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Dopamine, Low Dose Solian, Seroquel, Zyprexa Make Depression Worse

bipolar Seroquel

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#1 valdoxan2011

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Posted 09 February 2012 - 10:37 PM

Long time reader, first time asker and I'm desperate for advice.

I'm bipolar (mainly depressive with lots of intrusive thoughts) and rapid cycle from normal to irritable to depressed. My cycles run their course usually over a week, but sometimes over two weeks.

My problem is that so many things haven't worked. I was on lithium (both monotherapy and in conjunction with ADs - mostly Effexor) for nearly 20 years and that didn't stop any of the craziness. I stopped the lithium a year ago and switched to Lamictal. I suspect it's made things a lot worse, speeding up and intensifying the cycles - they never used to be this fast and this bad.

I can't try any of the AEDs - and choices are limited in general - because I'm hoping to get pregnant once my mood stabilizes.

I tried low dose Seroquel, but that really intensified the depression. Low dose Zyprexa (Zydis) worked for about two weeks and then pooped out. I tried to use Zyprexa PRN and it made things worse - felt a lot like the Seroquel experience.

I tried low dose Solian years ago and seem to remember it had been effective but discontinued due to terrible side effects. Also, the rebound depression was the worst I ever experienced. Because so many things have failed, I tried Solian PRN over the last couple of weeks. The first two times, it worked brilliantly, the third time it worked for about 12 hours, the fourth for about 5 hours, and the last one it didn't work at all and it felt a lot like the Seroquel and Zypexa crashes. I only wanted to use it PRN because it can interfere with fertility.

My question is: does it sound like I need to leave my dopamine the hell alone? Zyprexa and Seroquel inhibit it (from what I understand), while low dose Solian stimulates it. If so, where to next - especially considering that I hope to get pregnant.

One thought I had was maybe to try a combination of low dose (ie maximum 15mg - but most likely 10mg) Valium for the irritability and intrusive thoughts and a stimulant to knock out the depression and treat my ADD.

So sorry for the huge post. I'm at my wits' end and desperately hope someone can help me.

Edited to add: I apologize. I just realized I put this thread in the wrong category and that it should be in Treatment Options for Bipolar Disorder: The Spirit Levels of Your Mind, but I don't know how to move it.

Edited by valdoxan2011, 25 February 2012 - 06:32 PM.

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#2 Rockie

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Posted 12 February 2012 - 09:17 PM

What were your dosages of Seroquel and Zyprexa? And did you try them while on Lamictal or any other med?

AAP's tend to do different things at different dosages. Seroquel is an antihistamine at low dosages, an AD at mid dosages, and an AP at around 400mg or higher. I'm not familiar with Solian, but I'd assume that its actions would also be dosage dependent. If so, you were probably not getting much (if any) dopamine blockade at those dosages. It could also explain them not working, the cycling, and possibly even the poop-outs that you've been experiencing.

Have you thought about just upping the Lamictal? 225mg is on the low-end for mood stabilization. According to this article, Lamictal wins top honors for primarily depressive with rapid cycling.

Edit: Just wanted to add that I can't speak to the safety of meds during pregnancy, but I'm sure someone around here could.

Edited by Rockie, 12 February 2012 - 09:27 PM.

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Previous Meds
AD's: Prozac, Zoloft, Paxil, Luvox, Celexa, Cymbalta, Effexor, Lexapro, Wellbutrin, Remeron, Emsam, Imipramine, Nortriptyline,Trazodone, Viibryd, Nefazadone
AED's: Topomax, Trileptal, Klonopin, Ativan, Lamictal, Oxazepam, Triazolam
AP/AAP's: Seroquel
Other: Buspar, Ambien, Nadolol, Propranolol, Pramipexole, Hydroxyzine

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#3 Larkspur

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Posted 12 February 2012 - 10:53 PM

I might think of doing modafinil/armodafinil (Provigil or nuvigil). There have been promising studies on Provigil treating bpii with depressive symptoms. (http://www.ncbi.nlm....ubmed/17671288/) Not sure on pregnancy status but it should knock out the depression and focus problems pretty well.
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Dx: bipolar ii; social anxiety disorder/social phobia, GAD, OCD, insomnia
 


#4 valdoxan2011

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Posted 12 February 2012 - 11:20 PM

Thanks for replying, Rockie.

