Adding an antidepressant

[zef]

Oh, I so don't want to be on an antidepressant, but the depression won't let up. I've finally found some stability at 300 mg of Lamictal, nothing else (except 5-HTP, which definitely helps, but I probably shouldn't accept feeling perpetually down just because it's not horrible like it was before, right?). I'm not sure if maybe I need more Lamictal, but the doctor I've been seeing--who I plan to not be seeing shortly, but for now his advice is the only thing I've got--says that Lamictal doesn't have a powerful antidepressant effect, that it's much more subtle than that. I'm definitely feeling an improvement with just Lamictal and 5-HTP, but it's not enough and I think I might need more Lamictal and/or an antidepressant.

And ugh, I really, really don't want to go on an antidepressant. They sap my creativity and blank me out, I absolutely hate that. Before the bipolar diagnosis I was on a variety of SSRIs with varying degrees of success, Zoloft making me crabby and cruel, Prozac seeming to help (but who can remember? I was a wee kid) but definitely sapping my creativity, Effexor making me into a content and self-absorbed zombie, Stattera knocking me out for 20 hours a day...and Wellbutrin! Oh, Wellbutrin, I wanted you to be my friend, but you gave me cognitive troubles. I struggled to think of basic words.

One thing that seemed to work very well with Lamictal was Adderall, but naturally my doctor won't let me have it. Just Lamictal and then "we'll see." Amphetamine really seems to help my depression, though, which leads me to think I'm dopamine-deficient.

So has anyone had success with adding an antidepressant? With minimal side effects (psheeah, right)? Are there supplements that I might try with/instead of 5-HTP so I can avoid antidepressants? Any luck with that? Anyone? Anyone?

I'm working on seeing a new doctor and want to have some ideas.

EDIT: Oh, by the way, I'm also on fish oil.

[Dweii]

Is your diagnosis depression? It would help me to know the details.

I hate antidepressants too, so I totally understand you're reluctant to take them. And Lamictal doesn't do much for me, but my pdoc doesn't want to take it away. Argh.

Unfortunately, ALL meds have side effects. You've seem to have had bad luck with most classes of antidepressants. But you say that Wellbutrin worked, but with untolerable side effects. So that leads us to that dopamine is the way to go, right? There are some tricyclics that work on dopamine, might be worth asking about them?

Amphetamines can be good for treating depression, they also help with dopamine. Why won't your doctor let you have it? I can understand that, since here it is IMPOSSIBLE to get it prescribed if you don't have an absolute certain diagnosis or ADHD or narcolepsy. And they are powerful drugs. With their own side effects. In some cases, stimulants have been proved to aggrevate depression. But it works for some people.

If Strattera knocked you out, adding L-tyrosine to it might help. That is because if you don't have enough norepinephrine for you synapses to take up, the reuptake doesn't work. And L-tyrosine is a precursor to norepinephrine, hence giving you more of it. (Could some chemistry whiz help me with this, I'm pretty sure I got it wrong?) But for this you absolutely HAVE to talk to your doctor, it made me manic as hell. L-tyrosine on its own might be worth a shot too.

Do some research and talk to your pdoc and keep us updated!

Good luck.

[Squirlygrl]

This is totally made up, so please take it with a huge grain of salt:

Have you tried caffeine?

I ask because I'm one of those people who does badly on Wellbutrin (instant effectiveness followed by cycling), but seems to be helped by a tiny dose of Adderall (5 mg; I start to lose it around 15 mg). The Adderall seems to function much like caffeine (more like strong tea than coffee), except it doesn't make me as nervous and sweaty. In fact, even with the Adderall, I still need a little to dig out from my supermedicated state. Since you can't get Adderall, it may be worth a try ... just don't go overboard.

Sorry I have such a lame suggestion, but it's the only thing that seems to work for me. (We've never tried other ADs because the Wellbutrin reaction was so intense, not to mention resistant to mood stabilizers.)

Good luck,

sg

[zef]

My diagnosis at the moment is bipolar II. I've had severe depression my entire life but also have racing thought s and a tendency toward intense anger and irritability. SSRIs probably haven't worked out for me because of their mania- or hypomania-inducing tendencies, which for me has meant they took away some depression but left me agitated and pissed all the time. The Lamictal, once I got to 300 mg, has really helped me feel less prone to terrible rages and consequently has prevented me from falling deep down that hole of depression. But I was severely depressed when I started taking it and have been severely depressed throughout the titrating process, so what I'm left with now that it's working is a more stable depression. I'm not as depressed as I was, but I'm still deeply, deeply depressed. At least I'm not getting frantic or flipped out at about it.

I really do think I need dopamine, because right now I am just crippled by APATHY. I can't make myself do a damn thing. I have some tyrosine here and should probably give it another try. I don't really remember if it did that much for me, but I haven't taken any since the Lamictal stabilized me a bit (and I don't know if it's supposed to do more than it's doing now, if I should be on a higher dose or what, and I'm afraid that a higher dose might make me mucho ragey again). I know taurine was making me feel somewhat better, but that was when I was feeling very volatile and because taurine is calming.

