Bipolar Disorder and SSRI's

[Sweet P]

Hi everyone. I recently saw a shrink for a mental health assessment, and he seems pretty certain that I have bipolar disorder. I was actually diagnosed with this during my late teens, but then the diagnosis later got changed to borderline personality disorder which turned out to be incorrect, as I was using methamphetamine heavily at the time (the effects of meth must have presented as borderline personality disorder). Now that I've quit meth the diagnosis has been reverted back to bipolar disorder, which I think is the correct one.

Anyway, I'm taking 40mg of paroxetine a day for depression and that has worked great over the last few years. I still have episodes of depression, but it isn't as severe as it was before taking the paroxetine. Now my shrink wants to wean me off paroxetine completely and prescribe me sodium valproate instead, as he thinks a mood stabiliser will be better at controlling my hypomanic and mixed episodes along with the depression. I'm willing to do that, especially if it helps to control the horrible mixed states. Only thing I'm worried about is the depression returning. I'm considering asking the shrink if I can stay on the paroxetine (even just on a reduced dose, like 20mg's) and take the sodium valproate too. I know SSRI's can worsen mania and mixed states in some people with bipolar though, which is probably why he wants me to taper off it completely.

So my question is, has anyone experienced bipolar disorder and taken an SSRI - either by itself or combined with a mood stabiliser? If so, have you ever noticed the SSRI contributing to your mania or mixed states? Or have you found the combination of SSRI's and mood stabilisers worked well balancing out your mood? Thanks for any advice!

 

[BlueHues]

I've heard of people getting SSRIs, mood stabilizers and antisphychotics for bipolar....I think one of the determining factors is how severe any manic episodes you've had have been. If you cycle between severe depression and slight hypomania there's probably more of a chance of getting some type of antidepressant. If you're directing traffic in your underwear, full blown
manic?! it's usually depakote/lithium and seroquel/risperdal. Shit, I know people diagnosed bipolar getting adderall on top of the other shit....So, who knows......I don't mind seroquel. It's kind of just like a benzo that makes you really hungry and tired...depakote/valproic acid makes me feel like I have no soul, but I never stayed on it long enough to see if that would have gone away....I've had periods off everything and I think practicing meditation can work wonders if you do it for a half hour everyday and stay away from certain drugs. I was wondering why he changed his diagnosis? You must be too damn happy!! lol

 

[Sweet P]

I tend to cycle between severe depression and hypomania and mixed states... I don't get the full-blown mania itself, but the mixed states can be pretty bad (e.g. hating life to the point of wanting to end it, yet thinking I'm the best thing since sliced bread and the rest of the world doesn't appreciate my greatness!). I'm prescribed Seroquel already and it does work great, especially for getting to sleep at night, but it doesn't seem to be helping completely which is why the shrink wants me to try sodium valproate. I'd be taking the sodium valproate and Seroquel, but tapering off the paroxetine. I'm thinking of asking to remain on a smaller dose of paroxetine since my depression can get very severe, but I do wonder if my mixed states would improve if I tapered off it completely.

Like I said, I had been diagnosed with bipolar disorder when I was younger, so it's not really a "new" diagnosis for me. The diagnosis got changed to borderline personality disorder while I was using meth (which I think was pretty silly - it's hard to make a true diagnosis when someone is in the midst of a hard drug addiction!). But yeah, now that I'm off meth my so-called "borderline" symptoms have gone away and I've been returned to the original bipolar diagnosis.

Thanks for the advice!

 

[twyleskyles]

WTF? this is just like my story. Is this a joke on me?

 

[twyleskyles]

I take Fluvoxamine which is an SSRI but has no side effects for me and now I'm on Wellbutrin which is great for me

 

[twyleskyles]

The Valproic stuff never worked for me, I've been on lots of stuff. But everyone is different.

 

[mrflowers00]

lol directing traffic in your underwear thats the funniest most random thing i've heard in a long time so thank you for that it's lifting my depression and as for the OPs question you should tell your doc to let you stay on the SSRI while taking the mood stabilizer

 

[twyleskyles]

Hahah. You made me laugh at my own self.

 

[paranoid android]

SSRI's, SNRI's, Tricyclics and any other anti-depressant's that effect serotonin are generally a no no in treating bipolar disorder. However if you are mostly getting the depression side of things Valproate alone won't help that as it's just a anti-manic drug not a true mood stabilizer like Lithium or Lamictal (lamotrigine) as it doesn't have any anti-depressant effects. I personally never found Divalproex aka another Valproate to be of much use in treating my bipolar disorder at all but that may have been due to being on to low of a dose for me. I think i only made it up to about 750mg's of Valproate so yeah not that much for me maybe.

