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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by linkadge on July 8, 2021, at 18:27:36
More and more the 'consensus' in bipolar depression is to NOT use antidepressants. This really pisses me off. Bipolar is not a homogenous disorder and some bipolar patients really do benefit from antidepressants.
Not only that, what are the alternatives? Ramping up mood stabilizers? Antipsychotics? For many bipolar patients adding another mood stabilizer (in bipolar depression) does jack.
More and more in medicine, they just talk about what you cannot do. It really bothers me.
Linkadge
Posted by rjlockhart37 on July 8, 2021, at 18:38:52
In reply to Treatment of bipolar depression sucks, posted by linkadge on July 8, 2021, at 18:27:36
link, i'm not bipolar but i take bipolar medication, zyprexa, lamictal, nuerontin (add-on) i just eventually just said ok and started taking bipolar medications. They seem to help with calming thoughts, and lettin you be calmer in content. But also take prozac, and that usally helps the mood stablizers to work with improved serotonin. I know, when i was in a psych, i knew people who were defeintly bipolar...they way they spoke, severe bipolar cases, but they took depakote, lithium, tegretol .... and they had no antidepressants. I talked with them in the psych, we used to go to the therapy room and have class, and i had som conversations with them, group converations, They were on yeah, bipolar, but this is the thing, i am on 3 bipolar edications and there on their max soaw (400mg lamotragratin, olazpine 20mg, and nuerontin 600mg X 3 daily) and im not bipolar, it's documented that i had manic depressiv symtptoms in the psych, but i know for fact, not bipolar. I have diffiulty doing tasks, i tend to fall behind, rerember 15 years ago i was posting about being removed from ADHD medications, i have ADHD i know it, but it's gottn to a point where it's hard do tasks (work related) Prozac is mood source, if didnt have prozac i would be at the bottem of the mariana trench.
Posted by rjlockhart37 on July 8, 2021, at 18:46:07
In reply to Re: Treatment of bipolar depression sucks, posted by rjlockhart37 on July 8, 2021, at 18:38:52
but when i was in the psych, yes these people were defeintly manic depressive, they took lithium, depakote, tegretol, alot of hard core mood stablizers, with no antidepressants. Actually, they way their behavir was, yes an antidepressant would skyrocket, but maybe a low dose of zoloft would work for them. When we were in the therpay room, they usally were falling asleep becuse of the meds they were on. I don't know if they had an antidepressant, maybe mood stablizers could snyergy with antidepressant. But that's all, because psych there were many people on mood stablizers, heavy amounts
Posted by Christ_empowered on July 8, 2021, at 19:42:09
In reply to Re: Treatment of bipolar depression sucks, posted by rjlockhart37 on July 8, 2021, at 18:38:52
lamictal instead of depakote or lithium. low to moderate dosage trileptal instead of tegretol, when agitation and (hypo)mania are an issue.
careful about the neuroleptic. personally, abilify is relatively OK. not miraculous, but OK. full dose doesn't swing me down into dysphoria, at least. seroquel did...that stuff is rough. I've read that rexulti might be better.
my psych just stopped my ssri (prozac). wasn't a huge help, but it did mellow me out and reduce my ruminations at 20mgs. apparently, I'm "mildly hypomanic...:
no more prozac, a bit more lamictal, hope I don't get the rash. ugh.
neurontin? lyrica? i don't know the prescribing guidelines for benzodiazepines in older people...ativan? not to help the depression, per se, just..curb some of the angst and such. random thought.
try not to go for more than 1 neuroleptic at a time. especially in older women with mood disorders.
old school, but...amoxapine? a former psych brought it up. i brought it up to new psych. apparently, its good for cases heavy on the low mood, light on the psychosis. good to know...
a basic orthomolecular cocktail can do wonders. im good about my vitamin c (15 grams most day, 20 if I'm conscientious), not so good about B3 (makes my stomach hurt). vitamin E is a godsend for anyone on a tranquilizer. natural form, 1000 IU w/ mixed tocopherols with a high fat meal has kept me tic free for a long, long time now.
b-complex. i go for time release b-100, with food (otherwise...all kinds of nausea...). max 3 per day, usually 1-2.
ashwaghanda and/or rhodiola, maybe? Jarrow has been good to me. other reputable brands are out there...I had one, with the rhodiola, that mixed it with schizandra. good times...mellowing effect. Jarrow was on sale, after that.
ok. hope this helps :-)
Posted by jay2112 on July 9, 2021, at 20:44:29
In reply to Re: Treatment of bipolar depression sucks, posted by Christ_empowered on July 8, 2021, at 19:42:09
Interesting....
