Why am I still depressed?

[Oniliscious]

Hi everyone. I have bipolar l disorder with psychotic features, anxiety, ADHD and depression. Right now, I'm talking all of the medications below and I'm trying to figure out why I'm still dealing with depression. I also smoke cigarettes, which obviously aren't making my mental/physical health any better than what it could be without them. Right now, I take a combination of a mood stabilizer, an antipsychotic, 2 stimulants, a benzo and an antidepressant (Cymbalta 120mg). What I'm trying to figure out is if whether or not my med mix is causing all of my dismay or if my antidepressant is no longer effective, or whatever. I've also noticed over the years that I'm very depressive during the summertime, so that is something to take into consideration as far as having SAD and talking to my pdoc about it. The pdoc I see has a reputation for over-medicating his patients, but I didn't know this until I too started seeing him. I'm stuck with him for now until I can find someone who can make sense of my situation.  I'm just so fed up with these almost 8 years of trying to find the right combination of meds or if I even need this much! My pdoc is clearly over-medicating me to some degree right now (which I am sure you can agree), but I just don't have the insight to tell the difference of what's causing my depression, what's meds work well with each other and which ones don't.

What do you think? Do you think that my depression is a result of being on too many meds? The wrong meds? Did Cymbalta stop working? Can antidepressants stop working?Please provide me with your insight, experiences and knowledge! Thanks.

 

PS. I go to work 5 days a week able to somewhat cope, then crash into depression over the weekends, then I start all over.

Edited February 19, 2017 by Oniliscious
Forgot to ad more information.

[sugarsugar]

I can't contribute much to what's happening but I've surely been down the "meds are not helping my depression " road. I did have success with wellbutrin for a longish length of time, but had to keep upping the dose until finally it stopped working. At one point we tried a "med holiday " of maybe a month then restarted it but that was my only med st the time. That worked that time. Cymbalta worked so well it made me manic so not the solution. I just want to let you know it's not unusual but with so many meds I don't know the best approach except have this or a new pdoc sit down and re evaluate the whole lot. Funny part is, for years I refused meds but assumed they would work. What a shock to find trial and error is apparently required. I hope your pdoc will have an open mind and be skilled at reworking a med combo that works. 

[melissaw72]

4 hours ago, Oniliscious said:

What I'm trying to figure out is if whether or not my med mix is causing all of my dismay or if my antidepressant is no longer effective, or whatever

Personally, I don't know if it is your med mix that are causing the problems.  I think it could go either way.  But I am not a DR, so it is hard to figure out what is what.

 

5 hours ago, Oniliscious said:

What do you think? Do you think that my depression is a result of being on too many meds? The wrong meds? Did Cymbalta stop working? Can antidepressants stop working?Please provide me with your insight, experiences and knowledge! Thanks.

Personally I think it could go either way ... does it feel like the meds are causing depression ... or do you feel more sedated?

It is hard being on the med-go-round, but it usually take time to find the right meds and in the right doses, and combinations ... when you find the right meds/dose/combo though, it is totally worth it.

Not sure if the cymbalta stopped working or not ... how long have you been on it?  You need to give it time to work, about 6-8 weeks.  Is this the 2nd or more times taken it?  Sometimes a med won't work the 2nd or 3rd, etc, time taking it.

Yes, antidepressants can stop working, especially if you've stopped them, then re-started them again.  Or maybe you need a med tweak?

 

[ovOidampUle]

I'd be thinking I was over medicated with that mix, too. Whatever the mix, if it's not working, it's not working, and you should advocate for a change. Tell p-doc you feel like you're over medicated and would like to drop a few meds, and defer to him on which ones are most important (unless I have a good idea that a specific med is problematic). In my personal experience, psychiatric meds are far from any kind of exact science so I feel like I have a little more freedom in pushing the direction my treatment takes. At the very least, I'm the expert in knowing how I'm feeling, so if a med makes me edgy, or sedated, or depressed, I talk to my doctor and strongly encourage him to make a change.

