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Brad The Therapist
Brad The Therapist, LCPC
Category: Mental Health
Satisfied Customers: 549
Experience:  10 years of experience in working with youth and adults
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I have been told I am bipolar 2, before it was just

Customer Question

I have been told I am bipolar 2, before it was just depression. I am now on 300 lamotrigine and 300 bupropion and added lexapro which I think I will not continue. I exercise but still gaining some weight, and the big prblem is the Anhedonia just wont lift. it has been years.
What to try?
Submitted: 6 years ago.
Category: Mental Health
Expert:  Brad The Therapist replied 6 years ago.
Brad The Therapist :

Thank you for your post. Have you considered therapy? If not, why not? Also, when did your symptoms first started? What was happening in your life during this time?

Customer:

Yes I have been doing therepy for the last year or so.

Brad The Therapist :

Has it been helpful?

Customer:

I cant remember when I was not depressed or taking meds since I was 35

Customer:

for family issues yes

Customer:

May ask what are your credentials

Customer:

And I will apologize in advance for all the mistakes I will make typing

Customer:

I have had a few tramatic incidences in my life that made it a bit worse

Brad The Therapist :

I have a Master's in Psychology and in Psychiatric Rehabilitation. I'm in graduate school for a doctorate in psychology as wel

Customer:

Do these degrees give you knowlage on psychophamicolory?

Customer:

logy

Brad The Therapist :

Yes, my current training for a doctorate requires me to take classes in psychopharmacology

Customer:

My younger brother was dignosed with bipolar 2 with psychotic features

Customer:

he was a achoholic

Customer:

so is my other younger brother and he to is depressed

Customer:

I am now with my family and granddaughters and should feel great

Customer:

It seems when I exercise to much I become even more depressed and my immune system tanks

Customer:

I am 52, never been married, had 4 disfunctional relationships

Brad The Therapist :

When you exercise, you may feel a "high" because of the neurotransmitters firing and when you top, the neurotransmitters are depleted so you may feel depressed.

Customer:

same with to much coffe,. I have switched to green tea

Brad The Therapist :

caffiene also has the same effects as well.

Customer:

I beleive most of my problems fit well in to one of the catagories of attachment theroy

Customer:

anyway the Anhedonia

Customer:

I am sick of being blaaa

Brad The Therapist :

tell me more about the attachment theory

Customer:

cold mother, never said Iove you, showed her love through food mostly. Never was proud of us but what we did. that sort of thing.

Customer:

In my relationships fist thing I wanted was sex

Customer:

so they were never going to last

Customer:

that is the way I got my comfort, my antidepressant , if you will

Brad The Therapist :

Do you have contact with your mother, currently?

Customer:

when I lost my first girl friend I was never the same, I was told, I suppose it was a bit freudian , losing my mother type thng

Customer:

Oh yes

Customer:

we speak on the phone for a few min, then I talk with my father much longger

Customer:

some important info you may need

Customer:

I have been living in Asia for the past two years

Customer:

most recently cambodia, Project manager

Customer:

I cannot be sure about thier medication , but I am pretty confident it is real

Customer:

I have come back becasue my younger brother died on fathers day

Customer:

I am the oldest so....

Customer:

I am greiving , but I am well aware of the difference between that and depression and anhedonia

Customer:

oh yeah , I also have tinnitus, not sure which drug does it

Brad The Therapist :

I want to make sure I understand you correctly, you feel your unresolved issues with your mother is affecting your anhedonia. Is that correct?

Customer:

I am not sure that is the case, my understanding is that it is a symtom of depressioin, and may it could have something to do with it. But there have been times when I feel "OK" but never "Carpe Diem"

Customer:

I definatley feel better when I am working,

Customer:

or have a job

Brad The Therapist :

What is your hypomanic symptoms like?

Customer:

If I have any at all it would come out in the for of anger.

Customer:

Irritation

Customer:

I felt like Bupropion exsaserbated that at one point

Customer:

now that I am here it seems ok, but still seem to have put on a few pounds and have to force myself to go to the park or out to dinner etc...

Brad The Therapist :

So currently, your symptoms has decreased for the time being

Customer:

the depression has come to visit twice one day each.

