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I know that a lot of bipolar folks take an SSRI as part of their daily regimen of meds and apparently it seems to help.  But there's some growing concern in the pdoc world now that SSRI's may be causing manic symptoms and even directly causing manic episodes.  I was on SSRI's for 10 years before quitting last October.  In chronological order:  Celexa, Zoloft, Celexa again, Lexapro, Zoloft again, Prozac, Zoloft again briefly, back to Prozac to close it out. 

For me, personally, after stopping them altogether, I was able to see what they were doing to my system.  I truly believe they made me much more unstable and greatly increased compulsiveness and just made a bad situation worse.  Switching from Lexapro to Zoloft sent me immediately full-on hypomanic for over a month in early 2015.  I was high as a kite and on top of the fucking world.  It was unreal and so obvious at the time. From the beginning of it, I was certain something unusual was going on. Now I wasn't diagnosed bipolar yet, just depressed, so I didn't even know what hypomania was then.  It fizzled out eventually (sigh) but I had at least two more, shorter, and less intense episodes late spring 2015.  I've not had anything quite as euphoric as those since.

My last pdoc expressed some concern about the prozac but wasn't very insistent on me stopping it, just that I would want to eventually.  I've since read that there is increasing concern in the pdoc community.  Yet a lot of bipolar people still take SSRI's and don't seem to have problems. 

Do SSRI's seem to help your causes?  Do you notice any unusual side effects?  Have any of you stopped taking SSRI's and noticed a change?  Other comments?   This could be interesting.

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I had to stop taking SSRI/SNRI medication because if they didn't cause balls-out mania, they caused something I hate even more:  Apathy.  Just this wet fucking blanket of apathy where I didn't want to do anything, didn't have the desire to enjoy myself, and because of the meds, was totally okay with not giving a fuck about anything I ever cared about.  I couldn't write, I couldn't play games, I didn't want to talk to my friends, I didn't want to discuss shit on the internet, I didn't want to take care of my own body or my household, and I was totally, absolutely okay with that.

Currently taking an atypical antipsychotic and a mood stabilizer and it seems to be working pretty well.  At least a little more shit is getting done.

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10 minutes ago, Bad Haiku said:

I had to stop taking SSRI/SNRI medication because if they didn't cause balls-out mania, they caused something I hate even more:  Apathy.  Just this wet fucking blanket of apathy where I didn't want to do anything, didn't have the desire to enjoy myself, and because of the meds, was totally okay with not giving a fuck about anything I ever cared about.  I couldn't write, I couldn't play games, I didn't want to talk to my friends, I didn't want to discuss shit on the internet, I didn't want to take care of my own body or my household, and I was totally, absolutely okay with that.

Currently taking an atypical antipsychotic and a mood stabilizer and it seems to be working pretty well.  At least a little more shit is getting done.

Yeah apathy is probably very common among us but is not discussed so much.  Some SSRI's caused serious apathy for me, while others did not.  Prozac was the worst but the best at keeping me from the deepest lows consistently.  Even when I stopped Prozac, I didn't care to do a damn thing.  I could sit on the computer but I didn't care about much at all.  I went back on Bupropion at 150 mg to quit smoking again and that snapped me out of it big time. I hadn't realized how bad I was until I got back to normal.  The bupropion is activating though and does not help my temper at all, but I'm paying that price at the moment.  I need to figure out soon if I want to stay on it.  I think it's keeping in semi-hypomanic mode nearly constantly.  I've definitely been less depressed.  And just like you put it "At least a little more shit is getting done."  I finally overhauled my garage after ingoring it for 2 1/2 years.  And I got on it a week into the bupropion.  Totally snapped my ass out of a big funk.

