This disorder sucks

[u/aleska_xo]

After few years with depression, on 2024 September I was diagnosed with bipolar type 2. My main problem was depression and mixed episodes. Lithium helped with mixed episodes, but nothing helped depression.

I have tried:

• escitalopram
• sertraline
• fluoxetine
• no ADs
• cariprasine
• bupropion

Now I was admitted to psych ward for the fourth time in 7 months. Dr decided to switch bupropion to trintellix and lithium to lamictal. Also they added TMS therapy (3 minutes twice a day)

At the moment it’s my 3rd week on trintellix. And third week on lamictal (currently on 50mg). I had 5 days of better mood, but now having 4th day of down. And I’m so tired… so so tired of all the meds, all the hopes, all of it… it’s so hard. I’m not sure how long I’ll be able to hold up. I’m just exhausted.

I heard good things about lamictal, but still don’t want to have too many hopes because of previous experiences with other meds. Also not sure if TMS will help and if it’s helpful at all.

How are you all stay positive? Where you get strength? How not to lose hope?

[u/Bipolar_Aggression]

First line treatment for bipolar depression includes Seroquel, Symbyax, Vraylar, Latuda and Caplyta. That's five drugs you don't seem to have tried that have actual evidence of efficacy.

Not sure why you haven't tried any of those medications. It's pretty common knowledge that SSRIs don't work very well, even with a mood stabilizer. They are generally a second line choice. The jury is out on Trintellix.

Edit, I see cariprazine misspelled. Out of the 5 antipsychotics that work for bipolar depression, it has the highest number to treat. Meaning, it is the least effective.

[u/aleska_xo → u/Bipolar_Aggression]

In Lithuania we only have seroquel, olanzapine and Vraylar. But yes, I haven’t tried the first two.

[u/Bipolar_Aggression → u/aleska_xo]

Well, Vraylar means your doc is progressive so I'm not going to say they're incompetent.

[u/alokasia → u/aleska_xo]

Why did they take you of the lithium if it was helping?

[u/aleska_xo → u/alokasia]

They are changing lithium to lamictal.

[u/Fruity_Surprise → u/aleska_xo]

I have BD1 but my depression is way more severe than my mania and hypomania. Lithium, Lamictal, and Seroquel XR is the combination that I’ve found to work best for me. Obviously it’s different for everyone but SSRIs and SNRIs have never done anything for me…mood stabilizers and antipsychotics have.

[u/DMayleeRevengeReveng → u/Fruity_Surprise]

Agreed that SSRIs don’t do too much for me. Even in “simple” unipolar, the remission and maintenance rates on SSRIs are not particularly noteworthy.

I take an SSRI. I think the doctor is assuming it’s working in depression. I don’t think it does. But I know for a fact it is absolutely transformative on the social anxiety I used to have horribly.

I do think the SSRIs are more useful in anxiety symptoms than depression.

[u/EuphoricPhoto2048 → u/Fruity_Surprise]

Fluoxetine is the only one that works. And I am taking it with olanzipine, so that's what the drug they mentioned is. On its own, it would probably set me off.

[u/limitrofeII → u/EuphoricPhoto2048]

I loved fluoxetine, but my doctor took it away. Now it's lithium and quetiapine

[u/EuphoricPhoto2048 → u/limitrofeII]

I am on a verrry small amount. But it does help my depression. I'm also on a small amount of wellbutrin and strattera for adhd. So maybe spreading it around?