Am I going insane?

October 22, 2007 11:41 AM

I've been depressed on and off for 20 years but this is new, and scary. (Contains probably too much information but I'm trying to cover any potential questions)

I'm in a weird state where I've been up for three days and feel great, empowered, just spent a lot of money I cannot afford (new computer, game systems, games, on-line purchases), and having weird thoughts involving my body (secreting acid, images of cutting it in unique patterns). I can't get my brain to stop spinning and I feel on the edge. I keep having paranoid thoughts that maybe my brain will take over and I'll kill myself when I don't want to.

This was preceded by some of the lowest lows I've ever had. (Constant thoughts of suicide, spontaneously crying every two seconds.)

Is this what they mean by mania? But how can I have that when I've never had it before. I kinda like it because I'm quite productive yet scared that it will go on forever. What can I do to stop it? Will it ever stop?

I've been diagnosed with Major Depression Disorder and have been depressed more or less for 20 years (It seems to include a genetic component [everyone in my family on father's side is/has been depressed] as well as triggers [brother's suicide, father's death within 2 month span]). Usually I know how to deal with it but this is new. It scares me, and I'm afraid of it.

I'm in Canada (B.C.) and have to wait three months between seeing psychiatrist but I do have an appointment in two weeks. (I have in the past phoned in to say I really need to talk to his predecessor (he left) and still had to wait a week. There is no other psychiatrist options left to me. [Small semi - isolated town, on disability for depression thus no money])I can get into to see a "therapist" but the last two times I did I was faced with odd dismissal of my sexuality (bi) as well as a few god related expressions that bothered me (atheist) and with another one called close-minded because I did not understand how goal sheets could help me not kill myself. She explicitly explained that they don't have the time to be all "Freud-like". One was helpful but she went on sick leave and never came back.

I'm on Effexor XR, Amitryptaline, Resperidone, Cogentin, Eltroxin (under-achieving thyroid that levels have never varied since on med), Metformin (glucose-intolerant), Multi-vitamin, D, C. The amitriptaline is new but I've been on it for a month and a half (mainly for sleep - I have strong recurrent insomnia and seem to be immune to all sleep meds) and aside from being nauseaus and a wee bit dizzy in the first three days have been fine.

I took some melatonin with it when I was first starting. Could that have triggered it? My doctor didn't say if it would mix with any meds but that when I was on Nozinan that it was fine to take it.

Are there tips on how to stop this? Personal stories? Something to reassure me that I'm not going full-on crazy and calm my paranoia? This has happened to others? Scared.

Sorry for the length. I can't seem to stop typing. Ah I'm dumb. sorry.

E-mail: [e-mail]

posted by anonymous to health (50 comments total)

IANAD, but sounds like bipolar.
posted by futility closet at 11:50 AM on October 22, 2007

I am not a doctor and this is not a diagnosis. This sounds to me like mania. A close family member is bipolar and went through something almost exactly like this before he suffered a psychotic break.

Please call a close friend or family member and have them come pick you up and take you to either your physician's office or the emergency room. You do not want to take chances with this.

Good luck.
posted by TryTheTilapia at 11:51 AM on October 22, 2007

Second the emergency room.
posted by TorontoSandy at 11:55 AM on October 22, 2007

This is setting off a number--well actually a whole lot-- of warning bells for a manic episode, but the fact that you're recognizing that it may be a manic episode is a positive sign. With those symptoms and your mix of medication and recent personal issues you should certainly try to met with someone *as soon as possible*--if not a psychiatrist then at least a general practitioner. If that's not a possibility, you should at least try to spend the time till your appointment around friends and family who will recognize that you're behaving strangely and can keep an eye on you.

The thing about this is that it *will* soon pass and then you'll be due for a depressive episode. Please do not try to hold onto this feeling, no matter how much you like it, because it will pass.

