anti-depressants for people who can't take them?

December 17, 2011 8:44 AM

anti-depressants for people who can't take them?

the short version:

i'm bipolar (currently taking lithium, and buspar for anxiety). i need an antidepressant. i cannot tolerate antidepressants (either for the side effects or because they throw me into mania/mixed epis). reducing my lithium dose has only helped a marginal amount and i have a long history of being unable to tolerate other mood stabilizers.

YANMD, but what are my other options? i feel like i'm just running out of ways to control this.

(yes, exercise, diet and sleep are all under decent control)

posted by unlucky.lisp to Health & Fitness (20 answers total)

I've found that at this time of year, the short days and lack of sunlight make many people, including me, unhappier than usual. The simple treatment for this is some form of light box designed for SAD. An alternate to a light would be to take vitamin D supplements. Perhaps this might help a little this winter, but I don't have any ideas for year round solutions.
posted by sciencegeek at 8:49 AM on December 17, 2011 [2 favorites]

There are non-SSRI anti-depressants that are sometimes better for persons who experience mania from SSRIs. But you likely spoke to your pdoc about those.
posted by ClaudiaCenter at 8:53 AM on December 17, 2011

I'm bipolar as well, and I can't take antidepressants for the same reason. Have you already tried Lamictal (lamotrigine)? That one has been a life-changer for me and for many others. Another one to ask your doctor about is Tryptan (tryptophan). I've been on pretty much everything and now have struck a pretty effective balance (on five different meds). MeMail me if you want to talk more about it.
posted by mireille at 9:02 AM on December 17, 2011

I don't have a history of depression, but I get a bit sad and crave sunlight when I don't get enough. If I take a hefty dose of vitamin D3 each day, then I don't crave sunlight and I don't get sad. Could be helpful. I take about 4500 IU per day which is way more than the RDA. You might want to get a test every 6 months or so to make sure you're not getting too much. Everyone is different, and lots of scientists think the RDA is way too low.
posted by zeek321 at 9:29 AM on December 17, 2011

Hasn't your doc tried lamictal yet?

Also fish oil tablets and getting into sunlight will help, but the first place I would start is the lamictal assuming you haven't tried that yet. Ask your doc!
posted by St. Alia of the Bunnies at 10:23 AM on December 17, 2011

The evidence for fish oil helping depression is a bit shaky, but you could give it a shot.
posted by gregr at 10:28 AM on December 17, 2011 [1 favorite]

Nthing the vitamin D. My results came back astonishingly low yesterday and my primary care physician said (as she explained how much she wants me to take for the rest of the winter) that it should help with my mood (which is highly reactive to light changes.) She also suggested that if I do have to go on thyroid medication (for my currently not-quite-needing-meds-yet hypothyroidism) that it should help with my mood, too. I'm BPII and haven't really been able to shake the depressive thing - a "normal" mood, as opposed to hypomania or variously mild to severe depression, is pretty much absent from my life story after the age of 12.

And yeah, it's possible prescriptions you can try, but that's a psychiatrist question. Lexapro doesn't make me jittery or manic if I've got the right amount of Trileptal in me, but Celexa was a nightmare - and I can't find anyone who can explain why the difference between them should matter. Meanwhile, I know people who say the atypical antipsychotics changed their life; Abilify made me nauseous and Geodon gave me pre-diabetes, so... YMMV.

(My doctor assured me that at this time of year, at my latitude, neither sunlight nor milk will be sufficient for my vitamin D needs. If you're in New Mexico or something, though, you might not need the cute little pills.)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 10:28 AM on December 17, 2011

In addition to the above, you could try acupuncture and Chinese herbs.

One herb in particular, albizzia, has a long tradition of treating conditions like depression.

Here is a link to some info on that herb.
posted by umamiman at 10:43 AM on December 17, 2011

Response by poster: re: lamictal -- it gives me the death rash. :(

fee, that's nice to know about your experience with lexapro - i just had a terrible experience with celexa.

i am currently supplementing with vitamin d, even though i live in vegas - god help me if that isn't enough!

i have some experience with APs, but have not yet tried abilify - the risk of nausea might be worth it! (can't be worse than the other crap i've been through, i guess.)
posted by unlucky.lisp at 11:23 AM on December 17, 2011

I think the way to visualize the vitamin D thing is that the more deficient you are in it, the less effective sunlight is at keeping your mood positive. So while living in a sunny area reduces the effects, they are still there.
posted by gjc at 12:17 PM on December 17, 2011

I know light therapy was mentioned already, but there's some interesting stuff being done with light therapy for both depression and bipolar @ columbia u. and in chicago. Google Michael Terman chronotherapeutics or http://www.chicagochronotherapy.com/basictypes.html
posted by hungrytiger at 12:50 PM on December 17, 2011

Perhaps 5HTP?
posted by Ms. Moonlight at 1:19 PM on December 17, 2011

The recommended antidepressant to prevent mania/hypomania for bipolar people is bupropion (aka Wellbutrin) and it and all of its extended-release formulations (so you only have to take them once a day) are currently generic in the US.

