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BP depression won't go away


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Hello group,

I'm writing because I've been depressed for 7 months solid now and my medications aren't taking me out of it.

Some background:

I have BP1. I have had very severe manic episodes in the past, accompanied by grandiose delusions. Straight manic and mixed. So I really need to make sure my mania stays under control. For about 8 years, I refused to accept what the doctors said and went unmedicated. I was hospitalized at least a half a dozen times, until finally on one hospitalization I realized that the drug the doctor put me on made me feel different - slower, more able to think. That was a couple of years ago, and the drug was Seroquel.

I was still depressed on Seroquel, so Wellbutrin was added and then lamotrigine. At some point along the way Zopiclone (sleeping pill) was also added. I didn't feel that Wellbutrin was making that much difference, but in retrospect it's hard to know. The lamotrigine, on the other hand, made a huge amount of difference from when I first took it. I could think way more clearly. The fog got lifted.

I'd found a pretty good combination, except that I ended up having to take a sleeping pill that was only designed for 2-3 weeks' use for way longer. In fact, it was when I tried to get off the sleeping pill that I became manic again, for which I was hospitalized last March.

During that hospitalization, I told my doctors that I didn't want to take Seroquel anymore (due to a family history of diabetes and worries about my blood sugar). They also stopped my Wellbutrin, and I don't want to start on it again, because I'm afraid that it was the drug that was interfering with my sleep (even though I only took it in the morning). I decided to go on valproic acid, but in the meantime was taken down from mania with a variety of antipsychotics.

So I leave the hospital and I'm on the following:

valproic acid

lamotrigine

risperdal

I cannot take risperdal for long, because it makes me feel horrible inside, constantly agitated. In order to keep taking it I have to have Cogentin, an anti-Parkinson's agent. So the doctor gets me off of it...

So I'm left with the other two:

valproic acid

lamotrigine

And before long, I find myself feeling *horrible*! I have the most horrible depressed anxiety. It's so bad I end up in a crisis stabilization unit. The only thing that can calm me down at all is playing solitaire over and over again. They call the doctor on call, and they send in some Seroquel to "help me sleep" (I'm crying and crying, but that's not the point for them). I take it and I'm no longer freaking out, but I'm still very, very depressed.

Three months ago we decided to start me on an AD, this time Celexa. At 20 mg/day I've still been depressed, and we've just upped the dose to 30 mg/day. My mouth is often dry (I'm definitely worried about dental problems) and I have no sex drive. I might be a little less depressed than before - my mind seems sharper and other people's conversation more interesting - but overall it doesn't seem so great, and I'm worried that increasing the dose will just make the side-effects worse.

So right now I'm on:

divalproex (1000 mg/day)

lamotrigine (150 mg/day - note, this number is low because valproic acid doubles the concentration of lamotrigine in the blood)

Celexa (30 mg/day)

Seroquel (200 mg/day)

I'm seeing my doc on Wednesday and I don't know where to proceed here. I feel very frustrated. I don't know how to change this cocktail so I'll be less depressed and minimize side effects. There don't seem to be many options, according to what my doctor says: muck with antidepressants, increase Seroquel, increase lamotrigine (though that raises the risk of the rash), or try lithium. Any ideas? Something I could add, change, even remove, bearing in mind the family history of diabetes, the dry mouth concerns, and the panic I had when I was only on divalproex and lamotrigine?

I have done plenty of Internet searching on mood stabilizers and ADs. I gather than all ADs cause weight gain, dry mouth, sexual side-effects, activation, somnolence, or some combination of all. Has anyone found that some ADs caused them fewer side effects than others?I've also read that studies have shown that ADs as an add-on do nothing for bipolar depression compared to mood stabilizers alone. But if that's true, what else am I supposed to do? There aren't very many drugs described as having been tested and being approved as mood stabilizers. I read the Wikipedia article on carbamazepine, and the side effect of hearing sounds a semi-tone lower than their actual pitch would be intolerable (I'm very musical). Zyprexa makes me eat like a pig and gain tons of weight, and I know it has bad blood sugar problems too. I read that there at no studies supporting the use of Geodon for bipolar disorder. The name Mirapex gets bounced around a bit, but I don't think it has any studies to back it up for bipolar disorder either. Also, it has some quite common and scary side-effects, like hallucinations. Abilify has the same risks as the rest of the ASs, it seems: tardive dyskenisia and Neuroleptic Malignant Syndrome. Right now I'm on the valproic acid and I regularly have liver function tests and I'm worried about my hair falling out... And lithium... well it just plain scares me because of the toxicity potential, and tremor sounds pretty bad (I already have a fine tremor from the valproic acid).