You're not going full-on crazy, to alleviate that fear. The paranoia is a symptom of a manic episode, however.
posted by Benjy at 11:57 AM on October 22, 2007

And the emergency room is certainly not a bad idea.

*Disclaimer: I'm a counselor but not in this area, and not for you*.
posted by Benjy at 11:59 AM on October 22, 2007

That's quite a drug cocktail you have there.
I'm not a doctor, but maybe they're screwing with your brain chemistry?
Go to ER and try to look around for a psychiatrist who's less into drugs..?
posted by PowerCat at 11:59 AM on October 22, 2007

all good suggestions here, I take the liberto to add that besides the medical stuff, I'd return all the stuff you've purchased with money you don't really have
posted by matteo at 12:01 PM on October 22, 2007

I think you need to go to an emergency room.

It is also my understanding that the medications that are routinely used to manage depression may cause unintended effects/problems in people with bi-polar issues. So I really think you need to go to an emergency room, where they can at least look at the pretty large number of drugs you're on and help you be sure that you're on a safe-for-you combination until you can see a psychiatrist.
posted by thehmsbeagle at 12:02 PM on October 22, 2007

I think thats alot of drugs to be taking too. You should probably get a second opinion on all of these medications as soon as possible. Hang in there.
posted by pwally at 12:12 PM on October 22, 2007

I am not a doctor, but my wife had full on mania for about 3 months last year. Your symptoms pretty much sound exactly like mania, specifically, feeling great, empowered (do you have grandiose thoughts?), overspending, racing thoughts. How are your sleeping patterns? What about your appetite? Sexuality?

One thing that is a huge plus for you, is that you recognize this as being not normal for you. In about half of bipolar patients there is not this realization--resulting in refusal of treatment. Without treatment it only gets worse, and this is a disease that can destroy lives when it gets going.

I agree with pwally too, I would ask your physician(s) to help reexamine all of you current meds in addition to possibly getting on meds for bipolar.
posted by jockc at 12:28 PM on October 22, 2007

If a patient of mine came with this story, I'd escort them to the nearest emergency room.
posted by ikkyu2 at 12:33 PM on October 22, 2007 [3 favorites]

You're describing an acute change in your mental functioning characterized by both manic and depressive episodes. You should either go to the ER or call your doctor again and explain that the change is acute and alarming and ask for an earlier appointment.
posted by OmieWise at 12:34 PM on October 22, 2007

IANAD. I have been treated for depression with meds.

I am seconding the emergency room. I would recommend that you ask someone to explain the effects of mixing these specific meds to you and ask them to rule out a drug interaction that might have triggered a manic episode BEFORE prescribing something for bipolar. I was misdiagnosed as bipolar due to drug interactions over a decade ago and it was an awful mess for about a year.

However, if it turns out that you ARE bipolar, the appropriate meds can be extremely beneficial.

Do you have someone who can help you to undo the financial damage in the short term?

Take good care.
posted by jeanmari at 12:38 PM on October 22, 2007

Nthing this sounds like a manic episode, speaking as someone with multiple relatives afflicted by bipolar disorder. You need to talk to a doctor.
posted by puffin at 12:45 PM on October 22, 2007

Not a doctor. Am a lawyer, but not licensed to practice either in the US or Canada. So I am not offering legal or medical advice, just friendly common sense advice.

I would consider taking a step back and attempting to undo any major financial decisions you have made within the last few days. If you are, as you say, spending more money than you can afford, this could come back and be very difficult to undo later on when more time has passed. I've worked with a number of individuals whose mental health has deteriorated, and one of the unfortunate ramifications was financial ruin. It is hard to get mental health under control. I know, I've been struggling with depression myself for most of my life. Adding to that the financial stresses of a few hours worth of bad decisions can be crippling. I'd suggest undoing as much of it as possible.
posted by greekphilosophy at 12:48 PM on October 22, 2007

If you can't see your GP within 24 hours, I'd say get to an emergency room. 2 weeks is way too long to wait - there's no guarantee that you'll be thinking so rationally by then, if your condition worsens, its likely you wont go to your appointment.

