I’ve been on medication combinations for bipolar 2, mood stabilizers/antipsychotics such as Abilify, seroquel, and lamictal— and antidepressants, such as Wellbutrin (made me manic & more irritable), Zoloft, and prozac.
I took abilify for about a year or two and I had a crazy amount of weight gain (40 lbs in a year & a half) which is very unlike me. My weight has always fluctuated but only by 10 lbs max. Also, i noticed that I felt foggy brained on Abilify and could no longer social as well even with my close friends. I felt like my brain was empty. No thoughts.
I stopped taking seroquel because it would make me fall asleep sooo fast and i think it may have made me feel drowsy in the morning, i can’t fully remember since it was over 2 years ago.
I took Lamictal originally three years ago (in a combination of other meds i can’t remember) and i stopped because i thought i may have had the allergic reaction rash. After I gave up on the abilify due to weight gain I started taking Lamictal again in hopes that it was possibly eczema and my psych put me on 25MG to see if that had any adverse reactions. I’ve been doing that for nearly a year, with a combination of Adderall & gabapentin.
Last week my new provider upped me to 100MG Lamictal and added 10MG lexapro. I’m still on 100mg gabapentin 3x a day for anxiety and 20mg xr adderall for ADHD. I haven’t had any hypomania since being consistent with Lamictal although I’ve had a crazy increase of anxiety with the last two years and chronic depression after drinking alcohol. Anxiety may be related to the fact i was a habitual weed smoker and stopped in those last two years.
Essentially, does anyone have any recommendations of medication(s) that work well in substitute of Lamictal? The weight gain from Abilify really affected my self image and I’ve been able to lose 25 of the 40lbs gain so I’d like to stray away from medication that causes weight gain & brings down my usually lively personality.
Thanks!

My doctor has me going off of Lamictal because of the cognitive issues and I worried about the depression becoming unbearable as I reduce. Has anyone had their doctor simultaneously introduce another medication for the substitute the Lamictal?

I have bipolar 2 and have been on lamictal (300) for about 20 years. (I am 61 and i am currently Wellbutrin, Lamictal, Buspar and .5 clonazapam at night)
I have gone from forgetful over past 20 years to REALLY struggling in the last month. Yes, there has been a lot of stress and lack of sleep over this year but this seems VERY dramatic to the finding things in very strange locations with no memory of it. Naturally i am worried about Alzheimer's since my mother died of it and signs showed in her mid 60s. I have a full neuro work up on Monday and I am about to get some testing for Alzheimer's in a trial (by chance i was picked last month after being in DB for years!)
I think the issue is probably lamictal though, I tend to have almost IDENTICAL issues to my late dad's side (Dad had drug resistant depression AND his brother, bipolar 1, had dementia like issues with lamictal)
OK, assuming neuro/trial testing finds nothing significant, and the culprit is lamictal, has anyone gone off of lamictal and found an alternative? One that doesn't impair cognitively?
​

I acknowledge that any comment doesn’t substitute a medical professional, psychiatrist, or health-care personnel; I’m not looking for medical advice here but more of a personal experience; based on your experience, what's a good drug that addresses hypomania? I'm a medical student, and I find the racing thoughts to be really annoying and distracting. I have had it since I was 18 years old, and now I'm 30 years old. I have been treated for depression, anxiety, and ADHD. But my racing thoughts are consistent, and they are random, not necessarily anxious. So, when I looked at the DSM, I found that I meet the criteria for ADHD, Social Anxiety, and Cyclothymia. I've always been an A student. But when I was 18, I was under stress to perform high to get a scholarship, and I was crying almost every day. However, my academic performance was very high, and I didn't have problems with studying and enjoyed it. Then, before the finals, when I started studying for the exam, I started having this racing thought. I could not memorize things like before (I used to have a perfect memory of learning the material words to words), but while preparing for the finals, I started feeling that I was not retaining what I was reading. I go back over and over to read it, and sometimes, I feel like I'm not recognizing what I'm reading (like an aphasia). My personality changed overall; I became socially sensitive, not happy, and Impulsive. Studying becomes very stressful for me, and to be able to study, I have to read very fast or move my finger excessively on the touch mouse the whole time studying. Also, I developed hypersexuality, and I got into a few troubles. I felt the psychiatrist was missing something, and then I read about cyclothymia, and I think it made sense to me.
My goal is to have a calm mind and, at the same time, be able to study and function normally without being sedated. I think if I get a medication with a low profile of side effects, especially metabolic side effects, sedative, and extrapyramidal side effects for extended maintenance, I will be thankful. I take Lamictal 150, Escitalopram 10mg, and Adderall 20mg. I know that Lamictal has been approved for maintenance treatment. However, my racing thoughts are still there, and I find them distracting and do not make me feel normal. I looked up a few RCT and metanalysis, and most of them concluded that Lamictal is not adequate for hypomania/mania. So I was thinking if I add a medication that addresses that aspect, I will be able to feel normal like I was before I started having this problem. Based on your personal experience or If someone might know if there is something else other than hypomania/ mania that is causing these racing thoughts (Also, I wanted to clarify that these racing thought I had these before using any medication to exclude drug-induced hypomania/mania)

