New on meds - Is this rollercoaster normal?

Family
1

I’m new to the forum and this is my first post. My fiancee and I have been together for 6 years, and he has just had his first major psychotic episode. I have seen him get paranoid and say delusional things about people having been in the house twice before, but it only lasted a few hours and it was after he had barely slept for a few days (he’s always suffered from insomnia and so far, nothing really works to make him sleep except xanax which is so addicting that he’s avoiding it). This time it got out of control and he threatened me and was hospitalized. They put him on Seroquel and Cymbalta, and Vistaril to sleep. He stayed in the hospital for five days and the meds seemed to be working. He did not voice any delusions while there or for the first day or so home. Then it started to seem like the meds were wearing off in the afternoon, and then earlier and earlier, and then it progressed to another full break with another hospitalization. This all in less than a week - home Friday, back in hospital Thursday. They changed him to Risperdal and Doxepin, and he seemed to be even better than before - more himself, less flat. Happy even. He was released Monday and was fine again for a few days and now the same thing, The meds seem to be wearing off earlier and earlier each day and he’s voicing more and more of the delusions. Went to pdoc today (early am while meds were still working) and told him this and he said that he hasn’t seen any of the psychosis and therefore hasn’t actually diagnosed sz, and that the meds wouldn’t work that fast to control the psychosis and he basically said he may have a personality disorder, which means he may be faking for attention. Of course the pdoc never sees him in the ER before they give him something to calm him down. I feel like the meds calm him down just enough to enable him to keep his mouth shut to get out of the hospital and then his tolerance starts to build after he gets home.

Has anyone had any similar experience? Do meds typically just not work at all for a while and then gradually start to work, or do they work right away for some people? Do I really have to consider the possibility that he’s faking? (Side note - his mother was diagnosed sz and committed suicide 2 years ago, so there is a genetic predisposition.) I have seen the fear in his eyes, and I just don’t think he could fake this.

2

When I was first hospitalised, it took me 3 months on meds to become sane again. This is definitely one for the doctors though.

3

It is very hard to figure these things out.
My son was in the hospital last month for 3 days. I called the CIT team-because he was disturbing the neighbors in his apt complex. They would not take him in because he was not a danger to himself or others. The hospital did not force anything on him that I know of and let him go.
I know my son can get pretty logical when backed up against the wall. He has even said that he will do what he has to to get through a hospitalization, mental health court, etc…
He does have delusions. One case manager also told me she thought maybe he really had a personality disorder.
A lot of meds take a while to get into the system and hospitals always seem to release too soon.
There are so many variables–you`re never quite sure about anything!
I do not think he is faking anything. However, the doctor needs to be aware of everything. Injections would be the way to go,hope this helps

4

Have you considered getting a second opinion? I’ve been on this journey with my father, who has had sz for over 50 years. Some doctors prefer certain medications over others.

I’d do some research on those medications yourself if you are interested in discovering what they are trying to treat him for. If the Dr is saying that they haven’t seen any hallucinatory behavior, then they may not have prescribed any of those medications. Cymbalta, for example, is an SSRI, which is used for depression. It won’t, as far as my knowledge extends, treat hallucinations. That may be why you saw the first set of medications not taking affect for very long. It is true that anti-depressants take a while (several weeks sometimes) to start controlling symptoms. I know because I take them myself.

As for Risperdal, that is prescribed for anti-psychosis, often for sz or bi-polar. My father was on it for a while, then got changed over to Olanzepine (brand name is Zyprexa), which is a similar and very common drug. Generally, they control sz with a combination of anti-psychotics and mood stabilisers, which are often also the same drugs used to treat epileptic conditions interestingly enough. I do know that when my father would sometimes have his anti-psychotic meds changed (often more because of insurance company payment coverage than anything else), it would take a couple of weeks to take effect. His Dr did tell me at the time that there is a percentage of patients for whom some medications are not as affective. There is even such a conditions know as treatment-resistant schizophrenia incase you wish to research it. Even in the best of situations, anti-psychotics do have their limitations, and unfortunately, are very powerful drugs that can have significant side effects. It also depends on the sub-type of schizophrenia he has, if he has it. And since you are still in the pre-diagnosis stage, there is still a lot to be answered.

