Lamictal and hypomania

I was treated for unipolar depression back in 2020 with SSRI lexapro + amisulpride 50mg and was in remission until 2023 with it.
Then in 2023 I blew a small stressor TOTALLY out of proportion(I think hypomania had already begun then) and got into a really bad or probably even mixed episode (my first one if it was actually mixed). I'd get so restless I'd want to tear off my clothes, attempt to run away, suicidal, get so irritative that I'd say the most wicked shit to my loved ones who were really just trying to help me, lay in bed and cry and shout so loud ALL the time. It was so bad I felt like I was going to die and family members were so worried, I was admitted.
Doctors totally ruled out mania/bipolar disorder because I wasn't impulsively buying stuff, didn't lose control etc bullshit and kept treating me for unipolar depression but they did add lamictal with the 20mg Lexapro to address the aggression etc it was titrate to 200mg and put me in remission for a whole year.
But now in 2024 January I relapsed again and this time it was so bad that doctors were continuosly suggesting ECT. I was admitted for over 3 weeks. Same symptoms- agitation, restlessness etc being treated for MDD and borderline personality disorder Bullshit.
Finally, I saw this miracle doc who said I might actually be bipolar and experiencing mixed episodes. Both the combination of hypomania and depression were making me restless. He said he often sees his patients who're hypomanic get so restless they wanted to crawl out of their skin.
SSRI lexapro would only fuel both so it must be stopped immediately and suggested me to try ketamine (because my symptoms were mostly depressive) and started lithium 600mg/day. They worked like a CHARM. I loved ketamine so much and it put me in remission for 3 months.
But then I relapsed again 3 months later and doc now said it is now time to try the big guns aka antipsychotics and continue ketamine. He said he's willing to prescribe either Vraylar or Latuda which work great for mixed episodes.
TLDR : So, do you have any of my symptoms especially the restlessness during your depressive/hypomanic episodes and which antipsychotic of the two worked the best for you without fueling the restlessness. Personally leaning more towards Vraylar (it has amazing reviews and doesn't cause weight gain)
Symptoms list optionally if anyone wants to read that my son made :
What's your go to treatment plan for mixed states? Is this a mixed state rather than unipolar

• Agitation/Inner restlessness: Unable to remain calm/sit still. Blaming all of her symptoms on this restlessness. When this comes the other symptoms which I'll mention come along too:
  
• Crying and shouting loudly (simply can not control this to sorta escape)
  
• Excessive anger and snapping at/blaming others for no reason: Involuntarily blame people for the most random and petty things who've been the most helpful and kind.
  
• Very Irritable.
  
• Suicidality (to escape the restlessness). Suicidal attempts in aggression where she had to be stopped with a lot of physical force.
  
• Racing negative thoughts leading to Guilt and worthlessness
  
• Irrational/Questionable decisions and behaviors were almost always noted by my family members during these periods accompanied with extreme impatience.
  
• Energy: Being fatigued and unmotivated that she can't even move or do stuff. But at the same time having so much Energy to shout so loud and rip her chest open to escape the "agitation".
  
• Pupils get dilated.
  

I was treated for unipolar depression back in 2020 with SSRI lexapro + amisulpride 50mg and was in remission until 2023 with it.
Then in 2023 I blew a small stressor TOTALLY out of proportion(I think hypomania had already begun then) and got into a really bad or probably even mixed episode (my first one if it was actually mixed). I'd get so restless I'd want to tear off my clothes, attempt to run away, suicidal, get so irritative that I'd say the most wicked shit to my loved ones who were really just trying to help me, lay in bed and cry and shout so loud ALL the time. It was so bad I felt like I was going to die and family members were so worried, I was admitted.
Doctors totally ruled out mania/bipolar disorder because I wasn't impulsively buying stuff, didn't lose control etc bullshit and kept treating me for unipolar depression but they did add lamictal with the 20mg Lexapro to address the aggression etc it was titrate to 200mg and put me in remission for a whole year.
But now in 2024 January I relapsed again and this time it was so bad that doctors were continuosly suggesting ECT. I was admitted for over 3 weeks. Same symptoms- agitation, restlessness etc being treated for MDD and borderline personality disorder Bullshit.
Finally, I saw this miracle doc who said I might actually be bipolar and experiencing mixed episodes. Both the combination of hypomania and depression were making me restless. He said he often sees his patients who're hypomanic get so restless they wanted to crawl out of their skin.
SSRI lexapro would only fuel both so it must be stopped immediately and suggested me to try ketamine (because my symptoms were mostly depressive) and started lithium 600mg/day. They worked like a CHARM. I loved ketamine so much and it put me in remission for 3 months.
But then I relapsed again 3 months later and doc now said it is now time to try the big guns aka antipsychotics and continue ketamine. He said he's willing to prescribe either Vraylar or Latuda which work great for mixed episodes.
TLDR : So, do you have any of my symptoms especially the restlessness during your depressive/hypomanic episodes and which antipsychotic of the two worked the best for you without fueling the restlessness. Personally leaning more towards Vraylar (it has amazing reviews and doesn't cause weight gain)