You're also in a stronger position to decline meds than your are to demand them. You're under no obligation to take every medication your doctor prescribes for you. It's your body and you've not been committed to the hospital or had any of your basic rights taken away. If you do stop a med, though, you should tell your doctor and get instructions on how to taper off. The most your doctor can do is decline to see you (and I'm not sure if that's even minimally ethical? maybe someone can confirm?), and you can find a doctor that is more responsive.

 FWIW, no amount of mood stabilizers could contain a stimulant-induced mania, so I got those after some very happy times. 

Interesting about the summer depression. I always thought SAD was associated with the fall/winter. It could be that your social activities, schedule, etc. are different in the summer? Also maybe allergies ... I had really bad allergies for a few years, and it unfailingly made me miserable. 

[melissaw72]

4 hours ago, ovOidampUle said:

I'm the expert in knowing how I'm feeling, so if a med makes me edgy, or sedated, or depressed, I talk to my doctor and strongly encourage him to make a change.

Exactly right.  Unfortunately not every pdoc thinks that way ... mine included.  I know myself better than he does in all ways, yet if I want to go lower on a med (ie abilify), it is what he thinks is right.  He thinks he knows what I am thinking, feeling, and hearing ... and he "wins" all the time because his reactions or whatever are based all on what he thinks I am thinking/doing/hearing.  Even though obviously he isn't me.

 

4 hours ago, ovOidampUle said:

You're also in a stronger position to decline meds than your are to demand them. You're under no obligation to take every medication your doctor prescribes for you.

(bold) Sometimes you can be.  I wish my pdoc thought like this.  And I don't think I am the only one this happens to.  I have to at least stay on the abilify at 15 mg.  Long long story short, literally, he said (in words that meant) if I was going lower in dose or off of abilify (he won't allow me to do either), I would go IP, and he would tell them (IP people) I was taking "risky behaviors."  So I said, "So you'd lie?"  and he just paused.  So I am under obligation to stay on the AP.

(I would change pdocs, if it was an easy thing to do, unfortunately it isn't).

 

// Sorry for the tangent

Edited February 20, 2017 by melissaw72
added info.

[ovOidampUle]

3 hours ago, melissaw72 said:

  Long long story short, literally, he said (in words that meant) if I was going lower in dose or off of abilify (he won't allow me to do either), I would go IP, and he would tell them (IP people) I was taking "risky behaviors."  So I said, "So you'd lie?"  and he just paused.  So I am under obligation to stay on the AP.

This is very, very, very wrong. You should switch psychiatrists and/or talk to a  health advocate or specifically a mental health advocate group. 

[melissaw72]

20 minutes ago, ovOidampUle said:

This is very, very, very wrong. You should switch psychiatrists and/or talk to a  health advocate or specifically a mental health advocate group. 

Thank you for the support.

I can't switch pdocs at this point ... and regarding the MI advocate, I am almost totally positive he'd deny everything.  I mean why would he admit all this to a mental advocate (or anyone) ... he could deny everything and switch words around to make me look like I misinterpreted things (which I know I haven't), and that maybe just need a higher dose because of what I say to (anyone). 

Over the past couple days I have been taking a lot of notes/questions (about 3-4 pages, typed out, so far) about just this (and other things), that I plan on asking him when I see him next (March 2nd).  I think I've worded things where he would have to give an answer to defend himself.  The only problem is that when he reads what I wrote, he could say he 'didn't mean it that way' or something like that. 

All this shit started last mid-October and it is still bothering me.  And I plan on asking/telling him things until it is all out of my mind.  I told him I don't care anymore if what he thinks about me anymore.  I just don't care.  Which means that it is like what I think, hear, believe, do ... are what he thinks to be real.  What I say/do/think takes a back seat.  So by writing him the notes, I plan on getting him to get a huge reality check and to think about what he is thinking and the rationale for why he is saying what I feel, think, do is what he thinks.

(I don't mean you have to do this) but if you want to read what I have written (for the next appt), and have stuff to add, just PM me, and I can copy and paste it.  If not it is ok.  Was just a thought.

-----

(Plus I don't want to go off-topic from the OP's post ... it was just a tangent/partial rant that I am so frustrated with right now).

 

 

[ovOidampUle]

7 minutes ago, melissaw72 said:

A mental health advocate (or legal rights project type person) is the best person to talk to about this -- they'll know the laws in your state, etc., and can advise you. I doubt they would take action without your consent, and you probably don't even have to identify your p-doc if you're worried about that. 

