Dr. Ramchandra Lamba
Psychiatry
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Patient's Query
Hello doctor,
I have bipolar 1. Rarely manic, depressed 2 to 3 times a year. I have felt good since last four months. This afternoon I suddenly got very depressed, hopeless, ideation. I also have racing thoughts, cannot sit still, very irritable, heart racing and 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, Seroquel. Ativan and Atarax for anxiety. I was fine 2 to 3 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.
Hi,
Welcome to icliniq.com.
These symptoms are probably due to drugs 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 one tablet (1 or 2 mg) now and can be repeated after one hour if symptoms persist. Propranolol is also helpful but you cannot get it without a prescription. If you have fever also then you need to rush to the emergency room.
Patient's Query
Hi doctor,
Thank you for your response. I took 1 mg Ativan with 200 mg Seroquel and after half an hour or so felt much better. Slept fine. I feel better but still depressed and racing thoughts but not frantic like 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.
Hi,
Welcome back to icliniq.com.
Well, akathasia can be caused by Latuda, Seroquel and Wellbutrin. Also, Wellbutrin can increase anxiety symptoms so it is better to shift to another drug preferably from SSRI group if not tried earlier. These SSRI can be used for a short time 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 like it is actually akathasia or anxiety or Wellbutrin side-effects so that 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 in a year then adding Lamotrigine can be a good option. Thank you.
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Psychiatry
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