do I need to change meds?

[Moody]

I wasnt sure where to put this, please move it if you think it belongs in a med forum.

I have pretty standard seasonal changes, I get a mixed state every summer, and sometimes depression in the winter. My summer anxiety has finally let up over the past few months, but now I am starting to feel tired and mildly depressed. The same thing happened last year, I also gained 15 pounds. It is like my whole system suddenly slows down. I feel down and dont want to do anything, I just go to work and come home and sit on the couch.

I am currently taking 15mg of remeron, .25mg of risperdal, and .25mg of klonopin every day. I am trying to get off the klonopin, but I have been on it for a while, so I am having trouble going lower than .25mg. This combo helped my symptoms over the summer, but didnt completely get rid of them. I tried raising my remeron dose to 22.5mg over the summer, but it made me more anxious. Almost everything my pdoc tried on me over the summer made me more anxious, neurontin, lexapro, even seroquel. I like wellbutrin, but I cant take it with risperdal, the combo gives me dysphagia. I have already tried abilify, it worked very well at first, but then it caused rapid cycling and agitation, plus it was hell to quit.

So do you think it would help to change my meds? Increase risperdal? Decrease it? Change to a different med? My pdoc has mentioned Geodon, but she is hesitant to try it on me since a lot of her patients become manic when starting it, and I had agitation issues with seroquel. She gave me some Provigil to try, but I dont think my insurance will cover it.

Maybe I should not mess with anything because I dont feel THAT bad, just kind of tired and down. I have tried a lot of meds that didnt help, so maybe I shouldnt change anything? Do most of you just put up with anxiety and depression as long as it isnt too bad? I do not feel horrible, just tired and low.

What do you think? I know you are not doctors, but my pdoc has been running out of ideas. She has started asking me what I want to do, but how would I know? If I have some ideas to discuss with her, that would be helpful.

[AnneMarie]

Hi. I moved this to Cocktails since it's mostly about meds.

My mood changes over the year, too. I get depressed in the winter, so we focus more on the Lamictal and Lithium then. I also make a point of being in the sun or using a light box. That seems to help a little.

I would talk to your pdoc about a med change. There's no point feeling bad all winter. Even though there is potential for a bit of a med merry go round, you'll have the solution for years to come so it is worth it.

My pdoc starts Geodon at a high dose to avoid the agitation and hypomania that can be kicked off at low doses. This is based on her experience and that of other pdocs she knows. FWIW.

Risperdal isn't much of an antidepressant, so raising it alone probably isn't your solution.

Have you tried Lamictal or Lithium. Both have antidepressant effects with Lithium having a pretty strong antimanic one, too.

[Moody]

Have you tried Lamictal or Lithium. Both have antidepressant effects with Lithium having a pretty strong antimanic one, too.

Hi Stacia, thanks for responding and moving my post.

I tried Lamictal twice, both times my pdoc took me off because she thought it was making me hypomanic. I havent had good luck with anticonvulsants. Havent tried lithium, my pdoc is really into AAPs for bipolar II rather than lithium. I havent pressed her to give me lithium because I am scared of the side effects and bloodwork.

She also starts folks off on high doses of Geodon, for the same reason you stated. I thought that was kind of weird, but it is reassuring to hear that other pdocs are doing the same thing.

The lightbox is a good idea; does it matter what type/brand you get?

Maybe I will ask again about the lithium. I am still scared of the side effects, but I am also scared to try Geodon. Not sure which one scares me more. Sometimes putting up with low level depression seems preferable to going through another med change, sigh.

[netsavy006]

I take Lithium and have found it to be of help to me. I know I don't have bipolar II and instead have schizoaffective disorder, but I do have the bipolar type component to the illness. I use Lithium to help reduce the amount of times I get manic/depressed and to reduce the intensity of the episodes should they occur. Yes, you do have to go for blood work when you take Lithium but once your on a stable dose, you only have to have blood work for it once every 3 to 4 months. The doctor can work slowly to work up the dosages. My pharmacy uses the pink capsules and I use the 300mg IR generic Lithium Carbonate.

If you'd want a slow titration, you could start at 300mg and work up 300mg at a time. I know they make other dosage options but I only know of the 300mg's because that's what I've been taking long term.

I'm currently at 900mg and have been at that dosage for about a year now and it does help prevent depressions, because since reaching a stable dose, I've not had one depressive episode and I've been able to keep my manias away (though I do tend to still get hypos (but only 3 this year, compared to maybe 9 - 10 a year in the past which is a great improvement).

In terms of side effects that I got from the Lithium, for the first 1 - 2 months, I did have tremors, but I didn't take medication for it, only because I didn't know it was available and fortunately it went away over time.

Because I'm also on Topamax (which can also affect cognition (and I've been on both for the same amount of time (roughly), I can't really say for sure how Lithium alone affects me cognitively but I've not had too many cognitive complaints from Lithium.

I hope this information helps and I wish you luck with whatever treatment path you take,

Andy.

[SashaSue]

I think lithium is more effective for treating depression than most AAP's tend to be, exceptions being, I guess, maybe seroquel and abilify?

