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, 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)
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.
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 :)
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:
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.
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
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.