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Midwestrunner147

Atypical Antipsychotic + SSRI / Symbyax

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Anyone with bipolar have success pairing an atypical antipsychotic, (probably with strong anti-manic properties) with an SSRI? Im wondering if that combo can actually work for bipolar or if it usually just makes folks manic, mixed or generally worse because of the SSRI. Does anyone have experience specifically with the combination pill called Symbyax? (Zyprexa+Prozac) 

Edited by Midwestrunner147

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3 hours ago, Midwestrunner147 said:

Anyone with bipolar have success pairing an atypical antipsychotic, (probably with strong anti-manic properties) with an SSRI? Im wondering if that combo can actually work for bipolar or if it usually just makes folks manic, mixed or generally worse because of the SSRI. Does anyone have experience specifically with the combination pill called Symbyax? (Zyprexa+Prozac) 

I’ve seen aap/SSRI work when the anti manic is added first and titrated to effective dose and then the SSRI is added very slowly once all manic/mixed symptoms are basically controlled...but many pdocs feel that SSRI effectivness for bipolar is somewhat iffy 

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I take Seroquel xr 800mg and prozac  40 mg and it works well for me. I have Bipolar 1

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I have rapid cycling bipolar 2. We stabilized me with valproate (Depakote) and brexpiprazole (Rexulti), but I still needed the antidepressant, hence the vortioxetine (Trintellix). The official guidelines don't support the use of antidepressants of any kind in bipolar patients but pdocs do anyway, and generally they prefer to treat it with bupropion (Wellbutrin) or mirtazapine (Remeron) because of a lower potential for manic switch with those two agents as well as a lot of evidence indicating that bipolar depression is noradrenergic and dopaminergic in nature and can be addressed with norepinephrine and dopamine reuptake inhibition (bupropion) or by antagonizing 5HT2C to cause a massive downstream release of norepinephrine and dopamine in the PFC to improve mood (mirtazapine).

In Italy recently, there was a study done on vortioxetine showing it not only improved depressive symptoms but also had the potential to further stabilize mania in bipolar patients already being treated for mania. This may be due to its serotonin antagonist properties.

https://www.ecnp.eu/presentationpdfs/71/P.2.f.031.pdf

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