[PsychoPhil]

Reading through signatures in this forum, I'm amazed at the number of drugs and combinations prescribed in conjunction with bipolar disorder, see list, feel free to add what's missing. Lithium and valproic acid seem to be less popular these days, btw?

Does everyone with bipolar need a drug combination, sometimes with effects/side effects offsetting each other? Are there mild cases, where a low dose of a single drug may suffice?

<< List: -------
Lamictal/Lamitrogine: mood stabilizer and anticonvulsant
Abilify/Aripiprazole: atypical antipsychotic, "add-on" for depressive and tic disorders, and irritability
Klonopin/Clonazepam: treats seizures, panic disorder and akathisia, but may cause sleepiness, poor coordination, and agitation
Inderal/Propranolol: beta blocker, treats high blood pressure, prevents migraine headaches, may worsen asthma, may help with anxiety in bipolar?
Zoloft/Sertraline: SSRI antidepressant to help depression, OCD, panic attacks, SAD. May cause sleep trouble, sexual dysfunction, and serotonin syndrome.
Zyprexa/Olanzapine: atypical antipsychotic to treat schizophrenia and bipolar. May cause weight gain, seizures, and tardive dyskinesia.
Topomax/Topiramate: antiepilepsy/anticonvulsant. May help with weight loss and prevent migraine.
Neurontin/Gabapentin: treats partial seizures, neuropathic pain, hot flashes, restless legs syndrome. May cause drowsiness, increased risk of suicide, and aggressive behavior.
Melatonin: sleep hormone
Synthroid/Levoxyl/levothyroxine: thyroid hormone deficency treatment. May cause weight loss, anxiety, trouble sleeping, tremors, and fast heart rate.
Wellbutrin/bupropion: SSRI antidepressant and smoking cessation aid. May increase risk of epileptic seizures and suicide.
Xanax/alprazolam: short-acting benzodiazepine to help with anxiety, panic. May cause sleepiness, depression, headaches, loss of inhibition.
Ambien/zolpidem: treats sleep problems. May lead to sleepiness, headaches, memory problems, hallucinations. Risk of abuse.
Tegretol/carbamazepine: treats epilepsy and neuropathic pain. Helps with schizophrenia and bipolar, but may cause suicidal thoughts and confusion.
Seroquel/quetiapine: atypical antipsychotic treats schizophrenia, bipolar, and depression. May cause sleepiness, seizures, and tardive dyskinesia.
Ativan/lorazepam: treats anxiety, sleep issues, seizures, alc withdrawal.
Rexulti/Brexpiprazole: atypical antipsychotic. Serotonin-dopamine activity modulator, treats schizophrenia and depression.
Trazodone: SARI antidepressant, treats anxiety, but may lead to suicidality, mania, irregular heart rate, and pathologically prolonged erections.
Lyrica/pregabalin: treats epilepsy, neuropathic pain, fibromyalgia, anxiety. maycause poor memory, poor coordination, weight gain.
Cymbalta/duloxetine: SNRI antidepressant. May cause suicidality, mania, and liver problems.
>> --- List ends

[Victoria'smom]

I have psychosis a lot (BP) have been on 5 meds at a time. Now with new pnurse I'm on 2 meds 1 PRN. My husband also BP has the same pnurse and is on 2 meds different meds then me. My son BP(?????) (Same pnurse) is on an AD and only on that 1 med but a very, very low dose. Everyone (Pdoc & T's) are surprised that I've only been to the hospital 2x and my boys have yet to be hospitalized. However we have house rules that prevent most hospitalizations.

Tegretol XR helps prevent mania for me, plus other odd psych stuff. I can't go higher on that without double vision kicking in, plus I'm on a high dose as is. Nothing replaces this med for me. Negligible side effects.

Lamictal has it's place as a partial "antidepressant" for me. It is activating for me, so my dose stays low. I'm glad because higher doses also caused me some mild cognitive impairment in addition to eventual mania. Perhaps I could go off, but why? If I ever needed help with depression I'd have to start from scratch with this med, if I went off. My current small dose gives me no side effects.

