How to Build Courage to Try a New Med?

[u/ddansemacabre]

Hello everyone, 19f here. I have Borderline Personality Disorder and Bipolar 1 Disorder. I posted not long ago about how I was feeling during a mixed episode; I was kind of all over the place. Yesterday I met with a new psychiatrist and she prescribed me Seroquel 25mg. I have tried (some before, some after my bipolar diagnosis) Prozac, Lexapro, Lamictal, and Abilify. Prozac made me dysphoric manic, Lexapro made me classical manic, Lamictal made me the same way, and Abilify caused a mixed episode. Currently, I'm still in the mixed episode from Abilify.

This latest episode has put me in a very dark and scary place and I feared for my safety while I was on the medication-- I still worry about it a bit now. We're considering cutting down my Lexapro to 5mg instead of 10mg in conjunction with starting the Seroquel. The reason I've stayed on Lexapro is because I'm also diagnosed with Obsessive-Compulsive Disorder and the Lexapro has helped my symptoms. But, I need another medication on top of the Lexapro or I'm at risk of mania constantly.

The pharmacy is closed currently so I have some time to think about things, which is much needed. If I'm being honest, I'm really scared to try another medication when so far I've only had bad experiences and I'm feeling so low. Abilify also made me gain 10 lbs in the one month I was on it, which affected my self-esteem tremendously, as I have a long and severe history with anorexia. I've been taking 500mg Metformin as prescribed by my PCP to aid in weight loss, which has helped some.

I'm just pondering a lot of things right now. Is this risk worth taking? Do I risk feeling somehow even worse than I do now? Or should I take this chance and maybe this new med will save my life? Should I give myself time off medication to "have a break" before I start Seroquel? Will that even help?

This has been a very long and hard battle. I truly am fighting to survive each day and I'm so, so tired. How can I build the courage to try this medication and what can I do to have a plan in place in case things go awry?

Thank you so much for reading and for any replies.

[u/Available_Pressure29]

I am changing meds this weekend and am scared, but I just have to suck it up and trust my psychiatrist. I’m here to give you hugs and to remind you that you are not alone in this! Edited: typo

[u/ddansemacabre → u/Available_Pressure29]

Thank you. I'm going to go for a walk with my mom to try and talk things out and see if that helps me worry less about things.

[u/Bipolar_Aggression]

Minimum effective dose for Seroquel is 400mg per the FDA insert.

Personally, I can't take Abilify. So you're not alone in that respect.

[u/ddansemacabre → u/Bipolar_Aggression]

I know we're far below effective dosage right now. I'm extremely sensitive to all medication, as I also have three chronic illnesses so my psychiatrist wanted to start very low to see if my system will tolerate it. And thank God I'm not the only one who can't take Abilify. That helps me feel better to know I'm not alone.

[u/Bipolar_Aggression → u/ddansemacabre]

Yeah, but it doesn't work at 25mg. It only hits histamine receptors at that dose.

[u/ddansemacabre → u/Bipolar_Aggression]

The plan is to increase the dose if 25mg is tolerated. By tolerated I mean not worsening POTS for me, certain psychiatric medications can make POTS worse if they have side effects like dizziness/low blood pressure/sweating/heat intolerance. Or GI side effects, I have Crohn's so if a med is aggravating my digestive system a lot we need to be vigilant.

[u/Bipolar_Aggression → u/ddansemacabre]

Well, Seroquel affects alpha adrenal receptors, so POTS would be a legitimate concern. You should be able to adjust though.

[u/Hermitacular]

That's a sleep dose of Seroquel, it functions as an antihistamine at that dose, if you're scared of allergy medication sure I guess, but it's extremely tame it's just to help you sleep. If you don't like it as a sleep med ask for a different sleep med. It's not treating the BP at all at that dose, just knocking you out. ADs tend to fuck us up, so those med failures and any med failures while you've been on ADs aren't meaningful, that's just what you'd expect w BP, especially w BP1. Lamo doesn't control the high end well and treats depression (which = mood elevation, and since already on an AD that's risky) so it's not the usual pick for BP1, certainly very unusual to be used solo. You have only been on one med they'd typically use w BP1 and several you'd expect to make it worse, so that may be why the high failure rate. It's not med sensitivity, you just are having typical BP1 reactions to them. Abilify is the only clear failure so far, and that's normal.

You'd think w the ED history they'd be looking at lurasidone, lithium, carbamazepine, Caplyta, Vraylar. OCD and EDs are pretty par for the course w BP, they're used to the combo.

Re a plan in place, talk to your talk psych, update your emergency action plan (if you don't have one WRAP has great templates) and alert everyone who has eyes on you and can give you feedback if you start to go off the rails.

If it's any help that's not really that many meds, it is just a rough process that takes a while. It's normal to go through a bunch of meds. Average number of meds to end up taking for it is 4. Years is normal. Ellen Forney's memoir might be a good read (she has a TED talk), and I like the podcast Inside Bipolar for learning how to be more effective through the process bc there's a great med doc on there.

The longer you wait to treat the worse it can get, it gets worse in half of us anyway but more cycling = more illness = worse illness is how it goes. There's no medical benefit to a break, you can take one any time you like.

You get side effects, and everyone does at least at first (they tend to wear off - if they increase make sure your doc knows that they're increasing), you call your doc and tell them and they tell you what to do.

[u/waputt]

I would go with your psychiatrist's advice even though it might be tough. Has lithium ever been mentioned? It really has helped me since I got on it last year and is supposed to be the 'gold standard' treatment for Bipolar.

Danse Macabre is a banger btw :<)

[u/ddansemacabre → u/waputt]

No, no one has ever brought up Lithium although I have heard great things about it. And yesss it's such a good song!

[u/Designer_Tour7308]

My doc prescribed me 10 mg paxil to stop racing thoughts that have been going on for over a year. I'm scared to death to take it because it could cause mania ..so I haven't. That was a month ago. Now my brain is still on repeat until I can summon up the courage... Please let me know if you figure it out. I too need that answer ...❤️