Psycho-Babble Medication Thread 1109960

Shown: posts 1 to 25 of 31. This is the beginning of the thread.

 

5 drugs better than ADs for bipolar disorder

Posted by Hugh on May 4, 2020, at 15:19:42

Conclusion
Findings from STEP-BD studies indicate that antidepressants should be avoided in most cases in treating acute depression in patients with bipolar disorder. Rather, one should choose from among five medications with a reasonable evidence-base for effectiveness and safety in treating or at least preventing bipolar depressions, namely: lithium, quetiapine, lamotrigine, lurasidone, and cariprazine -- or combinations of these.

Dr Osser is Associate Professor of Psychiatry, Harvard Medical School, and Consulting Psychiatrist, US Department of Veterans Affairs, National Telemental Health Center, Bipolar Disorders Telehealth Program, Brockton, MA.

Complete article:

https://www.psychiatrictimes.com/depression/case-against-antidepressants-bipolar-depression-findings-step-bd

 

Re: 5 drugs better than ADs for bipolar disorder Hugh

Posted by SLS on May 5, 2020, at 8:54:55

In reply to 5 drugs better than ADs for bipolar disorder, posted by Hugh on May 4, 2020, at 15:19:42

Hi Hugh.

I hope all is well with you.

> Conclusion
> Findings from STEP-BD studies indicate that antidepressants should be avoided in most cases in treating acute depression in patients with bipolar disorder. Rather, one should choose from among five medications with a reasonable evidence-base for effectiveness and safety in treating or at least preventing bipolar depressions, namely: lithium, quetiapine, lamotrigine, lurasidone, and cariprazine -- or combinations of these.

I think lurasidone has garnered the most attention recently for bipolar depression. I wasn't too crazy about it. Cariprazine made me feel worse right from the beginning, and I stopped taking it immediately. I was not willing to take the chance that it might continue to make me feel worse. The half-life is extraordinarily long, and it might have meant weeks of hell. Lamotrigine helps me at a dosage of 300 mg/day. Not too long ago, I tried reducing it to 200 mg/day. I deteriorated quickly.

Aripirazole (Abilify) wasn't mentioned. I wonder why.


- Scott

 

Re: 5 drugs better than ADs for bipolar disorder SLS

Posted by Hugh on May 5, 2020, at 10:41:37

In reply to Re: 5 drugs better than ADs for bipolar disorder Hugh, posted by SLS on May 5, 2020, at 8:54:55

Hi, Scott. I'm doing pretty well, considering. I hope you are, too.

I know you've been helped by MAOIs. Have SSRIs ever helped you?

 

Re: 5 drugs better than ADs for bipolar disorder

Posted by Lamdage22 on May 5, 2020, at 12:52:50

In reply to 5 drugs better than ADs for bipolar disorder, posted by Hugh on May 4, 2020, at 15:19:42

Is really low dose Lamotrigine worth any shot? Like without cognitive side effects?

 

Re: 5 drugs better than ADs for bipolar disorder

Posted by undopaminergic on May 6, 2020, at 0:08:07

In reply to Re: 5 drugs better than ADs for bipolar disorder, posted by Lamdage22 on May 5, 2020, at 12:52:50

> Is really low dose Lamotrigine worth any shot? Like without cognitive side effects?
>

I'm on 200 mg and notice no cognitive or other effects. Unless it is keeping depression away.

-undopaminergic

 

Re: 5 drugs better than ADs for bipolar disorder Hugh

Posted by SLS on May 6, 2020, at 8:26:29

In reply to Re: 5 drugs better than ADs for bipolar disorder SLS, posted by Hugh on May 5, 2020, at 10:41:37

Hi.

> Hi, sScott. I'm doing pretty well, considering. I hope you are, too.
>
> I know you've been helped by MAOIs.

I am currently taking Nardil 60 mg/day. It is helping. I have not felt this well since 1990.

It took many weeks to recover from the exacerbation that Trintellix (vortioxetine) produced. It was excruciating.

> Have SSRIs ever helped you?

Not really. Maybe a little on Zoloft. I responded transiently to Effexor and Cymbalta.

Currently:

Nardil 60 mg/day
Nortriptyline 100 mg/day
Lamictal 300 mg/day
Lithium 300 mg/day


- Scott

 

Re: 5 drugs better than ADs for bipolar disorder Lamdage22

Posted by SLS on May 6, 2020, at 8:35:24

In reply to Re: 5 drugs better than ADs for bipolar disorder, posted by Lamdage22 on May 5, 2020, at 12:52:50

> Is really low dose Lamotrigine worth any shot? Like without cognitive side effects?

