Hi,

I've been struggling with Bipolar depression immensely since the end of my second manic episode 2 and 1/2 years ago. I am 29 and diagnosed Bipolar 1/schizoaffective. My problem is not that I have bad thoughts, it is that my energy has been decimated since the manic episode. I need 12 hours of sleep and when I am extremely lethargic. Basic things like making food and cleaning your clothes are difficult for me and often go undone.

I have tried many classes of drugs: SSRI, SNRI, NDRI, MAOI, stimulants (modafinil, concerta), abilify, lithium, lamtrogine, supplements (rhodiola, curcumin, NAC), dopamine agonist (pramiprexole), clonazapem. Of all these drugs, the only one that has helped is pramiprexole, and even now I am trying it again and it doesn't seem to be kicking in. Rhodiola had an amazing effect on me for around 3 weeks, regular sleeping (8 hours) and energy to socialize, work and play sports, it however died out.

I am on the last few options regarding classes of drugs to try, including trying St Johns wort, maybe a retrial of wellbutrin (NDRI) and finally ECT. I am very anxious right now as the pramiprexole is not kicking in and my thoughts have turned to suicide and I am very anxious about the ever more likely scenario that no medication/treatment will help me. I am faced with a life where I cannot work, cannot have a relationship, cannot do meaningful activities and am in a constant that of lethargy, fatigue and darkness. After my first manic episode, I recovered after 2.5 years with an SSRI being added on and returned to normal functioning, but I fear that after my last very intense manic episode that my brain circuitry has been permanently damaged.

Has anyone been in my situation before and did any treatments I did not list help? There any many novel treatments that may have promise with bipolar, and I am lucky to have a doctor who will let me try them (such as pramiprexole, used mostly for restless legs and parkisons). I feel my hope fading, I love my family and friends but I am beginning to see that I may never improve, and the prospect of living like this for the rest of my life is too painful. Any advice would be greatly appreciated, god bless