Depression after Mania?

[slw]

As I’ve mentioned, my son’s current psychotic break is really different from the one’s he’s had in the past, and while most of the paranoia has went away with the meds, the delusions weren’t budging.

I’ll also explain that I’m the kind of person who’ll look for the tiniest changes as a predictor that things are changing - for good or bad.

So, here’s where we are today.

I don’t think he slept night before last. He was up, active and talking about his delusions a lot yesterday, and stayed up well after I went to bed. But, he was asleep without the help of meds when I got up this morning. (I had put out everything last night but he didn’t take them).

He slept until about 1 PM, then took his meds. At around 4 PM, he wanted to show me this video where a comedian mentioned the name he has for an invention in one of his delusions. He fastforwarded to the spot, and I thought I heard it too, but it wasn’t in context, so I asked him to rewind so we could both listen closely to what was said so we could talk about it.

The guy said a word close to what we both thought he said, but it wasn’t the word.

So, he said, so what does that make me? Just some crazy guy?

Talk about heartbreaking, even though I’ve been watching every minute for some form of insight.

Now he’s covered up on the couch. I asked him if he was OK, and all he said was he felt like life wasn’t worth living. This is after a few hours ago when he asked me several times if I was OK. That’s a sign his general anxiety is kicking back in - he’ll constantly ask me that and call me if I’m late thinking something bad is going to happen to me.

As bad as it is to say, at least while he was delusional, he was kind of happy. I’m wondering if this is a psychotic mania breaking (Google says in 3-6 months, if it’s psychotic mania, it can lift even without drugs) or something else.

And, if it is, I guess we’re looking more at bipolar I or schizoaffective than schizophrenia.

Any ideas from anyone who’s been there?

I guess I’ll call the case manager tomorrow & see what she thinks. They’re all thinking schizophrenia, but I think that’s more because he shuts down around people and can barely talk. Do you guys think that if he had disorganized thoughts, etc from SZ that he’d be able to pull it together around me & his dad? He talks about bizarre stuff, but it’s all fully formed, organized thoughts at home.

[Catherine]

@slw My son was sz AND depressed for a time and the pdoc added Zoloft to his meds for awhile which helped. Maybe he is schizo-affective OR the low mood could be caused from him having to deal with the delusions, in my experience with my son they are exhausting and can precipitate a depressed mood or at least they did in my son for a time until his meds were adjusted right and some of his worse symptoms subsided. As for the disorganized thoughts --Our sons’ stress plays a big role in that and when it happens it is not about ‘control’ it is a symptom, and it is not a choice that your son or my son can decide ‘hey I will not do it here or in front of mom and dad’ etc…and the stress they feel can be stress you or I would not even think is stress, for example if I am upset or sick or angry about something (not even concerning him) he will get very stressed in his own way and devolve a little-If I asked him if he is stressed he would likely say ‘no’ but his actions and perceptions say otherwise, to him my normal behavior is either confusing or upsetting when I frown or raise my voice or get loud or whatever I do —so I have to really be mindful of extreme emotions and stay super even for his sake as much as possible…that’s just one example but I have done what you do…googling everything 24/7…sometimes I still do it…ultimately it just leaves me with more questions than answers—if you can— talk your son’s pdoc about all of this and get a professional take on it. (hugs)

[Mom2]

Hi there, I’ve been wondering how you both were doing? I can only speak from experience. When I agree or go along with my son’s delusions, he loves it. Now, because of the delusions he has, I have to really watch it because it can easily go south and harmful.

It is so good that you have details to talk to doc about. This illness is so unpredictable. We had company over the weekend and my son chose to leave and go to the office Saturday and evening, after spending only a couple of hours with his aunt and uncle.

He came back on Sunday morning and went for a long walk with his uncle. It did them both some good. He and I had a good day afterward.

It seems like we go from intolerable to accepting behavior on any given day. I am still having luck doing routine things with my son which for me is cleaning related. If we stay ahead of the messes, I consider it a good day and let’s face it, we all like a little help from time to time. Good luck with the diagnosis. It will come with time.

Talk soon.