Hello everyone - I hope everyone is having a lovely day so far.
I restarted some of my psychiatric medications around two weeks ago following a complete cessation of administration due to my prior drug regimen inducing serotonin syndrome, for which I was briefly hospitalized.
Following medication stoppage, my bipolar II symptoms came roaring back, and I subsequently restarted two of the prior medications I was taking.
These events have led me to reflect on my journey with prescription medications for the treatment of Bipolar disorder, as well as other mental health issues that my psychiatric nurse practitioner prescribed and recommended medication for.
Prescription medications taken prior to Bipolar II diagnosis:
Escitalopram - 20 mg for about a year (for what was thought to be for depression)
Bupropion XL 150 mg for four days (also for depression; instead, medication triggered first episode of dysphoric hypomania, leading to Bipolar diagnosis)
Prescription medications taken since Bipolar II diagnosis:
Lithium Carbonate - 150 mg twice a day, used for a couple weeks at a time in and off for first year of diagnosis.
Lithium Carbonate ER - 450 mg twice a day, used as needed for acute dysphoric hypomania and immediate suicidal ideation. (Hasn't been used for this purpose for at least a couple years)
First successful drug cocktail (regimen):
Lamotrigine - 200 mg once a day for mood stabilization
Fluvoxamine - 300 mg split over two doses throughout the day for obsessive compulsive disorder and anxiety/latent depression
Quetiapine - 300 mg once nightly for manic depression and dysphoric hypomania
This cocktail was used successfully for about a year, until quetiapine had to be ceased due to weight gain.
My PNP and myself worked though a host of medications in order to seek a replacement, and much trial and error was undertaken.
Medications that were substituted for quetiapine include:
Oxcarbazapine - anticonvulsant mood stabilizer (stopped due to itchy rashes appearing on body)
Atypical Antipsychotics:
Aripiprazole
Lurasidone
Cariprazine
Finally, we arrived on Lumateperone, which has not had significant side effects, or at least any that I notice. Therefore, I kept taking lamotrigine and fluvoxamine, and ultimately replaced quetiapine with lumateperone.
This cocktail was working, and soon Adderall was added to address ADHD. I think it is here where mistakes were made. Based on discussions with my PNP, as well as information from drug interaction checkers, it appears that the combination of Adderall and Fluvoxamine enhanced each others' serotonergic effects, inducing serotonin syndrome.
Following my hospitalization, I have restarted both lamotrigine and lumateperone, and currently at 50mg and 42 mg respectively.
I have also replaced fluvoxamine with sertraline for my OCD; hopefully, I will experience less interaction risk with this SSRI.
So, current cocktail as of today is as follows:
Lamotrigine (Lamictal) - 50 mg daily for mood stabilization (aiming to be on 200 mg maintenance dose)
Lumateperone (Caplyta) - 42 mg daily for manic depression and dysphoric hypomania
Sertraline (Zoloft) - 25 mg daily for OCD/anxiety and latent depression (aiming for at least 200 mg maintenance dose)
N-acetylcysteine (NAC) - 600 mg daily for OCD
Propranolol - 40 mg as needed for anxiety
The adderall was did appear too effectively treat my ADHD, so it is a little disappointing to no longer have this tool in my kit, but alas.
In finality: This is my present drug history and cocktail used to treat my mental health conditions.
What prescription medications have you used in the past for treatment, and what is your present drug "cocktail" you use currently to keep your symptoms in remission?

So, I had horrible Post Partum Depression. It took 9 months of trial and error, but we landed on Lamictal and I've been doing well for the past 7 months.
I am suspicious that my body does not process Vitamin D supplements well for some reason, but not sure why. Everyone's body is different, right?
Anyways, I hadn't taken Vitamin D since starting Lamictal, and I'm still just not sure it's possible or just a coincidence that I'm always depressed when I take it. Not sure it can truly trigger depression when so many testimonials say it helps. So, I started taking it just 3 weeks ago and my anxiety has been ridiculously high and feeling crummy and almost depressed like again. Not fully drowning in depression, but don't feel quite as motivated and like myself. I know something is off.
I just read that Lamictal can lower calcium levels, and I already don't have many sources of calcium in my diet due to being dairy free and not drinking milk substitutes.
Has anyone experienced horrible mood due to vitamin D supplements?

30 y/o male, 6ft/185cm, 170lbs/77kg. I had a late thanksgiving on Saturday evening, my friend cooked "guineafowl" which is like the European substitute for turkey.
He air fryed it according to the recipe and showed between 75-80 Celcius / 167 Fahrenheit on internal temp with a needle, but when we cut and started eating, there were parts that looked and tasted cooked, but tasted slightly cold/room temperature. We thought maybe it sat out and cooled down a bit and went on eating.
I was a bit nervous but seemed fine, but this evening it was a bit difficult on the stool, and it was difficult to urinate (fine at first, then a few bits every 20 seconds) , and I had mucus in my urine which I've never seen before. That's what concerned me.
Now, I do take fiber pills and if I haven't eaten much, I do tend to have hard solid stools to push at the end of the day, but the urine mucus has me worried given the timing (almsot exactly 72 hours since eating it that I got the mucus in urine).
Haven't asked any of the others I ate with yet. I feel fine otherwise.
Meds and supplements: 400mg lamictal nightly, 5 to 10mg theralene nightly, 54mg concerta every morning. 1 psyllium fiber pill every night, can't find the dosage but it's a standard daily supplement from the pharmacy.
Heavy tobacco user (30 cigarettes a day), moderate drinking (3-4 times a month), no recreational drug use.
Edit: no other known health conditions other than the depression, sleep issues, and ADHD take my meds for. Family has a history of diabetes and some cancer, just had a total checkup and bloodwork last month and doc said everything was fine.

I understand any advise given is not a substitute for professsional advise.
I recently started lamictal 3 weeks ago and was on just 75mg until yesterday. My 100mgs are in the mail and should (fingers crossed) be here in 2-3 days. The problem is - I ran out. I have 1 25mg this morning and that's it until the new supply arrives. Realistically, anything I can do to minimize withdrawl side effects for a couple days to get through? Sudden withdrawl from zoloft in the past almost put me in the grave mentally. We have multiple social-heavy events this weekend so I can't be a cave troll like I'd prefer. It's the weekend and I can't get in touch with my doctor for a temporary fill locally. I'm on multiple daily meds for depression and anxiety, and other conditions. My current med list:
Desvenlafaxine 150mg QD Buspirone 15mg TID Rexulti prn (I took for 2 weeks, stopped last week, and now have a prn supply) Clonazepam 0.5mg prn (I've been taking 1-2 daily for the last 3 weeks, up from 1-2 a month) High dose Omega-3 supplement Propranolol ER 120mg QD Omeprazole 40mg QD Losartan 25mg QD Rosuvastatin 20mg QD L-thyroxine 125mcg QD Pregabalin 100mg BID Ozempic 2mg/3mg Qweek Modafinil 200mg prn Multivitamin
I recently stopped marijuana 3 weeks ago (Heavy use, but legally recreational) and need to not resume. Recreational Psilocybin is legal in my area and readily available. I'm temporarily using a nicotine vape due to an accidental purchase but do not regularly use nicotine products. I don't routinely use alcohol (maybe 1-2 beers or shots a month)
We are going through an exceptionally difficult time (husband lost job, dog of 14years died (my unofficial emotional support animal), I'm about to leave my job over mismanagement of a sexual harrasment complaint against a co-worker.) So any advise to keep my head above water would be appreciated.
Hugs to everyone struggling out there, and thank you in advance for any advise.