[melissaw72]

3 minutes ago, ovOidampUle said:

A mental health advocate (or legal rights project type person) is the best person to talk to about this -- they'll know the laws in your state, etc., and can advise you. I doubt they would take action without your consent, and you probably don't even have to identify your p-doc if you're worried about that. 

I just looked up 'legal MH advocates in MA (my state).'  I will look into that tomorrow.  Thank you!

[Alien Navel Cord]

On 2/18/2017 at 5:17 PM, Oniliscious said:

Hi everyone. I have bipolar l disorder with psychotic features, anxiety, ADHD and depression. Right now, I'm talking all of the medications below and I'm trying to figure out why I'm still dealing with depression. I also smoke cigarettes, which obviously aren't making my mental/physical health any better than what it could be without them. Right now, I take a combination of a mood stabilizer, an antipsychotic, 2 stimulants, a benzo and an antidepressant (Cymbalta 120mg). What I'm trying to figure out is if whether or not my med mix is causing all of my dismay or if my antidepressant is no longer effective, or whatever. I've also noticed over the years that I'm very depressive during the summertime, so that is something to take into consideration as far as having SAD and talking to my pdoc about it. The pdoc I see has a reputation for over-medicating his patients, but I didn't know this until I too started seeing him. I'm stuck with him for now until I can find someone who can make sense of my situation.  I'm just so fed up with these almost 8 years of trying to find the right combination of meds or if I even need this much! My pdoc is clearly over-medicating me to some degree right now (which I am sure you can agree), but I just don't have the insight to tell the difference of what's causing my depression, what's meds work well with each other and which ones don't.

What do you think? Do you think that my depression is a result of being on too many meds? The wrong meds? Did Cymbalta stop working? Can antidepressants stop working?Please provide me with your insight, experiences and knowledge! Thanks.

 

PS. I go to work 5 days a week able to somewhat cope, then crash into depression over the weekends, then I start all over.

IMO, it doesn't look like you take too many medications for MI. A lot of us have to take that much in order to function. Your mileage may vary, of course.

[aura]

Any chance you can get a second opinion? It can't hurt, especially if you feel like things aren't going well. 

[Oniliscious]

On 2/21/2017 at 9:45 AM, aura said:

Any chance you can get a second opinion? It can't hurt, especially if you feel like things aren't going well. 

Yeah, I'm about to get a second opinion. My mind is literally going crazy right now. Sorry that I have not been responding. I have so much anxiety and I feel neurotic. I'm off from work on Friday. I have to see my current pdoc for now until I find someone else. 

[Oniliscious]

On 2/21/2017 at 7:09 AM, Alien Navel Cord said:

IMO, it doesn't look like you take too many medications for MI. A lot of us have to take that much in order to function. Your mileage may vary, of course.

That's interesting that you say that people usually take more. I thought that I was on a lot but I guess for me, it's more of the case that I'm just not on the best combination for me. Keep in mind, I also smoke cigarettes which most likely is contributing somewhat to my mental problems right now and quitting cold turkey (like I want to b/c nothing else works) makes me more neurotic than usual. I've tried cold turkey 8 times already. Bad idea, but I am so desperate to feel 'normal' and healthy again. Cigarettes just make my anxiety worse when I don't smoke one!

[melissaw72]

3 hours ago, Oniliscious said:

I've tried cold turkey 8 times already. Bad idea, but I am so desperate to feel 'normal' and healthy again.

I think the more you quit meds the longer it will take to find the right ones.  For example, if you quit one med that had been helping, and you stop it, going on it again it might not work the second time, so that option is now out. 

Things might work, it takes time though.  Each time you quit you are back at square one, making it so you feel like crap that much longer.

I'm sorry if I missed this, but I am wondering why do you keep quitting cold turkey?  Is it out of frustration, or you don't think you need meds, etc?

[Oniliscious]

16 minutes ago, melissaw72 said:

I think the more you quit meds the longer it will take to find the right ones.  For example, if you quit one med that had been helping, and you stop it, going on it again it might not work the second time, so that option is now out. 