I know they all have side effects and it's rotten. I work in a creative field and avoid them because my creativity is my paycheck. As far as I can remember, Wellbutrin made me cranky but also gave me severe cognitive difficulties, though maybe that was just depression, who knows. It definitely makes me want to avoid Wellbutrin, whatever it was.

The antidepressants I most often see people here using with mood stabilizers are Wellbutrin and Lexapro. Is anyone seeing a lot of success with an anticonvulsant/antidepressant combo? I guess I'd just like to know how it's worked out for people.

[zef]

Oh, and about the Adderall: the doctor I was seeing wanted to try monotherapy so he could first see how Lamictal was affecting me. I've had some problems with him and am looking into other doctors. I understand his attitude toward Lamictal first, though it's been very hard knowing that Adderall could take some of the apathy and awfulness away if he would just give me a prescription. I definitely understand why you'd want to avoid that at first with a new patient, likely bipolar, definitely with sleep disturbances. But I was on it before (when I was still titrating Lamictal--different state, different doctor) and it brightened my depression quite a bit.

EDIT: And oh yes, caffeine: it has a minimal effect for me.

[lemonflavor]

How about adding Abilify or Geodon for something activating instead of an anti-depressant? Risperdal is somewhat activating for me but it kind of acts like an anti-depressant does almost in a bad way, causing some hypomania. I may try switching to Abilify after the Trileptal is at a stable dose.

Lexapro helps me with night terrors and panic attacks but I'm trying to lower it right now because I think it makes me irritable.

[zef]

I don't even know what those meds are for! I'm in the dark about a lot of these things. I'll look into it, though!

[revlow]

I'm interested in the answers you get here, zef. I really don't want to add an AD either, but...

I want to push doc into raising the Lamictal, but he's reluctant to do so. Wants to send me to a pdoc (reluctant to do that for a whole other set of reasons, which I'll spare you). I'm on hormones, so even though I'm taking 450 mg Lamictal, it's like I'm getting only 225. Definite improvement, but still not *there* yet. And, as with you, some people need more Lamictal.

PS - Sorry, I don't remember...are you a man or a woman? If you're a woman and are either taking hormone replacement or on the pill, you may need more Lamictal. Hormones essentially half the amount of Lamictal available in your system.

[zef]

I'm female, though not on birth control. I think I really need to be on birth control because I have very bad hormonal acne and suspect my hormone levels aren't altogether right. I really think a stimulant would help, maybe even a stimulant paired with a low dose of Lexapro, I dunno. 5-HTP had a wonderful effect at first and I wish more than anything I could get that feeling back.

I looked up Ablify, Geodon, etc and don't think they fit my symptoms. Anything activating sounds damn good to me right now, though.

[revlow]

I know how frustrating this is. I've tried so many ADs in the past. But never with Lamictal, so that may be a whole new ballgame?

Anyone with input on this, whether taking ADs you've tried/used unsuccessfully in the past are different with Lamictal?

At this point, my doc and I feel like it's a bit of Russian roulette re: what to add. That's why I'm more in favor of upping the Lamictal. Again, long story, but I *really* don't want to go to a pdoc for a variety of good reasons, but it seems that my regular doc is going to insist. Pish.

[Anelize]

I am in the process of adding wellbutrin to my "mix" right now because of more frequent and severe cycling into depressions over the last six months. My pdoc feels that my topamax isn't doing much at all for me (it obviously hasn't been doing much for the cycling), and we decided to get rid of it and try the wellbutrin. It was hard for me to make that decision...I've been on it for quite a long time, and making a decision about switching meds always tends to freak me out a bit. I was on wellbutrin a longgggg time ago, as a monotherapy for depression, before I was diagnosed as BPII. I was still drinking then, so I seriously doubt that it did very much good.

But, I really am tired of cycling down. The last one lasted 10 days, and I burst into tears at work, in front of my boss, which has NEVER happened. It may seem like a little thing, but it means a lot to me--it got worse from there, and I needed to take a few days off. I had fears of ending up in the hospital again.

So. Wellbutrin. Lamictal. Seroquel. I get hypomanic without the seroquel. I hope the Wellbutrin helps. I can't take the SSRIs--they just make me manic.

[lemonflavor]

Anelize, I don't know if this is encouraging or not, but in Dr. Phelps' new book on BPII he seems to like Wellbutrin if an anti-depressant is needed. Just thought I would throw that out there.

[revlow]

Hey, lemonflavor...

Thanks. That may be a clue for me. Will discuss with my doc.

The only time I'd been on Wellbutrin was when it just came out. Was on it long enough to give it a good test, but no AD effect. In fact, all it did was give me a big fat headache.

But that was so long ago...what, more than 20 years? God knows, my body is different, and we can all have different reactions to meds at different times. So, who knows...might be worth a shot.

[Anelize]

Anelize, I don't know if this is encouraging or not, but in Dr. Phelps' new book on BPII he seems to like Wellbutrin if an anti-depressant is needed. Just thought I would throw that out there.