Has anyone tried ECT or TMS? Allegedly they can be really effective for bipolar and I'm getting desperate. I can stop mania/hypomania but am left with relentless adhonia/apathy and cannot stop the SI. I've tried so many meds and react badly to most of them. Currently on Lamictal alone and I just can't keep this up. I've been in therapy forever, I have a pretty healthy lifestyle and don't drink. Honestly if I didn't have a kid I'd just get off the ride st this point. I don't really even have the desire to get better. It seems so impossible, but I want him to have a good mom so I'm still going. A few years ago a therapist suggest ECT but I wasn't a big fan of her so I'd kind of forgotten till now.

I was treated for unipolar depression back in 2020 with SSRI lexapro + amisulpride 50mg and was in remission until 2023 with it.
Then in 2023 I blew a small stressor TOTALLY out of proportion(I think hypomania had already begun then) and got into a really bad or probably even mixed episode (my first one if it was actually mixed). I'd get so restless I'd want to tear off my clothes, attempt to run away, suicidal, get so irritative that I'd say the most wicked shit to my loved ones who were really just trying to help me, lay in bed and cry and shout so loud ALL the time. It was so bad I felt like I was going to die and family members were so worried, I was admitted.
Doctors totally ruled out mania/bipolar disorder because I wasn't impulsively buying stuff, didn't lose control etc bullshit and kept treating me for unipolar depression but they did add lamictal with the 20mg Lexapro to address the aggression etc it was titrate to 200mg and put me in remission for a whole year.
But now in 2024 January I relapsed again and this time it was so bad that doctors were continuosly suggesting ECT. I was admitted for over 3 weeks. Same symptoms- agitation, restlessness etc being treated for MDD and borderline personality disorder Bullshit.
Finally, I saw this miracle doc who said I might actually be bipolar and experiencing mixed episodes. Both the combination of hypomania and depression were making me restless. He said he often sees his patients who're hypomanic get so restless they wanted to crawl out of their skin.
SSRI lexapro would only fuel both so it must be stopped immediately and suggested me to try ketamine (because my symptoms were mostly depressive) and started lithium 600mg/day. They worked like a CHARM. I loved ketamine so much and it put me in remission for 3 months.
But then I relapsed again 3 months later and doc now said it is now time to try the big guns aka antipsychotics and continue ketamine. He said he's willing to prescribe either Vraylar or Latuda which work great for mixed episodes.
TLDR : So, do you have any of my symptoms especially the restlessness during your depressive/hypomanic episodes and which antipsychotic of the two worked the best for you without fueling the restlessness. Personally leaning more towards Vraylar (it has amazing reviews and doesn't cause weight gain)
Symptoms list optionally if anyone wants to read that my son made :
What's your go to treatment plan for mixed states? Is this a mixed state rather than unipolar

• Agitation/Inner restlessness: Unable to remain calm/sit still. Blaming all of her symptoms on this restlessness. When this comes the other symptoms which I'll mention come along too:
  
• Crying and shouting loudly (simply can not control this to sorta escape)
  
• Excessive anger and snapping at/blaming others for no reason: Involuntarily blame people for the most random and petty things who've been the most helpful and kind.
  
