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Old 10-29-07, 05:05 PM
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Can bipolar meds just quit working?

I know some medications for some disorders can stop working - antidepressants, for example. And a person can develop a tolerance to certain levels of some medications, like stimulants for ADHD.

But I was wondering about medications for bipolar, specifically Trileptal. Can it stop working, or can an individual develop a tolerance to it so that it is not as effective?

My husband has been on Trileptal for over a year, and just recently it REALLY seems like his moods have started to cycle again. It's much milder than before, when he was unmedicated, but it looks quite familiar.

Thoughts? His psychiatrist appointment is in a couple weeks, and we'll discuss with him all the possibilities. But I figured the people here could tell me whether bipolar medications just quitting working, of having a tolerance developed to them, was even possible. Thanks!
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Old 10-29-07, 05:18 PM
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Re: Can bipolar meds just quit working?

I think we can build a tolerence to most anything. Perhaps he needs to tweek it...or add something?

Has anything ...else changed...with this health or anything major..?

If he was a girl..I would ask his age....for the whole hormone thing....

Medication for Bipolar is only for a cessation of symptoms, not a cure. We will continue to cycle our whole lives. I have a wonderful combo and compared to where I used to be it's very good, but I still cycle....


IF you can have him keep a journal, or perhaps you can...and let the doc know how often and things going on when the cycles are happening...

BTW...

Welcome to ADDF and Welcome to the Cycling Team Section!


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Old 10-29-07, 05:22 PM
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Re: Can bipolar meds just quit working?

Diane, bipolars are subject to cycling forever, even with the best of meds. It would be nothing unusual for your husband to have a mild cycle here and there, even if he seems perfectly fine the rest of the time.

I think most of us here on the Cycling Team can report that we do cycle while on meds. I know that I do from time to time and yes, they are quite a bit milder than when unmedicated, true enough. There is no "perfection" in bipolar treatment, only "optimum".

Of course report the cycling to his doctor and all that rhetoric, and consider the possibility that his meds need tweaking, possibly due to a new stressor in his life or something like that. Is there a new stressor?
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Old 10-29-07, 06:51 PM
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Re: Can bipolar meds just quit working?

Sounds like maybe a tolerance has occured but maybe not. Is there anything going on in his life right now that may be causing extra stress? Any trouble anywhere. I know that when my moods start to cycle I am under a lot of stress at the time. Just a thought. But talk to his pdoc about possible tolerance. A year doesn't seem like a long time but it will all depend on his system and how it breaks down the meds.
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Old 10-29-07, 07:40 PM
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Re: Can bipolar meds just quit working?

Can someone elaborate about bipolar individuals continuing to cycle even while on meds? I had NO idea about that. I think my husband has a really good psychiatrist, everything else about his other meds has matched up really well with what I read on this board. Maybe he's not as experienced with bipolar as with the other diagnoses. Hmmm....

But cycling while on medication was never mentioned - just information about how the medication will stabilize his mood, which I took to mean it would stop the cycling. If the mood is stable, then what exactly is still cycling? If someone would enlighten me about that I'd appreciate it...

He's having some job trouble right now, so that would definately count as a stressor.

We already keep track of his moods, attitudes, attention span, etc on a calendar. But thanks for the reminder.
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Old 10-29-07, 07:52 PM
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Re: Can bipolar meds just quit working?

Yes, it is still possible to cycle on meds and it stinks.

Unfortunately it seems like meds can also stop working. Sometimes it is a case where the dosage needs to be increased and sometimes something just stops working. I have read about people where the medicine "pooped out" on them. I, like my friends here, know how painful cycling can be and I am sorry for the both of you having to suffer.

Has he given any thought to joining and making some new friends on the cycling team?
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Old 10-29-07, 10:37 PM
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Re: Can bipolar meds just quit working?

Stabilizing moods is the ultimate goal of meds, but it doesn't always work. Something could trigger a cycle and the meds cannot compete with natural occurance. An increase may be needed to stablize him again then the doctor can slowly bring him back down in dosage once he is stable. But, the meds can stop working altogether. Are you ABSOLUTELY certain he is taking his medications? I ask because I have a tendancy to stop taking my meds because I will go months without a cycle and I think I am fine and no longer need to take them.
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Old 10-29-07, 10:45 PM
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Re: Can bipolar meds just quit working?

