Psycho-Babble Medication Thread 87320

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Are antidepressants right for someone with Bipolar

Posted by JackD on December 18, 2001, at 17:20:28

I am really starting to think I have some kind of mood disorder... Every antidepressant I try works, and often works well for a while and then starts slowly making me more depressed than I was to begin with! Judging from my fast and often robust antidepressant response, along with my history of having been made hypomanic by Wellbutrin, I fear I have bipolar tendencies. I am now trying to add in Lithium 600mg a day to my 60mg a day of Remeron. Are bipolars doomed to experience mood anomolies on AD's? Should I be on JUST a mood stabilizer? Should I be on a mood stabilizer, and THEN introduce an AD slowly? God, I'm starting to feel some of the frustrations you guys on this site are complaining about!

 

Re: Are antidepressants right for someone with Bipolar JackD

Posted by Mr. Scott on December 18, 2001, at 19:35:39

In reply to Are antidepressants right for someone with Bipolar, posted by JackD on December 18, 2001, at 17:20:28

This is probably the hottest topic in psychiatry right now. The appropriateness of AD's at any level for bipolars. Not so much for Bipolar type 2 as type 1. I haven't the answer however..

Scott

 

Re: Are antidepressants right for someone with Bipolar JackD

Posted by Mitch on December 18, 2001, at 23:36:40

In reply to Are antidepressants right for someone with Bipolar, posted by JackD on December 18, 2001, at 17:20:28

> I am really starting to think I have some kind of mood disorder... Every antidepressant I try works, and often works well for a while and then starts slowly making me more depressed than I was to begin with! Judging from my fast and often robust antidepressant response, along with my history of having been made hypomanic by Wellbutrin, I fear I have bipolar tendencies. I am now trying to add in Lithium 600mg a day to my 60mg a day of Remeron. Are bipolars doomed to experience mood anomolies on AD's? Should I be on JUST a mood stabilizer? Should I be on a mood stabilizer, and THEN introduce an AD slowly? God, I'm starting to feel some of the frustrations you guys on this site are complaining about!

Jack,

I don't think you can go completely without them *all* the time. All I can say is you need a mood stabilizer or two and be very careful about which antidepressant you take and keep the dosages as minimal as you can. If you are watchful about it I don't think you will do yourself any harm. The trouble is the dosages that are currently available are designed for people with unipolar depressions and those dosages are often far too high for people like us.

Mitch

 

Re: Are antidepressants right for someone with Bipolar

Posted by JohnX2 on December 19, 2001, at 19:21:51

In reply to Re: Are antidepressants right for someone with Bipolar JackD, posted by Mitch on December 18, 2001, at 23:36:40

Mitch,

In what sense are the recommended dosages
far too high for us bpii's if we are on mood
stabilizers. I take a moderate dose of topamax
and lamictal and klonopin and my thinking is that
these meds normalize electrical conductance more
to that of a depressed patient's and a depression
would thus require a similar dose. Am I off here?

What would happen if the AD dose is too strong?

-john


> > I am really starting to think I have some kind of mood disorder... Every antidepressant I try works, and often works well for a while and then starts slowly making me more depressed than I was to begin with! Judging from my fast and often robust antidepressant response, along with my history of having been made hypomanic by Wellbutrin, I fear I have bipolar tendencies. I am now trying to add in Lithium 600mg a day to my 60mg a day of Remeron. Are bipolars doomed to experience mood anomolies on AD's? Should I be on JUST a mood stabilizer? Should I be on a mood stabilizer, and THEN introduce an AD slowly? God, I'm starting to feel some of the frustrations you guys on this site are complaining about!
>
> Jack,
>
> I don't think you can go completely without them *all* the time. All I can say is you need a mood stabilizer or two and be very careful about which antidepressant you take and keep the dosages as minimal as you can. If you are watchful about it I don't think you will do yourself any harm. The trouble is the dosages that are currently available are designed for people with unipolar depressions and those dosages are often far too high for people like us.
>
> Mitch

 

Re: Are antidepressants right for someone with Bipolar JohnX2

Posted by Mitch on December 20, 2001, at 0:47:07

In reply to Re: Are antidepressants right for someone with Bipolar, posted by JohnX2 on December 19, 2001, at 19:21:51

> Mitch,
>
> In what sense are the recommended dosages
> far too high for us bpii's if we are on mood
> stabilizers. I take a moderate dose of topamax
> and lamictal and klonopin and my thinking is that
> these meds normalize electrical conductance more
> to that of a depressed patient's and a depression
> would thus require a similar dose. Am I off here?
>
> What would happen if the AD dose is too strong?
>
> -john
>
>
>
>

John,

I am thinking in terms of someone who is adequately controlled(the highs) with monotherapy on mood stabilizer(s) who then adds an antidepressant and experiences breakthrough hypomania or worse. I just don't buy (my opinion) the idea that if you have control over hyperthymic situations with mood stabilizers, that everything is okeedokee with respect to adding normal "therapeutic" doses of antidepressants for breakthrough depression and to invariably expect a unipolar's response to the addition of the AD, that's all. In other words, if you are bipolar and are controlled adequately with mood stabilizer monotherapy and have a breakthrough depression episode-don't be surprised if you respond with a hypomanic or increased cyclic reaction to the addition of the antidepressant (which a unipolar would most likely not not have). So, in conclusion, I believe you have to be extra careful with *dosages* despite the presence of mood stabilizers (at whatever dosages-level of control) in a biplolar patient.