• Very Irritable.
  
• Suicidality (to escape the restlessness). Suicidal attempts in aggression where she had to be stopped with a lot of physical force.
  
• Racing negative thoughts leading to Guilt and worthlessness
  
• Irrational/Questionable decisions and behaviors were almost always noted by my family members during these periods accompanied with extreme impatience.
  
• Energy: Being fatigued and unmotivated that she can't even move or do stuff. But at the same time having so much Energy to shout so loud and rip her chest open to escape the "agitation".
  
• Pupils get dilated.
  

(Note: I've added this here and to the Bipolar sub, just to see if I can maximize getting the perspectives of others.)
I’m finding myself on a very strange journey. I was recently diagnosed with focal epilepsy, after 20 years of having seizures, and prescribed Lamictal.
I’m on day 9 of the med and the last week or so has been a very strange ride. The way I have described it countless times at this point is that it’s like having someone running through my mind flipping on light switches. I am remembering things I haven’t though about since I was a kid/teen, it’s bringing up a lot of emotions, and in a way that I am unable to fully understand or describe, it’s changed a bit of how I perceive my own day to day life. I’ve also gleaned that these particular experiences will level out or stop.
A close friend of mine is diagnosed Bipolar II. My brother is Bipolar I. They have both, separately, told me that I need consider that I may be bipolar. My immediate reaction is No. I am not bipolar. Just because a medication makes me feel a specific way at the start, when the full effects aren’t experienced until much further down the line at a higher dose, does not somehow indicate that I am bipolar.
All of that said, part of the odd side effect of feeling like my memories are more lit up that I’ve experienced in years, is the effect of really contemplating my mental heal through being a kid to a nearly 40 year old adult. I grew up poor, my mother suffered from mental illness and anger issues, my parents fought all the time (I recall wishing they would get divorced when I was a kid), as a teen I became depressed, but also very angry myself. I took steps as I got into adulthood to remove myself from my past and ensure my success. In a lot of ways, I have done better than anyone in the history of my family. In other ways, I know there are still demons I can’t chase away.
In recalling my childhood, I absolutely remember experiencing hypomania. Between middle school and high school, it was absolutely there. I remember getting really wound up at night and doing all sorts of weird things in my room. I recall one night where I took a white t-shirt and scrawled these arrogant lyrics on the back, and then cutting the t-shirt down the center and wearing it over a band tee. I remember often getting really wound up and making a plan for myself, writing everything out; This was how I was going to succeed and get to where I wanted to be in life! My bursts of energy would typically revolve around being better for myself or becoming better than those around me. Rising above them, in an egotistical way. Of course, you get on the path and a few days later realize that it’s not quite so easy and head right back to a slump. There are so many of these occurrences in my life.
The description of hypomania in relation to alcohol is something I have absolutely experienced. Alcohol winds me up and I could drink until I pass out. In addition to this is hypersexual behavior. This occurs with or without alcohol, but alcohol certainly make things and related decisions much worse.
I question the potential that I might be bipolar, because I know so many have symptoms that are well worse than mine. If bipolar exists on a spectrum, then I would think my moving back and forth between a state of depression and a state of hypomania would be less severe. With some of the experiences I’ve read here I think, “Ok, well I’ve never done anything as bad as that.”, but then again, I don’t know.
I have always had a temper and it seems to come in cycles. I would say that the last 7-8 years of my life, I don’t know that I have experienced the swings quite like I did when I was younger. I’m not sure if having the same job, kids, etc. would impact my perspective on it or any other potential bipolar symptom. I managed to get my degree and keep a 3.9 GPA. Knowing myself, it seems like if I was truly bipolar that would have been impacted.
At one point I was on Lexapro and Xanax. I finally weaned myself off of Lexapro due to sexual side effects. I’ve been in therapy for 4 years.
I’m just looking for thoughts, advice, experiences of others. This whole thing is weird. My mental health has always been an issue, but it’s also always been an elusive thing for me to make sense of. Am I depressed? Anxious? Bipolar? Do I just have anger issues? Am I just trying to fill a void somewhere by having multiple sexual encounters?
Why do our brains seem to want to kill us?

