I want to experiment; pdoc is not interested.

Despite being on wellbutrin and abilify, I still get deep, dark, sui depressions. I know that I won't be able to get through med school and residency as I am, and it's my dream to become a psychiatrist. I need to do something to get this depression under control. I feel like I won't make it to see 25 if this continues; there is only so much of this that I can take.

Since this is such a desperate situation, I am willing to try anything. I don't care if a medication causes me to gain 50 pounds; if it lets me be a doctor and keeps me alive, it's worth it.

I know that many of you struggled for years before you found the right meds. But you found them eventually, and that is really encouraging to me. I want to experiment with different meds until I find something that truly works. My pdoc, however, believes that I'm already on the best possible combination.

I know that there are other options to try. Wellbutrin is the only antidepressant that I have tried. Abilify is the third mood stabilizer, but I know that there are others. I read somewhere that there are over 200 possible med combinations for bipolar; I've only tried 4!

How can I convince my pdoc to be a little more adventurous? He is afraid of "overmedicating" me, but my life is at stake here. At this point, I want to be a lab rat.

For those of you who have experimented, did your doctors just keep going until you were stable enough to reach your goals and live a decent life, or did you have to push them to keep trying?

Thanks

Secretum:I had to push them. I had to convince them that " good enough" wasn't good enough for me or my life's goals.

And, when I didn't succeed with that, I had to find a new psychiatrist.

My DH is experience this with his pdoc. He's doing everything he can think of to physically help improve his body and hopefully help his mind. After getting physically healthy if his mood doesn't change he's approaching his pdoc again. However he doesn't think he'll ever improve.

My old pdoc would change meds after I would stop taking them but didn't care why I stopped taking it. My new pdoc I'm more of a partner. He dx me and took of all the medication that could possibly conflict between them and let me decide what I would take. He waited until one medication was stable before adding another. So he could know which one I was reacting bad to. I've been there almost a year and had only changed my anti-depressants twice before taking AD's "off the table" for me.

until you were stable enough to reach your goals and live a decent life? I have learned "stable" for me is taking very small steps, and changing goals a little. It'll take me at least another 8 years and clinical's to get to where I want to be. Stress will land me in the hospital and on a lot more meds. So I take it slow.

My pdoc keeps adjusting things until I've got the best possible control of my depression. We are still trying new antidepressants. Its a long process but hopefully this one will work out well enough.
I think you should keep on trying for better control if you are feeling like that. Are you still getting manic or hypomanic as well as the depressions or just the depressions? For me abilify controls my manias really well so we just have to keep on trying different antidepressants until we find the right one. It really sucks to change meds cos you have to taper down and then back up again and they don't work straight away so its a bit risky.

So far, my pdocs have lived to switch my meds around, have had no problem overmedicating me. I on the other hand I didn't want this. I didnt mind experimenting to find ones that work, but I think I would be more tempted to replace one with another than to just keep adding to them. If you are overmedicated you might not be able to meet your goals either.

Would he be willing to let you try a different antidepressant perhaps? Or even something other than abilify? I have tried abilify but honestly it didn't do much in terms of stabilization for me at all. My best results have come from lithium, but lithium hasn't been enough to keep mania away, but again antipsychotics haven't, neither have anticonvulsants. I have tried so many AD's only to become manic, mixed or rapid cycle every single time. If I were you I would keep requesting trying something new. It's you who's living with it, and just "meh" isn't that good.

Maybe you need to change your goals? It is possible that your dream of being a psychiatrist simply isn't realistic. I've given up a lot myself. That's bipolar!

Personally experimenting is horrible. Fluoxitine and sertaline induced mania, severe migraines from venlafaxine, vacant drooling on risperdal, ballooned on olanzapine, tremors an diffculty thinking with lithium. Initial side effects of adjusting to good meds are bad.

If you are stable, can focus and hold attention at school maybe expecting beyond limitations. Taking fewer classes, more down time, might take an extra year but save you from an episode setting you back further. Meds can become ineffective or adversive over time when they do you will recall medication trial and error is something best to avoid.

I've done medschool in the UK on meds at times and also off meds. Trust me, being overmedicated is just as bad as being under medicated can be. You need to have a big long look at whether now is a good time to rock the boat. If you can get through all your classes as you are, then maybe good enough is actually good enough? I could go to the wards suicidal, but not when I was a zombie on risperidone for example.

I wish you all the best with medschool, and I hope that it works out for you. But it doesn't for everyone (it didn't for me; I wanted to be a psychiatrist too) and sometimes we have to accept that it's not meant to be. I used to think that being a doctor was the be all and end all. At one point I said that I'd rather be dead than leave medschool!! But that's ultimately what I did do in the end. I voluntarily walked away from the punishing schedules and the consultants who treat you like crap, and I don't regret it for one second now. I'm now retraining in psychology to do something just as rewarding, but easier on my health. After all, we need to be well before we can really help others.

All the best,

*Willow*

Ditto to last post.

You mention gaining 50 pounds... but that is probably the "best" side effect. Meds can turn your cognition into mush, being overmedicated will not make you briliant at school.

