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Meds
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Bipolar Disorder is also known as "Manic Depressive Disorder". This forum is for questions and support for people with, or for loved ones of people with Bipolar Disorder. The forum covers topics ranging from Aggressive Behavior, Affect on friends and Family, Alcohol and Drug Abuse, Appetite Changes, Chronic Pain, Denial, Depression, Difficulty Concentrating, Euphoria, Guilt, Manic Depression, Medications, Mood Swings, Poor Judgment, and Sleep Disorders

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Meds

Okay Im new to this...My doc diagnosed me with BP 2...I also have hep C and weight issues....Soooo I am here to ask you guys what kind of drugs there are out there...My doc has suggested that I reaserch it and then go back to talk about meds because she would like me to have some kind of say in this instead of just telling me to take something...Sooo any help is well taken! and I appriciate it!   I suffer extreem mood swings from highs too lows...mostly lows though...I hope that helps!
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Avatar_f_tn
That's a tough one with the Hep C, I also have weight issues too. I have found one drug that's been great, I've pretty much lost my sweet tooth altogether. I'm going to find a link of BP

Here's the link I found, it's not perfect, but it's a good start. Some of the drugs that they state first are not "first line" drugs.

There are three main categories of BP Drugs;

First  are Mood Stabilizers, the act much like Anti-Depressant but work better on the BP brain the AD's to as a start drug.

Some are actually Atypical Anti-Seizure meds, These meds listed are First Line medications :  like Lamactil, Gabapentin, Topomax (topamax), some are straight MS's like  Lithium being the oldest and longest studied drug.

(Personally Lamactilbeen a miracle drug, I've got very few food cravings since being off SSRI"s. . It took me almost 2 months to get to a therapeudic dose, but since Mid December I've had no depression. )


Second are Anti-Psychotic Drugs, AP's for short. Don't let the name scare you, they help with hypo and standard Mania, and can help with anxiety as well. ( a godsend to me)

These being the safest and are  First Line Meds:
Olanzapine (Zyprexa),Quetiapine (Seroquel),Risperidone (Risperdal),Clozapine (Clozaril) and aripiprazole (Abilify), Though Seroquel, Abilify and Zyprexa from other studies I have seen, are more affective then Clozaril.

Third Anti-Depressants, AD's for short. These are generally used 3rd if the MS and AP drugs don't work.  There is hesitancy in the literature in using these drugs because they can be activating (causes mania and worsened anxiety).  The more often used route is to have two MS's instead like Lamactil AND Lithium. Both of these drugs in concert can help significantly with anxiety and hypo/mania depending on the dosage.

These are the three meds that are chosen by Cdn pdoctors :Bupropion (Wellbutrin)
then SSRI's: fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), then SNRI Venlafaxine (Effexor).
Effexor AND Cymbalta may be more likely to cause side effects or to set off manic episodes or rapid cycling.

If all else fails :Mirtazapine (Remeron)

Nefazodone (Serzone)

Monoamine oxidase inhibitors: phenelzine (Nardil), tranylcypromine (Parnate). These are very effective but also require you to stay on a special diet to avoid dangerous side effects.

Tricyclic antidepressants: amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), imipramine (Tofranil), nortriptyline (Pamelor). Tricyclics may be more likely to cause side effects or to set off manic episodes or rapid cycling.


I hope that gives you enough meds to look up, it is always important to look up the drug monograph with anything you are taking.

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Avatar_f_tn
http://www.healthyplace.com/communities/bipolar/treatment/medications_2.asp
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607502_tn?1288251140
Umm wow.

Hi and welcome to the forums, its hard to be diagnosed but its the step forward so you are heading.  First question what sort of a doctor is this? Is this a psychiatrist

If yes then hmm if no then you need one.

Basically a doctor that asks you to do your own drug research is of concern - they have medical degrees and access to databases of drugs for good reason - they are expected to be able to prescribe them.

