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05/08/2007 04:52 PM

Bipolar Type II meds

Billyb
BillybPosts: 17
Member

My doctor recently changed my diagnosis to Bipolar Type II. I have been battling what we thought was a very severe unipolar depression for almost 4 years. He said this was a good thing as it explained why the massive list of anti-depressants I have been on didn't work well.

My original optimism has been replaced by fear as the meds we're using for Bi-polar if anything have made me worse. With the anti-depressants there was some cycling but my current despair is even more painful.

I am currently taking 100mg Lamictal, 2000mg Depakote, and 600mg Lithium daily. He tends to be very heavy handed with the meds but he said it can take multiple meds to treat Bi-polar. I'm even more concerned that some of the other anti-psychotic drugs will be next if I don't improve. I've read they can be nasty regarding cognitive thought as they basically dull the senses.

I guess I'm just looking for feedback from anyone who has been on a similar combo. The Lithium was only added 2 weeks ago so I guess it needs time. I realize I must be patient but that's almost impossible. The last 4 years of my life have been a living hell as apparently I was being treated for the wrong illness. I need something to work as playing musical meds has practically destroyed my life.

By the way. My doctor has a great reputation but since my life is on the line I guess a secong opinion is in order. Thanks for any feedback.

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05/08/2007 08:02 PM
callme2crazy
callme2crazy  
Posts: 288
Member

Billyb I want you to know that everything you are experiencing is common and has happened to most of us in this trial to find effective treatment. Finding the right med combination is a difficult and arduous process. It does seem like 'musical meds' and it will make you wary of your doctors.

I have to ask a few questions about your new diagnosis. What are the bipolar symptoms you have exhibited? I assume you are no longer taking any anti depressant?

Okay here is my opinion for what its worth. Doctors typically treat mania more aggressively than depression because they believe it is more responsive to medication. This is a widely held belief within psychiatry and one I completely disagree with. What I think doctors are observing is the way a patient responds to the correct medication. Response in my experience is very profound. When its right you know it and in my experience it happens rather quickly. Anti depressants do not work in this way. The response tends to be slower and almost always needs fine tuning with a combination of AD meds.

This is important to you because it seems you are not on AD meds. And it looks as if your doctor is aggressively treating mania with the three meds you are taking. Since you did not mention your symptoms I have to wonder why he is doing this?? Please remember that you have the right to question your doctors choices for you and you should do as much as possible to educate yourself about the meds you are prescribed.

About the meds you are taking now: Your dose of lamictal is low but it has a tendency to make people tired and lethargic. Lithium in high doses can cause excessive sleep but it is the frontline medication for mania and has been for may years. I had atypical response to Depakote and it made me edgy.

That said I suggest you ask your doctor to treat your depression with medication just as aggressively as he treats the manic side. You need to be on an AD as soon as possible. Read all the info about your meds, try webmd.com its great, and see if you are having any undesired side effects. Learn everything you can about bipolar II disorder and see how the symptoms do or do no fit with you. These are the tools you need to help your doctor

and yourself get through this process.

I hope this helps Wink please let us know how things go with you.

Dee


05/09/2007 03:59 AM
Billyb
BillybPosts: 17
Member

Thanks so much for your thoughtful reply. During the almost 4 years I have been depressed I was taking almost exclusively anti-depressants with some bi-polar type meds mixed in. I would start getting well only to have devastating setbacks time and time again.

Months back I started becoming very agitated as well. My doctor said he felt I was Bi-polar type II and I was going through a Hypomanic state. I actually think he may be right. For as long as I can remember I have been unable to sit still and prone to being very edgy and quick to anger. A low level sadness was always present too. I would chock it up to just being an unhappy person and look at my accomplishments as a reason things were OK.

I would never feel the euphoria that comes on the manic side of Type I. I have never had any type of phsychosis mixed in either. I'm always painfully aware of my behaviour and how I'm feeling.

