u/TruckAnnual775

My brother went into post-manic depression this week (he was diagnosed two months ago after his first manic psychotic episode), and his doctor has now started him on lamotrigine. He’s currently on day 2 and taking 25 mg. I know that’s a very low dose, but when should we expect the main effects to start kicking in? He’s really struggling and I’m very worried about him.
He’s also sleeping a lot, and his sleep schedule has become completely disrupted — he sleeps during the day. He’s currently taking lithium + 5 mg of Zyprexa as well.

Hi, of course someone with bipolar disorder can become a doctor—I already know that. What I’m actually wondering about is how productivity and performance are affected.
My brother was diagnosed with Bipolar I Disorder two months ago, right around the time he graduated from medical school. I’m also a medical student. Throughout this process, I’ve helped him a lot and became almost obsessed with researching his illness so that I could help him manage it in the best possible way.
In the country we live in, after graduating from medical school, doctors take a specialty exam and then start their residency in the field they choose. Before his diagnosis, my brother always wanted to specialize in dermatology because it’s considered a relatively comfortable specialty. However, the score required for dermatology is quite high, and because he has been going through such a difficult period, he wasn’t able to study enough to get the score he needed.
So now he has decided to become a family physician instead. Family physicians here generally work regular daytime hours, from 8 a.m. to 5 p.m., which seems like a very good fit for managing his illness. However, the first three years of residency involve hospital rotations, and unfortunately, there are night shifts.
Because of this, we got a medical report from his psychiatrist stating that, due to his illness, he cannot work night shifts. I really hope the hospital where he will work takes this into consideration, because this is genuinely very important. As far as I understand, avoiding night shifts completely is crucial for him.
And by the way, I’ll be choosing my specialty in two years. Guess what it’s going to be? :) Psychiatry.

Has anyone here experienced difficulty falling asleep due to medication or dosage changes?
There have been several medication changes and dose reductions in my brother’s treatment over the past few days and weeks:
Olanzapine was reduced from 10 mg to 5 mg.
Lamotrigine was started.
Sertraline was added but was stopped immediately because he started showing signs of shifting toward hypomania.
I think my brother’s recent difficulty falling asleep at night, wanting to sleep throughout the day, and waking up late may be related to these medication changes.
Has anyone had a similar experience? If so, how long did it take for your sleep schedule to return to normal?

Has anyone here experienced difficulty falling asleep due to medication or dosage changes?
There have been several medication changes and dose reductions in my brother’s treatment over the past few days and weeks:
Olanzapine was reduced from 10 mg to 5 mg.
Lamotrigine was started.
Sertraline was added but was stopped immediately because he started showing signs of shifting toward hypomania.
I think my brother’s recent difficulty falling asleep at night, wanting to sleep throughout the day, and waking up late may be related to these medication changes.
Has anyone had a similar experience? If so, how long did it take for your sleep schedule to return to normal?

Does anyone here have Bipolar I and take lithium + lamotrigine + olanzapine? If so, how does this combination affect you, both positively and negatively?”

My brother was diagnosed with Bipolar I Disorder two months ago after his first manic episode. He was hospitalized for two weeks, but after being discharged he stopped taking his medication and had a psychotic relapse one week later. Since then, he has been taking his medication regularly and is currently in remission.
He takes lithium and olanzapine, and his doctor recently added Lamictal (lamotrigine) because he has been feeling somewhat depressed. His olanzapine dose was also reduced recently.
For the past two weeks, his sleep schedule has become extremely irregular. He often falls asleep at 3–5 a.m., wakes up around the time he needs to take his medication in the morning, takes it, and then goes straight back to sleep. He can sleep until noon or even later. Because he sleeps so much during the morning, he struggles to fall asleep at night, creating a vicious cycle.
What worries me most is that he seems to have become less motivated and more careless about his sleep routine. In the evening, he agrees that he needs to fix his schedule, but the next morning he does the same thing again. I am exhausted from constantly reminding him and trying to get him out of bed.
He says he is depressed, although he is still able to laugh, joke, enjoy himself, and function relatively normally during the day. He also seems to be struggling with accepting his diagnosis and taking responsibility for managing his illness.
Could this excessive sleepiness and lack of motivation be related to his medication combination, particularly lithium + olanzapine + Lamictal, or could it simply be part of the depressive phase or his disrupted sleep schedule? Could the recent reduction in olanzapine be contributing to his difficulty sleeping at night?
I am also worried about whether this irregular sleep pattern could increase his risk of another manic episode. I would really appreciate hearing from people who have experienced something similar, especially regarding excessive daytime sleepiness, lack of motivation, and medication-related sedation in Bipolar I Disorder.

