[liveforsummer]

I've a question and looking for some feedback/opinions.

Here's the short version: went to fam doc for anxiety and depression in Jan, gave me cipralex (escitalopram) 5 mg first wk, 10 mg week 2. In third wk had hypomanic symptoms. Went back for follow up, told him how great I was feeling (symptoms were disruptive to day to day living and work) and he took me off it and put me on mood stabilizer, Divalproex. The next few months were a mix of hypo/depression and mixed. Then he put me on both together. I took myself off of all meds (my decision) as of mid May. Ok but on and off bleh and want to feel better. Last wk decided to try the cipralex again. Ok so far. (I do have a first ever appointment next wk with pdoc so shall listen to what he says of course). Fam doc started out thinking I was cyclothymic then shifted to BP (after I was honest with him for first time ever-always afraid of being judged though never crossed my mind ever that I may be BP.) sorry I'm rambling now...

With BP is it safe to be on an antidepressant as your only med or is it risky?

[Guiness187055]

With me none of them are safe they all push me manic. I have to have my depression controlled with and anti psychotics and mood stabilizers.

[wildflowerchild25]

It is risky if you have BP to be on an anti depressant alone, especially because this has already caused hypomanic symptoms in you before. I know that I absolutely cannot take an AD without some sort of mood stabilizer or antipsychotic on board. I get manic, then mixed and psychotic.

[still_crazy]

i seem to recall reading that some people with bipolar II can do ok on antidepressants. I don't think its standard practice, but its interesting to think about.

with bipolar I, I don't think its a good idea to take stimulants or antidepressants without something to balance it out. actually, a lot of people who are diagnosed with bipolar I are not prescribed antidepressants, at all. I had a shrink once who would prescribe some controlled substances for my problems, but not an antidepressant .

having said that...this is psychiatry, not..."science." Go to 2 shrinks, get 5 opinions, and a variety of "treatment options." I'm not saying that to discourage you from getting help you need, but I am saying that the real goal is to keep whatever your major problems are under control well enough so you can have a normal-ish life. Personally, I've found that lowering my expectations from the drugs has helped me as I continue the "recovery process," or whatever the current term is.

Please do keep in mind that some of the drugs used for Bipolar I and Schizophrenia are heavy artillery. Not saying its the worst thing ever, but there are definite adverse effects from the get go, and often the problems get worse (and more likely) over time. I'd really, really encourage you to be careful about the drugs you consume.

[Victoria'smom]

I wouldn't risk only being on an AD. As a mixture med sure but not stand alone med. look into something like abilify for a stand alone med.

[raspberrytorte]

I think an AD alone is probably a bad idea. When I was on zoloft alone it made me manic. Now, however, I'm on 150mg of it and aren't having any problems because I'm on other meds to balance it out.

[Wild Coyote]

My pdoc uses ADs alone in BP II, unless it causes a problem.
If it causes a problem, then he'll add a mood stabilizer.

If your main issue is depression, you might do very well with Lamictal, which is a mood stabilizer, yet also prevents some depression. (I cannot take it. Med reaction.)

I think you'd find Lamictal less sedating than Divalproex.

Everyone is different. I live with BP II and, at times, I need a mood stabilizer, other times not. When in severe depressions, I drop the mood stabilizer and am on 3 meds which work as an antidepressants and one stimulant.

My H lives with BP II and he's been very stable on Lamictal and klonopin for approx. 10 years. He's very high functioning. His major issue was depression, although he did get hypomanic with some AD meds.

It's truly a very individualized matter.


WC

[BastetsMuse]

Originally Posted by liveforsummer

With BP is it safe to be on an antidepressant as your only med or is it risky?

A lot of psychiatrists won't prescribe just an AD for bipolar people because of the risk for mania. In fact, that's how I was diagnosed as bipolar... my family doctor had put me on an antidepressant, and I went manic while on it. It's not safe.

[bioChE]

In general, antidepressants are not recommended in BP treatment. In some cases they're prescribed, but usually in the presence of a mood stabilizer and/or an antipsychotic. The other posts here have given good information.

[Wild Coyote]

My pdoc states antidepressants are used often in many cases of BP II and not always with a mood stabilizer.

It's very individualized.


WC

I am sure that there are bipolar people out there who can take just an AD. I'm not one of them but I know they exist. Be careful.

[Wild Coyote]

Now that mood stabilizers have been mentioned, it's important to use some caution with them, as well.

Meds used as mood stabilizers are usually either an anti-epileptic/anticonvulsant (AED) med or are atypical anti-psychotics(AAP).

You've tried Valproex, which is an AED. Lamictal, Depakote, Trileptal, Tegretol are some other AED meds.

Some of the AAP meds are Abilify, Latuda and others. Some of these are used in BP II only after the AED meds fail.

Many people new to these meds are not aware that AAP meds carry the risk of a long-term side-effect called Tardive Dyskinesia, which is a movement disorder. It's a condition you definitely do not want to have to endure. Many of us here take this risk when we have to do so.

If you are new to meds/treatment, and since your diagnosis is BP II, I'd strongly suggest you try to work with the ADs and/or AED mood stabilizers before getting into the AAPs. There's no sense in exposing yourself to the potential long-term risks of AAPs, unless you have to do so.

