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Avatar universal

Medication for Cyclothemia-HELP!!!

I have resently been diagnosed with Cyclothemia.  I am over 40 and for the past decade I have been diagnosed separetely with Depression, Anxiety Disorder & Bipolar II.  I have taken many combinations of medications and NOTHING has worked for me.  At least now I think I have been labeled right so I want to find the right combination of medications so that I can live a normal life.  I feel like my psychiatrist can definitely help but I want to do my own research as well.  I have cronic depression and hypomania.  For years I took Anafranil and that seemed to be the only medication that helped me.  It doesn't take away the depression but it really helps me with anxiety, racing thoughts, busy mind and other issues having to do with hypomania.  My doctor resently perscribed Prozac and it right away took away my depression but then I bacame manic. IThis reaction is so strange as I had never experienced mania if it wasn't for Prozac and it also happened in the past when I tried Lexapro.  Doctor perscribed Lamical and it has helped a bit but I just feel like I need to find better medicines for my diagnosis.  I have tried just about all stabilizers and none have really helped me.  Sometimes I feel like going back to Anafranil because it just gives me peace of mind although it does nothing for my depression.  Any advice on what alternative medications could work?  I was thinking of combining Anafranil with Prozac???
10 Responses
Avatar universal
What dose of Lamictal are you taking?
IMHO, Anafranil with Prozac would not be a good choice, too likely to cause mania.  
Perhaps Anafranil with Lamictal?
Avatar universal
I'm cyclothemic and 40!  I'm current on Seroqual, it's a wonderdrug, it worked immediately, and my mind was going a mile a minute. You can also adjust the dose as needed, though you must talk to your pdoc first. I try an extra 25-50mgs before using ativan, as the Seroqual just long term works better.(but if I need Ativan I will take it)

I am off all SSRI's, including Prozac, that drug can indeed cause anxiety, like most SSRI's. I take Lamactil, it's slow acting and takes a while, but darn it, it's better then an AD I'm on. I've gone more then 2 weeks without a remotely suicidal thought, and that's a miracle for me. I'm currently at 200mgs of the Lamactil, give it sometime. Remember, no drug is a cure, you have to work at it too,.like group/individual therapy. I hope this helps. LCC
574118 tn?1305135284
Your post is strange to me, for yet you said you turned manic after the SSRI prior to it you said you were dx BP. What made your pdoc suggest BP. If it is depression only then it's cyclothemia for sure as the other manic pole is not present unless you trigger it by an AD. In this case I believe your drug is lamictal. Of course I am not a pdoc but can tell from my experience because it's my case typical. Although I haven't tried the drug but believe in it for my case. It's just that I am stable for a month on AP only. Seroquel is the magic pill for me and I'm giving it a try. Note that for lamictal to work it takes 9 weeks to kick titrating up to 200mg. Be patient and don't fidel with many drugs.

Look, from what I gather from my readings and participation in many forums across the world, you wouldn't need to test more than either lamictal, seroquel or abilify. These 3 are the best for your case. The 1st AC for depression. The 2nd is antimanic and a moderate MS. The 3rd is AP atypical like the 2nd but a 2nd generation stabilizing the dopamine instead of supressing it.

that's my modest view
Avatar universal
Some folks don't go fully manic until an AD like Effexor or Cymbalta pushes them there. I always had anxiety, but in hindsight, I was really manic in my 20's - I was very hyper, took on way too many projects, couldn't focus, had quite an ego, did dangerous things.had compulsive behavious - all  classic mania. I then went into a long term moderate depression for 10 yrs, with break outs of serious anxiety and mini manias.

Are you trying to diagnose me or someone? It sure sounds like it. It seems you are having difficultings expressing yourself, is english not your first language?  Google has a translating tool that's good so you can express yourself better.

I highly suggest you steer clear of attempting to diagnose someone or suggest lines of drugs, including myself.

. I was told it can take up to 3 months to be at a therapeudic dose of Lamactil, but only the pdoc and patient can decide. I'm am now at a stable level of Lamactil and on LIthium, the combination of drugs are good for me, the Seroqual really helps with the mania and anxiety.  For me it's a good combination, maybe not for others.  It's good to be well read on the different drugs for sure.
574118 tn?1305135284

I'm afraid I don't suffer from any handicap in English and my letter was addressed to deeleedee and not to you.

Don't take it that I am angry or the sort, on the contrary I thank you for your mail. I was only trying to help with my modest view which I acquired for the last 3 months about BP. Although a little period but I read like mad and surfed the web and participated in dozens of forums.

BP is hard, perpetual, cyclic and totally unstable. The less med you take the more your control over the illness. Psychiatrists rank it 2nd after schizo in the queue of the 5 main psychic illnesses (along with OCD, depression only, and anxiety etc..).

