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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by phidippus on April 11, 2012, at 20:18:55
I'm bipolar 2 with adhd and OCD. I'm on Lithium, Viibryd, Latuda and Vyvanse. How can I be depressed? What do I do about it?
Eric
Posted by SLS on April 11, 2012, at 20:45:11
In reply to depressed, don't know what to do., posted by phidippus on April 11, 2012, at 20:18:55
> I'm bipolar 2 with adhd and OCD. I'm on Lithium, Viibryd, Latuda and Vyvanse. How can I be depressed? What do I do about it?
Perhaps using lamotrigine and/or Abilify would help. Besides having antidepressant properties, there are indicators that both drugs can be effective adjuncts to SRIs in treating OCD.
- Scott
Posted by Phillipa on April 11, 2012, at 23:11:12
In reply to Re: depressed, don't know what to do. » phidippus, posted by SLS on April 11, 2012, at 20:45:11
P the anxiety of the OCD will depress you is the anxiety being controlled? Phillipa
Posted by tensor on April 12, 2012, at 9:20:14
In reply to depressed, don't know what to do., posted by phidippus on April 11, 2012, at 20:18:55
> I'm bipolar 2 with adhd and OCD. I'm on Lithium, Viibryd, Latuda and Vyvanse. How can I be depressed? What do I do about it?
>
> EricI don't know what doses you are on, but make sure you optimize dosages on the first three meds before adding another agent.
/t
Posted by bleauberry on April 13, 2012, at 6:57:33
In reply to depressed, don't know what to do., posted by phidippus on April 11, 2012, at 20:18:55
I'm sorry I'm not sure I can offer any possible suggestions of what exactly to do but I can offer a perspective. That is, if you are depressed like this on these meds, then that doesn't say anything positive about those meds, does it. It doesn't. Any of those meds can help depression and can worsen depression....flip a coin. You might need to think hard about which ones are really helping you a lot, if any, and start your battle plan to replace the others or drop them completely. The absolute worst mistake you could make at this time, my opinion, would be to add another drug on top of these failed ones. So many people do that and dig a deeper hole.
Bipolar symptoms are often nothing more than accumulated toxicity, inflammation flare-ups, occult infections, sensitivity to certain foods. I mean, these are all serious issues and take a longterm purposeful plan to cover those bases. All of them have bipolar as predominant outwardly visible symptoms. So if you do not become an expert on these areas in the same fashion you become an expert on your meds or bipolar, healing is going to be much harder. imo
For depression specifically, in your case, I would be looking at either savella or nortriptyline/zoloft combo. I don't really see anything meaningful in your cocktail to address serious depression.
Posted by phidippus on April 13, 2012, at 12:42:20
In reply to Re: depressed, don't know what to do., posted by bleauberry on April 13, 2012, at 6:57:33
Lithium I've been on for nearly a decade and has always worked for me. Latuda has been good to me for about a year now. The culprit may be Viibryd-although it treats my OCD very well, it doesn't seem to have any affect on my mood (most SSRIs don't).
If I add more antidepressants, I run the risk of cycling and having mixed mood episodes. I need to find something to treat depression that won't make me go bonkers.
Eric
Posted by phidippus on April 13, 2012, at 12:44:33
In reply to Re: depressed, don't know what to do. » phidippus, posted by tensor on April 12, 2012, at 9:20:14
All dosages have been optimized. I am cycling in and out of these depressed phases. Maybe a mood stabilizer will help.
Eric
Posted by phidippus on April 13, 2012, at 12:51:22
In reply to Re: depressed, don't know what to do., posted by Phillipa on April 11, 2012, at 23:11:12
The anxiety is well controlled, however I am doing a lot of worrying.
Eric
Posted by phidippus on April 13, 2012, at 12:57:41
In reply to Re: depressed, don't know what to do. » phidippus, posted by SLS on April 11, 2012, at 20:45:11
I would love to add Lamictal, unfortunately, it makes my OCD unbearable (studies show Lamictal can cause or excacerbate OCD in Bipolar II patients). I've had luck with Abilify in the past, but adding it would mean having 3 medications in my system agonising 5ht1a receptors-wouldn't that be bad?
Eric
Posted by SLS on April 13, 2012, at 14:42:50
In reply to Re: depressed, don't know what to do. » SLS, posted by phidippus on April 13, 2012, at 12:57:41
> I would love to add Lamictal, unfortunately, it makes my OCD unbearable (studies show Lamictal can cause or excacerbate OCD in Bipolar II patients).
Good to know. I don't think the studies I saw included bipolar subjects.
> I've had luck with Abilify in the past, but adding it would mean having 3 medications in my system agonising 5ht1a receptors-wouldn't that be bad?
I think lithium acts on postsynaptic receptors while vilazodone acts predominantly on autoreceptors, both presynaptic and somatodendritic.
Vilazodone seems to act preferentially on 5-HT1a receptors located in PFC and hippocampus. I don't know where Abilify acts with respect to 5-HT1a receptors. Being partial agonists instead of full agonists, I don't know if there would be much danger of over stimulation of receptors, even if the receptor reserve were saturated. That is just a guess, though. Taking your body temperature can act as an index of 5-HT1a agonism, as they are positively associated.
Because Abilify has such a long half life, you wouldn't want to take 20 mg loading doses, just in case there is a problem. If you do try Abilify, you might want to start at 2.5 mg.
I got some of my information from the following article. The serotonin system is complex, and I don't understand all of it. I would say that vilazodone acts to modulate rather than to stimulate serotonin activity because of its agonism is partial rather than full.
- Scott
Posted by SLS on April 13, 2012, at 14:50:08
In reply to Re: depressed, don't know what to do. » tensor, posted by phidippus on April 13, 2012, at 12:44:33
> All dosages have been optimized. I am cycling in and out of these depressed phases. Maybe a mood stabilizer will help.
>
> Eric
I think Trileptal (oxcarbazepine) was already mentioned. I would probably try that first.I have seen Keppra (levetiracetam) used a few times for rapid-cyclicity.
- Scott
Posted by phidippus on April 14, 2012, at 20:41:38
In reply to Re: depressed, don't know what to do. » phidippus, posted by SLS on April 13, 2012, at 14:50:08
I tried Keppra and it made me very depressed. Just started Trileptal-mainly on your advice- (Oxcarbamazapine)today...Hopefully get it up to 900-1200 and see if it helps. I'm trying to find this journal article about Trileptal's serotogenic properties, but I can't find it.
Eric
This is the end of the thread.
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