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1 minute ago, Distorted Me said:

Yeah apathy is probably very common among us but is not discussed so much.  Some SSRI's caused serious apathy for me, while others did not.  Prozac was the worst but the best at keeping me from the deepest lows consistently.  Even when I stopped Prozac, I didn't care to do a damn thing.  I could sit on the computer but I didn't care about much at all.  I went back on Bupropion at 150 mg to quit smoking again and that snapped me out of it big time. I hadn't realized how bad I was until I got back to normal.  The bupropion is activating though and does not help my temper at all, but I'm paying that price at the moment.  I need to figure out soon if I want to stay on it.  I think it's keeping in semi-hypomanic mode nearly constantly.  I've definitely been less depressed.  And just like you put it "At least a little more shit is getting done."  I finally overhauled my garage after ingoring it for 2 1/2 years.  And I got on it a week into the bupropion.  Totally snapped my ass out of a big funk.

I love Wellbutrin in small doses, but once I get to what the doctor considers a 'therapeutic dose' I start having these horrible fits of rage.  Maybe an increase in Lamictal would temper the anger a little. (Lol, puns.)  Maybe I'll try it again.

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I only recently heard the term "Wellbutrin Rage" so I didn't know it was so common.  I'm clearly affected by it even in low dosages.  I'd say 90% good but 10% bad.

In mid 2015 a pdoc wanted to try me on 450! mg of bupropion just to see what happened.  All fucking hell broke loose and I didn't know what hit me.  I got so unbelievably emotional.  I would have crying spells out of nowhere for 1/2 hour and I felt like I was wound up like a clock.  I'm at 100 mg on lamictal right now going up to prob 300 eventually.  I like it better than any other I've tried.  I have a feeling lamictal by itself is going to be 80% of what I need to be stable. 

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My current pdoc is pretty set against SSRIs for BP...especially BP1. Apparently some research has shown that even if it doesn't cause problems, the SSRI is less likely to be helpful than another mood stabilizer or AAP. This has been true for me will all antidepressants (either didn't help or caused manic/rage reactions). I'm of the mind that choosing to try a AAP or something like lamictal is definetly the safer choice and can definetly be more effective as well. However, clearly some people with BP do ok on SSRIs and other ADs...probably a good reminder that bipolar disorder is a diverse spectrum and not a black and white condition 

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13 hours ago, Iceberg said:

My current pdoc is pretty set against SSRIs for BP...especially BP1. Apparently some research has shown that even if it doesn't cause problems, the SSRI is less likely to be helpful than another mood stabilizer or AAP. This has been true for me will all antidepressants (either didn't help or caused manic/rage reactions). I'm of the mind that choosing to try a AAP or something like lamictal is definetly the safer choice and can definetly be more effective as well. However, clearly some people with BP do ok on SSRIs and other ADs...probably a good reminder that bipolar disorder is a diverse spectrum and not a black and white condition 

Great summary of what I think is basically the current situation.  Seems to be a definite shift occurring.  Some pdocs are still ok with SSRI's for BP, while others, probably a minority right now, are pretty strongly against it.  My personal experience is most are still ok or supportive of SSRI's for the antidepressant effect but only in conjunction with mood stabilizers or other psych meds.  They're just not ready for wholesale change yet. I guess the psych meds are keeping things in check, but I don't like this personally.  After I quit SSRI's completely in October it was so obvious how destabilizing they were for my system (but yes I never had psych meds with them).  I felt so much calmer, clear headed - like painfully obvious change there.  And then I looked back at the last 10 years on them and saw how much more emotional and compulsive they were making me - I'm BP you know I don't need any more of that.  Obviously I can't be 100% certain but I'm 99% and my gut agrees.  There were other weird things like getting frozen at my front door, unable to walk out and go to work.  I'd just sit there with my mind saying "get up and go" then "no don't go" with my ass glued down unable to move for an hour.  I can't say for sure that was SSRI related but I just don't feel like that's even possible now, you know?  You all know by now when you're on something new or stop a med when things are just very different.  You can't always describe it perfectly, but you know, no doubt whatsoever.  That's how it is for me with SSRI's.