Things might work, it takes time though.  Each time you quit you are back at square one, making it so you feel like crap that much longer.

I'm sorry if I missed this, but I am wondering why do you keep quitting cold turkey?  Is it out of frustration, or you don't think you need meds, etc?

I keep trying to quit cold turkey, because I'm fed up with smoking cigarettes and it just adds more problems to my plate. I wish that I had never started. And yes, the cessation meds like Chantix are too powerful for me and interefere with my current meds. But I haven't tried everything, except Chantix and vaporizers.

19 minutes ago, melissaw72 said:

I think the more you quit meds the longer it will take to find the right ones.  For example, if you quit one med that had been helping, and you stop it, going on it again it might not work the second time, so that option is now out. 

Things might work, it takes time though.  Each time you quit you are back at square one, making it so you feel like crap that much longer.

I'm sorry if I missed this, but I am wondering why do you keep quitting cold turkey?  Is it out of frustration, or you don't think you need meds, etc?

Also, I did not know that stopping and starting up meds loses its effect. I will keep that in mind!

[Oniliscious]

On 2/18/2017 at 11:39 PM, melissaw72 said:

Personally, I don't know if it is your med mix that are causing the problems.  I think it could go either way.  But I am not a DR, so it is hard to figure out what is what.

 

Personally I think it could go either way ... does it feel like the meds are causing depression ... or do you feel more sedated?

It is hard being on the med-go-round, but it usually take time to find the right meds and in the right doses, and combinations ... when you find the right meds/dose/combo though, it is totally worth it.

Not sure if the cymbalta stopped working or not ... how long have you been on it?  You need to give it time to work, about 6-8 weeks.  Is this the 2nd or more times taken it?  Sometimes a med won't work the 2nd or 3rd, etc, time taking it.

Yes, antidepressants can stop working, especially if you've stopped them, then re-started them again.  Or maybe you need a med tweak?

 

I think my meds are causing sedative effects, lack of motivationn, overeating and mild depression. I feel like these symptoms all tie to an issue that's not fully being addressed. I've been on Cymbalta since March of last year, so about a year. I don't like it very much. It doesn't take away my anxiety and barely my depression. I'm just always tired and fatigued to the point where it's hard to go to work and stay up at work and to do my best. I think that I need some kind of tweak in my meds. I just don't really know what to tweak or what to suggest Timmy pdoc. He overmedicates and it's so hard to keep up. ?

 

PS. Invega has made me gain weight. I also attribute my weight gain to depression. I hear voices even while being on Invega, but the Ativan calms my voices more than Invega. Strange, right?

[Flash]

18 minutes ago, Oniliscious said:

I think my meds are causing sedative effects, lack of motivationn, overeating and mild depression. I feel like these symptoms all tie to an issue that's not fully being addressed. I've been on Cymbalta since March of last year, so about a year. I don't like it very much. It doesn't take away my anxiety and barely my depression. I'm just always tired and fatigued to the point where it's hard to go to work and stay up at work and to do my best. I think that I need some kind of tweak in my meds. I just don't really know what to tweak or what to suggest Timmy pdoc. He overmedicates and it's so hard to keep up. ?

 

PS. Invega has made me gain weight. I also attribute my weight gain to depression. I hear voices even while being on Invega, but the Ativan calms my voices more than Invega. Strange, right?

I'm not having any luck with Cymbalta, either. I think the VERY tiny improvement is due to the depakote. So I will change to some other AD at my next pdoc appointment in a  couple weeks. I think I will push for another TCA, because the newer meds have never worked for me. I still have Zoloft, trintellix, viibryd, fetzima, and pristiq to try among the newer ones, but I think that's it. I just don't have any faith in them.  Amiltriptylene (sp?) seems to be the logical choice ATM, so I'm going to push for that. 

[Oniliscious]

22 minutes ago, Flash said:

I'm not having any luck with Cymbalta, either. I think the VERY tiny improvement is due to the depakote. So I will change to some other AD at my next pdoc appointment in a  couple weeks. I think I will push for another TCA, because the newer meds have never worked for me. I still have Zoloft, trintellix, viibryd, fetzima, and pristiq to try among the newer ones, but I think that's it. I just don't have any faith in them.  Amiltriptylene (sp?) seems to be the logical choice ATM, so I'm going to push for that. 