And I though I don't recommend changing up what sounds like an otherwise stable regimen, there are a few anticonvulsants you could try out (it's a common alternative these days to lithium) like oxcarbazepine or carbamazepine or divalproex.

Good luck!
posted by honey badger at 4:40 PM on December 17, 2011 [1 favorite]

A friend of mine just started cranial electrotherapy stimulation treatments a few times a week for their depression, rather than fuss around with SSRIs.
posted by carsonb at 5:44 PM on December 17, 2011

I'm on lithium and recently dropped Trileptal (which was holding diwn the high end) and Celexa (which only worked for PMS anymore) so I could start taking Emsam, an MAOI delivered in the form of a daily patch. The major risk with MAOIs you take orally, aside from drug interactions, is the fact that eating or drinking anything with tyramine (aged cheese, tap beer, I think tofu, god knows what else) could send you into a potentially fatal hypertensive crisis. But at the lowest dose of the patch, you're immune to that. (If you have to go up they get cautious and tell you to observe ordinary oral MAOI precautions. Patient opinion on this seems to be mixed, going by the internet.)

Emsam can induce mania, like other ADs. But it immediately brought me out of a no-more-trileptal-induced hypomanic episode that had been startung to feel dangerous. Over the last four months I've had some insomnia (strangely unaccompanied by unbearable fatigue), but no hyperactivity or unusual spending or buzzing feelings or episodes of thinking that I have suddenly become much more insightful. The great good thing is that I can feel anxious now and also feel other things at the same time.

It's pretty new, and most doctors associate MAOIs with insane dietary restrictions, so a lot of pharmacies don't carry it. And if you ever lose your insurance, apparently it'll cost $600 a month instead of $10. And you might want to wear a medic id necklace or something so EMTs know not to give you epinephrine or Demerol or cough syrup. But this stuff has been a godsend for me. Seems to be the drug I've been looking for for 11 years. In conjunction with a low dose of lithium, of course.
posted by Adventurer at 6:25 PM on December 17, 2011

In addition to CES, there is transcranial magnetic stimulation.
posted by provoliminal at 7:41 PM on December 17, 2011

Things that have been suggested to me in the past year by my mental health team:

Biggish doses of Vitamin D (1000 IU/day)
SAD light + never, ever wearing sunglasses
5HTP
Primrose oil
Organic wild salmon oil

I've done the vitamin D, the no sunglasses and the oils. It seems to have helped? But we keep fiddling with the other meds, so I don't even know for sure any more.

I couldn't get enough good information about the 5HTP to feel comfortable taking it. My psychologist was really pushing for it but wasn't entirely sure how it would interact with Wellbutrin, my psychiatrist wasn't sure it was a real thing (!), my family doc reserved comment. I didn't want to figure it out on my own. I'm not bipolar, but I have a past episode of AD induced mania, so I try not to fuck around. You might be able to find someone who has a better handle on it, though.
posted by looli at 7:56 PM on December 17, 2011

Response by poster: thanks everyone! i feel like i have a few more possibilities to take to my pdoc now, and some new things to research.
posted by unlucky.lisp at 8:57 AM on December 18, 2011

Hmmm... This is a bit left-field, but the mention of Light therapy makes me think of Dark Therapy.

So, part of the current problem is that anti-depressants are setting off mixed/manic states? There's increasing evidence that pitch darkness, for around 8 hours a night, can diminish manic symptoms and rapid cycling (wearing Amber safety glasses for about an hour or two before total lights out, can also block blue light getting to your eyes, which is what triggers the 'this is not night-time').

It's worth trying, because, if that could get you more stable, that might open up more treatment options.
And, definitely combine that with a bit of light therapy in the morning, & vitamin D.
posted by Elysum at 3:40 AM on December 19, 2011 [1 favorite]

Don't give up! I can't take SSRI's but I do a lot better on the SSNI's like Pristiq. I also take fish oil, which I consider a supplement. I am really careful with the herbal medications, I had a really terrible reaction to SAMe a few years back, so I always consult my doctor before trying anything.
posted by heatherly at 11:17 AM on December 19, 2011