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mariela10
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Default Nov 05, 2019 at 11:59 AM
  #1
Hi! I am writing to see if anyone out there has experienced what I have when using antidepressants for bipolar disorder I. I have tried several antidepressants over the last few months and every time I try a new medication, after 3-4 days I start experiencing intrusive suicidal thoughts which are very scary but I do not feel compelled to act upon them. After a day or so off the medication the thoughts disappear but I am left with the exhausting depression in which I go from hour to hour, day after day. I actually dread going to sleep at night because I know what the next day will bring even though I approach it with an optimistic attitude. I saw another psychiatrist who said I had treatment resistant depression (even though I am bipolar) and refused to treat me, saying medicinally, there was nothing he could do for me. I am on high doses of night meds - 750 Seroquel, 200 Trazodone, 25 Thorazine and 2.5 valium. My question is this: With all of the meds I'm on, could this be the reason that none of the new meds I try will work? I am currently taking 1/2 of a 1.5 vraylar capsule. My system is super sensitive so I'm just taking a tiny amount and hope to find some relief. The dreaded word ECT was mentioned and I freaked out. Anyone having that experience? I'm determined to keep fighting this but my life sucks right now because I am constantly battling the depression. I would really appreciate your input and thank you for taking the time to read this post. It's good to know that I can go somewhere where people get what I'm going through.
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Default Nov 05, 2019 at 04:52 PM
  #2
I am sorry you are struggling and think it is great that you are here on PC getting involved. Lots of smart, experienced people here to interact with.

I have at times been considered a treatment-resistant bp1 person. I've never been on thorazine or Vraylar. But the others, I have. Like I am sure you have, I've also been on more antidepressants than I can truthfully recall off the top of my head, but I have never experienced the kind of ideation you describe just after starting a new antidepressant. I am wondering what those antidepressants have been, because some of them are very, very different than others. Cymbalta is not at all like Wellbutrin. And those two are not at all like an MAO inhibitor. So, if you are responding like this to very different types of medications, I have to confess that I find that sort of baffling. Sorry.

Which brings me back to MAO inhibitors. Have you ever tried one? I took Emsam for quite awhile. I had high hopes. But I don't think it did a thing for me. Something to consider, though. What about Lamictal? Or lithium? Or Tegretol? Or Depakote? I've been on all, but the one that helped my depression the most by far was lithium. And it's not really supposed to be that great for depression. But for me, it saved my life. That's why you can't just rely on what the conventional wisdom is if you have sever bp1 depression--in my opinion. With the exception of Provigil, none of those fancy new medicines have done a darn thing for me.

So, I also, as it turns out, spend a lot of time dealing with SI. It has gotten much better since I joined PC (thank you PC people!!). I don'[t feel as alone and isolated and I feel like I am not quite so much of a freak. That said, it's still a problem. You can see my meds below. We re-started Abilify last week and added an emergency sleep Rx for Zyprexa, because I do not sleep and because I got psychotic last week. My psychiatrist is brilliant. I cannot take Lamictal because I got Stevens-Johnson and wound up in the burn unit many moons ago. I am very worried about my SI because I do have prior attempts, one of them extremely serious. Anyhow, my pdoc says we will have to look hard at Clozaril if this SI continues. I hate that idea. I do. But I don't want this suicide stuff to take my life at some vulnerable moment. So, I might do it. we'll see. The other option is ECT. That, I would do without hesitating. I have no problem with ECT. I'd do it tomorrow, if he thought we should.

Anyhow, I am so sorry you are struggling. Bad depression is just brutal. There are several ECT threads here at PC. Maybe check them out and see what you think. Or, start your own. Maybe read about Clozaril. Or lithium, or any of the other mood stabilizers. You know, just because a drug is old, does not mean it isn't fantastic for some people. I'll take lithium over Latuda any day of the week.

Sending you positive vibes and thinking of you. Hang in there. Don't give up. Things will get better. You just need to find the right game plan. I am sure you will.

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Default Nov 05, 2019 at 08:46 PM
  #3
i take tons of antioxidants and b-vitamins with my prozac, abilify, and as-needed gabapentin. I'm happy to report that the core ailment (whatever it is...) is under control, I don't usually require the gabapentin, the prozac helps -tremendously- at only 20mgs, and i dont have td or eps.

DoctorYourself.com: Andrew Saul's Natural Health Website

((free info on orthomolecular)

im just mentioning this because i once had to deal with all kinds of adverse effects, less than awesome results, etc...

and now, i think the orthomolecular (I cobbled together my own protocol) has helped me get more mileage out of fewer Rx, with no major adverse effects, except i always kind of seemed...stoned, probably from the abilify. could be worse. :-)

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Default Nov 06, 2019 at 08:24 AM
  #4
Hi mariela. I can't know what will work for you, but I will share my experiences as a person with bipolar type 1. Though I tend to lean much more to the manic side, I have definitely experienced stubborn depressions in my life.

