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Misc Desperately need a new antidepressant

T

The.Ghost

Bluelighter
Joined
Jun 20, 2011
Messages
274
I have bipolar II and have been having some severe depression lately. I've been on just about everything, and my current regiment (lamotrigine + aripiprazole) just isn't cutting it.

A brief summary of what I've tried:

  • Lexapro (escitalopram) – worked for a little while, then made me suicidal
  • Paxil (paroxetine) – same thing
  • Effexor XR (venlafaxine) – worked for a little while, then made me hypomanic, then depressed beyond suicidal. Never going near that shit again. Don't even get me started on the withdrawals.
  • Pristiq (o-desvenlafaxine) – only took this to get off venlafaxine
  • Prozac (fluoxetine) – took it off and on, didn't help overall
  • Lamictal (Lamotrigine) – helps a bit, still on it because, why not?
  • Abilify (aripiprazole) – masked the feeling of depression for a while, but the symptoms were still present. I'm still on it, but all it's really does at this point is prevent mixed episodes.
  • Desryel (trazodone) – too many side-effects, only took it 2 days
  • Wellbutrin (bupropion) – took it for ~2 weeks, didn't work
  • Zoloft (sertraline) – took it for a month or two, didn't help. I had nasty side-effects on it and withdrawal symptoms for 5 months after stopping.
  • Viibryd (vilazodone) – yet another SSRI, didn't help

Is there anything good left? I'm through with SSRIs / SNRIs; MAOIs are out because of other stuff I'm on. Maybe a tri / tetra-cyclic? I'm really getting desperate here.
 
Have you tried using an SSRI with Lithium?

Or have you possibly tried using a mood stabilizer on its own rather than an SSRI along with your regiment of medication?

It's worth a shot - it may help :)
 
I've looked into ketamine, but being a general aesthetic, it's a little hard to come by. I've been thinking of asking for some scopolamine, as it's said to help in combination with ketamine; I think it works by itself.

I haven't tried lithium. From what I've read, it's more anti-manic than anti-depressive, and it's been years since my last hypomanic episode. And yes, I am on lamotrigine w/o an SSRI.
 
hmmm...

perhaps SSRI's are not made for you then - what dose of lamotrigine are you taking at the moment?
 
I've tried most of those. I think 2 weeks bupropion is not nearly enough time. I've worked up to 450 mg daily. It was a least a month before it was really useful. That's pretty much true of most antidepressants, and while I agree that Trazadone isn't worth much; it pretty much knocks me out for 6-8 hours- but hey, I'm not depressed during those hours ;)
I was also on Parnate, an MOAI and at first it was very helpful, than I went off, and then I tried it a second time and it didn't work so well, practically not at all. I've done desipramine a long time ago, I remember some unpleasant side effects. Tricyclics are generally unpleasant.
Ketamine experiments are pretty much over because of serious bladder and kidney damage from long-term use.
What helped me most of all, was Adderall. I was surprised to get a script (I have had substance abuse issues), but it worked great and I could think clearly! I didn't dare abuse it or share any because I didn't want to risk having my script discontinued. Restrictions meant only one month supply, and I had to show ID to the pharmacist each time. Long term health issues eventually made me stop, but I regret going off them quite often.
I don't know if Adderall would trigger mania. I never had a manic episode.
 
have you tried microdosing iboga rootbark? It is extremely effective for fixing up depression. I've used it three times for several week periods so far this year. First time I did a full flood dose after three days of microdosing (never planned on flooding but I felt so good i said why not!?) and i was a new man.
 
What is your diet like? If you have a poor diet your body can not make the proper chemicals to regulate body chemistry.

Think of it like playing with a play dough hamberger set, at first you have a the proper colors to make a correct burger.

After a whole of playing with it, the dough dries up. You lose pieces and have to make a burger with missing parts or green buns instead of brown buns. It works but isn't quite right.

Look into taking vitamins and supplements.

Get a vitamin blood plasm level and see if this can be causing the imbalance.

It may not fix everything but can can help out tremendously with the way you feel and perceive life.

Another option is trying GABA and 5-HTP Suppliments. They work by relieving stress and putting chemicals back into balance. They worked for me. Ask your dr. And if they seem not to know ask a health food store clerk. They usually know about herbs and pharmacology.

