RE:

Sometimes a comment comes along that is easier to answer as a post,or is better to answer as a post because the points are really valid.  Today we have one of those.

Jean Grey wrote:

I don't think that most of the older, typical antipsychotics are that bad for weight gain compared with the atypicals. Clozaril is another story, it is pretty bad- but so is Seroquel. Just a thought- I wonder if Ensalm is the right drug for you- as it is very strongly dopaminergic, and you seem to respond to large doses of the antipsychotics which are dopamine antagonists. And to really play devil's advocate- if you are rapid cycling, should you be taking an antidepressant? But I know that I need antidepressants, so I am just tossing that out. But research does not support the use of antidepressants in bipolar.

First, thanks for the reassurance about weight gain.  I just don't want to go there.  Although sometimes I have had weird weight gain.  I gained a great deal on lithium really quickly (60 lbs in 4 months) and then on Depakote which is supposed to be much worse for weight gain I only gained 8 lbs in 6 months.  I gained on regular Seroquel but lost it when I changed to XR and dropped Depakote.  So who knows.

I need to be on antidepressants.  I had been on so many before diagnosis that they were stopped then and I didn't use them for years and I was continually very depressed. In fact it was when I was reading about bipolar and realizing that this is what I had and then that people with bipolar shouldn't be on ADs that I managed to get it together long enough to see the guru who diagnosed me.  The problem was that off of them I stayed mixed all the time because I was depressed every minute of every day.  So we tried again.

 I was ok on Remeron for a while then had some problem with it and changed to imipramine.  I was on it for years and it was fine except that I had to mess with the dose all the time.  Emsam works well for me because it is more dopamergic; the other antidepressants trigger mania because tweaking serotonin or norepinephrine is bad for me; it makes me manic.

You are right that my need for dopamine and my need to antagonize it contradict each other.  Perhaps it is is different receptors?  Emsam is very specific what receptors are targeted and they may be different than the anti-psychotics hit.

I think that if I asked my dr., and I probably will since now I'm curious, she'd say that this is just another one of the many ways that my body reacts to medications oddly.  I may need huge doses of anti-psychotics only because smaller ones aren't absorbed or something.  We know for sure that my body processes meds differently than most people; there are few meds that I don't need either a really high dose or a really low dose and even then it's hard to get the response we want (ie sleep from something most people find extremely sedating).  I need an MAOI because other antidepressants either cause cycling, make me very sick (Wellbutrin; I lost 15 lbs in 6 weeks back when I only weighed 120 to begin with) or require a dose range that is very tight and leaves no room for an increased dose if severe depression occurs.  I've had that horrible reaction to the progestin in the Mirena, akathesia from surgery/Reglan we think, and after my hysterectomy they gave me the first dose of morphine after waking me.  I remember a lot of people telling me to breathe and to stay awake and an ambubag on my face.  I thought it was a memory of being put under but instead it was the morphine put me back out and they had to reverse it and lower my dose a great deal.  I didn't even react normally to vaccines.  After finding out that I wasn't immune to chicken pox after having pertussis we ran titers and while I was immune to everything my immunities were on the low end of normal and one  was barely normal.  So it's probably related to those things. 

I just wish that what used to work still did.  But they don't so we do this instead.