Questions about meds - I be a-changin'.....

Although the drugs I was put on almost two years ago now seemed to be working well for my bipolar II, I also suffer from very bad SAD, causing me to have v. low energy, become listless & indifferent, basically to "lose myself", my interests, my motivation, my emotions, my get-up-and-go for about half a year - it sucks! Yet I can also suffer some anxiety & panic attacks, and I eat everything sweet & carby in sight, not helping my already high cholesterol, and over-the-top end of my BMI.

It starts end of July, and runs 'til approx. Mar. - I have since learned from the SAD expert @ the Clarke, Dr. Levitan, w. whom I had an appt. this past Monday, that this length of suffering is NOT unusual (yay, i'm not the freak i thought i was), in fact, he actually said that all SADs are bipolar (sounded like a pretty strong statement to me!).

I subsequently saw my shrink yesterday (basically my psychopharmacologist), who took Dr. Levitan up on his recommendation of changing meds (as felt I am already doing everything I can in terms of light therapy).

So from a regimen of Seroquel, Divalproex, & Paxil, there will probably be a slow move over to Wellbutrin (from the Paxil), a cutting down of the Seroquel, and then to lithium (from the Seroquel, and maybe the Divalproex too (?))

I wonder if anyone can share their experience with lithium & Wellbutrin with me. I know of some friends already who have successful long-term experience with the former, just have to drink a lot of water. And I already know that Wellbutrin can cause some anxiety as a beginning side effect, but it can resolve itself.

Another drug that might be considered as a possibility is Lamotrigine; I know about the rash possibility, but has anyone had any success with it?

Thank you so much for reading my post.

Happy Wednesday, and see you at the next Meetup.

Ingrid :)

Hey Ingrid,
You'll feel a big difference when you get off the seroquel. It likely won't take away all the lethargy, but it'll help. I went from seroquel to lithium (with a sidetrip through lamotragine). Best decision ever. Made a huge difference. I don't have the other meds to contend with, so I have no idea about the interactions. I do wish I could have stayed with Lamotragine, but the rash got me. Still, I'm a fan of the lithium.
Be well!

Hi Ingrid,

I am cyclothymic and have been on antidepressants for a long time now.
For the last couple of years I am on a Wellbutrin XL and Lamotragine combo that seems to work reasonably well.
I have no side effects that I know of, and the depression seems to be less deep.
What do you do about SAD ?
What kind of lamp do you use and where can I get it?
I hope you're well ( or, at least, better) and I will see you at the next meeting.

Fred.

Thanx so much guys for replying to my post! So nice to be heard.

Jon - good to hear from you, missing u these days at the meetup, but I know life can get busy (which is good!), esp. when u've got young 'uns. :) V. inspiring to hear your feedback!

Fred - great to hear about ur combo as well. :)

For SAD, I own both a light visor (I used to wanna fall asleep in front of my stationary light box, so i got a visor, which allows me to move around, make coffee, watch tv, etc. while i get my light) & a dawn simulator (which slowly lights up while i am still asleep, so as to trick my body into believing dawn is occuring earlier than it really is during our dark fall & winter months), which I bought from Bio-Brite in the U.S., both not cheap, each running around $200. There are some similar appliances available now in Canada (I bought mine quite a few years ago, when such was not the case); not cheap yes, but I couldn't stand the suffering anymore, not to mention that it was affecting my functioning in every area of life. And of course, as you read, it still hasn't been quite enough.

Doing somewhat better this week due to the hope I'm feeling now that I know my doctors & I will be trying the new drugs to help me feel better, and quite honestly too, now that i've moved into another part of my cycle (i am very affected by my female cycle).

Hope I've been able to help, and look forward to seeing you too on Monday.

Ingrid :)

Hi Ingrid,

With regards to the Epival that you are currently taking I was on that for years. I gained a lot of weight and ended up developing Polycystic Ovarian Syndrome and difficulties with my mentsrual cycle. When I ended up in hospital at St. Mike's the psyciatrist immediately took me off of it. He said it should not be prescribed to women of childbearing age as it can effect fertility. Once I came off of it I was able to loose weight, my BMI went down and my period started again. I was taken off effexor as it was inducing my cycling. I have BP 2. I am now on Lamotigine and Seroquel. I did not experience the rash and I have been doing really well the past 3 years since my med change. This is the longest I have been working full-time in a long time with out a short term disability leave. Lamotragine does not have as much as a weight gain as a side effect. Good luck. Med changes can be a difficult time. Mine was done in hospital and I was very depressed. Lamotrigine has to be initiated very slow due to the rash and it takes a long time to reach the theraputic dose so be prepared for that.

