[beetle]

Richard B, on 11 October 2009 - 02:04 PM, said:

Hi everyone,

I am bipolar II, social anxiety, and I'm taking:
40mg Celexa, 1200mg Lithium, 100mg Seroquel (at night for sleep), and 0.5mg Klonopin PRN

My biggest complaint is that, hypomanic episodes are easily abated, because I have the Seroquel and Klonopin. But, depressive episodes make me feel helpless. I can't add a little of anything to pull out of them. I do get regular exercise, I do jiu jitsu, and I have a Happy Light I use to make sure I get plenty of winter light.

Other than that, when I get into a depressive period, I'm helpless. My doctor suggested perhaps I might want to try Lamictal. I'm thinking I might want some Adderall on hand for an as-needed boost out of it. Do either of those sound reasonable? I don't have insurance, so the Lamictal makes me go ehhhh, another expense.

I don't think the Lithium is completely controlling my mood swings, so maybe I just need to up that... but the downside there is, it tends to give me acne.

Any general thoughts, or specific thoughts on my doctor's Lamictal idea or my Adderall idea?

Many thanks!

Richard

What other ADs have you tried? Any? Wellbutrin is usually a "safer" AD for someone with BP. It tends to not cause the cycling that other ADs do.

The lamictal sounds totally reasonable. The titration is frustratingly slow but you have to go slow to avoid side effects. Lamictal isn't much of an anti manic. But if your main problem is depression this may not be a problem.

I may be wrong but you might be hard pressed to find a pdoc willing to Rx a stimulant for depression. Some do but usually only after everything else has failed.

My pdoc surprised me when she offered ritalin to me. Not so much for my depression but some other things she thinks is going on, though I'm sure she knows it can help with the depression too. Since I've been on the ritalin I do feel better. I felt REALLY good the first week but you can't keep chasing that feeling. After awhile you just feel kinda normal on it...not so up and speedy. I do think I could use an increase but that might just be me chasing that REALLY good feeling I got off of it at first.

My tdoc wasn't even surprised when I told him about the ritalin but he automatically thought it was for the depression. When I told him it was for the suspected other stuff (possibly autism spectrum stuff) he totally disagreed with my pdoc's assesment there. But he said he's seen it Rxed for depression. I just think that it's usually saved as a last resort.

[pinkiemarie]

I'm also on 1200mg of lithium and although it's controlling my bipolar swings quite nicely, I have other issues going on that are making me consider adding lamictal to the mix as well. I'm lucky in that I have insurance and the financial decision is a non-issue for me. For you, it really depends on what you and your doctor feel the costs vs benefits would be to add that to the mix. Beetle mentioned Wellbutrin, and although it's generic doesn't seem to be on the $4 list, it could be worth a shot. I found some doses online for about $40. IDK if that's worth it to you or not, but if you don't feel like you're getting relief from celexa, you may find it more helpful.

Many people do feel that lamictal has antidepressant qualities for BP patients, btw. It can cause acne though, worse than the lithium I believe. I guess it's all about priorities :\

[pinkiemarie]

Well I don't know what to tell you then It's so hard to find a combination of meds that A) works and B) doesn't make you sick.

[beetle]

Richard B, on 11 October 2009 - 03:17 PM, said:

pinkiemarie, on 11 October 2009 - 02:06 PM, said:

I'm also on 1200mg of lithium and although it's controlling my bipolar swings quite nicely, I have other issues going on that are making me consider adding lamictal to the mix as well. I'm lucky in that I have insurance and the financial decision is a non-issue for me. For you, it really depends on what you and your doctor feel the costs vs benefits would be to add that to the mix. Beetle mentioned Wellbutrin, and although it's generic doesn't seem to be on the $4 list, it could be worth a shot. I found some doses online for about $40. IDK if that's worth it to you or not, but if you don't feel like you're getting relief from celexa, you may find it more helpful.

Many people do feel that lamictal has antidepressant qualities for BP patients, btw. It can cause acne though, worse than the lithium I believe. I guess it's all about priorities :\

I actually have a stockpile of Wellbutrin and get it pretty cheap, so that's not an issue. I don't like that it makes me jittery or the fact that most of the time when I'm taking it, I don't feel depressed (so I stop taking it ). I have a hunch that replacing Celexa with Lamictal could still not be enough antidepressant-wise, and I'm worried what it would do to my anxiety, since Celexa already does a pretty good job with that.

I can't really think of an AD that can be used only "as needed". If there is one, someone please correct me. I think you just have to take the AD long term even if you don't want to or don't feel like you need it anymore. Because you will cycle down again and most of the ADs take awhile to kick in, so you're really never getting stable.

The lamictal might work out for you. There are plenty of people on this board who have gotten relief from their depression with lamictal. I'm not one of them though. But again, it's not something you take "as needed". You take it all the time.

You (and your pdoc of course) might even consider one of the AAPs that have some AD effect. They can also stabilize mood to varying degrees. Abilify and Geodon (what I'm currently using) come to mind. Both of them aren't too good for squashing mania but your lithium might be enough to do that. Again, they are taken long term, no matter if you feel better, you don't stop taking them and then start again when you begin to feel bad.

These are of course only my opinions and I'm no professional. There are plenty of folks on here that are BP II who will probably chime in about cocktails that work for them.

This post has been edited by beetle: 11 October 2009 - 02:48 PM

[notfred]

I think you have to just try things, there is no way to predict how things will effect you. It is easy to talk yourself out of things by fixating on what *might* happen. If you find meds you like, side effects like acne and the shakes are treatable.

nf

[pinkiemarie]

You know, now that I think about it, there's something they prescribe for lithium shakes, though I can't remember what it is. Maybe the same drug can be prescribed for Wellbutrin shakes? Meh, maybe it isn't worth it if you can find something that's better for you anyways.

[rowen]

I'm a Lamictal believer. I didn't get acne from it. Or much of anything else. Mainly headaches and muscle cramps which are quelled by lots of water drinking. Love, love, love the stuff. Would absolutely do what I could to keep taking it if I didn't have insurance.

Can you do the community health clinic pharmacy thing? Very good pricing.

EDIT: I do get acne from Abilify. I use Acne Free for sensitive skin. Works great.

This post has been edited by rowen: 11 October 2009 - 03:47 PM

[notfred]

Propanol (Inderal) is used for tremor and shakiness. I use it in situations where I do not want to appear nervous, like interviews.

nf

[beetle]

Richard B, on 11 October 2009 - 07:24 PM, said:

notfred, on 11 October 2009 - 04:09 PM, said:

Propanol (Inderal) is used for tremor and shakiness. I use it in situations where I do not want to appear nervous, like interviews.

nf

How is that different from Klonopin?

It's not a benzo. Completely different class of drug.

[SashaSue]

I tend to get relief from depression by increasing my AAP. There've been a couple of studies showing seroquel to be useful for depression, at dosages around (I think) 400mg. That might be something to look at.

[Persephone]

If you have a Coscto near you, check out their pharmacy. Generic lamotrigine is about $25 if you get on their Patient Assistance program.

[gizmo]

Richard B, on 13 October 2009 - 07:54 PM, said:

Good call... I'm doing exactly that! What worries me though is, we're adding yet *another* medication, and I'm just frustrated at the sheer number of pills I have to take per day.

It's not how many you take, it's how you feel. Some people feel good with two, some people feel good with ten. You just have to find your majic number.

Think of it like a mental majic 8 ball, only much less funny.