Patient's Query
Hello doctor,
I have bipolar 1. Rarely manic, depressed 2 to 3 times a year. I have felt good for the last four months. This afternoon, I suddenly got very depressed, hopeless, and had ideation. I also have racing thoughts, cannot sit still, am very irritable, my heart is racing, and I cannot stop crying.
I have never felt like this. The doctor is not available, and the suicide hotline was no help; she did not know anything about bipolar. I take Latuda, Wellbutrin, and Seroquel. Ativan and Atarax for anxiety. I was fine two to three hours ago. Now every time my son asks me a question, I feel like screaming, so I am hiding in my room.
I do not want to scare him. I do not know what to do. I have never felt like this, having so many thoughts so suddenly and without warning.
Please help.
Thank you.
Hello,
Welcome to icliniq.com.
I understand your concern.
These symptoms are probably due to drug side effects called akathisia, which includes almost all the symptoms you mentioned. This can occur without any warning and also change in any drug dose or schedule.
Take Ativan (Lorazepam), one tablet (1 or 2 mg) now, and it can be repeated after one hour if symptoms persist. Propranolol is also helpful, but you cannot get it without a prescription. If you have a fever, then you need to rush to the emergency room
I hope this helps you.
Thank you.
Patient's Query
Hello doctor,
Thank you for your response.
I took 1 mg of Ativan with 200 mg of Seroquel, and after half an hour or so, I felt much better. Slept fine. I feel better, but still depressed and racing thoughts, but not as frantic as yesterday. I have never heard of akathesia before. I will ask the doctor about it.
My feet shake a lot in the early evenings (after the second dose of Wellbutrin), and I have assumed it was anxiety. But now that I think about it, it started about nine months ago when I started Wellbutrin. Maybe akathesia? I will talk to her about it. Might be time to switch from Wellbutrin to something else.
Please advise.
Thank you.
Hello,
Welcome back to icliniq.com.
I understand your concern.
Well, akathasia can be caused by Latuda (Lrasidone), Seroquel (Quetiapine), and Wellbutrin (Bupropion). Also, Wellbutrin can increase anxiety symptoms, so it is better to shift to another drug, preferably from the SSRI group, if not tried earlier. These SSRIs can be used for a short period to get out of depression associated with bipolar illness. Meanwhile, you can use your Ativan tablet to manage your symptoms until you meet your psychiatrist.
Discuss the likely cause of your symptoms, such as whether it is actually akathisia, anxiety, or Wellbutrin side effects, so that a further course can be planned accordingly. Once you find the exact or likely cause, then a change of drug will help you. As you mentioned earlier, that you are depressed two to three times a year, then adding Lamotrigine can be a good option.
I hope this helps you.
Thank you.
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Answered byDr. Ramchandra Lamba
Medically reviewed byDr. Divya Banu M
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