HEY GUYS..CAN I SUBSTITUTE LAMICTAL 100MG WITH LAMITOR DT 100MG??LAMICTAL IS SCARCE AND TOO EXPENSIVE FOR ME NOW.PLEASE HELP!!

HEY GUYS..CAN I SUBSTITUTE LAMICTAL 100MG WITH LAMITOR DT 100MG??LAMICTAL IS SCARCE AND TOO EXPENSIVE FOR ME NOW.PLEASE HELP !!

HEY GUYS..CAN I SUBSTITUTE LAMICTAL 100MG WITH LAMITOR DT 100MG??LAMICTAL IS SCARCE AND TOO EXPENSIVE FOR ME NOW.PLEASE HELP!!

I was such a smart kid. “Gifted,” if you will. School was easy for me and I was pretty happy and carefree. I had a good childhood.
When I was 16 I started dating my “high school sweetheart” which turned into an awful, toxic, emotionally abusive five years that did a lot of damage to me and I’m still working through a lot of it (I’m 30). When I started college, I started having a really hard time focusing. School got real hard real fast. I couldn’t even focus on conversations I was interested in, it was bad.
And then came the depression. It was seasonal at first. Then my boyfriend and I broke up I stopped the pill and developed PMDD and just awful hormonal problems so my mood began to worsen and become less stable all the time.
When I graduated, I wanted to teach. So I began studying for that (I needed some more credits as it wasn’t my major), and substitute teaching. Did some long-term stints and realized I couldn’t handle teaching in public school. The stress was astronomical, and I disagree with so much of the way things are done in American public schools. I’d get fired.
The seasonal nature of my disorder started becoming more pronounced in the spring and summer months when I started getting hypomanic. Took a few years to realize there was a pattern. And of course things have just worsened since.
I moved and got a job in a preschool that was Montessori-adjacent and wanted to get certified to teach in a Montessori school but ended up quitting that job because my boss was stealing from me and tried to get me to get a coworker fired. I nannied for a while and went back and forth between that and waitressing and just never found that passion again.
I was single for 7 years and because of my social anxiety and generally fucked up brain I spent a lot of time alone. Things are easier alone. No chance of conflict.
I got with my partner three years ago and he is wonderful. I had a very hard time (psychosis/severe hypomania) about a year into our relationship and decided to try real meds instead of supplements.
I’m now on lamictal, gabapentin, and klonopin. I’m prescribed Ritalin but I hate it and stopped it. The Lamictal especially has made a big difference and probably saved my life. My swings were getting worse and worse. Now they are not nearly as intense.
I’m just lamenting how truly dysfunctional my life is. I can’t stick to any type of routine or meet goals. I can’t pursue something without losing interest within weeks/months. I am broke and in debt and my credit is shit. When I try to work more hours I get really unstable and have lost jobs because I start losing my mind. My dog deserves so much more love and time from me and I just stare at my phone getting more depressed instead. I never call my family even though I love them all because I am ashamed at my life. I’m so disorganized. I’m a mess. Just always.
Bipolar is a disability. I want to start applying for disability because I need some support and I know it’ll take many tries probably. I also haven’t done my taxes in 3 years and I think I need to have that done to apply for disability.
I tried asking my dad for financial advice and I don’t think he understands how hard it has been for me just to keep my head above water, sanity-wise. I don’t want to be poor, and I know I’m smart, but life has changed a lot since my bipolar revealed itself. I don’t plan on letting that govern my life. I just recently realized how important “mood hygiene” is for me. And therapy. And the right medication.
I’m really hopeful that I can turn things around now that I’ve come to terms with how bad it is and how dysfunctional my life is. It’s just such an uphill battle. I feel optimistic and hopeful one day, and completely despondent the next. I’m fucking tired you guys.
Thanks if you read talk that. I needed to get it out. Advice is welcome 🙏♥️

TL:DR I’m currently on Lamictal and it’s not working like we thought it would. We’re adding Risperdal to eventually wean myself off the Lamictal. When weaning myself off Lamictal if there’s no change then we’re done with Lamictal. If there is a change we either A. Stay on it or B. Find a substitute for the Lamictal. (Possibly Lithium, I’m not sure not trying to worry about that yet.)
———
I was recently put on Risperdal last Monday after only seeing a little improvement with my anger and mania while on Lamictal after a year of being on the medication.
I called to make a last minute appointment today to talk more about my anger issues and my lack of ability to control them and wanting to know how we’re moving forward with my medication.
I started 0.5mg of Risperdal last Monday then went to 1mg yesterday. After voicing my concerns on the call today, she immediately noticed an improvement in my overall tone of voice and outlook on life after only 9 days! That made me so happy as I was somewhat crying on the call explaining everything I was worried about. 🥲
———
Well long story short, she explained to me what she wanted to do all along after explaining everything.
She wants to work me up to a healthy manageable dosage of Risperdal where I’ll be able to control myself unlike on Lamictal - then work me off of the Lamictal as it doesn’t seem to be doing much and I have my Wellbutrin to counteract my depression for now. (She doesn’t know if she wants to take me off of Lamictal completely or try a new medicine while lowering the dosage of Lamictal - unless there is no change when weaning off the Lamictal.)
I brought up Lithium after that as I read a lot about it and see so many success stories from it and she kinda cut me off and was like, “Let’s not do too much at once because I want to know what’s happening and able to easily track down a problem if it arises. It’s going to take time but with what I’m currently seeing I’m happy with where we’re going. We’re gonna be meeting up very often during this time frame so if something happens I know what happened and how to address it.”
So when I start weaning off Lamictal here soon and if it causes some problems I feel like Lithium might be an alternative to Lamictal. (I’m not speaking for her though, just my thought, but that’s what I would like to try if weaning off Lamictal causes issues. Or if it’s actually working then maybe I do stay on it.)
I’m just happy to finally start feeling a little better mentally because I’m so tired of my life being torn apart by the inability to control my bipolar. 🥲
———
Bipolar used to be an excuse for me…
I’m trying to not make it one anymore!
I’ve had my fair share of challenges but I’m gonna work through them to become the change I want to see in the world! 😊

I was dx with Cyclo nearly three years ago and have been under the care of a psychiatrist since that time. I love my psych and value her opinion; however, I've recently begun wondering if I'm on too many meds given the milder aspects of Cyclo vs. BD. Not to disparage those who are Bipolar I or II, by any means, but my psych even refers to it as "Bipolar Lite."
Here is the list of my current meds: Lamictal 150mg, Lithium 300mg, Cymbalta 20mg, and Seroquel 50mg, along with Melatonin 20mg OTC, and various meds for other health issues. Which leads to my question: Is the array of meds I take excessive based on my diagnosis?
I know you all are not a substitute for my own doc. I'm just curious if others with Cyclo are on similar med regimens. Thanks!