From what I have seen, it is unusual for someone to respond to less than 200 mg/day. It is logical to experiment and try taking 200-300 mg/day if you haven't already. See if you really do experience cognitive or memory impairments. I experienced memory problems during the first few weeks of treatment the first time I took Lamictal. You might want to keep this in mind.


- Scott

 

Re: 5 drugs better than ADs for bipolar disorder

Posted by Lamdage22 on May 6, 2020, at 10:01:19

In reply to Re: 5 drugs better than ADs for bipolar disorder Hugh, posted by SLS on May 6, 2020, at 8:26:29

That is so awesome! Welcome back. I have taken Lamotrigine 200 in the past and I felt pretty stupid.

> I am currently taking Nardil 60 mg/day. It is helping. I have not felt this well since 1990.
>
> It took many weeks to recover from the exacerbation that Trintellix (vortioxetine) produced. It was excruciating.
>
> > Have SSRIs ever helped you?
>
> Not really. Maybe a little on Zoloft. I responded transiently to Effexor and Cymbalta.
>
> Currently:
>
> Nardil 60 mg/day
> Nortriptyline 100 mg/day
> Lamictal 300 mg/day
> Lithium 300 mg/day
>
>
> - Scott
>
>

 

Re: 5 drugs better than ADs for bipolar disorder SLS

Posted by undopaminergic on May 6, 2020, at 10:46:14

In reply to Re: 5 drugs better than ADs for bipolar disorder Hugh, posted by SLS on May 6, 2020, at 8:26:29

>
> I am currently taking Nardil 60 mg/day. It is helping. I have not felt this well since 1990.
>

Wow, that's amazing!

I have "only" been depressed since the end of 1999 myself, but I'm currently at my best for years. The "mood" disorder is gone, but I have residual symptoms in the form of apathy and cognitive impairment.

-undopaminergic

 

Re: 5 drugs better than ADs for bipolar disorder undopaminergic

Posted by SLS on May 7, 2020, at 13:15:57

In reply to Re: 5 drugs better than ADs for bipolar disorder SLS, posted by undopaminergic on May 6, 2020, at 10:46:14

> > I am currently taking Nardil 60 mg/day. It is helping. I have not felt this well since 1990.

>
> Wow, that's amazing!
>
> I have "only" been depressed since the end of 1999 myself, but I'm currently at my best for years. The "mood" disorder is gone

That's great!

> but I have residual symptoms in the form of apathy and cognitive impairment.

That sucks!

What are you taking that you feel is responsible for your remission?

It's early for me with Nardil. I hope it lasts. No guarantees, unfortunately.


- Scott

 

Re: 5 drugs better than ADs for bipolar disorder SLS

Posted by undopaminergic on May 8, 2020, at 0:11:08

In reply to Re: 5 drugs better than ADs for bipolar disorder undopaminergic, posted by SLS on May 7, 2020, at 13:15:57

>
> > but I have residual symptoms in the form of apathy and cognitive impairment.
>
> That sucks!
>
> What are you taking that you feel is responsible for your remission?
>

As far as I can tell, it may be due to trimipramine, but it seems to involve psychodynamic factors as well. Eg. as far as anxiety is concerned, it's the latter.

-undopaminergic

 

Re: 'safer' not 'better'?

Posted by linkadge on May 8, 2020, at 6:45:28

In reply to Re: 5 drugs better than ADs for bipolar disorder SLS, posted by undopaminergic on May 8, 2020, at 0:11:08

I have some qualms with the notion that more mood stabilizer is the best option for bipolar depression. I feel that many psych patients are not treated as aggressively as they were in the past. The goal seems to be to 'stabilize' rather than restore.

Linkadge


 

Re: BPI and BPII very different

Posted by linkadge on May 8, 2020, at 6:49:53

In reply to Re: 5 drugs better than ADs for bipolar disorder SLS, posted by undopaminergic on May 8, 2020, at 0:11:08

Another thing to mention is that, according to a recent (fairly large) genetic study, patients with BPII had more genetic overlap with MDD rather than BPI.

If this is the case, then the BP diagnosis could really be a hinderance to a proper recovery.

If I have 'BP' it is BPII. For me, mood stabilizers alone DO NOT WORK. If I got the BP diagnosis, I'm afraid I would be relegated to a treatment course that avoids antidepressants and/or stimulants.

Personally, I don't know how somebody would function on say lithium + olanzapine. I don't know how they would experience any pleasure at all. But, of course, we are all different.


Linkadge


 

Re: BPI and BPII very different

Posted by undopaminergic on May 8, 2020, at 7:30:35

In reply to Re: BPI and BPII very different, posted by linkadge on May 8, 2020, at 6:49:53

I agree that there is to much emphasis on stabilisation, as opposed to relief.

