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Are you including actual antidepressants in that question? Or just mood stabilizers and antipsychotics?

Yeah. Including a real AD in the mix might make more sense.

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Amitriptyline has been miraculous for my depression, but it's a TCA which may be tricky for some with BP, especially without a MS/AP in your cocktail.


Hmm... I think the AAP Latuda was recently approved for BP depression (correct me if I'm wrong someone), so that may be something to look into.

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Seroquel. Adding an AD (an SSRI, SSNRI, wellbutrin, TCA, MAOI, etc.)


Those are some options to discuss with your pdoc.


Latdua made me manic and didn't control my psychosis either. I feel ya.


I hope you feel better soon.


ETA: I don't know if the latuda made me manic or if it was the coming off of seroquel that did it or just my random brain cooties. Probably a combo of all three. heh.

Edited by Wonderful.Cheese
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More Evidence That Regular Antidepressants Do Not Work in Bipolar Depression

October 21, 2013

Psychiatrists most commonly prescribe antidepressants for bipolar depression, but mounting evidence shows that the traditional antidepressants that are effective in unipolar depression are not effective in bipolar disorder. At the 2013 meeting of the American Psychiatric Association, researcher Jessica Lynn Warner reported that among 377 patients with Bipolar I Disorder who were discharged from a hospital, those who were prescribed an antidepressant at discharge were just as likely to be remitted for a new depression than those not given an antidepressant.

The average time to readmission also did not differ across the two groups and was 205 +/- 152 days. Those patients prescribed the serotonin and norepinephrine reuptake inhibitor (SNRI) drug venlafaxine (Effexor) were three times more likely to be readmitted than those not prescribed antidepressants.

These naturalistic data (generated from observations of what doctors normally do and information in the hospitals clinical notes) resemble those from controlled studies. In the most recent meta-analysis of antidepressants in the treatment of bipolar depression (by researchers Sidor and MacQueen), there appeared to be no benefit to adding antidepressants to ongoing treatment with a mood stabilizer over adding placebo. Randomized studies by this editor Post et al. and Vieta et al. have shown that venlafaxine is more likely to bring about switches into mania than other types of antidepressants such as bupropion or selective serotonin reuptake inhibitors (SSRIs).

In addition, a naturalistic study published by this editor Post et al. in the Journal of Clinical Psychiatry in 2012 showed that the number of times antidepressants were prescribed prior to a patients entrance into a treatment network (the Bipolar Collaborative Network) at an average age of 40 was related to their failure to achieve a good response or a remission for a duration of at least six months during prospective treatment.

Editors Note: Antidepressants are still the most widely used treatments for bipolar depression, and their popularity over more effective treatments (mood stabilizers and some atypical antipsychotics) probably contributes to the fact that patients with bipolar disorder receiving typical treatment in their communities spend three times as much time in depressions than in manic episodes. Using other treatments first before an antidepressant would appear to do more to prevent bipolar depression. These treatments include mood stabilizers (lithium, lamotrigine, carbamazepine, and valproate); the atypical antipsychotics that are FDA-approved for monotherapy in bipolar depression, lurasidone (Latuda) and quetiapine (Seroquel); and the combination of olanzapine and fluoxetine that goes by the trade name Symbiax.

Evidence from several sources suggests that the SNRI venlafaxine may be a risk factor for switches into mania and lead to re-hospitalizations. Other data suggest that in general, in bipolar depression, augmentation treated with antidepressants should be avoided in several cases: in childhood-onset bipolar depression, in mixed states, and in those with a history of rapid cycling (4 or more episodes per year).

Conversely, I take Pristiq (desvenlafaxine).

Acta Psychiatr Scand. 2010 Mar;121(3):201-8. Epub 2009 Aug 19.

Venlafaxine monotherapy in bipolar type II depressed patients unresponsive to prior lithium monotherapy.

Amsterdam JD, Wang G, Shults J.

Depression Research Unit, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.jamsterd@mail.med.upenn.edu



We examine the safety and efficacy of venlafaxine monotherapy in bipolar type II (BP II) patients with major depressive episode (MDE) who were unresponsive to prior lithium monotherapy. We hypothesized that venlafaxine would be superior to lithium with a low hypomanic conversion rate.


Seventeen patients who were unresponsive to prior lithium monotherapy were crossed to venlafaxine monotherapy for 12 weeks. The primary outcome was within-subject change in total Hamilton Depression Rating (HAM-D) score over time. Secondary outcomes included the change in Young Mania Rating (YMRS) and clinical global impressions severity (CGI/S) and change (CGI/C) scores.


Venlafaxine produced significantly greater reductions in HAM-D (P < 0.0005), CGI/S (P < 0.0005), and CGI/C (P < 0.0005) scores vs. prior lithium. There was no difference in mean YMRS scores between treatment conditions (P = 0.179).


Venlafaxine monotherapy may be a safe and effective monotherapy of BP II MDE with a low hypomanic conversion rate in lithium non-responders.



I would say that venlafaxine would be one of the best medications to really cure the depression but has the risk of mania. Beware. I was already on Lamictal and Abilify before I started it.  

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Please post the title and opening paragraph of the article that you wish to provide to a larger audience. Then create a link to the rest. You are violating copyright when you cut and paste an entire article.


What is the "best medication" for you is not necessarily best for others. And you might want to put your commentary *after* the article; as it is, it looks as if it is a part of the article.

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I'm really leaning toward amitriptyline. Seems to work for others too.

It really has been the only thing that's ever helped my depression. I was in a depressed episode for two years before amitriptyline dragged me out of it. That's just my experience, and I'm sure there are some whose experiences differ, but I think it's worth discussing with your doctor. These boards are riddled with threads about amitrip with some good information/experiences, you might want to give them a look if you haven't already. Good luck! 

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For me: Effexor. Hands down.


Fascinating. I had such a terrible experience with Effexor that I told my doctor I honestly believed it should be taken off the market due to the horrifying side effects I experienced that no professional seemed willing to admit existed (ie. brain zaps). But this is what I love about pharmaceuticals... there are about 7 billion variations of human DNA walking around on the planet right now - what works in one body might not work in another.


I'm on Prozac at the moment, but I'm only 3 days in and I'm already noticing very strong manic features rearing their ugly head... I'll be stunned if I don't end up calling in early and switching to Lamotrigine.


All antidepressants I've taken so far have the tendency of "ramping me up" too much, or making me go outright manic. One thing that I've usually had to do is use 2-3 meds in combo to achieve the best balance, and remove the anti-depressant from the combo when it starts to "build up" too much.

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doc gave me trileptal and deplin...we shall see. with a chance to try amitryptline in a few weeks

I hope you're going to try it longer than "a few weeks." Typically to give a med a real try, you need to plan on a minimum of 6 weeks. That is minimum. Well, that's unless you get side effects early that warrant discontinuing.


I've tried AD after AD. The only one that works consistently for me is amitriptyline at high doses. I know it's a TCA and if you're BP, TCAs are supposed to not be a good choice. Just because a med isn't supposed to be good for people that are BP doesn't mean that it won't work for you. You need a pdoc that is willing to try different meds until you find the right combination. Sometimes, it takes years to find exactly what works for you. Studies are great. The thing about them is, they don't tell you how the med is going to work for you. The only way you'll know is to try it yourself.

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