As other posters here, I'm also alarmed by the amount of medication you're taking. I'd get that reviewed asap, your problem could be as simple as a bad interaction between your many meds.

If it's any reassurance, I've had a similar episode and I'm not bipolar. I went through a very crazy period about 10 years ago - it wasn't a short lived episode and I did some really crazy things (rather than just thinking about it), including drinking bleach and acid and cutting myself into pretty patterns, though I could never get the pattern quite right.

But I'm fine now, I still get the occasional bout of depression and the odd crazy impulse but I've learned to control it and get on with my life. The most important thing is a good support network, my boyfriend takes care of me and keeps me sane. Do you have anyone in your life who can look after you during this difficult period?
posted by missmagenta at 12:50 PM on October 22, 2007

Go to the emergency room and then return the expensive stuff later. Do not say "I'll go to the ER right after I do X." Grab your pill bottles, and go go go. If someone else can drive you, or you can take a cab, that would be ideal.
posted by Eringatang at 1:02 PM on October 22, 2007

OP: You say you've been depressed for about 20 years. Are you seeing more than one doc? If so make sure all your docs are aware of what medications the others are prescribing.

Both Effexor and amitriptyline are anti-depressants. One is an SNRI and one is a tricyclic. As far as I know neither of these is a first line drug against simple depression. Risperidone is an anti-psychotic used for schizophrenia. Benzatropine is used in schizophrenia to reduce the effects of the Risperidone, AFAIK.

It sounds like you maybe are being treated for schizophrenia as well as depression; make sure your docs are being straight with you as to whether that is the case or not. In the context of your post it seems pretty clear that an ER trip is called for.

Keep in mind that someone in your position is often not in the best position to judge their own mental state. Please go to the E.R.
posted by Justinian at 1:45 PM on October 22, 2007

Oh yeah, I'm not qualified to judge the many possible drug interactions of those medications but I would not at all be surprised if manic episodes were a distinct possibility, especially given that you are taking two different types of antidepressants as well as antipsychotics. Taking multiple antidepressants really has to be monitored pretty closely.
posted by Justinian at 1:48 PM on October 22, 2007

I'm no doc, but you better get to the ER. I mean it.

Yep, it does sound muchly like bipolar.
posted by konolia at 2:19 PM on October 22, 2007

So what happens when he gets to the ER?

ikkyu2, would you really escort him? Would that help them not blow him off in favor of the 3 gunshot wounds and the car wreck that happened right before? (Is that less of a problem in BC?) What could he expect from going there?

I have always been reluctant to recommend the ER to anyone because it seems like you lose all personal power once you're there. Is that the case?
posted by small_ruminant at 2:25 PM on October 22, 2007

nthing the ER. I grew up with a bipolar parent. This sounds very familiar. I had to call 911 once after the hair dryer told her to kill herself.
posted by desjardins at 2:31 PM on October 22, 2007

small-ruminant, this person's brain chemistry at the moment may very well rob him of whatever personal power he has left. Right now, this person is still cogent enough to ask this question. This person has a chance not to end up, say, running out of his house, naked, at four o'clock in the morning, crossing four lanes of interstate traffic, jumping into a lagoon that is below freezing and subsequently being admitted to a hospital with a body temperature of 86 degrees. That is what happened to someone I love very much, and believe me it has been a looooong road to wellness, such as it is now.

Please do not turn this thread into a discussion about the merits or lack-thereof of your local emergency room. Please understand that this situation is very serious, many of us in this thread are very concerned about this person, and two medical professionals have already chimed in saying that he needs to go to the emergency room, or, at the very least, get himself to a safe place where he can be under a doctor's supervision.
posted by TryTheTilapia at 2:43 PM on October 22, 2007

Please get someone to take you to the ER. I've been through this and it was a manic or hypomanic episode. Keep all the receipts for everything you bought - don't take off the tags - and go to the ER now. You can then take care of the financial ramifications once you're better.