I have that at the word of my own psychiatrist, Diane and as Sponge said, it does, indeed, stink. Ideally, we would all love to be free of the cycles for good...but we have discovered, as a group and as individuals, that that is not meant to be.

I am now, at this stage of the game, thankful just to have my cycling slow down to a slight trickle and when they do raise their ugly heads once again, that they are quite mild and no longer cause extreme chaos in my life. I hold the same gratitude over my child's treatment and that is all I expect any longer.

I know it has to be a blow to hear this from us but we would be doing you and your husband a disservice to be less than honest.

And Sponge brought up another excellent point...would he like to maybe join the Cycling Team? Of course you are welcome too; you always have been and I hope you continue to rely on us any time you need us!
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Old 10-30-07, 12:02 PM
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Re: Can bipolar meds just quit working?

Quote:
Originally Posted by DianeS
Can someone elaborate about bipolar individuals continuing to cycle even while on meds? I had NO idea about that. I think my husband has a really good psychiatrist, everything else about his other meds has matched up really well with what I read on this board. Maybe he's not as experienced with bipolar as with the other diagnoses. Hmmm....

But cycling while on medication was never mentioned - just information about how the medication will stabilize his mood, which I took to mean it would stop the cycling. If the mood is stable, then what exactly is still cycling? If someone would enlighten me about that I'd appreciate it...

He's having some job trouble right now, so that would definately count as a stressor.

We already keep track of his moods, attitudes, attention span, etc on a calendar. But thanks for the reminder.

First Welcome! Please continue to visit us here. We are always happy to help someone who loves and wants to understand one of "us"
And please do take the official invite to your husband as well. For many of us, this is a lifeline. There is nothing we are afraid to discuss here, and nothing we feel ashamed to discuss here.


So to answer your question let me start by restating the facts about Bipolar.
It seems you are educated, and a rare breed. Meaning someone who loves a bipolar but is all about education and understanding. There are not enough of you in the world. Speaking for us all and I am sure for your husband, Thank you.



So we know Bipolar consists of Dramatic Mood Changes, characterized by irriational shifts in behavior and tempermant. *Cycling* or easier, Shifting.

We experience dramatic changes in sleeping patterns, eating habits, subject to becoming addicts, may go on spending sprees, drive reckless, make foolish business investments, infidelity etc. And boy can it cause some major issues.
Moods and behaviors are as chanagable as the weather's unfolding divergence.

In both extremes: The "Dark Pole" & The "Light Pole"

Dark;
Minor symptoms, depressed, fatigued, passive, and lethargic. Extreme is of course delusional , having hallucinations, and suicidal.
Light: Wild racing thoughts, expansiveness, agitation, restlessness, excitement, irritability, grandiosity, hyperactivity.
Severe: Delusional, hallucinations which repeatedly sweep over us and alter normal personalities.


Even medicated, we still cycle or shift between the "poles" .

We still have altering mood swings, cycles within cycles. It might vary now, it might be less severe, it might be so mild you don't even notice it. Especially if he was severe before. But they are still there. He might have very well have been one of the ones that the mood/cycling/shifting seemed to disappear, but it's there, just below the surface.

It could very well be that he built a tolerance.
Or that life has been fairly stable and the amount he was on, was sufficient for that type of life.

However, if there have been some recent upheavials, changes, or "triggers" as we call them, that level of med that used to work when life was more balanced might not appear to be working at all now?

Small changes can set us off. Large ones can blow us right off the charts. And what is deemed small to normal folks can be huge to us. It depends on the person and their comfort zone.

You stated there were some changes or issues at work. I will use this as an example.

If in the past his job has been a safe place. A place where he can be accepted, be himself, and be creative, and now something has changed, something as simple as the hours, a new boss, a change in the way things were done...it can set us off. It's no longer a safe place or a haven.

Our lives are so out of control on the inside, we cling to safe places in the outside world. When those places become unsafe or chaotic with change, it reeks havoc in our little world of security.

I don't know what they told you? I would be happy to share more with you, and I have a lot of research links if you would like them. You sound like you know quite a bit, but it is only to your and especially his benefit to become educated and become an advocate for one's own care and condition.


