Would an Antidepressant Help? I Need Some Relief
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Q:  Would an Antidepressant Help?  I Need Some Relief

Three years ago I went into a manic episode. It was followed by depression and I tried to commit suicide. I had 49 ECT treatments in 1 year and my meds constantly changed. However I was resistant to most of them. I am a rapid cycler with about 3 months in between. My mania is not as severe as the depression as I was hospitalized 14  times in this last year. I am not on anti depressants just mood stabilizers (1600mg seriquil, 240 carbrotrol, 320 mg geodon, 8 mg lorazepam, 20 mg sleeping meds) My depression is so severe that I am suicidal every time. I stopped the ECT treatments in Feb. and have had been hosp twice up to July. Now my doctor just gives me shots of geodon when my husband takes me to the emergency room. Since I am already a rapid cycler with suicidal tendencies, why wouldn't an antidepressant work on the depression. I need some relief before something happens. I have started cutting during my depression I just need relief. Should I be looking for another treatment of meds? My doctor refuses to change them after this last year.

Dear Ms. T' -- 
Sorry to take so long in getting back to you here. As you've come to recognize, yours is a very difficult-to-treat version of bipolar disorder. For some people, perhaps about 20% of people with bipolar disorder, in the data of Dr. Nassir Ghaemi, one of the world's experts in this realm, antidepressants are necessary and helpful. I'm still concerned about the long-term future of people on antidepressants, but it's very clear that in the short term (less than 10 weeks) they do work, though not as well as for people with "unipolar" (not bipolar) depression.  It also appears that people who have done well for over two months may be more likely to continue to do well if they stay on them rather than stop, though these folks were not studied in "randomized" trials with a placebo control group, and they were rather select patients compared to the general population of people with bipolar disorder, so their experience is less generalizeable.  

In your circumstances, nearly every option must be considered, and most psychiatrists would have little hesitation considering the use of an antidepressant in your case. I would, but I'm not the average guy here. I hope you're able to find something really effective soon. 

Dr. Phelps

Published February, 2007

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