Antidepressants only do me harm. Period. I haven't taken one for 9 years. I realize they have value for some people, though.

Stimulants make me manic.

I do well with medications known to have both antimanic effects and are helpful with depression, including Lithium, Lamictal, Seroquel/Seroquel XR, Latuda, and the sort. I must avoid medications that have been ONLY helpful for mania to the degree that they squash mania but leave me depressed. Depakote fits into that category for me. I do benefit from medications that are antimanics, but don't drag me down.

I find Seroquel XR quite helpful for both my depression and mania. However, it must be at the right dose. Sometimes the dose becomes too high, and actually having it reduced (vs. raised) provides me with depression relief. Then if my mania starts developing, my dose is increased again with good results. If I am in a mixed state with agitation, increasing is the usual best move for me. I respond much better to the once daily (evening) Seroquel XR than I did to the twice daily regular Seroquel. Seroquel XR still has sedating qualities for me and helps me sleep, but I find the sedation "peak", for lack of a better word, milder than regular.

Lamictal is activating for me, but a small dose of 100 mg is just right, along with my other meds. Tegretol XR is a balanced med for me, in that it helps with stabilization overall without making me depressed.

I have had a series of ECT about 9 1/2 years ago. It's not that bad and it does indeed help many with treatment resistant depression. It helped me, but then my doctor put me back on the same failed med cocktail from before it and depression returned. I needed the overhaul, but believe that the ECT I received might have made the new med cocktail capable of working when perhaps it would have struggled if I hadn't had the ECT.

Last edited by Anonymous46341; Nov 06, 2019 at 12:08 PM..
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Default Nov 06, 2019 at 10:33 AM
  #5
Thanks so much for your reply! I'm so happy for you that your meds are effective. As far as that "being stoned" effect goes, I know it's annoying and it seems to waste your day away but to me it's better than dealing with intrusive SI. Wouldn't it be nice to feel the same way each day! Take care and have a blessed day.
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Default Nov 06, 2019 at 10:43 AM
  #6
Thanks for your reply. Sounds like you got your meds under control which I think is awesome. Seroquel has been a life saver for me. Gotta love that drug! I see you are on a rather high dose too. I'm on 750 mg per night. I've been struggling recently so I take just about 50 mg of my night dose during the day to get me through. Makes me feel a little high and drowsy but it's better than the alternative SI which scare me immensely. Needless to say, I'm home a lot. Trying to stay busy and ward off the depression. I've decided not to take any more antidepressants and see if I can just keep my night meds. My doc said the Seroquel and Trazodone do work for depression. Hate to think of the alternative that has been suggested to me - that being ECT. Take care and have a great day!
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Default Nov 06, 2019 at 11:58 AM
  #7
Hello and welcome to PC!

I am sorry you are suffering.

I suffer from "treatment resistant" depression. I have a diagnosis of BP2.
My depressions have been much like you describe.

For a very long time, I had accepted that I had a treatment resistant depression. I was told this over and over. I felt hopeless .My pdoc had discussed ECT:he later decided it was not the best idea for me. It is, however, very helpful to some people.

I had often heard that when a doctor tells me that my depression is resistant and there is nothing s/hecan do, it is time to look for another doctor. The idea being that we have to find doctors willing to take the time,and withstand the frustration we experience, in order to fully try meds and combinations thereof.

Eventiually, I was referred to a pdoc who was very unlikely to know any more than the pdocs I had seen. I decided to give it a try. She changed up my meds right away, slowly tritrating down with some and up with others.

She put me on Lamictal (lamotrigine), which is often thought to help in making depressions perhaps less frequent and less severe. It has been a year and I have had depression; however, I can get out of bed and can function. Previously, I could not get out of bed and/or function in very basic ways. So I feel this med has been helpful to me. AsBirdDancer has mentioned, we are all different and she cannot tolerate high doses of this med.

This new pdoc had also used a specific med for treatment resistant depressions. It is called: "Mirapex" (pramipexole). It is usually used for other conditions. I have done quite well on this med. I still have some depression, yet am doing much better most days. Now, pdocs/we need to be very careful with this med. It does have the potential to cause hypomania and mania. At the very least, one might need a mood stabilizer on board. If BP1, it is likley there will be additional meds along with those mentioned in the previous sentence. Please consult with a pdoc on this. Pharmacists are also often very helpful. It is my opinion that use of this med needs close monitoring, at least until the client is used to the med and can recognize any mood change very quickly. This med is used more often in BP2 than in BP!; however, it is sometimes used in BP1.

