I have been seriously off-the-wall manic. But not in a very long time. And it hit me recently that I really never had particularly hard-to-treat mania, even back then, I just had really bad psychiatric care- which really dragged things out and let my world get totally out of control.
Depakote doesn't work for me. And I had recently had lithium toxicity. So every psychiatrist I saw at the time would freak out and say there was nothing to do- or try me on some inappropriate medication. But I had been on Tegretol before, and it worked- and that was what eventually got me out of the manias in the end. It must have fallen out of favor. The one doctor I did suggest Tegretol to told me I was "drug-seeking." Well, technically yes, but what a drug to seek. I eventually got put on a baby dose by one doctor- a third of what I had taken in the past- and when he told me I was at a therapeutic level (I wasn't) and there was no point in going higher, and I wasn't responding- well, I was manic. I had no patience for idiots. I told him where he could go and stormed out.
But I now know that Tegretol works, lithium works, Zyprexa works. And for a little transient hypomania, klonopin works. I really don't need a bigger arsenal than that for keeping mania at bay. I am hoping not to to have to re-start the Tegretol anytime soon (and certainly not as long as I am taking Zyprexa- they are both anti-cholinergic), but it is there. Ideally I would like to get off of the Zyprexa- and just rely on the lithium. I hope that I can.
I just cut my Zyprexa a bit more last night after reading another article linking exposure to antipsychotics to brain volume. I've been on Zyprexa 15 years or so- perhaps most of the damage is already done. But who knows.