My own curse is being a rapid cycler. I was great on my med combo through a huge crisis with my Bipolar teenage son. HOwever the fall out after , combined with some other huge triggers left me thinking my meds stopped working. After torturing myself for a few months living in denial, I finally told my doc about it. My depression was virtually gone, however the mania reared it's ugly head again and my sleeping cycles were a mess and my moods anxious and aggitated. He kept me on my Lamictal (core med, mood stablizer) but tweek it a little and added another med for the mania, and aggitation.

We are in the "testing" phases, so far so good.

Sometimes we are able to recover from these things on our own, with support and the coping skills we have obtained on meds, sometimes we can't and we need to make some modifications. It's not a sign we are more Bipolar. We just need to bring in a little more balance.



So in summary:
Drugs Do Not cure Bipolar, they simply relieve the symptoms, and not always very well. For the fortuante few, a drug can deliver what appears to be a lifelong remission like relief, they are very very few. For the unfortuante, which are the majority, the symptoms will return, regardless of which medications we are on. It is a continual journey of change for us.


Hope
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Old 10-30-07, 02:25 PM
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Re: Can bipolar meds just quit working?

That was beautiful, Hope. I can apply my own recent experience for you too, Diane, just to give another picture for you to look at....

When I first began on Lamictal, I felt, for the first time, a lifting of the crushing and omnipresent depression I had lived with for more years than I could possibly count. After only 3 days on 25 mgs, I might add! It was amazing, yet...

Just recently, I went through a period of not-so-crushing depression, but depression nonetheless. I am a trucker's wife and that puts enormous stress upon me. Usually, I take that pressure in stride, for the most part, but this last trip home, he was sooooo amazing and such a great presence to have in the house, that when he left? I was crushed, once again, and thus triggered a depressive phase.

Stressors will do things to us, it's a fact, and we are helpless in the wake of them. It's axiomatic for this illness. In time, we come back to baseline and those of us here at ADDF are truly blessed to have the Cycling Team to fall back on!
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Old 10-30-07, 03:10 PM
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Re: Can bipolar meds just quit working?

I have read of many cases of treatment refractory mania's and depressions and ECT treatments that did nothing, meds are also only part of the bipolar equation. A woman by the name of Mary Ellen Copeland had Bipolar I Disorder and no medications whatsoever work for her, she's the author of the Depression and Manic Depression workbook and has a Wellness Recovery Action Plan, in it that helps her stay stable.

Meds can quit over time as well, and unlike stimulant therapy, taking 2 days off doesn't make them work again either.
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Old 10-30-07, 04:47 PM
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Re: Can bipolar meds just quit working?

Quote:
Originally Posted by msam76
Are you ABSOLUTELY certain he is taking his medications?
No, I cannot be absolutely sure he's taking his medications. But I'm almost sure he is.

He's done like you describe in the past - not taken them because he doesn't feel he needs them - and after a few days of not taking his meds, his mood and behavior begins swinging rapidly around. He could be irritable, talking too fast, not understanding simple questions, depressed, zoning out, needing to move, needing to sleep, etc, all in the space of 30 minutes.

But this episode (for lack of a better word) is different. This was a slow creeping up of a depressed state. It mimiced the way his moods cycled before he was diagnosed. His cycling was always slow - it takes 3 to 3.5 months for him to go through the entire cycle. Once he left "normal" and started to slide into depressed I could practically chart his cycles out on a calendar in advance and predict when he'd be through depressed, productive, manic, and back to normal, as well as when he'd start to slide again. And the moods that I'm seeing now are much more similar to his pre-diagnosis cycling than his not-taking-meds periods.

That was a lot of words - all intended to just explain why I think he is taking his medications but they're not working the same as they did before.

And now that I've typed all that out, it makes sense why I wasn't thinking about his job issues being a trigger that could start another cycle - becuase he never really reacted to triggers even before diagnosis and medication. I never had to pay attention to those. So THANKS for reading my rambling, I think that helped...

Keep the stories about triggers that affect you even while you're on medication coming. What change does it produce when you encounter one of your triggers? How does your doctor choose to deal with it? And afterward - when your triggers are back to normal does your doc remove all the extras?
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Old 10-30-07, 04:59 PM
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Re: Can bipolar meds just quit working?

Well, go on and ramble, girl...the Cycling Team never turns away a good ramble ...just imagine how much any of us can ramble during a manic cycle! It's all good if that's what it takes to get you through the next moment...

