[Stitchwitch1224]

Hi, I was diagnosed just 1 month ago after having a manic episode triggered by Prozac. I had been on other antidepressants for years and think they made me hypo manic the whole time, but I thought that's the reaction I was supposed to get. Certainly brought me out of the depression.
5 days after starting Prozac I had my husband drive me to the hospital in full manic mode, with audio hallucinations having not slept for 3 days, scared to death.
I have been on geodon 2x per day since. Can't take the side effects so switching to 400 mgs of seroquel and after 1 week of that adding tegretol.
I am a mom of 3 boys aged 2-13, I work full time.
This is my question, I am still cycling up and down. My pdoc says taking antidepressants (prior to all this occurring) has caused the major cycling and that I will never be able to take antidepressants again. I will just have to deal with the depression, which can be very bad. Is this common? How do people with bipolar handle the depression part of it?
She also said that anti depressants were so bad for bipolar sometimes it can mimic or trigger disassociative disorder.
This is all very overwhelming and hard to handle.

[ultramar]

Some pdocs, including mine, believe that antidepressants should never be prescribed for those with bipolar disorder. As far as depression, Lamictal has been rather miraculous for me. Not for mania, but for depression, yes, and there seem to be many others who have had success with it, and often with minimal side effects. Perhaps you could bring this up with your pdoc?

[Victoria'smom]

I can only take a very low AD or I'll flip into full all out psychotic mania. Depression for me isn't bad I usually go into a mixed mania. My baseline naturally is high, and my husband's is naturally low. This means his AD is high. It took me going through most classes of AD's to find one that didn't flip me into mania. I would never allow any of my loved ones go to a pdoc that doesn't allow AD's. To me bipolar is a two part problem that needs to be treated mania and depression. If one part is not being treated then bipolar is not being treated.

I've been dealing with depression for a few years now and have been on several antidepressants. My last doc and current one are positive I'm bipolar so now we are working on adjusting the medications to prevent the up swings. I just tapered off of welbutrin from 300mg to 150mg to 0 now. I may end up trying lamictal in the future, my new doctor seems to think its the best for bipolar. Maybe ask about lamictal and or abilify. I'm not a doctor or anything this is just from my experience but abilify seems to take the edge off of the ups but I'm not sure if it really helps with my depression or not.

[ultramar]

What you say (Miguel'smom) makes sense, and I'm actually perplexed by the 'no-AD' thing. My pdoc consulted the head of the Bipolar program here, who's quite well-known in the field, and that's what he said. In my case, Lamictal alone really kicked the depression in the butt, but I really don't know what they do with people with more persistent depression.

Does anyone know if there are other mood stabilizers, apart from Lamictal, that tend to help with depression?

Actually, I just looked it up, now I get it. The hospital where I receive care (and work) was involved in a gigantic research study STEP-BD and these were the results re AD's.

7. What are the results from the STEP-BD acute depression medication trial?

A. Of the 179 participants who received an antidepressant in addition to a mood stabilizer, 24 percent achieved a durable recovery (at least eight weeks with no more than two depressive or two manic symptoms), compared with 27 percent of the 187 participants who took a mood stabilizer plus placebo. Moreover, adding an antidepressant did not increase the risk of a switch to mania or hypomania. The similar rates of durable recovery indicate that the addition of an antidepressant medication to adequate, optimally dosed mood-stabilizing medications does not improve recovery from bipolar depression any more than adding a placebo.

Nonetheless, clearly people have benefitted from AD's. It's just since the hospital conducted this study, they go by the results. I'm actually going to google around and see if I can find more recent research.

Also, you'll see that *some* people did benefit (just not statistically more than those who did not take it), but interestingly, it says AD's (or the one's they prescribed, which were specific and I can't remember which type) did not send people into mania *either*. So maybe, even going on these results, if there isn't much danger of sending someone into mania, then may as well give it a try.

When I took Zyban (aka Wellbutrin) over a decade ago to stop smoking (before being diagnosed) it sent me into a psychotic mania. Though it's possible that this class of AD's was not used in this study.

I know there are plenty of people who have been sent into hypo/mania from AD's, at least anecdotally, I don't know the studies.

[Stitchwitch1224]

Thank you for all the responses. In addition to whether it works or not, I have to consider whether my insurance will cover it, which rules out Abilify. And also she (pdoc) doesn't want to prescribe anything to me like lithium which would require frequent lab tests as I live on a small island and the labs are not reliable and difficult to get into.

Lamictal is a mood stabilizer most known for helping with depression in the mood swings supposedly not as great with mania but the seroquel could take care of that. I personally have been on ADs since before and since my diagnosis through several drs who are notorious for switching up meds from previous drs. I am on 2 now. But also on 2 mood stabilizers and an antipsychotic. Fun stuff.

[Amelie10]

Unfortunately it takes time to find the right cocktail of meds and everyone is different.

It was Zoloft that sent me into my first manic episodes many years ago. Depression is a major problem for me. I alter my meds slightly based on my mood. I think based on what I have read this is unusual.

Lamictal is the only steady med I take all the time. When the depression comes on, I slowly add Lexapro and continue to take it as long as the dark mood is present. When I start to feel better and have more energy, I taper off the Lexapro to avoid mania.

When I start cycling up into hypo mania I add seroquel.

That is what works for me. My depression is a big issue, much more dangerous for me than the mania.

Good Luck. Getting a diagnosis is the first step.

[choocha]

Hi. I strongly agree with Miguel's Mom. BP is a 2part problem that needs to be treated equally for both of it's parts. My doc and I are aware that my AD may trigger my mania but I know the warning signs and to back off on it or stop it if it gets too bad. Right now my depression bad enough that it is worth the risk of triggering any manic symtpoms. There are so many AD's out there that I think it's possible to find one that doesn't trigger you. Effexor and Cymbalta have both worked well for me in the past. If I was on an upswing, I would just decrease my dose. When I was on a downswing, I would go back to maximum dose. It's all about being self-aware of your warning signs and addressing both states depending on how good or bad they are at the time. \
If you can get by just taking a MS that would be best, but if you need an AD for your depression, then just keep trying out different ones till you find one that suits. It can and does take years to get meds right for BP. Don't give up or lose hope. It just takes time.
Good luck, take care and keep us posted on your progress and any developments.