Posted by barbaracat on August 5, 2005, at 9:50:25
In reply to What to try next for stubborn Biplar?, posted by holymama on August 3, 2005, at 16:19:56
Dear Autumn,
Re-reading your original post, it seems like anxiety is a factor. I know personally that if anxiety gets out of control it will most definitely spin me into an agitated depression.You mention Serotonin as something to shy away from because of it causing possible rapid cycling, but I wonder if your current combo is a little too devoid of serotonin and adding to your depression. Wellbutrin is heavy on dopamine and norep. Dopamine has inverse effects on Se, so you may be getting a bit imbalanced in your neurochemicals.
I haven't heard many glowing reports of Buspar, but it might have just enough anti-anxiety effects by providing some Se. I'd certainly stay away from atypicals. I had the same reactions to them as you - groggy and then agitated depression. Ugh.
My personal favorite TCA is nortriptyline. It brought me out of a black despairing mixed states after my mother suddenly died 2 years ago. I have to stay on lithium, no ifs ands or buts, but nortrip was a godsend for the depression. I'd be on it today if it weren't for the sx's - dry mouth, constipation. I felt like I was drying up despite gallons of water. However, that was just my ultra-sensitivity coming up. Princess and the pea.
I really like Cymbalta. Heavy on the norep and about equal on se. It does not cause cycling for me and has kept me stable and feeling pretty good. But I strongly suggest starting off quite slowly by emptying a capsule into a container and taking pellets - 10 to start - and working up from there. A bit of a hassle, but 8mg or 80 pellets seems to be the magic dose for me.
We bipolars are so danged sensitive when it comes to ADs. I think we're typically overdosed by well-meaning pdocs who give us the standard dose for non bipolars. Microdosing of ADs has been effective for many of us.
Good luck. I know how frustrating this is. Oh, and get yourself some fish oil. It really helps. The liquid kind is best because you need at least 1 tablespoon. I like Carlson's Best which I get from iherb.com. And definitely B vitamins. You need B6 to make se. Consider getting your hormones checked too. If they're out of balance no amount of ADs are going to work for long. Best bet is seeing a naturopath that specializes in natural hormone therapy. Stay away from the synthetics. - Barbara
> I am on Lithium 900 mg
> Wellbutrin 400 mg
> plus a sleeping pill and an ativan for anxiety once in a while. I am DEPRESSED.
>
> I went off all my meds a couple of months ago to get off the bleeping antidepressants I was on that I think may have kept me rapid cycling for the past two years.
>
> So, I can't try antidepressants. THey make me manic and cycle.
>
> Antipsychotics -- I tried two (while on antidepressants, mind you) and they did weird things to me. One flipped me into mania, the other sent me into a agitated depression that sent me to the hospital.
>
> Lamictal gave me the rash.
>
> SO what next???
>
> I've been in this state of mild/moderate depression for 5 months. It's getting really old, and I have no idea what my new doctor is going to want to try with me.
>
> Do I have more options????????????????? ECD is definitely something I would try if there is nothing else.
>
> ~~Autumn~~
>
poster:barbaracat
thread:537167
URL: http://www.dr-bob.org/babble/20050803/msgs/537816.html