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I bolded the important parts for people who don't want to read. ;) I like how I could have basically written this post in just a few sentences, but instead wrote a bazillion paragraphs.

I know some of you have read my recent posts. If you haven't, here's a brief (haha like anything I write is brief) summary: I've been REALLY depressed, and went on Pristiq which I thought gave me rapid-cycling hypomania... but now that I am looking back over the past month, it looks like I've dealt with mixed states, and it was beginning to send me into mania by the time I finally went to my pdoc. After I got off Pristiq and was off it for 2 days, I woke up unable to remember if I had even slept or eaten in the 2-3 days leading up to my pdoc appointment. I do have some interesting, lengthy, and confusing rants in my journal, though. (Even my post here after my pdoc appointment on Thursday is a little off, but it's nothing like the rants in my journal. The best journal rant was about how I was going to write my own memoir -- at the age of 23.) I honestly believe if I had stayed on it longer that I would have begun having psychotic symptoms. My mind is so much more clear now that I'm off of it. I was NOT myself for the past month... it's very scary to even think about. I have NOT been diagnosed with Bipolar, and seem to only show clear symptoms on anti-depressants. SSRIs have given me mood swings, but NOTHING like this. Pristiq is the only SNRI I've tried, so I'm going to assume that all SNRIs are bad for me, at least for the time being. This was the only time that I think I was beginning to deal with mania or mixed states as opposed to just hypomania. I don't believe I suffer from Bipolar disorder unless it's induced by anti-depressants, but that is still an issue I need to discuss with my pdoc. From what I've read, I show mostly the "soft" symptoms of bipolar, so I do need to keep in mind that it may be a possibility when I think of treatment options. (Example -- no more SNRIs which make me go crazy!) I talk a lot. That's the briefest summary I can give! :)

When I went to the pdoc on Thursday, he took me off of the Pristiq and upped my Wellbutrin from 300 mg to 450 mg. Wellbutrin has always helped my depression immensely, but has never been able to completely get me out of it. I'm hoping 450 mg will help. Though he wanted me to taper from the Pristiq, I stopped taking it cold turkey because I just want it OUT OF MY BODY. (I know. Bad idea. I should follow pdoc's orders. But I've NEVER had a problem getting off medications -- not even Effexor or Paxil, though I was on them for short periods of time. No withdrawal symptoms here, either. He also gave me Prozac to help with the withdrawals, but I luckily haven't had to take it.) I am feeling SO much better, but I am, of course, still dealing with pretty bad depression. I go back on April 30 and he will be putting me on Lamictal. I requested it because I've heard so many good things about its antidepressant qualities and I figured that if I actually do end up finding that I have some flavor of bipolarity, it would also benefit that. He agreed that Lamictal seemed like a really good option for me, and he was actually going to bring it up himself if I hadn't done it first.

Lamictal definitely seems like it's the right drug for me right now, even though I'm concerned about how long it will take to affect my depression. I wish I could do something that would be faster-acting, but I'm not sure if there are any options I have. I looked at Abilify as an add-on for depression, but I guess I would rather take Lamictal, which sounds like a better drug for me, than try something that would possibly help me quickly, but doesn't really sound like the right drug for me overall. Which is more important -- fast-acting or long-term? I honestly can't decide right now, since the present seems so bleak.

I guess what I'm mostly scared about is the fact that I feel I'm running out of options. What if the Lamictal and Wellbutrin don't work? While I may be willing to give SSRIs another shot if I must once I'm on Lamictal, I do not want to go on them without some sort of mood stabilization. (I figure that if ACTUAL bipolar people can take SSRIs while on mood stabilizers, then I would probably be okay as well. But they aren't an option right now.) And other mood stabilizers don't seem right for me, since most of them are to help with mania, which I don't have. Neither my doctor nor I want to resort to MAOIs or TCAs, though I would take them if I had to. I thought about Remeron, but because I have such poor body image, I don't think it's the best idea. (I get incredibly depressed when I gain weight and refuse to leave the house, which makes me MORE depressed, and so on. This is something I am trying to work on, but my dumbass tdoc didn't seem to think this was a big issue... hence why I'm finding a new one.) My pdoc and I have talked about ECT if we have to. I told him I would rather do that before MAOIs or any drug that would make me gain weight, and he surprisingly agreed with me. Of course... that's a last resort.