I began taking lamictal almost a month ago and now I reached 100 mg in the morning. But I still feel depressed. I also take 200 mg seroquel at night. Could that be too much and making me depressed still? I remember when I took lamictal 100 in the past with no seroquel I almost got into hypomania so I know I need seroquel but maybe its too much. i take 100 lamictal for almost a week but I still feel demotivated and depressed .

I started on Lamictal 2 months ago once I decided after years that I needed some kind of help. But now I have my follow up psych appointment next week, and she wanted me to track my symptoms for it. I realized that I haven’t really had hypomania since starting them, and I’m craving it more than I did before. I am fully aware of the destructive things I’d do while hypomanic. I burnt bridges at jobs while in derealization. I spent myself into way too much debt. I affected people around me. There were days where I was irritable about anything and everything. But I was also euphoric and felt what I would call a high, even when doing self-destructive behaviors. I miss the productivity and the intense focus on interests. I miss how being hypomanic made me feel. My meds have stabilized my mood more than it has been in a long time, but it’s like I wish they hadn’t because while I feel a sense of normality, I also feel like I’ve lost a sense of myself. How have people dealt with the loss of hypomania and the craving for it? All I want to do right now is stop my meds, but also my stupid new rational brain knows that’s a bad idea.

I am 39 now but was diagnosed at 26. BP1. This past summer, I started pursing treatment in earnest. I was medicated only once prior for like a year after I was diagnosed, until a manic episode convinced me I was cured and I went off meds for the next 11 years. So, this is my first time noticing episodes and dealing with them while medicated.
3 weeks ago, I had an allergic reaction to lamictal and had to go off per dr's advice. That triggered a negative hypomanic episode which I have been stuck in ever since. (I'm also on lithium so wasn't medication-less)
Saw dr. today and she is trying abilify, in addition to my lithium, and added trazodone to replace seroquel.
But, it takes weeks to work. Do I just ride out hypomania and wait? It's negative featured so it's hell and affecting my family.
Any tricks to slow down the hypomania, minimize it, or get it to stop, or do we just wait for the meds to work or our brains to decide it's over?
TIA

Hi everyone, I went to see a new psychiatrist for a second opinion, we reached the same conclusion that I have BP2 with a margin for uncertainty. His recommendation was to stay on my previous dose of 50mg lamictal and add effexor, anticipating a hypomania to confirm.
Now, I went there because lamictal gave me debilitating brain fog and he said effexor should help lift it up. Anyone has this cocktail saw an improvement with brain fog and cognition?
I’m also thinking of cutting off lamictal and go on effexor on its own to see how they work individually, is this a good or bad idea?
I’m very hesitant to try new meds cuz I feel like my brain has been fried by the amount of mental related meds I took over the last 9 years…
TL;DR: has effexor helped lift lamictal’s brain fog? And is it wise to stop lamictal and start Effexor of its on?

I have a hard time coming to terms with my diagnosis, despite all the evidence to the contrary. If you met me, you would never know I'm bipolar. Nobody does. I'm ambitious and my life is "together."
Last year I (29f) started experiencing rapid mood cycling like never before. I impulsively ended a bad relationship, lost a lot of weight, had classic bipolar rage, hypersexulization, dramatic energy fluctuations, did things that weere out of chatacter, and toward the end I did feel paranoid and heard sounds. Often, i was in a state of sadness.
But at the same time, I kept moving forward in life. I felt like I couldn't trust myself but on the outside, everything was fine and nobody was worried about me.
I would have done anything for the cycling to end. I got diagnosed and put on Lamictal, which wasn't a fit for me. My psych then wanted to try an antipsychotic plus some diabetes medication to prevent the weight gain side effect. It all felt like too much. I'm not up for the trial and error. Since then, I've spent 6 months depressed and off meds. Gained all weight back.
Also, the start of all this cycling can be traced to a time when my schedule changed suddenly. Now I know better.
I've gotten into therapy again and am committed this time because I don't want to live like this. I feel like I'm wasting my life being depressed.
Today my therapist said if I'm going to manage this holistically I need to learn how to offset hypomania when it comes on. Typically I just try to enjoy the ride because it's a relief from the depression and I feel I'm a better version of myself in most cases, last year being a dysphoric exception.
I never really do anything too crazy so it's hard to see the harm in it. She told me all about the damage it can cause overtime, which I've heard about and emphasized that I need to let it go or it will get worse. This is a hard pill to swallow, I don't want to subdue it if I'm lucky enough to feel energetic and sociable and productive.
I dont really have a specific question. I don't know where to start. I guess I'm wondering if anyone can relate to this high functioning spectrum of bipolar and feeling like medication is not the way for you and worried if you'll ever feel good again without mania.

