Q: Has Tried Many
Dear Dr Phelps,
I have been
diagnosed with BP2 for many years, (and depression, mood swings, like crazy)
have taken many antidepressants, Topamax, wellbrutin, Prozac, Zoloft, Cymballta,
etc.( and lots of combination's) (with some, like Prozac, working for a couple
of years).I am currently on Lamictal, and had to increase the dosage 4x, in the
past 5 weeks( with a few days to a week of relief).
to have bouts of crying spells, many times a day, have no interest in anyone, or
anything, and even have so much trouble getting up in the am, going into the
shower, ( can make it in 1x a week,) I am not currently suicidal, at all, I am
extremely treatment resistant, and when something works, after increasing
dosages to the fullest, it no longer works, anymore, again, I am back to the
I am so
tired of trying so many things, ( and having lots of side affects) with nothing
working, to allow me to even plan, what I will do the next day, since I have to
wake up first, to see how I feel..
I went to a
new Psy Dr, and it's the same journey. He continuously tells me, that we will
have to add an antidep. and when he attempts to, I have heart palpitations, and
need to stop right away.. It appears, that I often baffle, and frustrate my own
Drs, which is so frustrating for me as well. I have been in therapy almost
continuously, and had to stop, at times, when I was too depressant for any of
the therapy to work. I am 54 years old, and have been experiencing this uneven
journey now, especially for the past 5 years.
hospitalized, 1x in my entire life, for 2 days, about a year ago, where I no
longer wanted to be on the planet. I come from a spiritual place, and know who I
am and my purpose on this planet, yet I cannot live my days, for the most part
enjoying my life...Are there any new treatments out there, that can possibly
save my life???
I am really
tired of living like this...and I am continuously willing to try new things,
which truly shows me, just how persistent I have been, to feel, and get well, if
that is at all possible. I thank you in advance, for your reply.
Dear L’ –
Some people can do well on a single mood
stabilizer. But many need more than one. As you have experienced, there is
still a lot of controversy as to whether someone who is not doing well on a
single mood stabilizer like lamotrigine/Lamictal should take an antidepressant
on top of that -- or instead, add another mood stabilizer.
For example, here is a very balanced, levelheaded review
about the role of antidepressants and bipolar disorder: Goldberg, Current
Psychiatry, May 2010:
(if the link no longer works, but the above reference in Google). This article
is technical, so if it overwhelms you, just skim along and ignore the tables,
but it is fairly well-written (no unnecessary jargon).
In this article, Dr. Goldberg has several tables
showing who is a good candidate for an antidepressant, and who is not. My
practice seems to be full of people who are not, but I guess there are actually
people out there who are reasonable candidates. From your account, it does not
seem that you are one of them.
In general, I think mood experts around the world agree
that in people who cannot tolerate antidepressants, the strategy instead is to
use mood stabilizers on top of one another until things are smooth. Of course
the trick is to do this without too many pills, side effects, or risks. My
master list of options:
In addition, I think our number of non-medication approach
options is also growing. The big ones are regular sleep at regular hours;
avoiding any kind of substances that you discover make things worse (alcohol,
marijuana, caffeine, too much refined sugar); and maybe even careful attention
to light and darkness (see my
light and darkness in bipolar disorder essay if
you're curious about that).
Good luck with the process. I hope your results
Published May, 2010