Danger! Lithium Orotate

If you do a basic Google search for this supplement, it will bring up things like:

  • Lithium orotate works!
  • Lithium orotate is NOT a prescription drug!
  • It is NOT toxic like lithium carbonate! (1)

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Well, what do you think when something sounds too good to be true?
It probably is.

Over the counter supplements can be extremely dangerous when put in the wrong hands. Diet pills are a good example. So many diet pills are put up and pulled down from the market in any given month, and serious side effects are later reported: heart failure, anxiety, liver or kidney problems. Sure, people abuse over the counter supplements because they think they are safe, but some over the counter supplements can do far worse than a prescription medication.

This article is probably going to piss some people off because I’m fairly anti-over-the-counter-supplement, unless I need something for my cough or flu. Vitamins are always a good idea, but you should still make sure you need them. Sometimes more is too much. This is my side, and many medical professionals, sides of lithium orotate. I’m not saying it’s going to immediately kill you, it may work, but tell your doctor, as with any supplement you may be taking because they can interact with other medications and dietary supplements too. I can’t stress that enough. Also, it isn’t allowed in Canada.

Let’s get started.

What is lithium orotate?
Another way of delivering lithium. Lithium carbonate is generally used in bipolar disorder in doses of 300mg and up. They claim that lithium orotate goes “straight to the brain”(2) but this is untrue because medications have to be processed by the body, mainly liver and kidneys, and the blood-brain barrier has it’s own defence system, which basically means, drugs don’t go directly to the brain. The barrier is needed to keep the brain and central nervous system healthy. It treats medications as an enemy, not allowing them through. (3)

Okay, so lithium orotate is just another method of delivering lithium to the body in hopes of it helping bipolar disorder, depression, anxiety, and whatever else.

Lithium orotate is a salt of lithium and orotic acid. There are no systematic reviews of the efficiency of lithium orotate for any condition. In 1979, it was found that lithium orotate was more dangerous to the kidneys than lithium carbonate.(4) Don’t forget about the thyroid! Lithium effects that, too.

Lithium attacks the kidneys. I know this because I have diabetes insipidus. People complain of symptoms such as urinating too much and being constantly thirsty on lithium orotate. I am not saying its causing diabetes insipidus in all the users, but that’s not necessarily good for you. Ok, I’ll stop giving you my opinion and give you some facts.

Lithium Toxicity from Internet Dietary Supplement (5)
The internet has made it easier to get supplements, and easier to overdose on them. An 18 year old woman presented in the emergency room after taking 18 tablets of a lithium orotate based product, each containing 120mg of lithium. She had a low lithium level, was vomitting, and given IV fluids. 90 minutes later, her lithium level was higher, and she was transferred to a psychiatric ward with stable vital signs, but also lithium toxicity.

Lithium orotate is not FDA approved. (6)
There is no research of it being used on humans, but it is available online to anybody.

Lithium orotate releases more lithium into the body than lithium carbonate, bringing us back to kidney issues. Kidney disease, kidney failure, and death. Talk to your doctor. Don’t believe everything you read, take caution, and read the bottle. Unlike a prescription bottle, whose to say if the information is accurate?

“Controversial claims regarding the actual benefits and side effects of lithium orotate are widespread. Much of the debate centers around the last recorded study done on rats in 1979 by Smith and Schou. In the study, equal amounts of all three lithium derivatives were given to the rats. The results indicated that lithium orotate was not eliminated by the rats’ kidneys, unlike the other two brands.” (7)

So what am I trying to say?
Lithium orotate could help you. Or it could not. It could damage your kidneys or kill you. If you need to be on lithium, get it through your doctor or psychiatrist, not off the internet. It’s been used since the 1970’s. You need kidneys and the risk of damage is lowered when a physician is having regular levels drawn and monitoring your treatment.

(1) http://mysite.verizon.net/res003jh/lithium-orotate/
(2) http://www.marsvenus.com/p/lithium-orotate
(3) http://www.health.umn.edu/research/corridors/brain/blood-brain-barrier/index.htm
(4) http://www.ncbi.nlm.nih.gov/pubmed/34690
(5) http://www.ncbi.nlm.nih.gov/pubmed/18072162
(6) http://www.ehow.com/about_5531532_lithium-orotate-information.html
(7) http://www.ehow.com/about_4614151_side-effects-lithium-orotate.html

Break

Taking a break from blogging for a bit as I’ve fallen into depression and don’t really want to do anything. I could change my mind tomorrow, or next week. We’ll see how things go. Thanks everyone. I’ll be back eventually.