Many here have shared their experiences with ECT. As mentioned above , there is a lot of info here on this. A lot can be found by doing a search. You may also find members might come along and share their ECT experiences.

I was recently at a "grand rounds" presentation on TMS. The take-home on that was: TMS is up and coming and will be used much more in the near future. Some hospitals have already been offering TMS and it is predicted more will offer this treatment in the near future.

Transcranial magnetic stimulation: Transcranial magnetic stimulation - Mayo Clinic

If you hesitate on the idea of ECT, please do see the noted experineces here at PC.
If you hesitate on the idea of ECT, try to find a pdoc willing to continue to work with you on meds.
You may also benefit from therapy, even if just supportive therapy to help you to cope while trying to find help.

I am hoping you have some additional options for further consult(s).

Keep posting here at PC. We will do our best to offer info, experiences and overall support!

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Default Nov 06, 2019 at 11:43 PM
  #8
I've noticed that many people with BD are treatment-resistant, especially with regard to depression. Last winter I slammed into my usual winter depression. I asked my pdoc to look into ECT for me. She agreed, but suggested I give Pristiq a try first. I was truly amazed! Pristiq helped me through the winter, and did so without any weird side effects.

I've felt some of the seasonal depression returning lately. If it comes on full blast I am going to ask for ECT. I won't go through another winter of struggling to crawl through every hour.

Have you tried Lamictal? It mainly treats bipolar depression. Others on this thread have made really good suggestions about meds. Also, therapy is so helpful - and a pdoc who doesn't say what the one you saw said! Geez

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Default Nov 07, 2019 at 07:14 PM
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Thank you so much for this, @BethRags. I am going to ask my pdoc about Prystiq. I don't think he has ever even mentioned it. I wonder why? I am also ready for ECT, if it becomes necessary. I would rather do that than go on Clozaril, which is the other thing being currently discussed. The side effects freak me out.

I may get in trouble for saying this and I am not saying it cannot work for some people, but in my experience being on it for several years and talking to other folks who have taken it, I just think Lamictal is overrated for bipolar depression. I don't think it did a damn thing for me besides putting me in the burn unit for a week. Just my take and, of course, everyone's mileage does vary. But I had to get that off my chest because I believe Lamictal is pushed on us too hard as some kind of panacea for depression. And I don't believe it is.

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Default Nov 08, 2019 at 12:06 AM
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Originally Posted by bpcyclist View Post
Thank you so much for this, @BethRags. I am going to ask my pdoc about Prystiq. I don't think he has ever even mentioned it. I wonder why? I am also ready for ECT, if it becomes necessary. I would rather do that than go on Clozaril, which is the other thing being currently discussed. The side effects freak me out.

I may get in trouble for saying this and I am not saying it cannot work for some people, but in my experience being on it for several years and talking to other folks who have taken it, I just think Lamictal is overrated for bipolar depression. I don't think it did a damn thing for me besides putting me in the burn unit for a week. Just my take and, of course, everyone's mileage does vary. But I had to get that off my chest because I believe Lamictal is pushed on us too hard as some kind of panacea for depression. And I don't believe it is.
Oddly, Pristiq was receiving so much attention just a few years ago, especially for bipolar depression. Suddenly it seemed to disappear, in a way. But it's been helpful for me.

My issue with Lamictal is the flattening effect. It does seem like it's stabilized my moods, but it has also caused me to lack intense feelings, regardless of what kinds of feelings. That does bother me.

Anyway, I do think it's worth asking about Pristiq.

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Default Nov 08, 2019 at 07:08 PM
  #11
mariela, remember that what you saw of ECT in One Flew Over the Cuckoo's Nest was dramatized and completely inaccurate. It is nothing like Nicholson made us believe. Don't let yourself get freaked out by a fairy tale.

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Default Nov 08, 2019 at 08:18 PM
  #12
Marilea10, have you tried an MAOI? I've been on Emsam for 10 years and that made the difference between treatment-resistant depression to very few depressions. I've had many mixed episodes but those are more on the manic side for me (and those are much better with my other magic med, clozaril). Before Emsam I was either failing on ADs constantly or needing one that allowed for 10 mg dose changes (not normally but for me) that we could tightly control. Now I can just adjust the dose a bit if needed, up or down, just like ADs should be used.

