHS (I live in another country) but you need to get a second opinion. Otherwise I would go to a private doctor ..... but that depends also on the honorarium they might charge in England.
I wish someone else on the forum can advice you, in the hope that I'm not seeing it right!

Grace

[SteveW]

"Well what do you think we should do about it?" isn't a really very helpful question to someone who doesn't have a fair degree of
sophistication in psychotropic drugs. His thinking puzzles me. Venlafaxine is a SSRI/SNRI drug. It increases the amount of Serotonin and Noradrenaline in the gaps between nerve cells. Sertraline is an SSRI which increases Serotonin. Too much Serotonin can be a bigger problem than too little, it can trigger a syndrome that can kill you. Why the alternate day taking of Sertraline I haven't the faintest idea.

I hesitate to mention it but sexual problems come into things. The people I met who had sexual problems on Venlafaxine  have generally experienced delayed or lack of ejaculation. I read a document from the then patent holders for Sertaline. They went the whole hog and just described the percentage experiencing "impotence." This is not the area of drugs I would really be keen on you exploring.

I think it may be time for some more specialist intervention. You have described the classic symptoms of BiPolar twice to your GP. If he is not going to make a definite diagnosis he really ought to be thinking about referring you to someone who can. It shouldn't be a problem for him. GP's refer people to specialists every day. That means referral to the Community Mental Health Team. They do have waiting lists. There is nothing to stop your GP from ringing the CMHT psychiatrist and explaining your situation and asking for advice on how to proceed pending a CMHT appointment coming through. I think that is a perfectly reasonable use of a specialist psychiatrist.

I would probably write my GP a letter requesting CMHT referral since you only saw him today and drop it off at the surgery. There are also plenty of test if you are bopolar pages on the Internet. Downloading one, filling it in, and including it with the letter would be a good idea.

In the meantime I will keep my fingers crossed that things don't get worse. If they do there is always the Crisis Team but I think they wouldn't regard you as deep in crisis yet.

Love

Steve

[Pip]

Have you thought about getting a second opinion from another GP?

There are doctors in our surgery who are the ones to see for diabetes or angina or other specific needs.  It's worth asking to see another doctor.   

[Russell]

I have seen 3 different doctors over the past 3 weeks at the same practice and they all spout the same thing. I was supposed to have an appointment with Solihull Healthy Minds 2 months ago,which hasn't materialised yet. Rang them today,told them about my recent obsession with jumping in front of a train,on my low days,and that seemed to make them take notice. I really have no idea what to do. I feel great ATM. Loving life,no sexual disfunction,sleeping well,no headaches etc. Are the venlaflaxin kicking in? Do I try the new meds? Totally confused ,but happy for now.

[Russell]

I have decided to stick with venlaflaxin and it really seems to be working. Still waiting on Healthy Minds Solihull after 10 weeks and requests from myself and GP. Other meds made me tired and out of it. Feeling good for now.

[SteveW]

Sorry not to have replied sooner. I have spent a day and a half as decorators labourer. We bought a load of Amazon posters that had been priced wrongly. They honoured the contract with us and we ended up with about twenty posters for about £5. Deidre decided she wanted to move them all around.

I am glad you are still feeling OK. I dug out my old case notes on two people with bipolar  who were on Venlafaxine and found they were both also on mood stabilizers as well, both Depakote. I decided to look up what Venlafaxine is officially licensed for and found that it has four licensed indications.

Major Depressive Disorder
Generalized Anxiety Disorder
Social Anxiety Disorder
Panic Disorder with or without Agoraphobia

You'll notice the absence of Bipolar Disorder in the list and the fact that you don't fit into any of them that are on the list. I can't see you having some weird presentation of Major Depressive Disorder. It is impossible to ignore the cycling.

I think that having some form of specialist assessment from the Community Mental Health Team is the best way forward.

I was also concerned about thoughts of jumping in front of a train. When I was a kid of about 12 the mother of my best friend was on a station waiting for a stopping train a couple of feet away  from me. As an express train approached she simply walked to the edge of the platform and jumped off just in time to be hit by the front of the train.I won't go into details but the next couple of hours were horrendous.

You need a back up plan in case the impulse becomes too strong. The first thing is to remember that 999 deal in mental health as well as physical. Ring 999 and the paramedics will come pretty quickly. Then there is 111 . You tell them the problem and they will work out with you the best course of action. Bipolar can take you into some very deep lows.

Love

Steve

[Russell]

Having told my manager about my depressive issues/medication she has been very supportive,however I am coming down again and am scheduled for a meeting tomorrow which I really feel I cannot face. The meeting is in relation to a project manager role I had been promoted to, which I have subsequently stepped down from. I know this meeting will involve a personal attack on me/my performance ( a task I could perform in an empty room at the moment!). How should I approach this? Still not sure about my meds either and still no further with Solihull Healthy Minds.