Customer:

the anhedonia still here

Brad The Therapist :

I find it interesting that you are on two antidepressants and one anticonvulsant (mood stabilizer)

Customer:

well I have been treating myself, no persciptions needed in Cambodia, and my therapist has a social worker back ground

Customer:

My understanding that lamictal is supose to be the cure all for bipolar

Customer:

if I am

Customer:

Bupropion, well I have stopped smoking for quite some time now.

Brad The Therapist :

Yes, lamictal is used as a mood stabilizer, but not a cure for bipolar

Customer:

the lexapro well , I just thought I would try

Brad The Therapist :

Bupropion is used to quit smoking but acts like an antidepressant/antianxiety as well

Customer:

yes I know

Customer:

and according to many , bupropion and lamictal help bipolar, but you are the expert

Customer:

Hell I am not even sure I am bipolar, but the therapist seems to think so

Customer:

perhaps she could give you a better read on me

Brad The Therapist :

Have you tried just taking Lamictal, only?

Customer:

yes, but I may not have given it a fair shot

Brad The Therapist :

Is your therapist can be better at diagnosiing, than I since I would need to see you in person to do this

Customer:

well then I guess I am bipolar

Customer:

the only time I was truly happy very happy was when I was dating a lady I met in Phnom Penh ,from spain

Customer:

that lasted about a month

Brad The Therapist :

If you take both a mood stabilizer and an antidepressant, this may actually increase irritability

Customer:

I was on only lamictal then

Brad The Therapist :

what made you take the antidepressants

Customer:

depression

Customer:

research

Customer:

I was on prozac for years

Customer:

I wish I would have just upped the dose before messing around with this other stuff

Brad The Therapist :

What do you think you will do now?

Customer:

as far as meds?

Customer:

or life?

Brad The Therapist :

yes, meds

Customer:

thats why I am here

Brad The Therapist :

I believe you answered your own question when you wrote that you felt better when you only took lamictal

Customer:

maybe give the lamictal another month, stop the lexapro stay with the bupropion

Brad The Therapist :

Is there a doctor you can consult there in Cambodia?

Brad The Therapist :

A psychiatrist on this forum would say the same thing here as well

Customer:

yes, there are a few. I went one a few times he was from belgum I beleive. I was taking prozac the time with only 100 lamictal, he suggestion was stay with it

Customer:

there is another I will see when I go back

Customer:

So you can not even give hypotheticals on here

Brad The Therapist :

My clinical judgement at this point is to stick with one class of medications. If you are on both a mood stabilizer and two antidepressants, in my clinical experience, I have seen patients experience less side effects when they are on either a mood stabilizer or an antidepressant, not both. My recommendation for you is to obtain a clear cut diagnosis first than choose between the two classes

Customer:

hmmm

Brad The Therapist :

What do you think? Do you have any other questions?

Customer:

well I am not sure what side effects you are talking abuot, but I will see a doctor I guess

Brad The Therapist :

Anhedonia (although a symptom of depression) can be a side effect

Customer:

of shich?

Customer:

which

Brad The Therapist :

The side effect could be from the combo you are taking

Customer:

I have had anhedonia through all combinations

Customer:

ok

Customer:

well I will take only lamictal and mess with the dose

Customer:

what do you recomend to your bipolat patients as a first line of treatment

Customer:

bipolar 2

Brad The Therapist :

First line of treatment is medications, and supplement medications with therapy.

Customer:

which medication

Customer:

I am guessing you are going to say "it depends"

Brad The Therapist :

Since I'm not a psychiatrist, it is difficult for me to say which medications. Anticonvulsants, such as lamictal is typically used for treating bipolar

Customer:

well how do I chat with a Psychiatrist?

Customer:

here

Brad The Therapist :

psychopharmacology is difficult because it really depends on the person, body type, allergies, etc

Customer:

or is that possible

Brad The Therapist :

I cannot say as I would need to meet you in person, first, to do a complete assessment. I am not able to determine if you have bipolar 2, depression, PTSD, unless I do the assessment in person

Brad The Therapist :

do you have any other questions?

Customer:

Well as my reason for coming here was to get an answer on medications, which it sounds like you can not answer as an expert or probably legally, I am going to have to ask that you not charge me for this. Thank you in advance.

Brad :

I will opt out for a psychiatrist to answer your question regarding medications.