Medication Change

[Katiee]

I've been feeling awful the past 6 months or so. My moods change very rapidly. I'm up and down, down and up. When I'm up, I feel fine, I laugh, I smile. When I'm down, I feel empty, depressed, hate myself and everything/one, have thoughts of self harm, and have actually had a couple of episode of self-harm.

I also have Borderline Personality Disorder.

I'm on Fluoxetine 40mg (Prozac) right now and have been for the past five years or so, before prozac I was on Citalopram for around 4/5 years, but switched because I didn't feel it was having an effect on me anymore. The doctor said at the time that after a while anti-depressants can stop working because the body gets so used to it.

I don't feel Prozac is having ANY effect on me now. I feel like I might as well be taking a placebo.

The question I have is that I'm not constantly depressed, but constantly up and down - so I was wondering do you think I could ask the doctor about mood stabilisers instead of anti-depressants? I've never been on mood stabilisers before.

I'm seeing the doctor on 30th April for a medication review, so I though it'd be a good time to bring it up.

[sherlock holmes]

Yes I would certainly ask about mood stabilisers. As their name suggests they are better at stabilising the ups and downs of mood, whereas an antidepressant will only work to lift your mood.

You mentioned you have BPD, have you received any talking therapy for this? Lots of studies show that the most effective treatment for BPD is therapy like DBT and CBT where you learn skills to manage your moods and so on. Can you ask about that also? Medication alone can only do so much.

[Katiee]

Yeah, that's why I thought I need a mood stabiliser rather than an anti-depressant right now.

What are the most popular mood stabilisers?

I've been offered CBT before, but haven't taken up the offer because I tend to find it a bit too gruelling for me, like when I used to be with the mental health services. Now my GP deals with me instead and have been doing really well. Although they've always said I can be referred back to the mental health team at any point.

[Steel Maiden]

What are the most popular mood stabilisers.

It's hard to say which ones are the most popular but valproate and lithium are well-known but have their own side-effects (generally, lithium has more side-effects). Antiepileptic and antipsychotic medications are quite often used as mood stabilisers and each have their own side-effect profile.

I think you should bring this up with your doctor as I have read of successful treatment of BPD-related mood swings with mood stabilisers (even though they are different to bipolar mood swings in duration and presentation).

There are a lot of mood stabilisers out there, but as I said it is a matter of balancing the side-effects, efficacy, and tolerability of each, and that is something your doctor will hopefully do.

If you do talk to your doctor, and s/he does prescribe you medication, I am happy to tell you anything helpful I know, although I am not a doctor, just a pharmacology student.

[Katiee]

Thank you so much for the information.
I will let you guys know what, if anything, I get prescribed.

Are anti-depressants useless for rapid changing moods?

[tiptoes]

Depends on the cause of the rapid changing.

I had an unstable changeable mood due to depression, anxiety, stress and blood sugar changes and an antidepressant stabilised my mood and allowed me to put other things in place that also helped me stabilise my mood.

That was quite a long time ago now I am very sensitive to antidepressants and a small doses are sufficient to cause rapid changes in my mood.

And these are just two causes, there are many other causes of rapid changing moods some of which will be made better by antidepressants and some that will be made worse.

I have now found long term stability on an anti-psychotic and previously have been on an anti-epileptic. When I started to have issues with antidepressants I though I would never find a medication that would help with my depressive episodes, but eventually I got there. I hope you get some stability too, there are many many options out there.

[sherlock holmes]

It's best to ask all your questions to your doctor, and to let him decide which medication would be suitable for you.

[random.swirls]

Also who is the med review with?

Some GPs won't make big med changes without input from a psychiatrist. That said it is definately worth talking it through.

Have you tracked your mood?

[Katiee]

It's with my GP. I really need something changing though.
No tracking my mood would seem helpful to show the doctor.
Are there any mood tracking apps you can recommend?

[tiptoes]

I use Moodscope which was recommended to me by my psychiatrist. I'm not sure if this comes as an app, I have only used it on the website.

It asks you to rate how much you feel various feelings such as irritability, motivation etc from very slightly/not at all to extremely and based on your responses if gives you a mood score as a percentage.

I like it as it require you to go oh I am feeling mildly/moderately depressed or anxious or whatever. It also helps me realise what areas my mood are affecting and improves my ability to put things in place to improve those areas. The one downside to it is it will only put one score a day on the graph you can do it more than once a day it just doesn't store it. For me when my mood is fairly stable recording my mood once a day is sufficient and times when my mood is varying during the day I just add any repeat scores to the comment section for that day. So this is really much of a negative for me.

[Arienette]

I am on quetiapine as a mood stabiliser - and I have found it really helpful lately.

If you're a female of child bearing age they can be reluctant to give you a mood stabiliser as the effects on a feotus can be really bad. even if you say there is no way you'll be having a baby in the next 5-8 years they still are reluctant.

but antipsychotics often have a mood stabilising effect.

i hope they manage to help you .

[Steel Maiden]

Tbh my neurologist initially prescribed me valproate even though I'm a female of child bearing age. Although but it took me explaining that I'm asexual and have zero interest in love/relationships and sex.

But valproate has a relatively high incidence of causing neural tube defects in the foetus.