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BiPolar Type II Medication Tweak


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About 10 or so years ago I was diagnosed with MDD & SAD & GAD. That's all I thought it was until things just wern't adding up, I'd be ok for a few weeks, then down again for anywhere between a few days to a few weeks & this wld happen @ least 2 to 3 times each month.

So, about 3 or 4 years ago, I went to see my shrink (who I've seen since I was 1st diagnosed) & let him know that I didn't feel like it was just depression, and he did a revamp of everything & re-diagnosed me with BiPolar Type II & GAD & SAD, which fits my symptoms ALOT better.

However, I have only been on 50mg of Pristiq once a day, we've discussed mood stabilisers over the years, but decided that the side effects of going on them weren't worth it at that particular point in time.

Now however, I've gotten to the point with my illness that I NEED to agument my Pristiq with something as it's just not cutting it on it's own. I'm happy to stay on it 1. because it does help with my "depressive" episodes, 2. it helps with my GAD and 3. the withdrawl effects are too severe for me to handle (esp as I have a 5yo son to look afer too).

I've had a full blood work up & everything's fine (inc my iron & cholestrol) and have made a 45 min appt to see my Shrink on the 25th March so we can talk about what's been happening (as I haven't seen him for a while) and we can discuss which meds I'd like to try first (as I'm expecting to have to play "musical meds" a little before we get the right combo that works for me).

I was just wondering what your personal experiences have been with mood stabilisers, esp in combination with antidepressants and any advice you'd like to share with me :)

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Lamictal is the anticonvulsant best for depression. Side effects on average are least. Some people benefit from the AAPs with strong AD properties. Abilify, Geodon, and Seroquel are examples.

Why did your doc wait this long to put you on a stabilizer? You should have started taking one then. Bipolar is a progressive illness. Stabilizers help stop the advancement. If you were cycling these past years, then your illness, including physiological impacts, probably worsened. A second opinion may be in order.

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Lamictal is an absolute staple for me. I have been taking it for 4 years (maybe longer), and when I'm off of it for more than a few days it's bad news. Cymbalta in a low dose has been a decent AD for me, and has been relatively helpful for my anxiety. I went from taking 4mg Clonazepam daily to now taking 2mg Valium prn, which is maybe once per week. I have been on Abilify, Geodon, Seroquel, around the merry-go-round a few times with them all. Seroquel works best for me currently, and as much as I hate to admit it, it has kept me by far the *most* stable that I have been... probably ever. It's not just the Seroquel, it's the Lamictal as well. I saw my pdoc today and discussed weaning off of Seroquel. He kindly said that was a no-go. He's a smart man. smile.gif I look forward to hearing about your appt on the 25th. Good luck!

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I'm currently on sodium valproate as a mood stabiliser, which I think in America is Depakote? Anyways, it's been good for my mania but not so good for my depression, so maybe you'd be looking at another mood stabiliser is your primary concern. I did augment valproate with Pristiq and Abilify for a time and that helped my depression somewhat, but I've found augmenting it with an atypical antipsychotic like ziprasidone [Geodon] quite helpful in keeping my depression away. I found Pristiq a little too flattening and I also didn't like its sexual side effects.

I'm also surprised that it's taken this long for you to get on a mood stabiliser. I think usual practice is to put someone with bipolar on a mood stabiliser, to stabilise the moods. You don't get that sort of stabilisation with ADs alone.

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I like Seroquel a lot - if you were using it to augment the Pristiq, you might even be able to use an MDD dose (300 mg ish) rather than a BP dose (600 mg ish).

I've been on it for a couple of years now, and it's the only thing that's ever really worked well for me (though I've mostly been on antidepressants and a very shortterm, low dose round of valproate).

Sedation is a problem at first, but it wears off with time, and I found the weight gain tolerable.

I got to choose between Seroquel and Lamictal recently, but the reason I chose Seroquel is mainly because I'd been on it at a lower dose for a long time, so I knew it was going to play nice. If I were choosing between the two and I didn't have a history with either of them, I'd probably have chosen Lamictal.

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Lol. I echo what everyone else has said - Lamictal. I was just taking Zonegran for my mood stabilzer, along with Abilify and Pristiq, but now I take two. My pdoc took me off the Pristiq because ADs cause rapid cycling, and that I was, and added Lamictal. I also switched out Abilfy for Geodon because of weight gain. And echoing everyone else again, surprising you are just now getting on one. Good luck in finding the right combo.

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I love the Lamictal. It has been unbelievably helpful. I'm a train wreck without it (hell, I am a train wreck - but just a different kind).

