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Antidepressants & Bipolar Depression, meta analysis...


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http://www.psychiatrictimes.com/bipolar-disorder/content/article/10168/1770988

Researchers found that the issue with using antidepressants in the treatment of depressive episodes in bipolar disorder was not so much the risk of eliciting mania, as their lack of efficacy, which bery much mirrors my experiences with them. And maybe suggests that depression associated with bipolar disorder is in some fundamental way different from MDD, at least in some instances.

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Gives more credability then to bipolar "soft" signs and also Bipolar as a spectrum disorder then.

Oh, that's interesting, Helen. You mean the idea that some people who present with what looks like MDD, but don't get much response to AD's are in fact somewhere on a bipolar spectrum?

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Gives more credability then to bipolar "soft" signs and also Bipolar as a spectrum disorder then.

Oh, that's interesting, Helen. You mean the idea that some people who present with what looks like MDD, but don't get much response to AD's are in fact somewhere on a bipolar spectrum?

Yes.

There are a collection of about 11 evidence based things that indicate some sort of bipolarity but aren't officially used.

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i was reading about this when i was first diagnosed. in fact, many of the symptoms of bipolar depression are the opposite of MDD, which was something i always struggled to reconcile with when i was younger and thought MDD was my problem ("i know i'm VERY depressed, but i hardly meet any of the criteria, wtf?"). it makes sense.

personally, most AD make me manic and/or rapid cycling and i have bad seizure-like reactions to SSRIs as well, so they're out for me anyways. but i have noticed they don't do anything for my depression (i don't count euphoric mania as helping depression. feeling completely out of control is not a good thing.). MAYBE they do a little for my anxiety, but only if it sends me into a euphoric mania. if not, anxiety skyrockets.). interesting how that works out.

a good read though!

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Fascinating! My pdoc and I talk about the AD issue all of the time on a scientific basis if I don't need anything important at the appointment. He says that for most BPers he diagnoses, they aren't effective and/or promote "switching" which tends to agree with this study. He also indicated that some, like ME, will only be helped with antidepressant augmentation. I may bring up another hypothesis, and it is only a hypothesis. I think that those of us labeled Bipolar who lean more toward the schizoaffective and schizophrenic diagnosis without the "proper" diagnosis and who don't exhibit the "euphoric mania" but rather go into a psychotic fugue so to speak, are more likely to respond to AD's over anticonvulsants.

NOW THERE's some food for thought. That is my goofy hypothesis. Tell me if you have gotten the same "Feel."

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Gives more credability then to bipolar "soft" signs and also Bipolar as a spectrum disorder then.

Oh, that's interesting, Helen. You mean the idea that some people who present with what looks like MDD, but don't get much response to AD's are in fact somewhere on a bipolar spectrum?

Yes.

There are a collection of about 11 evidence based things that indicate some sort of bipolarity but aren't officially used.

I can say yes to 7 of those in addition to having BP in my extended family on both sides.

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My dad actually treated brain injured patients with what he considered "soft bipolar," since he figured it might get worse. So it is definitely an accepted concept. Dr. Akiskal also supports this theory.

He also thinks there is soft TLE.

Although my dad and Akiskal disagree on how "spectrum-like" the illness is. I actually don't understand why Dad doesn't agree, though.

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This doesn't surprise me. I'm by no means an expert on all things med, but I'm on my second psychiatrist who avoids AD's for the BP crowd unless there's a clinical reason - depression typically not being one of them.

In my experience, AD's are destabilizing. I'm on one now for OCD, and I plan on 86'ing it before spring hits. I can't do another spring fever. Just can't. I don't know if it will help, but it certainly can't hurt.

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Fascinating! My pdoc and I talk about the AD issue all of the time on a scientific basis if I don't need anything important at the appointment. He says that for most BPers he diagnoses, they aren't effective and/or promote "switching" which tends to agree with this study. He also indicated that some, like ME, will only be helped with antidepressant augmentation. I may bring up another hypothesis, and it is only a hypothesis. I think that those of us labeled Bipolar who lean more toward the schizoaffective and schizophrenic diagnosis without the "proper" diagnosis and who don't exhibit the "euphoric mania" but rather go into a psychotic fugue so to speak, are more likely to respond to AD's over anticonvulsants.