Hmmmm for me? I usually blast off into a boiling hypomania when confronted with a triggering event. I have got to admit that this is the first time since I achieved stability that a stressor has caused me to become depressed, and I attribute that to the fact that I was sad to begin with. It occurs to me that maybe the BP just took off with that sadness and ran?

It might be a good thing to interject that I have also managed to survive a stressor or two and still maintain my stability, much to my own amazement!

SEE HERE FOR THAT STORY.

As far as I know, there isn't any method to determine just HOW we might react to any given stressor. It's just a given that we MAY react with a cycle.

ETA: I had at my disposal twice now an atypical antipsychotic to use if I felt an impending hypomania (since that seems to be my usual MO)...but both of them resulted in a rare side effect for me and I have reported that to my p-doc and discontinued them. I will hopefully get some other form of medication to combat that symptom when I see him in December.
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Old 11-05-07, 12:44 AM
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Re: Can bipolar meds just quit working?

Quote:
Originally Posted by DianeS
No, I cannot be absolutely sure he's taking his medications. But I'm almost sure he is.

He's done like you describe in the past - not taken them because he doesn't feel he needs them - and after a few days of not taking his meds, his mood and behavior begins swinging rapidly around. He could be irritable, talking too fast, not understanding simple questions, depressed, zoning out, needing to move, needing to sleep, etc, all in the space of 30 minutes.

But this episode (for lack of a better word) is different. This was a slow creeping up of a depressed state. It mimiced the way his moods cycled before he was diagnosed. His cycling was always slow - it takes 3 to 3.5 months for him to go through the entire cycle. Once he left "normal" and started to slide into depressed I could practically chart his cycles out on a calendar in advance and predict when he'd be through depressed, productive, manic, and back to normal, as well as when he'd start to slide again. And the moods that I'm seeing now are much more similar to his pre-diagnosis cycling than his not-taking-meds periods.

That was a lot of words - all intended to just explain why I think he is taking his medications but they're not working the same as they did before.

And now that I've typed all that out, it makes sense why I wasn't thinking about his job issues being a trigger that could start another cycle - becuase he never really reacted to triggers even before diagnosis and medication. I never had to pay attention to those. So THANKS for reading my rambling, I think that helped...

Keep the stories about triggers that affect you even while you're on medication coming. What change does it produce when you encounter one of your triggers? How does your doctor choose to deal with it? And afterward - when your triggers are back to normal does your doc remove all the extras?

We love ramblers! Happy it helped!

Hmm well for me...a couple of triggers...

Well when my son , who is also BipolarII had his first experience with ER after a cutting episode that went wrong,,ended him up in the phsyc ward...I sat there for hours...watching him cycle endlessly...I knew when I went outside for a needed break...I would hit mania from all the adreneline and exhaustion, and I knew I would hit depression after. That is the normal cycle after a what I call a sudden unexpect trama. I went to the car, I let myself cry....and cry....then I went and go something to eat, because if I hadn't, I wouldn't at all. I meditated, as best I could, remembering everything I had learned, knowing what I was facing, and feeling. And I let myself feel it.
I took myself off of my Adderall, which I take for ADD, because it is not good to take when I am headed for mania...the doc knew because he is my son's too, he said, call off work, and rest...call if you need me.
This happened on a Sat, so I just cancelled all of my plans, did no chores...and planned an easy day. I called my mom, talked to my sister, and came here for support, and wrote alot...that is my therapy. There was no medication to add, just one to stop. I was educated, and aware. Therefore, taking my own stumbling blocks out of the way, and giving myself a break let me recover faster. I never would have done that before, I learned myself, and about this disease.


Many times, there is nothing you can do about the triggers. Some you cause yourself, some come with life....but by journaling and learning about yourself, how things make you feel, what happened last time that ended badly, helps you learn to cope and how to avoid what dind't work out well last time?
There are no, instant meds...for us, well unless you are off in the ozone and those usually come the locked door, white coats....and a hospital stay...so unless you are needing some tweeking because you have tried the other stuff, you just have to learn coping skills, find a good outlet, and remember never to be too proud or ashamed to seek support.

If I think of some more specific ones ...I'll share them.

Please let us know how your husband is doing?

Hope
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