I wanted to make this post because I promised myself that if I ever recovered, I would make a post. I remember scrolling through this subreddit when I felt the brain fog, emotional blunting, metabolic crash, exhaustion, hair loss/skin dryness, and of course the sexual dysfunction that was PSSD. I remember what it felt like to tell other people and have no one understand, so I want to pay it forward.
The med that did it: Buspar (buspirone). It's not a common offender for PSSD, but I remember reading that at high levels, it acts similarly to an SSRI. I am a small woman (5'1", 154cm), and I was brought from 0mg (and never took any med in the past) to the max dosage of 60mg in four months. I didn't react well to it, was told by my psychiatrist that I could cold turkey it. I took myself off SUPER fast and crashed. I'm sure the speed at which I was brought up and down played a huge role in what happened after. Perhaps it could have been avoided had I never been on such a high dose.
PSSD period/details: Everything that you could find on this subreddit (symptom-wise) I remember having. My hair was thinning and becoming brittle, my skin looked aged and dried out, I had zero sexual drive or function, no emotions at all, and my brain was dead. Everything had lost its flavor - I didn't care for food (even tho I did eat lol), and I stopped listening to music (and I am trained in classical music). I felt like I was staring at a wall all hours of the day. Early on in withdrawal, I probably did spend multiple hours a day doing that. I couldn't comprehend or do most basic tasks, and I remember starting a job (at a clinic) and being so frustrated that I kept screwing up things that would have come naturally to me before. I actually was unable to hold down two jobs before that one (both due to PSSD). Honestly, I felt like giving up on life, and I did for a while.
My family + another psychiatrist assumed this was caused by depression, and I was started on Lamictal (don't ask me why this was the drug of choice). Lamictal made me angry beyond belief and gave me a painful red rash (I know the Lamictal risk, not sure why the psychiatrist didn't listen). I spent ~3 months on that before realizing that I was constantly having fits of rage, and tapered off of it almost a year ago (and chilled out after lol). The time I spent on lamictal is included in the ~2 year recovery period.
What helped the recovery: I know this is not what anyone wants to hear, but time was the biggest factor. I remember being so irritated whenever I saw a recovery post on here mentioning time, but there is no substitute. I realize I am lucky because people deal with this for far longer than 2 years, and some subredditors believe anything less than 2 years is just a very protracted withdrawal.
I will say that once I began taking DHA fish oil I noticed considerable improvements in brain clarity and thinking. Some people have tried DHA and fish oil supplements and have not seen any results. Who knows, it could just be that time was what healed and the DHA was coincidental, but DHA seemed to work wonders for me when every other supplement did almost nothing. I continue taking it to this day. Additionally, my hair has grown back to full thickness, and my skin looks more normal now. I have been taking a super high dose of biotin, which did not take effect until very recently (3 months in).
What else: Focus on something, anything else. It really sucks to hear this, but it's important to do things until time passes. The time will pass either way, and it will not come back. I was in a set of unideal life circumstances when I had PSSD (as most of us are), and being in an unhappy place made me wanna apply to things (jobs, school) and get my life moving, even though I couldn't enjoy things or feel motivated. Moving my life forward during that time laid a foundation that I'm able to enjoy today. But I will also say I had a period immediately after the crash where I sat and stared at the wall.
I would not assume whether you will or won't get better (I told myself I wouldn't), because your mind will get stuck there. I kept asking myself during my PSSD period if I wanted to leave this earth, knowing I hadn't done at least the best I could, even in my stunted/blunted state. Again, I wanted desperately to be anywhere but what I was.
I'm currently in a Master's program and will interview at the medical school linked to this program in the fall. No, I am not interested in psychiatry, but I will consider doing research on psychiatric drug withdrawal. I was also in a physically intimate relationship recently. It's hard to say whether things are back at full baseline (although I can say my last partner and I had great physical chemistry), but the improvement is absolutely there.
If you're on this subreddit, I'm so sorry this had to happen to you. Truly the best advice I can give is just to keep your life moving until your body (or mind) decides one day to catch up. The only silver lining in this experience was realizing how to listen to and empathize with patients in a way I hadn't before. Hopefully, this can become a norm, and we won't have to hear cases of PSSD in the future.
Take care and godspeed 🙏 I'm open to PMs also!

I have combined much of the information into one post to make it easier for you to look through everything. Also if you look through the sub look for "Information" posts in yellow and "Resources" in orange.