Also, the risk of a switch to mania from antidepressant treatment is exaggerated. I have never reacted that way, and I have BP 1.

Sure, memantine induced a condition more or less indistinguishable from mania, but that was only the acute effect of a drug, and it subsided promptly and completely upon discontinuation.

-undopaminergic

 

Re: BPI and BPII very different

Posted by linkadge on May 9, 2020, at 8:12:32

In reply to Re: BPI and BPII very different, posted by undopaminergic on May 8, 2020, at 7:30:35

Right, and doctors seem so afraid of making a 'mistake' that they undertreat and perhaps avoid effective treatments.

Examples of this include: not prescribing opiates for legitimate pain, not prescribing benzos (thinking that SSRIs are as effective for everybody), avoiding MAOIs, and treating bipolar depression by layering on more mood stabilizers.

Linkadge

 

Re: BPI and BPII very different

Posted by undopaminergic on May 9, 2020, at 9:57:32

In reply to Re: BPI and BPII very different, posted by linkadge on May 9, 2020, at 8:12:32

> Right, and doctors seem so afraid of making a 'mistake' that they undertreat and perhaps avoid effective treatments.
>
> Examples of this include: not prescribing opiates for legitimate pain, not prescribing benzos (thinking that SSRIs are as effective for everybody), avoiding MAOIs, and treating bipolar depression by layering on more mood stabilizers.
>
> Linkadge

That is all true, unfortunately. And for treatment-resistant conditions, doctors need to be willing to try all kinds of drugs, with or without an official indication for the condition. And not just follow official "guidelines", because *if* such treatments work, then the condition was not particularly "treatment-resistant" in the first place.

-undopaminergic

 

Re: 5 drugs better than ADs for bipolar disorder SLS

Posted by Jadde on May 9, 2020, at 14:24:56

In reply to Re: 5 drugs better than ADs for bipolar disorder Hugh, posted by SLS on May 6, 2020, at 8:26:29

> Hi.
>
> > Hi, sScott. I'm doing pretty well, considering. I hope you are, too.
> >
> > I know you've been helped by MAOIs.
>
> I am currently taking Nardil 60 mg/day. It is helping. I have not felt this well since 1990.
>
> It took many weeks to recover from the exacerbation that Trintellix (vortioxetine) produced. It was excruciating.
>
> > Have SSRIs ever helped you?
>
> Not really. Maybe a little on Zoloft. I responded transiently to Effexor and Cymbalta.
>
> Currently:
>
> Nardil 60 mg/day
> Nortriptyline 100 mg/day
> Lamictal 300 mg/day
> Lithium 300 mg/day
>
>
> - Scott
>
>

Hi Scott, I, too, am at 60mg of Nardil. Got down to 15mg with the intention of trialing Marplan, but was so miserable I had to go back to a full dose of Nardil. Strangely I had that one week of feeling great as soon as I increased back to 60mg. I was hoping it would last but it didnt. Guess Im going to wait it out again and see what comes. Anyway, so happy for you that you are feeling better.

Jade

 

Re: 'safer' not 'better'?

Posted by beckett2 on May 11, 2020, at 2:04:23

In reply to Re: 'safer' not 'better'?, posted by linkadge on May 8, 2020, at 6:45:28

> I have some qualms with the notion that more mood stabilizer is the best option for bipolar depression. I feel that many psych patients are not treated as aggressively as they were in the past. The goal seems to be to 'stabilize' rather than restore.
>
> Linkadge
>
>
>

For a number of years, my psychiatrist encouraged me to consider an AD. (My BPll depression was entrenched and monolithic.)

I refused and hewed to the opinion that, given time, Lamictal would be enough. Well, that did not happen, and so I tried Lexapro, and together with the Lamictal, the lights went on for the first time in maybe 8+ years.

Further contraindicated by some experts, a little Adderall was added. I haven't, knock on wood while there is still some available, been hypo.

 

Re: 'safer' not 'better'?

Posted by linkadge on May 12, 2020, at 7:01:53

In reply to Re: 'safer' not 'better'?, posted by beckett2 on May 11, 2020, at 2:04:23

The problem is that the genetic load of say bipolar vs. unipolar is not categorical. It is along a continuum.

Therefore saying categorically, that antidepressants should be avoided in 'bipolar' is not useful. Future research would look to uncover which of dozens (or hundreds) of genes influence the response to one drug or another.

I.e. you would need a subgroup analysis of 'bipolars' to see which respond to antidepressants. There are some studies that show that (at least for some bipolars) antidepressants can acts as mood stabilizers. I recall one head to head study of venlafaxine vs. lithium in bipolar II showed that venlafaxine was more effective and didn't lead to instability.

Linkadge

 

Re: 'safer' not 'better'?

