View Full Version : Can Someone PLEASE Answer My Question.....


glgalle_99
05-30-04, 03:55 PM
I have had depression for over a year and a half, and since I have gone and got tested for ADHD, my doctor said my depression is Bipolar I. Well, I have some questions that might help me understand what I am going through. I am taking Effexor XR 75mg's Adderall XR 45mg's and Wellbutrin XL 300mg's. Well, the question is I have no idea if the med's are working or not. I am experiencing my highs and lows, but I seem to switch to lows a lot through out the day. Is that a part of being Bipolar or is it that my med's are not working. I have been on Effexor XR for about a year, and just recently, my doctor uped my Effexor to 225 mg's and have an anxiety attach and then he took me off and experience the worst withdrawal of prescription medicine and put me on Lamictal and Seroquel . Then he put me back on Effexor and added Wellbutrin.

I guess I am just not understanding the whole manic and mania of bipolar and not understand what I am going through. I was wondering if someone out there and help me and explain it to me so I can go on about it and try to start making myself feel like me again.

Thanks,
Gretchen

Tara
05-30-04, 04:51 PM
Is the medicatioin helping you live a happier more productive life? If the answer is "no" then you really need to communicate in detail to your Dr. how you are feeling and what's going on. Maybe a sencond opinion is also something to think about too.

FightingBoredom
05-30-04, 06:34 PM
IMO and experience no amount of medication can "take" depression away.

Professional therapy and neuro linguistic intervention or reprogramming is the best bet.
Look into NLP or listen to some Tony Robbins CD's.

They have helped me start phasing out my Zoloft. I went from 250mg/day 1 year ago to 100mg/day now. I feel better now and some days I forget to take my Zoloft (like usual) but I still feel great without it. In fact, I'm not sure why I still take it except that I know I have a tendency to be less aware of the effects my meds have on me than my family is. So, I'm using them as a gauge which takes longer since my real reason for taking it is to make my interactions with them better......

I've also had nearly 2 years of counseling since I was diagnosed.
Though therapy can and does help you have to master your own destiny, IMO, and not rely on any doctor who can only scratch the surface of YOU in a 1 hour session.
YOU, on the other hand, are an expert on YOU. What you need to do is find tools that work to help you manage your life and exceed even your own expectations....

Lafnalot
05-30-04, 07:43 PM
Bipolar disorder is a two fold disorder, one of emotion and one of chemical, we cant go off half cocked.I have watched people lose children , loved ones, jobs and freedom over that. Discuss with your doc, work with your doc but do the footwork.AND never ever go off or lower your dosage of meds without talking to your doc first. It can put you in a chemical tailspin you will find hard to recover from.

lucy2
06-08-04, 11:46 AM
Lafnalot is right. I went off my lexapro recently and I almost went
over the edge, even though I had tapered off. I finally realized I
had to start back and it seemed to take longer than usual to
get back under control. I think I am one of those people who just
have a chemical imbalance and will always have to take an
antidepressant.

smooch
06-08-04, 02:23 PM
Hi Gretchen~

I found this article/doctor training on treating BP I. I know it's lo-o-o-o-ong and laborious and full of "medical wordiness," but I thought of you as I read some of the info.... I did edit out a lot of the doctors' training/testing text and tried to emphasize some stuff that may be helpful.... I apologize for the length.... :dizzy:

:D
smooch

New Treatment Guidelines for Bipolar I Depression
News Author: Laurie Barclay, MD

April 21, 2004 — Based on available clinical evidence, an international group developed consensus guidelines for the treatment of bipolar I depression and published them in the April issue of the Journal of Clinical Psychiatry.

"In the treatment of bipolar disorder, the guidelines available for treating mania are fairly standard worldwide," write Joseph R. Calabrese, MD, from Case Western Reserve University School of Medicine in Cleveland, Ohio, and colleagues. "However, guidelines for treating bipolar depression vary, sometimes substantially, from country to country."

Barriers to effective treatment of bipolar I depression include unrecognized bipolar I depression, routine use of antidepressant therapy for either unipolar or bipolar depression despite the availability of more specific treatment for bipolar depression, and common misconceptions about bipolar depression. The authors stress that bipolar disorder is a chronic illness requiring lifelong treatment, and that the entire illness, rather than just acute episodes, must be treated to ensure success.

Based on the quality of available data, the authors classified evidence for each agent used to treat bipolar depression. Drugs meeting category 1 evidence had randomized, placebo-controlled trials in acute bipolar depression and in long-term treatment of both depression and mania. Category 2 evidence consisted of randomized, placebo-controlled trials in acute bipolar depression or in long-term treatment of either depression or mania, while category 3 evidence had randomized controlled trials in any phase of bipolar disorder treatment.

Recognizing that long-term safety and efficacy data should affect medication selection, the authors developed an algorithm for acute treatment of bipolar I depression. First-line treatment should be lithium or lamotrigine (Lamictal) (category 1), or olanzapine (Zyprexa) as monotherapy or in combination with fluoxetine (Prozac) (category 2). Patients responding to first-line treatment should continue it for the long term.

