I have noticed a lot of people are taking lithiem. I take Zolof, Klonopin,and Lamictal. I used to take Depakote and Wellbutrin with the Klonopin. I am much better since I went to the Zoloft and Lamictal. I am more stable. I have much better control of my thoughts. I had racing thoughts terrible, but so far changing those two meds are working. Have you talked to your pdoc about your depression lows? He may need to change something. I have taken several different ones. Sometimes he adds something temporary to get me back together. Hope you get something to help you soon. Sorry I couldn't help you. RJ
SSRIs are used to treat depression in Bipolar patients, but they are usually used with mood stabilizers to prevent causing a manic episode. Talk to your doctor, as RJ233 suggested, you may need a change. There are are many medications and combinations that have been shown to be effective, but different meds and combos work for different people. And sometimes med changes are needed periodically. Don't despair! I take Li, Lamictal, and Prozac (an SSRI).
SSRI's are user VERY carefully - they are able to cause very rapid and extreme mania and can and do lead to suicide in a segment of patients. You should NEVER be taking an AD without an MS as a BP anyway but you must be especially carefull with SSRI AD's even when on an MS - there are known effects of SSRI's on Bipolars and any usage must be supervised and managed - again what works for one person does not work for another.
They are a useful theraputic drug but they must be prescribed by a pdoc not a GP - sorry I am a major anti SSRI person because in Australia they are handed out by GP's (our version of a family doctor) like lollies and theyre not only dangerous to BP's theyre also highly habit forming and should only be used as part of a therapy program by anyone. Its actually easier to get Prozac here than Valium and Prozac is far more habit forming and dangerous to patients but its not seen as 'Bad' like benzo's
I admit to being biased - Prozac almost killed me and I know they work for people but you MUST speak to a pdoc before taking anything - a family doctor is not the person you should be using for meds like these,
Jim I think I have said several times now to see a doctor about this, its up to the doctor what drugs you should be taking not the patient - however as I said in another thread you must then go out and educate yourself on those drugs - Bipolar is an illness where education is a vital part, not only about the illness but the drugs you take as well - I mean what most people dont realise is its not just the prescribed meds that can be a problem - Lithium for example has known interactions with a host of other drugs; psuedoephedrine for example can block lithium absorbption so you must tell the pharmacist what you take when you have the flu and want something and you thus must educate yourself on your drugs.
I guess its the IT guy in me but I cannot conceive of how you can put a drug into your body every day and not know about it - this is common sense to me.
Jim, I am about to be discussing the same subject with my own pdoc. As monkeyc says a GP (family doc) should not prescribe you any type of AD when you are BP and under the care of a Psych. I know for a fact that even if I asked my GP she would tell me to speak to my Psych. I tend to veer more towards the depressive side of BP and like you the winter months are particularly difficult for me. The mood stabilizers are great for quelling the manias but unfortunately tend to leave me on the edge of depression, even lowering the dose doesn't help. So, I shall let you know what the psych comes up with when I see her in a couple of weeks.
Also, have you considered light therapy. I think Lizz67 posted a thread on this fairly recently. There has been a lot research to show how effective light boxes can be in helping to alleviate the symptoms of SAD. I have daylight bulbs in my standard lamps at home but I am looking into the costs of light boxes which you use for about half an hour per day to help increase the serotonin levels.
I also agree with monkeyc pointing out the importance of educating yourself on any medication that is suggested to you. There are many contra-indications with mood stabilizers and other medications, also with some mood stabilizers certain foods are a definite no go area, for instance I was recently put on to carbamazepine and it was only through my own research that I discovered that I musn't have grapefruit and also that hormone contraceptions are decreased!
Having had SAD for many many years now I think it is important to get yourself out of the house for at least half an hour per day for a walk, the gentle exercise and fresh air is good. Make sure you are eating healthy foods, get plenty of rest etc. These things may seem like common sense but sometimes when you actually evaluate your lifestyle it can be a shock to realise that maybe you are not having enough exercise, vitamins, relaxation etc.
As I said I shall let you know the outcome of my appointment regarding help with the depressive side of BP - although don't hold your breath that it will be anything mind blowing!
