I don't want to spiral downward

September 18, 2009 9:12 AM

Please tell me about your experience with mood stabilizers such as Lamictal and Depakote.

I've been diagnosed as Bipolar II after over 20 years of being diagnosed with major depressive disorder with anxiety. I work with a wonderful therapist who "changed" my diagnosis after nearly a year of therapy, so it wasn't a snap decision. I also have ADHD which I take Adderal for and have been prescribed Valium prn for anxiety. My therapist and I work on CBT principles and those help quite a bit, but I can tell I'm started to cycle downward. I tried Abilify but had that crappy side effect where my body felt like it was shaking all the time and my brain felt like it was bouncing back and forth inside my skull-so that one is out.

My therapist today suggested I consider one of the "old school" mood stabilizers and mentioned Lamictal or Depakote. She explained that they are anti-seizure medications and that I would probably need a low dose but she's very concerned that I am not on any sort of medication for the cycling. After having crappy side effects from SSRI's for years, I'm reluctant to try another medication. Sexual side effects are a deal breaker for me as well as feeling like my brain is moving around inside my head.

My questions:

1-what side effects have you experienced with mood stabilizers?

2-do you think it's possible to manage your bipolar II with CBT, mood journals, therapy and the like?

posted by hollygoheavy to health & fitness (20 comments total)

I took Depakote for 20 years and now take Lamictal -- both as anti-convulsants, not for mood stabilization. Depakote was a horror show for me -- it made me gain an enormous amount of weight and sapped my energy to nothing. I didn't even realize how bad it was until my neurologist took me off it. Lamictal has been much better, but also has some side effects (well, may have some side effects) I'm not crazy about (some cognitive issues, some minor skin issues). As I say, these may or may not be attributable to the Lamitcal.

These are purely anecdotal observations -- I'm obviously not a doctor and I have no reason to know what I'm talking about except that I've been taking those particular meds for a long time.

If you're interested in VERY detailed anecdotal evidence from people who have taken those meds -- and who may be a little or even a lot nuts -- you want to look at Crazymeds. The site content is realtively good (for example, the page on Lamictal talks about its off-label use for treatment of bipolar disorder and the pros and cons), but the forums are where the action is. And you want to make sure you take the forum posts with a HUGE grain of salt. Some of the "side effects" reported there are . . . highly suspect.

Good luck and feel free to MeMail.
posted by The Bellman at 9:33 AM on September 18

Oh and one more thing -- I note from your use page that you are "such a girl". Talk to your neurologist about the specific issues effecting women taking Depakote. If your neurologist goes "huh?" talk to more neurologists until you find one who knows about the latest learning on this. Depakote is an old, well-understood, often prescribed drug for seizure disorders, but many neurologists specializing in the care of women with those disorders will tell you it's a last resort for women.

Again, I'm neither a doctor nor a woman, and I'm in no way qualified to give medical advice, so my only advice here is to find a doctor who understands the issue. But, again, feel free to MeMail me for background on the above.
posted by The Bellman at 9:37 AM on September 18

I'm on Lamictal for panic disorder, but I also have a family history of bipolar (I do not have it).

Side effects I've experienced:
- Drowsiness. You do not want to start this drug when you have to work at 6 am the next day. Since you're also taking Valium (I'm on klonopin), this is doubly true. And DO NOT DRINK while you're on both.
- Extremely vivid dreams. These have faded with time.
- Withdrawal. I can tell precisely when it's been 24 hours since my last dose. I feel "floaty" (not in a good way), my teeth feel metallic, and I just generally feel off.

That's it. No sexual side effects. I don't know what you mean by your "brain moving inside your head," but I've definitely not felt that.

Do not take more the prescribed dose. Seriously. I had a very bad experience. Also, watch out for a red rash that's a rare but serious side effect. Get thee to an ER stat if you see this. I did not experience this reaction; my grandfather did.

