Question for those successfully treated by antidepressants/mood stabilizers

OP, I have not been on an anti-depressant for years; I'm so sorry to hear you're in pain.

I just saw a pill doc yesterday and am contemplating going on medication.

I have horrible thoughts of suicide. All I can say is try to keep in mind that things will get better.

A friend killed himself last year; it's so depressing for those left behind.

Take care. Try to live.

I was on anti-depressants for 20 years, then off for about six months, and then back on (starting about six months ago). I found I couldn't reach an acceptable "baseline" without the meds. I think the right meds, prescribed in the right strength, have the potential to work wonders. I wish you all the best, OP. In the worst times, it was always helpful to me to believe that things will get better. They will. Also, I made it a point to get outside and exercise (at my age, primarily walking!). And I would silently count "1, 2, 3..." up to "8," then start over. It was kind of a walking meditation. That, and the fresh air, helped a bunch. Hang in there.

Meds help but they need therapy and other ways to help change your thinking. It’s changing how one thinks and views things. Meds help but they require other components to get the full benefit. If you plan on just taking a pill and expect things to be different, you may be disappointed. Especially after your body becomes resistant to the meds.

Thanks r1. I don't think I could kill myself while my parents are still alive; but my mom has Alzheimer's, and when I think of being old and alone, all bets are off. So I figured I should get my depression under control while I'll young (I'm 35).

Have you ever thought about getting eaten out more? That can help. Doctors have found that oral to anal contact fights depression. Try getting eaten out more.

Thanks r3

You really need to be in therapy as well, practicing cognitive behavioral techniques to change your thoughts.

Self-hate is particularly responsive to CBT.

Remember: Feelings aren't facts.

Thanks too r7.

Hello, OP! I'm glad you posted. You may get the occasional nasty response, but, if so, just ignore them.

R2 has some wonderful, balanced advice:

[quote]I think the right meds, prescribed in the right strength, have the potential to work wonders.

Some people who are struggling with a diagnosis of bipolar disorder swing between the extremes of "only medication can help me" and "medication is useless and/or harmful." I think the healthiest plan has three components. 1) Work with your doctor to find the best medical treatment for your particular situation (which you are already doing!). 2) Use lifestyle changes to strengthen yourself: establish a regular sleep schedule; go stand or walk outside to get fresh air and sunshine every morning; find a physical activity that you love, or at least can enjoy, and do it faithfully; eat healthy food, drink plenty of water, and avoid excessive alcohol consumption. 3) See a therapist (whether CBT-based or otherwise, depending on your needs and preference) for help understanding and changing your thinking patterns.

I know that all of that is so much easier said than done, especially when you're already struggling to function, and have a limited social support network (as you hint in R4). It's normal to try, and fail, and try again many times before a new plan of medical/lifestyle/mental health care finally "sticks." But we are talking about your life, and the decades of happiness that may be possible for you, even if you can't see or imagine them right now ― you are worth all of this effort, and more.

Question: Are you only on antidepressants without antipsychotic?

Nvm Lamictal is not antidepressants, I just check

I absolutely agree with R7 about CBT. If you can't find a therapist with CBT as a specialty, read book and work i workbooks. If you like, I can give you titles that helped me a great deal. Give the Lamictal a chance. It's a godsend. Good luck.

Thanks r12

I can't afford to be depressed.

Hey dude--I'm on a nice lamitctal, lexipro combo that goes down real smooth. i was always very skeptical of ssris or mood stablizers, and i put off going on them for years. i didnt want to lose my sense of humor, my appreciation of music, my emotionalism. it got to the point where i grew tired of death seeming like not such a bad idea, so i went on both and shit improved. night and day. i don't dread waking up anymore. work is enjoyable. i value my friendships so, so much more. i see the bullshit for what it is. its not like being an autobot.

as former posters have said, it's so important to be in some sort of therapy. i'm currently doing CBT, which is great, but find what works for you. lifestyle changes are crucial as well: not eating like shit, exercising, going to bed at a reasonable hour, reading books instead of staring at a screen all day.

get past the nausea--it will eventually go away. the thing that stands out to me most about lamitcal are the extremely vivid dreams, for better or for worse. they are fascinating. good luck, stick with it for a while, and if it don't work, try something else.