I hope you get well better soon and find balance.
 
^Honestly for something as serious as Bipolar Disorder I don't think vitamins and most supplements will do shit.
synthetix said:
Have you tried using an SSRI with Lithium?
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IME SSRIs cause mania and lithium would be a step down from Lamictal in terms of side effects. Lithium works, but it would fuck me up in a not fun way and has a thin line between an effective dose and an OD. Lamictal really doesn't have much side effects, but it can cause one really fucked up side effect. Don't look up lamotrigine rash if you want to keep your food down.

The only antidepressant that worked for me is mirtazapine. I think it has a different action on the brain than any of the other antidepressants you listed.
Mr.Dopamine said:
What helped me most of all, was Adderall.
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Yeah, if you're stabilized on anti-mania drugs it can help depression. Also many Manic-depressives also have ADD. Strangely, it still has a stimulant effect even though the other drugs should reduce it.
I don't know if Adderall would trigger mania. I never had a manic episode.
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It can cause mania, but it never did for me. Still the doc kicked me off, because the books say it's bad for psychotic disorders8(. Really caused much grief:(.
 
You would be surprised at what vitamin deficiencies can do to a person.

I suggest this because he has tried everything else. It's worth a shot if they find a imbalance and a vitamin can reduce some symptoms.

It's worth a shot to get it checked out. Vitamins and amino acids are the building blocks for neurotransmitters and tissue growth.
 
Look, depression is not something that you treat by just randomly choosing antidepressants. I was diagnosed with severe depression, panic disorder, generalized anxiety disorder and obsessive-compulsive disorder over 10 years ago. Through the years I've sometimes been a walking pharmacy, having used lots of different antidepressants (SSRI's/SNRI's/NaSSA's/Tricyclics), antipsychotics (olanzapine/ketiapine), beta blockers (propranol, atenolol, bisoprolol), benzos (oxazepam, alprazolam, diazepam, clonazepam and now going through withdrawal), and others (Lyrica, 5-HTP, St. John's Worth, GABA, Kava Kava, Rhodiola, Inositol, Melatonin etc etc). But I've noticed drugs only do so much, they're never really a true cure.

However I'm going to mention one antidepressant for you; mirtazapine. It is quite unique in its mode of action and does not resemble SSRI's. It's extremely effective for sleep, having very powerful sedative effects (almost like antipsychotics), but they ease after a few weeks. It is often used in treatment-resistant depression when SSRI's don't work. Try reading more about it though, it's not without side effects. Heavy lethargy the first weeks and extreme cravings for sweet/fat is to be expected, and hence a heavy weight-gain is often the result. You have to learn to control your cravings on it unless you want to turn into a sugar-obsessive whale. It's without many of the side effects SSRI's have though IME.
 
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you might find relief with Seroquel (quetiapine) together with the moodstabilizer your currently on, im not saying cut the abilify, maybe, but bring up the idea of seroquel with your psychiatrist and something good might come of it. IME i find cannabis relieving, but do not advocate self medicating with it, you might also benefit from CBT but just an idea. Overall IME it is key that the BP II patient avoid alcohol mainly, and generally it is wise to avoid all street drugs, cocaine ecstasy and meth can precipitate depressive symptoms, as well, substances like lsd and mushrooms can produce some nasty effects in the wrong person (that person being a depressed person imo), while there are contrary theories about all of these drugs and some people can say that all these drugs can be beneficial but all I'm saying is that it is probably most beneficial to avoid all drugs in general, and while it is still a drug, cannabis is the most benign imo. And somewhat contrary to what I have already said about avoiding street drugs, but since it is not a street drug the most important thing is avoid meth, but my idea is to try dex-amphetamine as it has proven effective in many people in relieving depressive symptoms, but you should most certainly discuss dex amphetamine with a doctor first as you should be prudent with bp2 , as well another type of medication which can relieve depression but has some side effects are the maoi, however above all it is important to discuss any changes with your doctor. the two latter medications i suggested are old school, and the former (seroquel) may actually be the best option, together with lamotragine-seroquel might be an excellent option. Best of luck
 
Zoeylynn said:
Mirtazapine is a fairly safe drug to try. They give it elderly as a first choice because it has lower side effects plus the weight gain.