Mitch

 

Re: Are antidepressants right for someone with Bipolar JackD

Posted by Cindylou on December 20, 2001, at 12:37:26

In reply to Are antidepressants right for someone with Bipolar, posted by JackD on December 18, 2001, at 17:20:28

Hi Jack,
Your question may already have been answered, but I'll throw my 2 cents in ...

After years of being on various ADs, and suffering horrible fatigue from them (even though they did help my mood), my pdoc and I have considered that I do have bipolar II disorder (I also suffer bouts of agitation ... so I'm either exhausted or agitated or both.)

So, I've started Lamictal, which does seem to help me "stay afloat" but isn't helping the depression much. It's more like a safety net that keeps me from falling into that horrible deep dark pit I can't climb out of.

My pdoc said from the start that I would need to add an AD to the Lamictal. I am on a low dose of Serzone which helps with the anxiety, and may add a low dose of Paxil to see if it will help with the depression aspect.

(I also take Klonapin to help me sleep, and have just started experimenting with a bit of Wellbutrin in the daytime to help with motivation and energy. I never wanted to be on such a big "cocktail", but I'm starting to realize that my mood disorder might be the type that needs all these different meds in low doses together ... kind of like vitamins, I heard someone say on this board.)

Hope this helps a bit.

Hang in there!
cindy

> I am really starting to think I have some kind of mood disorder... Every antidepressant I try works, and often works well for a while and then starts slowly making me more depressed than I was to begin with! Judging from my fast and often robust antidepressant response, along with my history of having been made hypomanic by Wellbutrin, I fear I have bipolar tendencies. I am now trying to add in Lithium 600mg a day to my 60mg a day of Remeron. Are bipolars doomed to experience mood anomolies on AD's? Should I be on JUST a mood stabilizer? Should I be on a mood stabilizer, and THEN introduce an AD slowly? God, I'm starting to feel some of the frustrations you guys on this site are complaining about!

 

Re: Are antidepressants right for someone with Bipolar JackD

Posted by Elizabeth on December 28, 2001, at 12:29:41

In reply to Are antidepressants right for someone with Bipolar, posted by JackD on December 18, 2001, at 17:20:28

A lot of people with BP need ADs, yes. A general rule is that you should get on a mood stabilizer because of the risk of a manic reaction from an AD alone. Sometimes it's assumed that people who get worse on ADs must be bipolar. I think this is a mistake, but it is true that ADs can cause problems (including severe mania or mixed mania, not just a pleasant hypomania) for bipolar folks.

FWIW, I had a similar problem on Nardil, but not on other ADs. Adding anticonvulsants and lithium didn't help me, but I think the lithium is a good idea for you. (600 mg of lithium was the amount that put me at a therapeutic serum level, FWIW. You might need more depending how much you weigh; also, I think the therapeutic range for bipolar disorder might be higher than that for AD augmentation.)

Anyway, I wouldn't worry about it too much -- just be sure to watch for any signs of mania or hypomania.

best,
-elizabeth

 

Follow up Elizabeth .....

Posted by spike4848 on December 29, 2001, at 8:44:31

In reply to Re: Are antidepressants right for someone with Bipolar JackD, posted by Elizabeth on December 28, 2001, at 12:29:41

> FWIW, I had a similar problem on Nardil, but not on other ADs.

Elizabeth,

Are you refering to hypomania while on nardil? When I am on nardil, I sleep less, much more social, actively date, become much more involved in work. And yes sometime I get irritable and upset. I spend a little more money and go to the theatre in times square. My father is bipolar so I am alway on the look out for soft bipolar signs. But my mother is unipolar with panic ... much like myself.

Two pdoc have said my behaviour is not consistant with mania, hypomania. I think it maybe easy to miss though, and maybe it is nice to see your patient a little hypomanic then depressed.

So I have been reconsidering a trial of parnate for a mood stablizer-probable depakote and an antidepressant like wellbutrin. I am just afraid I am taking things to far.

What was your experience on nardil like? Any advice on parnate vs. depakote/wellbutrin? Thanks

Spike
>


 

Re: Follow up spike4848

Posted by Elizabeth on December 30, 2001, at 17:00:05

In reply to Follow up Elizabeth ....., posted by spike4848 on December 29, 2001, at 8:44:31

> > FWIW, I had a similar problem on Nardil, but not on other ADs.
>
> Are you refering to hypomania while on nardil?

No; I meant that I did well on it at first, then after a few months things got worse than they had been. (The way that I got worse could have been characterized as dysphoric hypomania, but I tried various mood stabilizers and nothing helped.)

> When I am on nardil, I sleep less, much more social, actively date, become much more involved in work.

That's not hypomania, that's recovery!

I don't really have enough information to form an opinion as to whether you should try Parnate, Depakote, or Wellbutrin. Wellbutrin doesn't help with panic attacks, although Depakote might.

-elizabeth

 

Thanks Elizabeth

Posted by spike4848 on December 30, 2001, at 17:19:03

In reply to Re: Follow up spike4848, posted by Elizabeth on December 30, 2001, at 17:00:05

Thanks .....


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