There are some good resources out there on drugs but it depends on what you need, not all drugs work for all people and the Hepatitis C is a complicating factor that may mean drugs like Lithium for example are not a good idea, the problem is knowing what to prescribe and thats what a doctor is supposed to be able to advise on.

There is a lot to be said for knowing the drugs and understanding their side effects and this is smart consumer practice but thats very different to a doctor setting homework.   Anyways some advice

What you need to start with is a mood stabiliser - this page has some informatiojn on the basic and common types : http://www.blackdoginstitute.org.au/docs/6.MoodStabilisers.pdf

For anti depressants this file does the same : http://www.blackdoginstitute.org.au/docs/4.AntidepressantRegimes.pdf

There are also 2 other fact sheets here which are superb :- this one is pharmacological Management Strategies for Bipolar Disorder :  http://www.blackdoginstitute.org.au/docs/5.ManagementStrategiesforBipolarDisorderpharmacological.pdf

And this one is Non-pharmacological Management Strategies for Bipolar Disorder : http://www.blackdoginstitute.org.au/docs/7.ManagementStrategiesforBipolarDisordernonpharmacological.pdf

This information is aimed at Health Proffessionals but its very usefull for the general BP person.

We cannot give you general medication advice and indeed no one should in this situation - the risks are just too high sorry because we are not doctors however there are some key things all bipolars need - the planks to the disorder if you like from where I sit.

1. Education - understand the illness, the treatments and the symptoms - education is the key to building a wellbeing plan and tracking moods and triggers and managing stress - you need to learn how to arm yourself against the day to day things that can overwhelm you

2. Medication - management is management and medication is vital in this but that means the right meds

3. Doctor trust - you need to have a relationship with your doctors that is built on trust and willingness to listen on both sides, the right medical team (and it is a team) is vital and you should not hesitate to seek second opinions or change if a doctor is not working for you.

4. Support structures - you need people you can lean on who are willing to understand who you are and what is wrong, family or friends you need people in your life who are there for you.

Thats a few off the top of my head.  We of course are here, there's someone around pretty much all day and night so never be afraid to sing out, send notes, ask for help - the people here will help you, they have helped me many times over.

Welcome to the family, you are not alone :)
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585414_tn?1288944902
  Well the hep. c. issue complicates things and normally I'd say a psychiatrist who has a consumer show a little inituitive and do some research is one I'd get respect from, rather than "take this and you'll feel better". The problem is you have to ask him if the potential of liver damage would rule out a medication and if that would be the case, not only shouldn't he have you research it, he should be consulting with your doctor. That's not a serious concern with most people taking medications but if any medication could potentially affect the liver that might not be one you could take and many medications fall in that category. Please ask him. If that's not an issue then Lamictal would indeed be a good option but if it is it may be of concern. But not all medications affect the liver.
  As for mood stabilizers I think LeftCoastChick summarized it well. "Depression Central" is a good link and this has mood stabilizers that approved medications used off label for bipolar:
http://www.psycheducation.org/depression/meds/moodstabilizers.htm
As for antipsychotics, Clozaril is actually the most effective but is a last resort medication due to strong side effects (and weekly bloodtests) so psychiatrists use that one when others fail although when I was on it although I have schizoaffective I did not require an additional mood stabilizer and that's very common. Zyprexa has strong mood stabilization effects but is being used less and less by psychiatrists because of the potential of weight gain and diabetes. Seroquel has a good mood stabilization effect. Abilify has perhaps less of a mood stabilization effect but is still used in that regard and has the least potential for weight gain so that might be the one best for you if that's an issue (Geodon as well but I would not reccomend it because of the potential of heart arrythmia which happenned to me and other people and its used less for that reason but it can be an option).  
  The antipsychotic I am on is in Phase II FDA study and has not shown any potential of weight gain but because you have an over riding physical disability I would not present it even as a potential option until its FDA approved which is years off although the new antipsychotics in study (glutamate antagonists among others) will be much safer as regards weight gain and other long term side effects but they still haven't finished controlled studies and I'm not one to reccomend an unknown quantity but when they are available I do believe they will have a greater recovery rate and a more favorable long term side effect profile including weight gain.
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700212_tn?1240764420
Thanks so much I know where your comming from with the whole research thing...she gave me a list of drugs she wants me to talk to my hep docter with and do some research of my own so I can know....In the end she will have the final say...I guess I worded it wrong I dont know Im not good at this stuff...I just want to know as much as possible before getting into something like this because I know I will likely be stuck taking these drugs for a really long time...and going into hep treatment I need the best help I can get cause the treatment worsens your anxiety and depression symptoms...it kinda ***** but Im sure Ill make it....Thanks so much for your list and your help though...I Know I def need a good mood stabalizer and Im going to try abilify and effexor...I was effexor before and it seemed to be working I think I needed a higher dose though....so well see how it goes
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723341_tn?1232341853
Hi Shnoogy,