Hey, are there any of you who have ED together with bipolar? I'am suffering from an ED since my childhood. About 20 years now. For a long time I had bulimia and I still have body dysmorphia. Three weeks ago, at the age of 26, I was diagnosed with bipolar type 2. Lamictal and Xanax are now part of my everyday life, but since I started taking the tablets I have lost a lot of appetite, which has a positive effect on me as someone who suffers from ED. But I am also aware that eating so little is not entirely healthy. And because of hypomania, I move around a lot and do more sport than normal. I burn a lot of calories... How do you guys cope with it? Would be happy about recommendations.

I don’t know if I really have bipolar. I kinda pushed my psychiatrist for the diagnosis cuz depression meds haven’t worked out for me at all. I think my work and college before were the culprit for my depression. My ‘hypomania’ always comes in when I make strides to not care about either, Id start slacking off or doing the bare minimum.
Lamictal kinda helped in protecting me from entering a major depressive episode like the ones I had before but it also made it extremely difficult to focus and feel human. I tapered it off completely for 3 weeks, and felt more in control of my cognitive abilities but my mood wasn’t stable and was more quiet and sensitive than when I was on it.
I have an appointment with a new psychiatrist in two days and I’m not sure how I want to take it, do I ask for a new evaluation or just ask for a different medication

So I had a somewhat late diagnosis (37 years old) of BP2, and after years of SSRIs/SNRIs which essentially numbed me to the point where, though the SNRIs basically helped me get into a super-high earning job, essentially (my theory) they made me feel ok to basically be antisocial and stay by myself just focussing on my work. In fact, the theory is that they pushed me into hypomania (hence the BP2 diagnosis) which then fuelled my workaholism.
Anyway, I've been on lamictal as a monotherapy for around 2 months - until I was up to 200mg I became super hypomanic and even had an incident where I drank too much, blacked out and fell over. Since I've been on 200, I've been way more stable...but the depression is definitely apparent.
I think partially this is because the lamictal has toned down all the noise in my brain - but I've been ruminating recently on the fact that I'm super socially stunted. All my friends are younger than me and are way more well adjusted (all have SO's, make similar money, and just in general have their life way more together).
I spoke with the psychiatrist recently, and he agreed to up the dose to 300mg - but I've been on 250mg for the past couple of days and the depression is still there, and possibly worse. He suggested adding on Abilify, but I'm kind of resistant to the idea of polytherapy. On the plus side, I no longer ruminate on negative stimuli, but I feel like its basically exposing all the shortcomings in my life and making me feel way worse.
Did anybody else have this experience? Or is lamictal basically not for me?

Hi. I have a question for the group. I’ve been taking Lamictal 150 mg at night for years. Normally makes me a little tired. I just started a new prescription and it is a different manufacturer. Same drug, same dose. What I’m finding in the last three days (Since starting this new supply) is that I’m feeling a little more activated and waking up throughout the night. Has anyone ever had this experience with just changing generic manufacturer? Also thinking that hypomania is on the horizon with the spring and all, however, I don’t really feel like it’s that. I will flip it around daytime if needed, it’s just the first time I’ve had this experience with it and it’s weird.

