Generally a full mood stabilizer should work on both mania and depression and an anti-depresent hopefully should not be needed. I am aware some people with bipolar need an adjunct anti-depressent and some people are able to tolerate it and some do encounter mania. I remember when I was on a combination of mood stabilizers to compensate for one not working as well on depression as it should and that generally worked (for me at least). Perhaps you could find a referral to a psychopharmocologist as I did if you are having difficulty having medications adjusted so that they work or recieving information that might be inaccurate.They would understand this in full detail and know what to do as they are medication specialists.
IL has a good idea there. I will get back to you later today hopefully with some info as I am about to quiz my pdoc who is a bipolar specialist about the same subject. TTYL
OK adel, so my pdoc tells me that seroquel that I am on, has anti-depressant qualities. That at lower doses (up to 100mg), it merely acts as a sedative. He said that to get the antidepressant effects that I need I would need to be on a minimum of 600mg, which would also help with the psychotic thoughts.
I had bad side effects with seroquel, but the only alternative he mentioned would be to go to hospital to have a medication change/review in a controlled environment which I am not thrilled at either.
He acknowledged that like yourself, I have fragile bipolar and knows the adverse reactions I had to AD's in the past. He suggested I take cipralex AD at very low dose of 5mg for the depression and to discontinue straight away if it causes any manic symptoms such as insomnia. I said I would go home and think about it and go back in 2 days - what do you think adel? or anyone else for that matter?
Thank you very much for your concern.
Your pdoc although I thank you for enquiring abt me, yet said nothing new to me.
Ok therapeutic dose is incidentally 150-400mg and not necessarily 600, and there are pts who take 1800, so 100 is not enough true but it works for some like it did for me as i was on 50 only and was doing fine except that BP worsens usually so i had to increase it. So it all depends on the person.
That seroquel has AD qualities, yes but extremely minimal similar to all the other atypicals, so truly speaking seroquel as astra zeneca says a monotherapy is doubtful. But that it's a strong antimanic this is true.
about cipralex eventually it will drive you manic after a while like it did for me for 5mg. All AD's do it. At the beginning you will find it super and anxiolytic but then without warning mania starts overnight and eating much, insomnia, etc...
I tried an SSRE called stablon/coaxil (google it) it's much weaker than cipralex but of course like all the AD's try to monitor yourself, what i do i take one day 1 pill the next day half and go like walking with a stick on a string. Still i had my mania twice whether from it or i switch more often is not known. So my view so long that we don't want to try the strong MS with their bad side effects then i am back on seroquel with an increase dose and with stablon again.
I really haven't got the clue, but your pdoc is not better than the ones we have.
finally having fragile BP is not an advantage because unless well managed it will become a strong BP. this is a problem with no solution. UNLESS we accept the strong MS with all the adverse effects. It's like cancer one has to accept chemotherapy otherwise cancer spreads more. true chemotherapy is bad but cancer is worse. Here MS is bad but brain loss is devastating
Hi, may I ask if you have tried the main mood stabilizers, depakote (sodium valproate) or lithium?
It seems that there are no easy choices for either of us. Perhaps your increased dose of seroquel will balance out the risk and keep any potential mania in check from the stablon. It is not available in this country (UK) unfortunately as far as I know.
What you said about the cipralex doesn't fill me with confidence about taking it, I may have to see if I can manage without. You are right about medications, but what can we do? keep taking them and hope some for some breakthrough in medical science soon! If you hear of one before me be sure to let me know friend :-)