As others have said, you are able to recognize now that this is out of the ordinary, but in a day or two, or even in a few hours, this may have progressed too far for you to take care of yourself. Please don't wait.
posted by la petite marie at 2:57 PM on October 22, 2007

Follow-up from the OP:

Thank you for the reassurance about not going crazy. It helped a lot and grounded me.

I cannot get into see my psychiatrist until at next week. I phoned today and stated the problem and my appointment was bumped up a week. I was offered a chance to talk with someone but it was with the two therapists I had before. I guess I should take what I can get? My

He is the only psychiatrist available to my town so switching is out of the question. I'm not sure what I can do about the amount of medication. I was not aware that that was a lot.

I haven't been eating a lot and my sex drive has ramped up to the extreme though I am not partaking of it with others.

I live with my mother so I do have someone to watch me, though I have not told her the situation. I tend to live my own life in my bedroom and she in the rest of the house.

Um, I'm a gal :)

My thinking has slowed some. Thanks.
posted by jessamyn at 3:08 PM on October 22, 2007

I just reread your initial message and noticed you said you've been up for 3 days. Lack of sleep will eventually twist up your brain something awful. Anything you can do to get tired (excercise maybe?) to get as much sleep as you can manage would probably help.

Also in general, you might want to let your mom in on the situation and both of you read everything you can online about bipolar.
posted by jockc at 3:14 PM on October 22, 2007

Nthing that this sounds like classic mania. In addition to change in meds, this can sometimes be brought on by purposefully or accidentally missing a night of sleep. Missed night of sleep to study, party or work, and this spins into mania in folks who are predisposed. Just a thought as a possible trigger if this is your first episode.
posted by thebrokedown at 3:18 PM on October 22, 2007

OP, your brain just picked out the parts of this thread that it wanted to read, and ignored the other parts. Please go to the ER now.
posted by Eringatang at 3:20 PM on October 22, 2007

TryTheTilapia- I just want to know what a person can expect when he or she goes to the ER for psychiatric stuff.

It's not an unreasonable question.
posted by small_ruminant at 3:20 PM on October 22, 2007

From personal experience, the higher you go the farther you'll crash once your mood changes. You mentioned that your brother committed suicide, and that you were feeling extremely suicidal just prior to this mania. You are at a very high risk, and just can't wait until next week to see someone. Either call back to your psychiatrist and insist on speaking to him (or her) himself and explain what is going on, or tell your mother or a friend what is happening and have them take you to the ER.
posted by la petite marie at 3:35 PM on October 22, 2007

OP - sorry for getting your gender wrong. Please tell your mother what is happening to you and have her take you to the emergency room.

I just want to know what a person can expect when he or she goes to the ER for psychiatric stuff.

Fair enough. And, no, it's not an unreasonable question at all in the right context. I'm am not aiming to pick on you. I am aiming to persuade a young woman who is showing signs of what might be mania to get to the emergency room so that she can receive appropriate medical care.

OP, again, tell your mother what is happening to you and have her take you to the emergency room.
posted by TryTheTilapia at 3:41 PM on October 22, 2007

I just want to know what a person can expect when he or she goes to the ER for psychiatric stuff.

This information would be useful for her to have, in order to make an informed decision.
posted by small_ruminant at 4:13 PM on October 22, 2007

small_ruminant-

From Wikipedia: "Informed Consent":

"The individual needs to be in possession... of his reasoning faculties, such as not being mentally retarded or mentally ill and without an impairment of judgment at the time of consenting...such as insufficient sleep..."

mania (in general) = paranoia++. As Eringatang pointed out, the OP might not be reading all the posts, just what she "wants to hear". Seeing as though she is not in an ER right now, and a majority of the posts say, "get thee to an ER", I would say that explaining any of the possible drawbacks of going to an ER would not be very therapeutically beneficial for the OP, versus simply listing the benefits of appropriate medical care STAT.
posted by nursegracer at 4:44 PM on October 22, 2007

I'm big on transparency.

