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What antidepressants can be taken with lithium?

3 Answers

masso 15 Oct 2017

"Best bipolar depression medications

There is no single best medication for bipolar depression.

Individuals all respond differently so it is not possible to make any such definitive statement.

In general, well regarded bipolar depression medications that will usually be effective against depressive bipolar symptoms and whose use is supported by good clinical evidence include:

Bipolar medication 1
1. Lamictal

2. Latuda

3. Seroquel

4. Antidepressants – Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin) are examples of antidepressants that may be prescribed to treat symptoms of bipolar depression.

Expand...

Although there is no definitive “best” bipolar depression medication, there are established treatment guidelines from the experts that suggest some bipolar drugs should be front-line (treatments of first resort) medications in cases of bipolar depression.

For example:

1. The American Psychiatric Association (APA) suggest:

“The first-line pharmacological treatment for bipolar depression is the initiation of either lithium or lamotrigine (Lamictal). Antidepressant monotherapy is not recommended. As an alternative, especially for more severely ill patients, some clinicians will initiate simultaneous treatment with lithium and an antidepressant.”

2. According to The Expert Consensus Guidelines:

“A combination of medication and psychotherapy is recommended
for bipolar depression. The doctor may also use medication
alone at first, especially if the person has severe or psychotic
depression and finds it hard to participate in therapy. Milder
depression can usually be treated with lamotrigine or lithium
alone. Combination treatment with lithium plus an antidepressant
or lamotrigine may be needed for more severe depression. For
psychotic depression, an atypical anti-psychotic is usually combined with an antidepressant, lithium, or lamotrigine.
Antidepressants should always be given with a mood stabilizing
agent in bipolar disorder to avoid triggering a manic episode and
should be avoided if possible in rapid cycling patients.”

3. The Texas Medication Algorithm Project (TMAP) bipolar disorder algorithms suggest that medications for bipolar depression be tried in the following sequence:

Lamictal
Start with lithium or another anti-manic. If lithium is insufficient, add Lamictal.
If no history of mania, start with Lamictal.
If there is no response, start quetiapine (Seroquel) or a olanzapine/fluoxetine combination (i.e Symbyax).
If there is no response try a combination of lithium, Lamictal and/or Seroquel, OR Symbyax.
The sequence continues until all drug options are exhausted, along with ECT.

Overview of bipolar drugs
In summary, medication for bipolar depression comes in several types of bipolar drugs that to a greater or lesser extent target the depressive pole of bipolar symptoms.

The mood stabilizers:
First and foremost lithium, although some anticonvulsant drugs, originally developed to treat epilepsy also have mood stabilizing properties. For example, Lamictal, Depakote, and Tegretol.

Antidepressants:
These can include SSRIs such as Prozac, SNRIs such as Effexor, and other well known antidepressants such as Wellbutrin. The key point is that these conventional antidepressants should not be used to treat bipolar depression unless used in combination with a med that is a mood stabilizer or an anti-manic agent. This is because antidepressants on their own can cause a switch into the manic state.

Atypical Anti-psychotics:
These are second generation anti-psychotics with different (and supposedly more benign) side effects than the original anti-psychotic medications. Some, such as Geodon are anti-manics, while others, such as Seroquel and Latuda have an antidepressant effect. Some atypical anti-psychotics such as Zyprexa are approved as maintenance treatments for bipolar disorder.

Main takeaway:

NOT ALL BIPOLAR DRUGS ARE PROVEN TO BE AN EFFECTIVE MEDICATION FOR BIPOLAR DEPRESSION."

Source: bipolar lives.com

I suggest you speak yo your Dr. about what combination is good for you.

Votes: +1
masso 15 Oct 2017

btw; I also suffer from Bipolar disorder.

Stephen Treloar 15 Oct 2017

Well masso just about covered everything. I'll only add that Lithium is primarily a mood stabilizer not a usual monotherapy and is normally taken with an adjunct anti depressant medication.

Stephen Treloar 15 Oct 2017

Likewise.

WildcatVet 15 Oct 2017

***"Antidepressant drugs may be useful during the depressive phase provided the antidepressants are used with a mood stabilizer. Mood stabilizers are very important in people with bipolar disorder. Without a mood stabilizer, antidepressants may trigger mania in people with bipolar disorder. (Keep in mind that people with bipolar disorder II may be misdiagnosed with depression only because they do not experience full-fledged mania. If these patients take antidepressants without mood stabilizers, it can trigger a manic episode.)"***

Votes: +0
smileyhappy 15 Oct 2017

Everyone is different! I had a major depression and a psychiatrist prescribed me seroquel. That gave me a psychoitic episode and I ended up at a hospital for 6 months before they found a good combination for my major depression. I have been on lithium and manerix! They are a great combination together. They are older meds but work great! I have been on this since 2007. I have my life back can handle anything and no longer am depressive or anxious! I hope you find your combinations to great health! For me depression runs in my family and I need to stay on these meds for no recurrence! I wish you the best!

Votes: +1
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