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Bipolar Disorder Community
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574118 tn?1305135284

controversy abt antidepressants

Hi
I am getting crazy that the medical circle can't resolve this manic-depressive problem, nor that it can even give us a definite answer about the use of antidepressants. According to

http://www.psycheducation.org/bipolar/controversy.htm

AD's can induce rapid cycling, mixed states, but worse the phenomenon of kindling. But all is based on statistics or views and opinions. My main problem is bipolar depression. But depression is depression no matter it's bipolar one or unipolar/major etc.. I have to resolve this problem and I don't know other solutions than AD's, even if it says lamictal or abilify. Alright i am preferring the near gains with the long and future pains, hoping that eventually somebody somewhere will find the clue. Sure there must exists a trivial and clear solution but needs an intelligent person. For sure he can't be an Egyptian because in our country the worst and most mediocre of high school students were the ones in the past to study medicine. Luckily they are now full <> professors  I don't think this is the case in the west. Here they learn from their mistakes with their patients. It happened that i saw once the script written by my pdoc to an illiterate from Lybia coming to see him. I read the same stupid typical antipsychotics. They don't even have the time to read any article yet they attend conferences very well sponsored indeed by the pharm companies. A couple of weeks ago i was in my mania and has to see my pdoc the assistant said he is in London in a conference, i phoned another one and the assistant said he is abroad so i said in London, she said yes, i counted six stupid pdocs all in London. Yet I don't see them learning anything from London and they are back to the same drugs. I stated to believe that they go for Marx and Spencer rather than to attend the conference and took the plane ticket for free.  

I am really exhausted, my bipolarity is getting worse. I've increased my seroquel hoping to compensate for my AD which i will restart on it today. I tried the tryclic, then 2 SSRI's now i am on stablon/coaxil it's an enhancer of the reputake of seretonin rather than inhibiting it, so it in fact decreases the seretonin so it shouldn't have driven me manic. So it's either i switched by myself to mania due to the abuse of the SSRI's before or that any AD's whatever name it has SSRE, SSNE, etc...will do the same thing eventually.

Sure some of you can give me an advice. Should it be a life sentence. Perhaps an engineer not a doctor who can resolve the issue someone with a basis in control theory and feedback mechanisms since it's our thermostat which is broken. to hell with it    
18 Responses
585414 tn?1288941302
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.
1039200 tn?1314912008
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
1039200 tn?1314912008
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?
574118 tn?1305135284
Hi

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
Avatar universal
Hi, may I ask if you have tried the main mood stabilizers, depakote (sodium valproate) or lithium?
1039200 tn?1314912008
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 :-)
1039200 tn?1314912008
No, I havent, but am on the highest dose of tegretol at the moment. I can't change to lithium due to the neurologist questioning epilepsy (as responsible for hallucinations).
952564 tn?1268368647
I just want to point out one thing that recently blew my mind about bipolar treatments.

Bipolar only has one medication that is specifically developed to treat bipolar, and that is lithium, and lithium is just a chemical on the periodic table, nothing fancy. All of the other medications are meant to treat something else, and just happen to be helpful for bipolar, (almost like a side effect since those medications don't always work for everyone.)

Antipsychotics were developed to treat schizophrenia.

Anticonvulsants were created to treat epilepsy.

Antidepressants were created to treat depression.

So, I'm thinking that bipolar is such a hugely complex thing that they don't even know how to create medications for it yet. That really makes me think and wonder why.
1039200 tn?1314912008
Yeah and even lithium was discovered by accident (for bipolar) and originally used 'offlabel' for the condition. It seems we have no claim to any original medicines we have had to borrow them from other places!!
Avatar universal
It does make me wonder if there is a link between epilepsy and bipolar.  This is probably way off!  
1039200 tn?1314912008
Actually temporal lobe epilepsy share a great deal of symptoms with bipolar disorder, which can include manic behaviour, hypergraphia, hallucinations, paranoia. There have been claims of a link but as yet there has not been enough research to reach a definitive conclusion as far as I know. Epilepsy also shares the same 'kindling' effect as bipolar as well and there is a greater number of epileptics than the general population with depression. Perhaps they WILL find a link before long who knows?
Avatar universal
Thanks for the info starbunny.  My son started having fits a year ago at the age of 15, completley out of nowhere.  His behaviour changed about a year prior to that.  At the time I kept having this "feeling" that it was somehow linked to my own bipolar, as if my condition had genetically been passed on to him but had manifested itself in a slightly different way, if that makes any sense :/