As to your other question - my mother has had bipolar for my entire life, and NOTHING has worked except medication. She is an entirely different person now. She's also on Lamictal AFAIK, and some other stuff I don't remember the name of. If she went off medication, I would refuse to be around her.

Neither of us have ADHD, so I can't speak to the interactions there.
posted by desjardins at 10:02 AM on September 18

I should mention that I've tried Zoloft and Cymbalta, and hated them both.
posted by desjardins at 10:05 AM on September 18

My husband was prescribed Depakote for a short time and it made him fall down - literally - on a regular basis. One time, we were walking in the woods and he just fell and rolled down the hillside. He didn't even realize what had happened until he got to the bottom of the hill. It also made him VERY lethargic.
posted by eleslie at 10:09 AM on September 18

I'm a clinically depressed person who had a medication induced manic episode (stupid Effexor). So even though I am not bipolar, for a short period of time, I was being medically treated like I was. I took Lamictal for a period of about 4-6 months. My major side effects were weight gain and hair loss. The hair loss really freaked me out. Did the drug do what it was supposed to do (stabilize my mood after I sunk into a major depression post-manic episode)? Sure, but I don't think I'd ever take it again.

Of course, IANAD and IANYD, but I do think it has been a relatively successful drug for treating bipolar, and my side effects wouldn't necessarily be your side effects. It sounds like you have a good doctor. I would strongly consider taking her suggestion of trying a low dose. Pay close attention to how it effects you, and once you have adjusted, if the bad outweighs the good, come up with another solution with your doc.

I can't really speak to your question about managing bipolar without medication. I can say that my current medications for depression (Wellbutrin XL and Adderall ER) have changed my life for the better, and I suspect I would not be doing very well without them, even if I was participating in therapy like I am now. I should also mention I was very resistant to medication for several years, but at some point, I came to accept it as something I had to do, like a diabetic taking insulin, and now I am totally okay with taking meds. I'm still very selective about what I will try, and very concerned about side-effects, but when I found the right combination, the trial and error seemed worth it. If you have any questions, please feel free to email me. Good luck!
posted by katemcd at 10:20 AM on September 18

I was prescribed Lamictal after years of poor results on SSRIs. Lamictal made me break out in a full body skin rash about a month into the treatment. That was a known risk of the drug. But I was disappointed it happened to me because the Lamictal seemed to be doing a good job stabilizing my mood. My physician abruptly stopped it and put me on a similar anti-seizure medication, Carbatrol. That was a couple of years ago and this has been by far the most effective pharmaceutical treatment for my bipolar disorder-- well cyclothemia to be precise. There are absolutely no sexual side effects and I have shown great sensitivity for those in SSRIs. I don't blame you; that's a deal breaker for me too. However, I may pay extra for a drug that makes it feel like my brain is moving around in my head. Anyway, I say give it a try.
posted by leonard horner at 10:59 AM on September 18

Don't let these answers freak your shit out. Ditto CrazyMeds, which is absolutely to the go to place for these kinds of answers. If your therapist is talking about a very low dose, then you may have very mild or curtailed side effects.

I would choose Lamictal over Depakote if my MD did not have a compelling argument for doing it the other way around just due to the statistical odds of suckage, although that may have changed with modern pharmacology.

Make sure you give yourself enough time to adjust before your decide "brain does not function, must retreat" or whatever and want to get off. Make sure you and your therapist agree what that time frame should be. Make sure there is a plan on the table for getting off when and if that becomes preferable or necessary.

I will tell you that when I needed it most, going old school and taking Lithium (even back in the day when it was even more of a MAJOR PAIN IN THE ASS) was the best thing I could have done and very probably saved my life. And while the drugs can seriously "suck donkey dong" in CrazyMed parlance, it can also be a huge relief to no longer be exhausted by your own brain and the CONSTANT FUCKING COCKTAIL PARTY in there.

Oh wait - that's me, not you. Sorry.
posted by DarlingBri at 11:07 AM on September 18

---Benzodiazapenes can cause depression. Consider slowly tapering off of the Valium and see if that helps. You don't want to be in a situation where you add meds to counteract the side effects of meds...