I have the book. I'll check it out. Thanks

[zef]

As far as I can remember, Wellbutrin made me cranky, but I was using Wellbutrin alone for what was diagnosed as unipolar depression. Does a mood stabilizer change the effect of the AD or will it still make me cranky? I guess that's not a question anyone can really answer.

And Wellbutrin gave me such cognitive troubles! That's another thing I wonder about. Would it do it again? Or would it work differently now that I'm on 300 mg of Lamictal.

I should update this by saying I've been taking some of my tyrosine and feel much better today than I did yesterday. I hadn't taken it for a while because I felt what I needed most was calming, so I was taking taurine or taurine with tyrosine when I remembered to use any aminos other than 5-HTP. Now that I'm on Lamictal I felt okay taking the tyrosine on its own and it's really given me a boost, which makes me confident that I definitely need dopamine. I knew that already, really, because I'm just soooo apathetic and that's a symptom of dopamine deficiency.

[Dweii]

FWIW, Geodon was very activating for me and got rid of my depression. But that's probably just me.

[borzage]

So has anyone had success with adding an antidepressant? With minimal side effects (psheeah, right)? Are there supplements that I might try with/instead of 5-HTP so I can avoid antidepressants? Any luck with that? Anyone? Anyone?

EDIT: Oh, by the way, I'm also on fish oil.

I take 5mg of Paxil as needed (usu. every other day). This is an extremely small dose - I cut 10mg pills in half. Helps me, without the side effects.

[Unregistered]

I did pretty well on amitryptiline (an old school TCA with few side effects).

[sheerah]

I'm new to BP Dx and intrigued by your question.

Actually. I'm confused.

My pdoc says that once I'm stabilized on Depakote and Lamictal he'll be taking me off my AD.

Has anyone elses tx involved removing ADs? Does this sound right? Should I be concerned?

I'm apprehensive because I've been treated for MDD and dysthymia for 15 years and don't want to find myself back in the abyss.

Sorry if this is posted in the wrong place (if I should have started a new thread) ... I haven't mastered board posting yet.

Sandy

[NARS]

I've been on wellbutrin for around 6 years. I got manic on it and old pdoc added depakote but kept the wellbutrin because I'd had so much depression before I flipped out. The cognitive effects of both meds wore off within a few months.

I switched to lamictal last summer and got to 400 before things seemed good. Then my pdoc wanted to try going off the AD, since lamictal monotherapy is so popular. It so didn't work--I flipped out with lots of rage. I got back on it and it's taken me months to look stable again. Assuming things are fine now, it seems I need wellbutrin with my lamictal.

I do think ADs feel different if you're on a mood stabilizer. You said you were "cranky" on wellbutrin before; that sounds like hypomania to me, which brings on its own cognitive problems. So maybe if you tried it, titrating slowly from a low-ish dose (maybe 100/day) to a therapeutic dose (maybe 300/day), for a few months, you could get past any side effects and get the help you need.

As for me, on the depakote/wellbutrin combo I was still edgy and had some anxiety and irritability. On lamictal/wellbutrin I'm much better.

[Anelize]

Well, the great Wellbutrin experiment is over. The stuff made me manic. Dysphoric mania. Uggggghhhh. I was on it a total of a week. Oh well. I'm going to stay on the seroquel and lamictal and hope for the best (no more rapid cycling into depression).

So far, so good.

[Rabbit37]

I haven't read all the responses thoroughly yet, not enough time, but I'll jsut throw this out there. I'm BP also, and was having a med-resistant depression. Zoloft was having too many s/e, so it was lowered dramatically and I started celexa. That brought me out of it. I'm also on lamictal and depakote, an unusual combo from what I understand, but it's keeping the AD from throwing me into mania. I finally am now weaning off of zoloft, and will just be using celexa alone. Haven't tried WB, and didn't have any luck with Prozac or desipramine (I've used desipramine in the past with success).

[cache-monkey]

Hello,

I just thought I'd throw this out there, but selegiline might be an option worth considering. Alex Bodkin, the chief of the clinical psychopharm research program at McLean Hospital, "routinely maintains bipolar patients with mild baseline depression or lethargy on a mood stabilizer plus a low dosage (5 to 10 mg/d) of [oral] selegiline. [see this article.] Bodkin was one of the principals involved in the approval of EMSAM, which wasn't available at the time that was written. Wonder whether he'd still opt for the lower dose oral, or the transdermal now?

Good luck,

cache-monkey

[borzage]

Hi Zef,

I share your loathing of SSRI's, I hate the side effects, and the feeling of being "fake-happy".

But, they work, and sometimes they're necessary. Currently I'm taking 5mg of Paxil. That's the smallest dose they make, cut in half. I take it in the morning. I can feel the effects about 6 hours later. It definetely makes my life easier to deal with by lifting the depression and anxiety.

The side effects I get are insomnia, loss of appetite, slight hypomania, and sexual numbness. It usually takes 5-6 days for the side effects to set in (even at the teensy dose I take). If I notice sexual side effects, I'll take a break for a day or two, then start up again. That works for me.

MG