The Basics

Most Common Antidepressants

• SSRI's - Works on Serotonin
  • Sertraline (Zoloft)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluvoxamine (Luvox)
  • Vilazodone (Viibryd)
  • Vortioxetine (Trintellix)
• SNRI's - Works on Serotonin and Norepinphrine
  • Duloxetine (Cymbalta)
  • Venlafaxine (Effexor)
  • Desvenlafaxine (Pristiq)
  • Levomilnacipran (Fetzima)
• SNDRI's - Works on Serotonin, Norepinephrine, and Dopamine
  • Nefazodone (Serzone)
  • Ansofaxine (Ruoxinlin) --- Available in China, coming to U.S. in 2024
• Atypical/Misc.
  • Bupropion (Wellbutrin) <--- NDRI, works on Norepinephrine and Dopamine
  • Mirtazepine (Remeron)
  • Esketamine (Spravato)
  • Bupropion/Dextromethorphan (Auvelity)
  • Gepirone (Exxua) --- Available in USA in early 2024
  • Zuranolone --- Now Available in USA
  • Trazodone --- Used mostly as a sleep aid
• Tricyclic
  • Amitriptyline (Elavil)
  • Imipramine (Tofranil)
  • Nortriptyline (Pamelor)
  • Clomipramine (Anafranil)
• Meds for Anxiety
  • Gabapentin (Neurontin)
  • Pregabalin (Lyrica)
  • Propranolol
  • Buspirone (BuSpar)
  • Hydroxyzine (Vistaril)
• Mood Stabilizers
  • Lamotrigine (Lamictal)
  • Depakote
  • Lithium
  • Oxcarbazepine (Trileptal)
  • Carbamazepine (Tegretol)
  • Antipsychotics (seroquel, abilify, risperdone, vraylar, rexulti)

What to Expect When Starting Antidepressants
When you are first prescribed antidepressants you are usually started on a low dose as your body needs to adjust to the medication. You usually have more side effects when you first start. These side effects may include, nausea, drowsiness, headache, lower libido, and increase in anxiety to name a few. These will usually subside over the first few weeks. If at any point you have suicidal ideation or thoughts you need to contact your doctor immediately as this is a side effect not to mess with. Also just because you don't have a follow up appointment for a month later if you are having problems call the office up and talk to a nurse.
Antidepressants are not a medication that works immediately. The brain has to adjust to the changes and it reacts rather slowly. You may notice some changes after 2 weeks, but they can also take up to 8 weeks to start working. I say this is the time to give your brain a little help with some lifestyle improvements. Add some regular exercise as studies have shown this to help depression and anxiety. Try improving your diet. Start by removing junk food/drinks. There was a study just done that showed that artificial sweeteners actually increase anxiety. Finally make sure you are getting plenty of sleep. Your brain needs that time to recover from out stressful lives. If after 8 weeks you are not noticing any kind of improvements it is time to contact your doctor about changing your dosage or trying a new medication. Don't be frustrated by this as it is normal for people to have to try a few before finding the one that works best for you.
When you start noticing improvements it usually isn't an overnight event. The changes are gradual and you may not notice it. Sometimes if you journal or rate how you feel it can help. You may start to notice you don't feel so awful or you feel like you want to start doing activities that you had been avoiding. Also make sure to communicate with your doctor how you are doing. You may need to gradually increase your dose to find what is optimal for you.
People often ask how do antidepressants actually work. I came up with a good analogy based on how my doctor explained it. People seemed to like it so you can find it here: https://www.reddit.com/AntidepressantSupport/comments/14bjnrh/explaining_how_antidepressants_work_with_an/
Additional info about Antidepressants

• Wellbutrin can cause an increase in anxiety.
• Trazodone and Mirtazapine both can be used to help with sleep
• If the antidepressant causes insomnia you may want to try taking it in the morning, and if you take it in the morning and you are drowsy try switching it to the evening.
• Even though Trintellix and Viibryd are considered SSRI's they have a different mechanism of action so if other SSRI's don't work for you those two could still help you.

Information Bias on the Internet
When people start looking up antidepressants and want to see how they have worked for other people they find all of these horror stories about terrible side effects. Please remember when someone has a negative experience they are more likely to complain or are looking for help. Look at the number of stories you read and think about the fact that tens of millions of people take antidepressants. The people for whom they are working don't go online to tell people about their experience. They are back to enjoying their life. I have found that drugs.com has a more rounded reviews. Also if you are having anxiety be careful about reading some of the horror stories as all they do is end up increasing your anxiety.
Tapering Antidepressants & Withdrawal
If you ever decide you are going to stop antidepressants it is very important to taper off of them very slowly. The longer you have been on them the slower you want to taper. The reason for this is the brain gets accustomed to the effects of the medication and it expects those effects on neurotransmitters. This causes dependence, not addiction. So if you yank the medication away from the brain it will result in withdrawal which can be awful. You can experience nausea, dizziness, headaches, brain zaps, emotional highs and lows, insomnia, agitation, etc. So you need to slowly over time take the medication away. Doctors are taught in school that tapering can be done in a short time and withdrawals only last a couple of weeks. This isn't true. Research has shown that the 10% method of tapering has been found to be one of the safest methods. This is taking the dose you are taking at that time and subtracting 10% each month. This is a long process, but the goal is to get off the medication with the least amount of withdrawal. If you were taking 100mg this is how your tapering schedule will go. 100, 90, 81, 73, 66..... For more information on tapering and how to make these custom doses you can visit survivingantidepressants.org.
Withdrawal is something you want to avoid, but if you find yourself going through there are some things that you can do to get yourself out of it. Withdrawal is most common when going off a medication cold-turkey or tapering too fast. There is no timeline for how long withdrawal will last, it could be weeks or months. One way to possibly get your self out of it is going back on a lower dose than you were last on. This is called reinstating. You let your brain stabilize and once you feel better give yourself 2-4 weeks to heal properly. Then you want to begin tapering off again. People also report that taking Fish Oil can help with recovery from withdrawal.
Sites and more information on tapering and withdrawal. https://www.reddit.com/AntidepressantSupport/comments/10krlmd/sites_and_resources_for_tapering_antidepressants/
Switching from one Antidepressant to Another
There are 3 methods doctors will use when switching from one antidepressant to another. Many times it is just the doctor's preference to which they recommend.

1. Direct switch - the doctor gives you an equivalent dose of the new medication and you stop the original and the next day you start the new one.

Dose Equivalence: 40 mg fluoxetine 350 mg bupropion 40 mg citalopram 75 mg pristiq 20 mg escitalopram 40 mg paroxetine 150 mg fluvoxamine 50 mg mirtazapine 100 mg sertraline 500 mg nefazodone 150 mg venlafaxine 125 mg amitriptyline 125 mg imipramine 115 mg clomipramine
Drugs not listed do not have any reputable source for dose equivalency. Doses are rounded up.

1. Taper and washout - you slowly taper off the old medication give your body 2 weeks without any medication and then you start the new one and titrate up.
2. Cross taper - As you taper off the old medication you titrate up on the new medication. The doctor will usually give you a schedule. If you are taking 100mg of Med A. and wants you to go to 200mg of Med B. Week 1 -- 75 of A and 50 of B, week 2 -- 50 of A and 100 of B....

