I don't want to take mood stabilizers

I'm probably going to sound like a typical person with mood instability who refuses to take their medication, but hear me out. I've dealt with depression for ~7 years in various degrees. I'm 24. My dad has bipolar type I.

In the past year I have come to believe that my form of "depression" doesn't have much to do with sadness and feelings of melancholy, but rather lack of motivation, apathy, and in general the normal functioning of cognitive processes that have to do with reward mechanisms and goal-orientation. I'm a huge procrastinator and have a lot of avoidance mechanisms I engage in, most commonly pornography which I have used daily and compulsively since high school. I do occasionally feel sadness and despair, but this is usually resultant of the situation I am in in my life, e.g., lack of job, lack of money, problems getting worse because of my procrastination, etc. There are few times that I feel sad for no reason at all, but to be honest, I've almost always been in fairly stressful and unhealthy states in my life so I can't really judge.

I have limited knowledge of pharmacology/neuroscience, but it seems that my symptoms have more to do with dopamine imbalance rather than serotonin. But whatever neurotransmitter that is involved doesn't really matter so long as I'm on a medication that adequately treats my symptoms. I have been on multiple mood stabilizers (depakote and risperdal) and antidepressants (Welbutrin, Effexor, Lexapro). The mood stabilizers seemed to have made more stable, but I'm not sure if I actually perceived that effect or just expected it. The antidepressants varied in effect. Effexor made me feel very speedy and sociable, but I was a senior in high school when I took it and had recently had a very bad psilocybin mushroom experience which caused me to fear I was schizophrenic and gave me TERRIBLE anxiety. Because of this, I can't really say what the effects of Effexor were.

Lexapro gave me a feeling of light euphoria and social connectedness. I felt very empathetic, and shortly after I started taking it, my girlfriend at the time and I broke up. It was the healthiest and most mature break up I've ever had. Lexapro didn't cause that, of course, but it certainly helped my attitude. But after a couple months I stopped taking it because it seems that it caused eye floaters (though this may have been coincidental) and I was ashamed that I was taking an antidepressant, partly because of social stigma, partly out of personal beliefs.

I took Welbutrin in high school and can't really remember its effects. The only thing I can remember is being more optimistic in the morning. I started taking Welbutrin again last fall. This time, it produced a dramatic change in my behavior. Prior to taking it, I was living very irresponsibly by spending a lot of money on food and alcohol, not going to classes, playing games all night, and sleeping all day. Literally the day that I started feeling a strong drug-like effect (two or so weeks after initial ingestion) I felt a very uncanny desire to engage in more healthy, rational behavior. That day I started meditating, went to the gym, cleaned my house, budged groceries (which I never do), studied photography techniques online, organized, etc. This behavior lasted two or so weeks. I also stopped looking at pornography completely and had very little interest in watching it.

But alas, the effects ended completely after a month or so. My doc switched me to Lexapro, but this time rather than making me feel more empathetic, I felt very emotionless, but stable. I didn't feel very sensitive or caustic, which was nice, but I also didn't feel much of anything else either. My girlfriend was becoming very concerned (especially about the erectile dysfunction), so I stopped taking it.

In regards to mood instability, I generally feel that my mood is stable, i.e., low. There are times when I get sudden spurts of creativity and energy. These almost always are caused (apparently) by being really excited about some idea I'm contemplating. They don't seem to arise ex nihilo. They seem to be causally related to what's going on in my mind at a conscious level, though I won't deny that I don't have proper insight into any such mechanism/relation. It makes sense for me to call these states "hypomanic." They are short lived (less than a day) and don't feel like any full blown mania I've read about or seen in my father.

There has been one exception. Last summer (2013) I traveled to Europe to study abroad for a month and backpack for a week. I spent most of my time in art museums, sometimes spending 10-12 hours view paintings and sculptures. The combination of being alone (while backpacking) and viewing so much dramatic works of human expression sent me into a very euphoric, poetic, but extremely sad state. I was extremely lonely and was desperately wanting to connect with someone on a spiritual and emotional level. I was in a sort of hell living between two works simultaneously, the one of art and beauty, the other of banality and indifference.

