Aa
Aa
A
A
A
Close
574118 tn?1305135284

A safe AD

Hi Folks
People like MonkeyC, Buldozer and ILadvocate posts are really informative. Here is my case and pls give it a little thought. I probably duplicate some of your queries:

I was diagnosed bipolar after a long journey of OCD. I assume I must be bipolar all along without knowing. It was the tricyclic antidepressant (Anafranil) that caused my 1st mania. So either I was bipolar all along, and the AD only set it off or that even if I'm not BP in origin but since I had my 1st mania then I am classified from there on BP.

After a few trials I settled with

         Stelazin (trifluoperazine) 2 mg
         Xanax (benzodiazepine) 0.375 mg
         Risperidal ( risperidone) 1mg
         Seroquel (quetiapine) 25 mg  
         Tegretol (Carbamazepine) 100 mg

So I take 3 antipsychotics and one antiepileptic. Although 3 AP are many, the doses are sub-therapeutic so my pdoc say they act more like sedatives.
My problem is that although stabilized a few days, a little of depression usually arrives. Not depressive ideas but laziness and not wanting to do much work. I fear from AD especially the tricyclics to drive me manic again and the vicious circle. So perhaps a good mood stabilizer is the answer. But which? One with the least side effects.
I have 3 Questions:

1. Can you tell me the least harmful i.e. the weakest antidepressant which can maintain me without driving me  manic.  They say BP tolerate well lexapro (SSRI) others say welbutrin (stimulant) what about MAO ? is it still in use?.
2. What do you think of Lamictal (Lamotrigine). I heard is good for BP and was approved by the FDA. My pdoc say that had we started it before then it's OK but now we went far by the above drugs. Can you tell me whether I can start it? Or it's too late?
3. Tegretol is not used anymore in the USA due to drug interaction. Which you think is a good MS with the least side effects? Apart from lithium and depakote.

N.B: I only tolerate low doses of drugs

very GRATEFUL
Ezz
8 Responses
Sort by: Helpful Oldest Newest
Avatar universal
I take Lamactical (Lamotrigine) and it really helps me stay level.  I have "lazy" periods at time, but have not serious depression or manic episodes since I have gotten the leveled dose I am on now.

It's an anti-epilectic med, and I feel better than I have felt in a lllooong time.  

Cymbalta wasn't good for me, but I took it with an ADD med, and it made me go manic, so it might have just been the combo.  I don't take and AD med right now.  He has mentioned that we might try one, but right now, I am doing ok on the mood stabillizer.

I have taken a huge assortment of AD's over the last 20 years, and the Lamactical is the best I have ever - ever felt.

Good luck!
Helpful - 0
626901 tn?1261872805
I have been on lamictal for a few years now, along with low dose risperdal and cymbalta.  this combo works well with me.  I still have mood swings but they aren't as severe as they had been in the past, and my family and I can deal with them without things getting "out of proportion".  I've tried lithium and for some reason it messed with my eyesight after about a week, so I can't offer much on that one.  In the 4 years prior to this combo I was on a number of different meds, with little to no side effects, just little to no results for me either.  Good luck with your search!!
Helpful - 0
607502 tn?1288247540
Sadly not available in australia nor approved - its apparently considered a drug of potential abuse here and thus the TGA who manage this stuff have rejected it - its not used much outside of Europe and Latin America.

Ive just checked and its not in MIMS which is the prescriber database (dont ask how) either under any name.  Pity as it looks interesting.

Helpful - 0
574118 tn?1305135284
Thank you very much for all of you
ezz

Incidentally. I have just read about something called Stablon (Tianeptine) here is a link
http://en.wikipedia.org/wiki/Tianeptine
look at it could be your choice monkeyc it's an SSRE (enhancer) it's not MAO. I read good things about
ezz
Helpful - 0
607502 tn?1288247540
One hears side affects about Lithium for 2 primary reasons : its been around since the 1860's and thus has had well over a century to collect a list of side effects as long as your arm most of which do not affect the average patient and second its generic and thus cheap - its very hard for a doctor to prescribe lithium when the drug rep has just been in that week with the latest freebies and information on the new wonder drug of the moment.  Lithium is seen as old fashioned by many pdoc's and its more common I have found to see younger pdoc's wanting to try the latest wonder drug of the moment - the good things about the drug I already mentioned - its also a natural product (a heavy metal even) and not a psychoactive.

The bad thing from a drug company point of view but good from a patient point of view is cost per dose is low.  Downsides include the careful monitoring needed (if you dont like blood tests lithium will suck) and the length of time it takes to build to theraputic levels - those levels also tend to be quite narrow.

No drug is right for everyone, thats why we have pdocs but when they prescribe a drug go out and read about it, learn about itm understand it and be an informed patient, that way you can discuss this with your doctors inteligently and get more effective treatment - rliz said to me something today that makes a lot o sense ; she referred to her medical 'team' which she works with and it is a team and to be a team player you need to learn the moves.  I firmly believe you should never take anything without learning as much as you can about it.

Every single MS has side effects - Lithium in fact is one of the mildest of them in some respects - for example weight gain may happen on lithium as it affects thyroid in some patients but its almost certain on some of the other MS drugs.  And thats before you look at the list of side effects of the atypical AP's and AE drugs which ca be alarming just to read.

There is no such thing as a psychiatric drug with zero side effects.

I guess the thing to do is talk to your pdoc about what is best with an open mind and then you and he will be able to make an informed decision about what is best for you.  As for a cure.  No.  Its not going to be cured is my thoughts.  We have been studying MS for a lot longer and still do not understand it fully.  But you CAN live a normal life with BP.

