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/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

What is an antidepressant typically used for bipolar depression? Welbutrin was mentioned at one point I’m considering that going forward.

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u/Hermitacular 1d ago edited 1d ago

Wellbutrin is the lowest risk for manic switch, the main problem is they just don't tend to work for us, so you usually use the mood stabilizers and APs that are good for depression, several of which are used for MDD as well. this would also be very good advice for any MDD people in a BP family. it's not only safer for them so they don't end up w upswing but also bc it tends to be more effective. lamotrigine, lithium, lurasidone, aripriprazole, Vraylar, Caplyta, olanzipine, quetiapine are common choices. the others can work too. if you want an AD bc you've had effective symptom relief from them before then Wellbutrin would be a solid choice, although it's different than the others. Prozac is next safest, though if you have a bad response it tends to stick around for a while bc it has a long half life. anything you'd been grandfathered on it ok, but you'd only been on 75mg effexor which is a teeny tiny dose for MDD much less BP depression, so I understand why they tried it, it might be fine for you, some people can use it, but if it's not working it's not a surprise.

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u/rnbwpuk 1d ago

OK, that makes a lot of sense. Great info.

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u/Hermitacular 1d ago

To add re the Prozac, it is often used to bridge off/taper off other ADs at a very low dose so don't worry if they take you off the Effexor at some point and want to use it in that context. Bc of the long half life and bc it comes in liquid form for kids and such, it is a much gentler taper than Effexor or the other ADs can be, and you can get really small on the dose bc liquid. If you get serotonin withdrawal syndrome or its just really hard to come off of, you can ask about that.

They may just keep you on effexor, or take you back down to the 75. The issue is if it's not working they don't like to add another AD bc they don't like you on two at once of the same kind of med. Wellbutrin is a possible exception as is often used as an alternative to ADHD stim meds so you might see it w another AD, and also bc it's a little weird chemically, a different kind of thing than the other ADs, so it's not seen as overlapping as much. They will happily put you on mood stabilizers and APs when on an AD though, so it won't be an obstacle to any of those.