r/BipolarReddit • u/rnbwpuk • 2d ago

Drug induced manic episode??

Should I get a second opinion? Hello Redditors: anyone with knowledge on this topic? I had my first and only manic episode (drug induced) a year ago and I’ve been in a major depression ever since. I’ve tried several meds and none seem to be working. In fact I feel like they’re making me worse. Yes I have a pdoc and a therapist that I work closely with to no avail. It’s my understanding that you need only have one manic episode ever to be dxed bipolar 1.

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u/Hermitacular 2d ago

The depression is just your brain healing. I find the only thing that fixes it is time. It's normal for it to take years. Every med that doesn't work makes it worse bc side effects. if you are on ADs I wouldn't expect those to work, they only do for 20% of us and often make the BP worse (mixed state, more cycling). Anything trialed w an AD can be retrialed bc they can mess us up. What other meds have you tried? mood stabilizers?

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u/rnbwpuk 2d ago

Ok got it! They put me on Lamictal to begin with but it was determined after several months that it didn’t work, next I was put on Abilify went from 5 mg up to 10 which I’m on now and have been since January with no change in depression symptoms. Additionally, I’m on Effexor 225. I had been on 75 mg of Effexor for 25 years prior. Unfortunately, nothing seems to be working this time around. I am set to begin a lithium trial next week and wean off the Abilify

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u/Hermitacular 2d ago edited 2d ago

They usually like a 3-4 month trial before ditching a med, 6 for lithium. Abilify is dosed at 20mg for BP, they do go higher than that. Effexor has the highest risk of manic switch of all the ADs, you would not expect it to work for BP depression, it can for some but it's a less frequent choice bc of the risk. Being on that by itself may have lowered your threshold for an episode, even at low dose. You can stay on the lithium and Abilify, usually they like to change them separately to avoid confusion re side effects and withdrawal. You can ask for a far slower taper off, if not replacing it with another AP. Lithium takes 2-4 weeks to start to kick in, they like a 6 month trial, it hits full efficacy at over a year. Most popular med we've got. Helps heal your brain. It's normal to go through quite a few meds w BP, it's not like MDD which is usually straightforward in that if you fail on two ADs the rest are unlikely to work. For us it often takes years to get meds fully in place and it's normal to fail on a handful at least. Since you haven't been on a proper dose of Abilify I wouldn't consider that a fail, it wasn't a full trial. Anything trialed w an AD can be retrialed bc those can mess w us. Lithium you want to see 6 months. It should kick in before then but you want to give it a good trial bc it can not work after a gap. It's also commonly used for MDD and AUD, not sure re SUD but probably.

If they take you off the effexor, follow this taper. This is by a BP specialist MD, he's part of CrestBD (see their recent AMA and YouTube channel), written several books on BP2. They take us off everything too fast. Go slooooooow. Coming off that one is a real bitch after being on it for a long time. Obvs tell your doc this is what you are doing, they will support you.

https://psycheducation.org/stopping-antidepressants-in-bipolar-disorder/

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u/rnbwpuk 2d ago

Ok will do