Anyone have more success with treatment resistant depression taking a mood stabilizer rather than antidepressant?

[gb84]

I haven't had any success with antidepressants.  It seems like antipsychotics work to a point for depression.  I take Gabapentin but it really just acts as an anxiolytic for me.  

Has anyone had success with treatment resistant depression using a mood stabilizer?  If so, what do you take and/or recommend? 

Edited October 20, 2018 by gb84

[looking for answers]

lithium helped me immensely

[argh]

Gabapentin but you already are on it and it’s more anxiolytic for you.

did you ever try Wellbutrin? Doesn’t touch serotonin at all.

im doing better now on a combo of gabapentin and Wellbutrin than I’ve been in 23 years...granted most of those years were unmedicated, but the sprinkling of SSRIs in that period didn’t help any.

[Iceberg]

I'd second a conversation about lithium 

[gb84]

29 minutes ago, argh said:

Gabapentin but you already are on it and it’s more anxiolytic for you.

did you ever try Wellbutrin? Doesn’t touch serotonin at all.

im doing better now on a combo of gabapentin and Wellbutrin than I’ve been in 23 years...granted most of those years were unmedicated, but the sprinkling of SSRIs in that period didn’t help any.

I want to try wellbutrin since it's approved for Sad.  

[argh]

1 hour ago, gb84 said:

I want to try wellbutrin since it's approved for Sad.  

Would definitely recommend if you get SAD. I don’t have a SAD dx, but I’ve noticed that my mood tracks the seasons.

Aside from some insomnia, all side effects went away for me after a few months. That insomnia was only at 300xl. I don’t have insomnia on 150xl however. Kept me relatively ok, but didn’t have the punch to pull me out of an episode at 150xl. If you find it works but have insomnia at 300xl and 150xl isn’t cutting it, I’d recommend trying the Ir version at 200mg a day, so long as you can remember a dose early afternoon. Almost has the punch of 300xl but with out the early awakening insomnia.

[Arj72]

Lots of luck with lamictal and seroquel.  MDD for 9 years.  Recently changed to bipolar NOS, but as my doctor says, who cares about a diagnosis.  Take what works.

[gb84]

14 hours ago, sbdivemaster said:

Man, I loved Welly, but Welly didn't love me - the hives were a deal breaker.  I wish I could take it again.  Give it a try, really brightened my mood.

Lamotrigine is what pulled me out of the depths of extreme lithium induced depression.

YMMV

Always talk to your doctor or pharmacist to see if these medications may be right for you.  heh

I'm just trying to research options.  It's hard to get everything out at the pdoc when I only get 20 min.   Just wanted to know others experience. 

[jt07]

Antidepressants alone do little for me. The main meds that help me are carbamazepine (Tegretol), Abilify, and Ritalin.

[gb84]

I don't know what to do.  Clearly antidepressants aren't doing the trick for me either. 

I get a little boost from vraylar, but it's not enough.  Dexedrine basically just allows me to have the energy to do basic things. 

I've only seen the doc once and I forgot to mention SAD.  I will definitely be mentioning it next time.  Hopefully she will be open to treating it via another method. 

Thanks for mentioning Tegretol, I will research it. 

[mjs190]

I know I'm a little late to the game, but a Depakote-Lamictal combo is pretty life saving for me. I don't take an antidepressant. Tried Wellbutrin for a while but finally ad to admit defeat because it continued to push me into mania despite hefty doses of Depakote and even an antipsychotic.

[sming]

On 10/31/2018 at 1:10 AM, gb84 said:

I don't know what to do.  Clearly antidepressants aren't doing the trick for me either. 

I get a little boost from vraylar, but it's not enough.  Dexedrine basically just allows me to have the energy to do basic things. 

I've only seen the doc once and I forgot to mention SAD.  I will definitely be mentioning it next time.  Hopefully she will be open to treating it via another method. 

Thanks for mentioning Tegretol, I will research it. 

I'm TRD and ADs generally do very little for me. So then I tried APs, anti-convulsants and lithium and others. Which also did very little. Abilify can help in fits and starts but always poops out. So for me the answer is "no" but that's hardly surprising since nothing works except stimulants for short periods of feeling human. 

Pete

[browri]

On 10/19/2018 at 9:19 PM, gb84 said:

I haven't had any success with antidepressants.  It seems like antipsychotics work to a point for depression.  I take Gabapentin but it really just acts as an anxiolytic for me.  

Has anyone had success with treatment resistant depression using a mood stabilizer?  If so, what do you take and/or recommend? 

 

On 11/19/2018 at 8:55 PM, mjs190 said:

I know I'm a little late to the game, but a Depakote-Lamictal combo is pretty life saving for me. I don't take an antidepressant. Tried Wellbutrin for a while but finally ad to admit defeat because it continued to push me into mania despite hefty doses of Depakote and even an antipsychotic.

I would second @mjs190 on this. Depakote+Lamictal worked really well for me in the Spring/Summer. I still need an antidepressant in the Fall/Winter though. My depressive episodes are also very seasonal but Wellbutrin doesn't quite agree with me. Check out this article:

http://bipolarnews.org/?p=230

Lamotrigine + Valproate (Depakote) was better than either alone for bipolar depression.

 

I also have STELLAR results with Rexulti. It has been a lifesaver for my depression AND my anxiety.

 

[sming]

6 hours ago, browri said:

I also have STELLAR results with Rexulti. It has been a lifesaver for my depression AND my anxiety.