I hope this info. helps. I wish I had the Canadian names for these meds for you.


WC

[Nammu]

I can't take ADs alone or with other meds. Be careful

[liveforsummer]

Oh my gosh thank you everybody for all your input, information and suggestions!!! I'm being very cautious, those closest to me are aware and looking out for me. It's the mood stabilizers I'm scare to take after reading the possible side effects (liver damage). Had no idea about AAP meds ugh! I shall address this Med issue next tues with new pdoc.

[glowsinthedark]

I'm BP II and take 25mg of zoloft without a mood stabilizer. In the past when I was on 50 or 75mg I was either manic or mixed or severely depressed, but for some reason 25 (which is a very low dose) seems to help take the edge off of my anxiety, and sometimes my depression.

[xRavenx]

I was told by a pdoc that some, though few with BPII can get by with just an AD, but it is riskier with BP1, due to the risk of full-blown mania. Sometimes even with a mood stabilizer + an AD, it can put some individuals at risk for mania too, and there's some research that shows that no matter what, SSRI antidepressants can exacerbate BP symptoms.

At least AD's that aren't SSRIs (such as Wellbutrin) are less of a risk. Unfortunately, I fall in the category where I cannot use AD's without becoming manic, even with mood stabilizers, including with Wellbutrin. So it really depends on the person, but you must be careful and aware of possible risks.

[liveforsummer]

Have felt a little edgy in the evenings last few nights after taking the cipralex, I notice it more if sitting around watching tv but if I keep busy then not so much but its gone by morning and I'm fine in the day. I'm thinking if the evenings change for the worse at all I will stop and just wait until my appointment next week.

[Unrigged64072835]

During my last IP I was put on Latuda as a mood stabilizer/AP, then Viibryd for the depression. I was weaned off the Viibryd because it made me more anxious. It all depends on the person's chemistry.

[liveforsummer]

Jitters last night and into mid morning today. Gone now and just tired. Jury still out so will take next dose of cipralex tonight.

[Happy Camper]

Originally Posted by glowsinthedark

I'm BP II and take 25mg of zoloft without a mood stabilizer. In the past when I was on 50 or 75mg I was either manic or mixed or severely depressed, but for some reason 25 (which is a very low dose) seems to help take the edge off of my anxiety, and sometimes my depression.

Just wanted to add I have been on 25mg of zoloft and it caused some hypomania symptoms. Even 12.5 mg seems to be making me jittery.

[glowsinthedark]

Originally Posted by Happy Camper

Just wanted to add I have been on 25mg of zoloft and it caused some hypomania symptoms. Even 12.5 mg seems to be making me jittery.

@happycamper, just curious - did you stay on 25mg? if so, did the hypomania continue, or what happened?

[jacky8807]

Originally Posted by Happy Camper

Just wanted to add I have been on 25mg of zoloft and it caused some hypomania symptoms. Even 12.5 mg seems to be making me jittery.

Interesting. I have been taking 25mg of Zoloft for close to a month I would say and I am feeling really jittery. But I am stressed as well so I cant tell one from the other or if one is making the other worse.
I am very jittery,was told by my mom I am acting paranoid and a few days later basically told by my boss that her company wide email was not "targeted" to me after I sent my own email thinking it was. Time is passing blurry
and I feel out of it and so on.
I think stress causes this too so IDK. I wont be asking to go up on it that's for sure!

[Wander]

The standard dose for fluoxetine (Prozac) is 40 to 60 mg. I was started on 10 mg then after a week it was increased to 20 mg and I went bananas - agitated, irritable, wild and sleepless. It was dropped to 10 mg and the depression continued. Finally, it was increased to 15 mg (3/4 of a 20 mg tablet) and I hit the sweet spot where my depression lifted without any of the negative symptoms. It seems to be a delicate balance with me and that is with Lithium and Abilfy on board.

[Sunflower123]

Originally Posted by Wild Coyote

My pdoc uses ADs alone in BP II, unless it causes a problem.
If it causes a problem, then he'll add a mood stabilizer.

If your main issue is depression, you might do very well with Lamictal, which is a mood stabilizer, yet also prevents some depression. (I cannot take it. Med reaction.)

I think you'd find Lamictal less sedating than Divalproex.

Everyone is different. I live with BP II and, at times, I need a mood stabilizer, other times not. When in severe depressions, I drop the mood stabilizer and am on 3 meds which work as an antidepressants and one stimulant.

My H lives with BP II and he's been very stable on Lamictal and klonopin for approx. 10 years. He's very high functioning. His major issue was depression, although he did get hypomanic with some AD meds.

It's truly a very individualized matter.


WC

I've never thought about coming off my mood stabilizer when I'm severely depressed. I'll ask my pdoc about that at my next visit.

[Happy Camper]

Originally Posted by glowsinthedark

@happycamper, just curious - did you stay on 25mg? if so, did the hypomania continue, or what happened?

I was told to reduce it to 12.5mg and I did. I stopped feeling energetic but I'm still a bit twitchy . This is all while being on zyprexa. Going to to see the doc soon.