Be direct. Tell your doctor about the depression symptoms you may still be experiencing. Zoloft can be effective for some people, but if you are still having depression or anxiety symptoms, then by definition the current treatment is not fully effective. Take a Beck Depression Inventory (http://www.orlandocvi.com/documents/BeckDepressionInventory1.pdf ) and rate it, then bring it to your appointment. Ask the doctor about FDA-approved treatments for bipolar depression (like Seroquel or Symbyax), or medicines that have been shown in research studies to work better than a sugar pill (e.g., Lamictal, lithium).
Dear isntitironic, Seroquel is one of the best-studied treatments for bipolar depression. If you are taking it in combination with a stimulant, that ought to counteract sedation. Some people think the XR formulation of Seroquel may cause less drowsiness than the immediate release form. In bipolar depression, the antidepressant target dose was 300 mg/day in the research studies that were done. Combining Lamictal with Seroquel also can be a potent and synergistic pairing, so I would not think of them as mutually exclusive options.
There has been some discussion posted lately about the use of antidepressants and best approaches for treating bipolar depression. Here is a short video link discussing these issues that may be informative.
Hello all, The American Society for Clinical Psychopharmacology (ASCP) is a professional organization of psychiatrists with interest, knowledge and expertise in psychopharmacology. They maintain a website which includes a link for patients seeking help in finding practitioners, which may be useful....so I am passing this along.
Hi Snowy, Looks like The Doctor's Channel hasn't yet posted all the video that was shot. The only 2 FDA-approved medicines for bipolar depression are Seroquel or Symbyax. No antidepressants per se are FDA-approved for bipolar depression -- some have been studied and found to work no better than a placebo (notably, Paxil), some have been studied and found to work about the same as lithium or Depakote alone (notably, Wellbutrin or Paxil), and most have not been studied in comparison to a placebo at all (Lexapro, Effexor, Pristiq, Remeron, Cymbalta, Zoloft, Celexa, Prozac with anything other than Zyprexa). So, traditional antidepressants may be useful for bipolar depression, but they have not been well-established. Yet doctors and patients alike assume that they treat bipolar depression the same as unipolar depression -- same notion as thinking an antibiotic treats all forms of bronchitis (bacterial, viral, fungal.....). Strangely, most psychiatrists don't seem to know, or care, that Seroquel or Symbyax are the only 2 FDA-approved drugs for bipolar depression, and instead seem wedded to their own beliefs that other medicines may work better. Apart from Seroquel or Symbyax, there are some data to support the use of Lamictal, especially when combined with lithium. If antidepressants are used, Wellbutrin is among the better-studied ones (but again, data show that adding it to lithium or Depakote does not make for a higher response rate than using lithium or Depakote alone). There are many "novel" treatments that have been studied and shown to work better than placebos for bipolar depression -- among them, the stimulalnt Provigil; the Parkinson's drug Mirapex; and the ALS drug riluzole. Abilify and Geodon and Risperdal and Consta all have been shown NOT to be any better than a placebo for treating bipolar depression.
Bipolar depression unfortunately remains one of the harder aspects of the illness to treat, largely not because of the risk that antidepressants throw people into mania (far rarer than we once thought), but because they often simply don't work very well.