There are lots and lots to choose from. If you want something where the side effects aren't too terrible, Lamictal or Trileptal are good bets (if you're more depressive, Lamictal will probably be the one your doc picks). Abilify and Geodon can be helpful, but they can be activating (which may work for you). Lithium and Seroquel do double-duty - good for mania or depression. Might be good options to look at.

I will say from experience that if you're on an AD, you might want a stronger mood stabilizer on board. Lamictal is awesome, but it doesn't do a lot for quashing mania. I take both Lamictal and Abilify with Effexor XR, which do OK but not great (Seeing pdoc in a week).

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It really depends a lot on what kind of symptoms you're looking for help with, and how severe they currently are. If you need more help managing depression, lamictal is a good bet. Seroquel also works well, and tends to kick in a lot more quickly, if you're needing help ASAP. Some people get significant relief from depression with lithium, as well.

If you've got more of a mixed state thing happening, then you'd probably be best off with either depakote or an AAP. That probably applies to rapid cycling as well.

And if it's a hypomania you're needing to treat, your best bets would probably be lithium or an AAP.

We can help you based on our own previous experiences, but your pdoc is going to be the best source of complete info, including the likelihood of various side effects and such.

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I'm also surprised that you were dx'ed with BP II three or four years ago but your pdoc is just now starting you on a mood stabilizer. Lamictal has been great for me in combo with Wellbutrin.

Lamictal has a slow titration, but if that's what the pdoc decides on, it's definitely worth the time. I also had bad headaches for the first few days of every dose increase, but since they only lasted a few days each time, I took some Advil and carried on.

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Thanks for everyone's advice. I'll let you know how I go with my Pdoc appt on Fri. Yeah I think it's been a real double edged sword with my diagnosis. Because I present as fairly high functioning and my Pdoc is about 2.5hrs from where I live (making it hard to get to him in a crisis) I've let going on mood stabilizers go because I've been "ok" up until now. It;s more the depressive side of my BPII that's getting to me, that and the anxiety and irritability, I don't really get "manic" so's to speak & when I do it's expressed more as a "hypersexual" phase so I have no idea what/ how we'll treat that! (lol! ~ I can laugh at myself! when it's not happening that is!~) It's only happened twice in the past 2 years, but it was 2 times too many!

Yeah, I've written down EVERYTHING and am going to get hubby to read it and write a letter to my Pdoc if he feels the need (as he's working and can't make it to the appt with me) and I'm going to give it all to my Pdoc and we'll go from there. There's a few things I haven't told my Pdoc until now and I suspect that it will tie a lot of things together for him. I haven't deliberately NOT told him, but cause I haven't been able to get to him when I'm rock bottom, I usually brush my more "irrational" stuff off when I'm there cause I'm feeling better, but there will be none of that now as I realise that not telling him everything is stuffing up my treatment.

I'm quite nervous about going on something new as I have a 5yo son to look after and get to school and pick up, and nausea is a very common side effect for me (I'm going to see about getting some anti-nausea stuff to take for the first few weeks). I'm also worried that I'll go into one of my "manic" phases again (cause I can't control it when I'm in it) and do something I'm REALLY going to regret (which I've already done before)! The good thing is that hubby's work has changed and he's now home in the evenings and night, which drastically reduces my changes of doing something ultra stupid like I have in the past.

Anyways, sorry about the TMI & thanks for the support :) and I'll def let you all know how I go :) I'm looking forward to if not stopping then slowing the depressive rollercoaster ride that I've been on for way too long!

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Ok, so I had the appt with my shrink yesterday, he read through all the notes and the mood chart I gave him. After reading it all, he decided that instead of a 'typical' Bipolar II, that I was rapid cycling with mixed states, so I guess i fit in somewhere along the bipolar spectrum! After a lengthy chat, we decided to try Epilim (sodium valproate) first and see how it goes. His words were "In my opinon, it's the best one of a diffcult bunch of medications", & he also said that he's found it good for rapid cycling, so I figured I'd give it a shot. He's put me on 200mg twice a day to start with and then I go see him again in 3 weeks (it was going to be 2 weeks, but there were no appts left!) and we'll see how I've been and adjust the dosage again.

He warned me about the fairly common side effect of weight gain (I've put on weight anyways from 'comfort' eating) but I figure I'll watch my diet and start back exercising for @ least 30mins each day and hopefully that will stave off any drug induced weight gain. Since I've told my shrink EVERYTHING, I'm actually feeling alot better.

He said that if weight gain on Epilim became a problem, he cld switch me to ?Tegratol (I think that was the name, but I honestly can't remember!)

