lots of medication questions

Hi,
15 years ago I went to the family doctor with mild symptoms of depression and social anxiety. He prescribed me paxil. Finally I had energy again, when I look back on that period it was false energy and I did things and took decisions that I might not have done when I wouldn't be on paxil. But who am I? The doc is the "specialist"... I thought....
Now, many years and many therapies later my depressions only worsened. Sometimes I go hypomanic on paxil and even on remeron (although I cold finally sleep) I had a lack of inhibition. After i took paxil last september I suddenly had this false energy again, 7x/week to the gym, plus a martial art, sometimes twice a day, agressive, just 3 hours of sleep, impulsive, lack of inhibition and judgement, spending money, risky sexual activities, lots of alcohol, unstoppable speech, study beside my full time job and who knows what more. I switched to remeron which finally made me sleep. After a couple of months I got completely exhausted, first I thought it was the remeron so I quit but as a result I became severely depressed, my day/night rithm was completely reversed and even worse: I didn't come out of bed for a couple of weeks or more, didnt eat, hardly drank and I didn't even care if that would be the end. Was that all the result of the remeron, or was it because finally I was exhausted because of excessive sport? Or was it the depressive crash after a period of hypomania?

Sometimes I wonder if it is just the medication making me do certain things because of a lack of judgement and inhibition, or is it a combination of a lot of factors? Now I am calm, I only take seroquel (sometimes promethazine) to help me sleep. What would happen if I take remeron now, now that I am conscious about this false energy, that I don't go sporting excessively anymore? The state I described above was not solemnly the result of paxil. I had a very hard time, relationship problems, exhaustion, sleeping problems, a lot of stress. Might all that have contributed to that state? Is it possible that a medication induced hypomanic state can last for a couple of months? Or was it "just" an extreme way of non-constructive coping with my problems?

Always in my life, a lot of things are mixed up. Never I can point out one factor. (and never there has been a period of 5 years that my life was stable and that I can really point just a single factor for my problems)

Now I have this energy problem again, lack of energy problem. My psychologist said (in contrary to that family doctor 15 years ago) that I am an expert in medication because I am the only one who knows what it does to my body. But what medication should I take now? Paxil I don't prefer and in the end it didn't even work anymore against depression, on the contrary it made me tired. Remeron I don't know, it is a good sleeping aid but does it work well as anti depressant? My psychiatrist mentioned wellbutrin because it seems to have the least possibility to bump me into a hypomanic state again and might even help with ADD. But how about sleeping problems? What else can help in my social anxiety, depression, energy problems and sleep, without being to hard to wean off? Tried lithium for a couple of weeks but even on the lowest dose (200mg) I already had severe side effects like drinking a lot, dry mouth, thirsty and going to the toilet a lot of times (which isn't quite helpful at night while I already sleep very bad).

I live in Holland, how is it in other countries, I mean choosing the right medication. Is it a mutual decision, does the pdoc decide, can you decide or suggest meds? I don't always want to be the wiseacre (at least that family doc 15 years ago gave me that feeling) but on the other hand what my current psychologist says, he might be right.

Sorry for the long story and it is not even coherent but I wanted to share my experiences.

Sounds to me,like you should be assessed for bipolar disorder, since the anti-depressants seem to trigger what sounds like mania in you.

And I've heard that the depression crashes that follow mania can be severe.

Are you seeing a psychiatrist or a family Dr. If you're not seeing a psychiatrist I'd ask for a referral to one.

Tell them bipolar has been suggested - maybe show them a copy of your post since it explains your responses to medication really well, and then ask about mood stabilizers.

Good luck.

splitimage

I think your psychologist is right. You are the expert. Especially if you have taken them a lot. My psychiatrist lets me pick pretty much what to do. Or he may suggest and I go along. It is a partnership.

Anti depressants can for sure trigger hypomania. When I started my current one, Fetzima, I was hypomanic for two months and then it balanced out.

I take Remeron for sleep and it works great but for me it is useless for depression. I would rather use it than Seroquel unless the Seroquel was helping other things.

It's trial and error. Maybe dump the paxil and try the wellbutrin.

The thing is there is a huge variation in how me metabolize these meds and then how the active metabolites affect us. A psychiatrist has no may to predict. It's like throwing a dart. I think the most reliable and consistent ones are the benzo's for anxiety but they have other problems. I think ADHD meds are more reliable too. Antidepressants and atypical anti psychotics....its any ones guess and you just have to try if you are willing to play the med game.

the seroquel is also for agitation. i found the withdrawal from mirtazapine horrible.

Lamictal is used a lot as a mood stabilizer for bipolars.

I haven't had many docs ask me what I wanted to take, although I have been given a few I recommended--and they have worked!

Have you tried Ambien for sleep?

Just some thoughts, I don't know what will work for you either, but I know how tough it is to be bipolar, so I hope you can get stable soon.