I was on Lamictal 325mg (couldn't go any higher without going toxic) and it did nothing to stop the rapid depressive cycling (my cycle is a few days normal, then a few days of declining mood, then a few crash days, then a few improving days, then back to normal).

The thing is, I don't remember ever having rapid cycled before the Lamictal and because it has anti-depressant properties, I suspect it of at least contributing to the cycles. Right now, I'm tapering down the Lamictal because of the hope of pregnancy and because I suspect it of making things worse.

As for Seroquel and Zyprexa, I was always on super low doses. They both messed with my cognitive function - the Zyprexa made me nearly non-functional. Seroquel never went higher than 50mg and Zyprexa never higher than 5mg.

Because of the stupids (ie, I couldn't even drive safely), I couldn't go higher on the Zyprexa, and because the Seroquel at lower doses made me suicidally depressed on a constant basis, I could never get past 50mg.

But thanks for explaining that dopamine was not at issue at those doses with Zyprexa and Seroquel. I do know that dopamine is stimulated at low dose Solian. From Wednesday last week, I started taking 50mg Solian daily in the hope of staving off crashes - even if I do have to come off it for pregnancy, because the crashes are really scary and because if it does work, I'll start back up after pregnancy.

Another thing my Pdoc and I are looking into is the possibility of being on a stimulant or Provigil by itself for the dual purpose of treating the depression and ADD. In theory, if anything scary happened, I could just hit myself with Zyprexa as an antidote to stim-induced nuttiness.
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#5 chiara

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Posted 17 February 2012 - 02:57 PM

I am having some similar problems and this post may have shed some light on some of my issues however it may have also made some things more confusing. I don't mean to shift the focus of this post to "all about me" however I'm having medication crisis, also may have similar mental issues, and am trying to figure out what the heck to do about it. I don't have answers but I have a similar (or close enough) story.

I have been rapid cycling for 2-3 weeks within one day and from day to day. I have NEVER had a mood episode like this before. (On a side note, I started and finished a 50 page manuscript in 11 days while screaming from anger in a way that I don't recognize, being in tears 10 minutes later, and being able to write 10 minutes after that.) I feel so out of control that it's kind of freaking me out.

Anyway, my point is that the last time I had a mood "episode" which was mainly depressed (less than 4 months ago), I was put on Lamictal in addition to Adderall. My doctor took me off of adderall about a week ago because he thought I was hypomanic which has really led to more craziness where my world seems to be collapsing around me. It hasn't seemed help and in fact has made things go from bad to worse. I never thought for a second that Lamictal could have something to do with it. Maybe it is the Adderall. I have no idea at this point and I'm so confused however I have never been this out of control before feeling like I am going from one extreme to another in a matter of minutes or days... depending. It's bizarre.

Onto my AAP debocle. My doc has tried a bunch on me in the past and the only one that has helped is ripserdal. The others have made me want to rip my brain apart, rip my skin off, and leap out of my second story window (I think there is a scientific term for that.) He wanted to put me on zyprexa last week and I just flat out refused. I haven't slept much in weeks so yesterday he gave me hydroxizine (sp?) and instead of mellowing me out, it gave me that wanting to leap out of my skin feeling and I spent the entire night rocking back and forth, very much like taking AAP, which SUCKS! So, I feel like what is prescribed to help with the depression symptoms I am feeling just misses the mark and goes straight to the "freak out" zone.

He prescribed me trazadone which DOES make me sleep for the weekend but I have no idea what to do next. There is a part of me that is instinctually leaning towards the tetracyclics as those have helped me in the past but made me into a zombie... i wonder if there is a middle ground.

I'm going to look into the Provigil some more. The big pattern that I have seen over the years is that the stuff my doctor gives me to mellow me out usually freaks me out and vice versa. I feel like anything designed to promote "wakefullness" may have the capacity to take the edge off. Provigil seems to be a bit more complex than your standard ADD med.

