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Treatment of bipolar depression


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This question has been bugging me for quite a while but I'm not sure if anybody knows the answer.

One of the treatments of bipolar depression is OFC (olanzapine-fluoxetine combination).

I'm wondering why fluoxetine is often not recommended in the treatment of bipolar depression, even when used with a mood stabilizer and it is OK to used as part of OFC?

And why can other antipsychotics not be used in combination with fluoxetine? What is so important or special about olanzapine that it is the only antipsychotic indicated, alongside fluoxetine, for the treatment of bipolar depression.

Why can't ability, risperdal, geodon, seroquel etc be used. For example AFC ( aripiprazole-fluoxetine combination ).

I take seroquel and fluoxetine and this sorted my depression

Any thoughts??

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Idk the answers to your questions, but the first thought that came to mind after I read your post was that when a person is treated for (bipolar), there is no set combination/standard for each MI that everyone uses.  Some people react differently to meds and in different combinations, so ie, someone could have a different set of meds that work for them (for treatment of Bipolar), when they wouldn't work for someone else. 

Does that make sense?

 

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49 minutes ago, melissaw72 said:

Idk the answers to your questions, but the first thought that came to mind after I read your post was that when a person is treated for (bipolar), there is no set combination/standard for each MI that everyone uses.  Some people react differently to meds and in different combinations, so ie, someone could have a different set of meds that work for them (for treatment of Bipolar), when they wouldn't work for someone else. 

Does that make sense?

 

Yes it does make sense that different combinations suit different people.

I just wonder why the olanzapine-fluoxetine combination is approved for bipolar depression and other antipsychotics aren't

And that fluoxetine is not indicated for bipolar depression, except with olanzapine and not with other antipsychotics.

Sorry. I'm repeating myself. It just intrigues me... The mind boggles!!!

 

 

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Totally agree with the above. I think it just happened to be an idea that was pursued by the drug company and eventually got FDA approval and was patented. I think you're totally right to be curious. I've taken a SFC combo (Seroquel XR-fluoxetine) and it worked really well. The OFC combo was effective but in my experience, Seroquel worked a little better.

I currently take escitalopram (I want to switch to fluoxetine) with Depakote and Lamictal, and I feel like that really evens me out, but I've had a much more robust response to fluoxetine in the past. I think fluoxetine is a unique SSRI because it has other therapeutic mechanisms as well, which maybe accounts for its better efficacy in bipolar depression?

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Thanks so much for replying!

I never even thought that this would be related to money and politics.

I know that there is a drug called Symbyax which is a combination of olanzapine and fluoxetine. It is not available in Ireland where I live. I had forgotten that olanzapine, fluoxetine and symbyax are all made by lilly which is a rich and powerful drug company. So I guess money talks!!

I just thought that olanzapine had some unique formula that when taken with fluoxetine  was effective in treating bipolar depression. 

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Although I think the reasons above are most likely--there might be something specific about Zyprexa (olanzapine right?) that helps people feel safer about adding an antidepressant.  I know people's experiences vary, but for the majority of the people I've heard, Zyprexa is one of the hardest hitting, particularly on mania and hypomania, to the point that a fair number take it just occasionally in order to knock symptoms out early.  And to the degree that people will get relief on it even when getting nothing on Amy other ASP.  So, if that's the case, it might be the best suited/safest bet to prevent an antidepressant from kicking someone too high. 

that very well could be coincidence or it could be that the group I know about are not within the realm of typical AAP experiences, but because I have seen it fairly frequently, I wonder if it's at all a contributing factor. 

However I'd be more inclined to believe this rationale if the two drugs weren't by the same manufacturer, to be honest.

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1 hour ago, rowan77 said:

Yes it does make sense that different combinations suit different people.

I just wonder why the olanzapine-fluoxetine combination is approved for bipolar depression and other antipsychotics aren't

And that fluoxetine is not indicated for bipolar depression, except with olanzapine and not with other antipsychotics.

Sorry. I'm repeating myself. It just intrigues me... The mind boggles!!!

 

 

Before now I had never heard of fluoxetine not being indicated for bipolar depression.  I had it along with other meds including other anti-psychotics.  I don't remember what other meds I was on at the same time, but I know I was on the APs too, just not zyprexa specifically.  I have been on both meds at different times, ie I have been on zyprexa also; just not as a combo specifically for bipolar ... but the Prozac saved me from depression.  IME, prozac kept the constant tears away as well as depression.

However, I have read here on CB the prozac can be activating, but I have never experienced that (started it in 1991).

I'm interested in hearing what others have to say about about the questions you've asked.

No, you aren't repeating yourself  :)    The mind is a mysterious thing!

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I totally agree with the Lilly Is All-Powerful theory mentioned above.

Re: Prozac being contraindicated for BP depression because of how activating it can be in some people - the last time I took Prozac, I landed in the hospital for the first time in 13 years. I was psychotic and convinced I could walk out into the street and the cars/buses/etc. would just go right through my body like I was invisible. I was very, very tempted to run out into traffic to test this theory. This despite being on a hefty dose of Seroquel.

YMMV, of course, but this is what we're being warned about.

Edited by bookgirl
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And the thing is I am on 40mg prozac!! However I am also on Seroquel, lithium and lamictal. It really pulled me out of my severe depression. Well obviously the other medications did their stuff too. 

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I think one of the reasons why they chose olanzapine in particular to combine with fluoxetine is that olanzapine's 5-HT2C antagonism is pretty potent in comparison to its D2 antagonsim, and could thus be dosed in such a way to invoke 5-HT2A and 5-HT2C antagonism without seriously employing the antagonism of D2 receptors unless needed to, so as to combine the fluoxetine's 5-HT2C antagonism and maximize the synergy for norepinephrine and dopamine release enhancement.

Then again, Seroquel, by means of its metabolite, norquetiapine, has some pretty potent 5-HT2C antagonism in comparison to its D2 comparison itself.

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