Seroquel XR is the only one of my medications that is really manipulated. It, added to the above, is my powerhouse med. It has de escalated past manias and eased depression and anxiety. It's raised to fight mania, and either raised or lowered to fight my depressive episodes. The direction depends on the type of depression (lethargic/hypersomnia type vs. mixed/agitated type). It took me some time to get used to its sedating effects. Also, taking it at the right time and getting sufficient sleep lowers negative effects for me. Larger doses of 500 mg plus do make it hard for me to lose weight and/or may increase my appetite, but doses below 500 mg are mostly weight neutral for me. I've gained weight on higher doses, but not nearly as much as some people report. It may contribute to my high cholesterol. That's my assumption. It's much better than all of the other antipsychotics I've been on, which number eight. I must take an antipsychotic. Lithium or anticonvulsant moodstabilizers alone never cut the mustard.

Klonopin is a waste for me. It does nothing. It's a long story, but my doctors won't take me off of it. It's a small dose.

Ativan works well for me as an antianxiety med prn "as needed". The only reason I still take a baby dose daily is because I'm STILL in the process of being weaned off it. Not so much for anxiety, but because it was used to ease akathisia I suffered from for years when taking Geodon. I've been off Geodon for about a year now.

Mania is my biggest issue.

[Blue_Bird]

I'm on Trileptal, paxil, wellbutrin ER, seroquel, and clonidine. I'm also prescribed klonopin as needed but I try not to take it often. My dx is Schizoaffective bipolar. I used to be on Invega sustenna but got off it due to weight and other issues. My psychotic symptoms are more manageable now so I'm able to cope well most of the time.

Right now I'm on Depakote, Zyprexa, Trileptal, and Remeron PRN.

It's possible to just be on a low dose of a single med, especially for milder cases. I don't know how often that happens though.

[Guiness187055]

My meds are in my signature

[~Christina]

I take Latuda, Lamictal, Doxipin , Tenex and Xanax

“ most people need a combo”

Mine in general is a good combo after trying gawd knows how many others.

Psych meds can just poop out over time which can cause a need for a different Med or add on’s

If need be I’d take more meds. My family and friends and of course myself deserve the best I can be , stability is a wonderful place to be.

[HALLIEBETH87]

I take a lot of meds but for the most part they work. They’re in my signature

[jaysmotogp]

I feel like i'm one of the only/few that's on Lithium. May not be that way for long though, had bad episode the other week and over the phone my dr suggested possibly switching to Seroquel. So yes it appears to be trailing off.
But what i take right now:
Mirtazipine (Remeron)
Bupropion (Wellbutrin)
Lithium
Ativan, only when desperate

[Aurelius710]

I'm on lithium. As a primary med, it's about the only thing that works properly for me (few if any side effects). It's also one of the few meds that's supposed to work for both mania and depression. Even then, I've still had to take other meds (like haldol) as a PRN when I really need it.

I imagine there's some lucky SOB who can get away with a low dose of a single medication, but I haven't met them. The rest of us typically need a combo of some kind, which sucks when trying to manage side effects, but there it is.

[Pookyl]

As per signature I take three meds: Lithium, Epilim (Depakote) and Seroquel. This combo has worked better than anything else I’ve tried.

[AspiringAuthor]

Zyprexa has been FDA-approved as a maintenance monotherapy for bipolar (cf. e.g. Geodon that has been approved in conjunction with Lithium or Valproate, but not as monotherapy). In terms of making me functional, yes, Zyprexa alone works. It does double duty for me, helping, alongside BOTOX injections, in the prevention of migraines. But, I also take

Gabapentin, which improves the quality of my sleep and restores my dreams - medications in general cause me to have dreamless, robotic sleep that does not feel as restoring as normal sleep

Topamax to normalize the appetite that Zyprexa makes simply humongous and out of control and as an added benefit to further stabilize the mood

Melatonin , because while it is not sufficient as a sleep medicine for me, it is probably aiding some and is definitely harmless.