Meds are a tough and lengthy subject, especially when there are multiple concerns involved like yours. In regards to bipolar, I'd suggest a couple of books that have been helpful to me:

My personal favorite because I felt like she just hit the nail on the head for me is "Break The Bipolar Cycle" by Elizabeth Brondolo. As I read the book I keep saying, wow, she knows me. And I exhibit BP2 symptoms completely at this point.

I also like "The Bipolar Disorder Survival Guide" by David J. Miklowitz

Both books have sections particular to medications and are helpful for general BP information if you are new to the diagnosis. They are both helpful for both the BP person and for their family members to read.

I don't know if anyone has said this already, but one thing to keep in mind that it will likely take you some time to find meds that work well for you. People react differently to the same meds, especially when there are additional complications - which there usually are.

I am going to try to figure out how to get my meds person on board so that I can more rapidly try things and/or make changes if necessary. In other words, if I'm having bad side effects such that a particular med won't be acceptable, I want to be able to contact the person and make a change or adjustment or whatever, quickly. Otherwise you can spend (waste) huge amounts of time waiting for your next appointment three weeks or more away before you can make the change. Meanwhile you're suffering with symptoms and becoming frustrated with the whole deal. This seems important to me so I'd like to pass that along to you in case you run into the same sort of situation.
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Avatar_f_tn
Yeps being physically ill can really really affect your BP, it's really triggering my anxiety/mania badly. I can barely focus for more then 10 minutes at a time.

. Even if one isn't physically ill, it's still hard. We've been dealt a rough hand, but I think you can get the right combo. The meds do work. Sorry I should have said in my post that, we can't advise you on a drug in any way, but we share stories and histories with each other.

I think it's great your pdoc is willing to include you, getting you to research, deciding what you put in your mouth is empowering and in discussion with your family doctor. Remember these doctors work for you right?
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574118_tn?1305138884
Hi

You got all the answers you need from our group experts.

I just wonder - will all due respect to your pdoc - how come she leaves you to decide upon your own the kind of med you prefer. This is not a glass of ice cream. You will have to study this BP for sometime until you become aware of what is really going on. Those people who answered you are experts because they spent so much time reading and educating themselves.

med business is complicated and what is good for you may not be so for others. It's the pdoc who decide. make sure she is not a GP she has to be a psychiatrist. I am of your age and was firmly diagnosed about 6 months ago and since then i read and read but i confess i am far behind what i should be. it's the brain and sure nobody knows exactly how it processes.

I noticed you were on effexor. beware from AD , especially you said you need a higher dose, they can transform you into rapid cycler and drove you manic easily. Usually BP pts replace AD by MS because the latter have AD properties as well. I wonder has your pdoc (instead of advising you to chose meds) made any tests to convince you that you are BP. Mood swings can come from a lot of social situations.

