Medication for Bipolar

Hello,
I currently am on Lithium, Lamictal, Levothoroxine and recently put on Emsam. I have severe depression but have had Mania at times. Emsam is an older MAOI medication which used to have serious side effects but is now approved for transdermal use through a patch. I was on Paxil and spent 2 months getting off so I could try Emsam. I have been having extreme nervousness since being on it, at times I feel like it has helped a little with my depression. I have been on it about 2 weeks and I’m wondering if anyone else has ever been on it? If you have experienced the nervousness. I’m trying to figure out what to do. I tried coming off it but got extremely depressed. I just started a job that I spent several months trying to get, I don’t want to lose it and I’m concerned I may if I have a breakdown from coming off medicine. Any feedback would be appreciated.

I've been on Emsam for 9 years. It works really well for me. I did have anxiety at first and managed it with PRNs for a month or so and then it got easier and now it doesn't cause any anxiety at all although I do still take a lot of meds for anxiety but I don't think it is Emsam related since it doesn't change with dose.

I was left on 6 mg when I left the hospital after starting it and they suggested I stay on 6 mg for a month. My pdoc was off for a medical issue and my family dr agreed to increase to 9 mg at 2 weeks or so. 9 mg is the most effective dose for me although I go up to 12 if I get depressed and down to as low as 4.5 (by cutting the patches; it says not to but it works fine for me) if manic.

Did you go completely off the Paxil and then do the 2 week waiting period? I went on it IP so I didn't have to do that; I tapered down to none but skipped the waiting period b/c I was dangerously depressed. I think that regardless you need to give it time as it is a huge change. If you did the waiting period your body has been through even more and may need even more time.

If you have questions feel free to PM me or ask on this thread. I've got plenty of experience by now.

The only med I'm on with you is Lamictal, which seems to be a standard med for bipolar. Once, I was put on Paxil for a long depressed episode, and it caused me to go manic in less than 6 weeks. But I do OK on Wellbutrin, go figure. I think everyone reacts differently to meds, and everyone seems to be on different dosages of many meds as well, so it really contributes to the difference in my opinion.

I did go off Paxil, tapered as well. I may have been off it and then put on Abilify; I really can't remember. I do know that pdoc never just stopped meds other than Trazodone, so I'm sure she tapered and/or replaced the Paxil with something else and no waiting period, but that something else was not an MAOI. I know I have never been on an MAOI, so I can't help you there.

I've been on lamictal before. If you are having reoccuring bouts of mania, I suggest asking your doctor about Vraylar. I am on that now and I haven't had any mania since I've been on it for almost 2 years now. It is a very expensive medication that I had to get prior authorization on from my insurance ($1500 per month) but it is worth it if nothing else seems to be working. Hope you get better soon and find some relief!

By the way, the meds I am on right now are: buproprion, sertraline, levothyroxine, vraylar, metformin (for diabetes), and zolpidem for sleep. I haven't had any issues with depression or mania in a while, but I wish I could go off some of my meds because I am having other side effects (constant fatigue and achey muscles, blurry vision, etc.) but this could also be because of my diabetes..

I was on emsam for a year and a half. It worked VERY well for my depression. I have never had any medication work for depression as well as emsam. I’m not on it anymore only because I had to go off the AP I was taking at the same time (invega) and my dr wanted to try latuda as monotherapy. That didn’t work at all. I am now on lamictal as well and that seem to be controlling the depression well on its own. However, I too am starting a new job soon and if I get depressed again I would not hesitate to go back on it as I’m like you and can’t afford to lose another job to bipolar depression (I’ve lost three in the past two years).

I did not experience the nervousness that I remember. But I agree with beyond the rainbow, give it another few weeks to get used to it. If it works for your depression well, maybe your pdoc can add something like gabapentin for anxiety. Good luck!

Paxil fan here. Lamotrigine/lamictal=baby aspirin.

Keep in mind that "nervousness" or anxiety can be a symptom of dysphoric mania. So many AD's cause people with BD to go manic - and manic does not always mean "up". It can also mean anxious and/or agitated.