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Bipolar Depression and Antidepressants


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From what I understand, antidepressants should not be used for bipolar patients since they induce mania and it's also unclear if they actually work at all (someone correct me if I'm wrong about this, I'm not a doctor). I'm at the moment in a lower mood state (moderate depression for several weeks, mild depression for maybe 2 months), I'm dragging myself along with action plans, but it's getting very frustrating, I'm sick of it. I have told my doctor about the current depression, he said it would have to be much much worse for him to even consider antidepressants given my history, he said he can't give a number but in his opinion the risk for switching would be way too high to outweigh the potential benefits. I fit into the relatively stereotypical BP1 bin with very severe 4-5 months manias with some psychosis (not always) and full remission after episodes.

 

What experiences do others here have with bipolar depression and antidepressants?

When have your doctors considered you miserable enough to take them?

 

 

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I'm schizoaffective and my bipolar is NOS/2. I was originally diagnosed MDD and started on antidepressants. Antidepressants don't make me hypo/manic. Celexa made me agitated and panicky and what I think was kinda mixed though.

 

Generally, antidepressants just do nothing for me. I feel absolutely no positive effect from them. For example, I've been on Effexor XR for about 2 years. I was on it for 3 weeks at the maximum dose (300 mg) and MAYBE felt SLIGHTLY better. But still pretty much nothing. Then, we added Abilify and my depression disappeared in three days flat. Abilify made me hypomanic for about a week, then that settled down and I felt stable (mood wise). Then I was diagnosed BP after fessing up my hypomanic symptoms (past and Abilify induced). 

 

The only reason I've remained on Effexor XR is because my pdoc and GP are afraid that if we remove it, my depression will come back. I personally think Abilify is what keeps the depression away and we could lower my Effexor or drop it completely and I'd be fine. I feel it adds nothing to my stability. But there's that doubt, that risk, that depression might come back. So, I remain on Effexor. Blah. 

 

I may have reacted to a recent Effexor increase with extremely rapid cycling or a mixed episode or weird lability. I have been mildly depressed for a few months, so my pdoc decided to up my Effexor past the maximum dose, up to 375 mg. Well, shit hit the fan. I would be depressed for 2-4 days, then verging on/hypomanic for 2-4 days, then back to depressed, then back to hypomanic. This went on for a month, and is partly why we added Lamictal. 

 

Anyway, that was some kind of torture, so I lowered my Effexor back down to 300 mg and I've been fine ever since. No more mood swings. So, I guess you could say, antidepressants either do nothing for me, or they make me cray cray like a crayfish. 

 

I personally wanna drop Effexor and see what happens. 

 

Lots of BP people take antidepressants without issue. Even though antidepressants are technically not supposed to work for us. But, by looking around the board, you can see that many BP'ers take antidepressants and it helps them. 

 

If you're prone to mania, I can see why your doctors don't want you on an antidepressant. Perhaps you could try talking to them about adding Lamictal? Lamictal is known to be really good for bipolar depression, especially in BP 2, but I don't see why it wouldn't be worth a shot in BP 1. Sometimes Lamictal acts too much like an antidepressant for some people and can send them into hypo/mania. But it's pretty unlikely. As long as you can avoid the terrible rash, it's a pretty decent drug. i'm currently titrating up to 150 mg and it's been easy. I had one headache and I'm itchier than usual. Otherwise, it's fine. It's painfully slow going though. But many people feel relief from depression at low doses anyway. 

 

I'm kinda just blabbering now, but that's my experience with antidepressants and Lamictal. Hope that helps. 

Edited by Parapluie
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Personally some antidepressants make me manic and some don't. Strangely, I've been using Effexor for my depression and knock on wood I haven't gone manic yet. However, I know some people with bipolar can't tolerate antidepressants at all. In that case, I agree with Parapluie that you should consider lamictal since it helps with depression and is not an antidepressant. Latuda has also been approved for bipolar depression. Good luck.

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Before I was properly Dx'd, I was told I had plain depression.  Welbutrin made me manic.  Celexa and Prozac probably made me hypo at times.  Now I'm on a mood stabilizer (lamictal) and an AD (trazadone) for sleeping and an AP (geodon) to control the mania.  So it's not an AD by itself.  The combo keeps me stable.  

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Like Parapluie, antidepressants tend to just not work, rather than triggering mania for me. I am bp2. You could ask your pdoc about non-AD options. Seroquel and Latuda are approved for BP depression. Lamictal and lithium have AD properties as well.

Edited by mcjimjam
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Thanks everyone. I have been on Seroquel, I absolutely hate it. It makes me sedated and depressed. The doc actually suggested I should go on Lithium, at the moment, I am not sure why, but after 5month of mania last year, I think I'd rather drag myself through some more depression than risk another mania. I've had enough for a bit. I hadn't thought about Lamictal though, I'll bring it up at the next meeting.

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I'm in the minority. ADs work for me and do not catapult me to hypomania (I'm BPII). I find with an AD my lows don't fall as low as they do without one. I also have comorbid GAD and Social Phobia that the ADs are an amazing treatment for.

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My pdoc has always included an antidepressant in my med cocktail. When I was taking cymbalta I was ok. After starting lexapro I began rapid cycling. Although I don´t exactly experience mania. I switch between normal mood and depressed, really fast. From day to day, or hour to hour.

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Before I was diagnosed BPII, I was just diagnosed as depressed and took many many anti-depressants. None of them made me manic, they just simply did nothing at all. NOTHING. The only one I'd ever taken that did actually seem to improve my mood (not overly so, just help it some) was Effexor XR. So, I'm on Latuda, Effexor XR and Lamictal. Though I don't actually feel depressed, I do have symptoms of depression. If I don't set an alarm, I will easily sleep 12 hours, not much energy, etc. So, next pdoc appt, I'm asking for an increase in something. My next appt is in Feb.  My symptoms are not so unbearable that I can't make it til then, so I'll just wait until my next appt. I'm sure the options will be to increase the effexor or the lamictal, either is fine with me. I can't figure out for the life of me why I'm having these (mild, just annoying) symptoms of depression when really, my life is in a pretty good place right now.

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Wait, were you worried that *lithium* would make you manic? I can say this without exaggeration: lithium is one of the best if not THE best ANTI-mania medications. It also seems to put a floor under depression, making it difficult for one to sink down to a suicidal level. I use it as an add on for my Lamictal and Wellbutrin, and I really love it.

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Wait, were you worried that *lithium* would make you manic? I can say this without exaggeration: lithium is one of the best if not THE best ANTI-mania medications. It also seems to put a floor under depression, making it difficult for one to sink down to a suicidal level. I use it as an add on for my Lamictal and Wellbutrin, and I really love it.

 

No, that just sounded confusing. Sorry. I know Lithium is known as a very good anti-manic. I have this issue that when I write there should often be '.' but I put a comma. I'm not a native speaker which makes it even worse.

 

A funny thing actually happened and the bad part of the depression was gone one morning. I woke up, and was mildly hypo, depression gone. Now it has levelled off to baseline.

 

Even though many people here seem to be ok with anti-depressants, maybe I feel too scared about it making me manic. But the pdoc suggested lithium to me anyway since he thinks the Depakote might not be enough for the manic side. If that works against depression too, it sounds like a good idea and I'll ask to try it out at my next appt.

 

Thanks everyone again.

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Lithium is excellent for mania and depression.

 

I find some AD's help, some hinder.. I switch a lot. Right now, I take a lot that sedates, so the AD's don't really cause mania.. the topamax and haldol kind of keep it down, if that makes sense.

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