[dustintochampagne]

so, okay. i know i cannot be the only one in the world who has or has had this problem.... so i've decided it's time to reach out and get some opinions from others who have bipolar themselves.

at this point in my life, 10+ years after the disorder reared it's ugly face in my life, i have been on probably just about every medication there is. (therapy has been ongoing the whole time.) within the last year, i thought i had finally found the perfect medication cocktail: lamictal & lithium. wow. i felt like.... an entirely new person. a great person, but not TOO great - ya know? i was stable, i was doing things, managing stressful situations when they arose, functioning, etc. i had been on lamictal for about 7 years, and it worked pretty decent i guess - but it was when we added the lithium things really started changing. then, i got a nasty rash all over. and i had to go off my meds one by one, and several dermatologist appointments, a biopsy, & 3 months later, it turns out it was the lithium.

no, my doctor wants to try depakote (which i took for a few years when i was younger) alone for at least 2 months. i haven't been on it long, i suppose, but i do still feel that it should be managing my moods at least a little bit better by this point. i don't know. something. i've had a depression, hypomania, mania, and now depression again.

so i guess what i'm getting to is.... i feel lost. do i keep trying medicine combo after med combo for years to come, do i keep hoping more new meds are released? and i know this is controversial, but has anyone any experience with ECT? i mean, i feel like i'm at the end of a road. i've never brought the topic up with my pdoc, so i don't know even know if he'd go for it. but.... something has to give soon, i feel.

any comments would be greatly appreciated.

additional info: i have also tried meditation, hypnosis, a couple other natural routes. i'm getting kinda hopeless at this point.

[blueoctober]

imyourmonster; I'm sorry you couldn't stay on lithium. Lamictal for many people needs an add on med to help control the highs, so that may be why the combo between litium and lamictal worked well for you. Perhaps you could ask your p-doc to try you on lamictal and perhaps Abilify (atypical anti-psychotic).

For me meds are 60% of managing the bipolar and the other 40% is diet, exercise, therapy etc. I know trying new meds can be highly frustrating and it's the unfortunate process many of us with BP have to go through.

I would definitely bring it up to your p-doc. I had spent almost 3 years alternating between mild and major depression. I'm happy with my current combo, but I have only been on it since the end of May.

[thinker22]

Hi I.Y.M.,

They've tried almost all the meds on me as well over the past 2+ years. The combo that has finally worked for me came about only a month ago. Just before the last drug that was added and was my miracle drug, my pdoc had suggested ECT since I too was treatment resistant. I was scared at that point. I have heard it can erase short and long term memory...and it doesn't distinguish between good or bad memories. I would put that on my list after I had tried every possible med combo. And with so many out there, I think there are probably a few more you could try.

Cymbalta was the miracle drug when added to my Geodon, Cogentin, and diazepam. I finally shook off the 2 years of depression (with one manic episode for about 9 weeks this time last year). I am now neither manic nor depressed.

Are you on an anti-depressant? I've also been on Lamictal (which did nothing to help my mood swings) and lithium (which nearly destroyed my thyroid). So I'm no longer on a mood stabilizer, but I'm doing great. I think Geodon keeps the Cymbalta from sending me into mania.

All this to say, don't give up. I'm living proof that sometimes treatment resistant bipolar is just a prescription away from being cured. Trying to be patient is maddening though I realize. Ask for another combo, but if you're really convinced that nothing can help you, I would talk to your doc about ECT. Another option is an implant they put inside your brain that affects the mood center and can lift major depression. That would be very last on my list though and only if your insurance would cover it.

I'm sending you hope and encouragement. Don't give up.

[madisgram]

just a quick thought...have you considered changing your pdoc? like everything else they are not all equally skilled. sounds like a fresh look at your situation could yield some good results. worked for me after many discouraging months.

[blueoctober]

Originally Posted by madisgram

just a quick thought...have you considered changing your pdoc? like everything else they are not all equally skilled. sounds like a fresh look at your situation could yield some good results. worked for me after many discouraging months.

Great point madisgram. I have already started researching P-doc's in my area that specialize in mood disorders, so I'm prepared when my P-doc retires.

[BlackPup]

Lamactal is not very good as a mood stabiliser but really good as an anti depressants. Maybe try to add in something that is more of a mood stabiliser eg Epilim, rispiridal, seroquel... etc (some nasty side effects but hopefully one will work)

[PromisesToKeep]

Originally Posted by BlackPup

Lamactal is not very good as a mood stabiliser but really good as an anti depressants. Maybe try to add in something that is more of a mood stabiliser eg Epilim, rispiridal, seroquel... etc (some nasty side effects but hopefully one will work)

With all due respect, I think you have a typo there. Lamictal IS a mood stabilizer, a very good one, but not an anti-depressant. Resperidal and Seroquel are both atypical antipsychotics.
Best Wishes,
ptk

