[broconno]

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

[BeyondtheRainbow]

I am in a very similar situation. It looks like you haven't been through the atypical antipsychotics and those help stabilize a lot of people (except abilify but there's geodon, latuda,zyprexa, risperdal, invega, saphris, seroquel/seroquel XR, and a new drug related to abilify called Rexulti). You've also not done typical anti-psychotics. One of them, loxapine, I was on this summer and it was chosen because it metabolizes into an anti-depressant on the way out of the body so it has some double power. It worked fairly well but I had a dangerous, rare side effect and had to stop it before getting the dose high enough. You've also not mentioned a number of anti-convulsants that can help: depakote, trileptal, tegretol, sometimes neurontin, sometimes topamax. I'm probably missing some.

It is true that those meds are sedating (some much more than others; loxapine wasn't sedating at all after a few days) but sometimes a sedating med can help your symptoms enough that you have more energy. Seroquel XR (and Seroquel before it) have had that effect for me until I had to go on extremely high doses. And you can combine them with meds that help sedation and have more success that way.

I have been running out of meds for years. Seroquel was a huge life-changer about 8 years ago and when the XR version came out it made things a lot better for me. But now Seroquel isn't working well on the highest dose I can tolerate and I've been waiting and hoping for Rexulti samples. If we don't get them soon I will have to give up and go on clozaril which is considered and marketed as a last resort drug. My dr checked on ECT for me but the dr who does it doesn't think it will work well and now I'm manic.

So you really aren't as out of options as you think. They may not all be ideal options but for a lot of them you can't know until you try and see how it affects you personally. You've got 2 classes you've not tried much/really at all and that gives you lots of hope still. I hesitate so make comments about what is sedating because my body is so weird but I believe Latuda, Invega? (haven't been on it) and Geodon are less sedating (once you are used to them. Most of these will be sedating the first bit). I know I didn't find risperdal sedating but I wasn't on it very long because I'm very allergic.

If this helps I've been doing this for a long time with treatment resistant bipolar, med allergies, a tendency to get rare side effects and so I've been on 40 drugs in 68 combinations (not counting dose changes) and I STILL have 2 drugs left to try after having to eliminate nearly all the old anti-psychotics due to a history of movement disorders that happened one too many times to make having it happen again a good idea. And I've had times that things have been controlled moderately to pretty well (and pretty well was pretty well to well and lasted a long time).

So don't give up yet. You're a long way from the end of the line. It is so hard to be patient when you are failing meds but you have more to try and that's a very good thing. For me the last several years have been a matter of "can we hold out until something new comes out and works?". And now that something new is out it is "can I hold out until my pdoc can get samples b/c my insurance won't cover it or will leave me with hundreds of dollars of co-pay?". The answer is probably not (it's very hard for my pdoc to get samples due to hospital policy) so I'm probably moving on the drug that we've been keeping as an option we knew was coming if pharmacetical releases didn't keep up with me, and that would be clozaril. And it's more likely to work than other things, it just requires a lot of monitoring because it rarely can lower your white blood cell count which could lead to infections. So hopefully it works for me and I don't try that rare side effect out along with all the others.

[ComfortablyNumb5]

Have you thought of going into IP for observation and to get your meds tweaked? You seem like you're in such a bad spot with depression. Reminds me of myself a few months ago. I had to force myself to snap out of it because my house was literally looking like a hoarders episode. There's many options out there as rainbow has said. Sometimes what worked for you then, isn't going to do it now. You just need to find that cocktail that works for you. And I know how frustrating it is! Just hang in there and keep an open mind to treatment options.

Dx: BP2, PTSD, bulimia/anorexia
Seroquel 300mgs
Trileptal 300mgs
Buspar 45mgs
Ativan 1mg PRN
Vyvance 50mg PRN