Again you said you shall try abilify. Why ?? it's a new drug almost. Why not seroquel? why not anything else. For example I haven't tried Zyprexa because of the weight issues and other factors. I have a proposal for you. Why don't surprise your pdoc and tell her that you shall take abilify and effexor and see her reaction. If she agreed, then I am afraid she is not a doctor. Note that all mood stabilizers have some side effects some subside after a while. The no of MS are huge and your pdoc has to study each one by one for you. It's not dfficult but also not easy sometimes you give it a try until you are on track. LeftCoastChick provided with with a nice link from which you get plenty of info

http://www.canmat.org/resources/PDF/Bipolar_Guidelines.pdf
also for MS
http://www.psycheducation.org/depression/meds/moodstabilizers.htm

also the web is plenty


good luck and welcome to our club. You are lucky because here you are in good hand. in my view the people who answered you are better than many pdocs. Beside where i come from, there is a say: "ask a patient who experienced the illness and don't ask your pdoc" i am joking of course. I only hope this doesn't apply to your pdoc.  

Don't forget that there are also other avenues like psychotherapy , CBT which helps.

good luck
ezz
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585414_tn?1288944902
I get your point about the Effexor but Abilify has been around long enough to be an established medication and it is statistically the least likely to cause weight gain and if that's a problem for someone that's probably the first one a psychiatrist would consider. Its been part of the standard treatment regimen for a while. I know a lot of people who were started on an antipsychotic and it was Abilify and they did well. It works on a slightly different mechanism than the other atypicals and does have less side effects overall.
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Avatar_f_tn
Adel is right. I try not to put personal biases, but I like Seroquel for the fact, if I'm having a more hypomanic day or super anxious, I can add an extra 25-50mgs as needed. Abilify has very strict dosing from what my pdoc said and she said she wouldn't put me on it for that fact. If your moods swing quickly being on an anti depressant can trigger your hypo/mania. Mood stabilisers like Lamactil do not.  I know there are pro's and con's, but after being on SSRI's, I would never ever wish that on a person that has long term anxiety and BP, they don't work for long, maybe 2-3yrs max, then you have wean off them which is awfully uncomfortable then hop over and titrate up on another one. A pill merry go round per se. I've been on 5 SSRI's and 2 SNRIs (15yrs). They do work for some, but why take the chance? that's why I they were 3rd on that list I posted. They aren't first line meds at all, they are to augment a MS if it isn't effective enough.

I like Lamactil on top of stabilizing my depression it has anti anxiety qualities. My brain still zips around like I've had too much caffeine at times, but I don't have constant negative thoughts bombarding me. The only way I can explain it is as a quiet humm...
I hopet his helps.
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723341_tn?1232341853
Excellent advice from everyone. As I was reading through them I had one more thought that I would like to express. Well, it turned into more than one. :)

I would suggest, if at all possible, that you work with someone, anyone, that specializes in bipolar disorder. It may not be possible in your location, and if not, that's the way it goes. The reason for this suggestion is that this is a *very* tricky illness in regards to medications, and if you don't have really good support from someone, it can be hell, and it can cause you to say **** it, I'd rather live with the symptoms than put up with these side effects. I did that, and I can tell you that it was a big mistake.

If you have bipolar it is almost certain that you will do much better on some sort of medication for it, and it is worth the time and effort to find out what meds work best for you, even if it s**** while you're figuring it out, because the alternative, without medication, is likely to result in a more rapid increase in BP symptoms. And the more that you have these symptoms untreated, the harder it is to get them under control, and the more you lose, potentially permanently, in terms of the quality of your life.

It is written that the more hypo/manic episodes that you have, the more likely that you will have more in the future, so it's a very good idea to get them under control as quickly as possible. Also, as I've learned from my friends here, the intensity of the hypo/manic episodes usually tends to increase over time.

I'm not intentionally trying to make this sound scary, but the fact is, it is scary. Just read some of the posts here and you'll see.

