Can you elaborate on your symptoms?
A lot of antidepressants indicated for major depression can induce (hypo)mania in some cases, and this is more likely for those who seem to be bipolar. Some even consider a (hypo)manic response to an antidepressant response as sufficient evidence to make a bipolar diagnosis. So some practitioners might be reluctant to prescribe an SSRI or certain other antidepressants without some kind of mood stabilizer. I had (hypo)manic reactions to SSRIs and that was what led me to be eventually diagnosed as bipolar II... almost exclusively depressed, without medication.
Wellbutrin might be useful if you are unmotivated and lethargic. It is an
NDRI; kind of like a stimulant. It has worked well for me for the past year.
Lamictal is a mood stabilizer that's supposed to be good for bipolar depression... I titrated up too fast and
felt suicidal after jumping from 50 mg to 100 mg. I stopped taking it for a while, then restarted and have been increasing the dose much more slowly... no problems yet, but no clear evidence of benefits yet either.
Abilify is an atypical antipsychotic that is also a partial agonist at some dopamine and serotonin receptors. It does not have the same sedating effects and is supposed to help with depression; it's approved as an add-on for another antidepressant as well as for controlling bipolar mania and schizophrenia. I've tried it a few times and always found it to be activating during the first few weeks, but that effect never lasted long it results in
akathisia for me.
I currently take a low dose of Zoloft along with Wellbutrin and Lamictal and it helps with mood a little bit. However it gives me insomnia and right now I am trying to find a way to make things work. I expect I'll have to give up the Zoloft soon.
To deal with the insomnia, I was given Seroquel XR, another atypical antipsychotic, which is supposed to be effective for treating both bipolar depression and mania. It was extremely sedating - too much for my current workload, so I stopped taking it after four days. It was nice to finally get a good eight (well, more like 12) hours of sleep... If I had more time to sleep I would have stayed on it to see if the excess somnolence would go away; my mood was good and I felt a mild buzz while I was taking it. Yesterday I was prescribed instant release Seroquel, but last night it didn't work so well; I felt extremely tired and intoxicated, almost like being awake on Ambien, yet was restless once I got in bed and barely slept all night (giving up around 4 am). Maybe it's some kind of akathisia? Tonight I took a lower dose and it's just now starting to kick in; my feet feel slightly tingly.
I have also tried Emsam, an
MAOI. It is contraindicated with many other drugs (including Wellbutrin and Adderall/Vyvanse which I use) so i had to stop taking those. I gave it about 3 or 4 weeks, but it wasn't improving my mood at all, and was actually more depressed and less energetic. I'm not sure if it actually had an effect on mood, or if I was having problems because I had top stop taking Wellbutrin.
I've taken tianeptine, supposedly an
SSRE, but with little effect. Very slight mood elevation, but a bit of anxiety when it wears off. Some people find it euphoric, but not me.
Other potential drugs of interest: mirtazapine, more MAOIs, tricyclic antidepressants, a few unique antidepressants that were never marketed in the US, using stimulants to treat depression, using opioids to treat depression, various psych meds that are indicated for things other than depression...
