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Chichikova

BP and Antidepressants

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I'm having a difficult time with concentration, focus, brain fog and sleeping 16 hours a day. It's making functioning very difficult. 

I recently got a new pdoc. I'm currently taking Lithium and Lamictal as my main combo. He suggested that I try taking Wellbutrin to help give me a boost and increase my ability to concentrate and hopefully improve my mood. I'm cautious about it because I have had bad experiences with antidepressants in the past and I was told by one pdoc to never take antidepressants again.

Before I was diagnosed BP, Effexor pushed me into a mania with psychosis. Years later, after I had been diagnosed, I was put on Lamictal and Wellbutrin. I was still really symptomatic but somewhat stable. A few months in, I lost my insurance and had to see a GP rather than a pdoc. She took me off the Lamictal and the Wellbutrin by itself pushed me into a severely agitated mixed state. The pdoc in the hospital that time was the one who told me never to take antidepressants again.

Despite all of that, I'm seriously considering giving Wellbutrin a try again. I am desperate to have even the slightest amount of energy and ability to concentrate. I am trying to get through graduate school. I've returned after dropping out last year due to mis-medication and depression. I don't want to repeat that!

I want to ask you all what your experiences are with being BP and taking antidepressants, or even stimulants. I have read some threads where it is mentioned that BP people are able to take antidepressants successfully with mood stabilizers, but I'd like to hear more if anyone is willing to share. I've also read that BP and ADHD share some common traits and that stimulants can help with this, but again that makes me a little wary of possible mania. Any thoughts are much appreciated.

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Effexor was not a good choice for me,  either.  I think I was at my nuttiest on Effexor, all my hospital stays happened while on it..  Wellbutrin on it's own wasn't good either.  But I now take Wellbutrin and Lamictal plus a little taste of Abilify and I'm doing quite well.  But it's different for everyone.

I was having the sleeping all the time energy-less problem starting this last fall, and it was Abiify that recently did the trick to pull me out of it.  Wellbutrin gave me not much more than a nudge, Abilify was what got me out of the ahedonia and low energy.  Just as another thought.

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I'm BP 1 and antidepressants have ranged from maybe bad to total catastrophe. I've tried 5 (from bad to worst) Trazodone -for sleep but we used antidepressant doses along with remeron (weight gain no positive effect), Zoloft (useless one doc thought it was pushing toward mixed episode), Wellbutrin (anxious and hyper out of my mind) and celexa which started a manic episode that put me in the hospital 

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When I was younger and diagnosed with bipolar 1 about 16 years ago I was put on a variety of antidepressants until I settled on wellbutrin and I never had another depression after that. Then they took me off the wellbutrin after about 10 years of being on it. The doctor I had at the time didn’t believe in giving bipolar patients antidepressants. I went along fine for a few years until recently when I fell into depression again and was represcribed wellbutrin (I have a different doctor now). It’s been working well the past few days. I waited several weeks for it to kick in, though. I feel energetic and interested in life again.

The only antidepressant that kicked me into mania was effexor.  

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Titrate really slowly. Some antidepressants like prozac have made me manic or have given me no response whatsoever like wellbutrin but effexor and cymbalta worked without causing mania. There is just no way to know what will happen. Have you tried Abilify? It might be able to give you energy and help your depression without taking an antidepressant though it personally made me manic but I think that is rare. 

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Thanks so much everyone for replying. It's really helpful to hear your experiences. It sounds like it really varies from person to person and the best approach is to be cautious with it.

I think I am going to try adding the Wellbutrin to see if that will help. And I'll definitely take it slow so I can catch any possible mania before it gets too bad. When I was on Wellbutrin before it didn't get bad until the Lamictal was taken away, so I'm hoping with the Lithium and the Lamictal together my mood will be grounded enough. It would be amazing if it could even touch the depression. With the exception of mania and mixed episodes, depression is a constant for me, whether severe or low level. 

I was on Abilify and Lamictal immediately following my last mixed episode. The Abilify immediately evened me out with the agitation and anxiety, but it unfortunately didn't do anything to lift the depression that I went into immediately after. I didn't have a psychiatrist at the time due to my insurance and my depression got to the point where I couldn't read or think clearly at all and I had to leave school. 

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I've been on Wellbutrin since 1989, sometimes without a mood stabilizer. It has been good for me. Prozac (without a mood stabilizer) made me manic. Zoloft made me agitated, but not manic.

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I was misdiagnosed as MDD for several years and did the merry-go-round of SSRIs/SNRIs. I would get better and then inevitably get even worse than when I started them. Finally got a new pdoc who recognized the signs of BP2 and started me on lamotrigine. I was on 60mg of duloxetine at the time and cycling pretty rapidly. He dropped me down to 30mg as we started the slow titration up on lamotrigine.