I think the third option is the best as it is more of a gradual transition. If you get bad side effects from the new medication it is also easier to go back to your old medication. No matter the method there is a couple weeks in there where it can be kind of rough. You are stopping something your brain is accustomed to and adding something new that it has to adjust to.
Treatments Beyond Medication
If you have tried numerous medications and just can't find anything that helps there are few treatments that you can look into. You may even want to try some of these things before trying meds. Some of these do have higher side effect risks.

1. Talk Therapy - alongside your antidepressant or independent of taking a medication. This is about the safest thing you can do.
2. Life Style Changes - Exercise, Diet, etc. Again this is very safe and can be always used in conjunction with other therapies.
3. Ketamine - This is a medication, but is usually a treatment when meds don't work.
4. TMS, in 2023 we should see a new protocol for TMS called SAINT which is supposed to be more effective and involves less sessions. As of 2024 this is being done in California and Massachusetts.
5. ECT - This is usually done as a last resort, it has some significant side effects such as short term memory loss. Do your research before considering.
6. Stellate Ganglion Blocks - This is fairly new as far as being used for mental disorders.

Lifestyle Changes to Improve Mental Health

Medication can be helpful, but it is not the only way to improve your mental health. Here is a list of some things that can help you on the road to improved mental health.

1. Exercise -- Regular exercise is really helpful. Studies have shown that it can improve depression/anxiety. More intense exercise has been found to be more helpful for anxiety. Exercise can help produce endocannabinoids which can make you feel better. It is sometimes described as "runner's high". Plus if you can get out in the sun for your exercise that is good as sunlight helps Vitamin D. https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-truth-behind-runners-high-and-other-mental-benefits-of-running Here is a new study on the benefits of physical activity on depression. https://www.psypost.org/physical-activity-and-mental-health-exercises-therapeutic-potential-for-depression-highlighted-in-new-meta-analysis/
2. Speaking of sunlight many people will suffer from seasonal depression in the winter as their levels of Vitamin D drop due to the lack of sunlight. If you are in a northern climate when you go out in the winter the only skin exposure may be the little area on your face. To combat this you may wish to look into light therapy during the winter months. https://www.insider.com/guides/health/mental-health/light-therapy
3. Improve your diet. Cut out junk food/drinks. There is a link below about which foods help depression/anxiety and which ones aren't good for it. https://www.medicalnewstoday.com/articles/318428
4. Make sure you are getting enough quality sleep. Your brain needs that down time to rest and recover. If you feel like you are getting enough sleep, but are always exhausted talk to your doctor about having a sleep study done. They have kits you can do at home. I found out I had central sleep apnea and my oxygen levels were around 80% for half the night.
5. Socialize, keep the brain active. Try activities that challenge your brain. Suduko, crossword puzzles, trivia, etc.
6. You also may want to try some type of talk therapy or learn some different coping skills and methods of relaxation such as deep breathing exercises.
7. Volunteer. You are helping others and sometimes seeing just by giving your time to people and seeing how it helps them can be rewarding.
8. You may even want to consider getting a pet as they are supposed to be beneficial for depression. You can even go one step further and get and Emotional Support Animal (ESA). They are specifically trained and are allowed to go with you on airplanes and other public places. Some are even trained to recognize certain side effects in medications. For more information you can visit this site: https://www.certapet.com/service-dog-for-depression/

This was published during the pandemic, but has many helpful ways to help improve your mental health. Medications can be very helpful, but there are so many different things that can improve your overall mental health. As a bonus they don't come with side effects. https://neurosciencenews.com/resilience-mental-health-19986/
Talks about lifestyle changes to help with mental illness and other therapies like light therapy. Some doctors hand these out to patients. https://www.psycho.farm/resources
All of these are tools that we can use to improve our mental health. Medication may help, but it is also a tool and you need to help it out by working on yourself. I wish everyone the best on their journey!!!

Lab work and tests

This lists out some blood tests that can be done to see if something else is contributing to your depression. I'm sure their are others, but this gave a little explanation why you would check out some of these. This may not eliminate depression, but it may find something that can be treated and can decrease the amount of depression. https://www.optimallivingdynamics.com/blog/13-important-blood-tests-to-get-done-if-you-have-depression
Many times people ask about the genetic tests and are they helpful. These will tell you how you metabolize the medication, but that plays no role in whether it will be effective for you. The one helpful thing is the MTHFR gene mutation, but your GP could do this lab at a much lower cost. I actually just ordered this test for myself and even if insurance doesn't cover it, the cost is $188. The below article explains in detail why the FDA actually recommends not using these. An upcoming blood test will be able to show in a couple of weeks if a medication will work for you. https://www.health.harvard.edu/blog/gene-testing-to-guide-antidepressant-treatment-has-its-time-arrived-2019100917964 https://neurosciencenews.com/depression-antidepressant-biomarker-19863/

Sexual Side Effects

The is one of the most unfortunate side effects to antidepressants. Some things to remember is if you have sexual side effects on one medication it does not mean you will have them on all of the medications. Some people say that the effects are the worst when you first start the meds and can slowly recover after a few months. You may also realize this, but untreated depression and anxiety can have an effect on your sexual performance and libido. So for some people treating their mental disorder actually improves sexual issues.
This really dives into exactly what causes the sexual side effects, which medications are more likely to cause it, and ways to treat it. As of note nefazodone is another medication that is known not to cause sexual side effects. As well as the upcoming medication Ruoxinlin (ansofaxine). Nefazodone I also believe the new medication Auvelity is supposed to have lower sexual side effects. AuvelityMed https://psychscenehub.com/psychinsights/sexual-dysfunction-with-antidepressants/
Rate of incidence of sexual side effects of some of the medications. The average for SSRI's is 59%, but there are other antidepressants that have much lower sexual side effect percentages. https://pubmed.ncbi.nlm.nih.gov/11229449/
Nefazodone, mirtazapine, wellbutrin (bupropion), Auvelity, viibryd, and Trintellix (vortioxetine) are they medications with the lowest rate of sexual side effects. Wellbutrin is often added to an SSRI to relieve some of the sexual side effects.
Here is a guide I put together about sexual side effects: https://www.reddit.com/AntidepressantSupport/comments/14bicp1/guide_to_antidepressant_sexual_side_effects/

