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woofy28

MOA of Bipolar medication

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Not sure if this is the right area for this but just thought I'd try here. Does anyone know how a medication like Risperidone works for bipolar? Is it more the Dopamine receptor antagonist or is it the 5-ht2a antagonist, that works for controlling bipolar disorder? I know there are other antagonists for the serotonin receptors but the 5-ht2a seems to come up a lot. One of the reasons I ask is because I was put on Risperidone and cymbalta (while in a psych hospital) and being diagnosed supposedly with bipolar/mixed state.(Even though I feel depressed alll the time) Straight SSRI/SNRI medications alone tend to give me a somewhat  agitated euphoric feeling when I would yawn...not sure why, and its tough to explain. I don't feel good off of any SSRI's alone that I have tried and would just leave me the same... more Anxious and depressed. I didn't stay on that combo long because I landed in the ER because I couldn't settle down at night to sleep (literally flipping around in my bed)and cause my heart wouldn't stop racing.(my guess from the norepinephrine).

While I did notice positive things from it in the beginning like I felt better about myself and wanted to socialize more, which is strange for never feeling like that ever. Anyways, if I was diagnosed bipolar why would a doctor stick me on an SNRI while on a medication that should control it alone like RIsperidone? Wouldn't that just in turn make me manic from all the extra serotonin? It just doesn't make any sense to me. That's what had me confused on which serotonin receptor is at work to stop manic episodes, and level you out. With the new psych doctor Im seeing, I don't have a full diagnosis yet, but was put on Seroquel XR at 50mg, and guess work my way up. The mental health person who did my partial diagnosis(before being able to see my new psychiatrist) said that it was more towards major depression/social anxiety disorder though. I had the genetic test done from 'genomind' to try to find a medication that wouldn't give me so many issues. (been on about 14 so far) My old doctor had called them and they recommended that but I was afraid to keep taking a AP due to the side effects. No I have accepted it and giving it another try.

Still dont feel anything from it but I figure cause Im not upto the target dosage. The new doctor is trying to get a hold of the company to see what other medications might help. So, if anyone who understands this better, please feel free to explain how this med combo works, and all the receptor stuff. Sorry for rambling on as well.

 

 

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I have a couple of observations. First, what action works for bipolar (dopamine or serotonin) is going to depend on the symptoms you are treating. Secondly, it's not as cut and dried as saying this antagonizes dopamine and that serotonin because the brain chemicals tend to be linked. Changing serotonin can change dopamine, etc. I can't answer why your doctor would put you on an SNRI. Maybe your doctor thought you were depressed and thought the Risperdal would control any mania or hypomania that you might get from the SNRI. I don't know.

I'd also like to say that I took Risperdal for depression. It was very subtle, but it really did help me by helping me make plans for the future which I had no interest in before the Risperdal. I didn't really have any other effects from the Risperdal - either good or bad. It was almost like taking a placebo in terms of side effects. Unfortunately, I went off it (the name brand) and a few years later when I tried to get back on it (the generic), it didn't work the second time. Still no side effects but also no effects at all, I don't know if that had to do with it being generic or whether Risperdal is one of those meds that just don't work the second time around for some people,

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Well there is a lot we do not know about antipsychotics. The one common thing is they all block or work in some way with dopamine. Some AP's/AAP's seem to also to have some antidepressant activity. Some have quite a lot of antidepressant activity and usually these meds will have actions with 5-HT (serotonin receptors) or nor-epinephrine. For incidence I take Abilify solely for its antidepressant actions, So with AAP's sometimes the line between being an antidepressant and being an antipsychotic is fuzzy. The same can be said for select AP's. So you really can't work backwards with great surety figuring out what your diagnosis based on what med you are on because we don't resally know for sure the causes of these illnesses.  I was seen as bipolar because I took Lamictal (for seizures) and Abilify Z(for depression). I'm no more bipolar than the man in the moon and I have moved between several pdocs in past decades. None suggested bipolar. It is a common combo used to treat bipolar. Aren't they still working out your diagnosis ? This would be a bad time to make any concrete statements about your diagnosis.

It is hard to say what agent controls mania. In AAP's/AP's is is assumed to be dopamine. But lots of things control mania and have absolutely no effect on dopamine. The anticonvulsants, for incidence. They tend to work with electrical pathways in the brain. Some of the anticonvulsants used in bipolar work with one or more of the GABA receptors and benzos, which also work with GABA,  are used in mania. Tends to not be a main line treatment. Both have a place in controlling mania.

 

I will caution not to develop a simple tit or tat view of mental illness and its treatment, depression is not simply having too little serotonin and mania is not simply and excess of dopamine. It is far more complex than that and in most cases we don't know for sure.  

 

 

 

 

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Thanks for the replys. Yeah, They are still trying to figure out a diagnosis for right now. I think it was a LMHC that came up with the old diagnosis, or if they can even do that..not sure. I know I got to see the paper for the diagnosis though but I know it can change. I get to see a PNR on Tuesday to check how I'm doing on my meds, And next week see the psychiatrist to I guess adjust them. That's good the  Risperdal  worked for you. I'm almost wanting to try it again as it seemed to help things. Just gotta see how I do on the Seroquel first I'm guessing. It feels like I'm probably gonna end up with an AP and a SSRI eventually just from how things have gone so far. I can only hope for some relief soon.

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