Going through depressive cycle. Need help.

Hey all,

I posted a couple weeks ago about lithium and how long it would take to reach full effects. I have been at my therapuetic level (.8-.9) for approximately four weeks now. I started out with 23 great days in a row. That was the longest stretch of "good days" I've had for almost three years. I thought I had finally found the solution to my cycling depression and anxiety. I was living my life again and my parents said I was truly joyful on the phone for the first time in years. That being said, Thursday and Friday, and the start of today (although not quite as bad) have been awful again. Very depressed, hopeless, and anxious.

Are relapses like this common in the beginning of Lithium treatment. I know from former posts that the full effects can take 6-8 weeks. I've also heard they can take even longer.

Any support on this would be extremely helpful and appreciated. Thanks so much!

-golden goose

The site you recommended, psycheducation.com, as you said, has a lot of information about this, about what your psychiatrist believes you might have, which is depression, with no mania or hypomaina (but still seen as bipolar) which you said you believed you had.

That conditioned is called “Depression Plus” on that same website.

It seems to me, you talk about taking a series of anti-depressants which didn’t work, and sometime later taking lithium, which you are on now but after 23 days quit working.

In that same psycheducation.com website, on the first page, just a few sentences down from the top, it highlights two items: “Diagnosis” and “Treatment.”

Under “Treatment”, 10 or so paragraphs from the top of that section, I found a large boxed graph, and several paragraphs under that is had headline:

“Principle B: Evidence-based Med’s”

And the 2nd paragraph under that it says: “The main medications for bipolar disorder are called “mood stabilizers.”

The next headline 5 or more paragraphs under that says, “Principle C: Beware of Antidepressants" and notes:

“Depression is the big problem in non-manic versions of bipolar disorder (these versions include Bipolar II, and “softer” versions, as described in the Diagnosis section of this website). Thus many people with bipolar mood problems are offered antidepressants at some point. Seems logical, yet research does not strongly support this approach. Worse yet, antidepressants can make some people with bipolar disorder worse. Therefore most mood experts recommend using antidepressants only when one or several of the mainstay medications, the “mood stabilizers” discussed below, have not been able to prevent or relieve a bipolar depression. In other words, there is general agreement that antidepressants are not the first thing to turn to in the treatment of bipolar depression.”

So that does address the difficulties you’ve had with anti-depressants.

Under that above headline, 10 or so paragraphs down, there is a big red, blue and yellow chart. A topic of two below that is a headline which says,

“It Depends On Where You’re Starting From” under which it states:

“For people whose predominant symptom is depression, as is almost always the case in Bipolar II, then their “mood stabilizer” ought to have plenty of antidepressant `oomph'.... Here are some mood stabilizers that have well-accepted antidepressant “oomph”, yet are not antidepressants themselves.

lithium
• lamotrigine (formerly Lamictal, now generic)
• olanzapine/Zyprexa (capitalized is the U.S. trade name)
• quetiapine/Seroquel

Under that same above head line (“It Depends On…) he says,

“But as you can see, I emphasize lithium and lamotrigine over the rest. This helps avoid the “atypical antipsychotic” group, which includes olanzapine/Zyprexa and quetiapine/Seroquel, as well as risperidone and aripiprazole/Abilify, and now the new guy, lurasidone/Latuda. My patients usually don’t like to stay on those medications long-term, for two reasons. First, even the new “second generation” or “atypical” antipsychotics still feel like antipsychotics to a lot of people: they slow down thinking, especially. Sometimes that’s a very good thing, and when that effect is necessary, these are great options. But I generally prefer to use medications that when they are working well are still basically “invisible” to the person taking the medication: you feel “normal”, not “drugged” in the least.”

So, you said you’re on Lithium, which is what I’m on at 600 mg. But I’m also on an anti-depressant, Mirtazapine 7.5 mg., and I’m diagnosed with bipolar I, which has the full mania. But you say, you don’t have the reduced mania of hypomania for the full blown mania like I can have without medicine, which is Bipolar I.

But you do say your depression is very significant. So it sound like the Lithium might help, may take a some more weeks longer as others have suggested. My lithium at 600mg didn’t take long at all to take effect, so you’ll have to determine what’s going on with that.

It might can be increased, whatever you and your doctor think.

All of this is just what I’m quoting from the website you suggested. I would read over these items to see what you think.
I don’t have any experience with this situation other then with my Bipolar 1.

HT: I should have put "Golden Goose" at the top of my above post about the "psycheducation.com" website.

I was referring to you when I said, "So it sounds like the Lithium might help, may take some more weeks longer as others have suggested" for you said it might take Lithium 6-8 weeks to work. I also thought you would know more about this than I did, and was wondering what you thought about the psycheducation.com data.

You said you hardly refer to websites, but I use them from time to time because I often don't know a whole lot about the subject.