Involuntary Patient

Sorry, I had some stuff I was going to post yesterday but I had great fun going through the ER trying to find a new psychiatrist (mine retired) and ending up involuntary committed to the psych ward. I got out this morning after a 30 second “chat” with the staff psychiatrist, who referred me to someone not taking patients, back to the start.

I don’t see why I have to do all this by myself, or why I was admitted at all. I asked to speak to a psychiatrist about my medications, the doctor (it was his first day) demanded blood work and an EKG, which I had last week. I said no, I just want to talk to a psychiatrist. He asked if I ever attempted suicide.

If he saw my arms, he’d know, but I wear long sleeves. I said, once, when I was 17.

Apparently that made me a DANGER TO MYSELF and refusing the testing made me PSYCHOTIC so he served me with a Form 42 and would not let me talk to a patient’s advocate, which is illegal. 

They denied me my regular doses of Xanax and I went into withdrawal quickly.They referred me to this psych and that one, none are taking patients. I left with no med changes and with all of my patient rights violated.

I was not psychotic (I was saner than he) nor have I hurt myself in years (May 12, 2011). My last suicide attempt was in 2001.

I give up.

The Devil and God are raging inside of me

Hell on Earth: Bipolar “Mixed States”

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Bipolar I, and Bipolar II (was just updated in the DSM5), all tend to come with a symptom that isn’t quite mania nor depression. It can also be called dysphoric mania. It’s like taking the two, throwing them in the blender and see what you get. You can be depressed with a lot of energy (example: racing mind, many suicides are attempted in mixed states) or manic with depressed thoughts.(1) I find myself incredibly irritable and angry during a mixed state.

 

Sounds fun, eh?

It’s not, at all, even closely remotely to being fun.

 

The DSM-IV defines a mixed episode as a period of at least 1 week in which the criteria for both a major depressive episode (MDE) and a manic episode are met nearly every day. During a mixed episode, an individual experiences rapidly alternating periods of sadness and irritability and of euphoria accompanied by symptoms of a manic episode”(2)

 

Some symptoms include: agitation, insomnia, appetite dysregulation, psychotic features and suicidal thinking. At least 40% of those with bipolar disorder have at least one mixed state in their life. There is a greater rate of suicide, substance abuse (which definitely won’t help it!) It is literally mania littered with depression.

 

Those with mixed symptoms are generally diagnosed at an earlier age with rapid cycling, suicide attempts, more irritability and Bipolar 1. It affects more women than men.

 

Mixed episodes are difficult to treat, both states have to be identified, and works best if caught early (and can prevent future mixed episodes from occuring.) The treatment, for the most part, is medication, like Lithium or Depakote. Antidepressants can make the mixed state worse, or blow up into full mania. Mixed states have also been mistaken for ultradian cycling bipolar disorder. Mood stabilizers, antipsychotics (preferably atypicals) help with mixed episodes, and ECT(3) can also be used to zap you out of it. An antidepressant might be temporarily used, but as I said, it can do more bad than good.

 

Over the years, I’ve had a few mixed episodes. I have bipolar type 1 with rapid cycling. After ECT, my highs and lows weren’t as drastic, but I still get mixed states.

 

If you’re in a mixed state, or someone close to you thinks you are, please, go to a hospital before it gets worse.

 

 

  1. http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml

  2. http://newsletter.qhc.com/CP/CP_BMS2.html

  3. http://www.webmd.com/bipolar-disorder/guide/mixed-bipolar-disorder

More than just a lift: Off label use for Antidepressants

A brief history of antidepressants

Antidepressants were accidentally discovered by chance in the 1950’s.(1) While seeking out a medication for schizophrenia, the main diagnosis at the time, drugs were found that could “tweak” the balance of the brains neurotransmitters (even though they didn’t really know how it worked at that time) Patients that weren’t schizophrenic got worse, but other patients, depressed (“neurotic”) had bouts of euphoria.

In 1955, the miracle cure Tofranil (imipramine) was patented, and others started coming up with similar tricyclic(2) antidepressants. Relief came to 60-80% of the patients, but there were terrible side effects and tricyclics can cause heart problems, much moreso than many other psychiatric drugs. In 1987, Prozac, the first SSRI(3) was created, with the same effectiveness and less side effects.