Maybe there are life style changes you can do for yourself that could help.... at least they are not as risky as deliberatelly overmedicating yourself. Overmedicating "works" in the way that your life still sucks, but you don't care no more. And some side effects are irreversible. Risking this all for miracle (they don't happen) is bit foolish, no offense.

You seem to equal your school with life. Look, i know it sometimes feel important. I screwed up big time with my school recently (too many factors to count) and I am trying hard to remind myself of this.

Being psychiatrist is not the only way to live. YOu can find other ways to matter and help if you don't make it here. There are other goals you can aim for.

I am not saying to give up because you are bipolar. I would never say that.... but I think that one should give thing few tries... and then move on, if it doesn't work out. We all have talents for different things and sometimes we aim for wrong thing. So what? You wouldn't be the only person who tried few things. I am sure you have other passions than psychiatry... maybe you could explore them instead of equaling your "life" to your career in this particular field.

It could be your "all or nothing" attitude contribiting to your depressions.

First of all, everyone, I DO NOT want to be overmedicated. I NEVER said that. I simply want to find the med(s) that actually treat my illness. If that happens to be just one med, great. If it happens to be a 5 med combo, great. I just want to feel better. If the meds don't make me feel better, then I don't know why I'm even taking them. In fact, if my pdoc and I don't stumble upon something that actually works before the end of this summer, I will go off of meds entirely. That's how poorly what I'm currently on is working.

And Venus, I don't equate my education with my life. I'm saying that bipolar is threatening both my career and my life. *TRIGGER WARNING* If you've ever felt sui, you know that it is not over just one thing. When I'm sui, it's because I'm a failure of a human being, because I am invisible to most people, because I have lost the ability to appreciate life (anhedonia), because I will always have to put up with these damn mood swings, because everything is such an effort.... There never is just one reason why I'd end my life. And the mood swings, particularly the recurrent depressions, add to one another and erode my psyche like acid. Eventually, I'm just going to crumble, unless someone or something neutralizes the acid.

Roadie, I'm afraid I may end up having to do what you did. I would hate to though, because I love my pdoc otherwise. The man is a genius. After our first session, I felt understood by another human being for the first time in my life.

Willow, thanks for sharing your story. I'm sorry that you had to give up your dream of becoming a doctor, but you have a great attitude. I'm sure that you'll make a fantastic psychologist.

I really don't want to give up on my dreams. My pdoc assures me that he treats several bipolar physicians, so I know that it can be done. I just don't know if I can do it, and that scares me.

Thanks again, everyone. Sorry if any of this sounds a little harsh; I'm just angry. Not at you guys. At nothing.

Have you tried bringing research articles in to your psychiatrist? I'm meeting with my psychiatrist next week, and that's what I'm planning to do. I want to try topamax, but he shot me down. So I'm going to print off some studies and bring them into him to try and convince him.

Good luck!

Does "right now" count as ever?

I can actually horribly relate, but I guess dealing with so long... I do know it passes eventually and you seemed in the OP really focused on your dream. I think this might be part of bipolar, obsessivness about goals and things and not spreading your efford efficiently.

It definitely can be done. I'm bipolar I and doing well in med school, and there are plenty of bipolar med students/physicians around (so I hear). It can be done!!!

Are you in med school yet? Where are you located? If you have any questions at all about med school or the application process, feel free to PM me any time. Having gone through the process myself, I know how stressful it is!!

Wellbutrin affects dopamine and norepinephrine. Abilify works on dopamine and serotonin. I am of the mind we are all not text book cases. So even though your pdoc believes you on the best med combo, clearly it's not working or you would be feeling much better. Perhaps you might need a more serotonin selective med to combat your depression (Lexapro comes to mind). I hope your pdoc will let you give it a try.

The fact that he's not listening when you say your meds aren't doing their job unsettles me. A Dr is a service provider, and should provide the said service. I wouldn't let a waitress force me to eat something I don't want, even if it was her professional opinion that it's the best item on the menu... Go to your pdoc armed with facts, coz alot of them think they know better, but they forget they don't live in our shoes or heads. If he still won't budge, find a new 1. Remember you are your best advocate.

A few questions:

1. What meds have you tried?
2. Why are you not on a stimulant for your adhd?
3. Why are you on such a high dose of abilify? Is that your mood stabilizer?
4. Have you tried lamictal?

I would talk to your doctor about swapping the wellbutrin for lamictal (or adding the lamictal to the wellbutrin), possibly getting rid of abilify, and adding a stimulant for your adhd.

I have bipolar and adhd as well, and I'm on dexedrine (for adhd), cymbalta (for depression), valproate (for mood stabilization), and abilify (for hair pulling and depression). Works great for me.

Honestly, I think you really need to try lamictal (for your BP II) and a stimulant (for your adhd).

Medstudent, I am currently a sophomore in college, so I'm not in med school yet. Thanks for offering advice re med school and application; I might take you up on it! Lamictal was the first mood stabilizer I tried; unfortunately I had a reaction to it and had to discontinue. Then I tried tegretol, which didn't help. Wellbutrin was added to the tegretol, and eventually abilify was added to replace the tegretol. I'm not on a stimulant because I have a history of absence seizures. Abilify is supposed to help with the mood swings and mild psychosis.