Those with breakthrough mania should have first-line treatment optimized. Other options are to add lithium or olanzapine (category 1), valproate (Depakote)or risperidone (Risperdal) (category 2), or aripiprazole (Abilify), ziprasidone (Geodon), quetiapine (Seroquel), or clozapine (Clozaril) (category 3).

Patients failing first-line treatment who have continued depressive symptoms should be treated based on other clinical features. Those with nonrapid cycling should have first-line treatment optimized, followed by continuation of two first-line treatments or addition of an antidepressant other than a tricyclic or monoamine oxidase inhibitor. After optimizing first-line treatment, those with rapid cycling should have added valproate or olanzapine. Psychotic patients should have added olanzapine alone or combined with fluoxetine, or electroconvulsive therapy (ECT).

"Clinicians should consider the individual patient when deciding what treatment to use in bipolar depression as well as deciding what treatment to use for patients whose response to treatment is inadequate," the authors write. "All patients with bipolar disorder should be treated with psychological treatments in addition to any pharmacological treatment."

GlaxoSmithKline supported the consensus meeting at which the guidelines were developed.
J Clin Psychiatry. 2004;65:000-000

Clinical Context
Bipolar depression is often underdiagnosed or misdiagnosed as unipolar depression. Antidepressant monotherapy continues to be the most common treatment for bipolar I depression throughout the world despite the lack of evidence showing efficacy, according to a study by Ghaemi and colleagues, published in the July 2001 issue of the Journal of Clinical Psychiatry. Indeed, antidepressants, alone or in combination with lithium, may induce rapid cycling or mania in bipolar I patients. A study by Gyulai and colleagues, published in the July 2003 issue of Neuropsychopharmacology, showed that antidepressant monotherapy is significantly less effective at preventing depressive relapse than an antidepressant–mood stabilizer combination. Treatment guidelines such as those from the American Psychiatric Association now recommend avoiding antidepressant monotherapy for bipolar depression.

The International Consensus Group on Bipolar I Depression met in December 2003 to develop international treatment guidelines based on currently available evidence from randomized, placebo-controlled, double-blinded clinical trials of pharmacotherapy. The group agreed that bipolar disorder is a chronic condition that requires lifelong treatment, and that both acute and long-term safety and efficacy should be considered when selecting first-line treatments. In addition, the group stressed that therapy should be tailored to individual patient needs and response to previous therapy.

Study Highlights
**Although limited in quality, the research supported the efficacy of lithium over placebo in bipolar depression. Outcome measures that have been examined include symptom relief, return to premorbid functioning, and several depression rating scales.
**Abrupt discontinuation of lithium, especially after acute treatment, may make patient symptoms worse than if they had no treatment at all.
**Lithium was significantly more effective than imipramine (Tofranil) or placebo in the prevention of depressive or manic episodes in bipolar patients in a 2-year study.
**Lamotrigine was found to be superior to placebo for the outcomes of improvement on several depression scales, proportion of patients who were intervention-free (including use of antidepressants and ECT) for depressive episodes, and time to intervention for any depressive episode.
**In a study comparing lamotrigine and lithium, lamotrigine was found to be more effective at delaying intervention for depressive episodes while lithium was more effective at delaying manic episodes.
**Olanzapine and olanzapine combined with fluoxetine were superior to placebo in the treatment of depressive symptoms. In one study, the combination group had higher rates of response and remission than placebo or olanzapine alone.
**Strategies to optimize treatment include adequate dose and duration of therapy, checking compliance and serum levels, and treatment of comorbid psychopathology, and psychosocial and personality problems.
**If optimization is unsuccessful, the group suggested that 2 first-line treatments may be combined for bipolar patients with nonrapid cycling, although evidence is lacking to support this recommendation.
**Tricyclic antidepressants and monoamine oxidase inhibitors are most known among antidepressants to induce mania and should be avoided. If an antidepressant is used in combination, the evidence suggests that selective serotonin reuptake inhibitors are preferred because of lower manic switch rates.
**Psychotic features in addition to depressive symptoms may be treated with the addition of olanzapine, olanzapine-fluoxetine combination, or ECT. ECT has been found to be efficacious for patients with bipolar depression resistant to treatment. Bipolar patients who received ECT improved more rapidly and needed fewer treatments compared with unipolar patients.
**Both lithium and olanzapine have been found to be effective for acute and long-term bipolar depression. Olanzapine significantly prolonged time to relapse to mania, depression, or mixed episode in one study.
**Divalproex improved the course of depressive episodes and occurrence of relapse, especially in patients with more severe symptoms who showed good response during manic episodes.
**Risperidone improved mania symptoms in acute short-term presentations.
**Evidence is available for the efficacy and safety of lithium for 2 years, lamotrigine for 18 months, olanzapine in recently manic patients for 1 year, olanzapine in recently depressed patients for 6 months, and olanzapine-fluoxetine combination for 6 months.
**Patients who respond to a first-line treatment should continue that treatment long term. With serious mania, lithium is a preferred for delaying manic episodes. For serious depression, lamotrigine is preferred for delaying depressive episodes. In patients with psychotic features nonresponsive to treatment, ECT may be the best option.
**Psychological treatments such as cognitive behavioral therapy have been shown to improve quality of life, psychosocial adjustment, and medication compliance.
**A multimodal management approach is recommended for bipolar disorder treatment.