I have taken Effexor (venlafaxine), amitriptyline, Remeron (mirtazapine) and wellbutrin/Zyban (bupropion). The effexor i took before i knew i had bipolar disorder and it made my moods so fucked up that it turned me off all psych meds except benzos for years. It made me manic and mixed state so yeah not fun . Granted effexor is a SNRI and is supposed to be way worse then SSRI's for causing mania, mixed states or rapid cycling although at the low dose i was on it would have mostly have been acting as a serotonin reuptake inhibitor. Oddly enough amitriptyline despite being a tricyclic anti-depressant that acts as a SNRI did not seem to make my moods any worse and it did help with the depression side of things. However the anti-depressant effects crapped out around the same time as the painkilling effects did so i had to stop taking it. Hence why i am still on bupropion a dopamine norepinephrine reuptake inhibitor.

Lamictal (lamotrigine) is one mood stabilizer that seems to work better on depression then on mania. It really made a huge difference in my moods and has pretty much done away with the mixed states as well as rapid cycling. Ive been in a rough patch lately (to say the least) but lamotrigine may be worth a shot if you want a actual mood stabilizer that helps the depression as well as mania. Another plus is that you don't have to get alot of blood tests done like you do with Valproate or especially lithium.

 

[Sweet P]

I have taken Effexor (venlafaxine), amitriptyline, Remeron (mirtazapine) and wellbutrin/Zyban (bupropion). The effexor i took before i knew i had bipolar disorder and it made my moods so fucked up that it turned me off all psych meds except benzos for years. It made me manic and mixed state so yeah not fun . Granted effexor is a SNRI and is supposed to be way worse then SSRI's for causing mania, mixed states or rapid cycling although at the low dose i was on it would have mostly have been acting as a serotonin reuptake inhibitor. Oddly enough amitriptyline despite being a tricyclic anti-depressant that acts as a SNRI did not seem to make my moods any worse and it did help with the depression side of things. However the anti-depressant effects crapped out around the same time as the painkilling effects did so i had to stop taking it. Hence why i am still on bupropion a dopamine norepinephrine reuptake inhibitor.

Yeah I've been prescribed venlafaxine and bupropion in the past. Venlafaxine gave me terrible anxiety and made my mixed states a lot worse, so I discontinued that after 2 or 3 weeks. Bupropion worked pretty well for my depression, but I had at least two seizures while I was on it (granted, I was also using meth at the time), but the seizures kinda scared me off that med.

Lamictal (lamotrigine) is one mood stabilizer that seems to work better on depression then on mania. It really made a huge difference in my moods and has pretty much done away with the mixed states as well as rapid cycling. Ive been in a rough patch lately (to say the least) but lamotrigine may be worth a shot if you want a actual mood stabilizer that helps the depression as well as mania. Another plus is that you don't have to get alot of blood tests done like you do with Valproate or especially lithium.

I actually asked the shrink about lamotrigine, as I've known some people who are prescribed it. But he seemed to think it wouldn't be as helpful for my mixed states, which is a pity cos it's a newer medication compared to lithium and valproate, and like you say, requires less blood tests to monitor it's levels.

I was diagnosed manic depressive five years ago and I have had lot of different combinations over the years.

Right now I am also taking Prozac (fluoxotine) which is SSRI, in addition to Amitryptiline and quetiapine in form of Ketipinor (25mg) or Seroquel (200mg) depending on my needs. I think you should give SSRIs a chance but you have to be vigilant to stop them if you get first signs that they make you worse. I have finally found a cocktail that keeps me in balance and it contains moderate amount of SSRIs. Your organism might not take it like mine. But you should try if current situation is not satisfying enough. And start low like I did and make next doctor's appointment next week, or two weeks from starting new meds so you can be sure your doctor can keep an eye on you.

Yeah, I'm considering staying on a smaller dose of paroxetine - maybe 20mg's. Hopefully that and the sodium valproate will be enough to balance my mood better. I haven't got any further appointments with the psychiatrist, as it was just a one-off assessment, but my GP is gonna continue managing my medication. I'll need to see her in a couple of weeks so I'll discuss it with her then.

Thanks for the advice everyone!

 

[twyleskyles]

Can you mix meth with Wellbutrin?

 

[littlepenguin]

I have had an extensive history with this kind of thing.
I've been on damn near every ssri, mood stabelizer(sp), anti psychotic under the sun. I'm BP and BD. you can have both.
I haven't taken any meds for a long time, by choice - I can't stand the way they make me feel, and frankly, I'd rather 'ride the rollercoaster,' as difficult as it may be at times, than take those goofy drugs (I don't recommend this, it's purely a personal choice.)