[slw]

Well, he’s back to some delusional stuff today, but he doesn’t seem depressed or agitated, so I guess that’s OK.

[Mom2]

It is sad to see Anyone we love depressed. I think that is the hardest, don’t you?
I think that is why they say everyone is different. The mood disorder in my son can change so quickly before you can analyze it.

[slw]

Well, we’re back to the status quo today with the same old delusions.

I don’t know whether to be relieved or sad about it. Guess I’m just hard to please.

[Mom2]

I accidentally dosed 4 grams of Sarcosine to myself and son yesterday. I was alert all day but he said he could tell the difference in a good way. Today and onward it will be the 2 grams. I think I read it takes a while but I was curious if your son noticed any change since we both started the same day. Any hope is good.

[slw]

Well, my son said it felt good, so it kicked his addict tendencies into overdrive. No matter what it is, it seems like he has to push the envelope to see what it will do.

I emptied out most of the packet into another container without him knowing, then just left him with it.

I don’t think he’s going crazy with it, but I bet he’s at 4 to 6 grams per day. When what he has is empty, I’ll decide whether or not to let him have the rest. I even saw evidence he tried to snort it.

If everything settles down, I’ll give him some more - if not, I won’t.

[Mom2]

I have read a bit about it and someone was taking it under doctor supervision and found that less is more. 2 grams is recommended dosage. I believe there have been several studies. His doctor wouldn’t advise it until he heard results from other doctors. We just tried it anyway and I’ll print out the reports for his next appointment in December. His Pdoc believes in as few medicines as possible, nothing that can cause addiction so no benzodiazepines or anything they use when they are in the hospital😜

I think if I gave my son the bag he would do the same thing your son did and I would have no idea how it worked in the end. Good luck in Wednesday.

[Mom2]

I hope the appointment went well yesterday. I read on this forum that delusions are the last to go and I think boredom really plays into that. If we had limitless amounts of time in a day, we might make up people to hang with. Our son is an only child.

[slw]

Ours is an only child too. And, I’m sure he’s bored too, but I don’t know what to do about it at this point.

[Butterfly]

My son too. Moods can change back and forth in a day. Was diagnosed with schizophrenia 15 years ago but changed to schitzoaffective after hospitalizations through the years.

[Molly]

When my daughter can’t sleep for days I can now see that she is starting a downslide into delusions, auditory and visual hallucinations. Depression for my daughter is the hardest to deal with and doctors can’t give her anti-depressants because of the mania.

It sounds like you have a very good relationship with your son. He’s probably worried that if something happens to you what will happen to him - who will love him unconditionally and who can he count on. My daughter has similar worries but at the same time she resents me for depending on me so much.

Diagnosing with accuracy is difficult for doctors. Over the years my daughter has been given a few different diagnosis and all a doctor can do is make observations and they are not with our kids 24/7 so often times doctors are wrong… I remember a mental health care worker telling me - don’t marry the diagnosis, just flirt with it and I think he was spot on.

[slw]

The reason for my original post, hoping he’d had some insight, was shortlived.

As I’ve mentioned, I’ve been getting him to take his meds by letting him believe they’re something else, but about 2 days ago, he stopped taking everything, so we’ll see where he goes from there.

He seemed to suddenly realize how much time he’s lost last night when he started asking me when he’d stopped seeing each therapist. He got pretty depressed over it again, went to bed, turned out all the lights & everything & he’s been there for the most part ever since. When I came home from work, I do see signs that he got up and ate a salad and some chips and smoked about 1/2 a pack of cigarettes, but he seems dead asleep again from what I can tell from the hallway.

I blame the lost time on more than the psychosis - he’s been staying as sedated as possible on high dosages of suboxone and klonopin for about 5/6 years until he decided to quit, either because he was getting psychotic or the almost cold turkey stop pushed him into it.

I know it’s probably bad to hope that he’ll just kind of snap out of the worst of this, but he has done it before. The first psychotic break was at 15, and was probably over in about 3/4 days once we knew what was going on. We didn’t hospitalize because the ER scared us all half to death, so he came hope, we got him to finally sleep, and he got better really quickly.