I seem to be in the minority with my SSRI big hypomanic experience.  I actually think I was very, very close to full mania just that the euphoria was so awesome that's mostly what I remember.  Looking back, the intensity of the episode and how pronounced and obvious the symptoms were, I think I was close to going over especially in the first two weeks.  Maybe I crossed that line for a bit, I don't know but I never lost touch with reality, didn't overtalk anyone, and didn't hallucinate at all so I doubt it.  If I had all the BP knowledge I have now, I would know so much more, of course. Man, I would KILL to have that euphoria back!  SO MUCH BETTER than any drug, legal or not, ever created.  Unbelievable.

It would be very interesting to hear about other experiences anyone's had or knows others had that were similar. 

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Posted (edited)

Thanks eletricbamboo.  This is why I'm surprised they still prescribe SSRI's for BP at all.  Seems logical to assume they're still potentially harmful even with stabilizers.  There's something going on with the extra serotonin and BP systems.  I've tried 5-htp a few times and get really weird if I take even just a little too much, especially on an empty stomach.  I get like really paranoid but sort of like high and foggy headed at the same time. I know it sounds like being high on weed when I write it that way, but it's not that way at all - no fun whatsoever.

Edited by Distorted Me

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Every pdoc I’ve had, going back to 2000, has known that there’s a risk of mania with SSRIs, and has acted with appropriate caution when prescribing them to me. Celexa sent me utterly out of my mind, a long time ago, and after that it was about 13 years before I wanted anything to do with an antidepressant again. But since I’ve been on a combo of AAP, AED, and sleep med, I’ve taken small doses of several different SSRIs without problems. Well, without mania, anyway.

Until someone comes up with a better idea for treating anxiety, I’m going to keep taking them.

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It took me a second to realize that podcast was an autocorrect.

 

im not currently taking an SSRI, but I have taken them in the past.  They didn’t help me very much, so I stopped, but it didn’t cause mania or hypomania.  

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2 hours ago, Gearhead said:

Every podcast I’ve had, going back to 2000, has known that there’s a risk of mania with SSRIs, and has acted with appropriate caution when prescribing them to me. Celexa sent me utterly out of my mind, a long time ago, and after that it was about 13 years before I wanted anything to do with an antidepressant again. But since I’ve been on a combo of AAP, AED, and sleep med, I’ve taken small doses of several different SSRIs without problems. Well, without mania, anyway.

Until someone comes up with a better idea for treating anxiety, I’m going to keep taking them.

I think you've kind of hit the nail on the head here, Gearhead, with your last statement.  SSRI's are risky, more so in certain populations like BP and schizo.  But, I'm guessing anyway, that also SSRI's have been so widely prescribed for decades now that their efficacy and overall safety are pretty well established.  It's hard to think of any other class of drugs about which you can say the same.  In absence of better alternatives with similar track records, what else can they do? 

Celexa was my first SSRI back in 2006 trough 2009'ish.  I definitely felt a little lift at first, felt more normal I think.  But then I had no prior experience with any meds like this so what did I know?  It also made me SUPER sleepy, almost narcoleptic, between 9 a.m. and noon, every single day.  It was so bad I had to take daily naps at work and at home because I just couldn't go any farther without sleeping some. I just stopped Celexa myself in 2009, ended up on Zoloft for a few weeks but stopped that due to feeling too weird (without the extreme sleepiness).  It wasn't until I started Lexapro in 2012 or 2013 that I had that sleepiness come back again.  I can't say it was narcolepsy, I doubt it was quite that extreme.  But it was so powerful I literally could not stay awake at my desk no matter what I tried, even standing up.  After I switched to Zoloft again in early 2015, the magnitude of that effect really dawned on me.  Prozac also did that but not nearly as intensely.  This all should have been a big clue for me very early on but I just ignored everything and kept just following my doctors' advice without really speaking up enough.