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Wellbutrin (Buproprion)

Wellbutrin was created as an atypical antidepressant but they found it helped aid people in quitting smoking, in which it is called Zyban. (When I took it, I got so anxious, I started smoking again after 6 months smoke free!) It is a mild stimulant and is the fourth most prescribed antidepressant in the USA.(4) It is very effective and can be an add-on drug to an antidepressant without worrying about serotonin syndrome, a dangerous syndrome caused when there is too much serotonin in the brain. Often, it is prescribed because SSRI’s can effect sexual functions, and this can help get them back, as well as lose some weight while you’re at it!

Zoloft (Sertaline)

Zoloft is used to treat depression, obsessive compulsive disorder, panic disorder and social anxiety. It is the second highest selling antidepressant in the USA(5) and is approved for children and adults. It works in a similar fashion to tricyclic antidepressants and some say it helps control urges, such as binging and purging. I took it for bulimia, but it made me incredibly violent and agitated, so I was taken off it ASAP.

Off-label Uses 

Off label uses of antidepressants are on the rise. One in five doctors prescribing antidepressants are not psychiatrists(6) and aren’t being used for psychiatric purposes. They can help with: fatigue, non-specific pain, smoking cessation, headaches, abnormal sensations and premenstrual tension.

 Prozac, Zoloft and Paxil are approved for premenstrual tension. Wellbutrin for smoking cessation and Cymbalta for diabetic neuropathy, chronic musculoskeletal pain and fibromyalgia. Some antidepressants control menopause symptoms as well as hormones do, and if you switch it around, beta-blockers help anxiety. Many medications for schizophrenia were used off-label for bipolar disorder or to augment an antidepressant, and are now on the market, FDA approved for both, such as Abilify, Seroquel and Zyprexa. Many antidepressants can help with pain (migraines, for example) such as Elavil (amitriptyline).

 Hell, Viagara is even prescribed to some women to improve their sex lives too!

  1. http://www.time.com/time/health/article/0,8599,1952143,00.html

  2. Three-ring chemical structure

  3. Selective Serotonin Reuptake Inhibitor

  4. http://en.wikipedia.org/wiki/Bupropion

  5. http://en.wikipedia.org/wiki/Zoloft

  6. http://depression.about.com/b/2011/08/09/off-label-antidepressant-use-on-the-rise.htm

  7. http://www.consumerreports.org/cro/2012/05/off-label-drug-prescribing-what-does-it-mean-for-you/index.htm

  8. *Note: Off-label does not mean illegal. It is generally not FDA approved for that specific condition. Also, antidepressants don’t have the abuse potential of many other meds.

Mania slowly eats your brain (seriously)

Mania, the horrible mistress of bipolar disorder. We sometimes take it for granted in it’s early stages, hypomania, but in a full blown out manic episode, everything can go to hell. Many people accidentally kill themselves in manic episodes. But did you know, that during an episode, you’re killing your brain?

“Episodes of mania and depression may cause damage to learning and memory systems”(1)

Long term patients showed more cognitive impairment than those younger, or newly diagnosed. Bipolar disorder and time are not your friends. After 5-7 years, the newly diagnosed showed some cognitive impairment.

It can be blamed on medications, but that’s untrue. They can cause cognitive slowing but they aren’t a culprit. Some medications even repair parts of the brain, and are considered to have neuroprotective properties.

The brain breaks down as the disease goes on, and it isn’t able to process information the way it used to. (Remember, bipolar is a kindling disease, if left untreated, it just gets worse and worse, and the damage increases per episode)

“People with bipolar disorder suffer from an accelerated shrinking of the brain”(2)

Gray matter in the brain is lost during an episode, in the areas of the brain that control memory, face recognition and co-ordination.

“Evidence has been overwhelming that bipolar disorder is a disease of the brain, like Parkinson’s or MS”(3)

Those with bipolar disorder have enlarged ventricles in the brain and extra white matter, for example. Impaired awareness (50% of those with bipolar disorder are aware of their disease, diagnosed or not) is because of decreased activity in the pre-frontal area. This is similar to a stroke victim.