Earlier this year, got diagnosed with ADHD and autism by a psych in the public mental health system and also got an ADHD diagnosis confirmation by private psych specialising in ADHD.
Got prescribed Atomoxetine by the public psych but it brought on meltdowns. Told the public psych this issue within two weeks of starting but he insisted I give it time. Gave it time (6-8 weeks) but ended up back in hospital for an OD 4 weeks in, which is my second OD attempt in just 4 months. (The first OD was the reason I had to see the public psych in the first place).
I knoww how meds take time, and I felt like I gave it a good shot, but the public psych continued to insist taking it, even though it has made my mental health worse. Plus, it didn’t even help with ADHD symptoms so there was nothing truly beneficial to it. So I quit cold turkey.
Best decision I ever made.
Meltdowns lessened and I was slowly starting to emotionally self-regulate better.
However, my mother didn’t see it that way, which is understandable as meltdowns are horrifying to deal with, even with it lessening in frequency. So she suggested we go overseas and see another psychiatrist since it’s cheaper to go private than where we live, and we have family overseas for moral support.
I knew going overseas was a bad idea for my mental health as I was slowly getting better but because my mother was so distressed and even used seeing my grandmother to emotionally guilt me, I eventually relented.
Never even got to discuss medication with the private psych I went to on possible ADHD meds as the trip overseas was so rushed and my mother kept telling me that my ADHD and all other issues I had would be sorted overseas.
Well, after meeting the new private psych overseas, she couldn’t even prescribe me ADHD medications and instead ruled me as having bipolar and having manic episodes.
I certainly do understand where the overseas psych is coming from, as my meltdowns do present like hypomanic/manic episodes. However, these “manic” episodes only occur when I am actively triggered by something (eg changes in plans, social rules that I find to be stupid, losing something) and never randomly.
So I tell the overseas psych this, and that I should perhaps go back to fluoxetine since I know that it works well for me, but they insist that I shouldn’t be taking it anymore because it has made me manic.
Again, I would like to reiterate that I have never had any manic episodes while on fluoxetine. I had been on it for 11 years, with breaks between (6-12 months) and have never experienced anything resembling hypomania/mania. If anything, only mild depression and depressive episodes, which are often triggered by my inability to not achieve my goals and daily tasks due to ADHD.
It has only been atomoxetine that has made me have meltdowns/become manic/highly sensitive. Things that bothered me before are heightened to the extreme.
But anyway, the overseas psych prescribes me depakote but it didn’t do anything for me so I am now switched to lamictal since I’m also now taking other drugs for my PCOS.
Still at early stages so I don’t know if it’ll work but I just don’t like the diagnosis that the overseas psych given me as they doesn’t have my full mental health history and I feel like it doesn’t really fit me. Autism feels like a more better fit, especially socially and in my intense interests and sensitivity to certain things eg sound of metal on metal, outfit textures and styles etc.
Though I know that there is an overlap and it could be that I have both bipolar and autism, so there’s also that.
Anyway, the overseas psych hasn’t really explained their reasoning for this new diagnosis beyond the fact that it’s made me manic. She didn’t even explain the difference between SSRI, SNRI and a mood stabiliser. I literally just found out on my own through researching and will be doing more since I feel like I’m basically going through this alone.
I guess I’m just so confused, frustrated and angry about my mental health as each psychiatrist has given me different diagnoses and I know diagnosis isn’t the end-all-be-all but at least there’s something tangible I can hold on to.
But at least, all three psychs have confirmed ADHD so that’s at least a certain.

I (29NB) was diagnosed w/ Bi-Polar II and ADHD in Nov and prescribed 200 mgs of lamictal and then 10 mgs of Adderall in Feb. by my psychiatrist.
Then, I moved from TX to PA last month and started seeing a NP virtually through Happier Living hoping to get prescriptions to continue my current course of treatment. However, yesterday during our second meeting they told me that they don't believe in prescribing both mood stabilizers and simulants bc they can potentially trigger a manic episode. I do understand that approach and I am not against it or necessarily trying an alternative to the Adderall at a later date.
I have not had any hypomania since starting the Adderall - if I came to them and told them that I was having bouts of hypomania, that would be one thing but I have been stable since Feb. I don't want to keep doing this rollercoaster with meds - especially since I have a lot going on on my life with moving and trying to get into grad school. It just doesn't feel like a good time to potentially spend months trying different meds trying to figure out what is a good balance when I already have found one. And I am genuinely happy with both of these meds.
So, my question is should I continue with the current NP and try something different to treat the ADHD even though it is working and I feel stable? Are my concerns about messing up the balance off base? Or should I just try to find someone else that will be more open to continuing the current regiment of meds? Or is that too much to hope for?

