Posted by Tomatheus on May 10, 2015, at 22:34:35
In reply to Bipolar depression - need med suggestions, posted by momandwife on May 10, 2015, at 21:18:44
Hello, momandwife. First, I'd like to welcome you to Psycho-Babble and wish you a happy Mother's Day. I'm sorry to hear about your husband's bipolar depression and about the fact that his condition seems to be rather resistant to treatment with medications. The first thing that I'm wondering about after having read your post is how much your husband's current medications seem to be helping. And if some of your husband's medications seem to be helping, which ones seem to be helping the most?
As far as recommendations for new medications to ask your husband's prescriber about, I'll briefly discuss some that I think might be helpful for bipolar depression. Please feel free to disregard any medications that your husband has already tried, because other than Effexor and the medications that your husband is currently taking, I'm not sure what he's tried and what he hasn't. So, now for my discussion of specific medications...
* Lithium - As the oldest pharmacological treatment for bipolar disorder, lithium is a "true" mood stabilizer in that it's understood to be useful in alleviating both manic and depressive states. I personally take lithium in the orotate form and have also taken lithium carbonate, and even though my current trial with lithium (orotate) is basically just under way, I'm currently noticing what seems to be some improvement in my depressive symptoms, which are part of what I'd describe as likely being a persistent mixed episode with psychotic features. Unlike other medications that are used as mood stabilizers, I've never noticed a worsening in my depressive symptoms that I could definitively attribute to lithium.
* Abilify (aripiprazole) - Even though I understand there's some research that indicates that Abilify isn't particularly effective in treating bipolar depression, I think this medication should still be up for consideration, as it's used for both bipolar disorder and for the add-on treatment of depression. Of the antipsychotics that I've stayed on for more than a day, Abilify at low doses is the only one that didn't seem to make my anergia considerably worse. Abilify might be more effective for those experiencing long-term bipolar depressions at low doses -- the doses used in the add-on treatment of depression -- but I do think that some with bipolar depression could benefit from higher doses.
* Wellbutrin (bupropion) - With a reputation as being at least somewhat more "activating" than other antidepressants, Wellbutrin seems to be used frequently for bipolar depression at least in part because of some evidence to indicate that it's less likely to cause manic "switches" than other antidepressants.
* The tricyclics (TCAs) and monoamine oxidase inhibitors (MAOIs) - I just wanted to bring these older classes of antidepressants up because doctors tend to overlook them, and I think that it would in many cases be a mistake to give up on looking for an effective antidepressant if the TCAs and MAOIs haven't been tried. I think that the MAOIs are particularly worthy of consideration in treatment-resistant cases of depression because they're understood to boost neurotransmitter levels via a mechanism that's different from those of other antidepressants. Of course, MAOIs interact with a lot of other medications and come with dietary restrictions, so they're not used very often these days.
Before I finish, I'd like to ask if your husband has received psychotherapy and whether he's benefited from it if he has received it. I'm not 100-percent certain if this is the case with bipolar depression, but with depression generally, it's my understanding that treatment with medications and psychotherapy together tends to be more effective than either treatment alone. I also wanted to say that your husband's vitamin D dose of 10,000 IU seems to be high. If your husband's been taking vitamin D for several years, it would be my guess that his vitamin D level is probably plenty high and might benefit from a dose reduction.
Well, I think that I've written everything that I'd like to write as far as ideas for your husband's treatment are concerned. Please remember that I'm not a medical professional and that much of what I have to say about medications is based on my own experiences with them, so take what I say with a grain of salt. I hope that others here will also chime in to give their suggestions as to what might be helpful in your husband's case, as others might pick up on something that I might have missed.
Finally, good luck to you and your husband. I hope that your husband's condition will improve.
Tomatheus
Has long-standing difficulties with energy and concentration, as well as psychotic and cognitive symptoms
Taking Abilify & supplements
poster:Tomatheus
thread:1078863
URL: http://www.dr-bob.org/babble/20150407/msgs/1078865.html