The 2nd time, we skipped the ER, took him to the family doctor, and by the time they got him into a psychiatrist - about 2 weeks later, the psychosis was gone, but they started treating him for anxiety & depression.

The 3rd time was when they started antipsychotics, and he responded quickly, so it’s there’s no way to know what would have happened without them. And, since then, anytime he noticed he was feeling paranoid, he would take a little extra to head it off & it worked great.

Now, 8/9 years later, and his 4th psychotic break, he learned to hide most of his symptoms for a long time, and the meds are working like they did before. Of course, he’s probably been psychotic for months instead of just days, too.

But, after this long ramble, I’m wondering if anyone’s had a family member come back to reality, or close to it, when they weren’t taking meds. If he’s bipolar I (that runs in our family more so than SZ, but everyone’s been thinking SZ, and he’s said in the past he thinks he’s SA), do people with that finally swing back around?

[Hereandhere]

Hi slw,

Bipolar, Major Depressive Disorder, and Sz all share genetic traits, according to the latest research. So, once there’s serious mental illness in a genetic line, it can be any one of those, if this new research stands the test of time.

My family members with bipolar one spent extended periods of time entirely free of symptoms of depression, mania, or psychosis. My family member with sz has always had some level of psychosis since the first serious episode of psychosis. I"m not counting the time and symptoms of the prodrome, which was less debilitating though symptoms were within in the range of psychosis.

So, if positive symptoms of psychosis are always there to some degree, maybe looking at Sz or Sza. Also whether or not positive symptoms of psychosis are “mood congruent” is a way towards diagnosis. Accurate diagnosis can take years.

[slw]

Thanks so much.

I’m not sure what’s prodromal and what’s not. Maybe those early breaks that he recovered from quickly were prodromal?

They were definitely full breaks with extreme paranoia, absolutely no sleep for days, delusions, the whole 9 yards.

Edit: I know I sound like I’m grasping at straws, and I am. I just desperately want a few days of clarity where we can talk about the situation and maybe get him onboard with some better treatment options.

[Hereandhere]

I understand why you want some good days with your son and that you hope he receives effective treatment. What you’re going through is really hard.

Prodrome is the time before a first episode of psychosis. Every course of illness is different, but some people have long prodromes and some people don’t have a prodrome. Once a person is experiencing psychosis, that’s not prodrome, according to my limited and layperson understanding.

I hope you get the days of clarity.

[Mom2]

Our experience has not been good without medication. Without meds our son goes into his own world and might not converse at all with us. He might go outside and sit in the sun for hours. No appetite, no need to care for himself. We had to do so much for him and he was unpredictable as to when he would go off. It was usually once or twice a day and he would scream and run through the house punching and crying and was truly afraid. This psychosis lasted more than six months. He was prescribed Klonopin for the episodes but was never able to be trusted with meds and always begged for more. It was hard to get close to give him meds and then he became distrustful of them.

I do have to say that he wasn’t talking about drugs 24/7 at that time. He was not motivated to do much except walk in the woods, sometimes at dark. He is much improved now but the obsession with finding hallucinogens is constant. He is missing out on so much of life because we are afraid he’ll find the wrong element and disappear. I just had an invitation to a concert and I was planning to take him since he isn’t psychotic. My husband is discouraging it because he made a reference to him of finding some acid at the university town. He has no filter and tells everything that is on his mind. He doesn’t have a cell phone any longer and if he did go off it would be hard to find him.
I don’t know how to help him sometime.
Slw do you think your son is depressed? Is he still delusional?

[slw]

I was thinking maybe, since he slept so long and because of what he talked about last night.

But now that he’s up, he doesn’t seem depressed. And, yes - still delusional.

The subject change from time to time, but that’s about it.

[Sheyelo]

I can relate to everyone’s stories here! My son has been diagnosed with BPD and schizoeffective. Currently not taking meds. It’s 2:30am and I’m up worrying about him! Looking out window to see if everything looks normal around his house! Tiring but I love my son and I think we all deserve better answers and support than we are given!!