And if I were her, not knowing would decide me against it full stop.
posted by small_ruminant at 4:53 PM on October 22, 2007

If this is a manic episode, and I agree with everyone else in this thread that it sure sounds like it, then it's a miracle you can reflect on your behavior enough to ask whether there's something wrong -- mania is frequently characterized by absolutely knowing you're right about everything.

And that ability to reflect on your behavior could simply go away at any moment, and you could suddenly know absolutely that it's the best idea in the world to act in ways that could get you killed or seriously mess up your life.

Please, tell your mother. Show her this thread. Get medical attention immediately. Please.
posted by Zed_Lopez at 5:16 PM on October 22, 2007

small_ruminant - if you broke your leg, would you not go to the ER because you didn't know exactly what they would do first, xray or physical exam? This person might have a broken brain, I'm not sure that knowing the order of operations will be helpful. I'm guessing their first priority would be to prevent her from harming herself or others.
posted by tristeza at 5:36 PM on October 22, 2007

I am a doctor. If your description is true, you are likely suffering from mania, which can be at least as life-threatening as the worst depression. Please please please listen to all the good people here when they urge you to seek care.

Please do this now:

Take all of your pill bottles and put them in a paper bag or a ziploc bag. Take the bag with you and go to the nearest hospital. There are good people there who will help you. They will listen to what's going on and give you somewhere safe to stay while you get things back on an even keel. It's OK to be sick. They are there to help you. It might be just a matter of adjusting your medication but you can't do that on your own. Let them help you get your life back to normal.

Wishing you all the best. Go now.
posted by pammo at 5:39 PM on October 22, 2007 [1 favorite]

If you go to the ER for psychiatric emergency you are evaluated, much like anyone else presenting with a problem, and the extent of the problem is assessed. For issues that seem like they might take further evaluation and some time to resolve, it's usually recommended that the patient be admitted to the hospital. In some places, like many of the United States, people who refuse admittance can be committed if they are deemed to be a danger to themselves or others. In my experience such committance must be later reviewed (again in my experience, within three days) to determine if the patient still meets the criteria for being kept on the unit.

I suspect, small_ruminant, that you've never really been exposed to someone in acute psychiatric emergency. Although I am in no way diagnosing the poster, her question indicates that she at least needs to be evaluated immediately to determine if she is in a psychiatric emergency. Certainly mania qualifies as such an emergency. I've met and also treated many patients in such emergencies of all different types, and by far the people who have the most potential for getting themselves into trouble they later regret are those that present in a manic episode.
posted by OmieWise at 5:58 PM on October 22, 2007 [2 favorites]

Further follow-up from the OP:
I always get annoyed when anon posters don't follow the advice of the majority of the responders. So I will be a good askmefi-er and go to the hospital. The combination of your unanimous answers and a e-mail exchange with my best friend across the country convinced me. So who says on-line people have no influence in each others lives.

I fully admit I'm scared of the idea. I have no frame of reference for psych wings besides Girl Interrupted and One Bird Flew Over the Cuckoo's Nest. I understand logically that it is not like that but still the fear lingers. However, I know this is not my normal depression and that I've never been this way before. That scares me enough to go...so...and a thousand other thoughts but ...thank you.
posted by jessamyn at 6:31 PM on October 22, 2007

OP, if I could, I would hug the stuffing out of you. I wish you the very, very best of luck. If you want to, follow-up with us and let us know how you are doing. I'll bookmark the thread and check in with it. Whenever you have news, share it (or not, your choice) with us. I'm thinking good thoughts for you and wishing you peace.