I haven't tried any of the ones you mentioned above, except Cymbalta and Wellbutrin. No luck on either of them. I've heard of them, like Fetzima and was give a chance to take it, but at the same time, I'm so afraid of trying new meds. The thought of them not working terrifies me. We just don't know how they will affect us and there's just no time to waste if try don't work, you know? I have to find a way to take time off of work for at least 3 weeks to really reconfigure and get used to new meds.

[melissaw72]

1 hour ago, Oniliscious said:

I think my meds are causing sedative effects, lack of motivationn, overeating and mild depression.

Does you DR know about the side effects are really a problem?  Although you've been on the cymbalta for a year, so they might not be side effects, IMO.

 

1 hour ago, Oniliscious said:

I think my meds are causing sedative effects, lack of motivationn, overeating and mild depression. I feel like these symptoms all tie to an issue that's not fully being addressed.

If you don't have a therapist (tdoc) I would highly suggest one ... from personal experience, talking about stuff (rather than keeping it inside really helps with the stress and anxiety (or whatever) of whatever I am dealing with.

1 hour ago, Oniliscious said:

I'm just always tired and fatigued to the point where it's hard to go to work and stay up at work and to do my best.

I'd ask your pdoc about this ... this sounds to me like it might be because of the sedation and being over-medicated.

1 hour ago, Oniliscious said:

think that I need some kind of tweak in my meds. I just don't really know what to tweak or what to suggest Timmy pdoc. He overmedicates and it's so hard to keep up. 

I wouldn't worry about what to tweak ... leave that up to your pdoc.  Does he know you feel over-medicated?  Maybe the being over-medicated is causing the sedative effects, lack of motivation, overeating (I eat a lot when I am tired, even if not hungry), the depression, and the being so tired all the time.  That would definitely make me like you feel (the being over-medicated), and would make a lot of sense if that is happening to you also, IMO.  Maybe not being on meds with higher doses than you need will get rid all of the symptoms described above. 

ETA:  depakote and zyprexa, being on too much can definitely be a cause of the sedation, etc.  Maybe not for everyone, but I've BTDT and I was on a low doses of each.

Edited February 23, 2017 by melissaw72

[Oniliscious]

3 minutes ago, melissaw72 said:

Does you DR know about the side effects are really a problem?  Although you've been on the cymbalta for a year, so they might not be side effects, IMO.

 

If you don't have a therapist (tdoc) I would highly suggest one ... from personal experience, talking about stuff (rather than keeping it inside really helps with the stress and anxiety (or whatever) of whatever I am dealing with.

I'd ask your pdoc about this ... this sounds to me like it might be because of the sedation and being over-medicated.

I wouldn't worry about what to tweak ... leave that up to your pdoc.  Does he know you feel over-medicated?  Maybe the being over-medicated is causing the sedative effects, lack of motivation, overeating (I eat a lot when I am tired, even if not hungry), the depression, and the being so tired all the time.  That would definitely make me like you feel (the being over-medicated), and would make a lot of sense if that is happening to you also, IMO.  Maybe not being on meds with higher doses than you need will get rid all of the symptoms described above. 

ETA:  depakote and zyprexa, being on too much can definitely be a cause of the sedation, etc.  Maybe not for everyone, but I've BTDT and I was on a low doses of each.

I have a therapist, but I don't get to see her regularly due to my work schedule which also stresses me out. Shit, I'm just running crazy! But I do get to see my tdoc and pdoc this Friday. Tdoc comes first thing in the morning so I will definitely go over everything with her before I see my pdoc. I think that you're right, as far as Cymbalta might not being the problem as far as these symptoms, that it may instead be that my pdoc just doesn't know how to prescribe! Cuz i tell him everything, I even write things down so that I can remember to tell him how I feel. Maybe I'm just not saying enough or maybe I just recognized more that I'm having these major issues.

No periods for over 4 months and no sex drive either ever since I started treatment in general. These are just more apparent though because obviously not having a period is a serious problem while being on these meds.