Last week I started viibryd mostly for ruminating thoughts/anxiety and I am diagnosed bipolar 2, take lamictal and bupoprion also.
Anyone else experienced some hypomania at the start? I’m definitely feeling it, but am hoping that it’s a temporary adjustment side effect because I feel great (could be the mania lol).
Trying to figure out if this is temporary or I should stop taking it. Anyone else with this kind of experience?

So, I went on a 4 mile walk with my husband, went shopping, took a shower. I feel great, but where is the line about feeling generally good and possibly being hypomanic? It always worries me, and I feel like I constantly ask him what he thinks. I slept more than 9 hours yesterday, and I took basically all my meds like I generally do every single morning (also started on lamictal) I guess what I’m asking is, does feeling well/healthy make any of you paranoid? I just don’t want to push myself too far because honestly I’m scared I could go hypomanic, and I’m not a fan of my hypomania. Idk, just something I wanted to ask you guys for awhile.

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!

I’m trying to make this as neutral as possible to get more objective replies. I didn’t mean for it to be soooo long but I read the detail rules.
———-
My diagnoses includes possible bipolar II, BPD, ADHD, GAD, PTSD and severe irritable bowel syndrome, short (<1y) history of anorexia.. I have high blood pressure and acid reflux which are both well controlled with medicine. I am 30 years old and a female-to-male transsexual (my preferred term, he/him/his) on testosterone since 2015 and post-op. 5’5”(163cm), 166lbs (75kg). I vape nicotine and drink socially (and don’t socialise very often, max twice a month), no other substance use.
My psych meds in the morning are Viibryd 20mg (since summer 2022), lamictal 100mg (since April/May 2023), wellbutrin xl 300mg (since summer 2022). I also take dicyclomine (antispasmodic for IBS, new since April ‘24) and I usually do not eat breakfast as the dicyclomine needs time to work. This didn’t change, the antispasmodic I was on before also needed time to work. Also, I’m just not hungry.
My psych meds before bed are lamictal 200mg (since 2012) and latuda 20mg (since Sept 2023). I also take norvasc (high blood pressure), finastride & minoxidil (hair loss), and famotidine (acid reflux), and a probiotic/prebiotic. Occasionally I need mucinex and/or melatonin.
I have Ativan as a PRN but haven’t used it since fall 2023.
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My prescriber wants to deprescribe. He is looking at eliminating Viibryd in part because of seizure concerns. I’ve never had a seizure, but I did have 20 sessions of ECT in summer 2023 (idk if that affects my current susceptibility to it). I will be advocating to replace it with another SSRI. I was on venlafaxine 2011-summer 2022 but when I came off it my anxiety skyrocketed and my IBS became so bad I could not keep food in me for more than two hours. Adding Viibryd helped, but did not completely solve things. I started seeing a GI to help with IBS and I’m on an antispasmodic from him, but still it is not effective enough. Additionally, last time we decreased Viibryd (April 2023, from 20 to 10) I became suicidal and anxiety got a lot worse. That was when he added the morning lamictal, which was very helpful. The Viibryd dose went back up to 20 when I was hospitalized last summer (as was the latuda, which I have found to be very helpful).
He also wants to reduce my wellbutrin to 150. I was initially on 150 when I started and it was increased (by a prescriber in a PHP) to 300 because it wasn’t as effective as we wanted.
I want to add an ADHD med, in part because things will get worse with it if we go down on the wellbutrin and also because I have noticed I am more impaired by my symptoms now that I am in a new job that has different demands on by cognition (also I’ve been more distractable while driving which is not good).
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To give a brief psych history: Dx with ADHD at 7, GAD around 10. First psych hospitalization at age 16 due to rapid onset of self harm and suicidal ideation. Two more that year for suicidality. Went to college 2012-17. One hospitalization in fall 2012 for suicide plan and another for 2016 to address medication as I noticed signs of hypomania (dad has BP). Came out as FTM 2014, started testosterone 2015, never looked back. Stopped therapy after graduation; couldn’t find a suitable provider. Remained on medication with a psychiatrist. Chest surgery 2019. Smooth sailing until 2022, when I began to seek bottom surgery (had to actually confront the dysphoria instead of burry it). Relapse with self-harm and suicidality. PHP May-June 2022, IOP June-Aug 2022. Continued individual therapy afterwards. Hysterectomy Aug ‘22 had severe complications requiring (medical) hospitalization. Developed (diagnosed) PTSD from events of that hospitalization. rTMS Jan-March ‘23; helped with anxiety but not depression. Increased suicidality & anxiety spring 2023, tried ECT that summer, 20 sessions. Hospitalized most of Aug ‘23 due to increased SI. Readmitted ~2 weeks after discharge. Released end of Sept to receive bottom surgery (Oct 11, ‘23), which went perfectly and has had such a great impact on my QoL. PHP Sept-Oct 23, IOP Nov-Dec 23. Switched individual therapists during that time. Increased SI March/April 2024 (just like the previous two years). Doing -much- better now, but still emotionally labile.
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I left a job as a teacher’s aide in an elementary school after 5y in January, after confirming that I was hired to do psychschoscial rehab with a mental health agency. The job switch has been great, but it meant I didn’t see my prescriber Jan-April. Got him in touch with my therapist and they had a peer-to-peer. The next time I saw my therapist after that she starts talking about this deprescribing plan. I’m very skeptical. It feels like I’m just getting my life together. I have a job that has a career path, not a dead end, I’m reapplying to grad school, I’ve been able to be more financially independent because I’m making considerably more money at the new job (still living with parents, though). I’m rebuilding the most important relationship (non-romantic, just friends) that crumbled with my hospitalization last year as we realized just how codependent (in the actual sense of the word) it had gotten. I don’t want to risk that with a medication change.
It was proposed that this be done in a hospital, but because my prescriber is a nurse practitioner, he doesn’t have privileges anywhere and it would have to be handled at the county hospital because he has a connection with a doctor there. Their psych unit is crap, but the idea was to have it done in a medical wing, which sounds isolating as hell. Also I just don’t have the time off from work (it’s accumulated during the first year) and I’m not yet eligible for FMLA. And I planned on taking graduate courses this summer.
I’m all for being on as little medication as possible, but I don’t want to make changes like it’s an experiment. I don’t want to risk feeling suicidal. But I also want to trust my providers.
I would try to get a second opinion from a different prescriber and not just ask strangers on Reddit, but I can’t find anyone with availability and willingness to do a 2nd opinion.