Venus, I agree that obsessiveness about goals can be a part of bipolar. Once you've been hypo/manic, it's hard to settle for just mediocre goals.

I see. Well, you could try lithium. Lithium augments anti-depressants, so it should help with your depression. It also reduces suicidality. It does have some serious side effects/risks (weight gain, risk of hypothyroidism and kidney failure), but if you want to try a different drug, that's what I would try. You could also try adding an SSRI or SNRI to your wellbutrin to see if that helps your depression.

As for the absence seizures -- are you on any anti-seizure meds for that??

Unfortunately, I'm afraid to try lithium. I only have one kidney. I know that I'm hard to medicate. :P I'm not on anything for the absence seizures; when I was young, I had a neurologist who tried nearly everything just to find that nothing changed the EEG. So he basically gave up on me...

I would like to try an SSRI or SNRI. I also wouldn't mind trying a different antipsychotic, maybe seroquel since it has antidepressant effects.

Do you feel that working in a less-demanding career than psychiatry would leave you in a mediocre work field? Or that your abilities are such that to apply them to a field any less demanding than psychiatry would be to waste them?

Or am I wrong about both? If so, where does the mediocre figure into this?

Roadie, I didn't mean to put down other fields. I just think that having crazy goals is something that many people with bipolar have in common. Some people want to be rock stars; I want to be a psychiatrist. I'm definitely not any more talented than anyone else. Other fields are not objectively better or worse than psychiatry, but they are mediocre in the sense that they are not what I want to do. Does that make sense?

Abilify has antidepressant effects too, especially in combination with an antidepressant.

As for trying an SNRI -- I love cymbalta. Effexor is good too, if you are willing to deal with a tought withrawal. Personally, I'm not a big fan of SSRIs, but they do work for a lot of people.

As for the lithium/one kidney thing. I actually asked a psychiatrist about this who was prescribing lithium to a lady with one kidney. He said that it doesn't make a difference if you have one kidney or two. Because if lithium is going to cause kidney problems, it will cause it in both kidneys anyway. So you're not any 'worse off' for having one kidney when it comes to lithium. Of course, I understand if you don't want to try lithium -- I was too afraid to go on it too, which is why I'm on depakote instead. But if there was one drug I think could really benefit you that you haven't tried, it would be lithium.

I know that you never said you wanted to be overmedicated (who would?!), but that's always a risk when messing with new meds. I think we just wanted to check that you knew what you were getting yourself into, and it seems you do. If you're planning on quitting meds, they're that ineffective, then you may as well try changing meds.

I can understand where Venus was coming from on this one, because a lot of people can be so driven that it DOES become their life. I was one of them. I was perfectly prepared to die in my pursuit of medicine, I wanted it that badly. I would rather have been a dead medical student than alive and not doing medicine. What changed? Well, eventually the depression took away my passion for medicine, and without that passion medicine is just an awful lot of hard work and abuse, and I got tired of being treated like crap, so I left. It was the hardest decision I have ever made, and I wish that I could've done it, but I know that I made the right decision now.

It can be done. My friend has just graduated medschool with Bipolar 1, even though the faculty told her she couldn't do it. They treated her as badly as they treated me but she still had the passion for medicine and so she could still fight. It's not about the diagnosis, it's about how stable you are. You could have any diagnosis going, but as long as you're STABLE throughout the course, you will make it. If you have a small blip, you will probably still make it. My friend had to repeat her final year because of a blip, but she still made it. If despite yours and your pdoc's best efforts you are still having severe symptoms then it probably won't happen. That's the reality unfortunately.

I totally get what you're saying here, but times change and you're still young. I sincerely hope that everything works out for you but, if it doesn't, the sun will still rise and life will still go on. It will be devastating for a while but you will get through it. Medicine is important, but it is not the be-all-and-end-all and I hope that you can realise that as it will make medschool easier for you.

All the best,

*Willow*

I'm bipolar too, Secretum. I've always wanted to be a musician, in spite of being unable to carry a tune. I've taken musical lessons but still display only mediocre talent. After 15 years of trying, and with everyone pleading with me to stop, I gave up any hope of being a musician.

If you are "definitely not any more talented than anyone else," & your primary qualification for becoming a psychiatrist is wanting to be one, what makes you think that you will ever help anyone? I'm sorry, but if you see this as a typical, unrealistic bipolar "crazy goal," how does this logical end up with you as a fully responsible, functioning, and contributing member of the psychiatric profession?

Is there a disconnect here? Do you have a psychiatrist who has worked with you for a few years who is encouraging you to pursue this?

This is bit too harsh, I think.

I think though there might be another problem... you are pursuing a field that can you are already too involved in. It is PERSONAL to you. That creates a great potential for burn out. Not saying it cannot be done, but this risk is there and one should be aware of it.

I just think this is a greater issue than getting the right meds, so you can pursue your dream... It take more than that. And you need to find that in yourself.