ECT is next up for me should something happen with Emsam and I'm really fine with that but I'm happy to have Emsam as long as it works which so far seems to be a long time. My pdoc told me that it doesn't tend to poop out like other ADs and that's been my experience thus far.

I hope you are feeling better soon.

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Default Nov 09, 2019 at 04:42 PM
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I take Paxil but I'm also on two antipsychotics and a moodstabilizer, I don't have a problem with it making me manic

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Default Nov 13, 2019 at 09:29 AM
  #14
Quote:
Originally Posted by mariela10 View Post
Hi! I am writing to see if anyone out there has experienced what I have when using antidepressants for bipolar disorder I. I have tried several antidepressants over the last few months and every time I try a new medication, after 3-4 days I start experiencing intrusive suicidal thoughts which are very scary but I do not feel compelled to act upon them. After a day or so off the medication the thoughts disappear but I am left with the exhausting depression in which I go from hour to hour, day after day. I actually dread going to sleep at night because I know what the next day will bring even though I approach it with an optimistic attitude. I saw another psychiatrist who said I had treatment resistant depression (even though I am bipolar) and refused to treat me, saying medicinally, there was nothing he could do for me. I am on high doses of night meds - 750 Seroquel, 200 Trazodone, 25 Thorazine and 2.5 valium. My question is this: With all of the meds I'm on, could this be the reason that none of the new meds I try will work? I am currently taking 1/2 of a 1.5 vraylar capsule. My system is super sensitive so I'm just taking a tiny amount and hope to find some relief. The dreaded word ECT was mentioned and I freaked out. Anyone having that experience? I'm determined to keep fighting this but my life sucks right now because I am constantly battling the depression. I would really appreciate your input and thank you for taking the time to read this post. It's good to know that I can go somewhere where people get what I'm going through.
@mariela10 My heart goes out to you. I know exactly what you mean by dreading sleep knowing that the next day will bring more crushing depression. I know what it feels like to fight to get through every minute of every day. I experienced this more the lat several months. I want you to know that the depression WILL end, even though it doesn't feel like it. About 8 weeks ago, my deep, dark depression suddenly lifted. I don't exactly feel "normal", but I feel SOOO much better. I was having suicidal ideation (totally unlike me) and considering ECT or ketamine infusions. I tried Lamictal (didn't work and caused hair loss - however, it works for many people on here and many haven't experienced hair loss like I did) I tried Lexapro - also didn't work and made my depression worse along with thoughts of suicide. I asked my pdoc about Mirapex as someone else on here suggested, but she said no. Finally, because I thought perhaps the problem was a lack of dopamine, not serotonin (since the Lexapro SSRI didn't work) I asked for Wellbutrin. For the first 3 weeks I felt worse (including SI). I almost gave up on the med, but after about 3-4 weeks I began feeling so much better.

I should note that around the same time, I started taking L-Methylfolate 15mg. The prescription form is called Deplin, but I just buy it from Methyl Pro. I do not know if I have the MTHFR gene or not (i'll get around to testing for it eventually), but I was DESPERATE for relief and would try anything, so I just started supplementing with it. I've read that many people have the gene mutation and don't even know it. Symptoms of the gene mutation are depression, anxiety, AND Bipolar disorder, among other things. Supplementing with L-Methylfolate can make your antidepressant work better, again..only if you have the MTHFR mutation.

You may already be taking supplements, but NAC (2 grams), Vitamin D, Fish Oil, and Magnesium are also very beneficial, although it can take weeks or months to feel the benefit.

Also, L-Tryptophan is beneficial as it converts to 5-HTP which then converts to serotonin and melatonin. L-Theanine boosts levels of GABA, serotonin, and dopamine. I don't take these supplements individually, but I get them combined in a product called Twilight Time by Progressive Labs on Amazon. If nothing else it helps me sleep better, but I believe the amino acids must be somewhat beneficial.

'm sorry for the long response. I just wanted you to know that I completely understand what you're feeling and that anti-depressants have had the same effect on me.. I also wanted to share what is currently working for me. We are all different, but sometimes what works for others will work for us too! I will be praying for you. Always know that you are not alone.
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Default Nov 14, 2019 at 08:15 PM
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Originally Posted by mariela10 View Post
I saw another psychiatrist who said I had treatment resistant depression (even though I am bipolar) and refused to treat me, saying medicinally, there was nothing he could do for me.
Numerous studies show that SSRI's only work for about 70% of people. That leaves a large population "resistant" to antidepressants, so it's not like your case is rare.

I find it disconcerting that a shrink would give up that quickly. As for advice, I am not a doctor and would not give advice on meds. All I can say is I would find another shrink and get a second opinion about the "treatment resistance" label.
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