Posted by med_empowered on August 5, 2005, at 2:14:23
In reply to Re: What to try next for stubborn Biplar? » holymama, posted by barbaracat on August 4, 2005, at 23:02:01
hey! For most people with a bipolar disorder (myself included) depression is actually the *major* problem. Bipolar depressive episodes tend to last longer, be more intense, are more likely to have psychotic features, and sometimes resist repeated AD trials. That said...I think maybe a mood-stabilizer switch would help. Lithium seems to reduce suicide rates, but its really a *much* better anti-manic agent than it is an anti-depressant. Trileptal works nicely for some people, without blood tests. One combo that worked OK for me was Trileptal+Abilify+celexa (and then sleeping pills and klonopin as needed). I don't like antipsychotics very much--they tend to flatten out my mood-- but some people swear by them; Geodon and Abilify, in particular, have pronounced antidepressant effects (Zyprexa does, too, but I think the weight gain/diabetes risk makes Zyprexa a bit too risky, when there are other options). Then, for your anti-depressant, its good to think in terms of *augmentation* rather than focusing on an individual drug. If you're lethargic, adding Provigil or a traditional stimulant such as Ritalin or Dexedrine can be helpful...in those with bipolar, you need to watch out for cycling, but it can be very effective. Another option would be to add something to the Wellbutrin...celexa/lexapro, cymbalta, etc....and then further augment the combo with Buspar. There's some evidence that adding Buspar to an antidepressant speeds up reaction time and reduces some ill-effects of anti-depressants (like SSRI-induced anxiety). When all else fails, you can still use tricyclics. They have a bad reputation for causing cycling in bipolar, but they can still be useful as long as you're monitored and your mood-stabilizer is at an optimal dose. Tofranil-PM helped me a good bit; for treatment resistant depression, Sinequan, Surmontil, and Asendin are popular. Asendin is kind of a 2-for-1 medication; its an anti-depressant with some anti-psychotic properties. When it works, it usually works within 4-14 days. The only problem is that you get antipsychotic-style side effects, including the risk of TD. Good luck!
poster:med_empowered
thread:537167
URL: http://www.dr-bob.org/babble/20050803/msgs/537739.html