What do I do if this doesn't work? I am beginning to think I'm running out of options. I know most of you probably think I'm crazy for trying to avoid drugs that make me gain weight because mental health is much more important than my dress size... but I also know (from having gone down that path) that my mental health is only worsened as my weight increases. And I could try ECT... I could deal with the side effects, and it doesn't sound like an awful procedure, but I don't know if I could continue to keep it up for the rest of my life, and I know that it's not just a one shot deal and the depression is gone.

I'm a mess for worrying about what will happen if this combination doesn't work when I HAVEN'T EVEN TRIED THE COMBINATION. (I worry an insane amount when I'm depressed... mostly about illogical things, like now.) I feel like I'm unfixable, which I know was triggered from my experience on Pristiq. I mean, how do you treat somebody with unipolar depression when those treatments make her have symptoms of bipolar disorder? Sure, you could give her medicines for bipolar disorder, but most of those seem to treat mania, which she doesn't even have!

I guess what I'm looking for is for somebody to tell me I have options. I want somebody to help me figure out which is more important right now -- fast-acting or long-term. I want somebody to tell me that this isn't the last combination I can try. That there are other medications out there that can help me. That I'm not unfixable.

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It's crappy to go through multiple medications until you finally hit one that works. But once you get one that works, it's worth it. The symptoms do go away. You do feel better. You can live your life again. It's great.

So the biggest lamictal issue is the one that you identified...it takes so long to get up to a therapeutic dose because you have to titrate so slowly. That said, it makes sense that you would want to try it. It sounds like your pdoc is responding to the immediate concern by increasing the wellbutrin and responding to the longer range concern by doing the lamictal. So really you're getting both--it's not an either/or proposition.

If the wellbutrin doesn't help out in the short term, there's stuff like benzos to help chill you out until then. That was kind of my philosophy...that as long as I was given something to take away the anxiety, I could sit out the (very crippling, cry every day) depression because I had some hope that it would end once the drugs kicked in.

It sounds like you've been through two general areas of antidepressants....SSRIs and SNRIs. There are lots of drugs out there (TCAs, MAOIs), some of which have the weight gain problem that you mentioned, some of which don't. So hold on tight to that hope. It will pass. It truly will. It just might not pass as quickly as you want or really need it to.

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"Long-term" and "fast acting" are not mutually exclusive, as you seem to be making them out to be. Getting a fast acting med on board might be the first priority if you're in a bad state right now. That same med might also help long term, but if not, you have some breathing room to sort out what will be long-term.

I'm not sure why you're so negative on all the older drugs, MAOIs and TCAs. Just the weight thing? Not all the older drugs are notorious weight gainers. There is also Emsam, the MAOI patch, which is not an old drug.

Your sweeping dismissal of "bipolar meds" as only effective against mania is a little broad. Besides Lamictal which definitely acts as an an antidepressant, lithium has a long history of use for depression. Or is that one getting canned because of the risk of weight gain? In any case, even the ones you think are better anti-manics also may have a place in treating recurrent depression.

ECT does not need to be continued indefinitely for most people. Am I reading that right, that you thought it did have to be continued forever?

I hope this does not sound harsh, but I hope you're working on your body image issues in therapy, since it sounds like they are severe enough to be significantly interfering with your treatment.

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Sorrel pretty much stole my post! The only thing I have left to add is that you might want to talk to your pdoc about starting something like abilify, that will work more quickly, while you're titrating up on lamictal.

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It's crappy to go through multiple medications until you finally hit one that works. But once you get one that works, it's worth it. The symptoms do go away. You do feel better. You can live your life again. It's great.

So the biggest lamictal issue is the one that you identified...it takes so long to get up to a therapeutic dose because you have to titrate so slowly. That said, it makes sense that you would want to try it. It sounds like your pdoc is responding to the immediate concern by increasing the wellbutrin and responding to the longer range concern by doing the lamictal. So really you're getting both--it's not an either/or proposition.