Anyways, so I'm heading off to the chemist this morning to get my script filled, but I mightn't get it until tomorrow depending if the chemist has any on hand. I'll let you know how I go with the side effects and yeah, hopefully, I'll start to feel better!!

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I'm glad you told your pdoc everything. It's the only way we can be properly treated. Everything I would have said has already been covered, but one last thing is that valplroic acid has been a lifesaver to me in terms of controlling my mixed states and anxiety. It sounds like your pdoc thinks it'll help you in this way too.

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Depakote is good for cycling. But. Throw out all your junk and fattening food. Buy fruit and crackers and popcorn and other non-fattening foods. The problem with Depakote is less that the med is fattening, it's that it creates an unnatural appetite. You eat a full dinner and 10 minutes later your stomach is growling. This does not happen to everyone, but it does to quite a few. Better to be prepared than standing there in a couple weeks with an extra 15 lbs.

Tegretol is the Depakote backup. It worked better for me and was weight neutral.

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I used Depakote for migraine, and it didn't really affect my mood, and my weight swung wildly. Just as an FYI. I used it for years anyway, because it was working.

Another cheerleader for Lamictal with Wellbutrin. I have depressive, hypomanic (which might be what your "hyper-sexual" periods are), and mixed episodes. But no depression for a decade. That was just a change in how my illness presents. I hope you have good luck with the Depakote, depressed is definitely a horrible place to be.

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Hey everyone,

Thanks so much for your replies, I've been on 400mg of Epilim for 5 days now and am noticing a marked improvement in my irriability and anxiety. I'm being careful to not "graze" on food throughout the day, but try and stick to having breakfast, lunch and dinner, with healthy snack in between. So far so good lol. Next week, I'll get back into some exercise, (about 30mins of cardio @ least 3 days a week) but right now, I'm more concerned abt my mental health (which seems to be improving). I'll def update this thread if anything changes and will let u know how my next appt goes with my shrink on the 15th April :)

crtclms yeah I'm def hypomanic when I get "hypersexual"

Stacia yeah I'm def finding Epilim makes me more hungry

crazydiamond yeah I'm hoping it's a lifesaver for me too!! :)

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  • 3 weeks later...

Just saw my Shrink again on Friday and he's got me to up the Epilim (sodium valproate) to 600mg as I'm still having some breakthrough anxiety and irriation (so am still cycling). Have been on the higher dose for 2 days and haven't had any side effects which is good :) . Am going to have to watch my diet and exercise as I need to loose weight anyways and we all know that sodium valproate is not awesome for weight.

Interestingly my Shrink also diagnosed me with aspects of/ from the Personality Disorder Spectrum, but not with a Personality Disorder per se. Basically he's saying that I don't have the reason/ing in between feeling the emotion and then acting, which in my case is dead true. So whilst I'm finding it all a little overwhelming (it's kinda scary to find out that u have aspects of any MI, on top of what I already have lol) it's a good thing too because it helps me realise what's "wrong" with me and what I need to work on to become more "stable".

Am still on Pristiq (desvenlafaxine) 50mg as well and he's happy to have me stay on that to counteract my depressive phases/ cycles, which is great, cause I really didn't want to have to go off it and not have anything else to go on to as the wthdrawls from Pristiq are really evil and I have more depressive phases than I do hypomanic phases. I feel that for me personally, both Epilim & Pristiq might just be the combo I need to be the best me I can be (yeah, I know, it sounds corny!)

The Shrink has said that to give it abt 2.5 weeks and if I'm still Cycling (I'm doing a daily mood chart), then to add another Epilim to the mix and see if that helps. Either way, I'm seeing him again in a month and we'll go from there :) But it should just boil down to maintenance from now on. Am going to try and find a local psychologist to augment my Shrink's sessions, but I'm expecting to have a bit of trouble doing that as I've been through them all down here before (but not for a few years) so I might get lucky! lol

Anyways, thanks to everyone's advice, experiences and input, I really appreciate it all and will keep u all updated as to how I'm going :)

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  • 2 weeks later...

Well, it was all going good 'til the place Hubby had been working at for 6 weeks closed down due to not making enough money. Am so upset for him (as it was the best job he's ever had; close to home, paid by the hour, great hours of work, paid over time, public hols, sick pay, holi pay, etc). :(

Needless to say we're both abosolutely devastated D: I've uppped my Epilim (sodium valproate) from 600 to 800mg as a result of the stress, I'll take it back down to 600mg once our situation improves. I'd up the Pristiq (desvenlafaxine) but I can't tolerate to side effects of the 100mg dose, whereas I can tolerate the Epilim very well, and it tones down my anxiety and irritation (esp with the stress we're under atm) and allows me to deal with things a lot better.

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