Just started Rexulti 3 days ago at 0.5mg. Am getting horrendous nausea, my OCD's worse and so's my mood. Did it take a little while to help for you? Most positive reports on Rexulti seem to say it starts helping within 1-2 days ?

[Iceberg]

55 minutes ago, sming said:

Just started Rexulti 3 days ago at 0.5mg. Am getting horrendous nausea, my OCD's worse and so's my mood. Did it take a little while to help for you? Most positive reports on Rexulti seem to say it starts helping within 1-2 days ?

I think that's exaggerated. I don't know many treatments that work that fast outside of maybe ketamine and sometimes ECT for depression. If your talking psychosis or schizophrenia that might be different...but depression symptoms take a while. Also your still on a pretty small dose. The recommended dose from the PI is 2mg for depression sometimes up to 3mg. I'm not saying you need to get to that for effect, just that it probably needs more time/fine tuning 

[sming]

58 minutes ago, Iceberg said:

I think that's exaggerated. I don't know many treatments that work that fast outside of maybe ketamine and sometimes ECT for depression. If your talking psychosis or schizophrenia that might be different...but depression symptoms take a while. Also your still on a pretty small dose. The recommended dose from the PI is 2mg for depression sometimes up to 3mg. I'm not saying you need to get to that for effect, just that it probably needs more time/fine tuning 

Right. I spoke to my PDoc and he said to drop to 0.25mg for 3-4 days to see if the nausea subsides. It wasn't like "oh, I feel a bit queasy" nausea, it was like "I'm gonna chuck any minute" for 2-3 hours. Let's hope that his plan works.

[browri]

Actually to be honest I found 0.5mg to be an intolerable starting dose. I did it for 2 weeks and at the 2-week follow-up we dropped it down to 0.25mg and I did that for like 4-6 weeks before we tried increasing it again. When you've been taking it for a while and it's built up in your system. A dose increase can have positive stabilizing effects within 1-2 days, but when it comes to COMPLETE effect, this medication can take 2-4 weeks after reaching a specific dose and staying there until you really know how you respond to it.

Rexulti has a half-life of 91 hours and it takes 5.5 half lives (roughly) for a drug to reach steady levels in your system after you've been on that same dose consistently for that period of time. It takes the same amount of time for it to completely clear your system once you discontinue it. So this means 500 hours or about ~20-21 days before you have steady blood levels and there's still a lot that goes on for a week or two after that in my experience.

It was definitely a good idea to decrease. The 0.5mg gives you a nice jolt to get you started and then you go down to the 0.25mg until you've adjusted. When I did increase from 0.25mg back to 0.5mg it felt TOTALLY different. It was much more "brightening" and stimulating in a way while also strangely calming. Just give it time. It'll either be worth it or it won't but a lot of people on here who have given Rexulti a solid shot of a few months have really liked it. And this comes from many people who tried Abilify and just couldn't hack it.

[sming]

20 hours ago, browri said:

Actually to be honest I found 0.5mg to be an intolerable starting dose. I did it for 2 weeks and at the 2-week follow-up we dropped it down to 0.25mg and I did that for like 4-6 weeks before we tried increasing it again. When you've been taking it for a while and it's built up in your system. A dose increase can have positive stabilizing effects within 1-2 days, but when it comes to COMPLETE effect, this medication can take 2-4 weeks after reaching a specific dose and staying there until you really know how you respond to it.

Rexulti has a half-life of 91 hours and it takes 5.5 half lives (roughly) for a drug to reach steady levels in your system after you've been on that same dose consistently for that period of time. It takes the same amount of time for it to completely clear your system once you discontinue it. So this means 500 hours or about ~20-21 days before you have steady blood levels and there's still a lot that goes on for a week or two after that in my experience.

It was definitely a good idea to decrease. The 0.5mg gives you a nice jolt to get you started and then you go down to the 0.25mg until you've adjusted. When I did increase from 0.25mg back to 0.5mg it felt TOTALLY different. It was much more "brightening" and stimulating in a way while also strangely calming. Just give it time. It'll either be worth it or it won't but a lot of people on here who have given Rexulti a solid shot of a few months have really liked it. And this comes from many people who tried Abilify and just couldn't hack it.

@browri thanks so much for this message. It gives me a bit of hope that it might work out OK. Good to know about the 2-4 week period as well. 

I'm pretty familiar with its daddy Abilify and hence the crazy-long half lives. IIRC its metabolites' HL's are 84 & 95h or something like that. 

Also good to hear that 0.25 -> 0.5 felt different. I'm determined to give Rexulti as long as I can tolerate. I tried to do that with Wellbutrin most recently but just couldn't hack the 10/10 whole-body, skin-crawling, physically weak, trembling anxiety. Even at 75mg ?

Thanks again.

[browri]

Yeah and another thing to keep in mind is that Rexulti is definitely a different beast. While it's structurally similar to Abilify, it's not a TOTAL me-to drug like Effexor and Pristiq or Celexa and Lexapro. It is different. I've found Rexulti to be the OPPOSITE of Abilify. Where Abilify was stimulating in the lower doses and supposedly calming in the higher doses (I never made it to a moderate dose), Rexulti is sedating on the low-end of the dose-scale and stimulating as you increase. So it's much more tolerable starting up for most people than Abilify. I think I only made it to like 7.5mg on Abilify over 10 days. Totally couldn't handle it. Way to activating. Rexulti has been a DREAM by comparison.