NOW THERE's some food for thought. That is my goofy hypothesis. Tell me if you have gotten the same "Feel."

No... I'd think a psychotic fugue, whatever exactly that is, would respond to, um, antipsychotics. And I think people who think they're misdiagnosed should discuss that with their pdocs, as it will not tend to help with finding effective treatment.

My dad actually treated brain injured patients with what he considered "soft bipolar," since he figured it might get worse. So it is definitely an accepted concept. Dr. Akiskal also supports this theory.

He also thinks there is soft TLE.

Although my dad and Akiskal disagree on how "spectrum-like" the illness is. I actually don't understand why Dad doesn't agree, though.

Soft TLE is another interesting one. I have this abiding, yet vague, notion that there's something offish about my temporal lobes, or maybe just one of them, who knows?

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^ Sasha- why the angry tone? It seems like everyone is irate on this forum today. Yikes. You are really insulting me with the trite statement "um...antipsychotics." I am no idiot. My doctor, however, likes to take things slowly....very slowly, and admittedly is NOT concerned with labels as much as with what medication works. He hasn't mentioned my "label" in probably a year and a half. I think it would be silly to even say "Hey. I think I am Schizoaffective, Depressive Type" out of the blue, when, in fact, I am on the EXACT medication regiment you would expect from that diagnosis! I hope you are not harboring hard feelings. Everyone just seems on edge today on this site.

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Gives more credability then to bipolar "soft" signs and also Bipolar as a spectrum disorder then.

Oh, that's interesting, Helen. You mean the idea that some people who present with what looks like MDD, but don't get much response to AD's are in fact somewhere on a bipolar spectrum?

Yes.

There are a collection of about 11 evidence based things that indicate some sort of bipolarity but aren't officially used.

All but 3, 8, and 9 applied to me before I had an obvious hypomania last year. Up until that point my dx was depression with psychosis, but none of the SSRI's or SNRI's really did anything for mood and if they did they pooped out. I was at tricyclics before I stopped ADs altogether. The idea of a spectrum including recurring depression with no obvious hypomania at the bottom is fascinating, and definitely makes sense to me.

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^ Sasha- why the angry tone? It seems like everyone is irate on this forum today. Yikes. You are really insulting me with the trite statement "um...antipsychotics." I am no idiot. My doctor, however, likes to take things slowly....very slowly, and admittedly is NOT concerned with labels as much as with what medication works. He hasn't mentioned my "label" in probably a year and a half. I think it would be silly to even say "Hey. I think I am Schizoaffective, Depressive Type" out of the blue, when, in fact, I am on the EXACT medication regiment you would expect from that diagnosis! I hope you are not harboring hard feelings. Everyone just seems on edge today on this site.

I don't think I'm harboring any hard feelings. I really wasn't posting with any hostile intent. Just posting.

It sounds like the relationship you have with your pdoc is very different from what I have with mine. I'm sure I could do a better job of remembering that different from isn't necessarily synonymous with worse than. Any edginess that may have come through in my post would probably have been about that, if that makes any sense.

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I hear a lot of you saying how they can't pry <drug of choice> from your cold dead hand. For me that drug of choice is amitriptyline. It's a TCA. If I had to give up all but one of my meds I don't know whether I'd keep lithium or amitriptyline but it would be one of the two. The rest are optional as far as I'm concerned. I think this AD thing is like all others. There is variation. It doesn't work for the vast majority of the people but for some, it is a lifesaver.

You know, it's interesting to me that it's a tricyclic you get such a good result from. I think the AD's looked at in the study were SSRI's and maybe wellbutrin. But just from what people seem to have to say around here, the tricyclics are maybe a better bet for bipolar depression.

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