PepeSilvia, 11 months ago

Not really sure where this list came from, but I have a lot to add! Pharmacy background (not a doctor) here (in the US so YMMV) and Bipolar 2 with anxiety features and ADHD. I am only speaking from my educational background and this is most certainly not medical advice.

Typically these days AEDs are first line along with antipsychotics if the patient is distressed. Personally I take Lamictal and used to keep an emergency stash of antipsychotics but I don’t metabolize them well. Lithium seems to be a last resort kind of thing because of the small therapeutic range. It’s hard to ensure continuous blood level monitoring, but from what I hear from other pts is good things.

Drugs affecting serotonin should be used with extreme caution. These primarily include SSRIs SNRIs but also some drugs you might not expect. Trazodone indicated for sleep, buspirone indicated for anxiety, Zolfran indicated for nausea are a few on the top off my head but is not an exhaustive list. The fastest I have ever achieved hypomania was buspirone in about 2 weeks. In comparison it took about 4 months for Zoloft.

Benzodiazepines are the black sheep in pharmaceuticals in my opinion. The therapeutic range is huge so the odds of overdose are near 0. Primarily for anxiety, some of these drugs have a very mild mood stabilization effect. They also help reduce excess movement tardive diskenesia from long term antipsychotic use. Personally, I have never had to increase my dose and have been on a regular low dose schedule for about 4 years, but they can be addictive.

Beta blockers- Propranolol is unique in that it’s not selective as to which beta receptors it affects. Long story short, can prevent adrenaline rushes and in turn prevent anxiety attacks.

Stimulants are typically not advised but I’m sure a lot of people on here have comorbid adhd and can understand the value. Data on this is a bit polarized (pun intended). My opinion that is purely anecdotal to my experiences trying to find the right treatment is that providers only seem to care about preventing mania and rarely seem concerned about all the other facets of mental health once the BD is slapped on my chart. I’m lucky after 15 years to have found a provider who treats me as a whole person and sees that if I cannot manage my hyperactivity and regulate my emotions, then I say or do things impulsively that end up growing into larger mood episodes.

Sorry for editorializing this so much. I find chemistry fascinating

ickplant, 11 months ago

Thank you for such an insightful comment! Lots of great info here.

Drugs affecting serotonin should be used with extreme caution. These primarily include SSRIs SNRIs but also some drugs you might not expect.

Definitely agree. I may add a link to some antidepressant research in this post for educational purposes.

My opinion that is purely anecdotal to my experiences trying to find the right treatment is that providers only seem to care about preventing mania and rarely seem concerned about all the other facets of mental health once the BD is slapped on my chart.

I feel this so much. I'm so lucky to have my psychiatrist who sees me holistically. I also have ADHD and take dextroamphetamine. My life changed in an instant when I started on stimulants, I actually could function. They have not triggered any manic episodes; I'm also on lamotrigine, and it keeps me pretty stable.

PepeSilvia, 11 months ago

A lot of the references I can link to are pubmed and are pretty technical in the speculation of how serotonergic drugs essentially “activate” episodes in populations who are predisposed if anyone wants to see them. For now though, I think just looking at package insert can be helpful to the average patient as these are usually given to the patient with each refill and can be updated. For examples purposes I pulled up citalopram (Celexa) which is just a regular nothing special SSRI and the leaflet mentions 2.2 SCREEN FOR BIPOLAR DISORDER PRIOR TO STARTING CITALOPRAM TABLETS Prior to initiating treatment with citalopram tablets or another antidepressant, screen patients for a personal or family history of bipolar disorder, mania, or hypomania

If you would like to lookup your medications, here is the NLM website. Just type in the drug, select any form (tablet, capsule, etc) and look for package insert information.

I recently did this with lamictal as I’ve been on it since 2016 and found it to have a new black box warning about heart issues that I wish had been known before I had said heart issues.

Hope this helps someone!

SpezCanLigmaBalls, 11 months ago

Lamictal works really well for me at 100mg. At 125 I felt like a zombie though

ickplant, 11 months ago

It's all so personal - I metabolize drugs quickly, so I'm on 300mg of Lamictal.

SpezCanLigmaBalls, 11 months ago

While finding out your dose did you ever get songs playing in your head absolutely non stop? Around 125-150 I seriously had my own personal radio station going on 24/7. I then looked on Reddit and it is supposedly a thing

ickplant, 11 months ago

Hmmm, I honestly don't remember, it's been a while. But I am familiar with the feeling of having a radio station in my head, so it may very well be related.

Peacecraft535, 11 months ago

Good list, I'd also like to add Asenapine (saphris). It's an atypical antipsychotic. I had a lot of trouble finding a med that worked well without having terrible side effects. I started this about two years ago and in combination with my lithium, it's been a godsend, I've never felt more even-mooded for this long a duration ever before.

ickplant, 11 months ago

Thank you so much, I added it to the list. I feel like the new atypical antipsychotics are great, for me it was Vraylar (cariprazine) that helped a ton along with lamotrigine.

Peacecraft535, 11 months ago

They've definitely come a long way with medicinal treatment for bipolar, even just in the last 20 years. When i was first diagnosed the meds helped level out the bipolar symptoms, but basically made me a zombie; now the meds successfully even me out, but I'm still functional.

ickplant, 11 months ago

Absolutely, it's so much better now. You can actually hope to be functional and more or less "normal." I always liked that meme that says we would have been lobotomized 100 years ago... dark but probably true.

Peacecraft535, 11 months ago

Oh yeah, being bipolar in the late 19th and early 20th centuries was a horror show. First off, the general care in most asylums of the era were non-exist at best, and constant torturous abuse at worst; the most common treatments were powerful sedation drugs, electric shock therapy, or a lobotomy. My mom (who was also bipolar) didn't remember most of her teenage years because of electric shock therapy. Nasty stuff.

ickplant, 11 months ago

It was awful! I can't even imagine how different my life would have been.