[AspiringAuthor]

I do not think that Wellbutrin is an SSRI - I think it is in a class of its own

[Guiness187055]

Originally Posted by AspiringAuthor

I do not think that Wellbutrin is an SSRI - I think it is in a class of its own

You are correct

[Gabyunbound]

Does anyone think that pdocs can overprescribe at times?

I think there can occasionally be problems of adding on and adding on. New symptom, or a previous one rearing its ugly head? Add on a new med, instead of replacing a current med with the new one.

I haven't had this problem with my current pdoc, but I feel like I did with my previous one. Any thoughts?

[raspberrytorte]

I take cymbalta, lamictal, gabapentin, valium and haldol.

I hate being on so many meds, but they all serve a purpose, so I don't know which I would go off of.

[Victoria'smom]

I’ve been over medicated in the past. My pdoc thought my previous pdoc over medicated me. She cut down all the meds to half. We’re slowly adding back the meds. I think she’s starting to realize I wasn’t over medicated. I’ve stopped meds because I couldn’t comfortably take that many meds. My pdoc now is very “light” with meds and really believes in therapy. She has myself and my husband, both BP on two meds each (different meds) and my son on one. She likes to increase the meds you are already on then add a med. These last two times I’ve hoped she’d add an AD but she raised my lamictal and zyprexa. It has helped but not enough. I don’t know what she’s going to do. I think she’ll raise my zyprexa.

[Blue_Bird]

Originally Posted by Gabyunbound

Does anyone think that pdocs can overprescribe at times?

I think there can occasionally be problems of adding on and adding on. New symptom, or a previous one rearing its ugly head? Add on a new med, instead of replacing a current med with the new one.

I haven't had this problem with my current pdoc, but I feel like I did with my previous one. Any thoughts?

Yes, I think it can be a problem. Sometimes it's hard to tell what med is doing what and there are doctors who just add and add.

I feel like I had that problem with a previous doctor. But with that doctor it was more putting me on a ridiculous dose of a med which ended up causing me to be in the ICU with severe Lithium toxicity. Lithium was clearly not helping and she just kept increasing and increasing till it literally started shutting down my kidneys. That's not common and most doctors would recognize the signs long before it got to that point, so I hope I don't scare anyone.

I'm happy with my current doctor. I've been on the same meds for a couple years. One was added recently but other than that the meds were adjusted in dose and if needed switched out.

[Kitten33]

I'm on a combo that I think isn't all that common.

Venaflaxine and Well-Butrin.

I LOVE IT. Big time.


I tried many other things over the years and nothing worked well. Also, these two do not work that well by themselves, for me. Alone the Well-Butrin is just meh. It helps, but not much. 150mg a day, extended release. Once my doctor said let's try a higher dose of it! Seemed like a good idea. It was an awful idea! I was super angry, I remember being furious with some poor girl at the pharmacy. I hated everyone and everything for a few days and said nope, I'm going back to 150mg.

Venaflaxine (Effexor) is one heck of a drug. I've done a lot of research on it, it can be quite dangerous I believe. It really messes with your serotonin levels. At first I was on 75, then up to 150 mg a day of the extended release tablets. Without well-butrin. It had a lot of negative side effects. Most memorably, it killed all feeling in my lady parts. I was in a relationship at that time and there was absolutely nothing exciting happening in the bedroom. I wasn't even interested. I felt dull, like everything was kind of numb, especially my brain. Just in a fog all the time. But I wasn't a roller coaster of up and down emotions, so it was ok with me.