As far as personality disorders go, this may not necessarily imply that your fiancé is faking it. I am sorry if this was the impression you got from that particular Dr however. There are indeed a sub-class of mental illnesses called personality disorders. Among them is Borderline Personality Disorder. My mother suffered from it. Prior to this, she was told she had bi-polar disorder, but those were the says when very little about Borderline PD was known. It’s a very narccistic illness and very hard to be around someone continually who suffers from it. There’s an informative book for carers of people with BPD called “Stop Walking On Eggshells” which may//may not help you to decide if this applies to your situation or not.

Not assuming to be a fountain of knowledge here. Only that my situation has been long-standing. My father is in his 80s, so I’ve been aware of (and lived with) sz for a very long time.

You are in a difficult stage because you are very early in the diagnosis and treatment of whatever it is that is affecting your fiancé. I would persevere and persist with the Drs if you are really committed to the long-haul. Unfortunately, playing carer and advocate for a relative in this situation can be challenging and difficult. A good Dr-family relationship is key. Don’t be afraid to “shop around” until you find the most suitable physician to treat him.

Wishing you good luck!

5

Sz is a set of symptoms that can be caused by a very complex and diverse collection of genetic, epigenetic and environmentaal factors. Many sz pts will have to work with a good diagnostician / psychopharmacologist team to find a precise combination of medications that “works well” for them. All patented meds are at least slightly different and may be “better” or “worse” for specific genomic, epigenomic and stress-induced expressions.

Not gonna be popular for saying this here, but I’d be very careful of what you read on this forum, as many (though not all) of the participants are, well, delusional, learned helpless and quite obsessed with their sense of identity as their diagnostic labels. There are, however, many pretty trustworthy books on the topic, including these: http://www.amazon.com/Surviving-Schizophrenia-6th-Edition-Family/dp/0062268856 and http://www.amazon.com/The-Complete-Family-Guide-Schizophrenia/dp/1593851804/ref=pd_sim_14_1?ie=UTF8&refRID=1SPT2KV5V4AETJ8270RF.

6

This is a very difficult thing to deal with. My schizophrenic son has been on several medications and we have changed them due to his symptoms. Some meds work better for one but not the other. It is all a trial and error. It is a long hard road and I have been dealing with it for several years. I found with the Risperal, it was an outstanding antipsychotic, however, my son gained over 100 lbs and is now giving me a hard time about taking it. So we are trying Latuda in addition to Riserpal, but the Risperdal is in a lower dosage. My experience was once the correct dosage was put in place, he acted somewhat normal, but never 100%. The symptoms will not go away totally, at least that is what I am seeing on a daily basis.

7

For me personally, Risperdal took effect in something like a week, but it takes one or two months for my brain to fully adjust to a change in medication.

From what I have read, such quick adaptations to a new medication are unusual to say the least. Normally when someone finds a medication that works, it will keep working for a number of years.

8

Get a third and fourth opinion they’ll prolly say the same thing anyways but thats what I would do.

The one thing that they won’t tell you is they have absolutely no idea how to make your life more normal because the human brain is the last uncharted place on earth and when it comes to meds it’s all trial and error for the individual.

I was first givin one tiny pink pill when I was 13 I then spent the next 3 months constantly thinking of suicide.

There are maybe hundreds of combinations of psych meds and each responds differently to them.

9

When I started on meds (tilafon first, the a doubling, then another doubling and latuda addition, then a 33% increase on the trilafon) all within a few weeks. I never used to dream (or possibly even REM at all) now I have the most unusual vivid lucid dreams. some are downright nightmares. I feel like Im a little less flattened in the long run though. I do understand your body will develop a natural tolerance to just about anything so I totally understand what you mean by his meds seem to wear off sooner and sooner. make sure the doc knows and he’ll probably compensate by upping his doses slowly. Also please consider the placebo effect. The first couple times I popped the prescribed pills I immediately felt better even though I was totally aware it could take weeks for them to build up to a “therapeutic level”

10

Is there a possibility that once released he isn’t taking the medications?

11

Why do I need a dictionary just to understand what you are writing most of the time? If you are really smart you should be able to explain the facts as you have learned them to be for us who need to know these things in simpler words please. Thank you.

12

They have time released shots of some of the anti-psychotic medications. Maybe that would give a more even release of med’s into his system throughout the day. You might talk to a doctor about that option.

13

I read a book written by the late Dr. and psychiatrist, biochemist etc… Abram Hoffer titled: “Healing schizophrenia, complementary vitamin & drug treatment” that was helpful for me. He also did recommend vitamins as adjuncts to our medications to be helpful to early onset of these mental disorders.