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Question
Posted by: Kay in Gtown | 2010-01-17

How to manage a switch to mania?

Hello CS
Hope you are well?

To begin at the end and get straight to the point:
I suspect I am about to switch from depression to mania after just a week on Efexor. I will phone my pdoc at some stage if it happens but my question is: what self-help can *I* do to manage (and temper) the switch?

Background: I' m also on Lamictin, Seroquel and Wellbutrin. I' ve been sliding into a depressive episode over the last 2 months and it' s getting bad. A week ago my pdoc added 75mg Efexor at the risk of switching, but my depression has been terribly rx-resistant and it' s a case of " desperate times call for desperate measures"  so we were both prepared to take the risk.

I' ve switched before, on Efexor. The last 3 nights I' ve only managed 4-5 hrs sleep per night (I fall asleep easily, but can' t stay asleep). Last night when I woke at 1am after 3hrs sleep, I took a Dormicum 15mg which didn' t even make me drowsy. I eventually just got up. I take Dormicum very sporadically, so I doubt it' s tolerance.

My mood hasn' t lifted out of gloominess and my energy has only risen marginally. The only sign, really, is inability to stay asleep and the complete lack of response to a sleeping tablet.

I really, really want out of depression, by any means. I want to delay phoning my pdoc (he' ll probably stop the Efexor) until I know I am out of the dark, dark woods. I may err on the side of tardiness and then won' t see any need to phone as there will be no problem! How can I brake the speed myself, so I slow down at the yellow light and stop at the red, without sailing across?

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Our expert says:
Expert ImageCyberShrink

Hello again Kay !
Its long been my impression that Efexor is too stimulant to use for the depressive phases of bipolar disorder, and I suspect it may have a higher risk of nudging someone up into a manic episode. And, as you say, you have previously switched on Efexor. But this is something you need to discuss with your shrink, as he may have had special reasons for choosing it. And rather do that sooner than later. Mention your reluctance to stop the Efexor as you so want to be rid of this depression.
I wish there was something definite and non-chemical you could do to stop the arrival of a manic episode, but I don't know of one ; other than maintaining close vigilance ( as you know more than most people what signals the return of a high )so as to shift meds at the best time.



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Our users say:
Posted by: cybershrink | 2010-01-17

Hello again Kay !
Its long been my impression that Efexor is too stimulant to use for the depressive phases of bipolar disorder, and I suspect it may have a higher risk of nudging someone up into a manic episode. And, as you say, you have previously switched on Efexor. But this is something you need to discuss with your shrink, as he may have had special reasons for choosing it. And rather do that sooner than later. Mention your reluctance to stop the Efexor as you so want to be rid of this depression.
I wish there was something definite and non-chemical you could do to stop the arrival of a manic episode, but I don't know of one ; other than maintaining close vigilance ( as you know more than most people what signals the return of a high )so as to shift meds at the best time.



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