Results of MRI’s from the mentally interesting and people without mental illness show that those without mental illness had more gray matter in their brains.(4) Gray matter is consisted of nerve cells. An essential amino acid, called NAA, was monitored in bipolar patients and the amount decreased as the illness progressed, which indicates damage to neurons. These findings are comparable in Alzheimer’s.

In conclusion, if you’ve been diagnosed with bipolar disorder and want to make the best of your life, take your medications, live a healthy lifestyle, don’t drink or do drugs and learn some insight to get proper treatment before an episode happens.

And just remember this: What goes up, must come down.

  1. http://www.healthyplace.com/bipolar-disorder/articles/brain-damage-from-bipolar-disorder/

  2. http://www.sciencedaily.com/releases/2007/07/070720103036.htm

  3. http://www.pendulum.org/disease.htm

  4. http://www.ehow.com/about_5245785_effects-bipolar-disorder-brain.html

The Stigma of Bipolar Disorder

This is based on personal experience and the experience of others. If you want to add your own experience, please do so in the comments. Bipolar disorder has a stigma attached to it, and it needs to go away! The more that speak up, the better!

Mental illness has carried a stigma (a mark of disgrace or infamy; a stain or reproach, as one’s reputation) not only with family, friends, and the general population, but also with doctor’s, nurses and pharmacists, for as long as it has been around. Which is a very long time. They don’t throw us in snake pits anymore or burn us as witches, but the effects still hurt.

Bipolar disorder is a disease of the mind. The current theory is that it is a chemical imbalance with serotonin, dopamine and GABA. In a nutshell, a typical bipolar person swings between depression and mania, of varying degrees. We are said to be more likely to do stupid things in a manic or mixed episode, but everybody does something stupid. I am pro-medication and pro-treatment, and yes, bipolar disorder can be controlled with proper medication, exercise, diet and a good support system. We aren’t all raving lunatics. (Look at the state of the world today, we’re the sane ones!)

(1) We often get told we’re overreacting. Duh, that’s a symptom. One of my favourite things I hear is “Everybody has mood swings sometimes”. These aren’t mood swings they are mood episodes. Everybody’s mood swings, but not to the extent of that of a bipolar person. Our mood swings/episodes can be set off/triggered, but a lot of the time, they just come out of nowhere. Most people have a reason for having a mood swing, like losing someone close to them, a change in health, or circumstances.

People hear “bipolar disorder” and either don’t know wtf it means and you have to explain “It’s manic depression” and they assume you’re crazy, batshit, bonkers. I had a girlfriend ask if I was dangerous to other people. It didn’t work out. I’m not a “sociopath” (the accepted name nowadays is “Antisocial personality disorder) and there are very few bipolar people that fit the criteria for a serial killer!

I rarely get told I’m normal, maybe its the tattoos and sometimes crazy hair, but people with mental illness hate being told “You seem so normal.” Do you have any idea how much work it is to seem so normal? It’s a daily job. We aren’t “What You See Is What You Get”, nor is anyone. Don’t even get me started on asking if it’s “that time of the month”, either!

When I took Lithium, the second I said “Lithium” to a doctor of any kind, except a psychiatrist, because they’re more understanding (or should be) they’d immediately snap into attention and ask if I was bipolar. Lithium is often used to augment antidepressants and has a stigma attached. They would treat me differently. When I used to self harm, and needed medical attention, I was treated like a criminal in the ER.

Here’s a story. I used to be a competitive horseback rider but one day my horse refused a jump, I fell off, came down hard on it, and took the impact with my right upper arm and shoulder, protecting my head and neck, even though I was wearing a helmet. I thought nothing was wrong, so I put the fence back together, got on the horse, and finished my lesson. The next day I couldn’t grip with my right arm, and went to the ER. I had a fractured humerus and a shattered shoulder.

The doctor’s prescribed NSAID’s. I couldn’t take them at the time because they interact badly with Lithium. So I went without painkillers for a week until I saw an orthopedic surgeon. It was Sunday, my appointment was Tuesday. I didn’t want to wait in the ER because I needed a better painkiller, so I went to a walk-in clinic. I had been popping Tylenol 1’s (tylenol with 8mg codeine) but the pain didn’t fade. I was wearing a sling, so I gathered my meds (key note: when you see a doctor, always bring your medications or proof of medications, it makes life a lot easier) and my mom took me to a clinic because I hurt too much to drive.