Meditation helps. Check out Tara Brach. Exercise also helps. I am a lifelong sufferer of depression and finally quit the antidepressants.

R16, I am happy for you. However, OP has bipolar disorder, which requires lifelong management. It's really important for people with this diagnosis not to stop taking their medication (which is tempting to do when one starts to feel relief from symptoms).

R12, if you're still around, I'm curious to know which books you found most helpful!

OP here. I found the best therapy to be client-centered therapy, based on Carl Rogers' approach. Unfortunately I live in a new city now and only see that therapist maybe once a year.

I can't explain why it worked so well, but it did.

The Dialectical Skills Workbook and the books by Seth Gallihan, R17.

Thank you, R19. It's interesting that DBT was helpful to you, in addition to the oft-recommended CBT. Apparently, DBT was developed for use with people who have borderline personality disorder, but has also been found to be helpful for bipolar disorder. I found this summary online; do you think it's accurate?

[quote]DBT is simply a modified form of CBT that uses traditional cognitive-behavioral techniques, but also implements other skills like mindfulness, acceptance, and tolerating distress.

OP/R18, that's a great insight to have. Have you considered searching for a new provider of Rogerian/client-centered therapy in your new city, since it worked so well for you in the past?

r20 -- I have looked but so far haven't found a therapist here I click with.

Also, I wasn't aware of DBT being used for bipolar patients.

I go to a wonderful support group called Recovery Inc. for people with nervous/mental disorders. I've seen quite a few bipolar people there and it's a life saver to be with people who are just like yourself. Their main book is called Mental Health Through Will Training but they have a fair number of other books as well. There are quite a few Recovery, Inc. groups in the USA where it originated - check one out, stay with it for awhile, and I think you'll find some valuable help there.

Birdwatching. No, really! When I'm in my worst moods, birdwatching is one of the things that can give me a little lift!

It's because I'm out in the woods, concentrating on something other than myself or my own problem. And yes, birding takes intense concentration and focus, so if you can drag yourself off the couch and do something, anything, that requires intense concentration and focus on something besides yourself, it might help.

I have bipolar II too. It took 17 years and 3 different psychiatrists but now I feel great. Yes, 17 years! Having bipolar, you should never, ever not be on medication. The way I see it, bipolar is two separate illnesses, the mania/hypermania and the depression. I have been on Lithium for 17 years which eradicates all hypermania for me (excitability, feeling of being out of control), the depression was much, much harder to address. I tried every antidepressant on the market to no avail.

You need a psychiatrist who will persist in trying combinations of medication. In the end I believe I just hadn't been given the right antidepressant for me, and most importantly, an adequate dose, For me I realised I required quite a high does to address the depression.

Personally I found CBT useless for me but you may be different. All the anger and self loathing disappeared once I found the right antidepressant at a sufficient dose. I feel like a new person now. A lot of problems I put down to psychological/ personality were eradicated once the depression was in check, so they were just the illness/biological.

The only downside is that the antidepressant depletes my sex drive and I can't ejaculate. This can be devastating for a young gay man, or any man for that matter. If I want to have sex I stop taking the antidepressant for 3- 4 days and the sex drive and ability to ejaculate returns, usually with a vengeance, which is good. I'd rather feel happy and stable than be able to come every day, it's a small price to pay and if you really are that ill you will understand.

I had ECT for the depression which only erased my memory (short term, it came back) and although today it is given under an anaesthetic I still find it barbaric. Some people find it works for them but I've never heard of anyone who's had ECT who didn't relapse very quickly.

I also had TMS which is a fairly new treatment in which a painless magnet is placed on one side of your head for 40 minutes once a day for 20-30 treatments. For me it was remarkable how well it worked for the depression and my doctor believes it opened a porthole for my brain to function properly again and the antidepressant keeps that portal open, if that makes sense?