Side Effects & Medication Interactions

If you really want to read about the side effects of each medication pdr.net has some of the most comprehensive information. It even lists the rate of incidence of each side effect. It also lists out the interactions with other medications. Drugs.com has probably some of the best user reviews of each medication. You can even look how a medication is rated for depression, anxiety, ocd, etc. None of the information contained in this guide should be a substitute for your doctor. You should always run any type of medication change by your doctor and keep him/her in the loop on side effects you are having. Including supplements you are thinking of adding. There are some supplements that just don't mix good with antidepressants. You should be upfront with the doctor about how you are feeling. Always let them know about side effects. Most importantly it is your health so you deserve to have a say in your treatment plan. Don't be afraid to speak up if you are uncomfortable with something because it is your health.

I've been on so many med combos over the years I can't keep them straight. I'm on lamictal, valium and propranolol. I tried latuda recently (again) and realized the reason I stopped it before was because it makes me so drowsy during the day and I was dosing off at work, so I stopped right away and I've been ok on just the 3. So after talking with my psych we were just going to keep it this way for now.
I've noticed that I've been running slightly on the hypomanic side, which don't get me wrong feels great. I'm sociable, witty, funny and I'm in a great mood. So far I haven't made any bad decisions. I have noticed intrusive thoughts have increased, but I know they are intrusive thoughts still and I'm not delusional.
I've been thinking about adding Seroquel (again) to substitute some over the counter sleeping pills I take and maybe subdue some of the intrusive thoughts. I don't remember why I stopped taking Seroquel earlier, but I was in a med carousel at the time. Should I mess with my current med combo, though? I used to be funny and witty before my bipolar symptoms really showed up and I like the current me. Thanksgiving with all the family today was great. Maybe this is me as stable as I'll get. Do I deal with the thoughts coming from my brain knowing what they are and not listen to them, and try to stay in my current state? Or do I risk making a change? I feel good, but not too good where I think I should be worried about it. Could this be my baseline?

Should I just add more lithium or go down on lamictal? Obvi I’m talking to my doc this week but would like to hear just some opinions (won’t substitute it for medical advice)

I saw one person say it here and I wanted to ask. I have generalized anxiety disorder and major depressive disorder.

Quoting the psychiatrist answer to the question. “Your premises are incorrect.
Mania is not caused by excessive dopamine, nor is depression caused by low dopamine.
Bipolar disorder is intrinsically different in its mechanism of action than unipolar, or major depression.
Our understanding of depressive illnesses is that they are genetically predisposed, and environmental traumas, life experiences, psychological losses and the like trigger them, and neurotransmitters are involved in the genesis of those illnesses.
The antidepressants we use to treat those disorders cannot correct the inherited genetics, nor remove the triggers to those illnesses, but aim to correct the neurotransmitter changes.
Bipolar disorder is a disorder similar to epilepsy, but instead of ion channels being disrupted in the motor cortex in epilepsy, the disruption occurs in the limbic system, resulting in mood swings.
Calcium and sodium channels are opened excessively, similar to what happens in seizures, and mood swings occur. As with treating seizures, we use medications to control seizures, such as Depakote or Lamictal, which closes the calcium channels, and stops the seizures, or manic episodes.
Lithium works by substituting for sodium, another ion channel actor. Lithium is just above sodium on the periodic table of elements, which means they share the outer electron valence shell, and can substitute for each other.
In bipolar disorder, lithium ions substitute for sodium, block the excessive channel transmission, and the mania subsides.
Too little release of Dopamine is involved in ADHD in the prefrontal cortex, and too much release with psychosis.
Too little release of dopamine in the substantial nigra, due to withered dopamine fibers, causes Parkinson’s disease.
In the periphery, dopamine is a vasoconstrictor, used in acute, severe blood loss.
Disorders of the brain are complex, and the specific mechanism of action, as well as the location, are crucial elements in understanding.
Lastly, as for mixed episodes, we believe it is a combination of several ions overflowing that are involved in mixed states in bipolar disorder, often needing multiple medications to stabilize the person.”(psychiatrist)
Is the answer the psychiatrist give out true and valid. Like is the science accurate?

Hello everyone, first time on this sub.
TL;DR below
Before going any further I feel like I must first acknowledge that for this community medical success is subjective. One person's failure is another person's win, and I know that in many ways I'm very lucky.
With that in mind, I have been seizure free for maybe seven years now. Within the past couple years I had an EEG that confirmed I still need meds. I'm currently on 300mg of Zonisamide and 1500mg of Oxtellar. I'm wanting to make a switch in medication because I feel like I'll get Alzheimers in a couple years.
I have to take notes for everything, create tasks and reminders at work, and so on. I've made mistakes at work because of my memory that have cost the business. Some of the biggest problems of my last relationship were directly correlated to my memory. I'm sure a fair amount of you can relate with the phenomenon that happens when you're talking and suddenly you hit a wall and can't remember a word or even what you were saying. Or what you ate for breakfast.
So I thought that perhaps I should address the court of public opinion. My assumption is that it's the Zonisamide that is causing the problem and my neurologist suggested replacing it with Lamictal after I told her that my sister is currently taking Oxtellar and Lamictal for her epilepsy. Alternative suggestions were Briviact and Fycompa. The problem with replacing the Zonisamide with Lamictal though, is that then I'm taking two sodium blocking meds.
So what do you guys think? Is it worth switching meds or should I just continue my life winning Epilepsy but losing memory? Do you think Zonisamide is the culprit? Is Lamictal a good substitute paired with Oxtellar? Any other advice/suggestions/opinions/personal experiences are welcome!
TL;DR: I've gone seven years without a seizure, still need meds, but the meds I'm currently on (Zonisamide and Oxtellar) are really hurting my memory and cognitive function. To the extent that it has cost the business I work for money, hurt my previous relationship, and so on. I'm thinking about switching meds, and feel like Zonisamide is the problem. I told my doctor that my sister is taking Oxtellar and Lamictal, so my doctor suggested Lamictal but also mentioned Briviact and Fycompa. Oxtellar and Lamictal are both sodium blockers which doesn't seem ideal. Looking for advice/suggestions/opinions/personal experience.