---Get a second opinion, even if your therapist is great (sounds like she is). For example, borderline personality disorder is notorious for being misdiagnosed as bipolar II and the treatment is completely different. Make sure your thyroid is okay and there is nothing else medical going on. Cover all your bases and make sure that this diagnosis is the best diagnosis for you.

---Lamictal isn't that "old school". Lamictal does NOT have horrible side effects. It's not going to knock you out or anything and if you need it, you need it. I think it is a great drug for people with bipolar because compared to nearly everything else, it has so few side effects. It is MUCH better than most SSRIs. You start taking it slowly and ramp up to a dose that is effective for you so you're not going to be taking a ton all at once. If you don't like it, you stop.

---Avoid Depakote if you can...Depakote sucks and does have a lot of side effects. I wouldn't even mention it in the same context as Lamictal. Definitely try Lamictal first.

_____________________________
Okay, now I'll answer your actual questions...

1. Dry mouth right after I take it, not that bad. Uh...that's it.

2. I would not want to try to manage Bipolar II without medication, no. It is physical in origin and medications have been shown to help significantly. The best treatment is therapy plus medications.
posted by kathrineg at 11:43 AM on September 18

Ah, yes, it makes me a little sleepy which is why I take it at about 8pm. Free sleep assistance, woohoo!

Adderall and bipolar are not necessarily a good combination, that might be one of the reasons why your therapist is nervous...
posted by kathrineg at 11:47 AM on September 18

2-do you think it's possible to manage your bipolar II with CBT, mood journals, therapy and the like?

After years of having bipolar and being given coping techniques for depression and anxiety only, I found studies and information about bipolar that went well beyond what I'd ever been told. Examples: those with bipolar are generally much more affected by sleep disturbances, schedule disruptions, alcohol, and lack of sunlight than your average depressed Joe. Miss a few hours of sleep, or even throw your sleep schedule out of whack, and you risk triggering a mania.

Whether or not you decide to take medication, knowing bipolar-specific triggers and coping mechanisms will be a huge help for you. Here's a bipolar support page packed with helpful information about self care that goes beyond CBT and the like.
posted by moira at 12:12 PM on September 18

I'm on a low dose of Lamictal right now, titrating up. I'm taking it in conjunction with an SSRI for depression, not for bipolar II. No side effects yet. I spoke with several people beforehand about it. I was able to find 3 other people who take it either with an SSRI or as a mood stabilizer - all of them like it, and none have experienced any side effects. I also know one person who takes it both as an anti-convulsant and as a mood stabilizer, at a higher dose. She likes it a lot and doesn't notice any side effects. However, she has some sort of heart problems (I'm not clear on what they are), and her cardiac doc wants to keep her dose slightly lower than what seems to be optimal for her mood, so there's some difficulty there - I don't think this applies to the general population, however.
posted by insectosaurus at 1:35 PM on September 18

Anecdata time!

depakote: I was on depakote for a long time, and I was one of the few people that tolerated it (mostly) extremely well. No weight gain. Good energy level. Not too fuzzy, kept my cycling from getting wacky. It did make ADHD stuff more prominent, and I went on a brief course of lexapro at one point for a couple months, but that was really about it.
A caveat is - I was on a lower-than-average dose. My psychiatrist has been willing to work with me on having a lower medication dose, since I've been committed to doing therapy every week, exercise, and quitting various self-medications in the last few years.
Also, when she had me on a high dose at first, I WAS having cognitive problems - specifically being dangerously forgetful about things. This led to lowering the dosage.
Unfortunately, after a long time, I started developing some weird tinnitis/hearing loss. Quit Depakote, then it got better, and I'm no longer terrified of going deaf.