If the wellbutrin doesn't help out in the short term, there's stuff like benzos to help chill you out until then. That was kind of my philosophy...that as long as I was given something to take away the anxiety, I could sit out the (very crippling, cry every day) depression because I had some hope that it would end once the drugs kicked in.

It sounds like you've been through two general areas of antidepressants....SSRIs and SNRIs. There are lots of drugs out there (TCAs, MAOIs), some of which have the weight gain problem that you mentioned, some of which don't. So hold on tight to that hope. It will pass. It truly will. It just might not pass as quickly as you want or really need it to.

I know the Wellbutrin is supposed to help me out in the meantime. I also know that it obviously won't work so quickly! I'm just so ready to get out of this state... it's been crippling for months and I keep trying things that only worsen my issue. I'm just so worried about this because the past month really scared me... I've never had an experience like that. It wasn't me. And even though I'm off the medication, I still don't feel like myself yet, even though I'm getting there. I just want to NOT feel like this anymore. I can deal with depression when I feel like it's ME in there... but I don't know how to deal with what I'm going through right now.

Xanax does help like you mentioned -- but I am trying not to rely on that too much. I don't have a history of addiction, but I do want to be careful, especially because it DOES help so much.

My doctor does not want me on MAOIs, and to be honest, I'd rather not do them as well, just because they interact with so many things. Of course, I'll do them if I get to that point, but I guess I'm just hoping there are options before that.

You have a lot of options. I'm not just saying that because you want someone to say that, but because it's true.

If you get manic/hypomanic on ADs, it opens up the realm of mood stabilizers. Lamictal is only one of them. None of them have AD qualities the way Lamictal does, but generally if you can control the cycling, it helps. You can also try ADs again while on a mood stabilizer which will make a difference in how you react to them.

My pdoc really likes Abilify for your set of symptoms (similar to mine). It's worth a shot. There are also the other AAPs to look at. Fish oil is something you could add right now.

If you have been cycling a lot, sometimes ADs just don't work as fast as they might otherwise. You have to give them some time.

As well, if you're very depressed and monkeying around with meds, something may be quick-acting, but you might not get back to your normal mood state for awhile. It takes awhile to tweak meds. Even ECT isn't something that works right away.

Unfortunately, you just have to stay patient and do the best you can to get through this tough time. Once you get your meds and diagnosis somewhat worked out, treatment becomes a lot easier.

My only concern about mood stabilizers is that most are more helpful with mania, which is not an issue with me. And like you said, I logically know that I can try ADs again on a mood stabilizer and that could possibly help. I think I'm just getting scared after my experience on Pristiq. I don't even know why I am so desperate to know I have other options for depression, when I haven't even STARTED my new treatment and when I know that there are different things out there I can try -- sure a mood stabilizer might not benefit me on its own, but it might allow me to take anti-depressants I previously couldn't. I'm just being silly. I already feel embarrassed that I even posted this. I just want to be myself again RIGHT NOW, even if it's depressed me. I know I just need to be patient.

"Long-term" and "fast acting" are not mutually exclusive, as you seem to be making them out to be. Getting a fast acting med on board might be the first priority if you're in a bad state right now. That same med might also help long term, but if not, you have some breathing room to sort out what will be long-term.

I'm not sure why you're so negative on all the older drugs, MAOIs and TCAs. Just the weight thing? Not all the older drugs are notorious weight gainers. There is also Emsam, the MAOI patch, which is not an old drug.

Your sweeping dismissal of "bipolar meds" as only effective against mania is a little broad. Besides Lamictal which definitely acts as an an antidepressant, lithium has a long history of use for depression. Or is that one getting canned because of the risk of weight gain? In any case, even the ones you think are better anti-manics also may have a place in treating recurrent depression.

ECT does not need to be continued indefinitely for most people. Am I reading that right, that you thought it did have to be continued forever?

I hope this does not sound harsh, but I hope you're working on your body image issues in therapy, since it sounds like they are severe enough to be significantly interfering with your treatment.