I have BP2 and I have a career, a marriage, and a generally good life - its not perfect and I have my bad days but I dont consider my illness is a bad thing or a good thing it just is - there are some good effects of BP - it makes you appreciate the good days more and you get to experience life in a different way to other people, yes there are bad sides but on the whole you have to learn to take the good with the bad (and thats hard sometimes, trust me Im having trouble myself right now)
Helpful - 0
574118 tn?1305135284
Thank you guys

You've been of much help.

At first the 3 AP do'nt cause any side effects for me except a little sedation.  I sleep well at night almost 11 hours. The reason for the risperidal when I started on my OCD years ago, it organises my mind. I tried to wean off stelazine a week ago but had all the distortion in my brain, rapid racing thoughts,etc..so I returned taking it. Seroquel oh dear seroquel without it I would have remained manic. So I don't see how can I taper off from them. However since my pdoc seek an MS I objected to the lithium and depakine. One hears side effects. I said tegretol he advised 400 mg. I couldn't stand more than 200mg but intermittent headache. So I cut it to 100mg and seroquel 25mg. This combo works fine or so. Yet my fears is that the same combo a month ago after a few days I started to be lazy so I went back to my anafranil AD. Only 5 days with it and I was on the verge of a mania. I cut it directly and hit my head with my hammer (seroquel) to get back again well. So you see I am anticipating depression. But not the bad depression one hears of. I only need a very weak AD to lift me a little bit. My pdoc says Stablon I wonder whether it's MAO I never tried it.
As you said if life is ok why messing with other drugs. You are right except what can I do if I felt depressed soon. The answer one should take an MS. But which one? I suppose one like lamictal which suitable to depression. OR another MS in high doses to prevent the mania under an AD.
This illness is like in engineering trying to rectify an alternating current into a direct current. This they do through a rectifier (AC to DC converter).
Do you think I shall live to see a cure to this illness. I am 26 years old?
thanks
Ezz
Helpful - 0
607502 tn?1288247540
Im sort of going down the same path myself - I have such a bad past history with Proza that asking me about SSRI drugs is likely not going to get an honest unbiased reaction - they come with some risks but they are heavily used - Id say talk about it with your pdoc and be aware that in a portion of BP's (which varies depending on who you read) they can cause sever mania and suicidal thoughts and actions.  They may however work for you  (my major problem with SSRIs is the massive over use of them by doctors - they join Ritalin and Viagra as the most over prescribed things around)

Im looking at Wellbutrin which is an SNRI - this class of drugs appears to be much safer with none of the mania in bipolars and its what I will be asking my psychiatrist about next I see her and/or my GP.  My major problem is i need an AD that is non sedating and will not affect my ability to function and do my job otherwise its a waste of time.

As for Lamactil ive heard very good things about it, I dont know if its too late fo you to use it but then again i have never seen anyone on 3 AP drugs before at the same time either. Don't you get side effects? I mean at those doses all I see is a profit generator for medical companies - if they act as sedating my question to the doc would be why do I need sedating?  Isnt there an effective MS that can replace al of these meds which are long term not going to do you much good..

I am on record as being a fan of lithium, it works very well for me and many people and I like it because it is not a psychoactive and it does not become addictive, you can come off it if you need to and the side effects are often way over hyped not to mention it is cheap and generic.

Carbamazepine (Tegretol is a brand name for it) is still used in australia and NZ - its the second stage drug for many Bipolar patients here as per the college of psychiatrists treatment guidelines although Lamactil is becoming common - it does have a have a lot of interactions (not least of which rendering oral contraceptives ineffective) and side effects but its still used.

I myself would need a lot of convincing to move off lithium as it works for me, I am going to speak to my doctors about Wellbutrin as an AD myself - im not sure if that helps any.
Helpful - 0
Avatar universal
Hi,

I have heard that Lamotrigine is very good for BP, I know of someone who has been on this I shall ask them to comment on this thread for you.

Although AD's tend to have nasty effects on people with BP they can be used in conjunction with mood stabilizers, although there are some that through experience a lot of people would say they haven't got along with either on or off MS - such as prozac.

MAO's are still in use and tend to be given when all SSRI's have been tried to no avail.

I would suggest that if your MS and AP's are working well it would not be a good idea to start messing around with them, it can be so difficult to get the right MS for each individual.

Obviously none of us here are doctors so all we can really do is tell you are own experiences and each person is different.  I am certainly looking to include an AD in the cocktail as I tend to be more towards the depressive end of the scale and the winter months are particularly difficult for me.  If memory serves me correctly my psych has said that it will be the MAO next time as I have had no joy with the SSRI's which either send me manic or even more depressed.

I am sure that others will be able to offer even more advice, I have only been on this road a relatively short time (not diagnosed until approx 3 years ago).  Since being on MS (I cannot tolerate anti-psychotics) I have only tried one SSRI and that was citalopram, this worked for a very short time before my depression hit again despite the maximum dose.

Helpful - 0
Have an Answer?

You are reading content posted in the Bipolar Disorder Community

Top Mood Disorders Answerers
Avatar universal
Arlington, VA
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
15 signs that it’s more than just the blues
Discover the common symptoms of and treatment options for depression.
We've got five strategies to foster happiness in your everyday life.
Don’t let the winter chill send your smile into deep hibernation. Try these 10 mood-boosting tips to get your happy back
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.