lamictal: I take it now. It's great! okay, my acne is a little worse, and when I got sick and started having funky rashes, the doctor freaked their shit out (that whole "deadly rash" scare). I'm on a fairly low dose.
Titrate up really slowly. Consider doing it even more slowly than that intro 5-week pack they give you. That for me is the big thing about avoiding side effects .. when I very first took lamictal, they wanted me on a big dose ASAP, I went up too fast to too much, and had real unpleasant side-effects (intense cognitive dysfunction - getting lost and not being able to find my own home, horrible).

re: your question #2 .. I think that you can definitely manage it to a large degree, well, depending on how serious it is .. BUT for me, I do therapy, journals, exercise, vitamins, and try to take care of myself, and have had some long great times without medication .. yet it's like there's this little dark cloud in the sky that never quite dips below the horizon.
This last year, I've had a really, really, really bad year, and so I went back onto medication (lamictal), since no matter what I was doing, I just couldn't escape the creeping feeling of another mixed episode on the horizon.
It's hard to accept the idea of spending a lot of your life on medication, but eventually I had to rationalize it as another part of the self-care regimen of chronic illness.

you say your therapist is recommending meds - is your therapist also your psychiatrist?
posted by circle_b at 1:43 PM on September 18

Lamictal was my wonder drug. I had no side effects on it and it worked like a dream.

Thankfully it has been several years since I have needed medication, but if I ever needed to go back on that one again I wouldn't hesitate.
posted by St. Alia of the Bunnies at 2:05 PM on September 18

I have bipolar disorder and ADHD. Currently I take lamictal, vyvanse, and seroquel (and I recently stopped klonopin).

Two caveats: 1. I switched from lithium to lamictal after the lithium's side effects were too much for me, so by comparison I have found the lamictal to be amazing. 2. It's hard for me to know for sure which medication is causing what side effect, but based on when I started each and what happens when I adjust my dosages gives me a pretty good idea.

Here's what I've experienced:
- I've always had bad skin, but it's possible (probable) that the lamictal makes it worse.
- I had some hair loss last Spring during a period of really intense stress but it stopped once that passed (and I also started taking fish oil supplements, which might have helped).
- Unlike some other posters, I have not found it to be sedating and in fact have been told by a few different medical professionals that it is 'activating.' I take it in the morning with the vyvanse so I really have no idea.
- I started on one generic (Teva) and then switched to another (Dr. Reddy's) when I moved pharmacies. I was fine on the Teva but had a bad reaction to the Dr. Reddy's (really intense drowsiness, headaches, generally feeling "out of it" -- the same way I felt when I went a few days without taking it, by the way, so don't do that) and now take the brand.
- When I first started titrating up I would get headaches in the afternoons, but I've been at a stable dosage for almost a year and those have stopped.

There's apparently a new XR formulation which I just got a script for, so I might switch over to that. (Like some other posters, I notice when it's wearing off.)

Overall, I think it's a good drug. In the past 5 years I have been on probably 15 different medications in different combinations and lamictal is above and beyond the most 'innocuous' of any of them in terms of side effects and effective for me as a mood stabilizer.

Ironically enough, I know that it's working because I constantly think about stopping it. ("I feel fine! I don't need all these medications! I miss the old, exciting me!" -- when in reality, I feel fine because of the medications.) That's the harsh reality of bipolar disorder -- you will always be trying to convince yourself that the wonderful manias you lose with medication are worth the depression trade-offs, and the manias are not as destructive as they actually are. Put me in the camp that believes bipolar disorder needs some kind of chemical intervention. I have damaged my life in huge ways whenever I've been unmedicated.

That's not to say CBT or other types of therapy and lifestyle changes don't matter. They matter a whole lot. But for me at least, I need the medication to bring me down (or up) to a point where they can actually make a difference. If your moods are so out of whack that your thought processes are being affected, therapy will not be as helpful.
posted by cosmic osmo at 2:50 PM on September 18

I can't speak to the meds--I'm on Seroquel--I can answer the second part.

2-do you think it's possible to manage your bipolar II with CBT, mood journals, therapy and the like?

When I'm not on my meds, I think that it's totally possible to manage without chemical intervention, because hello, I am doing just fine.