I was just diagnosed with bipolar 2 with mixed episodes, my only hypomania symptoms are feeling the need to do something, can’t relax, extreme anxiety, energy flowing through my body all while being extremely depressed and having daily crying spells. I’m only Lamictal up to 75mg and making my way up, also 10mg lexapro and 3600mg of gabapentin a day
I just want to hear some success stories because I just feel like I will never live a normal life again, i’m scared of the next episode to come, I want to work again I want to live my life but each day is different my anxiety is paralyzing and I have a lot of fear that I will never be stable or confident again

I’ve been stable for a couple years now (taking a mix of cymbalta, lamictal, and abilify), but every once in a while, I’ll have the “I’m deluding myself, I don’t actually need meds” thought and go off meds for 1-2 days.
When I go off meds, I IMMEDIATELY feel symptoms of hypomania the next day: not needing to sleep, excess energy/fidgeting, racing thoughts, the sudden urge to fix everything in my life in 24 hours, etc. As soon as I notice this happening, I go back to taking my meds.
I’m once again in my questioning if I have bipolar phase and I’m questioning if what I’m experiencing is really hypomania, and proof that my medication is working/keeping hypomania at bay? Is it possible to “rebound” that quickly? (And it’s always hypomania, not depression.) Or, is this just a withdrawal symptom and I don’t actually need these meds?