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I've looked up how atypical anti-psychotics work, by affecting dopamine and serotonin

I've also looked up how mood stabilizers work, and it's completely different. For example, the explanation for Depakote was:  "The brain naturally produces a chemical neurotransmitter called GABA (gamma amino-butyric acid) that helps to calm and relax nerves, thereby stabilizing moods. Depakote works to increase the amount of GABA The brain may not produce enough GABA to soothe overstimualted nerves, so Depakote works to stimulate production of the calming chemical the brain needs." (From LiveStrong.com)

So I don't really understand how an AP is supposed to really be a mood stabilizer. My pdoc thinks I have Schizoaffective so I understand why she said "no" to letting me try an anti-depressant, but I also don't get why she thinks monotherapy with an anti-psychotic is the golden ticket and won't consider anything else. (And this could also include something in addition to the AP, not in place of the AP, so it's not like I'm trying to persuade her to let me go AP-free.)

In my experiences so far, APs do jack shit for mood, really. I felt hypomanic and impulsive on Latuda. I became very depressed and felt suicidal on Risperdal. Now both of these medications did have benefits. The Latuda for example relieved depression, I felt it. The Risperdal for example relieved some anxiety and agitation, I felt that, too. But neither of them had "stabilizing" effects, they just shoved me from one end of the spectrum to the other. Gee, thanks? 

When I've vented about this online on various communities, I get told the same thing, everywhere, that AP's have mood stabilizing properties, and that it makes sense that my pdoc wants to just use an AP.

Okay but like HOW? Nobody has been able to answer that yet. They are completely different meds that do completely different things, and my own experiences are not helping to convince me.

Since stopping Risperdal I have swung back from depressed, to feeling agitated and generally "wound up". My sleep is crap again. 

When I see my pdoc again on the 12th, I know she is going to try to roll out the next atypical anti-psychotic for me to try. And I know part of this (what I am thinking/feeling) is because I am already very agitated, so part of it is my "mood" I know, but at the same time it's like wtf is the deal. Obviously just an AP is not working out very well, and I don't see why she would expect it to given they are completely different meds. That do completely different things

Aaauurghh.

But my previous pdoc was the same way. Is this a recent trend in psychiatry? My previous pdoc said she thought I had Bipolar 1 with psychotic features. She noted that I seemed to experience very irritable mixed states, and also depression states. So she put me on Zyprexa. And that was after she told me out of nowhere, "Well I'm not going to put you on Depakote." I didn't even know what Depakote was and didn't bring it up, but she said it out of nowhere. Are people abusing mood stabilizers? Is there some street value to them? I felt like she was acting like I was after pain killers or something, and it was very confusing. Is this why psychiatrists are trying to turn to APs only?

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The are mood stabilizers in the sense that they shut down mania and can boost one out of depression. You are right that they have a different mechanism of action than anticonvulsants.

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3 minutes ago, jt07 said:

The are mood stabilizers in the sense that they shut down mania and can boost one out of depression.

But is it really a "stabilizer" if it just makes you switch from one to the other? To me stabilize means to get rid of both, not just switch it up. 

Like I said, I was able to identify benefits from both of the meds, so I don't think they are worthless for mood, completely. But they don't seem to stabilize. 

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But it does not switch from one to the other. An AAP should never switch one from mania to depression or vice versa. They should switch one out of both of the pathological states to a more natural, even state. They also serve as prophylaxes against these extreme mood states. That's why they are sometimes called mood stabilizers. Regardless of the mechanism of action, the result is the same.

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6 minutes ago, jt07 said:

But it does not switch from one to the other. An AAP should never switch one from mania to depression or vice versa.

Okay so what if it does. Am I just a freak of science. 

Edited by CoffeeBean

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7 minutes ago, CoffeeBean said:

Okay so what it it does. Am I just a freak of science. 

It certainly do different things to different people.

Here, off the top of my head, I can only remember the AAP Quetiapine approved for monotherapy to bipolar disorder, because covers depression and mania. (Besides Psychoses). 

If mania is an elevated state, antypsicotic are major tranquilizer, make some sense?

I think mania can take you out of touch with what so called reality and I have hard times seeing it as something far away from psychoses.