Hi Ingrid,
Has anyone suggested light therapy for you SAD?
I have a special light and find it helps a lot.
I have the box light (see link) and got it at Starkmans Surgical supply @ Bathurst & Dupont.
http://www.northernli...

Just a thought.

Lara

Hi Ingrid,

I have had a very encouraging experience with Lamotrigine. The co-prescription of Seroquel is something I have barely even needed to use in over 9 months. The absence of side-effects can itself be such a positive dimension to one's management strategy.

Best of luck with the transition.

Michael

Ingrid,

Funny your post should come along. Believe it or not, just prior to the end of summer bbq(a week to be exact) I was given Wellbutrin to help combat a major depressive episode after a hospitalization. I kid you not within days my mood shifted dramatically for the good. With that said, I spoke with Paul a couple times and he advised that Wellbutrin threw him into his worst manic episode ever. I am still taking 300mg of Wellbutrin along with Lithium and Seroquel and Zopiclone for sleep(which I don't like). I am certain that I am likely a little bit "WELLBUTRINZED" but am enjoying the positive mood I am in as fake as I hope it not to be!

As far as side effects your accurate to report the need to drink water. I have never had as extreme a dry mouth as I do taking this medication. It is almost as bad as when the dentist sucks the saliva from your mouth and your tongue shrivels away to nothing. Anxiety was also very present the first few weeks after starting it. I also had difficulty breathing at times which was discussed with psyc who advised to try and stick it out and hope that it subsides. I am thankful that this has happened but it has still cropped up infrequently. I hope I don't sound like the grim reaper but this what I know to be true for me. It should also be said that I am not entirely happy being on so many meds as my positive lifestyle lends itself to strong mental vitality. It is my sincere hope that this transition goes smoothly for you and hope to see you again at meet-up

Regards

Jeb

WOW, u guys have been more than amazing in getting back to me. Thank you SO much for your support & sharing.

Serenity - thanx for your info on ur experience with epival. sorry to hear it was such a bad one for you, luckily mine has been very good, been on it for 9 years now (before I was even properly diagnosed as bipolar really), and as for the fertility thing, I had decided some years back now (I am currently 44) that I would not be having any kids, so no worries for me.

Lara - I guess you missed the reference in my original post, but I do mention that I am already using light therapy, in fact I have been for years: I started with a stationary lamp 14 years ago, and these days, use instead a light visor, so that I can move around, make coffee, watch tv, etc., and i ALSO wake up to a simulated dawn from my dawn simulator, set to trick my body into believing that dawn is still occurring much earlier in the fall & winter months than it actually is. Thank you for the idea though. :) My case is still pretty fierce though, and the specialist I saw at CAMH, Dr. Levitan, felt I was doing everything in the way of light that I could be, and changing meds would be the next step.

Michael, thx. we may still try the lamotrigine, mebbe the switch to wellbutrin & lithium will be enough.

Jeb - sounds like things are going great for you, and I'm glad to hear it! :) The only thing that really freaks me out about your sharing is the not breathing well side effect. That would very possibly be a deal breaker for me => I went through many awful years of panic attacks, my "pet" symptom being the thought of choking to death/stopping breathing. My shrinks did say I might feel some anxiety, and it should pass, but I'm not sure I could deal with that. Please God, let me not get that; others have not mentioned that, so let me be one of them!

Ingrid,

I should have elaborated more about the trouble breathing thing. It must be said first that I tolerate medication quite well and do not go looking for side effects after reading info sheet that comes with the meds. There is mention of that potential effect and I did not pay attention to it at the time. I found that particularly at night when the day slows down I would have a real need to yawn which when finished would offer me great relief from some tightness in my chest. I would literally force myself to induce a yawn just to get a few minutes of relief. I know this sounds hokey! I have never had breathing issues in the past and have no other aggravating factors to explain this. I now can understand your fear of choking etc after my experiences here. The pharmacist advised me to stick it out as well having great confidence in Wellbutrin with positive feedback from his customers. Ultimately I believe this to occur rarely and have great optimism that this is going to be a walk in the park for you. Good luck and keep us posted.

Regards

Jeb