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Antidepressants and Bipolar 1 & 2

T

Traveler5

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Most of us are aware that in many cases taking antidepressants can aggravate Bipolar mania and hypomania. The question I have is how antidepressants affect mania? What happens to the person who is taking both medications -- what are the symptoms?
 
Wishbone

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Both medications? What's the other one?
 
Wishbone

Wishbone

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I can't tell you first hand what it's like to be on bipolar meds (mood stabilisers especially) and antidepressants at the same time as I was only ever on antidepressants on their own or for a short time with antipsychotics as well.
Antidepressants on their own made me speed up gradually until, as I described it once on here before, I felt like a carousel spinning faster and faster until the carousel came off its fittings and then I slammed into depression. Everything was too fast. I was trying to do too much. Nobody else was quick enough. I fell out with everyone.
On antidpressants and antipsychotics at the same time I was just a confused mess to be honest with a mood really mixed up and all over the place.
Lots of irritability in both, which also grew in the first one as things got faster and faster.
 
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keith74

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There are cases where a patient who is bipolar and in the throes of a severe depressive episode will (justifiably) be prescribed an antidepressant if other safer options (lamotrigine, quetiapine, etc) do not work in helping with the depression. In such cases, an antipsychotic is usually prescribed along with the antidepressant to guard against the mania. In fact, there is a med call symbyax, which is a combination med of an antidepressant and an antipsychotic, for exactly this purpose.
 
Wishbone

Wishbone

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Yeah Symbyax is the only one (or combination of) that I would allow anywhere near me. Olanzapine and Fluoxetine together, although I likely wouldn't even know what I was being given at the time. There's a tonne of research to show it's effectiveness particularly for, as @keith74 says, acute depressive epsiodes where you'd likely be in a hospital. I wouldn't want to be on it long-term though, just until I was out of the episode.
 
T

timing

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I have a history of acute depressive episodes since my diagnosis of bipolar in 2006. They only added prozac for a 3 month period in 2012. This was added to lithium, resperdone and remeron.
At the time I was dealing with caring for my husband who died during that time. It kept me relatively stable.
 
G

Gratefultobewell

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I am on an antidepressant, bupropion, but I’m also on an antipsychotic, seroquel, and abilify, and lamictal. From what I have learned it’s not a good idea to be on just an antidepressant. I have to say though that I have zero problems with hypomania, but still have depressive episodes.
 
B

BlueWater

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I can't tell you first hand what it's like to be on bipolar meds (mood stabilisers especially) and antidepressants at the same time as I was only ever on antidepressants on their own or for a short time with antipsychotics as well.
Antidepressants on their own made me speed up gradually until, as I described it once on here before, I felt like a carousel spinning faster and faster until the carousel came off its fittings and then I slammed into depression. Everything was too fast. I was trying to do too much. Nobody else was quick enough. I fell out with everyone.
On antidpressants and antipsychotics at the same time I was just a confused mess to be honest with a mood really mixed up and all over the place.
Lots of irritability in both, which also grew in the first one as things got faster and faster.
This post helps me tremendously. I am not diagnosed with bipolar but I do have OCD and problems with my moods. Lamotrigine has slowed my mood changes. I don't have as much rage because of it and Klonopin. But I've gone as high as I can go right now on Lamotrigine; any higher I feel flat but still depressed. While titrating up on Lamotrigine, the first two months were great. But during the third-sixth months while experiencing a new stressor in my life, I felt higher than a kite with energy and motivation but I was irritable and it was hard to fall asleep. Have you ever heard of this happening on a mood stabilizer? I had to go down a dosage, get depressed, then try increasing again a few weeks later once my stressor was gone. I increased without any problems that time.

For the last few months, I am content in the morning, often depressed in the afternoon, happy in the evening then anxious by bedtime. My doc gave me a bottle of Lexapro to try. I'm nervous about it because I've never tried an SSRI. I hope it helps me sleep. Right now I take a cocktail of meds to sleep.
 
Wishbone

Wishbone

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While titrating up on Lamotrigine, the first two months were great. But during the third-sixth months while experiencing a new stressor in my life, I felt higher than a kite with energy and motivation but I was irritable and it was hard to fall asleep. Have you ever heard of this happening on a mood stabilizer? I had to go down a dosage, get depressed, then try increasing again a few weeks later once my stressor was gone. I increased without any problems that time.