** TW for mentions of: suicide, self-harm, sexual abuse, menstrual cycles ** (Edited because I mistyped a few words)
Before I start, I want to make it clear that I am safe, I am NOT having thoughts of su!c!de right now, and I have the emergency phone number for my therapist saved in my Contacts. I will be abbreviating/censoring certain words so as to lessen any emotions it may trigger in others and in case Reddit doesn’t like the use of certain words (still newish as far as posting goes so I’m not sure – regardless, I want to avoid triggering others as much as possible). Also, I apologize for using parentheses WAY too much. :)
I (27F) started having symptoms of type 2 bipolar disorder (I use the abbreviation BD) at age 15 and was officially diagnosed by a psychiatrist a few months before my 23rd birthday. At that time, I was started on Lamictal. I recently (as in, within the past 2ish weeks) stopped taking Prozac after tapering over the past few months. I’d been taking it since 2015 and had been on the max dose for a few years. The psychiatrist I was seeing was kind of weird about changing/stopping medications, so between my diagnosis in 2017 and my seeing a new psychiatrist starting a year ago, he only increased my Lamictal until I found the right dosage. (FWIW, I wanted to see a new psychiatrist for a while but only finally did a year ago because I was forced to for insurance reasons.)
When my current psychiatrist was helping me taper off my Prozac, he warned me that doing so can exacerbate mood swings. That’s exactly what it did every time I tapered my dosage down – I’d have a hypomania, then a depressive episode that was more intense than usual. It involved [s-word] ideation and thoughts of SH, which I did act on once a few months ago. My cessation of the Prozac in the past couple weeks was no exception. I acted on the thoughts of SH a few days ago in the form of skin-picking on my thigh (either an ingrown hair or razor bumps). My thoughts of [s-word] were really intense, too; I thought of a very general plan, but I did not act on it.
I see my therapist weekly and should see him tomorrow (May 16), but ya know how I did some skin-picking the other day? Well, now I have this lovely red bump on my thigh that’s almost 2 inches in diameter that is warm to the touch and hurts like a female dog. I don’t have symptoms of cellulitis/sepsis, but since I intend on calling my Dr. tomorrow to see her ASAP (or going to an urgent care clinic/the local ER if I can’t see her), I may have to cancel tomorrow’s appointment.
I realize this Subreddit is not a substitute for professional advice, which isn’t permitted anyway as per Rule 3, but I wanted to ask if anyone else has experience/advice about my frequent su!c!dality. I’m concerned that, even if it is because my body is adjusting to being off Prozac now, I’m having these thoughts at least once every single month. (I should mention I have an IUD, so I don’t have monthly periods – part of the reason I got it was because my PMS would make my mood swings, especially my depression, a lot worse. So thankfully I don’t have monthly hormones to deal with anymore, at least not for several more years when it’s time to replace my IUD.) Perhaps now that my emotions have stabilized and my body starts to realize I’m not going to be torturing it with tapering off an SSRI anymore, these thoughts won’t happen as frequently. But when they do happen, they are SO intense. As in, I come up with plans (although I don’t act on them) and feel in my mind that my reasoning is crystal-clear, so much so that the “logic” of committing [s-word] not only outweighs the pain my loved ones would face, but my loved ones would realize that [s-word] was a logical, sound decision and that ultimately it was the only thing I could do. There’s a meme I found about INTJ personalities (I’ve taken the MBTI test a zillion times over the past ~5 years and got INTJ every time) that almost perfectly explains how my [s-word] thoughts affect me. The 1st panel shows a super-happy Trollface and reads: “INTJs when they solve a problem: I AM THE SINGLE MOST BRILLIANT MIND HUMANITY HAS EVER SEEN! MY CREATIONS WILL REVOLUTIONIZE TECHNOLOGY AND THE FUTURE!” Then the 2nd panel shows the guy crying and reads: “INTJs when there’s an error in their calculations: Why is this not working? I’m such a failure and disappointment; a waste and mistake of life.” I go through these extreme phases of thought (so to speak) a lot – not even just during hypomanic/depressive episodes. I do have some grandiose thoughts during hypomanias, but in general, I know that I am intelligent, compassionate, and good at things I love, like writing. Regardless, I have BD, panic disorder, PTSD, and Asperger’s, all of which make it difficult for me to be a functioning member of society (I’ve had difficulty with school since age 11 or so and couldn’t hold down the jobs I had within the 1-year span prior to C0VID). I went through two abusive/generally just toxic relationships and was r-ped by the one bf I had who wasn’t abusive (sounds like an oxymoron but I don’t feel like explaining it), and as hard as I try, I feel like I can’t move on and heal from it all. So sometimes I ask myself: why bother even trying to heal from it if it’s just a waste of time and energy over something that is apparently impossible to do? I have never lived on my own, and I’m unsure if I ever will be able to be independent. My relationship with my dad, with whom I’ve lived for my entire life and with whom I can't discuss anything related to BD because he went through a turbulent marriage/divorce with my mom (she had BD1 w/psychosis & PTSD and died from over-consumption of alc0h0l/her prescriptions for her BD/psychosis), is toxic – think a complete lack of emotional connection and VERY little support (my previous therapist mused he has a dismissive-avoidant attachment style, at least with me) – but I have nowhere else I can live. All this put together makes my thoughts of [s-word] not just extremely powerful, but my reasoning for them more and more logical each time they happen.
As I mentioned, I have means to keep myself safe. But I am concerned by why these thoughts/feelings are happening more frequently and are getting stronger, and why they seem to make more sense each time they happen. I am scared that while I have not and have no intentions of acting on my [s-word] thoughts, eventually it’ll get so bad that I will act on them. I see my psychiatrist in 2 weeks and will definitely be discussing it with him, too, not just my therapist. But in the meantime, does anyone else experience frequent bouts of intense su!c!d!ality? And if so, is there anything you might suggest I try to help with my reasoning that “yes, acting on these thoughts makes perfect sense” even if these thoughts do keep happening frequently?
TYSM, and much love to everyone else with BD and any kind of mental health struggles. We're in this together. <3