I'm only at 100 mg of Lamictal now but I'm pretty stoked about how good I feel so far.  It's having a pretty tremendous effect on my anxiety.  Like so much I forget I'm not on anything else for that.  Sobriety is also helping immensely of course.  I'm now 27 days sober and the difference in my anxiety has been night and day.  The first two weeks weren't so great while the alcohol was still clearing my system but since it's been just awesome.  I really think the first thing these doctors need to do is get anyone with depression or any MI to stop consuming alcohol altogether.  It's effect on the nervous system is just devastating to anyone who's already challenged in that area.

 

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Posted (edited)

Almost every single SSRI I’ve tried has sent me up to either hypo or mania. Well, I should say is, almost every farking AD has, sans Cymbalta. Wait...Viibryd helped some also, but I sat on the toilet 12 hours a day. 

Edited by BipolarSpinster
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4 hours ago, dancesintherain said:

It took me a second to realize that podcast was an autocorrect.

Thanks for catching that. God, computers are morons.

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I was first diagnosed with depression not too long after I started puberty which was probably back in 2002 or 2003. My family gdoc started me on sertraline at 25mg and went to 50mg after a few weeks. I took it until 2005 and went off it during freshman year of high school. Somehow I managed to make it through high school without antidepressants. I know, right? :wtf:

But then I got to my freshman year of college. I started to become homesick, and then in the winter 2009-2010, depression hit me like a ton of bricks again. I talked to my gdoc, and he started me on citalopram, which I took for probably a year and a half. 20mg at first, but most of that time was at 40mg.

However, I realized that while the depression went away mostly, I was left with apathy, low energy / motivation, fatigued in general. Got in touch with my gdoc again, but at this point, he told me to see a pdoc, because he felt out of his league.

Started seeing a pdoc my second year of college (I did my bachelor's in 3 years because I was on only an antidepressant and was pretty much hypomanic most of the time and went to school year-round). He started by adding 150mg of generic bupropion XL. Boy was that a mistake. It made me super agitated, snappy/irritable, and again, with only citalopram on-board at the time, it did actually make the hypomania worse, even though it has a lower propensity for manic switch than most antidepressants other than mirtazapine. I was on it for a relatively extended period of time later on when this didn't happen and I was taking Aplenzin (bupropion HBr) which feels to me like it has a much smoother release mechanism than the generic bupropion HCl, and when I started it I was on a mood stabilizer and never experienced a manic switch, and overall it was much more tolerable.

Pdoc then took me off citalopram+bupropion and started me on vilazodone working my way up to 40mg. Of all the ADs I took without a mood stabilizer, this arguably was the most intense hypomania. Very effective antidepressant, but very prone to manic switch. Ultimately went off it because of digestive issues. Chronic diarrhea. I could have conversations with my stomach at all hours of the day whether I ate or not. Insomnia if I took it too late. Paradoxical brain zaps that felt like AD withdrawal a few hours after I would take it. Vivid dreaming if I took it too late. All things that might have been corrected with mood stabilizers, but I haven't tried it since.

Pdoc switched me to desvenlafaxine 50mg, which I actually loved. Only two problems I had were excessive sweatiness and constipation, which was worse in the beginning but mostly went away and would only come back every once in a while. However, I had to go off it because my insurance was changing and wouldn't cover desvenlafaxine, as it was brand-only at the time. To 150mg venlafaxine XR we go, since it was the closest we could get to desvenlafaxine of course. At this point, it's roundabouts 2013, and I've finished college working my first job, and lose my first job because I was careless, hence going back to my parents' insurance. Eventually though, I get a DUI, lose my license and my ability to get to my second full-time job which was 45 mins away from my parent's house where I was living after losing my job out near college. Moved up from my parents' closer to my job without a car, relying on public transit and people to give me rides. I was in a really depressing situation and I basically crashed hard. I talked to my gdoc again who was comfortable changing the 150mg venlafaxine XR my pdoc had prescribed for 60mg duloxetine as I wasn't seeing the pdoc anymore at this point. It really helped me get through a hard time, but made me almost as manic as vilazodone did. I knew though that I had to find a pdoc near my new home, and this was where it all changed.