Anyway, I just wanted to share. I'm sorry I don't have any answers but I sympathize and empathize with what you are going through right now. Keep us updated if you figure anything out. I know I would be interested.
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Past meds:
AD: Prozac, Zoloft, Serzone, Remeron, Wellbutrin, Effexor, Strattera, Paxil
AP: Risperdal, Seroquel, Abilify, Saphris, Latuda
MS: Lamictal, Depakote, Trileptal, Lithium (gave me a rash)
Others: Ambien, Rozerem, Trazodone

#6 chiara

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Posted 17 February 2012 - 03:00 PM

oh, and here's something else to consider. I have always felt that some sort of Rx treatment for my ADD helped with irritability and intrusive thoughts and a subsequent over-the-top reaction that will come with them (they call that impulsivity.)
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Past meds:
AD: Prozac, Zoloft, Serzone, Remeron, Wellbutrin, Effexor, Strattera, Paxil
AP: Risperdal, Seroquel, Abilify, Saphris, Latuda
MS: Lamictal, Depakote, Trileptal, Lithium (gave me a rash)
Others: Ambien, Rozerem, Trazodone

#7 Larkspur

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Posted 17 February 2012 - 04:26 PM

Had you taken Zyprexa before? My doc says it's a great one for rapid cycling, and it works a little different than risperidone... if you are still miserable, it is something that can be taken short-term... my pdoc had me on it for just a week to pull me out of a mixed state. Sounds like it can't be worse than what you've had so far. I tend to get that skin-crawling, want to get out of my own head feeling, and Zyprexa squelched it. It was great!

As far as ADHD meds, my doctor tells me that taking stimulants is like putting kindling into the fire - it makes it flare up. Once you're stabilized, maybe Adderall will be back as a part of your regimen, but they make your brain more sensitive to going into mania or mixed states. So if you were a long time user of Adderall, your mind will be more sensitive to becoming manic or having mixed episodes than if you didn't take it. Not to say the benefits don't outweigh the risks for some patients, but that is a risk with stimulants and BP.
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#8 chiara

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Posted 17 February 2012 - 06:36 PM

I did start taking adderall and lamictal around the same time about 4 months ago. In this time, I have been able to get through almost 2/3 of my dissertation for which I haven't made that much progress in, oh, 2-3 years. However, I have never spun out of control like I have in the last few weeks. I don't want it to be adderall because that seems to have gotten me to focus. I feel like it has turned my brain that was a pasta strainer into a brain with a couple of funnels. I have been able to get the thoughts that have been in my head all this time to line up in a straight line and that is so fulfilling. I can definitely understand how it could be kindling into a fire though. i hate that this is such a balancing act.

he tried to put me on zyprexa last week and i refused because of the problems i've had with a lot of the AAPs. I have been on Abilify, Seroquel and Saphris and they have all made me want to rip my skin/face off and that feeling is worse than what I have been feeling which is like that already. i am really scared for this feeling to be magnified. I don't think I could take it. it's interesting that you said you got some relief from that feeling with zyprexa. have you had bad reactions to other AAPs?

I apologize for hijacking your question Valdoxan however i feel like we are playing in the ballpark. I look forward to your experiences with provigil.
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Past meds:
AD: Prozac, Zoloft, Serzone, Remeron, Wellbutrin, Effexor, Strattera, Paxil
AP: Risperdal, Seroquel, Abilify, Saphris, Latuda
MS: Lamictal, Depakote, Trileptal, Lithium (gave me a rash)
Others: Ambien, Rozerem, Trazodone

#9 Larkspur

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Posted 18 February 2012 - 03:42 AM

I had a skin-crawly and out of my skull reaction to Abilify, but it ended with Zyprexa. Seroquel so far also hasn't caused me to feel poorly. Different drugs act differently, especially in a diverse class like AAPs. No promises, but you may be able to tolerate Zyprexa better than the others. Only way to know is to try!
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#10 maria219

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Posted 06 September 2013 - 08:24 PM

I adore Provigil. Very first dose, in 2001, I told my doc, A whole new part of my brain lit up! It sure has been an antidepressant for me because I am awake, I feel like doing things, I can think ...and no side effects. Except ok I developed the dreaded drug rash, same as Wellbutrin. Even tho am on Prednisone for autoimmune disease. But doc has a different anti-inflammatory he says he'll try for the rash. In the case of Wellbutrin, it's to the bupropion itself - I get it compounded. All these years without Wellbutrin or Zyprexa (I think the Midrodrine (?) hurt my stomach, and too, you foolishly go off things, not knowing what you're going to lose.) ... just ordinary suckage. 


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