Posted by JohnL on January 17, 2001, at 2:29:22
In reply to Mood Stabilizers to combat Depression, no mania, posted by Cath78 on January 16, 2001, at 18:08:15
> I've been diagnosed as having Aytypical Bi-Polar disorder. My doc thinks that I need a combination of an antidepressant and mood-stabilizer.
> I've never experienced a manic episode.
> I don't want to take a mood-stabilizer because I don't think my mood needs stabilizing, I mean isn't normal to experience various moods over the course of a day?
> As long as my mood doesn't dip too low too frequently, then I'm happy with my changing moods. I don't want to feel blah all the time which is my reason for not wanting to take lithium or depakote or tegretol or any of those other drugs.
> Am I wrong about what these drugs are supposed to do for me? Can they really boost the anti-depressant effect of the lithium without making me feel blah or flat all the time?Hi Cath,
Ya know, I tend to feel that if 'blahness' is the main complaint, then mood stabilizers are not appropriate. I mean, anything is possible, and I could be all wrong, but generally I focus on other meds first before trying mood stabilizers.If you do go the mood stabilizer route, I think Lithium or Lamictal might be your best shots. I've tried them all. I found Tegretol or Depakote to be a bit on the dulling lethargic side, while Lithium or Lamictal were a bit on the stimulating side. But none of them did anything for my blahness except maybe make it worse. Lamictal helped in terms of social interaction, but I really had no interest in anything. But I was at least functional.
Generally I don't like antidepressants or mood stabilizers for the 'blahness' type of depression. If one is feeling blah all the time, yet not really severely depressed and not crying all the time, then usually an uplifting med seems more appropriate to me. In the SSRI category, that would be Prozac. In the tricyclic category it would be Desipramine. Ritalin or Adderall can be very helpful. Wellbutrin sometimes is helpful, though my doc has only seen spotty results with it. More often than not though I've seen the best improvements with a combination of low dose antipsychotic plus low dose stimulant. I for example did OK with Zyprexa and Ritalin, after not doing well with anything else, but I found I did the best with Amisulpride+Adrafinil (antipsychotic+stimulant). This has completely blown away any antidepressant or mood stabilizer I've ever taken. Blown them in the weeds. I do like a little Prozac in the background.
If your doc ends up putting you on Celexa or Paxil or Effexor or something like that, it would not surprise me at all if you improved in some ways, yet were not helped all that much in ways that are important. These meds don't often do much for the 'blahs'. Sometimes, but usually not. In other words, nowhere near getting completely well. And if your doc is sold on the atypical bipolar thing, then point out to him that Zyprexa (antipsychotic) is now approved for bipolar. Risperdal is very similar, though not as sedating, so it might be even a better choice, though it hasn't been officially approved for bipolar. You might want to do all you can to steer your doc in the antipsychotic+stimulant line of thinking and avoid years of frustration with the other likely meds that might be prescribed. And all you would need is small doses, versus possibly large doses of other meds.
Of course I could be all wrong. There are people who have experienced miracles with Lithium, SSRIs, Depakote, etc. I'm just trying to line up your best odds for success right from the get-go. You can always fall back to other meds if the higher-probability ones don't work out. No sense in starting with the lower-probability ones, which SSRIs and mood stabilizers are, as I see I it.
John
poster:JohnL
thread:51818
URL: http://www.dr-bob.org/babble/20010111/msgs/51842.html