Anyway my doctor said that anti-depressants usually make bi-polar patients cycle more and thus are ineffective. I'm just so confused because as I said I feel worse now. My anxiety over all of this is excruciating. I do extensive google searches on this illness and all I ever seem to find is conflicting info mixed in with a lot of depressing opinions about how treatment resistant this illness is.

By the way my doctor hasn't ruled out adding an anti-depressant back into the mix. Ironically I'm resistant to that since he told me that was the reason I didn't get well in the first place. I'm at a point where I have lost faith in the very system I am counting on to get me well. As you say it's hard to believe in your doctor when the results aren't there.

I do now challenge his decisions as my life is hanging in the balance. I'm trying my best to educate myself regarding this illness and the meds used to treat it. I am now debating a second opinion. My doctor has such a head start over someone new. I've had 2 in the past with little insight. My thought now is you would need to see someone several times to make it a true evaluation. My previous ones were single visits which I think are a waste.

I have tried ECT which was a horror and have been in therapy for 3 years. I am also looking into acupuncture and omega 3 simply for lack of a better idea. Thanks so much for listening as I truly appreciate this forum. The venting is so critical. Billyb


05/09/2007 10:55 PM
callme2crazy
callme2crazy  
Posts: 288
Member

Billyb I am also bipolar II and I identify with your symptoms. I was an ultra rapid cycler and it was exhausting. I have felt the despair you are feeling and it is hard to overcome when you research treatment options and find nothing but the negative. But I want you to know that it is possible to find treatment that works and perseverance is key.

I disagree with your doctors reluctance to prescribe an AD. It is bad medicine to treat a bipolar patient with ADs only but if you have symptoms you need full treatment. Since you are taking mood stabilizers you should be good to take them. I also suggest fewer mood stabilizers, three is too many and there is no way to tell what is causing your side effects. I don't understand why your doc would treat so aggressively for bipolar II. It would make sense perhaps for a severe mania more common in BPI or psychosis, none of which apply to you. If you think you need a second opinion you probably do. I always go with my gut instinct.

You mention severe anxiety, what treatment options has your doctor offered? This is typically treated with drugs like Ativan, Klonapin and Xanax. I had panic attacks and took Xanax for several years. Once my mood was stabilized with meds I no longer had the anxiety or panic. This type of treatment can go a long way toward relieving mood cycling. When you can isolate and treat individual symptoms then you respond better to mood stabilizers. You can recognize when your symptoms are exaggerated and when medication gives you relief.

Everyone responds differently to their meds, what works for one may be awful for another. I'm not sure if it is beneficial but I will tell you what has worked for me. First, Seroquel for a mood stabilizer. This drug often makes people sleepy and it is given at bedtime for this reason. It also causes weight gain which can lead to diabetes. I took Xanax until my mood stabilized and eventually did not need it. For depression I take 80 mg of Celexa and 100 mg of Welbutrin XR. It took a lot of fine tuning but when I added the Welbutrin to the Celexa my depression disappeared. It was amazing!

I have some of the typical side effects associated with Seroquel and over an eighteen month period my doctor and I tried to move me onto other mood stabilizers. My rapid cycling returned each time and I have decided that Seroquel is a godsend.

Billyb I hope some of this helps you and I look forward to the day when you find quality treatment for your symptoms.

God bless you.

Dee


05/10/2007 04:24 PM
Billyb
BillybPosts: 17
Member

Hi Dee. Just wanted to mention something in fairness to my doctor. When I recently complained how severely depressed I am he wanted to add 60mg of Cymbalta to fight the depression. I actually resisted the idea due to the fear he put in my head regarding bi-polar and anti-depressants.

I'm obviously going to need to be more open-minded about these combos as they may be necessary. I read that it's not unusual to need 3 to 4 meds to get well. He told me that the Lamictal I'm on has been known to be effective especially in combo with Depakote in fighting bi-polar related depression.

I find it so hard to figure out where the depression ends and the side effects begin. Depression symptoms and medication symptoms aren't all that different. Unless the side effects are horrific it's almost as if you need to get well first and then evaluate your side effects. I am very tired and have chronic body ailments that are mostly just different types of pain.