After getting off those, trying other meds, getting back on those, adding more meds, I finally just quit all meds. Nothing was working well. It was like no matter what, something was going to suffer. If it wasn't my emotions, I'd have to sacrifice my creativity and love life. I was tired of it, picking one or the other, the lesser of two evils. My bipolar disorder became unmanageable again after a long time and I had to get help. I said I'm comfortable with well-butrin even though it doesn't do a ton, and I'm ok with effexor because it calms my brain, I want those two. I had to pay out of pocket for that visit and the doctor said ok, but Effexor extended release is going to be about $400 a bottle, for a month. What??? That's too much! She said the instant tablets are much cheaper and I can give you a coupon, it's about $40 a month. Way better, let's do that. Then the Heavens parted and angels started singing and life was beautiful. It's nothing short of a miraculous combination for me. And the NOT extended release pills are great. I have a lot more control over what I take and when. I take 75mg every morning when I wake up, then usually half of that around 2 in the afternoon, and another half in the evening. Takes about 20 minutes to kick in. On days when I feel extra up and down, I can add another half or even two more half's and go up to 225mg, and that fixes me right up.

The two medications balance each other out, in my opinion. The well-butrin prevents most of the negative effexor side effects, like sexual issues, and brain fog. It also makes me not hungry at all and helped me completely quit smoking. The Effexor puts serotonin in my brain which makes me happy and even completely changes the way I think. Without it, there's like a million browser tabs open at once in my brain and I need to focus on them All at the same time. Very scattered thoughts, uncontrollable emotions. This pulls up one browser at a time, I can handle it logically and with "normal" emotions. I love being able to control the dose myself. I'll be on this combo the rest of my life as long as it works the same way.

[Kitten33]

Originally Posted by AspiringAuthor

Zyprexa has been FDA-approved as a maintenance monotherapy for bipolar (cf. e.g. Geodon that has been approved in conjunction with Lithium or Valproate, but not as monotherapy). In terms of making me functional, yes, Zyprexa alone works. It does double duty for me, helping, alongside BOTOX injections, in the prevention of migraines. But, I also take

Gabapentin, which improves the quality of my sleep and restores my dreams - medications in general cause me to have dreamless, robotic sleep that does not feel as restoring as normal sleep

Topamax to normalize the appetite that Zyprexa makes simply humongous and out of control and as an added benefit to further stabilize the mood

Melatonin , because while it is not sufficient as a sleep medicine for me, it is probably aiding some and is definitely harmless.

Topamax! Thank You! I have been trying to remember what it was that a doctor (who was awful) prescribed for me that nearly killed me. That's what it was. I was on Effexor, Wellbutrin, ativan, Valium and Topamax. All at the same time! I went for the effexor and wellbutrin, plus something for anxiety attacks, he said take all this! Then he said, almost as an after thought, "Also if you want to lose weight, take this too!" I didn't ask about losing weight. Wasn't even an issue. I was happy with my 190 pounds on a 5'6"ish frame. Not terribly fat! I guess he thought I'd look better a little thinner, so I took it, because he's a doctor that deals with nothing but mental disorders, he should know what he's doing, right? He almost killed me. I was in bed for weeks, couldn't stop crying, could barely move, wasn't eating Anything, lost like 15 pounds in 2 weeks and I wanted to die. Which was the only time in my entire life I felt that way. It was terrifying. I quit all meds cold turkey for about two years after that.

[tmg4me]

For about 20 years I've tried just about every SSRI out there with nothing working. Now that I've recently been diagnosed with Bipolar Depression 2 with major depression being my biggest issue with hypomania I am now on Vraylar, Wellbutrin, Adderall and Ambien. I just started the Vraylar 1 week ago and I'm starting to feel a little bit better. I was on Latuda for about 2 months then all of a sudden I went into a tailspin of anxiety and an episode of Major depression so she took me off the Latuda and started Vraylar. I heard good things about Lamictal being good for depression so when I see her next Tuesday I will ask her about that.
My Diagnosis are Bipolar Depression 2, ADD and Anxiety

[Scooter9]

I think I'm on an unusual combo: Latuda and Modafinil.

Both are being used to treat the depressive phase I've been in for a long time.