Posted by undopaminergic on May 12, 2020, at 9:07:59

In reply to Re: 'safer' not 'better'?, posted by linkadge on May 12, 2020, at 7:01:53

>
> I.e. you would need a subgroup analysis of 'bipolars' to see which respond to antidepressants. There are some studies that show that (at least for some bipolars) antidepressants can acts as mood stabilizers.
>

Yeah, sertraline was powerfully anti-manic for me. Even just a 50 mg dose turned out to be a bit too much.

Stimulants can also be stabilising. To an important degree, they seem to reduce my risk of screwing up. I remain in self-control.

-undopaminergic

 

Re: 'safer' not 'better'? undopaminergic

Posted by linkadge on May 12, 2020, at 11:38:55

In reply to Re: 'safer' not 'better'?, posted by undopaminergic on May 12, 2020, at 9:07:59

The SSRIs can enhance allopregnanolone (which increases GABA-a sensitivity) - perhaps providing mood stabilization.

When I take (low dose) Effexor, it 'stabilizes' me, but I end up quitting it because I just feel nothing at all.

Linkadge

 

Re: 'safer' not 'better'?

Posted by undopaminergic on May 12, 2020, at 11:59:18

In reply to Re: 'safer' not 'better'? undopaminergic, posted by linkadge on May 12, 2020, at 11:38:55

> The SSRIs can enhance allopregnanolone (which increases GABA-a sensitivity) - perhaps providing mood stabilization.
>

I think it was the increased agonism at 5-HT2C receptors.

I don't necessarily think it was a mood-"stabilising" effect, rather than just "anti-manic". But at least it's no worse than anti-psychotics.

> When I take (low dose) Effexor, it 'stabilizes' me, but I end up quitting it because I just feel nothing at all.
>

I have that problem (feeling nothing) but I connect this with depersonalisation, which was aggravated permanently by reboxetine.

-undopaminergic

 

Re: 'safer' not 'better'?

Posted by SLS on May 12, 2020, at 21:00:29

In reply to Re: 'safer' not 'better'?, posted by undopaminergic on May 12, 2020, at 11:59:18

> > The SSRIs can enhance allopregnanolone (which increases GABA-a sensitivity) - perhaps providing mood stabilization.

That's very interesting. I think zuranolone is an analogue of allopregnanolone. It also increases GABA-A receptor sensitivity (positive allosteric modulator). I look forward to seeing more investigations of zuranolone for depression and bipolar depression.


- Scott

 

Re: 'safer' not 'better'? SLS

Posted by linkadge on May 13, 2020, at 7:52:51

In reply to Re: 'safer' not 'better'?, posted by SLS on May 12, 2020, at 21:00:29

There seems to be evidence that gaba-a dysregulation is present in post-partum depression (and perhaps anxious, melancholic depression). However, only certain gaba subtypes are associated with mood regulation (as opposed to anticonvulsant, amnesic, muscle relaxant, and anxiolytic effects).

Reading up on CBD (also a positive allosteric modulator of GABA-a) it seems to increase the effects of the two gaba-a subtypes that are dysregulated in bipolar. I don't remember these off hand, but I believe one of them was the gamma subtype.

Some depression, however, is likely associated with a predominance of gaba (relative to glutamate). Gaba antagonists are generally considered 'stimulant' and 'pro-cognitive' (and there appears to be a gaba excess in certain disorders like Alzheimer's. Of course, too much gaba antagonism and you have a seizure.

Linkadge

 

Re: 'safer' not 'better'? linkadge

Posted by SLS on May 13, 2020, at 18:43:08

In reply to Re: 'safer' not 'better'? SLS, posted by linkadge on May 13, 2020, at 7:52:51

Wow, Linkadge! Great work. I like how much you are able to say in so few words. Very concise and efficient. Have you ever considered writing? I didn't know there were subtypes of the GABA-A receptor. Makes sense. How many are there?

Are you still feeling better?


- Scott

> There seems to be evidence that gaba-a dysregulation is present in post-partum depression (and perhaps anxious, melancholic depression). However, only certain gaba subtypes are associated with mood regulation (as opposed to anticonvulsant, amnesic, muscle relaxant, and anxiolytic effects).
>
> Reading up on CBD (also a positive allosteric modulator of GABA-a) it seems to increase the effects of the two gaba-a subtypes that are dysregulated in bipolar. I don't remember these off hand, but I believe one of them was the gamma subtype.
>
> Some depression, however, is likely associated with a predominance of gaba (relative to glutamate). Gaba antagonists are generally considered 'stimulant' and 'pro-cognitive' (and there appears to be a gaba excess in certain disorders like Alzheimer's. Of course, too much gaba antagonism and you have a seizure.
>
> Linkadge
>
>


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