Here is a link about Mirtazapine/ Remeron

http://en.m.wikipedia.org/wiki/Mirtazapine#section_1
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The weight gain can be a real issue though. I gained 20 kg's the first year I used it. Atm I only use 7,5 mg which is mainly effective for sleep. Mirtazapine is unique because it's less sedating the more you take. 7,5 mg is much more sedating than 45 mg. That said, just about any dose of it is heavily sedating initially and while the receptors become somewhat desensitized to its sedative effect, the initial very powerful sedative effect doesn't go anywhere IME. The first few hours are more or less like a knock-out like e.g. Seroquel.
 
Wow, that sparked quite a bit of discussion. I'll reply roughly in chronological order.

I'm on 200 mg lamotrigine / day.

I don't remember why I didn't give buproprion more time, but I think it was side-effect related.

I do take dextroamphetamine sulfate (15 – 20 mg sublingually / day), but it doesn't help the depression. Amphetamines have never triggered any kind of mania in me (sadly), even before I was stabilized on lamotrigine. Oddly, back then the withdrawal would make me suicidal, unless I was hypomanic. Long story there. And to lay your fears to rest, I have NO intention of ever trying meth.

I'll look into the iboga. I thought that was only effective at hallucinogenic doses?

My diet is not too bad, but a blood test might be a good idea. I was previously diagnosed with vit-D deficiency, but that was a while ago. Would there be a point in taking GABA if I'm already on benzos? I also didn't know 5-HTP had an effect on depression, but it makes sense, being a serotonin precursor.

I've taken my share of Seroquel (600 mg / night for a year or so) and it didn't particularly help. This was all while on lamotrigine, too. Add that to the pile of failures.

I do have some experience with mirtazapine. My understanding is that it is a sedative at low doses, and an antidepressant (tetracyclic, specifically) at higher doses. I took it for a month or two at low, sedative doses for insomnia and am acquainted with the side-effects. Nothing too bad. How long does it take to take effect at antidepressant doses?
 
It's in the link I shared but I think pretty fast like some people a week, up to 4 weeks.
 
we have been making too many visits to" Polly Pharmacy" w/o relief. it's apparent these drug combinations being prescribed consistently fail for many people. past and on-going clinical trials show ketamine low-dose i.v. works within two hours, it's antidepressant/anxiolytic effects lasting one to as many as four weeks. more than two-thirds of those on active drug obtain a significant anti-depressant response, those are fantastic odds compared w/ conventional treatments and poly-pharmacy. i must point out that just under one-third of those administered ketamine hcl are non-responders, likely due to genetic differences. most people fail to respond to most approved drugs most of the time. we must request that this treatment be made available and be paid for by insurance. what are your thoughts?
 
Indeed. The reason they haven't put you on Wellbutrin (bupropion) is probably because of your bipolar diagnosis. Do drink a lot of coffee? Do you use energy drinks or otherwise consume lots of caffeine? Stimulants are generally contra-indicated with bipolar...and Wellbutrin is technically a stimulant.
 
I'd really like to try ketamine, but don't have any access to it.

I have been on bupropion, but quit after a few weeks, due to miscellaneous side-effects IIRC. Nothing mania-related. My caffeine intake is moderate. Stimulants haven't had any particularly unusual effects on me since I stabilized on lamotrigine.

What do you guys think of the scopolamine idea?
 
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The.Ghost said:
I'd really like to try ketamine, but don't have any access to it.

I have been on bupropion, but quit after a few weeks, due to side-effects IIRC. My caffeine intake is moderate.

What do you guys think of the scopolamine idea?
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As long as you're not stable, refrain from dissociatives like Ketamine. I'm on benzo withdrawal myself and while I have to refrain from the use of psychedelics I know this is the right decision in the long term.

Bupropion is weak and most people have little benefit from it. Especially as you've been on quite a few drugs already that are much more powerful.

I've never used scopolamine but it doesn't seem to be too convincing. There is some evidence it might be effective in treating depression, but very few studies have been done.
 
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