Shown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by maz81 on June 2, 2008, at 7:34:57
There is some controversy as to the use of antidepressants in bipolar depression. The recent STEP-BD study (Sachs et al), suggest they are of no use. In response to this Rif S. El-Mallakh, M.D. has suggested this may be due to the fact that AD's were used in addition to mood stabilizers and that the mood stabilizers could have blocked the anti-depressant effect.
This is particularly interesting to me as I have bipolar depression and have failed about 10 antidepressant trials, whilst all along I have been taking one mood stabilizer or another. In the past when I just had unipolar depression, I responded quite well to AD's.
Wondered if anyone has any thoughts or insights.
Posted by Phillipa on June 2, 2008, at 10:48:33
In reply to Do mood stabilisers block antidepressants?, posted by maz81 on June 2, 2008, at 7:34:57
My ignorance in showing again thought if bipolar needed a mood stabalizer to take an ad. Does unipolare depression turn into bipolar sometimes or misdiagnosis? Phillipa
Posted by maz81 on June 2, 2008, at 11:07:50
In reply to Re: Do mood stabilisers block antidepressants? » maz81, posted by Phillipa on June 2, 2008, at 10:48:33
I think most doctors do recommend taking a mood stabilizer with an antidepressant to lower the risk of becoming hypomanic. However, in my case I haven't been anywhere near hypomanic for 2 years and would be willing to take the risk. I would rather be hypomanic than depressed anyway as it is much easier to treat in most cases! I have tried about 8 AD's whilst on various mood stabilizers and would be curious to try an AD without.
Posted by Phillipa on June 2, 2008, at 12:23:08
In reply to Re: Do mood stabilisers block antidepressants?, posted by maz81 on June 2, 2008, at 11:07:50
Seriously as I don't know why is it easier to treat than depression alone and do you feel that anxiety leads to bipolar? Love Phillipa
Posted by blueboy on June 2, 2008, at 12:28:00
In reply to Re: Do mood stabilisers block antidepressants?, posted by maz81 on June 2, 2008, at 11:07:50
What mood stabilizer? I'm a beginner in the Bipolar arena, but I am given to understand that Lamictal is especially useful for Bipolar depression.
Also, Mirapex is a current hot topic in treatment for bipolar depression. I've taken it in smaller doses for Restless Leg Syndrome (which I *think* was brought on by SSRI or SSRI/SNRI usage, but it could be coincidence) and the Mirapex at 1 mg had zero side effects and stops the RLS cold.
Posted by Horned One on June 2, 2008, at 12:48:38
In reply to Do mood stabilisers block antidepressants?, posted by maz81 on June 2, 2008, at 7:34:57
Some mood stabilizers (lithium, lamotrigine) are used to augment antidepressants, so not all mood stabilizers block the efects of antidepressants. They may prevent hypomania to a certain extent though, and some bipolars may be used to having a somewhat hypomanic response to antidepressants. I sometimes want to come off my mood stabilizer so that I can feel hypomanic, or even manic again.
-Horny
Posted by maz81 on June 2, 2008, at 13:32:14
In reply to Re: Do mood stabilisers block antidepressants?, posted by Horned One on June 2, 2008, at 12:48:38
> Some mood stabilizers (lithium, lamotrigine) are used to augment antidepressants, so not all mood stabilizers block the efects of antidepressants. They may prevent hypomania to a certain extent though, and some bipolars may be used to having a somewhat hypomanic response to antidepressants. I sometimes want to come off my mood stabilizer so that I can feel hypomanic, or even manic again.
>
> -HornyHi Horny
I know that some mood stabilizers are used to augment AD's. What was being suggested is that in some cases they don't augment the AD's but actually block the AD effect. I have copied and pasted the extract below;
To the Editor: The trial by Sachs and colleagues
is the latest in a string of studies showing that
the addition of antidepressants to mood stabilizers
in depressed bipolar patients is of minimal
benefit.1,2 However, antidepressants given in the
absence of a mood stabilizer either alone (in
type II illness)3,4 or added to a second-generation
antipsychotic drug5 are effective in treating
bipolar depression. The major difference in the
design of these studies is the absence or presence
of mood stabilizers. When mood stabilizers (lithium
or valproate, carbamazepine, or lamotrigine)
are used, antidepressants are of minimal benefit.
This finding has traditionally been interpreted as
showing that mood stabilizers have an intrinsic
antidepressant effect, which cannot be augmented
by the antidepressant agent. An alternative
interpretation that would reconcile the discrepant
data is that mood stabilizers may actually
interfere with or block the effect of antidepressant
drugs. This distinction is important, since it
would alter the approach to treating depression
in patients with bipolar disorder. Studies that specifically
examine this question need to be performed.
Rif S. El-Mallakh, M.D.
University of Louisville School of Medicine
Louisville, KY 40202
rselma01@louisville.edu
Posted by Horned One on June 2, 2008, at 15:07:53
In reply to Re: Do mood stabilisers block antidepressants?, posted by maz81 on June 2, 2008, at 13:32:14
I've taken a few ADs with lamotrigine and I'd disagree with the author's suggestion that "mood stabilizers have an intrinsic antidepressant effect, which cannot be augmented
by the antidepressant agent." Parnate had a very distinct antidepressant action when combined with lamotrigine. I'm not convinced by these findings.-Horny
Posted by linkadge on June 3, 2008, at 10:05:59
In reply to Re: Do mood stabilisers block antidepressants?, posted by maz81 on June 2, 2008, at 13:32:14
Sometimes its hard to demonstrate that antidepressants even work at all. So the fact that one study suggests the addition of an AD to a mood stabilizer doesn't do anything doesn't necessarily conclude that the mood stabilizer is blocking the AD effect.
The ratio of successful studies for bipolar depression compared to unsuccessful ones is not good. There is very little data at all to suggest that lamotrigine is good for bipolar depression. Even if you go to the GSK clinical trial registry there is a sparsity of failed clinical trials of lamotrigine for BP depression and only one or two successful ones (even then it was not successful on primary measures).
Linkadge
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