Oh, I know they aren't mutually exclusive! But the option my pdoc and I are currently planning to take is one that probably won't be fast-acting, though I do think it sounds like a good long-term treatment for me, from what I've read. I'm not against all of the older drugs. I've even looked into the Emsam patch. For various reasons, the MAOIs don't seem like the best option for me right now, but I'll consider them in the future if needed. I would prefer not to go on them because of the interactions they have with food and other medications, but I'll, of course, do what I need to do. My pdoc does not want to prescribe MAOIs anyways, so there isn't much of a point worrying about that until it becomes my only option. As for the TCAs, it is mostly about the weight gain. It's not that I WON'T go on anything if it affects my weight, but that they will be my last resort. I'm pretty sensitive to medicines that make you gain weight -- I gained about 20 pounds on Seroquel on a very low dose for sleep -- and I didn't even take it very long. In fact, in a 2 year period, I gained about 40 pounds, mostly due to drugs. (The drugs that tend to cause weight-loss or appetite-loss, on the other hand, don't ever affect me!) I lost 50 pounds on Weight Watchers in 2007, and I am more confident than I ever thought I could be, even with the depression. I feel so much better about myself, even while depressed, than I did when I was heavier. It doesn't make sense to me to go on a medication that will cause me to gain weight when I have gone that route and have lost a lot of self-confidence because of it. I have tried to work with therapists about my body issues, but they don't seem to take it seriously because I'm not "too thin". I've clearly had some BAD luck with therapists. I don't have an eating disorder and intend to stay at a healthy weight, but I am still on the borderline between underweight and normal. I should NOT have body-image issues and I logically realize this. I think part of this is because I went from thin to overweight in a short amount of time. I should note that my body-image issues do keep decreasing as time goes on. I think it's ridiculous that my therapists haven't taken me seriously, especially because I am pretty thin... if I DID have an eating disorder and was told that I wasn't "too thin" like one doctor said, she would have seriously fucked up a patient. I am looking for therapists, but I keep choosing shitty ones. I think I've made more improvements journaling and writing than I ever have in therapy. The last therapist was so awful that I think I'm going to take a break from therapy and journal for a while. I would come out of her office bawling and would be depressed for days. She never wanted to talk about issues that were relevant to my life, and so I would feel worse and worse as she minimized my problems and brought up issues that I don't even have -- like asking about problems with my family during each session, even though we're really close and have no problems.

I have looked at lithium and have heard that it can help depression. I actually considered asking my doctor for it before I researched Lamictal. Still, from what I've read, it's still more effective as a drug for mania. From what I've read about other mood stabilizers (which is minimal, since I deal with unipolar depression and until recently didn't know that drugs for bipolar disorder could help treat me), they are also much more effective for mania. I haven't read much about them helping with depression. Then again, I haven't done much research, because I haven't read up on drugs that are usually used to treat mania because I don't have it! It's not that I'm "dismissing" them... it's just that from what I've read, they're not the right treatment for me. I guess I haven't read enough, since I apparently sound ignorant.

As for ECT, I know it doesn't have to be done forever. However, I have read that most people do later need follow-up treatments after their initial sessions. I would assume that people would occasionally need follow-up treatments for a while, since the effect does tend to wear off the first time. I know that people don't need ECT forever.

While I do need to work on my body image issues, I don't feel as if they are hindering my treatment, since I am willing to go on them if I have to. I'm simply trying to find other options instead of just accepting a drug that will likely make me gain weight. Other people may find that they don't want to go on a drug with sexual side effects because it completely changes their lifestyle; however, people tend to understand when somebody says they don't want to go on a drug because of sexual side effects. That's somehow more acceptable than people who don't want to go on a drug that makes them want to gain weight. Gaining weight is the ONE side effect I want to avoid if possible; I don't think that indicates that my treatment is seriously hindered. It just means that I need to try alternatives before I try something that will likely make me gain weight. I'm sure that you also have a side effect that you'd like to avoid by any means. If you had the option of simply accepting a drug that will cause that side effect or researching other options, I am sure you would look for other options before you went on the drug with the negative side effect.

I feel as if your response indicates that you think I'm dumb or ignorant. I'm not. However, I AM new to researching alternative treatments for depression. I just saw a psychiatrist for the very first time in January and had always been prescribed drugs from my general doctor. In four months, I've learned more about what does/doesn't work for me than in the past 11-12 years I've been on antidepressants. I didn't know that there were options outside of typical antidepressants (SSRIs, MAOIs, TCAs, SNRIs, etc.) until I came to this board a month ago. I'm just trying to find some OTHER options that might work for me. I don't see why that's a bad thing. I'm sure your post was not meant to be condescending, but it certainly felt like it.

