Safely getting out of depression/getting & keeping your ***** together when new to BP

Hi! So I'll try to keep things short, but I'll bold the important parts for anyone who wants to skip the babbling, ha.
I'm 23 and I've always suffered from anxiety and depression, and have suspected bipolar 2 for a year or 2. I definitely have more problems with the depression side of things than highs. The only 2 hypomanias that stick out that I know of for sure were both while on Nardil, and relatively mild. I've had a few times that stick out as possible mixed states, one severe. Other than those, I know my depression is recurrent and I've seen possible trends and signs through the years, but I have a pretty terrible memory and can't really point out any other specific "episodes". I've wondered if I was experiencing rapid cycling before, including now.

I've struggled to know whether I'm really bipolar because of possible symptom overlap. E.g. irritability can be a problem for people with anxiety or depression without bipolar, mood swings can sometimes happen anyway with depression, hormones, etc. I have heard some people with bipolar can be primarily depressed, but I feel like most cases I hear about are more "typical" bipolar and I don't have much to compare mine to. Depression being so much of my problem (and the lack of any very high highs) makes me doubt bipolar, but if I just tend toward the dysphoric side of mania it could explain some things I just attribute to anxiety and other things. Every time I start suspecting it a lot it's like I'm new to it and start looking into treatment and things a lot, then I'll decide I'm just worrying and need to focus on treating just depression and forget about it, and I've been going back and forth a lot in which one I believe.


The thing that has me focusing on bipolar now is what's happened the past few days. I've been mostly going downhill/in a depression for months now. I was supposed to start Pristiq a few days ago, and the 2nd day I took Pristiq, I was up all night, my mind was racing more, I had increased anxiety, and things were just crazy. I suddenly became convinced Pristiq was going to throw me into a mixed state, and now I'm almost obsessively worried and trying to work on figuring out more about bipolar treatment. Even if I was overreacting, it brought me to thinking about how I should be careful and how my reactions to some other meds before could've actually been mixed symptoms without me realizing it at the time. But then it just brings me back to the uncertainty, because antidepressants can cause crazy side effects at first for anyone. I've heard of insomnia, anxiety, mood swings, etc as side effects of Pristiq.

I know some say labels aren't important and it's more about treating symptoms, but I feel like being more certain is important here. I'm desperate to get better ASAP and don't want to slow down trying to get out of the depression, but I don't want to end up in a mixed state. Anyway. I'm feeling like maybe I should be taking a serious look at treating things assuming I'm bipolar, and see how it works.



Assuming I am bipolar, how do you not constantly stay on edge and wonder when stuff's just anxiety, etc. and when things are getting serious? And how do you deal with bipolar when mania is barely a problem? I don't want to go on one of the "downer" mood stabilizers at all, I really don't think they're necessary for me. I know some use those before adding an antidepressant to make it more safe, but antimanic drugs seem unnecessary for me and I fear they'd make me flat/depressed. At the same time, I do not want to end up unstable or even just having symptoms I could avoid. I don't feel like I can find a med combo that's safe (assuming I am bipolar) while still taking care of my depression and anxiety. I've also considered adding dopaminergic drugs for my depression, but worry those could trigger manic type stuff, too.

As far as meds:
I'm currently just taking 250 mg of Lamictal and Dexedrine (hasn't triggered anything), just kind of waiting to find something else to help with depression and anxiety more. I've felt uncertain exactly what Lamictal does for me for a while because I started it during a weird time, yet I have mostly felt better the past year or so since I started it and think it's helping. I can't help but feel desperate to get off of it if at all possible, because I'm so uncertain and want to see how it really affects me and if it's necessary, especially because of side effects I really don't want to be dealing with for nothing. I've been tempted to try to just go back to monotherapy with an antidepressant at times, then I realize that could be unsafe if it really is doing a lot, and more "dangerous" if I am bipolar. And if I'm wanting to treat things without just focusing on an antidepressant, I feel like maybe I should actually be raising it if anything, especially since I do suspect it's become less effective.

I read things about bipolar treatment and feel like there just has to be something more than what I'm finding. Lamictal has possibly helped me, and then I know lithium and seroquel are also supposed to be on the antidepressant side, but I can not afford to gain any weight (plus lithium scares me and seroquel increases my depression). I've considered Abilify or Rexulti, but same thing with weight. I've always kept switching back and forth between whether antipsychotics are too serious and risky, or whether they're not a big deal. Other than that, though, it seems like other typical bipolar meds are antimanic. Plus, I'd really like to try getting off Lamictal if possible, if I could find something to replace it. Are there any other meds used as mood stabilizers that tend to be antidepressant? Aren't there any other meds used, even off-label, that I should know about?


I know I could google some of this, but I'm really lost and feel like here is more helpful/comforting. I also know I should ask my psych, but he's not helpful even with typical depression, much less bipolar. Sorry this turned into a long mess (as most of my threads do, haha). Anyone have any input?

++++++++++++++++++++(((HUGS)))+++++++++++++++++++

There are a lot of different mood stabilizers including lamictal, depokote, Tegretol and lithium. Anti psychotics are often used to prevent mania/mixed episodes. Not all AP's make you gain weight. I've gained nothing on abilify.

lamictal helped my depression but mostly when I hit 400mg ... trazadone really helped but not until 150mg ... had to stop traz though caused dizzyness ....

Yeah i feel you on "not wanting to go down" on meds. Did once before. People loved me because i was approachable for once. But i felt dead inside.

To answer one of your bold questions, I know that things are becoming serious when i feel out of control. When i become erratic, overly aggressive or obsessive

The bipolar med that has helped my anxiety the most is Latuda. It's VERY expensive, so you'll need to check to make sure your insurance covers it well. My p-doc is filling out a form for my new insurance to verify that no other medication works this well for my anxiety so they'll cover it. I also take Xanax XR and Xanax PRN. Good luck!

Thank you all for your replies! c: The comment about lamictal dosage helps, because I keep worrying my dose is high because of how studies claim doses over 200 mg make no difference, despite tons of peoples' experiences.

I feel maybe slightly better today than yesterday when I was obsessively worrying, but still weird. I can't decide whether this is bad increased anxiety and I need to just hurry and get on the Pristiq or something ASAP, or whether the weirdness is a sign I need to slow things down.

I feel this little bit of hypersensitivity and increased anxiety, and a feeling of increased agoraphobia even though I haven't left my house yet to know how I'd really feel when out. The weird hypersensitivity and stuff almost reminds me of something I felt as things were getting really bad in 2014, a couple months before I ended up in a psychotic break (not like straight up bipolar psychosis, there were a lot of other factors involved). It's probably just anxiety stuff and I'm overthinking everything I feel, but it freaks me out. I'm hyper-vigilant of any little sign that things could be getting that way again.

So I'm not sure whether I should go ahead and start the Pristiq tonight or not. :/
I'm gonna research Latuda and the other meds mentioned, though if I do start up Pristiq I'd wait a bit to start anything else. If it's safe Pristiq may be worth trying now since I already have it, even if I hate what I've heard about the withdrawals. I wish my psych were more helpful, then maybe I'd have more hope he'd have ideas and actually help me make a choice and it might be more worth waiting til then to start something else instead before Pristiq.