[AnneMarie]

Have you tried Lamictal or Lithium. Both have antidepressant effects with Lithium having a pretty strong antimanic one, too.

Hi Stacia, thanks for responding and moving my post.

I tried Lamictal twice, both times my pdoc took me off because she thought it was making me hypomanic. I havent had good luck with anticonvulsants. Havent tried lithium, my pdoc is really into AAPs for bipolar II rather than lithium. I havent pressed her to give me lithium because I am scared of the side effects and bloodwork.

She also starts folks off on high doses of Geodon, for the same reason you stated. I thought that was kind of weird, but it is reassuring to hear that other pdocs are doing the same thing.

The lightbox is a good idea; does it matter what type/brand you get?

Maybe I will ask again about the lithium. I am still scared of the side effects, but I am also scared to try Geodon. Not sure which one scares me more. Sometimes putting up with low level depression seems preferable to going through another med change, sigh.

My pdoc will not prescribe Lamictal without an antimanic because she's had too many patients go hypo or manic on it. That's her philosophy for BPII as well as BPI.

As long as it produces blue light and says that it's for SAD/depression, it shouldn't matter which type of light box you use.

Lithium is good medicine. It is a good antimanic for me, but even more importantly, it is an AD. It pairs nicely with Lamictal, too. Lab tests are there to make sure it's safe. They are sort of frequent to start but then taper off to every 3-6 months depending on your doc.

Geodon is a good med for some people. It seems to be a niche product. I did not do well on it, but I am different than you. It has antidepressant properties for those who do well on it.

I know what you mean about med changes. The thing is that low level depression can creep into something more without you even realizing it. That's not cool. Besides, life is better lived without any depression. It might take a while to get meds straightened out, but life is better once you've got that done.

[Moody]

So I saw my pdoc yesterday and asked about lithium. She said I could try the extended release lithium if I wanted to, but she wasnt sure it would work on me because 1) I dont have classic BP; I get mixed states and depression, but no pure mania, plus 2) I have had paradoxical reactions to a lot of meds, even topomax and seroquel have made me agitated.

I am still too chicken to try it though. I am scared of the weight gain, hair loss, cognitive dulling, lithium toxicity, and most scary, thyroid and kidney damage. However, if my symptoms are still not under control by the spring, I think I will go for it, because summer is when I get my super agitated mixed states, and I dont want to go through another miserable summer.

She isnt thrilled about the Geodon option either, because it has caused mania/akathisia in so many of her patients. I guess between the two, lithium seems like a better bet.

Interesting about Lamictal making lots of folks manic, I wonder if it would work if I took it with my risperdal? I have only tried it as monotherapy.

Thanks for your comments everyone, it is very helpful. Hearing everyone's positive lithium stories is slowly making me feel better about trying it.

[SashaSue]

I don't know why you would wait until spring, when you've already got a depression starting up?

[Moody]

I guess it doesnt make sense. Im just extra scared to change meds right now, because even though I am mildly depressed, this is actually the most stable I have been in months. I hate the thought of trying something new and getting worse again. I guess maybe I could add the lithium to what I am currently taking, then at least I wouldnt have to quit any meds...

[rowen]

Try the lithium.

It's great as an AD. Drink lots of water, and you shouldn't have kidney problems. Make sure your levels are checked regularly, and you shouldn't run into toxicity. Thyroid is a potential issue, but it's not so damn common that I'd worry about it. A lot of folks on here haven't gained weight from it. Take prenatal vitamins (not kidding here), and it may save your hair - or if anything, make it super pretty. Another dose issue, too. Cognitive dulling may mean your dose is off - just be willing to tinker with the dose. Another thing that doesn't happen to everyone.

If you read any PI sheet, they have scary potential side effects. But they are potential, not necessarily something you'll experience - even if you are particularly med-sensitive.

I've been told I'm med-sensitive and I do have funky reactions to things, but sometimes I don't and something will work for me. I had more problems with Lexapro than I have with Effexor, for instance. You just never know.

You do have the option of Trileptal or Tegretol, too. Maybe not the best for depression, but it may get your mood stabilized.

[AnneMarie]

I guess it doesnt make sense. Im just extra scared to change meds right now, because even though I am mildly depressed, this is actually the most stable I have been in months. I hate the thought of trying something new and getting worse again. I guess maybe I could add the lithium to what I am currently taking, then at least I wouldnt have to quit any meds...

In a lot of ways, you are better off trying a med addition while you are reasonably stable than waiting until you're in a full blown episode. Besides, if the med works, you get to avoid the full blown episode.

As far as Li side effects, keep in mind that it is the only drug that has been in use for nearly a century. Everything that can go wrong with it is known. This isn't true of all psych meds. Except for Clozeril, the AAPs have been around for less than 16 years, with some as little as one year. The long-term consequences from these meds simply aren't known. Most of the anticonvulsants have been around longer, but not as long as Li. And, if you look into their PI Sheets, you will see scary side effects just like you can find them in a PI sheet on Tylonol. The side effects with Li can be serious, but if you drink water, avoid contraindicated meds, and get regular blood work, you may feel better than you could on any other med. For some people, that is how it goes.