Bipolar has as spectrum??

I am diagnosed recently by a psychiatrist who said anti-depressants are no good for those with bipolar. my manics dont go for weeks thank goodness my arthritis couldn't handle it.

@tisme - you brought up some interesting points, and I'm wondering if you could explain a bit more.

Do you know why your psychiatrist feels antidepressants are no good for those with bipolar?

When you have manic episodes, how do those interact with your arthritis?

@lisalucier If memory serves she said something about it doesnt deal with that type of depression. as for the arthritis, when I peel vegies my fingers cramp ( ive cut myself a few times last time needed antibiotics due to infection getting in ) my hands wont grip bottles etc and the base of my palms hurt when I put them down on anything, the hips suddenly make me limp when I walk , my toes cramp up I cant go down on my knees , a lot of other issues are pain. Im a wreck and need a re build.

I was told a rash can happen on any anti-seizure/mood stabilizer med. Take it slow. I itched twice on Lamotrigine; Benadryl made it go away.

@tisme ADs work just fine for some with bipolar. I wish they did for me. I tried Lexapro and Pristiq; both made me more depressed and rapid cycle. My psych said some bipolar patients can take ADs and some can't.

@lisalucier treatment emergent affective switch is the reason that antidepressants are not first line therapies for those with bipolar disorder. Basically there is a risk of inducing mania or accelerating cycling between mood states. Some antidepressants carry a larger risk than others. It won’t happen with every person who has bipolar, but the risk is real, which is why many psychiatrists steer clear unless many other options have failed.

@ashleyharris728 I had a life threatening reaction to Effexor. It sent me spiraling downward and I had a near miss and went to the hospital as a result. Most patients on it don't experience what I did. But it can happen and I think there needs to be more awareness of this. Also, the sheer number of people reporting struggles withdrawing from it here and elsewhere, a process that for some can take a year or more and sometimes ends in failure to stop taking it, indicates to me that it needs to be reexamined in studies far more intensively than it has been so far. I was fortunate to be able to get off of it quite quickly. But a lot of people aren't that lucky. It was initially prescribed by my general physician before the bipolar diagnosis, and I question whether it might be better to restrict its use for treatment to psychiatrists alone. I also think patients should be fully advised on the potential difficulties of getting off of it before a prescription is given. I wasn't. If I had known, I might have declined starting it in the first place.

@lisalucier I found a couple of studies cautioning against prescribing antidepressants to bipolar patients. Especially Effexor, the one I was on. One was on NIH, and the other BMJ. So they were peer reviewed. Unfortunately I didn't bookmark them and haven't been able to relocate them. But my psychiatrist was aware of them. I was actually the one who brought them to her and said "This describes the last few years of my life. Almost to a T."

I'd only begun to see her after a then recent bipolar diagnosis. I'd previously been prescribed the medication by my general provider. She told me she hadn't seen the reaction previously in her practice, but after seeing the change in me after getting off of it, fully agreed that I had been hijacked by it. She said she's now using what she saw in me before I stopped taking it as a reference point so that if she sees a similar response, she can hopefully catch it. So there's evidence.

Psychiatry is the most difficult of all medical fields, and I told her I feel no resentment over her initially missing what was going on (it was within just a few months after I began seeing her that it was discovered). She switched me to Lamotrigine, and after a lifetime of several depressive cycles a year that had become nonstop and had reached the dangerous level by the end, I've had absolutely none for the last two. So I'm confident the new medication is working. I suspect I'm one of her favorite patients since on my quarterly visits I now arrive in a cheerful mood every time.

I've also stuck with counseling. That's been a lifesaver as well, and have no present plans to call it good and quit.

@depressedbutnotdead - was this perhaps one of the publications you found? I found it on the National Institutes of Health site, but then I went to the full publication, which is The Primary
Care Companion for CNS Disorders, which appears to be published by Psychiatrist.com.

- Review of Evidence for Use of Antidepressants in Bipolar Depression https://www.psychiatrist.com/pcc/review-evidence-antidepressants-bipolar-depression/

@lisalucier everyone! Watch out for pain meds too! Many, especially opioids, have an antidepressant quality that can set off cycling. Was put on a patch that made me start a manic swing, called my clinic and pharmacist right away. (After 10 years on Lithium for BP2 over 20 years ago, I’m sooooo careful when prescribed a new drug for any reason. Often not even picking up at pharmacy. Thank God my self awareness is always in check