The new pdoc pulled the duloxetine really quickly at the first appt. Dropped it down to 30mg and started me on lamotrigine. We moved up as quickly as was safe. By about 100mg of lamotrigine. He overlapped the 30mg of duloxetine with 10mg of fluoxetine for a week. The next week we eliminated the duloxetine and continued taking the fluoxetine for another week, then stopped the fluoxetine, all the while increasing the lamotrigine to 200mg. It was a lot of changes at once, and it took me a while to adjust after I finally got to just 200mg of lamotrigine. For the most part the cycling slowed down significantly. I'm definitely a bipolar 2 ultradian cycler without mood stabilizers.

Even after I adjusted to side effects and the lack of AD, my mood still always existed below the "euthymic" line. I still wasn't fully better, and at this point was still pretty resistant to the idea of multiple medications. Later on I realized that polypharmacy was the right thing for me. This is about end of 2014 to the beginning of 2015. Most of these changes were happening in the fall going into winter, so the absolute worst time for me to be yanking antidepressants. I was resistant at first to the idea of being bipolar after he told me. But as I read about it more and more, and as I looked retrospectively on the decisions I made in life and the poor actions I took as well as their consequences, everything finally made sense. I told myself that I was just going to try mood stabilizers, and if I got better, then maybe there is something to what this new pdoc is saying considering the first pdoc never caught on.

We talked about adding an AAP to the mix to try and have some positive effect on my mood. First tried lurasidone because it was approved alone or in combination with valproate or lamotrigine for bipolar depression. Worked my way up to 40mg, but eventually went to 60mg, and I think I had a brief stint at 80mg. We ultimately determined though that 60mg was my threshold for akathisia. I didn't understand what I was feeling at first, but my pdoc explained it to me and I realized it wasn't something I wanted sticking around, and my pdoc isn't a believer in allowing patients to take anticholinergics long-term to manage akathisia. He would much rather decrease to sub-akathisia dose and try to manage with another medication.

Was on lamotrigine+lurasidone for a while, but again, didn't cut it. My affect was off. Still always sub-level, and experienced major seasonal affective disorder (which apparently now is a modifier that can be used to describe bipolar depression in the DSM-V). We swapped out the lurasidone for aripiprazole I believe. Slowly worked my way up from 2mg to 7.5mg, but I just couldn't tolerate it. More akathisia, and just generally agitated. Lasted maybe 10 days? I've since discovered that I need predominantly antagonism because I have strong manic tendencies, but I easily switch to depression as well, mostly in the Fall and Winter. So I need something calming and mood usually falls in line.

At this point, I think we went to asenapine, which I actually liked at 2.5mg, but I couldn't go higher than that, again because of akathisia. Will point out at this point that we are now finally realizing just how low my akathisia threshold really is. Still, asenapine really helped me to sleep at night, and I actually felt kinda stimulated during the day. No real next day sedation. Lurasidone and asenapine both had minimal weight gain and took them for appreciable periods of time.

Because of akathisia, we ultimately switched to iloperidone to try because it supposedly had a low EPS risk. But Lord was that another big mistake. Sedation was good, but my heart felt like it was beating out of my chest. POUNDING. It was very uncomfortable. Ditched that after about 10 days too.

Switched to olanzapine 5mg, which definitely was quite helpful for both my manic and my depressive tendencies. It was very very effective for anxiety as well. It made me balloon though in weight, glucose, and lipids. But I stayed on it for a few months and stuck it out because of how positive of an effect it was having on me. I almost didn't mind the weight gain because I felt so much better. But then I saw the lab work and quickly changed my mind.

I can't remember the chain of events exactly for how the lamotrigine was switched out, but I believe it happened around the time we switched to olanzapine. I swapped out the lamotrigine for oxcarbazepine (Oxtellar XR to be precise). Based on experiences with several AAPs at this point, we realized that my akathisia threshold was too low to use AAPs to manage mania completely. A strong anticonvulsant needed to be there to pick up the slack. Oxcarbazepine did a fairly good job, but ultimately we determined that wasn't strong enough either towards the end of last year. I believe that happened toward the end of 2016 or so. Because of the weight gain we switched the olanzapine for loxapine around spring of last year, which I would recommend anyone give a try. In low doses <10mg at night, it can have more profound effects during the day than most would think. It had the calming properties of olanzapine but not the antidepressant qualities unfortunately.