Anyway I'm glad to hear your doing well on the right meds. It must be incredible to feel human again. I have forgotten what that feels like. I too would also deal with side effects to get my life back. Take care . Billyb


05/10/2007 06:38 PM
Billyb
BillybPosts: 17
Member

Hi Dee. Just wanted to mention something in fairness to my doctor. When I recently complained how severely depressed I am he wanted to add 60mg of Cymbalta to fight the depression. I actually resisted the idea due to the fear he put in my head regarding bi-polar and anti-depressants.

I'm obviously going to need to be more open-minded about these combos as they may be necessary. I read that it's not unusual to need 3 to 4 meds to get well. He told me that the Lamictal I'm on has been known to be effective especially in combo with Depakote in fighting bi-polar related depression.

I find it so hard to figure out where the depression ends and the side effects begin. Depression symptoms and medication symptoms aren't all that different. Unless the side effects are horrific it's almost as if you need to get well first and then evaluate your side effects. I am very tired and have chronic body ailments that are mostly just different types of pain.

Anyway I'm glad to hear your doing well on the right meds. It must be incredible to feel human again. I have forgotten what that feels like. I too would also deal with side effects to get my life back. Take care . Billyb


05/10/2007 10:20 PM
callme2crazy
callme2crazy  
Posts: 288
Member

Hey Billyb! I hope I didn't come across to harsh about your doctor. i think I was trying to answer some of your questions and I tend to be rather blunt.

When you find the right mood stabilizer(s) and start to see the benefits then you will have more insight into individual symptoms. It will be easier to isolate between them and side effects.

I'm not sure but I think you may have misunderstood about the use of anti depressants with bipolar disorder. It is a necessary component of your treatment. ADs should only be used in combo with mood stabilizers in order to avoid mania. This will not cause an increase in rapid cycling.

I don't know much about Cymbalta except that it is the newer AD in the market. And I had not heard about Lamictal and Depakote in combo but it sounds promising. You will need to keep an open mind about all these meds and combinations of meds. It would be a really good idea for you to keep a med diary so you can keep track of what helps and what doesn't and why.

You mention pain in different places, this could be an affect of the stress your body is under. I had chronic back pain until I was diagnosed. After my first hospitalization it just disappeared. I recommend finding a family doctor and get some help with any issues not related to mental illness. I find that a family doc and psych doc are essential to meeting all my health needs. Since you are on Lithium you will need to have your blood levels tested periodically and it is in your best interest to have complete blood workups every three months to ensure that your meds are not compromising any body functions.

I enjoy talking with you and I want you to know that you are doing a good job of trying to find treatment that works for you. So many bipolars don't have the capacity to understand and learn about their illness. Those of us who can are very fortunate.

God bless you today!

Dee Wink


05/29/2007 02:32 PM
bipolarmomma
bipolarmomma  
Posts: 440
Member

I am not as knowledgable as some of the other replies. My only advice is to make sure you don't start new meds at the same time. Some of these meds have harsh side effects, such as lithium, depakote and some others. I have also been through musical meds for some years and have since demanded my psych that we limit "side effect meds" <extra meds to relieve side effects from original meds> Also don't settle for psych's. You need to search for one that really understands meds.

05/29/2007 04:21 PM
Billyb
BillybPosts: 17
Member

I appreciate what you're saying. I'm on 2,500mg of Depakote, 900mg of Lithium, and 100mg of Lamictal. I'm completely exhausted but otherwise the side effects aren't terrible(although I do consider that significant since depression in itself makes you tired). The problem is I still feel depressed most of the day. I feel terrible in the morning and at night with the middle of the day being slightly better. I see my Psych tonight and we're going to have at it again regarding the meds and my body. I have started acupuncture and am taking Omega 3 and B12. Next is a second opinion with a new doctor. Be well. Billyb

05/29/2007 04:32 PM
bipolarmomma
bipolarmomma  
Posts: 440
Member

Your feeling exhausted is a side effect. There are meds that you can take that don't make you feel like a zombie in the morning or at all.
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