But even as we went up on it, I never REALLY felt better. We added lurasidone at 40mg and swapped the 30mg of duloxetine for 10mg of fluoxetine for a week or two to titrate me off. The lurasidone helped some with my depression but never really had a lasting effect and my mood was still kind of all over the place and I was irritable a lot. It also was terrible for mania.

We cycled through various antipsychotics to try and find a better antidepressant effect but it wasn't until I went back on escitalopram that I finally started to feel better again. Ended up going to vortioxetine after trying fluoxetine and bupropion hydrobromide as well but vortioxetine has been the best of all the ADs I've taken thus far both before and after mood stabilizers.

Not everyone with bipolar disorder can take antidepressants. But if you're taking the right mood stabilizers, it's a possible option. valproate and brexpiprazole made it possible for me. I've also learned that I do need both an anticonvulsant and an antipsychotic to be completely stable. Antoconvulsant is primary for baseline and antipsychotic closes the gap. If I use an antipsychotic as primary, the doses I have to get to for stabilization cause too much akathisia.

It should be noted that bupropion was associated in studies with the lowest rate of manic switch compared to SSRIs or tricyclics. Also in my experience, vilazodone caused quite a bit of hypomania for me. If you decide to try bupropion, try the Aplenzin brand (the bromide form of bupropion as opposed to Wellbutrin which is the chloride form). It made me less jittery. Felt "smoother". In trials it also caused slightly fewer seizures than Wellbutrin and the seizures were fairly consistently less severe. So really the only major difference is the safety data.

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There's been studies (according to two seperate, competent pdocs) that some show that even with a mood stabilizer to keep from flipping the ADs aren't really super effective in BP. in my experience that's true however if I say that as a blanket statement I'm bound to get blowback from all you BP folks that like your ads. So I'm only quoting what I was told/have read so I kno many will disagree but this isn't a personal opinion just stating one perspective 

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1 hour ago, Iceberg said:

There's been studies (according to two seperate, competent pdocs) that some show that even with a mood stabilizer to keep from flipping the ADs aren't really super effective in BP. in my experience that's true however if I say that as a blanket statement I'm bound to get blowback from all you BP folks that like your ads. So I'm only quoting what I was told/have read so I kno many will disagree but this isn't a personal opinion just stating one perspective 

Oh I would certainly agree. If you've been misdiagnosed and cycling through ADs then you get the correct diagnosis, you really have to give going without ADs a chance before you decide to go back to them. The only mood stabilizer that really ever came close to helping with my depression though was olanzapine, and ultimately even when we found meds that stabilized me, I was subsisting. I could barely function. Trintellix and Vyvanse gave me a chance to still feel human.

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Um, I don't think very many if any of us rely on ads to make medical decisions. That's kind of why we are on Crazyboards. But if it makes you feel better about yourself....

And how is stating  "one perspective" not an opinion? You imply in that very sentence that there are different perspectives. Yet somehow only the one you choose becomes "not a personal opinion?"

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@crtclms I think what @Iceberg is suggesting is that his personal experience (and subsequently his own opinion) is in line with a commonly held understanding that antidepressants GENERALLY aren't first-line treatment in bipolar disorder, and they aren't for a reason. A good portion of "antidepressants" (whether they be SSRIs, SNRIs, tricyclics, etc.) across a wide array of chemical structures and pharmacological profiles have demonstrated a propensity to trigger a manic switch. In fact, I'm not sure if any antidepressant other than bupropion has actually been studied for its low rates of manic switches relative to other available agents.

Most important thing to get out of this is that if you know you have bipolar disorder, you should at least try to go without antidepressants. If it doesn't work for you, then that just reinforces the fact that "general understandings" about how things work really aren't everything even if a few statistics and studies indicate otherwise.

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@crtclms It's not my opinion because I was quoting a doctor. And ads? What did I say about ads? AD- meant antidepressants. I'm not an idiot I don't watch commercials and then suddenly decide I want that medicine. Not my perspective because it was my doctor who said it and I actually say that it's not meant as a blanket perspective. there are tons of BP people on here who takes ADs - I'm not going to just say that they are all wrong...what happened to ymmv? 

Edited by Iceberg

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On 2/11/2018 at 1:11 PM, Iceberg said:

@crtclms It's not my opinion because I was quoting a doctor. And ads? What did I say about ads? AD- meant antidepressants. I'm not an idiot I don't watch commercials and then suddenly decide I want that medicine. Not my perspective because it was my doctor who said it and I actually say that it's not meant as a blanket perspective. there are tons of BP people on here who takes ADs - I'm not going to just say that they are all wrong...what happened to ymmv? 

I wasn't talking to you.

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