For the last few months, I am content in the morning, often depressed in the afternoon, happy in the evening then anxious by bedtime. My doc gave me a bottle of Lexapro to try. I'm nervous about it because I've never tried an SSRI. I hope it helps me sleep. Right now I take a cocktail of meds to sleep.
If you look at what Lamotrigine is useful for, maintenance/keeping depression away but not at getting you out of depression or mania, then you would have to see it as having slight antidepressant effects and a protective mood stablising effect. So I assume when you first went on it it was helping to lift you but with a mood on the up meeting with stressors you can get that mood 'zone' where you're hyped enough but moody and irritable with it - an energized bite, if you will. This is approaching mixed state territory where you can be stressed, depressed, angry at everything, but hyper and energized and on fast-forward all at the same time. Thoughts a million times a minute it seems. This is when you can struggle to get your head straight and just stop enough to be able to be calm and of course, to sleep; and with less sleep comes all of this more and more. So yeah, it can certainly happen with a mood stabiliser if what the person has turns out to be Bipolar with particular problems on the upper end of the spectrum and/or mixed states. Then you'd be looking for something more like Depakote or an antipsychotic like Aripiprazole to keep those things at bay.
If you get any of the aforementioned when you start the SSRI be sure to get onto a doc as soon as you can because they may well have got your mood thing wrong if so.
 
B

BlueWater

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If you look at what Lamotrigine is useful for, maintenance/keeping depression away but not at getting you out of depression or mania, then you would have to see it as having slight antidepressant effects and a protective mood stablising effect. So I assume when you first went on it it was helping to lift you but with a mood on the up meeting with stressors you can get that mood 'zone' where you're hyped enough but moody and irritable with it - an energized bite, if you will. This is approaching mixed state territory where you can be stressed, depressed, angry at everything, but hyper and energized and on fast-forward all at the same time. Thoughts a million times a minute it seems. This is when you can struggle to get your head straight and just stop enough to be able to be calm and of course, to sleep; and with less sleep comes all of this more and more. So yeah, it can certainly happen with a mood stabiliser if what the person has turns out to be Bipolar with particular problems on the upper end of the spectrum and/or mixed states. Then you'd be looking for something more like Depakote or an antipsychotic like Aripiprazole to keep those things at bay.
If you get any of the aforementioned when you start the SSRI be sure to get onto a doc as soon as you can because they may well have got your mood thing wrong if so.
Thank you so much for that explanation. That was the oddest state of my life. I understand the phrase "mixed state" better now.

For decades, there's been this water main inside me that's about to break. I look at other people who remain calm and I don't know how they do it without a mood stabilizer. I don't know how I made it to 44 without one except for the calmness and stability of my husband and for a fast-paced job that worked for my racing mind. I could've used a mood stabilizer at 23 when I first began working and fought with coworkers and throughout my career when I couldn't get along as well with others as I needed to. I've been competitive with everyone and have almost destroyed a relationship with a close relative.

For the last year, I've been working with a counselor to establish a sleep routine, learn how to be compliant with meds without fear of the side effects, learn how to set healthy boundaries with others as well as recognize my OCD triggers.

You've helped me understand better why my doctor recently said Lamotrigine is not an anti-depressant then gave me a bottle of Lexapro. He told me in order of what he thinks will benefit me: Lexapro or Lexapro+Wellbutrin, Desvenlafaxine or Desvenlafaxine+Wellbutrin. He's trying to target mood, depression, energy, fibromyalgia, PMDD and OCD all in one or two meds. He said after whatever anti-depressant he's able to get me established on he wants to review all of my meds again and see if something needs to be removed or decreased. It'd be ideal for me to not need a cocktail to sleep and to take my benzo less often.

Since starting Klonopin last year, I saw how anxious I'd become and felt like I had a new lease on life. Three months later I added Pregabalin and got some pain and more anxiety relief. Then my mood lability surfaced as my worst demon, so Lamotrigine was added and as my moods were stabilized my depression and what looks like PMDD surfaced. I feel like a person patched together. I hope to feel complete and to know what it means to feel at rest. I'd love to lie down and nap but my mind hasn't been able to since I was 19.

Thanks for communicating with me.
 
AnnaBanana267

AnnaBanana267

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Diagnoses: Bipolar II, SAD ( mid-Aug. - April), Health Anxiety, GAD, obsessive tendencies.
Meds: Wellbutrin (AD), Abilify (anti-psychotic), Divalproex (mood stabilizer), trazodone (for sleep), light therapy. It all seems to work pretty well, though I still stay up most nights late, and the SAD is never completely eliminated. Diet, exercise and stress reduction could be MUCH better.
Don’t like being on this many drugs, but at least I am more stable than I used to be. Only have GP currently, no shrink, who might have the expertise to find me a better combo.
 
I

InnovatingProfessor

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No GO for me, when I did take Lexapro at my 18-years, it sent me in a manic psychosis.
Had more luck with Remeron => no mania.

But I don't take AD's due the risk of mania AND because I am always more manic the last years.
 
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