A few years ago, I was in a deep, dark nasty depression/low that just wouldn't break. I found a doctor who was out of my network, knowing that they wouldn't have any of my medical history. I went because I knew for a fact that he/she would take one look at me and throw out some type of ssri/anti depressant. Why did I do this? because I knew it would break the depression and send me into a manic state. Anything better than the depression I was in......heh

So, I was right, went to doc, told him I had a history of major depression, and he prescribed me a crazy high dosage of celexa. sure as shit, it sent me through the roof just like I wanted. (DO NOT TRY THIS AT HOME.) it was great for about 2 weeks, and I didn't get depressed again, stayed very manic, but it turned into an incredibly irritable, angry mania. it was like nothing I had experienced before. being manic and angry is fucking weird and highly uncomfortable, and the suicidal thoughts were manifesting as if I was in a low and depressed, but this time I had the energy and imagination to plan and carry ideas out. to make a long story short, i had a psychotic break and ended up in the looney bin after a series of events that I don't recall, and I'm sure I wouldn't want to from what I heard.

SO, anyways, no doctor with half a brain would prescribe someone knowingly diagnosed with BPD a ssri without something else to go with it. They had always had me on some type of anti depressant, but never ever by itself, it was always with lithium or depakote or zyprexa or something like that, with xanax or some other thing. it specifically states on almost all of the ssri drug info under "who should not take this drug" it lists "manic depressives."

finding the right drugs for any specific person is a taxing task; it takes usually 3 or more weeks for these types of drugs to reach their full effects, only sometimes to realize that it is absolutely not the right drug for you, and then fuck, you're back at square one again, with another new drug to sample. it's an endless circle and it sucks, and that's one of the main reasons I choose to not take these kind of drugs. however, they are totally necessary for some people, and they should be taken by doctors orders if you are one of these people. if you have the patience and can bear with the experimentation, you may just find a combination of drugs that will make you happy and help you live a totally 'normal' life without the stress of the highs and lows and the crap that comes along with these mood states.

i wish you all the luck.

 

[paranoid android]

^ I had a similar thing happen a few years ago when i decided to add L-tyrosine to the wellbutrin. It lifted my mood but after a week it drove me more manic then i have ever been and for a longer period then i have ever been. I think that's what caused it anyway so maybe abit too much norepinephrine floating around in the old synapses 8( . I had to take 2-4mg's of risperidone a day along with 300mg's of seroquel at night to keep me from jumping out of my skin. Even then i was bouncing off the walls and would exercise until i dropped so i wouldn't hurt myself. That was hellish to say the least.

Mania is no fun at all and mixed states are just torture.

 

[dilated_pupils]

So my question is, has anyone experienced bipolar disorder and taken an SSRI - either by itself or combined with a mood stabiliser? If so, have you ever noticed the SSRI contributing to your mania or mixed states? Or have you found the combination of SSRI's and mood stabilisers worked well balancing out your mood? Thanks for any advice!

I've been on numerous different SSRI's, and combinations through out my childhood up to adulthood. I've noted that SSRI's have made me worse and have stayed away from them, although recently I was on a low dose of amitriptyline and didn't notice anything positive after a months use, in fact my sleep worsened.

My mother was on Paxil for a long time and I know without it, it would drive her nuts. It's something to be treated like a benzo taper, in my opinion. I have taken mood stabilizers myself though after being diagnosed bi-polar and noted that Lamotrigine (Lamictal) had helped probably more than any other medicine I've tried. I'm now taking gabapentine for migraines but it doubles as a mood stabilizer. I really can't speak to your body chemistry though, so the only thing that will tell you what works is time and patience, which is always an unfortunate answer to hear, trust me I know.

I would give the mood stabilizers a try, and if you're uncomfortable with the paxil being off the table completely, then just ask to remain on both the paxil and the mood stabilizer as you convert your regimen. I wish you luck, and continued happiness.

-dp

 

[Furry mouth]

I was on every type of ssri for 12 years. Then had complete breakdown and was diagnosed with BPD and immediately taken off ssri. Been on every type of Benzo, mood stabiliser, and ssri over last 15 years.

Currently on epilim, lyrica, topamax, rivotril, and Xanax. Lithium only drug I haven't been on.

When I was on ssri it was sheer hell. At its worst my family were literally trying to hold me down to stop me going out in the car cos they were terrified i was going to kill myself, which i came close to on several occasions. I was screaming and eventually got free. I do wonder how im still here. Anyway, i was in a severe mixed state when i went into hospital.