[PromisesToKeep]

i had been on lamictal for about 7 years, and it worked pretty decent i guess - but it was when we added the lithium things really started changing. then, i got a nasty rash all over. and i had to go off my meds one by one, and several dermatologist appointments, a biopsy, & 3 months later, it turns out it was the lithium.

no, my doctor wants to try depakote (which i took for a few years when i was younger) alone for at least 2 months. i haven't been on it long, i suppose, but i do still feel that it should be managing my moods at least a little bit better by this point. i don't know. something. i've had a depression, hypomania, mania, and now depression again.

so i guess what i'm getting to is.... i feel lost. do i keep trying medicine combo after med combo for years to come, do i keep hoping more new meds are released? and i know this is controversial, but has anyone any experience with ECT? i mean, i feel like i'm at the end of a road.
additional info: i have also tried meditation, hypnosis, a couple other natural routes. i'm getting kinda hopeless at this point.[/quote]

You have a lot going on here so I am going to try to address your situations in the order you have listed them.
1) lithium was the first effective treatment for bipolar disorder and is a mood stabilizer. Lamictal on the other hand is the first FDA approved drug with the on label use for treatment of bipolar disorder as a mood stabilizer. Since the rash was identified as being related to the lithium, will you pdoc restart the lamictal? You have to be 1000% certain though that the rash was not related to the lamictal. If it was and you take lamictal again, it could be lethal.
2) There are several mood stabilizers on the market. Be patient. It might take a combination of them to get you back to the point where you feel stable. Tegretol and Lamictal work well as a combination for me but it took seven years to find this out.
3) I notice that you are not on any anti-depressants, some of these can have a stabilizing effect as well. You might want to ask your pdoc about those.
4) As you are describing it, you are rapid cycling. I hate to break the news to you but ECT while very effective in long-term drug resistant severe depression, it will not do anything for your mood swings. Bottom line is that you have to figure out with your pdoc some method of stabilizing your moods.
5) I find for myself if I utilize the principles of getting out of a rip tide, I can also better manage the mood swings that I do have. I do not hear you complaining of suicidal ideation or psychosis and thats a good thing so all we are really talking about is moderate depression to hypomania. Your life is not in danger but I hear you are suffering.
To escape a rip tide, one that drags you out to sea, if you try to swim directly to shore, you will exhaust yourself and eventually drown. The technique to escape is to swim parallel to the shoreline until you are no longer in the rip tide and then swim back to shore. How does this relate to hypomania and depression?
Rather than exhausting and frustrating myself trying to get back to "normal", I have a list of positive activities that I can utilize when I am in either state. There is a reason that we were once referred to as insane geniuses. I bet you have a creative streak in you a mile wide whether or not you have discovered it yet or not. Swim with the hypomania and use the extra umph to make your star shine bright. Conversely, I have a list of activities when I am depressed that uplift me. Going out for coffee with my daughter, watching a favorite movie, taking a bubble bath... the point is, just swim with it until you can find a solution, because it is only temporary. The mood will pass. Do whatever you need to get through it.
5) Keep up with the pdoc, the therapy and post here like crazy. You are only as alone as you want to be. Finally, don't give up. There will come a day, I promise you, where if your disease might not be a blessing, at least you can appreciate some of the gifts that come along with this malady. Hang in there, its worth it.
I will be praying for you.
ptk

[BlackPup]

With all due respect, I think you have a typo there. Lamictal IS a mood stabilizer, a very good one, but not an anti-depressant. Resperidal and Seroquel are both atypical antipsychotics.
Best Wishes,
ptk

PTK: Lamotrigine: is an atypical anticonvulsant not a mood stabiliser.
Maybe I wasn't clear before I'm not talking about their classes, but what kind of effect you get.
All of the drugs that are used as mood stabilisers (in a general sense) have different strengths at stabilising highs and lows. Some drugs are really good at getting rid of the depressive moods eg, (TCA > SNRI > SSRI > Lamotigine > Lithium) then others are better at getting rid of manias eg, (Risipirdal > seroquel > epilim > lithium).
It is marketed as a "mood stabiliser" rather than anti depressant in the US and hence most of the world due to medico-legal reasons, It is the drug with an antidepressant effect that is LEAST likely to induce a mania.
Hope this is clearer.

[dustintochampagne]

Originally Posted by PromisesToKeep

i had been on lamictal for about 7 years, and it worked pretty decent i guess - but it was when we added the lithium things really started changing. then, i got a nasty rash all over. and i had to go off my meds one by one, and several dermatologist appointments, a biopsy, & 3 months later, it turns out it was the lithium.

no, my doctor wants to try depakote (which i took for a few years when i was younger) alone for at least 2 months. i haven't been on it long, i suppose, but i do still feel that it should be managing my moods at least a little bit better by this point. i don't know. something. i've had a depression, hypomania, mania, and now depression again.

so i guess what i'm getting to is.... i feel lost. do i keep trying medicine combo after med combo for years to come, do i keep hoping more new meds are released? and i know this is controversial, but has anyone any experience with ECT? i mean, i feel like i'm at the end of a road.
additional info: i have also tried meditation, hypnosis, a couple other natural routes. i'm getting kinda hopeless at this point.