So, in conclusion I would suggest finding the right psychiatrist (and really it has to be a psychiatrist, you can't do this with a G,.P. they just don't know enough about it) persisting in trying different medications until you feel a change, then making sure you are on an adequate dosage, TMS worked well for me, but isn't available everywhere. Of course, this is just my experience, everyone is different. But yes, the palpable anger and self loathing, the negative thoughts have all gone. After 17 years I think I deserve a break.

Good luck with your search for health and happiness. Depression and bipolar are a true nightmare, it's agony. I wouldn't wish it on anyone.

OP here.

Lamictal has made me really horny for some reason

To the OP. I have been on Anti-Ds every day for 20 years. I plan to stay on them for the rest of my life. The biggest side effect so far, is that I have not tried to kill myself nor felt like killing myself, since I have been taking them. Depression is HORRIBLE I truly would not wish it on my worst enemy. Do whatever you have to do to deal with it. Being on Anti's for the rest of your life, is a great deal, if you get to be alive for the rest of your long life.

Thanks r26

I think the lamictal is making me hypomanic ...

OP, some people find that combining their mood stabilizer (Lamictal, in your case) with a low dosage of lithium helps control mania or hypomania.

Thanks r28

When’s your next appointment, OP?

if you're horny then you're getting manic/hypermanic, probably best to stop and tell your doctor.

In a week r29

Call his office and see if you can talk to your doctor or leave a voicemail.

My partner is bp2, and after trying everything, found Lamictal works well. You know how some mood stabilizers make you kind of groggy/zombielike? Lamictal is different in that it can also have a mildly antidepressant effect. If you're getting a little too hypomanic, the pdoc may have you take a small amount of another mood stabilizer with it to bring things in balance.

For the self-loathing, my partner has that, too. But no meds could take that away. He had to go into therapy, where he was diagnosed with complex PTSD that had developed in response to being raised by an NPD mother and a bipolar, BPD father. He's doing better. DBT and CBT and a lot of work on your part can help you reprogram your brain and learn to deal with the triggers that send you into the self-loathing spiral.

Thanks for the insight, r34

My father has narcissistic tendencies and the self-loathing could be related to that

I think that many people (including OP) in this thread would benefit hugely from ketamine infusions. I was one of the lucky bastard recruited for a clinical trial and it changed my life so far (don't want to say forever - cause superstition - but fingers crossed). I was resistant to all SSRIs/SNRIs and other atypical antidepressants (Remeron, Wellbutrin, Emsam patches), mood regulators (including Lamictal), antipsychotics... You name it, I probably did it.

I can't wait for ketamine-treatment to be available to the masses! I had six infusions in six weeks and then six further over the next six months and I've managed to be symptom-free ever since, 4 years and counting, just on a light DBT (not CBT) maintenance program. On top of it exercising (which helps significantly) doesn't feel like a chore anymore.

Hang in there OP! A problem is never as permanent as a solution.

Thanks r36!

Are ketamine infusions wildly available yet?

*widely

I am still on a low dose, but I've crashed and am starting to feel rather depressed again

I wish Lamictal worked faster -- or that I could start at a higher dose. They have to increase the dosage very gradually.

Yes, my partner slowly built up to a high dose of Lamictal that works for him better than anything else he tried. It's crucial to increase slowly, because you don't want the dangerous rash reaction.

It took me until I was about 37 to be diagnosed as bipolar. I'd been on a pharmacopeia of SS- and SNRIs wich had only done moderate things to help me. It wasn't until I described what my feelings were leading up to my suicide attempt that made my first NYC psychiatrist (who I hate that I had to give up, though my current one is very good) think "bipolar" and not MDD. He wanted me to try Lithium first, but I really couldn't commit to making sure my kidneys weren't shutting down. So I asked for Lamictal instead, and it's the been...godsend is the wrong word, because I don't entirely like the way it makes me feel, but it makes me more stable than I've been at any point on my life. And even though the Stevens-Johnson rash is serious, it's completely avoidable if you titrate the dose slowly and don't skip multiple days in a row. And that's only real side effect.

