[rovers95]

Hi

I have been diagnosed with bipolar 2, and read that it is debatable how effective ADs are for the severe depression alongside and whether they worsen/cause cycling in the long run. Although I note some people feel they may be okay with a mood stabiliser alongside.

As well as a mood stabiliser I'm going to suggest an anti psychotic to treat the depression. I'm thinking low dose abilify, or vraylar (rexulti not available in the UK). Does anyone have experience for using these at a low dose to specifically treat depression whilst trying to avoid hypomania? The only thing that ever worked for me in this respect was riluzole.

However I'm concerned that these dopamine boosters may 'poop out'? Perhaps I can lengthen the time they are effective by dosing every 2/3 days? (I note they both have long half lives).

wait. Are you even on a mood stabilizer yet? You add mood stabilizers and antipsychotics one at a time. If you add them both at the same time and something bad happens, then you don't know which one is the culprit.

Most pdocs start bp II patients on mood stabilizers because the *assumption* is that the bp II patients don't get psychosis and thus an antipsychotic MAY be overkill for treating symptoms. (Keyword: *may*. Some do have antidepressant properties, but so do some mood stabilizers like lamictal.). They like to try mood stabilizers first. Then when those fail, antipsychotics are used. But YMMV with pdocs.

[Wild Coyote]

Hi rovers95,
."BP is thought of as a "spectrum." disorder. It is clear that people do not have their illness play out exactly the same. Someone with BPII might need an anti-psychotic, while another person with a BPII diagnosis may never need an AP. Some people with BPII may only very rarely experience hypomania and, in these cases, concern about instigating hypomania is not at the top if the list of concerns.

I have used low dose APs for depression in the past. I did not have good luck with them. I am now on a dopamine agonist called "Mirapex." I am having very good luck with this med. It is my goal to get off of any AP and rely upon Lamictal (a mood stabilizer) and some Mirapex as needed for depressive episodes.

I wish you luck in finding out which meds and which doses work best for you!

[Blue_Bird]

I've taken both (not at the same time), was on vraylar before and abilify now and I have good experiences with them but I'm not/wasn't taking them for depression although I know low dose abilify is often added to antidepressants for adjunct treatment of depression.

[still_crazy]

hi. vraylar has more D2 blocking/less stimulating than Abilify. my psych says its good for mania, agitation. rexulti is more for Schizophrenia maintenance, when depression and negative symptoms are a big part of the picture. Abilify is in between, according to --this 1, individual, psych prescriber-- .

Abilify has a whole lot more data on it. its...good for me, but its still a neuroleptic. mirapex seems like it might do what low dose abilify is supposed to do without...being a neuroleptic, and therefore carrying all the risks --all-- of the major tranquilizers carry, no matter how 'atypical' (EPS, TD, dypshoria, NMS, etc.).

for a while there, low to moderate doses of Seroquel were popular in milder Bipolar disorders. weight gain, metabolic issues...problems, potentially. but, on the + side, its low potency, and low potency tranquilizers usually= less EPS, less akathisia, but more sedation. also...at 300mgs or so, Seroquel can control agitation, (hypo)mania, and then a metabolite functions as an antidepressant, too. I forget the dosage, but...it actually takes a couple hundred mgs/daily for Seroquel to act as a neuroleptic, and not just...a densely sedating antihistamine.

lamictal seems standard for Bipolar II. I've taken trileptal, which is kind of an alternative to either tegretol (chemically related) or depakote (covers hypomania, etc.), but with minimal blood work. Problem there is...the data is actually kind of sparse, so in the US its "off label" prescribing. Also, trileptal can cause depression. happened to me...what fun! :-(

wellbutrin? right now, the going wisdom is that it can lift mood without as much of a risk of 'switching,' but...i dunno. chemically, it is closely related to Tenuate, a milder, stimulant type diet pill that was semi-popular for a season. there's a higher seizure risk than with some (many?) other options, especially at...I think its 400 or 450mgs/daily, it goes up, considerably...

and with drug-drug interactions in the mix, its not always the best option, -but- it did help me, with the full dose Abilify, till I got jittery after a while. no big deal...i stopped it, i was sleepy and pensive for a bit, then i was OK.

now...the thing about Bipolar Disorders (I+II) in the 21st century is...its a lot of people with very different problems, who share only the label. it used to be that "Schizophrenia" was the label applied to most people/patients, then the antipsychiatry movement happened, blah blah blah, now...

varying degrees of "Bipolar disorder" are assigned to problems that would have been labeled differently, in years past. a better way to deal with this might be to consider a "drug-centered" approach, not a "disease model..."

as in, instead of "I have Bipolar (I/II)," break it down...so, maybe (I don't know you, so this is just an example) "I have recurrent episodes of very low mood, occasional episodes of better than normal mood, and agitation is a problem at both ends." again, that may or may not be you, I'm just throwing it out there. Another drug-centered way of approaching your problems might be to try to replace something like "I've had limited success with antidepressants" with "I did not do well with the ssri drugs, because of apathy and lethargy. I found that stimulants provided a mood lift." again, that may or may not actually be your situation, i have no idea, but....breaking it down so you and the psych can work on identifying drugs that will address your main problem(s) is often more helpful than saying "I have Bipolar (I/II)."

ok. i hope this helps. as a side note, i will say that if you (or anyone) can avoid a neuroleptic, try to do so. im not 'antipsychiatry,' i even take a full dose of one, but...avoid, if you can. safety 1st! :-)

rovers, I just wanted to welcome you to Psych Central. I see that you are still fairly new here.

I have bp1, not bp2, but am enjoying all of what has been written here. There are a lot of learned, wise, and helpful members at this forum.

[Sunflower123]

I take Abilify (tapering off) and Vraylar. I’ve not had problems with hypomania.

Good luck finding a combo or med that works well for you.