The doctor was fine until he saw my medications and reason I was there. He made me submit to a drug test and yelled at me to see my GP (general practicioner). It was a Sunday. I told him the drug test would show benzos, as I take Xanax, and opiates, as I had been taking over the counter tylenol with codeine. He basically accused me of drug seeking and he yelled at me when the hospital was too busy to send my file. He did not touch my arm. “Hmm, you’re bipolar, so you must abuse substances”. He eventually gave me 10 Tylenol 3’s, and I left crying, from the pain and how I was treated.

I’ve had “friends” make jokes about self harm and suicide. I’ve had my parents not understand that my moods were cycling and the meds weren’t working. I was even fired by a psychiatrist once because I made a shitty attempt at suicide. I’ve been told to pull myself up by the bootstraps (whatever the hell that means) and get my shit together.

I’ve included these links below because I find they are helpful in explaining your diagnosis, and how you should be treated.

  1. http://bipolar.about.com/od/stigma/a/10-bad-things-not-to-say.htm

  2. http://bipolar.about.com/od/stigma/a/dont-challenge-bipolar-diagnosis.htm

  3. http://bipolar.about.com/u/ua/stigma/hurtfulthings.htm

  4. http://www.news-medical.net/news/20120913/Stigma-impacts-functioning-in-bipolar-disorder.aspx

  5. http://www.psychologytoday.com/blog/bipolar-you/201002/dispelling-stigma-revealing-your-bipolar-truth

  6. http://www.crazyboards.org

 Don’t let others get you down! You are a person too, probably a better person!

Fun Facts About Bipolar Disorder

I hate being bipolar. It’s awesome!

Well, we know that people with bipolar disorder are definitely mentally interesting (I much prefer that to mentally ill) but here are some fun facts I’ve pulled together. I’m writing this for a bit of a laugh, why so serious?

Lithium can make concrete harder and can power small batteries. (Also, when I broke my jaw at age 18, I poured my lithium capsules into cranberry juice as that was the only way to take it, my jaw was wired shut, and it turned the cranberry juice green!) Also, lithium is extremely toxic to humans in it’s normal form. When it is converted to a salt (lithium carbonate) it is safer. (Same with table salt!) Nobody knows exactly why lithium carbonate stabilizes the mood.

Bipolar disorder is often misdiagnosed. In women, they are more likely to be diagnosed with depression (unipolar) and men are more likely to be diagnosed with schizophrenia. I’ve actually been diagnosed with both at different times, but eventually, they just said, “you have bipolar disorder type 1 and schizotypal personality disorder”.

Nobody knows what the hell schizotypal personality disorder is. I went to a walk-in clinic because I had a UTI and the doctor asked why I was taking all these psychiatric medications. I told him my diagnosis and he said “oh, schizo-TYPICAL personality disorder” and I then argued with him for a good ten minutes, because schizo-TYPICAL personality disorder doesn’t exist. It’s schizo-TYPAL. I eventually got my damn antibiotics and he wrote down on my file that I’m schizo-TYPICAL. Is that a good thing or a bad thing?

Us bipolar folks are said to be the hardest to treat. Why, thanks! I guess it’s because we’re all over the goddamn map. Over half of those with a bipolar diagnosis have attempted suicide, and 1/5 do so successfully.

Manic episodes can be brought on by irregular sleeping patterns. Too much sleep? You can end up manic. Not enough? Same thing. I once worked at a restaurant, doing 8-12 hour shifts during a manic episode. I didn’t sleep for 3 days, got some sleep on my day off, and then resumed. I was full blown manic and I don’t remember the details, as with most of my episodes, but I ended up on lots more medication.

Rapid-cycle bipolar disorder means that you have more than 4 episodes a year. Only one manic episode is needed to diagnose somebody as having bipolar disorder. Ultradian (episodes lasting hours to a couple of days; may be phased out in the DSM-5) cycling is extremely controversial and is often mistaken for a mixed episode. (And mixed episodes can also been mistaken for ultradian cycling)

The higher you swing, the harder you fall. (True!)

The hippocampus, which means “sea horse monster” is bigger on the left side of a bipolar brain.

Mania is not always fun. It can be downright devastating. A lot of people with bipolar stop taking their meds when they get hypomanic, thinking that they’re normal and don’t need them, and WHAM, get him with mania. Some things manic people like to do: Spend every cent in the bank, have sex with anyone that has proper ‘equipment’, abuse substances (self medicate), drive recklessly and don’t think of consequences.