It's certainly interesting and I would love to read some research into it - another "to do" task for me!
1039200 tn?1314912008
I might look into it too, but if you find something before me be sure to post it out!
Avatar universal
Hiya, just had a quick google, (tiredness rapidly overtaking me at the moment) and there seems to be a lot out there on the web to read though I haven't found any actual medical journals on the subject.  Something I will have a proper look into after some rest.  Likewise, if you find anything then please let me know :)  Will also ask a Dr friend of mine to check the BMJ back copies for me.
574118 tn?1305135284
OK

the story for many of us proceeds as follows: depression comes first; and your family becomes concerned (because nobody when elated consults a pdoc), so you start on an AD even with a little of AP and eventually a mistake occurs (stresses, any trigger...) and mania arrives. Usually at the onset of the disease mania is euphoric and in a way pleasant.  

Next, you pass a period of denial of the illness, and of course things get worse, the doses increase and you stuck with another mania and so on and so on. Your brain is never the same again. Eventually everybody of us will end up taking lithium like all of the bipolars, but in the meantime you read and read and come to the conclusion that AD's are wrong to take (yet most clinicians give them and there is a lot of controversy here). Then you start to think and ask members of forums whether the ones taking lithium or valporate take AD's along with, and you get the answer yes for most of them. So you conclude if I am stuck anyway with AD's why not compensate it with AP's rather than lithium. At least you will not monitor the toxicity and run an eventual risk of kidneys, etc...

If you can go on like this, which i doubt, then good for you, this is how the story begins and ends up with the strong MS. some even take take lithium+valporate as time goes on. Of course there remains the choices of lamictal or abilify to improve the mood. But if you ask someone old enough and has BP for decades, you will find him taking say lithium + zyprexa + lustral/zoloft, etc..etc...and passed also a couple of ECT.

as to cipralex/lexapro/escitalopram it's an SSRI produced by a Danish firm which still produces an earlier version celexa/citalopram/cipram a bit weaker. You hear lots of stories that BP folks tend to prefer celexa or cipralex or welbutrin, all is rubbish, it all ends up the same way. You think of course of omega-3, st John's wort, but in vain, etc... etc...

here is something interesting abt epilepsy (in fact i mentioned a relationship once and ILADVOCATE our authority here said that BP is pschy, seemingly epilepsy is neurological). A friend of my father a great fan of flaxseed oil (linseed oil, used from the time of the pharaohs to preserve colours) told my father that a friend of his has a daughter that has epilepsy and improved a lot on flaxseed oil (it's sold in capsules in the west, here extracted in cold not hot and is cheap) and said she improved tremendously, so perhaps it's a kind of MS, it's very rich with omega3 and omega6 and people take it as a substitute to fish oil. Of course why fish oil is rich of omega3 because the fishes feed on marine plants like the linen plenty of omega3.

As to anticonvulsants are used off-label for BP, of course in medicine they can use drugs to treat different diseases, like tegretol for many neurological issues, but still how come BP improves with them unless there is some relationship between epilepsy and BP.