You have a lot going on here so I am going to try to address your situations in the order you have listed them.
1) lithium was the first effective treatment for bipolar disorder and is a mood stabilizer. Lamictal on the other hand is the first FDA approved drug with the on label use for treatment of bipolar disorder as a mood stabilizer. Since the rash was identified as being related to the lithium, will you pdoc restart the lamictal? You have to be 1000% certain though that the rash was not related to the lamictal. If it was and you take lamictal again, it could be lethal.
2) There are several mood stabilizers on the market. Be patient. It might take a combination of them to get you back to the point where you feel stable. Tegretol and Lamictal work well as a combination for me but it took seven years to find this out.
3) I notice that you are not on any anti-depressants, some of these can have a stabilizing effect as well. You might want to ask your pdoc about those.
4) As you are describing it, you are rapid cycling. I hate to break the news to you but ECT while very effective in long-term drug resistant severe depression, it will not do anything for your mood swings. Bottom line is that you have to figure out with your pdoc some method of stabilizing your moods.
5) I find for myself if I utilize the principles of getting out of a rip tide, I can also better manage the mood swings that I do have. I do not hear you complaining of suicidal ideation or psychosis and thats a good thing so all we are really talking about is moderate depression to hypomania. Your life is not in danger but I hear you are suffering.
To escape a rip tide, one that drags you out to sea, if you try to swim directly to shore, you will exhaust yourself and eventually drown. The technique to escape is to swim parallel to the shoreline until you are no longer in the rip tide and then swim back to shore. How does this relate to hypomania and depression?
Rather than exhausting and frustrating myself trying to get back to "normal", I have a list of positive activities that I can utilize when I am in either state. There is a reason that we were once referred to as insane geniuses. I bet you have a creative streak in you a mile wide whether or not you have discovered it yet or not. Swim with the hypomania and use the extra umph to make your star shine bright. Conversely, I have a list of activities when I am depressed that uplift me. Going out for coffee with my daughter, watching a favorite movie, taking a bubble bath... the point is, just swim with it until you can find a solution, because it is only temporary. The mood will pass. Do whatever you need to get through it.
5) Keep up with the pdoc, the therapy and post here like crazy. You are only as alone as you want to be. Finally, don't give up. There will come a day, I promise you, where if your disease might not be a blessing, at least you can appreciate some of the gifts that come along with this malady. Hang in there, its worth it.
I will be praying for you.
ptk[/quote]

1. The process of trying to find out what med was causing the rash took roughly 3 months. in the end, the dermatologist seemed certain it was the lithium causing it, and i agreed. while we stopped the lamictal first, the rash continued. we stopped the lithium last, as i said a good 2-3 months later, and the rash was almost completely gone in about 3-4 days. i feel as though perhaps my pdoc was slightly hesitant to restart the lamictal, though. i suppose this could be my interpretation, i did not outright ask, so i admit this is a guess.

2. i feel like although the lamictal kept me afloat for the 7 years i was on it, that i would definitely be willing to add it again in combination with another mood stabilizing drug. i do feel like it helped with the depression side of things. since i posted this, i have spoke with my pdoc on the phone and we have doubled the depakote. i am cycling less, but nonetheless still cycling. only a few very intense, brief episodes that left me exhausted. not ideal, but i guess that's what i have right now. i am hoping, i guess at this point, that i just need to keep waiting. i see my pdoc in his office this week.

3. i cannot take anti-depressants. i have tried several in the past over the years, always resulting in moderate-severe (for me, at least) mania.

4. thank you for the feedback about ECT. i have mostly been curious about learning more about it, and so i appreciate your comments.

in addition, thank you for the rest of your sharing. you have good points about doing things and getting through certain times. i am in fact, what i would consider i guess a pretty creative person, that is actually what i graduated with a degree in and i use to paint on almost a daily basis. for the past 6 months i have really been struggling with these things though, so recently i have decided i am interested in maybe starting to focus my creativity in other outlets.... music, for instance.

again, thank you for your kind words.

[Grkgjohn]

what is ect?

[thinker22]

Electro-convulsive shock therapy.

[TOTT]

I've been going through some of that. There's a chance ECT is my next step. I'm so fed up with everything, at this point it's like "just shock my brain already" and hope for the best.

[kindachaotic]

(((((tott))))) so sorry you've had such a struggle. Don't know anything about ECT but it's come a long ways, now they put you to sleep to do it.

Don't give up, (easier said than done) new drugs are always coming out, sounds like you may consider ECT & you still sound young. There's hope yet!

Anyway just wanted you to know someone read your post & cares.

[TOTT]

Thank you