When I first got diagnosed, I was relieved - finally I could pin a name to the d*** thing. I started taking lithium which fairly quickly turned me into a zombie - it was horrible. I can't even remember much from that time and it was only 9 years ago, but fortunately my wife remembers.

I said, man I just can't take these prescription medications, they just always screw me up. So I stopped and went to a Naturopath for help instead. Naturopathic physicians are great and they can really help your body heal itself in many ways, and I had some very good successes with this doctor.

This one is hard to admit, but I also saw an energy healer that helped me and my wife in a number of ways. My wife still works with him amazingly successfully on particular physical issues. It may be unproven scientifically, but if you call and talk with the guy and you can feel things happening in your body while he's on the phone with you, and then the pain that you've been suffering with for weeks or months is gone, you no longer care so much about that proof.

All that said, right now, after all of it, I really wish that I would have continued and figured out the right pharmaceuticals for this bipolar. I wouldn't take back anything that I did. I still see the Naturopath who is the best doctor that I've ever had. But I feel that it is just imperative for me to bite the painful bullet of pharmaceuticals and their side effects in order to keep this thing under control as much as possible before it takes away even more of the very sheltered life that I'm left to live with now.

It feels like the world is closing in on me now, and that if I would have stuck with finding meds until I found ones that worked, I very well might still be able to work now, still feel like a productive member of society. But that is gone, at least for now. But I have rededicated myself to finding the meds that work best for me.

Two more things and I'm going to bed. First, educate yourself on this the best that you can so that you really understand it as best you can, and keep up with the latest information. Second, it's been proven that therapy along with meds is definitely more effective than just meds. Give yourself the best chance that you can with this thing right off the bat and you'll do well.

Well, there's the advice I wish I'd heard and taken to heart a long time ago. Hopefully you'll find something useful from it.
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607502_tn?1288251140
What works for you works, energy healer, yoga, shakra if it works it works AS LONG as no promises of cures are made or false hope given - the second a healer promises to cure you walk out; they are at best naive and at worst frauds.

There is nothing wrong with Abilify from everything I have read and for every one person who likes Seroquel there is another who hates it and vice versa.

Most likely in most places Lithium would be the first line drug of choice but no idea how that would work with Hep C.

Abilify would not be shocking and neither would effexor - sure SSRI AD's can caude mixed episodes and mania but so can Tricylics and MAOI's (and those should be banned outright anyway) and even SNRI's can - the thing about Anti Depressants is they should NEVER be used long term by ANYONE let alone BP's - they are usefull in acute phases but an AD in the maintenance phase is not reccomended outside of special circumstances - The reality from what I see any my experiences is a bipolar on a working mood stabiliser and following the common sense guidelines and in therapy should stabilise and not need an Anti Depressant drug long term  - if not something is not working.

Anti Depressants are dangerous drugs long term full stop, they are dependance forming, all have nasty side effects (and Adel every single AD drug causes weight gain - its part of the way they work, the ones that say they dont are lying if you do some research - they all do it - Effexor is no better or worse than any other SNRI or SSRI and if you want REAL weight gain go Remeron or and MAOI) and all of them can be dangerous to get off not to mention long term use of an Anti Depressant can and does lead to emotional blunting which makes it nigh on impossible to come off it as you can no longer deal with normal emotions on your own.
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607502_tn?1288251140
Oh and side effects are over rated and over talked about on the web - the majority of the **** written about these drugs is just that - the rubbish posted about lithium is amazing sometimes and thats just one of the drugs.

Web forums are not always the best place to research drugs - everyone has a point of view and you have no guarantee people have taken the drugs - here with a room ful of bipolars you will get honest opinions but as each drug works differently on different people..
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700212_tn?1240764420
I have tried seroquel and It made me SLEEP! as much as like sleep cause I have two youngens I have to get up if they need me and I was noticing that I was unable to get up for them and had to ween off it...otherwise I did like it, I mean besides the weight I gained
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