Education is just a basic for anyone, James is doing that I think hes just having trouble getting a pdoc - I cant understand the US system as it makes no sense - there is a lot of talk here about waiting lists for surgery and private medical insurance is a must have if you an afford it but in the end we have universal subsidised healthcare and free public hospitals of superb quality (id be dead 2 times if they were not) - if you really need access to medical care its there and its available and its of an excellent quality.
Add that to our PBS which subsidises prescriptions and also has a safety net which lowers costs even further... I have exceeded the $1500 PBS so my scripts are now subsidised even more - my lithicarb 250mg x 200 scripts now cost me about $6.00 to fill and even without the safety net limit were only about $17.00. The max a PBS medicine can be is $31.00 from memory and most medicines are subisised - of course there are non PBS drugs but theyre rare and often the very very expensive and unusual ones or newer drugs.
I feel for James and people struggling to get access to doctors because they cant afford it or have none in the area - we have a shortage of pdocs here as well and getting in to see a private psych has taken me 6 months but thats more down to the realities of an 8 year education at Uni coupled with psych being unglamarous and a hard subject to boot and on top of that many psychs here are not taking new patients as they have full books - My psych is a hospital one which means I pay nothing for her, ive been seeing her and a guy before her for over a year every month and it does not cost me a cent (though we do pay a medicare levy in our taxes to pay for increased costs and trust me the system is far from perfect but it works a lot better than the alternative)
You cant just breed new psychs sadly. But we can just go to the hospital and get free help and if you are acute immediate help.
Personally as an outsider looking I think the US Health Care system is something that rhymes with clucked. Health Care should be available to those who need it free or at a cost based on your ability to pay whereas in the US the HMO's are profit making businesses - instead of AIG and Fannie Mae/Freddie Mac your government should start by nationalising the damn HMO's and start putting the care back into health. But thats just an outsiders view I guess.
Exercise is great if for no other reason than its good to clear the mind.
Actually after that long screed a thought. James how low is your low side right now?
Funny as it sounds I find plain of Diazepam (Valium) to be very effective for moderate blue days, its an anti anxiety and muscle relaxant and can be very effective for sleep as well and the best thing about Diazepam is its been around a long time and is easily prescribeable and generic and thus cheap and its also safe with Lithium which helps.
And the best thing about it is you can take it and still function normally - ive used it before meetings and when under high stress loads and you dont feel zonked out if you watch the dose ( I take 10mg normally and 20mg when im very anxious - 20mg makes me feel sedated, 30 puts me to sleep) and its also very very effective for racing thoughts if you get them - i take it sometimes at night when I cant quiten my head and it calms me and I sleep - i find it more effective than Temazepam for sleep to be honest.
It might not hurt to get your doc to give you a script and see if it helps you - its worth discussing with him anyway and its cheap so if it does not do the job you have not lost anything in the process.
Hi, Here in the Uk our healthcare system is similar to yours monkeyc. Many wrinkles to be ironed out but nonetheless its there for everyone regardless of financial status.
I see you mentioned diazepam - this is a drug that is not readily prescribed here in the UK as it is considred a dependency risk. If you are lucky enough to get it you will only be prescribed a mere weeks supply. Anything remotely linked to valium seems to have big red flashing warnings on it. However, if you are a recovering drug addict they throw the stuff at you -
It is interesting to see how different countries prescribe and treat mental illness.
I am grateful to our National Health Service, I know that if i was to be transplanted into the USA in my current financial situation I would be a gonna. There are times however when the system does let you down, ie, lack of choice of care providers - in other words you get who you're given.
The Mental Health system in the US is lacking greatly, it is missing too many people in need of care. Not to mention the Medical Care System as a whole. There is too much red tape for care and not even enough psychiatrists and psychologists to go around. There aren't enough psych beds in the units and you screwed if your kid, where I live they sometimes have to send you 250miles away for the first available bed and you sit in the ER sometimes 2 or 3 days before one of those come available. IT REALLY REALLY BITES......The waiting time for the only Pediatric/Adolescent Psychiatrist in my area is 3 to 4 months. (when he is taking new patients)
Diazepam here suffers from that in some ways too, its seen as massively addictive which is a joke as its not and its a safe drug.