As for stablon/tianeptine/coaxil/tatinol is produced by a french firm called servier and it reduces the seretonin in the brain by enhancing the reuptake of it rather then inhibits the reuptake like the SSRI, so the dopamine /seretonin ratio increases and the mood becomes better.this proves that BP is a deficiency in the dopamine and has nothing to do with the seretonin. I take one pill only in the morning.In egypt it's the safest drug ever and has very little side effects and no interactions with other drugs this is why it's given to the old (geriatric), in fact many of our relatives, friends, my aunt a professor of neurology takes it irregularly, my grandmother, all of them, except none of them is BP. So really the key in our illness is depression. I happen to have posted once here under the title" no depression no BP" because you can take anything and become safe. So really it's the AD which represents the key not only to BP but to all of the pshy illness, you name it, panick attack, anxiety, OCD, etc..etc...But only the BP which is tough to handle and none of the pdocs knows how, except by advising MS's.

I am corresponding with a nice guy from Russia and he is BPII he is taking something for depression, can't remember what but not an AD it's something like seliligin for parkinsonism but works well for depression. The guy has it from a long time and experimented too much and there in russia drugs are not available easily, but i believe him because he is so well read about BP articles, research papers, he is a radio engineer, married and has a son. Sometimes he quarells with his wife but seemingly his married life is stable. So I assume everybody of us must do his own research than relying solely on the stupid pdocs

incidentally the British medical guide still says that BP is dealt with classically with either lithium or tegretol or valporate. You know the British are conservatives and go by the book ages and ages, and perhaps they are right, because all the new MS all their side effects or adverse effects are unkonwn or unlisted well yet

keep well    
Avatar universal
You keep well to.  I am from the UK and the very first MS I was offered was Valproate (Depakote), these did not suit me and I then tried all of the "inbetween" meds to no avail and have ended up on Lithium which suits me down to the ground.  My psych does not like to mix medications, she was even unhappy about me taking low dose valproate alongside low dose lithium.  In her mind mixing too  many medications makes it more likely to have side effects and then difficulty in knowing which meds are responsible, which are reacting with which.

When I was on the high dose depakote I was put on an AD as my depression was not improving.  The AD sent me into mania (manifesting as extreme anger).  I am now very very dubious about taking any AD.


AP's also don't suit me, they give me restless leg syndrome, muscle jerking and insomnia.

So I was glad when I finally relented and agreed to the lithium to find that it actually suits me and has helped me become more stable than i've been in a lifetime.

I am convinced of a link between epilepsy and bipolar.  Ok so yes epilepsy is neurological and bipolar is psych, however I did read in my quick scan last night that it is thought that bipolar episodes of mania are like mini fits in the brain - so this would make BP both neurological and psych????

It's all very interesting and very very complex and I think it's going to be a long while if ever before they find a med as good as lithium which doesn't have the side effects that some people experience.
Avatar universal
As to the link between bipolar and epilepsy, I'm not sure what they are. However, I do have both and this discussion intrigues me. I know my seizures started breaking out worse last September, and that's about the time I changed treatment facilities for mental health outpatient treatment (I had to change because the place I was at didn't treat eating disorders and the new place did; ironically, the new place no longer does). Unfortunately, I have both epileptic and non-epileptic seizures so it's hard to tell which I'm having unless I happen to be hooked to an EEG at the time (and even then it's not always clear-cut).

I'm not sure if I had med changes when I changed facilities, but I'm intrigued enough to look into that. Maybe something I had for psych was keeping the seizures at bay? I can't think of anything off-hand. I don't believe that I had med changes when I switched facilities. I know at the old place, I had changes fairly frequently since I'm very sensitive to medication (mostly nothing happens, but sometimes I get nasty reactions and have to stop the med). I had 3 meds that induced seizures at ok doses (Clozaril, Trileptal, and Wellbutrin XL possibly) and another that induced a seizure when I took an overdose (Zyprexa). So, it's always a guessing game as to what I can and can't take, whether it's by itself or in combination.
1039200 tn?1314912008
I have been told that bipolar and epilepsy do interact.
Certain medications for bipolar can lower the seizure threshold, and things like medication changes can 'stress' the body and make one more likely to have a seizure.
Likewise I have been told that the stress associated with mood changes/unstable mood can also lower the seziure threshold as can lack of sleep, alcohol etc and as a result seizures can become worse during these times.
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