If anyone has any advice, I'd really appreciate it... Things are really awful right now. I'm not fit to work, and I sleep in 'til 4 or 5 pm every day. At the moment I'm not just sad, but very anxious too. I think it might be because of my recent Celexa increase, though.

And if I'm in the wrong forum, I'm sorry. I'm new around here. I haven't introduced myself in the introductions forum...

I'm so sorry this is such a long message. Thank you for reading it, for those of you who get to the end!

frog

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Abilify has been approved by the FDA to help with depression when used with an AD. I know it helped me a lot with motivation, apathy, and sad moods when I was on it. I had to stop due to it causing me anxiety, but starting on a low dose may lessen the chance of side effects. It can't hurt to ask your doc about it. Has he had any suggestions for you?

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I have done plenty of Internet searching on mood stabilizers and ADs. I gather than all ADs cause weight gain, dry mouth, sexual side-effects, activation, somnolence, or some combination of all. Has anyone found that some ADs caused them fewer side effects than others?I've also read that studies have shown that ADs as an add-on do nothing for bipolar depression compared to mood stabilizers alone. But if that's true, what else am I supposed to do? There aren't very many drugs described as having been tested and being approved as mood stabilizers. I read the Wikipedia article on carbamazepine, and the side effect of hearing sounds a semi-tone lower than their actual pitch would be intolerable (I'm very musical). Zyprexa makes me eat like a pig and gain tons of weight, and I know it has bad blood sugar problems too. I read that there at no studies supporting the use of Geodon for bipolar disorder. The name Mirapex gets bounced around a bit, but I don't think it has any studies to back it up for bipolar disorder either. Also, it has some quite common and scary side-effects, like hallucinations. Abilify has the same risks as the rest of the ASs, it seems: tardive dyskenisia and Neuroleptic Malignant Syndrome. Right now I'm on the valproic acid and I regularly have liver function tests and I'm worried about my hair falling out... And lithium... well it just plain scares me because of the toxicity potential, and tremor sounds pretty bad (I already have a fine tremor from the valproic acid).

It sounds like you've been reading all the scary side effects and not much on the positive aspects without or with minimal side effects that some receive.

I take Lithium, have virtually no side effects (including tremor), and benefit from both the antimanic and antidepressants effects. Of the meds you mentioned, that is the first I'd suggest trying. That's partially due to your severe manic history. This one will not aggrevate that. It's also apt to augment Lamictal and your AD.

Abilify gave me akathisia and amped me in the short week I was on it. Geodon made me highly BPII mixed and then very hypomanic. This was while on something close to the cocktail in my signature. I have heard that they can flip BPI people manic. Others do okay.

Mirapex turned out to be good for me. (It followed Geodon as an add on.) It plays with dopamine but in a kinder, gentler, and different way than Wellbutrin. It works for some, not for all. It is less apt to be agitating at lower doses. It's an off-label use, but might be worth asking your pdoc about.

Carbamazepine has not caused any change to my hearing. I don't think that's a common side effect. Although it's not known to cause much cognitive dulling, it hit me pretty hard for a while. I don't know if this med works on depression or not.

Since ADs are bad news for me, I can't say much about them other than a lot of people seem to find them effective w/o untenuable side effects.

Your mileage may vary on all meds. Don't let yourself get too caught up in the side effect pages. You may rule out the med that would work best for you.

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Thanks for your input, guys. What you said was reassuring.

I think I'll write ALL these meds down in a list and show that to my pdoc tomorrow and see what she says. Is lithium as good for depression as it is for mania, though? I've heard it's better for mania.

frog

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Thanks for your input, guys. What you said was reassuring.

I think I'll write ALL these meds down in a list and show that to my pdoc tomorrow and see what she says. Is lithium as good for depression as it is for mania, though? I've heard it's better for mania.

frog

It's stronger for mania as are all the anticonvulsant stabilizers except Lamictal. However, it has a moderate AD effect and many years of history augmenting antidepressants (i.e. Lamictal, Celexa, and possibly Seroquel - hopefully!).

I forgot to say that although Mirapex is a mild AD (well, anti-Parkinson's off label use), if Wellbutrin is inclined to make you manic, you'd need to treat this med with care. I'm on a what I think is a relatively small dose and it works. Not sure what would happen at a high one, though, and I don't think my pdoc would let me go there unless I was sunk at the bottom of the sea.

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