Scientific speaking at least from what I know all the meds contain at their description something like "by reasons unknown" and explain one or other chemical action and possible effect from it.

It's not hard to imagine someone getting out of depression after getting symptoms like mania or psychotic related out of their lives...

The same thing that you're in doubt applies to mood stabilizers.

Besides Lithium and Depakote, again, from memory, I don't know anything else officially approved as monotherapy for bipolar disorder.

You have to test those meds, unfortunately it's not one week that you're going to see the results of which one.

The reaction from each drug is so different from person to person, you can see scrolling this board.

Monotherapy treatments are RARE, specially if you have comorbidity with something else.

From different PDOCS, I would say I wish my first one had this approach, because he sedated me so much that I spent two months without knowing what was going on and I have problems remembering my second semester of college because of over medication.

I had moderate PDOCS and light ones...

MI has not a blood test.

We have neuroplasticity which means that our brains adjust to chemicals, takes time to form, take times too to break and form again new connections.

I'm replying because I got your first posts and I'm seeing your struggle, I think it's normal trying to fix this, but it's not that simple, it's not a shot that you will take that will make you better but if you give a time you will catch yourself improving and tailoring better options for yourself.

This works by trial and error.  

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Some APs act not only on dopamine receptors but also on serotonin ones.

Edited by Bixo

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AP's have been the most helpful to me. I also take lamictal but Seroquel and Abilify have changed my life for the better. 

It can take years to find the right AP for you. And have you only tried latuda and risperdal and zyprexa? Have you ever tried a typical AP of just those 3 AAP's? 

My point is there are so many options out there. Failing on 3 AAP's doesn't mean that none of them will work in that category. And you have to decide if the side effects of the meds suck more than the actual untreated illness. I know how it feels to want to be better NOW RIGHT THIS SECOND. But it takes a while for the meds to kick in as well. They need time. 

Lastly, if you don't think your pdoc is treating you properly do you have the option to get a second opinion on what meds you should be taking? But I'd try to first discuss this issue with your current pdoc to see if this issue can be resolved. 

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5 minutes ago, Bixo said:

Some APs act not only on dopamine receptors but also on serotonin ones.

Exactly! Most AAPs act on serotonin as well as dopamine and thus exhibit antidepressant activity as well as antimanic activity.

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Yeah, but for the most part AAP's are serotonin antagonists.  So their antidepressant efficacy probably results from a different moa than SSRI's. 

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Anticonvulsants are a very large and diverse group of pharmacological agents, each one acts on different parts of the brain, and they don't have the same effect on everyone (as most drugs used for mental illnesses). So...it depends. It's really hard to get an idea of how psychiatric drugs work if you're not an expert on the field. I usually search a giant load of information on the web, then ask some friends who are studying Medicine, and if I can I ask my psychiatrist or family doctor.

I've been taking Lamictal for two weeks now and I've read that it blocks the sodium channel or something like that, but I don't know what the heck that means. I could send you a message after I've asked my friends, if you want.

I also suggest the same as @Wonderful.Cheese, discuss this with your doc if you think it's not going to be an appropiate treatment.

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1 hour ago, SashaSue said:

Yeah, but for the most part AAP's are serotonin antagonists.  So their antidepressant efficacy probably results from a different moa than SSRI's. 

Certainly different from the SSRIS, but serotonin antagonists can function as antidepressants in some cases as well. Remeron (mirtazapine) antagonizes a number of serotonin receptors, and it is a fairly good antidepressant. I 

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2 hours ago, Wonderful.Cheese said:

I know how it feels to want to be better NOW RIGHT THIS SECOND.

Yes I know I am struggling with this feeling. I feel almost panicked half the time that nothing is going to work. I have the sort of mind where if I can at least understand something better, though, it can help to ease anxiety. 

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2 minutes ago, CoffeeBean said:

Yes I know I am struggling with this feeling. I feel almost panicked half the time that nothing is going to work. I have the sort of mind where if I can at least understand something better, though, it can help to ease anxiety. 

The trouble is that nobody understands exactly how these meds work. There are hypotheses but nothing is sure with 100% certainty.

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It took something close to 100yrs before they understood the mechanism of aspirin. But it still worked even when they didn't know why. :)

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