Hello everyone,
My brother had his first manic episode two months ago and was diagnosed with Bipolar I Disorder. He stayed in the hospital for two weeks, but the doctors discharged him before he had developed much insight into his condition. As soon as he was discharged, he refused to take his medication, and one week later he had a psychotic relapse.
We decided not to hospitalize him again because he was not refusing his medication, and we made sure he took it regularly. This whole process has been incredibly difficult for my family and, of course, especially for my brother.
Thankfully, he is now in remission. Throughout this process, I have done a lot of research and read many papers, and I have always tried to guide and support him. He is usually cooperative about his treatment, but sometimes he seems careless or dismissive about it.
For the past two weeks, his sleep schedule has been very irregular. He sometimes doesn’t fall asleep until 3, 4, or even 5 a.m. because his antipsychotic dose was reduced, and he says that he is feeling depressed.
In the mornings, he wakes up around the time he needs to take his medication, takes it, and then goes back to sleep. He doesn’t wake up until around noon. We try to motivate him and convince him to get out of bed, but because he sleeps during the morning, he struggles to fall asleep at night again.
We have been arguing a lot about his sleep schedule. I constantly tell him that we need to establish a regular sleep routine. He agrees in the evening and says that he will try, but the next morning, the same thing happens and he stays in bed for hours.
I am exhausted from constantly reminding him. Eventually, he yelled at me, told me to leave his room, and said that he was going to sleep.
Because he said he was feeling depressed, his doctor recently added Lamictal. He is currently taking lithium and olanzapine as well.
He is not severely depressed—we can observe that he can still laugh, have fun, and joke during the day. However, he has struggled a lot with accepting his illness and coming to terms with his diagnosis.
I honestly don’t know what else I should do anymore. I feel so exhausted. I wish he could take responsibility for his own sleep schedule and understand how important it is, instead of me having to constantly remind him.
I am really scared that this excessive sleeping and sleeping until noon could somehow trigger another manic episode. I know that sleep disruption can be a warning sign, and this is why I am so anxious about it.
Thank you so much for reading. Writing here and getting everything off my chest actually makes me feel a lot better.

My brother (26M) had his first manic episode 2 months ago, and it was a terrible experience. When I realized what was happening, I immediately flew to be with him, but he was like a completely different person—someone I didn’t recognize at all. I was terrified. I couldn’t convince him to go to the hospital, and I had no authority over him. Somehow, my uncle came from another city and took him to the hospital against his will, and he stayed there for 2 weeks. He was diagnosed with Bipolar I disorder.
Before this, he had been diagnosed with dysthymic disorder and had been depressed almost constantly since adolescence. The hospitalization was extremely traumatic for my family and me. The hospital where he stayed was a terrible place, and he never regained insight during those 2 weeks. They eventually discharged him, but he refused to take his medications and insisted that he wasn’t ill. He put me through some very painful psychological experiences. I know he wasn’t himself at the time, but I still cry when I remember it. I was so scared.
Despite everything, I didn’t let my family see how much it affected me. I tried to stay focused on finding solutions and constantly researched everything I could. I’m also a medical student, so I regularly talk to psychiatrists and professors in psychiatry.
When my brother refused his medications, he quickly had another psychotic episode. That was also terrifying, but because it was a mixed episode, he was more emotional and could recognize that something was wrong. He started taking his medications regularly, and he has now been on lithium and olanzapine for about 1.5 months.
But I’m so anxious that I constantly wait for him to fall asleep and write down the times he goes to sleep and wakes up. He doesn’t fully realize how important these things are. I try to control everything—his medication times, his sleep schedule, even how much tea or coffee he drinks in the evening. This is exhausting me, but my parents also have chronic health conditions, so I always feel responsible and feel like I have to put myself forward and take care of everything.
I’m constantly researching “What triggers mania?” and trying to keep him away from every possible trigger.
But now my university is starting, and I have to return to the city where I study. My brother lives with my parents and our other sibling. I’m leaving in a week, and I’m terrified that something will go wrong when I’m not there and that he won’t be careful enough.
Psychologically, I’ve been deeply shaken by everything that happened. There was a moment when my own brother looked into my eyes so coldly and said he wanted to kill me, and I genuinely felt like my life was over. I thought I was going to die.
I don’t know what to do anymore. Am I obsessing over the details too much, or am I actually doing the right thing?
Are there people here who have been through something similar and can share their experiences? For those with Bipolar I who have remained euthymic/stable for years, what do you do to stay well? What does your routine look like? How much do you actually monitor sleep, medications, caffeine, stress, etc.?
I would really appreciate hearing from people with lived experience.
Btw, my brother's current medications: litium+olanzipin+lamictal(new)

My brother had his first manic episode 2 months ago and was diagnosed with Bipolar I. He then stopped taking his meds and had a psychotic relapse about 1.5 months ago. Since then, he’s been taking litium and olanzipin regularly.
He’s been a bit depressed lately, and he was also experiencing a lot of morning sedation, so he talked to his doctor and the olanzipin dose was cut in half. His doctor had also added sertraline, but we noticed that he started becoming hypomanic literally from the first day, so the doctor stopped it.
Now, for the first time, he’s going to start lamotrigine instead. Has anyone here had a similar experience? I’m really worried about it triggering mania.