Among the 5 main drugs which helps (apparently a lifelong disease but not for sure ), starting from the lowest level of tranquilizers being addictive only i.e. with little side effects: the benzo's say, till the utmost one the lithium (the only MS and the worst in its side effects) and passing by the AD, AP and AC, it is the ******* AD (excuse my word) which constitutes the keypoint to the illness. If the person doesn't take it , then, in my view as well as others, he is on his way to recovery and prophylaxis. Why is that, because AD throw you into mania most probably and thus the viscious circle. For example I was dx OCD 6 years ago and I took anafranil (tricyclics) and I kept oscillating between hypomania and depression. So your friend saying she can combine anafranil with prozac is the worse thing she can do (in my view of course not being a pdoc). So unless her depression is horrible and suicidal, you try - if you can of course - to go to the gym, try a boyfriend, stimulants, omega-3, don't stop trying everytrhing, then if you give up you go for an AD. Pdocs advise welbutrin for BP, some lexapro, some st-John wart. Unfortunately all AD turns you manic unless you are not BP. This is why they advise an MS to go along with it.

So my view (I mean here to report it to her pdoc, i.e. to discuss it with him/her) is to mention lamictal (AC) and abilify (AP). They both work upwards i.e. good for depression. With this she hits two birds with one bullet. But being suitable for depression, they have one disadvantage of making the person anxious or having perhaps an insomnia. In my case I don't use them because I believe in the proverb "if ain't broke don't fix it". I am stable for a while with seroquel, it's a magic drug (antimanic) so no need to change. Again - in my view only - lamictal+seroquel is perfect because one works upwards while the other downwards thus an equilibrated combo. Both have little side effects and no "excessive" weight increase.  

thanks again


Avatar universal
I agree with you on those two drugs, they have worked wonders for me as well. I still have mild hypomania which I control, and have only had one serious hypomanic episode, because I had too much coffee!
Both Seroqual and Lamactil have very few side effects to them, and from what I am told the safest on the market. Albeit there is a slow titration of the Lamactil, because of the rare cases of a serious rash which has been necrotic in a couple of cases.

It took me 2 months to get to 200mgs of Lamactil, but my patience has been rewarded. I still take the Lithium, I don't have any side effects, and it seems to work well with the Lamactil to deal with my depression (which I have had moderately for over 12 years)  I still have social anxiety, something I have had since I was about 6, but after a conversation with my pdoc on Friday there aren't really any drugs that make a significant impact with the anxiety.  I am currently starting cognitive therapy with my pdoc, as well I am in a support group. I'm also starting a support group in January to learn new behaviours, I can't wait. I am sure like many folks, we want to take control of the BP and not let it control us. That's my mission, drugs can only do so much.

Cyclothemia is horrid and very frustrating - it's like a mini storm, you are never sure when it will start or end and so many different parts to it. I'm told it's worse then BP1 as it's more ongoing and harder to treat with meds.

I'm sorry Ezz if I came off defensive, so my deepest apologies.

Sincerely, Jane
683400 tn?1226941779
I, too, have been struggling to find the right drug cocktail. Personally, nothing seems too help with my Bipolar. I try the mood stabilizers, and they make me agitated and anxious, the antipsychotics make me suicidal..  I don't know if this is off base, or if this is something that puts you off but I was recently introduced to the idea of having Electroconvulsive Therapy because of the fact that medication just doesn’t work for me and because I am so depressed…Maybe it’s an option for you?
The only real side affect is short-term memory loss and possible maintenance ECT annually. But, on the upside "in a study, ECT was shown clinically to be the most effective treatment for severe depression, and to result in improved quality of life in both short- and long-term".
Well, that's my 2 cents. Hope it helps. If not, sorry.
574118 tn?1305135284
Electroconvulsive Therapy if it works is wonderful. Usually the statistics is 1 in every 20,000 fails, very little. But some people can't stand the temporary loss of memory, Ernest Hemingway didn't for example. Usually people exhaust all other possibilities before resorting to ECT. Besides, ECT has to be renewed every couple of years at least, yet very conclusive as far as therapy. Psychiatry says the last card you use. Try to be patient if you can , it takes a hell of a lot before you reach your combo

no hard feeling of course. Lamictal rash occurs to 1 in 1000 and lessened by titration. You start by 12.5mg for one whole week and increase it till week 9 to reach 200 (therapeutic level yet changes for every individual). But it's a wonderful drug. I never used it however I deduced its benefits by doing reflexions on it. It's only logical to be one of the best. in one of the sites they rank it 3rd. The 1st is abilify, a 2nd generation atypical AP (regulates dopamine instead of suppressing it) also good for depression but leads to anxiety the ennemy to all BP. My mind tells me you shouldn't combine the 2 drugs but you can with seroquel (my own med) because as I said it works downwards(antimanic) . Again titration in seroquel is very wide, so while abilify dose 10-30mg seroquel 400-1500mg or about.
good luck for all of us
Avatar universal
Lamactil is slow going at first, I started at 12.5, and upped it by 12.5 until I got to 100mgs, they figured by then I wouldn't have that rash, and I had no side effects besides thirst. I was upped 25mgs a week -it's a good drug, much better then any AD I've been on. Though I am still sluggish, it's better then constant mental depression. I can always go further up on the drug, and considering it. Seroqual is great, if I'm having an anxious day (with of course a previous conversation with my pdoc) I can add up to 100mgs a day if I'm manic and/or really anxious. I only take ativan when I really need it, or if I'm having a hard time getting to sleep. I'm contemplating starting a med for my social phobia, but I really want to give congnitive therapy and my support group a go before I do that, I'd rather retrain my brain first.  Drugs don't cure this, but it helps.
574118 tn?1305135284
correct. Go 1st for congnitive therapy (CBT)
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