help pls : 2 choices which ??

[adel_ezz]

Suddenly I fell into deep depression.

Antidepressants are my only enemy, sending me manic right away by even slightest dose

my regimen: 50mg seroquel, 1mg risperidone, 1mg stellazin (typical antipsychotic)

my last mania 4 years ago. I extinguished it by 300 seroquel. After which I kept reducing seroquel dose, until a month ago succeed till 50. Perhaps at this dose no antidepressant effect of it. Perhaps should be higher than that. Already I am BPII so depression is my problem.

2 choices remain, which require your insight:

A) reduce risperidone to half mg (it exists) to boost dopamine
B) increase seroquel to 100 (Anonymous said below this dose doesn't have AD effect)

Of course I can add an antidepressant and add more antipsychotics but this increases my drugs. he doesn't know. Without any responsibility on your part, contemplate the matter

concerning (B) I remember at 150 seroquel when feeling lethargic I reduced it so become less depressed and more energetic, because after all seroquel is antimanic and antipsychotic reduces dopamine. the mechanism of this drug is not understood well at high doses antimanic very low doses help sleeping disorder at perhaps 100 antidepressant effect.
thanks

[adel_ezz]

i HAVE FOUND THE SITE

http://askdrjones.com/index.php/ranking-the-mood-stabilizers/

http://askdrjones.com/index.php/mood-stabilizers-vs-antidepressants/

[Anonymouse88]

Actually, lamotrigine, carbemazepine, and valproic acid are all approved by the FDA as monotherapy for BP I.  Things like topiramate (brand Topamax) and oxcarbazepine (brand Trileptal) are off-label, but the anticonvulsants in general are known for mood stabilization properties (oxcarbazepine is very similar to carbemazepine, but with fewer side effects, and a lack of license might be a monetary thing, not a clinical one).  With some of the off label ones, they seem to be really hit or miss in that some people are completely stabilized, but maybe those people aren't nearly common enough for it to make a difference in trials.  Those ones should probably stay as third or fourth line treatments.

I believe what happened with the anticonvulsants was incidental findings of mood stabilization in epileptics who also had bipolar.  Someone noticed it, and they decided to test it out on people who didn't have epilepsy.  If you read the prescribing information (easily googled, not hidden behind pay walls), they all have dosage instructions for bipolar as well, often with different target doses depending on what you're treating.  There are at least some people who believe that epilepsy, migraines, and bipolar might all be part of some broad spectrum of related disorders.  I'm not sure if I buy that, but it's an interesting theory and would help explain how anticonvulsants can help epilepsy, bipolar, and migraine, and would help explain some of the symptom overlap.

TL/DR: Tegretol and Depakote are still first line treatments for BP I, and they as well as Lamictal are approved as mood stabilizers.

[adel_ezz]

thank you i am aware of abilify it's an atypical AP and is activating. I happen to have come across a site of dr stone about the best mood stabilizers but it escapes me now to forward it to you.

I tried lamictal for one week and was bad. There is something akward about these anticonvulsants (lamictal, tegretol, depakote..) they are for epilepsy mainly, yet used off-label for BP something weird

thank you

[Anonymouse88]

Zyprexa is actually a pretty good antidepressant, but its side effects suck enough that people are reluctant to go on it long term.  

Your problem with BP might be the depression (BP II especially has more depression in general), but full blown mania can wreck your life a lot faster if you do things like max out your credit cards on a spending spree, have sex with a bunch of people and happen to catch something or lose a relationship because of it, or even get arrested doing something because you were psychotic or highly delusional.  Those are severe cases, but it can happen.  And mixed states, mania and depression at the same time, are the highest risk for suicide.  Pure depression can leave people without the energy to actually go through with suicide, but adding in the manic energy can create the perfect storm.

Wellbutrin on average is LESS likely to make people manic, but there are always exceptions.  

Abilify is mood stabilizing, and is not an AD (many people think it is due to marketing)--it's an atypical antipsychotic.  It can make people agitated at low doses, though.  Lamotrigine is also a mood stabilizer.  It sometimes makes people a little hypomanic at under 100 mg (100-200 mg is the standard target dose, assuming no interference from drugs that change enzyme expression).  The hypomania can often be offset by a temporary increase in APs.  It tends to be better at treating depression than mania, which is why it's a favorite for BP II, but it's actually approved as monotherapy for BP I in the US.  It's a good idea to fiddle with dosages of meds you already have before adding yet another drug, but if you continue to have issues, a drug change is a very reasonable option to consider.

[adel_ezz]

Thank you. I am better now I can't tell the reason why all this happened. I am keeping the same dose. Strange thing occurred for only one day but I was in a distress suffocating and suicidal and almost tears.

About the drugs I know them all abilify, lamotrigine, etc... for depression I can't run the risk of changing my combo, although it looks weird 3 antipsychotics in one meal usually one is better and at a therapeutic dose. But again nothing is definite is psychiatry and the important thing no one knows anything the brain is complicated.

CBT is nonexistent here

The problem with BP as I always write is depression and not mania because you would want to take an antidepressant and is bad, whereas manic phase is easily extinguished by AP especially zyprexa (strong). There is an AD though by a french firm servier tianeptine-coaxil the wiki says chances of mania is little. People say also welbutrin but not true cases driven manic on it. Seroquel has the advantage that it's antipsychotic and antidepressant at some dosage, that is why the FDA approved it as a mood stabilizer

thanks

[Crystal413]

I would try one thing at a time. If Seraquel worked for you in the past, I would stick with that. Hopefully your dr has the amount he gave you before that helped you. I know many people that take 100mg of Seraquel and it works for them. But really, your dr knows best as to what dosage you should try with the symptoms you are experiencing.

[CRSeaside]

It seems like you have a better grasp on the medications & their doses than the average Psychiatrist!
   Personally I rely less on bipolar medication & more on talk therapy. Have you incorporated cbt into your wellness plan?
   The other factor is the so called poop out. When you need a med change because something no longer works. Have you tryed Abilify ?