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Antidepressants vrs. Seroquel XR
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gingerladypet posted:
Dr. G. I have recently been taken off Seroquel XR 600mg. due to health concerns. I was taking it with 600mg. trileptal, 100mg lamictal and continue to take the 2 drugs with Klonopin to sleep. I don't sleep well and I am depressed. What antidepressant will work for me either with the aforementioned drugs, as a substitute for one or all three, or as an adjunct medicine? Also, my mind races so much, I talk to myself constantly. I have great body energy and move around a lot, but I have been this way all my life and it is the only good thing in all this. I need an antidepressant since being off Seroquel and also something for sleep. Thank you for trying to help me.
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Joseph F Goldberg, MD responded:
Dear Gingerladypet,

The three FDA-approved antidepressant treatments for bipolar depression are Seroquel (300 mg/day), Latuda (20-80 mg/day), or Symbyax (Prozac plus Zyprexa). These are the gold standard drugs and should be considered carefully before trying other experimental approaches to bipolar depression.

Dr. G.
 
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gingerladypet replied to Joseph F Goldberg, MD's response:
Thank you very much for taking the time to address my concerns. Seroquel is out because it causes me to eat and even eat in my sleep. I have gone through hell getting off a 10-year bout with Seroquel and Seroquel XR, and will never consider it again. The weight gain was enormous and unacceptable. Zyprexa also causes uncontrolled eating and weight gain. I will give Latuda a try if there is no (or very little)weight gain side-effect. Wouldn't Prozac alone help? I took it years ago and it seemed to help. (That was long before I was ever involved with these heavy psych. drugs.) One Dr. told me I've changed my brain now, and I can never go back to successful use of any SSRI. Is this true?
 
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Joseph F Goldberg, MD replied to gingerladypet's response:
Dear Gingerladypet, Expert panels frown on antidepressants without a mood stabilizer in bipolar I disorder for concerns they can destabilize mood, plus, as I have said many times here, there are no bald published data showing that they work in bipolar depression. One can either take medicines proven to work and try to manage side effects if they occur or else gamble with unknown or unproven experiments like Prozac alone. Dr G
 
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Joseph F Goldberg, MD replied to Joseph F Goldberg, MD's response:
Also...not sure why a doctor would tell you that an SSRI has "changed your brain" and that means an inability to go back on them. Medicines don't "change" the brain any more than glasses change eyes -- they regulate symptoms. That advice sounds inaccurate to me.

Dr. G.
 
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gingerladypet replied to Joseph F Goldberg, MD's response:
I have been told by my present Dr. that you are right, the antipsychotic drugs I have been taking does not mean that I can never return to a simple SSRI. I don't believe that Bipolar 2 (rapid cycling) was EVER the correct diagnosis and was made years ago in one hour without proper intake information or previous history. Since I was a child I have struggled with difficulty sleeping, a little anxiety, and depression. Quite a bit of this was caused by mistreatment during my childhood both at home (mother) and in a very strict Catholic school. Things got worse during puberty. I am now 58 years old, happily married, with a very successful grown daughter and none of the stressors of my youth. I want to get off all anti-psychotics and take 1 or 2 meds just for a good night's sleep and depression/obsessive bad thoughts about my childhood).
My Dr. is trying to wean me off Seroquel first (then we will work on getting rid of the Trileptal , Lamictal and Klonopin). She is starting me on Doxipin as she weans me off 100 mg of Seroquel but I am skeptical about Doxipin. What do you think? Also, I am starting with a highly-reputable psychotherapist in a week and hope that he will help with processing these childhood obsessive thoughts.
 
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Joseph F Goldberg, MD replied to gingerladypet's response:
Dear Gingerladypet, It's hard to offer an informed opinion about a medicine for a particular patient without having a confident diagnosis, and harder still in someone I haven't examined myself. But, generally speaking, doxepine, an old tricyclic antidepressant, is rather sedating and so therefor is sometimes used at low dose as a sleep aid, and at higher doses such as yours for depression and anxiety. Lamictal has value for preventing (more than treating) depression in bipolar disorder and isn't so well established in unipolar depression. Trileptal was at one time hypothesized to have antimanic value until randomized study found it to be the same as placebo since it's seldom used nowadays by doctors who follow the medical literature. Good luck! Dr G
 
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gingerladypet replied to Joseph F Goldberg, MD's response:
Thank you so much for your advice. I will keep posting as I attempt to wean off these drugs and see how Doxipine handles my sleep/depression issues. Hoping for the best, for sure! Again, thank you.