I started mood stabilizers in November 2011, and after about 2 months of adjustments, I felt better than I had in years – clear-headed, stable, and just more myself. Added to my existing cocktail of stimulants for ADHD and bupropion (Wellbutrin) for depression, it seemed like a minor concession to bipolar disorder, medication-wise.
Recently, however, I experienced a bout of depression that was fiercer and longer than I’ve experienced in quite awhile. With both monthly hormonal shifts and high anxiety over a new job, the stage was set for a mood swing. This one was notably worse than any “blips” in recent memory and I lost several work days, which only increased the anxiety.
So it was with some trepidation that I went to my psych appointment earlier this week, at which point I was also starting to feel a bit better. It was already incredibly hard to admit how depressed and anxious I had felt just days before, not to mention feeling like I must be exaggerating or overly dramatic. I was armed with my mood charts and notes to keep me honest and had a good discussion with the psych nurse, who seems to really want to figure out the causes, and not just treat the symptoms.
In the meantime, treat the symptoms we shall. Returning to the subject of the post, that means medication. It’s no secret that working out the right cocktail of psych meds for bipolar disorder, particularly if co-morbid with other conditions (as is so often the case, particularly with anxiety), is a process that can take awhile. Years, even. Some people never find a good combination.
It can be enormously frustrating to try one drug after another, seeing little improvement but many side effects. At some points, the cure can be worse than the disease. So I dragged my toes about going to the psych nurse, because I knew that after only about 6 months of relative stability, I was in for a change of meds. I also knew that something needed to change.
To deal with breakthrough depression, I’m trying an additional SSRI, sertraline (Zoloft). I can limit it to half the month (consistent with treatment for PMDD), or take it all the time. I plan to try the minimal approach to start. I took sertraline around 15 years ago during a very tumultuous period in my life, but I barely remember it and it carries the risk of triggering mania. Another SSRI had previously made hallucinate, so that’s something I have to watch carefully. On the plus side, it’s weight neutral.
And after two months of discussing anxiety symptoms, the psych nurse prescribed an anxiolytic. Maybe it’s because I said I figured a panic attack was a normal response to prep for an oral surgery procedure? So now I have a benzodiazepine, more specifically lorazepam (Ativan), in a very low dose to take as needed. Just when work-related anxiety becomes paralyzing, or I start having a panic attack. I’ve read enough on benzos to know that you don’t screw around with them without consequences, so I’m treading cautiously.
I feel worse about adding two new psych meds, even on an as-needed basis, than I did about adding each of the three before them, although one at a time. Managing bipolar (and ADHD) has taken me from one prescription back in 2000 to five in 2012. That alone is depressing. One might think it symptomatic of our overprescribing society, but every drug has been carefully weighed for benefit over risk and collateral damage. They help me remain functional, and that’s my bottom line.
Hopefully I’ll see some relief from symptoms without intolerable side effects. By my calendar, it’s time to start the new antidepressants today. Hopefully I can find a little more stability sometime soon.
© DeeDee and A Canvas Of The Minds 2012. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to DeeDee and A Canvas Of The Minds with appropriate and specific direction to the original content.
A Canvas Of The Minds 
I will be thinking about you as you go travel on the new leg of this journey. No need to feel bad, we do what we have to in order to stay sane and functional. You have a great mind and have calculated the benefits and risks…you won’t go about this haphazardly. Be thankful…it’s all good.
Even so, it’s a bit nerve-wracking to venture into the great pharmaceutical unknown all over again. I’m sure it will work out alright, but I’m just hoping it’s a relatively smooth process.
This is what I refer to as ‘medication roulette’. I played the tables for years, with everything thrown at me that could be (and then some). Most of what got me through and kept me feeling active, empowered, and (somewhat) in control was the meticulous research I did on every med, before I popped the first pill.
And while the fact that I survived six years of heavy duty everything is pretty astonishing in and of itself, I now have the most extensive and detailed understanding of what any given drug (or drug class) is going to do to me. To me, personally, because everyone’s physiology is different and I don’t care how “most people” react (sorry, recent frustration with psychiatrist leaking through).
Good luck with the latest round. And hey, remember that I managed to find something that is working wonderfully for me. And if a “metabolic mystery” like me can find a good balance, then there’s hope for all of us. 😉
I know what the stuff works on, I just don’t know what it is that my brain needs. I figure it will get there eventually.
I wish you stability very soon!
If there’s one thing I’ve learned in the 20+ years that I’ve been on psych meds, it’s this: DON’T TREAT BIPOLAR SYMPTOMS SYMPTOMATICALLY. That means: treat it with meds designed to treat bipolar. NOT antidepressives for the depression and antianxiety meds for the hypo/mania. YES treat bipolar with bipolar approved neurostabilizers. Lithium has been and continues to be the cornerstone of treatment. Next come the anticonvulsants: Lamictal, Tegretol, and others. Next come the atypical neuroleptics: Risperdal, Seroquel, etc. But NOT a cocktail of SSRIs plus benzos plus semi-stimulants like Wellbutrin, which can be a culprit in producing bouts of hypomania.
My advice as a physician with bipolar: seek out a mature, highly experienced neuropsychiatrist who can fine-tune your meds so that you can just take the durn things and go on with your life. Unsolicited advice no. 26,286
It does sound ridiculous with a mood stabilizer plus antidepressants plus stimulants plus anxiolytics. Obviously fewer meds would be better, but at least the new ones are PRN. Me, my husband, and my therapist have all been very wary about this. The doc heading up this practice is in fact a top-notch psychopharmacologist, and I’ve found them substantially better than anyone I’ve ever seen before in my 20+ years on psych meds.
It’s been an interesting process so far. For treating the bipolar first, Lamictal was the starting point. It has really worked wonders; the depressions are much shorter and a number of other cognitive functions are massively improved. But every time I’ve tried to reduce Wellbutrin, it goes very badly very quickly. I was off stimulants for 10 horrible, nonfunctional months to verify that they didn’t cause hypomania, and didn’t re-start them until after I was on Lamictal. And so on…
Every change has been relatively slow and cautious, and every body works differently. The prior combination was working beautifully about 80% of the time, so for now it makes sense to tweak a good mix rather than jump ship to another mood stabilizer.