That state followed me throughout Europe. At one point I stood on a bridge above a river contemplating suicide. I was drunk. I do not think I actually wanted to do it, but I was frustrated and didn't know what to do.

When I came back to the states, I was supposed to graduate college in the winter. I could not focus on my studies. I usually procrastinate enough as it is, but this time it was especially bad. I felt very sensitive and irritable in class. I stopped going to class completely. During the nights I had a lot of creativity and I would experiment with my camera constantly and surprised myself with how many interesting techniques I could find. This was abnormal as I usually feel very self-critical and hard-pressed to create interesting art and my childhood was not spent pursuing art, even though I really wanted to.

The feelings of creativity were also met with extreme sadness and loneliness. I lashed out at friends and family when they wouldn't be present with me or listen. The feelings of aloneness were so bad that I would roll around on the floor wanting to pull my hair out, but at the same time I was feeling utterly alive.

My doc put me on risperdal which did not seem at the time to have any effect, though in retrospect, I stopped feeling those manic states, so I guess it did. He then put me on the Welbutrin. After the two weeks, the Welbutrin had all of those positive motivational effects.

Since last year, I haven't experienced any states of mania and have not been on a mood stabilizer. I do occasionally feel those hypomanic states, though. This usually consists of me sitting at the computer reading, then walking in circles while I contemplate some idea I want to pursue. It generally does not persist the next day.

I started seeing my dad's psych because of a worsening feeling of apathetic depression I've had. I have struggled to leave the house and find work, even when I have zero money and am not paying my credit bills. I'm digging myself into a whole, so I wanted to try medication again.

It was taking a long time to schedule an appointment with the doc, and I had leftover Welbutrin so I started taking 150mgs. The effect the following few days was feeling a little stimulated and more anxious. Today (it's been about 8 days since first ingestion) I've felt very motivated, more focused, and elated. For the past week I had been compulsively playing online video games. Today I did not want to do that and immediately went out and bought some literature, which I have been engrossed in for the better part of the day. This sudden shift is very similar to what I experienced last fall on Welbutrin.

I saw the doc last week. He immediately wanted to put me on a mood stabilizer. I used to see him when I lived with my dad 5 years ago and he had me on Depakote. He thinks I have a mood disorder, though he is disinclined to saying if it is bi-polar or whatever. His belief was that it is very important to regulate my mood because mood instability is dangerous. He provided me a lot of examples of great human beings who experienced mood instability and had difficulties because of it. His explanation was aggravatingly elementary. I felt like it provided no insight, at all, into what I was/am going through. He strictly follows the DSM in believing that, if you have had at least one change in mood, you have a mood disorder. I'm not sure how to interpret that.

So, I thought I'd give in and take another mood stabilizer. I decided on lithium, he basically left it up to me which one to take. I chose it because another psych diagnosed me with type 2 bipolar and prescribed lithium, though I never took it because I was afraid of its side effects. He did not want to put me on an antidepressant until I was on a stabilizer. I understand why he is erring on caution, but I'm also concerned that I'm seriously f*cking up my life through not getting out of bed, playing video games, and not looking for work. I'm close to being on the street. It feels like mood stabilizers really are not going to do much for me, and honestly an elevated "shift" in mood would seem to help.

I'm still taking the Welbutrin, though I have not told him. Perhaps this is dangerous, but I'm desperate. I'm still taking the Lithium, though it's only been a few days. I wanted to write this out to see if someone has some insight. Sorry it is so long.

That was a lot. In your first paragraph your description of depression is very common. Very often it has nothing to do with sadness and has everything to do with lack of motivation and avoidance. That is how it is for me.

Sounds like you have had decent luck with anti depressants overall. The psychiatrist would be concerned with one like wellbutrin because it is so activating that it might trigger mania or hypo mania.

Typically for bi polar I or II an anti depressant and a mood stabilizer would be used. Nowadays the atypical anti psychotics are real popular for some reason. Even for depression and anxiety. Risperdal is an AAP.