I don't think the Latuda is doing much except for giving me amazing sleep but the Modafinil I started several months ago seems to be helping.

I haven't reached baseline but I'm not as depressed as I was before. I'm coping and trying CBT to get the rest of the way there.

I've been on various combos before this.

Hope this helps!

[BonsaiGuy]

Originally Posted by PsychoPhil

Reading through signatures in this forum, I'm amazed at the number of drugs and combinations prescribed in conjunction with bipolar disorder, see list, feel free to add what's missing. Lithium and valproic acid seem to be less popular these days, btw?

Does everyone with bipolar need a drug combination, sometimes with effects/side effects offsetting each other? Are there mild cases, where a low dose of a single drug may suffice?

<< List: -------
Lamictal/Lamitrogine: mood stabilizer and anticonvulsant
Abilify/Aripiprazole: atypical antipsychotic, "add-on" for depressive and tic disorders, and irritability
Klonopin/Clonazepam: treats seizures, panic disorder and akathisia, but may cause sleepiness, poor coordination, and agitation
Inderal/Propranolol: beta blocker, treats high blood pressure, prevents migraine headaches, may worsen asthma, may help with anxiety in bipolar?
Zoloft/Sertraline: SSRI antidepressant to help depression, OCD, panic attacks, SAD. May cause sleep trouble, sexual dysfunction, and serotonin syndrome.
Zyprexa/Olanzapine: atypical antipsychotic to treat schizophrenia and bipolar. May cause weight gain, seizures, and tardive dyskinesia.
Topomax/Topiramate: antiepilepsy/anticonvulsant. May help with weight loss and prevent migraine.
Neurontin/Gabapentin: treats partial seizures, neuropathic pain, hot flashes, restless legs syndrome. May cause drowsiness, increased risk of suicide, and aggressive behavior.
Melatonin: sleep hormone
Synthroid/Levoxyl/levothyroxine: thyroid hormone deficency treatment. May cause weight loss, anxiety, trouble sleeping, tremors, and fast heart rate.
Wellbutrin/bupropion: SSRI antidepressant and smoking cessation aid. May increase risk of epileptic seizures and suicide.
Xanax/alprazolam: short-acting benzodiazepine to help with anxiety, panic. May cause sleepiness, depression, headaches, loss of inhibition.
Ambien/zolpidem: treats sleep problems. May lead to sleepiness, headaches, memory problems, hallucinations. Risk of abuse.
Tegretol/carbamazepine: treats epilepsy and neuropathic pain. Helps with schizophrenia and bipolar, but may cause suicidal thoughts and confusion.
Seroquel/quetiapine: atypical antipsychotic treats schizophrenia, bipolar, and depression. May cause sleepiness, seizures, and tardive dyskinesia.
Ativan/lorazepam: treats anxiety, sleep issues, seizures, alc withdrawal.
Rexulti/Brexpiprazole: atypical antipsychotic. Serotonin-dopamine activity modulator, treats schizophrenia and depression.
Trazodone: SARI antidepressant, treats anxiety, but may lead to suicidality, mania, irregular heart rate, and pathologically prolonged erections.
Lyrica/pregabalin: treats epilepsy, neuropathic pain, fibromyalgia, anxiety. maycause poor memory, poor coordination, weight gain.
Cymbalta/duloxetine: SNRI antidepressant. May cause suicidality, mania, and liver problems.
>> --- List ends

Wow! Thank you for the information and the very detailed and comprehensive list of meds. I will continue to take a look at these with my doctor to find the best combo for me.

[PsychoPhil]

Thanks everyone for their answers, very helpful!

[cashart10]

Depakote and Seroquel are my most necessary meds, helping with mood stabilization and psychosis. I also take Wellbutrin and Navane. I took Navane for a long time but came off of it about a year ago. Due to a recent manic episode though I had to restart it. Now, because I further could not sleep I started Restoril which is a sleep med but that is only temporary.