When I'm on my meds, I can't imagine that it's possible to manage without medication, because I realize how much stuff I fucked up when I wasn't on mine.

Like everyone else, I'm not saying that those things don't help, but for me, at least, they're inadequate on their own.
posted by MeghanC at 8:17 PM on September 18

Lamictal rocks, I have been on it for four years now. It costs a mint, even after having gone generic, so I hope you have good insurance. At this point I have taken over $10,000 worth of the stuff. I am up to 400 mg a day now. No side effects worth writing home about, except I do feel dizzy if I don't take my morning dose.

Do not take this drug if you plan on becoming pregnant. Research has shown an increased risk of cleft palate. I took the drug while pregnant with my daughter (they hadn't finished the study at that point), and she was born just fine. However I did have very low milk supply and my daughter was quite sleepy and fed poorly. None of the experts I talked to knew if Lamictal would have an effect while nursing. Regardless, I would avoid in both scenarios now.

It's not a magic bullet. You will still have polypharmacy. I have fish oil supplement, vitamin D supplement, multivitamin, plus klonopin prn on top of Lamictal.

All that said, I feel fantastic and I'll keep up this regimen until my insurance company refuses to pay and I decide to quit my $3k/year drug habit.
posted by crazycanuck at 8:52 PM on September 18

(Background: I have been diagnosed with ADD several times, starting when I was eight, and then with an underactive thyroid in my teens. I am not bipolar.)

I want to second the advice to have your thyroid checked out if you haven't already. I recently spent a few months on Lexapro after developing general anxiety and suffering panic attacks. It turned out that, despite having taken thyroid hormone supplements for the past 15 years, my levels had gotten out of whack and my meds needed to be adjusted. The improvement was immeasurable.

I found Adderall to be a very, very difficult drug to use while dealing with anxiety disorder. It's essentially an amphetamine and the side effects can mimic those of panic/anxiety and caused me, more than once, to spiral quickly into a full-blown panic attack.
posted by lalex at 12:54 AM on September 19

Thank you so much everyone for your answers and sharing your experiences. To answer a couple questions people have raised:

the Adderall is absolutely essential for me to function every day. The difference between me on it and off it is incredible. I'm a full time student and have a small child still at home and without my Adderall I would get absolutely nothing finished and hardly anything started. Giving that up is not an option if I want to stay married and be a parent effectively.

My therapist is not a psychiatrist, but her minor was in pharmacology and spends nearly all her CEU focus on medication management. I trust her judgement and haven't had my psychiatrist question any of her suggestions (yet). She has a good working relationship with my psychiatrist so I feel like I have a team approach to managing this.

I understand the feeling during a manic phase of "I"m just FINE-I don't need any help!" and then crashing pretty severely and I honestly don't think that's what's going on here right now. I am slowly cycling downward where my anxiety is ramping up and I respond with anger rather than rationally. I'm just trying to evaluate any and all options for managing this cycle.

Thanks again everyone!
posted by hollygoheavy at 12:19 PM on September 19

Sounds like the bases have been covered, but I just thought I would add my experience with Depakote. I took my first dose in the evening, as my doc instructed. I then proceeded to have one of the longest nights of my life. I became extremely agitated, frustrated and fidgety, and needless to say I was awake all night. I had to coach myself, almost minute to minute, that the medication would wear off eventually and I just needed to hang in there until it did. My mind was really racing, so time seemed to pass very, very slowly. By late morning I felt much better, and gratefully slept all day. And never took the stuff again.

I now take Lamictal, though not for Bipolar disorder. After 12 years of trying various depression meds, I added Lamictal to Effexor - my miracle combo. I've had no burn-out, I have my libido back, and I feel like a completely new person. Like I'm finally ME. I did gain weight, which I am not happy about, but it's infinitely preferable to living a basically sexless life. I will gladly take these meds every day for the rest of my life, if I have to.

I wish you well.
posted by shifafa at 3:23 AM on September 20