Iceberg

Makes sense. Theoretically it’s approved for up to 15 for depression, but I’m not sure if higher doses make the mechanism of action more effective in ocd

It can at 10-15 but I think the dose is usually kept low for OCD, although o may be wrong and there are always exceptions

I wasn’t meaning you should retry and SSRI specifically just that the AD+Abilify combo is probably a solid option

I have a close family member doing well on high-ish dose of SSRI with low dose abilify

Risperdal is popular for ocd combos

I think obsessive rumination is probably found in some form in most anxiety disorders, just with different presentations/triggers. Panic can involve worry over a common theme, social anxiety causes repetitive concern with going out etc. I don’t think the term “obsessive” means it is totally limited to ocd or ocpd

I’d think gradual taper unless there is a severe issue. Also might partially depend on how you’ll dose quetiapine

Personally no - but I have a close family member who had good results. I know it’s scary- but if you have a good therapeutic relationship with your therapist I think it’s really worth a shot. With MI, we put ourselves in doctors hands all the time, dealing with meds and trauma and all that other stuff, this way is just more.... direct. I think all you can do is go into that next meeting with an open mind

For what it’s worth the memory loss was annoying but bearable for me from ECT. If start with “low dose” unilateral treatments and they work without going to bilateral (big if), some people have minimal cognitive issues. Rexulti is an AP- it’s is theoretically very similar to abilify, but some people find the effects very different. Some people with bipolar find it helpful for depression, not so much for maina There is also a very new AP called caplyta which has shown some promise with BP depression. Being new many docs still don’t use and many insurers still don’t cover it

hey- i think you posted somewhere else, but i forget what does your med history look like? what are the major symptoms of this current episode? some off the top of my head ideas- remeron is supposed to be more bipolar friendly than other antidepressants. what about the other usual suspects for BP depression? latuda, abilify, rexulti or the second line options (for depression, not overall, i know lithium isnt always a second line option) like lithium or maybe zyprexa ? I guess theoretically you could switch to mirapex another dopamine agonist- but that is pretty far out in the realm of unknown. Also- have you tried cytomel? its a T3 booster but also lesser known BP depression treatment. Unfortunately, bipolar can evolve across the lifespan, and i think the ratio of depressive episodes gets higher as people age (but id have to check the stats on that)

when i got put on high dose valproate and later lithium, they had me try selenium and zinc

Wellbutrin is thought to inhibit reuptake of dopamine and norepinephrine, meaning prolonged exposure of receptors to those neurotransmitters, causing the mood enhancing effect. Vraylar is a dopamine partial agonist (at D3 receptor and also D2) which means it modulates the level of dopamine action in the brain leading to antipsychotic and some antidepressant possibilities. Vraylar may also affect some serotonin receptors which can help depressive symptoms, which is a mechanism. Shared by other atypical antipsychotics

ever discussed ketamine ?

That’s not uncommon, lots of pdocs don’t prescribe stims for depression, and if the serotonin + ropinirol made you hyper it’s possible stimulants could make you even more hyper

I am usually pretty good with med stuff, but I’m not sure I could comment with much accuracy. I have seen dopamine agonists in treatment resistant depression (usually mirapex) with mixed results in studies punished. However, most of the preliminary stuff done was not paired with a med that could be very stimulating like Wellbutrin so that combo would certainly be creative. Would it be just the two or other meds? I’m assuming you’ve tried all the regular suspects already