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Depression as a byproduct of psychosis...how to treat?

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How do you treat depression that has resulted from long term and still ongoing psychosis? I’m taken care of in the AAP department as I continue to titrate up on the clozapine, and hopefully soon decrease two other AAP’s.

Would an AD be out of the question to ask for? I have SZA bipolar type. I do have a tendency to go manic when off of seroquel and rarely even on it, but I really am protected this time with the clozapine.

I fear my pdoc will refuse my request to try trintellix. She does nothing to treat my depression while over preventing and treating the mania. Why do I have to spend my life depressed? Sleeping all the damn time, feeling worthless, no motivation, not doing a damn thing but lay in bed listening, sometimes wanting to die before the sensor in my head gets me first, and there is more too.

i will be defeated if she denies this. What else am I supposed to do?

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12 hours ago, aura said:

My treatment team currently thinks my mood symptoms are secondary to the psychosis too. We've talked about decreasing my mood stabilizer completely, since clozapine is working so well.

Thanks aura. That is good to know. That gives me hope that when I get to a good dose of Clozapine for me maybe things will be better. Maybe some or more of those symptoms I listed are negative symptoms?

I wonder what my pdoc will say to my AD request. She might deny it. I just can't stand the no motivation and laying around listening to voices or the sensor most of the day. I don't know if an AD or the Clozapine would be more helpful for that. I'm not sure. 

Do you take all your Clozapine at bedtime? I currently do. I know some take it twice daily. 

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5 hours ago, CeremonyNewOrder said:

Have you tried lithium? It can have anti-depressant properties and it could give you extra cushion against mania. I'm having trouble finding an AD that will work for me too and soon running out of options :(  

I have not tried lithium. I will keep that idea in my back pocket. I’m so sorry you are having trouble finding an AD. That sucks so much. I hope you find one and soon at that. 

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12 hours ago, Iceberg said:

The only thing is adding a new ad in the midst of all those other changes could also probably have the potential to destabilize or make things worse

I don’t think doing nothing is not an option though. Which is what every pdoc I’ve had before has done, nothing. Why can’t my depression be treated? Mania is definitely taken more seriously. Even though depression is serious too.

But I understand that things get sticky as to what to treat. If psychosis is causing the depression, then they’ll want to treat the psychosis to hopefully treat the depression too all on one shot.  It’s hard to tease them apart, like are both going on or is one causing the other only? And like you said, 2 med changes at once could get tricky or worse even.

I’ll just have to see what she says I guess. I see her in about two hours.

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My pdoc has tried adding ads but honestly they've never helped..

Maybe we never found the right one..

I gave them all a good try but just got side effects..

Maybe I'm sensitive to ads..never went manic though..

Lithium has been mentioned to me in the past..


Try not to worry to much about your appointment..

I'm sure it will be ok..


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