Its up to you if you want to take meds. you should do it under the supervision of a psychiatrist and not hit and miss. something you have to stick with for awhile and see how things go.

If the wellbutrin is working and you want a mood stabilizer I would suggest Lamictal instead of Lithium. It has a very low side effect profile and helps with depression. it is very popular with psychiatrists today. I started taking Lamictal before I switched anti depressants and I felt a big lift in mood elevation. it didn't eliminate any other symptoms but it did elevate my mood. then I switched anti depressants to fetzima and it worked. it is very activating like wellbutrin and even with the lamictal it make me hypo manic for two months. nothing bad though and it leveled out.

If you had a "full blown manic episode" or "mixed mania" in europe and after and your father is bi polar I that is why they would be worried. Anti depressants can trigger it too. It maybe 10 years before you have another one but there is no way to predict so they want you on the mood stabilizer.

I read most, but not all of your post, so I apologize if I miss something in my reply. You pdoc is wise to get you started on a mood stabilizer before an AD because it does take some time for them to start working. I'm taking lithium and lamotrigine (lamictal) and an AD, with a plan to get off the lithium once the lamotrigine is at the right level. I'd always heard that lamotrigine can be a boost to ADs and also is somewhat of an antidepressant itself, but it was news to me when my pdoc told me the other week that lithium can also be somewhat of an anti-depressant. All I know is that right now I feel really normal, and that's good.

So, you have options. See how you do on the lithium--make sure your blood levels are checked with each increase and that you drink a lot of water. It might lift your mood enough all on its own. And/or switch to lamictal/lamotrigine for your mood stabilizer because it has fewer risks. It takes several weeks to ramp up on lamictal because of a rare but fatal rash, so that would be a reason to be on both stabilizers. Lithium works more quickly, which would allow you to get on an AD sooner if you find that you still lack motivation and engagement with daily life. Once you are at a therapeutic level with the lamictal, and doing well, you can try to drop the lithium.

It will take some trial and error, but once you find what's working, try to stick with it because it's hell to start up a few years later and try to figure it all out again.

Just my two cents.

It might help if you asked your doctor to refer you to a clinical psychologist who has experience of using approaches like Cognitive Behavioural Therapy and/or Acceptance and Commitment Therapy with his/her clients.

Often a combination of those approaches and medication is more effective than either is in isolation.

When they say something effects (agonizes, antagonises etc.) serotonin or dopamine, or what have you, they neglect to add that the drugs typically have a much broader profile of effects than that. A drug can have varying effects on all of the transporters AND on metabolic functions too.

Another weird thing is that drugs can have counter-intuitive effects, especially at non-typical dosing levels... like low-dose naltrexone for example.

So much this. I wish there were magic pills in Psychiatry, but there just aren't.

Thanks all for the replies. Sorry my post was so long. I guess there are a lot of things I've wanted to address and I haven't been able to do so with past psychiatrists.

In any case, I'm going to stay on the lithium and wellbutrin. The wellbutrin has given me a lot of energy the past couple days, but it has made me hypomanic. I haven't been engaging in dangerous activities and actually have been very productive and excited about learning and experiencing life.

Last week I bought a PS4 on credit, which was incredibly stupid. I was binge gaming all last week until the Wellbutrin kicked in. Today I decided to return it. I have no regret or attachment like I usually would. I have no impulse to obsessively game. I guess this is an effect that I really appreciate about Wellbutrin; it seems to provoke rational decision making.

I don't just want to be on medication. I also want to see a therapist who uses evidence-based methods. I'm just dreading having to go through all the initial meetings until I find someone I like. I don't just want to call the first one who looks good and stick with him/her.

I don't know what to reply. I just wanted to say that I read your post, I hear you, and you're not alone.

A therapist is a great idea. Make sure your meds are managed by a psychiatrist. For one thing you need refills. For another if you take Lithium you need regular blood tests. High levels can be dangerous.

Thanks. It's important for us to all be heard.