Has Tried Many Treatment Approaches
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Q:   Has Tried Many Treatment Approaches

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). 

I continue 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 drawing board.

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.

I was 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: http://www.currentpsychiatry.com/article_pages.asp?aid=8618  (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: Mood Stabilizers. 

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 improve soon.

Dr. Phelps

Published May, 2010


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