I do hate feeling like I'm cut off from the full spectrum of my emotions. It's not even so much that I want to be hypomanic all the time, I weirdly sometimes miss being sad. But it's impossible for me to function when I'm off of it.

Thanks for your perspective, r42. That was helpful.

Cymbalta helped me with that specific symptom, among others. However, it stopped working around 4 mos. Doc raised the dose and then I got 2 more months out of it until it stopped again. I had to taper off slowly because I was having really odd symptoms from stopping abruptly. There are a few websites out there about problems with getting off cymbalta

Also, r42, I understand what you mean about "missing being sad."

Ketamine "Clinics" for both Depression and Chronic pain are now available in larger cities but they are expensive ( like $800/ session) and not really covered by insurance yet. It IS going to be the wave of the future though. I was talking to a doc who's daughter is ALSO an M.D. in an ER setting, and according to the daughter they are now using Ketamine in emergent mental health scenarios. Ex: patient comes in with acute suicidality that they are attemting to stabilize prior to transfering to mental-health unit- infusion of Ketamine= Patient walking and talking, wondering what the hell was wrong in the first place!

Meds help, but they're not magic. Get counselling on why you feel this way, no pill is going to take away a real psychic wound. You are worthy of love, not loathing.

Bipolar has some serious biological underpinning. I'm not saying therapy isn't important, but "why you feel this way" is not going to help with mania or hypomania. I've done plenty of therapy, and nothing has helped me as much as the Lamictal.

It's not like mild MDD or anxiety, which are incredibly responsive to therapy with or without meds.

Interestingly, a lot of my self-hatred comes from stupid things I've done as a result of the bipolar disorder.

It's a terrible, vicious cycle.

I have been on an antidepressant for years and it has helped greatly reduce intrusive, negative thoughts I had about myself and things that I have done in the past.

It's good to see you still posting here after all these years, Voice of the Night, now a full-fledged doctor. Cheers to Lamictal. I don't think I could live with my partner if he had to go off it.

OP, your response at R49 makes perfect sense.

I had a narcissist mother and alcoholic father. I haven’t been diagnosed as bipolar, but I think I might be. Lexipro helps me.

Lamactil is a miracle drug. Titrate up very slowly onit. Start at 25mg and titrate up by 25 once a month until you dial it in.

Ketamine-based antidepressants should appear in the next few years. They are by many accounts very effective and also work immediately. At least hang in there till then.

I am also BPII, but I err on the side of hypomania. I got over my last major depression with California Rocket Fuel (Effexor and Remeron combo). Which actually triggered a pretty major hypomanic episode, but once that settled down, I’m pretty stable for quite a whike.

Have never had a problem with self-loathing (hypomania makes me like myself a bit too much, actually, so opposite problem), so I’m sorry I can’t advise on that.

And if you don’t already, start an organized regular exercise routine. Helps me hugely with depressive downturns. Also sun exposure (or full spectrum lamp).

I have very severe bipolar I and take meds everyday, but it has enabled me to live a relatively normal life with a job and a happy relationship.

Just take the meds - if you are a diabetic you should take your insulin; if you break your leg you should wear the cast and if you have a mental illness you should take all the required medication.. For the self loathing you need to see a psychotherapist and learn some form of cognitive behaviour therapy. It works, but you have to make the effort to learn it. Good luck.

OP here.

A little less than a month and a half in. The suicidal thoughts that have been more or less constant for 2 years have almost entirely subsided. The self-hatred is less pronounced, but not gone.

I’m glad to hear from you, OP. Sometimes medications take a long time to work full strength, so I hope you continue to improve.

I’m unipolar my shitty shrink prescribed topamax with the other antidepressants I’m on. Big mistake. Made me almost commit suicide! Fuckin bitch!

I hate my shrink! She is a fat slob who does nothing to help me.

Glad to hear it OP. Is there any dreaded weight gain involved? Is bipolar II the same as ‘baby bipolar’?

OP here again. r60, I don't think Lamictal causes weight gain (unlike, say, Depakote). In some cases, it leads to weight loss.

I'm noticing the Lamitcal is causing akathasia ...

Get in touch with your psychiatrist, R62.