Now I'm in a situation where I am thinking of asking my shrink to put me on small dose of Prozac so I can reduce epilim. I'm on huge doses of all drugs and I'm increasing my doses on an ongoing basis. Depression is the worst one. Can't haul my fat epilim ass outta bed most days. Hate life and this is with drugs!'!!!!!!

I am so tempted to come off them all. I've turned into a fat, hairy sloth from these fecking drugs. I do miss th energy that comes with the euphoria.

Be very careful with ssri's on their own. My shrink told me that they are to blame quite a lot of the time for sending people into full blown mania or even more dangerously (her words not mine) mixed episodes. From my own personal experiences I wouldn't wish the latter on my worst enemy.

 

[KitCat]

Sounds like you're diagnosed with bipolar type 2. My personal opinion is that a lot of people with this diagnosis wouldn't have had the high part (hypomania/mixed) if they weren't taking ssris i.e. they'd only have a problem with depression. So you really need to ask yourself whether it's ssris that "fixed" one problem for you but created another and you'd be better off without them or trying something else.

I'm bipolar type 1 and I was diagnosed 6 years ago. I get full blown manias in the absence of any medication/other substances... I'm just batshit crazy. I also suffer from crippling suicidal depressions. Doctors tried the standard approach with me which is lithium and antipsychotics. That worked well for manias but unfortunately I was left with the depressions and my impression is that being on lithium/antipsychotic actually made my depressions even deeper. I tried epilim as well but couldn't stay on it due to nausea. I was admitted to a hospital during a particularly bad episode of depression and the hospital doctor put me on effexor which turned out to be a bad move, very bad. But it was seen as a quick fix for depression at the time and prozac/lovan was tried later for the same purpose. Every time I got put on SSRIs I'd go manic within 2-4 weeks. For as long as we "played" around with SSRIs I was rapid cycling and trust me, you want to avoid that as it literally burns your brain out, that's going up and down and everywhere in between on steroids, plus manias turn out to not be so euphoric anymore but rather turn into dysphoric mixed states. After I stopped taking SSRI my mood stabilised in a few months. For me, SSRIs are a no no, even with lithium on board.

If you have any suspicion that SSRIs cause you to have episodes/mood lability more frequently or cause mixed episodes, then keep away from them. The safer alternatives (in that respect) for depressive component of bipolar disorder are lamictal and wellbutrin.

 

[Sweet P]

finding the right drugs for any specific person is a taxing task; it takes usually 3 or more weeks for these types of drugs to reach their full effects, only sometimes to realize that it is absolutely not the right drug for you, and then fuck, you're back at square one again, with another new drug to sample. it's an endless circle and it sucks, and that's one of the main reasons I choose to not take these kind of drugs.

I am so tempted to come off them all. I've turned into a fat, hairy sloth from these fecking drugs. I do miss th energy that comes with the euphoria.

I think I'm reaching that point now... I've been on Epilim (sodium valproate) for over several weeks now (I started on 500mg's a day, then increased to 1000mg's) and I'm finding it absolutely ghastly. My mood has been a little better, but instead I'm feeling tired, dizzy, and nauseas all the time. I'll give it another few weeks, but if those side effects don't improve I'll probably have to stop taking it and go back to square one. So frustrating!

As far as the SSRI's go, I've tapered down to 10mg's of paroxetine a day, and next week I'll be off it completely. Haven't had any major rebound depression yet, though I'm a bit worried it'll return if I decide to stop taking the Epilim. I guess I'll just have to wait to see how things pan out.

 

[Furry mouth]

I think I'm reaching that point now... I've been on Epilim (sodium valproate) for over several weeks now (I started on 500mg's a day, then increased to 1000mg's) and I'm finding it absolutely ghastly. My mood has been a little better, but instead I'm feeling tired, dizzy, and nauseas all the time. I'll give it another few weeks, but if those side effects don't improve I'll probably have to stop taking it and go back to square one. So frustrating!.

SweetP, yes the nausea can be very bad with Epilim, could you get something to help with that? I used to use Stemitil which helped a lot.

 

[chrisalt]

I hear that the combo of Anti Ds ad Biplor can make it worse.

 

[Sweet P]

SweetP, yes the nausea can be very bad with Epilim, could you get something to help with that? I used to use Stemitil which helped a lot.

I've been prescribed anti-emetics like Stemetil and metoclopramide in the past, but they gave me bad extrapyramidal side-effects, so I'm reluctant to use them again. I've got an appointment with my GP tomorrow, so I'll discuss the Epilim with her then and see what she thinks.