How do I express my desire for an antidepressant increase?

I started feeling heavily depressed on Wednesday afternoon around 3pm. I've been depressed ever since, with ONE blip of feeling "ok" yesterday for a few hours.

I'm maxed out on all of my doses EXCEPT lexapro. So, maxed out on lamictal, maxed out on rexulti, and maxed out on ritalin. I want my lexapro dose increased, but my pdoc doesn't like antidepressants for people with BP. Why, though? I have ritalin. If anything, ritalin is WORSE than an antidepressant.

ANYWAY, I have no other symptoms besides depression, I think. I've been consistent on my meds for once in my life, and have only missed ONE dose in the past 3 months. That's it. And I missed that dose 3 weeks ago because I fell asleep by accident, so it was a genuine mistake.

All I want is an increase in my lexapro, not a different AP or different mood stabilizer. I don't mind waiting 4-6 weeks for an antidepressant to kick in. But I have no idea how to tell my pdoc that I want a lexapro increase, considering he didn't even want to renew my existing Lexapro Rx when I first met him. My appt is on Thurs.

A lot of AD meds, when given to someone with bipolar, can induce mania, so many physicians are very hesitant to use ADs, and when they do, the dosage has to be very carefully monitored.

Did your doctor increase all your other meds and leave the Lexapro, or did you choose to increase them? Either way, your doctor needs to know that you've increased them (either arbitrarily or as directed) and your mood is tanking. They'll need to make some adjustments to help you through this.

I'm so sorry you're struggling, bluebycicle Unfortunately there aren't a lot of ways to put it. Just tell him that you're feeling really, really bad and ask peacefully if an increase in med may be possible and helpful to improve your mood. Let us know how it goes. Sending you many hugs and encouragement along your way. I'm so sorry you have to deal with this

Hey there, Blue!

I would just ask. I cannot think of another way to get an answer from your pdoc.

I saw your post about your therapist telepathically breaking into your apartment and am concerned.

I hope you can run all of this by your pdoc and your T.

I hope you have a decent weekend!


WC

I thought my pdoc was going to put me on a AD, instead she raised my AP. Now my husband (has the same DX I think) she doubled his AD. I would just write down what's going on and give it to pdoc.

It makes tons of sense to be extremely cautious about prescribing AD's for bipolar or people with a tendency for that. I had my first manic episode in my 40s the first time I ever took a psychiatric med, that was celexa and it was prescribed for 'somatoform disorder', when actually I needed Lyrica for a chronic pain condition and was depressed.

AD's can make a what would be a mild manic episode 1000 times worse in terms of the destruction of one's personal well being, finances, legal jeopardy ... all the bad things that happen when people get seriously ill. They can also destabilize people who would otherwise never have a manic episode at all,

I really do believe that. Anyone with bipolar having delusions and/or hallucinations shouldn't be on an AD at all in my book.

I'm lucky not to have bipolar so I can take anti-depressants. I do think it's weird that you can take Ritalin though, as I thought that would be more stimulating (and more likely to cause mania) than Lexapro.

But if you think your therapist broke into your apartment, it sounds like it could be psychosis in addition to depression. Be sure to tell your pdoc that.

I would just ask the doctor. He will say either ‘yes” or “no”, or give you a med with a similar AD effect like the AP Risperidone.

I think there are exceptions to the observation that a bipolar person will become manic on an AD. I had been one time in the past on the following combo of meds all at the same time. This list is Fluoxetine, Buprorion, Amphetamine Salts (Adderal), and Levothyroxine. All of them have the effect of a stimulant to different degrees, besides the Fluoxetine and Bupropione being ADs. The Levothyroxine is normally used to treat hypothyroidism. I did not become manic. I did eventually get out of my depression.

Just to clarify my post:
I wasn't suggesting/advocating for an AD in writing my post.
I do think raising an antidepressant at this time runs a huge possibility/probability of decompensation. I am very concerned about you, Blue.

I'd meant the only way Blue could know her pdoc's response is to ask him.
Maybe I'd misunderstood the nuances of Blue's question. I hope this clarifies.


WC

I agree, in order to know what your pdoc thinks, it's best to ask him.

I have seen this, in some situations, as well.


WC

I was just agreeing with what you wrote. Sorry if there was a misunderstanding!

I was wondering if my original post was confusing to Blue and thought I'd clarify, that's all. I totally appreciate your post! No misunderstanding between us.

Thanks, tecomsin!

WC