The hilarious, sickening and stupid thing we see here is the sheer volume of Ritalin, Prozac and Zoloft being handed out like lollies to people as if they were totally safe. Then again Rohypnol was available easily here long after it got its reputation as a date rape drug.
Its getting almost impossible to buy Psuedoephedrine as well because it may be used to make amphetamines and meanwhile speed and meth are cheap and easy to find and last i read a hit of heroin was about $10-15 in pretty much any city.
Valium has such a bad rep and the wierd thing is varies from doc to doc - even the information on the web says its addictive in as little as a week (its not) .
Sad thing is its so well know that is safe and so usefull..
Oh on the system - you dont get a great choice in health care providers in the hospitals you get what you get but they are normally decent docs.
In the private way it is subsidised on what we call a mental health plan which is on a referral from a General Doc and means 10 visits at a heavy subsidy which = $25AU a visit and you can go back as many times as you want for a referral.
Choice isnt always there either
Our systems have waiting lists as well and the previous govt did major damage to the system by removing compulsory bulk billing (which means free) from all but pensioners and people on health care carss (students, unemployed, disabled) which means GP's can charge what they can get away with
But in the whole the treatment you get in hospitals, at least in Brisbane where I live, is of an excellent standard - As I said ive had 2 times where I would be dead if it wasnt and ive had 6 hospitalisations and 1 major surgery in 18 months and could not make a single complaint about the quality of care, nurses or doctors. The killer is my bowel resection and fistula repair I had to wait 3months for (because of a computer screwup believe it or not) but the whole op, surgeons, 7 days hospital, follow ups, CT scans and everything cost me a total of $12.50 which was a script for painkillers on the way home.
I have no idea what that would cost in the USA, I shudder to think.
Mind you mental health isnt perfect here, the number of inpatient and long term care beds has shrunk due to cutbacks and policies of returning the mentally ill to the home on some idea of its better for them (cheaper one suspect for the govt) and there are never enough beds in mental wards
Somehow 99% of the time it works and its taxpayer funded. You would think a country the size of the US could do it even better.
I work for a state funded children's hospital, we do not even have inpatient psych. My daughters first hospitalization for mental health was in a hospital 250 miles from home. The total stay was about 500dollars, and that is with two insurances. Her 2nd and 3rd stay were out of state about 70miles from home, with a total of actually less than the first stay. Lets not go into the three hospitalization not related to mental health which the bills haven't started trickling in yet. Her new psychologist is 50dollars a visit after insurance, because they are out of network.
I could go on for months..... and I am a health care provider.....
I would honestly stay away from SSRI's altogether because they can induce mania, which happened to me, as well the cost is outrageous even if you do have prescription coverage. Mood stabilizers like Lamictal which I am on do the same thing, faster, cheaper and less side effects. I am also on 50mgs of Serequal 3 x a day as well for the hypomania . I just had Lithium added(150mgs) until they have titrated a higher dose of Lamacti(50 mgs)l in my system. I'm still bottoming out at times even on drugs. I was told that Lithium isn't the first drug they consider, but I have been acutely suicidal even on mood stabilizers, so they are augmenting my drug therapy with Lithium temporarily. I don't want to go back into the hospital, so normally I wouldn't think about the Lithium, but I am desperate at this point. I even brought up ECT with my pdoc, she said that would be something to consider if all other drugs fail or I become acutely suicidal for days. I have learned a lot about these drugs, and I am very glad to be off ssri's. I hope this helps, this is just my experience.
ps. I'm in Canada, and thank god in BC we have fair pharmacare or I would be paying for drugs and not eating. We also have something called plan G if someone is really low income.
We don't do SSRI's they caused Sky to cycle like a mad man (pardon the pun) and happen to cause at least one suicide attempt. She is on Lithium 900mg AM/600mgPM, Lamictal 150mg and Geodon 40mg. We are weaning the Lamictal and stabilizing with the Geodon. She was on the Lamictal for about 10 months and started having psychosis about 6 weeks ago, she sees things move that aren't moving. The Geodon hasn't helped alot but her mood has stabilized alot.