Many people with bipolar disorder are more creative than the rest of the population, in such things as art, writing, and more. Some people refuse treatment because they don’t want to give up their gift.

Bipolar disorder doesn’t discriminate on race, religion, sex, gender or age.

 And finally:

We are dazzling, passionate, and adventurous lovers.

Scary Side Effects Part 3 – Antidepressant Induced Mania?

In the 1980’s, bipolar disorder was called manic depression and was a feared word. It was changed to bipolar (two poles) later in the 1980’s and diagnosed more and more. But often, the patient will present with depression symptoms, and get prescribed an antidepressant, which can cause horrible hypomanic, mixed, and even full blown manic episodes. This can be because we go to the doctor when we feel down, not up. After years and years of being bipolar, I know when to see a doctor for mania. (Also called “insight”)

 Mania can feel great, but it can also be dangerous. Impulsivity, people giving away all their money. Then comes the inevitable crash. Many bipolar suicides are accidental during a mixed or manic state. Some may say that antidepressant induced mania is just a side effect, it isn’t indicative of bipolar disorder. There are a lot of controversies about it.

 Some people put on antidepressants are bipolar, but it can have the same effect on somebody who isn’t bipolar. Their moods start cycling(1) and they start showing clinical features and meeting the diagnostic criteria of bipolar disorder. Is this a lasting effect? It can be. The criteria for bipolar disorder is one manic episode, although most have several.

 The findings of this study confirm that treatment-induced mania is a clinical phenomenon that belongs within the bipolar spectrum rather than a coincidental treatment complication, and that it should be placed under ‘bipolar disorders’ in future classification systems.” (1)

Statistics

Thirty-five percent of the patients had a manic episode rated as likely to have been antidepressant-induced. No variable was a predictor of vulnerability to antidepressant-induced mania. Cycle acceleration was likely to be associated with antidepressant treatment in 26% of the patients assessed. Younger age at first treatment was a predictor of vulnerability to antidepressant-induced cycle acceleration. Forty-six percent of patients with antidepressant-induced mania, but only 14% of those without, also showed antidepressant-induced cycle acceleration at some point in their illness. (2)

 Antidepressants can be devastating to someone with bipolar disorder. It can send the patient into a mixed or manic state. Some people are able to tolerate antidepressants such as tricyclics, MAOI’s, or Wellbutrin, but SSRI’s and SNRI’s have a tendency to push you over the edge. However, this may not be true at all!

 

Myth or Mania? Controversy

Sometimes the myth is just an incorrect use of language. Many people have detected a temporal association between the use of tricyclic antidepressants and mania in patients with bipolar disorder, but no mechanism is indicated. There is an assumption the association could extend to all antidepressants despite chemical and pharmacological transformations.(3) 

This association between mania and SSRI’s hasn’t been found. Studies find that the switch rate is no different than that of normal bipolar disorder when the patient is on an SSRI or SNRI.

 Revisiting the Controversy

Mania is likely to be antidepressant-induced and not attributable to the expected course of illness in one-third of treatment-refractory bipolar patients, and rapid cycling is induced in one-fourth. Antidepressant-induced mania may be a marker for increased vulnerability to antidepressant-induced cycle acceleration. Antidepressant-induced cycle acceleration (but not antidepressant- induced mania) is associated with younger age at first treatment and may be more likely to occur in women and in bipolar II patients.”(4)

 

Conclusion

Antidepessants can make a bipolar patient exhibit signs of mania. When the antidepressant is stopped, the mania generally goes away. Antidepressants are often prescribed for those that are bipolar, for the symptoms during depression. (I take Luvox for Pure-O OCD). However, a mood stabilizer with an antidepressant effect such as Lamictal or Lithium would be more effective than adding on antidepressants.

 

There are controversies, so keep that in mind. Also, with any medication and diagnosis: YMMV (your mileage may vary)

 

 

  1. http://psychcentral.com/news/2011/10/13/antidepressant-induced-mania-similar-to-bipolar-disorder/30300.html

  2. http://www.ncbi.nlm.nih.gov/pubmed/7625459

  3. http://thelastpsychiatrist.com/2005/07/do_antidepressants_induce_mani.html

  4. http://ajp.psychiatryonline.org/article.aspx?articleID=171161