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    Dr. G question
    monkeybee posted:
    I'll try not to make this too long. I tried to prepare for/expect a mood episode after the baby was born, but I expected it to be postpartum depression. After crying for a week and a half, I knew that is what I was experiencing. But, I am prone to mania and, after not sleeping my mood quickly escalated. Now, I am still feeling normal much of the time, just revved up and restless. My mind has been racing quite a bit. But, a couple days ago, I decided to try to climb the walls with knives to hang from the ceiling. I didn't do it because I knew my husband would get mad. I was still able to reason. Then yesterday I told my husband that I could jump from the top to the bottom of the stairs but he insisted I not do it. I just laughed. I also told him I was going to leave him for a woman (I'm not gay). When I told him, I told him it was a joke and laughed like a fool but he didn't think it was so funny. I have seiously considdered doing this. As if this weren't bad enough, I have been extremely irritated with the kids and feel like I can't be their mom anymore (which is HORRIBLE and unlike me). You already know I am a worrier, but what if I lose my impulse control or worse, become psychtic? It feels like it's not far. I am sleeping only a few hours a night, and not just because of the baby. My doctor is on vacation this week and I think the ER is unnecessary (I'm still very coherent). What is your opinion? This might be a ridiculous email, I realize I am loose lipped when I feel this way but I just want to stop this before I do something extremely stupid. Thank you!
    Joseph F Goldberg, MD responded:
    Dear Monkeybee,

    Postpartum psychosis or mania is as much a concern as postpartum depression, if not even more so. You're describing the kinds of symptoms that at the very least seem to warrant an urgent evaluation (if not hospitalization...high risk-taking and impulsivity are safety hazards that warrant an urgent evaluation, especially in the context of having a new baby). Doctors have other doctors covering for them when they are on vacation so it is probably worth calling your doctor's office to speak with the doctor covering for him about how best to have your symptoms evaluated and make decisions about the best next steps in terms of treatment.

    Dr. G.
    monkeybee replied to Joseph F Goldberg, MD's response:
    Thanks so much Dr. G. My doctor has me doing an IOP. I still am a little afraid I will act on one of these very bizarre impluses...especially the impulse to get in my car and drive VERY far away, which is not so much bizarre but very wreckless. I haven't felt this manic in quite some time and I am pretty sure I could kill a shark with my bare hands, I mean I could do all kind of crazy things and my family is babysitting me and has me couped up in this house and I just want to jump out of my skin or leave...but I have kiddos, but unfortunately sometimes that doesn't stop my head from going there...which is one of the main reasons for the IOP. Anyway, if I don't shut up, I will clearly ramble all day. Thanks again for your response. If you have any more input, like how to (insert foul language...even though I don't cuss) keep from killing myself, it would be great, ha! I am so sorry if this doesn't make sense...but just know i appreciate you and all of the great info you provide me and everyone,
    Joseph F Goldberg, MD replied to monkeybee's response:
    Dear Monkeybee, Lithium deserves consideration (if not already in the regimen) whenever impulsivity and suicidal features are part of a mood disorder presentation. And antidepressant elimination is also recommended by most experts when any agitation or mania symptoms occur or coincide with depression symptoms. Dr G
    monkeybee replied to Joseph F Goldberg, MD's response:
    Thanks again. I am currently taking Lithium and not an antidepressant. I have one more question, please. Besides the IOP, my doc introduced Geodon and Klonapin to my meds. How fast is Geodon in the treatment of mania? Thanks again.
    Joseph F Goldberg, MD replied to monkeybee's response:
    Dear monkeybee,

    In the original FDA studies of Geodon for acute mania, the dose was rapidly brought up to 160 mg (80 mg twice a day) within 2 days, and with that rapid dosing, many patients saw improvement within a week.

    Dr. G.
    monkeybee replied to Joseph F Goldberg, MD's response:
    Thanks again!

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