For what it's worth, I was afraid of going to the doctor for a long time, too. It's always better to have the facts, I promise. Again, good luck with everything and good on you for being brave enough to go to the hospital.
posted by TryTheTilapia at 6:46 PM on October 22, 2007

If you're still reading, OP, good for you. Believe me, the hospital is nothing like either of those two movies. It's more like a college dorm. There's a big day room with a TV where you can meet with visitors. Your days are usually pretty full with various groups, and you'll see your doctor usually every day or every other day. It's a safe place to be until you can get your meds in place. I was so scared before I had to go, but it wasn't anything like I had feared.

Come back and let us know how you are!
posted by la petite marie at 6:49 PM on October 22, 2007

Good job! You are making a very, very good decision. I'll be thinking about you.
posted by Eringatang at 6:49 PM on October 22, 2007

Thank you, Omiewise. That's the clearest description anyone's given me.

tristeza, even with a broken leg I wouldn't go to the doctor if I thought they could keep me there against my will.

OP- good luck to you, and congrats on making a decision. If jessamyn doesn't mind being the go-between again, will you let us know how you're doing later on?
posted by small_ruminant at 10:30 PM on October 22, 2007

Surely your town has a crisis intervention line. Call it. They can direct you to which hospital has an emergency room especially for these kinds of problems.

Having had the problem with the spending thing, I agree with taking back anything that it's still possible to take back. I do look back on the manic episodes with some nostalgia, though. I was more on-track and energetic when I was going maniac.

Much good luck. My email is in my profile if you want anectodal stories from my own experience.
posted by Meep! Eek! at 2:14 PM on October 23, 2007

Follow-up from the OP

I thought that I'd post back here about what happened to me as I'm always curious when I read AskMeFi about what occurred and I know a few of you suggested you'd like to know. First, thank you all for your kind words and recommendations about going to the hospital. I needed that frank talk to get over my nervousness and actually go. The hospital was much different from what I expected. Nothing like the scary movies at all. A tad boring and noisy but otherwise good. My doctor did say that he was relieved that I came in as I seemed to have played down the problem on the phone and he didn't realize it was that bad. I stayed about a week and slept a lot and have stopped most of my medication. We are now trying to "reboot" my system and streamline everything so I will not be on so many.

Since then I have had another mild/minor mania event but now I know enough about it and feel confident enough that I was able to phone and talk to him right away about it. So it looks like I'm developing bi-polar tendencies after all...which is oh so much fun! I ended up also biting the bullet and agreeing to meeting a therapist to start getting some tools to cope with it all. So far they seem to be alright and at least aren't openly displaying their religion and biases as the other ones did.

I was able to return about 3/4ths of what I bought so tremendous thank yous for that advice as I'm not sure I would've thought of that at all. All in all I just ended up 150 dollars in the hole instead of 1000. Apparently depression is more costly than I thought.

So that's what happened. Thank you for everything. I am glad that I listened to you all.

posted by jessamyn at 9:37 AM on November 27, 2007 [2 favorites]

I'm glad to hear that things are going well for you, even if it would have been nicer to not have to deal with it at all. Thanks for the update.

Take care.
posted by OmieWise at 11:27 AM on November 27, 2007

Thank you so much for the update. I was thinking about you! So glad to hear that you are doing so much better -- you "sound" a lot better. I hope it works out with this therapist.
posted by Eringatang at 12:24 PM on November 27, 2007

How wonderful! I am so glad you got the help you needed. Thanks for letting us know about it.
posted by ikkyu2 at 3:33 PM on November 27, 2007

I've been thinking about you, too. Thank you so much for the update!
posted by small_ruminant at 2:24 PM on November 29, 2007

I've been clicking back to see if you'd post a follow-up. I'm so excited that things worked out so well. It's great that you have a team of good people and that you felt OK to call them before things got worse. I'm also glad you could take most of the stuff back. Good luck!
posted by la petite marie at 5:01 PM on November 30, 2007