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I'm going to echo what sorrel said, specifically the weight gain issue. It really sounds like something you need to deal with in therapy. As well, even if you're on a med that causes weight gain, you still have the choice to eat well and exercise. Weight gain and loss don't happen without taking in more calories than you're burning. Exercise is great for body image, overall health, sleep, mental health, confidence, and much more. If you're not already active, work on it. If you are, the weight gain issue probably won't be that pronounced for you unless you're significantly overeating. I've struggled with my weight my whole life, and the only thing that affected it in significant ways up or down have been food intake and activity level.

I am active and I do regularly exercise it. I also (generally) eat healthy, drink enough water, etc. I'm not a perfect example of health, but I'm pretty good.

I actually didn't significantly overeat when I took certain drugs before, but I did gain A LOT of weight. In fact, I was actually more active during that time since I was waitressing full time and therefore always moving! I'm very sensitive to medicines that make me gain weight, though medicines that are supposed to cause a lack of appetite or weight loss don't seem to affect me in that way. My friends are SHOCKED at the amount of food that I can eat when on my ADHD medicines. They just don't affect my appetite, and I never lost weight on them. I honestly tend to eat exactly the same despite what medication I'm on. I honestly couldn't tell you why I gained so much weight before, if it wasn't for my medications, since I truly didn't eat enough calories to account for the kind of weight gain I had. My metabolism must be weird.

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I did not intend my post to be condescending and I apologize for it coming across that way. I also in no way feel that you are dumb or ignorant. In fact you seem to be putting quite an effort into researching your treatment, which is far from dumb or ignorant.

As a weak point of explanation I'll mention that I am really sick at the moment (physically) and all my niceness and tact filters may not be in place.

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I did not intend my post to be condescending and I apologize for it coming across that way. I also in no feel that you are dumb or ignorant. In fact you seem to be putting quite an effort into researching your treatment, which is far from dumb or ignorant.

As a weak point of explanation I'll mention that I am really sick at the moment (physically) and all my niceness and tact filters may not be in place.

I know you weren't trying to be condescending! I'm just very sensitive. I have dumb-blonde complex... I admittedly look like a dumb blonde, even though I'm not, and often get treated that way by people who don't know me, so I can get upset if I feel somebody thinks I'm dumb. (One of the customers at my work is the worst; he used to make me cry every time he came in because he made comments to all of the other servers about how stupid am and that he's surprised somebody who is only bound to be a trophy-wife is working... I had never even met him!!! One of the girls got pissed and finally set him straight.)

I didn't realize my dumb-blonde complex transferred to the internet! Don't worry -- you said nothing wrong! I think I'm just a little too sensitive right now.

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Just as an aside...

You mention that you didn't know about mood stabilisers to treat unipolar depression/bipolar treatment. Sorry if you've already come across this one before, but have you seen the following website?

http://www.psycheducation.org/depression/frameset.html

If you read the first few pages, you'll find some of the reasoning behind WHY these drugs are suggested, used, and work well in many cases.

*bows out to allow those who are more experienced on the med-go-round throw their hat in the ring* ;)

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Just as an aside...

You mention that you didn't know about mood stabilisers to treat unipolar depression/bipolar treatment. Sorry if you've already come across this one before, but have you seen the following website?

[link=http://www.psycheducation.org/depression/frameset.html"'>http://www.psycheducation.org/depression/frameset.html" target="_blank]http://www.psycheducation.org/depression/frameset.html[/link]

If you read the first few pages, you'll find some of the reasoning behind WHY these drugs are suggested, used, and work well in many cases.

*bows out to allow those who are more experienced on the med-go-round throw their hat in the ring* ;)

I JUST found about a week ago, actually. I'm pretty sure he's been following me around and has based his information on my life. It's exactly like me. It is one of the reasons I asked my doctor if I could try Lamictal.

I just ordered the book last night, even though I don't think it's different than the website. I found his insights so interesting that I figured I would buy it.

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