I have been doing some heavy research on atypical antipsychotics. The ones that antagonize 5-ht2a and 5-ht2c appear quite efficacious in majorly reducing agitation and social anxiety. Yes, Risperidone (Risperdal) binds strongest to those receptors, with a lighter dopamine blockade, and also blocks adrenergic receptors.
The issues with Zyprexa, Saphris, and Seroquel, to name a few, is they also block, very heavily, histamine and muscarnic receptors, and heavy dopamine blockade. Like you said about Seroquel, it's a heavy baby, and it drove me into the abyss!! Haldol seemed like a walk in the park compared to Seroquel...lol. Zyprexa, combined wirh Risperdal, seemed smooth. Zyprexa alone causes anger, crying, and peeing my bed at night!
Saphris caused MAJOR td, at times.For me, Abilify was very, very strange. It seemed like I was on a combo of speed, and a ton of Mellaril! Nightmares, td constantly, sweating so much, summer and winter, I had to wash and change clothes constantly! But...this all shows how different we all are. Genetics, environment..etc.
Yeah...it sucks!! Uggghhhh....
Jay
Posted by undopaminergic on July 10, 2021, at 6:05:35
In reply to Re: Treatment of bipolar depression sucks, posted by jay2112 on July 9, 2021, at 20:44:29
> Interesting....
>
> I have been doing some heavy research on atypical antipsychotics. The ones that antagonize 5-ht2a and 5-ht2c appear quite efficacious in majorly reducing agitation and social anxiety. Yes, Risperidone (Risperdal) binds strongest to those receptors, with a lighter dopamine blockade, and also blocks adrenergic receptors.
>I didn't enjoy risperidone at all. It made me feel weak and made me gain a little weight, so I quit. It was my first antipsychotic, and my condition is substantially different from back then. Perhaps for that reason, I've never experienced the feeling of weakness again, despite trying a multitude of other antipsychotics, so maybe I wouldn't if I tried risperidone again.
> The issues with Zyprexa, Saphris, and Seroquel, to name a few, is they also block, very heavily, histamine and muscarnic receptors, and heavy dopamine blockade. Like you said about Seroquel, it's a heavy baby, and it drove me into the abyss!! Haldol seemed like a walk in the park compared to Seroquel...lol.
>Actually quetiapine (Seroquel) is one of the weakest dopamine antagonists among antipsychotic drugs. Some say that the action is so weak as to be clinically irrelevant. Meanwhile, haloperidol (Haldol) is one of the most potent dopamine antagonists, and incidentally, one of the most dopamine-selective.
So I agree with what you say below:
> But...this all shows how different we all are. Genetics, environment..etc.
> Saphris caused MAJOR td, at times.
>I think you mean EPS (extrapyramidal symptoms) not TD (tardive dyskinesia).
-undopaminergic
Posted by SLS on July 11, 2021, at 9:51:03
In reply to Treatment of bipolar depression sucks, posted by linkadge on July 8, 2021, at 18:27:36
> More and more the 'consensus' in bipolar depression is to NOT use antidepressants. This really pisses me off. Bipolar is not a homogenous disorder and some bipolar patients really do benefit from antidepressants.
>
> Not only that, what are the alternatives? Ramping up mood stabilizers? Antipsychotics? For many bipolar patients adding another mood stabilizer (in bipolar depression) does jack.
>
> More and more in medicine, they just talk about what you cannot do. It really bothers me.I totally agree with you.
Did you ever notice that all of the antidepressants studied since the 1980s using RCTs yield positive results comparable to all other antidepressants? What's the likelihood of that?
- Scott
Posted by Lamdage22 on July 14, 2021, at 4:54:49
In reply to Re: Treatment of bipolar depression sucks » linkadge, posted by SLS on July 11, 2021, at 9:51:03
Well, if you cured yourself, maybe you can cure your mother as well? I refrain from advising anyone to take anything. You never know if something bad might come out of it.
Posted by Lamdage22 on July 14, 2021, at 5:12:23
In reply to Re: Treatment of bipolar depression sucks, posted by Lamdage22 on July 14, 2021, at 4:54:49
Try to anyway.
This is the end of the thread.
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