Probably around the switches to oxcarbazepine and olanzapine we actually added back in antidepressants. We decided to start with escitalopram because I responded fairly well to citalopram, side effects aside. I was having persistent depressions issues and mixed states. I just couldn't get level. But we knew that the depression was becoming a serious problem. I still felt a lot of the same side effects from escitalopram that I did from citalopram though, so that's when we switched to Aplenzin, which I really liked and I would consider going back to because of it's lower propensity for manic switch, and it didn't make me feel jittery or amped the way that generic bupropion XL did.

Ultimately toward the end of summer last year, we did an overhaul. Replaced the oxcarbazepine for divalproex sodium ER, replaced the loxapine with brexpiprazole, replaced whatever AD I was taking with vortioxetine (believe I was taking fluoxetine, which I switched to from the Aplenzin because it was starting to give me worse anxiety), and he let me start taking lisdexamfetamine for my persistent concentration/focus issues. Vortioxetine is absolutely an amazing antidepressant in my book, but so is brexpiprazole (even though it's an AAP). In fact, for me, only brexpiprazole has had both the same calming and antidepressant effects that olanzapine had. Vortioxetine worked quite synergistically with the stimulant to keep me alert and focused. It DEFINITELY helped with cognition. Noticed it when I was increasing the dose and for quite some time after I started it until I simply got used to the extra clarity. But it was very apparent as I was decreasing because my cognition decreased as well.

We removed the vortioxetine because of an insurance change, and part of the prior auth for brand-name ADs is that you not only have to try a few generics first (step therapy), but they also must be used only for their FDA-approved indications, which obviously wouldn't fly since I'm BP2. Additionally, after I got through last winter, I found that vortioxetine was causing more and more tension and agitation. Had to decrease my stimulant dose because I noticed facial tics coming back that weren't there before even though we hadn't changed the dose of anything. My body is just incredibly sensitive to the seasons and weather.

What this EXCESSIVELY long and drawn-out story is meant to portray is just how bad it is for someone with bipolar disorder to take antidepressants as monotherapy. However, if mood is mostly stabilized with other appropriate medications, then adding antidepressants should always be an option and can be quite beneficial for many. I've been on just lamotrigine now for several weeks. Felt some mild withdrawal effects of vortioxetine but it has a long half-life so it tapers really easily like fluoxetine. All-in-all, even though I'm taking 3 mood stabilizers and a stim, I feel great. But I know there's always a chance that I need to take antidepressants just in the fall and winter and go off of them toward the end of winter before spring starts. Arguably I stayed on vortioxetine longer than I should have this year after winter was over. I figure I probably liked it a BIT too much. ;)

Anyway I'm done. Sorry if this hurts people's brains. :wtf:

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They don’t make me manic, but don’t help much with depression either. Prozac was good for intrusive thoughts at one point.

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      Been back at work a couple wks and doing pretty well. The first of the month came and I had no way to pay my rent. A small disability pymt was expected but hadn’t arrived (not enough for rent anyway). The way our pay works, and since I was gone 3 wks, no pay for me until the end of the month.
      Yesterday I came home to a 3 day notice on my door. The property management is a big corporation and not willing to even give a few days and see from my dr release I’ve been out, doctor’s orders. I’ve asked a couple of people but they can’t help. I’m sad that I’ve failed. Loathing myself and my illness at all right now, I’m just hit in the face how much having this sucks. 
      The costs go way beyond buying something one doesn’t need. Even when doing things the way they’re supposed to be done, it still can bite ya in the butt. Tired. Exhausted. Fed up.
      Rant over.
       
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