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Have depression and bipolar. Not cured by citalopram. Family history of depression. Required treatment?

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First off I am a female, 39 years old. I've over my life suffered from what I figured was just depression but masked it well. I have a family history of depression. 6 months ago I went to my doctor, finally couldn't mask it anymore. I had been treated with depression, using Citalopram, first time ever taking meds for such reason. It made my symptoms worsen and I weaned myself off. My mother was an extreme case of Bipolar. I never wanted to admit it could be that. After doing much research and looking over my life and the similar patterns, I believe I have a milder form of Bipolar and the depression I'm suffering from is linked. I've read how taking antidepressants can worsen the effects. Also the side effects of medications worry me due to my experience taking Citalopram, I was very sluggish, zoned out, sugar cravings(gained 10 pounds) felt horrible, constantly yawning( not good at work), began having suicide thoughts, isolated myself more so than usual. I've looked up different meds and am interested in Wellabutrin, says for depression but known to help mild bipolar tendencies and quit smoking aid. I am a moderate smoker. Side effects look
bearable. Lithium side effects terrify me. Lamictal, says for bipolar specifically and less life interfering side effects. Any input on these medications? I haven't actually been diagnosed but am in the process of trying to get on track one way or another. I will be seeing my family doctor and want to be as much informed as possible before doing so. Thanks in advance :)
Posted Fri, 22 Mar 2013 in Bipolar Disorder
Answered by Dr. Shoaib Khan 1 hour later
Hello and welcome to XXXXXXX

Thank you for writing to us.

First of all, a diagnosis has to be made and once confirmed, we will have to treat you accordingly. Each individual will require a different treatment regimen.

The normal regimen of treating a patient with bipolar disorder, also requiring anti-depressants is by first initiating a mood-stabilizing drug, after which an anti-depressant is added. The reason for this is because, most patients with bipolar disorders who also suffer from depression, usually have a manic or hypomanic episode because of the treatment with only anti-depressants. Thus, guidelines were issued in 2002 (by APA), to initiate treatment of bipolar patients with acute depression with litium or lamotrigine (shown to be more effective in preventing future depression episodes).

Also, the most extensively studied anti-depressants for treating depression in bipolar patients are: fluoxetine (prozac), wellbutrin (bupropion) and zoloft (sertraline).

Citalopram belongs to the group of drugs called benzodiazepines. These are mainly prescribed if the patient suffers from mania (but you suffer from exactly the opposite of mania, which is depression, this is wy your symptoms worsened). They have a long list of side effects and are habit-forming drugs. As you had a bad experience with this, you should completely avoid these group of drugs.

In my opinion, the best option would be to add a mood-stabilizer (lamotrigine or litium) and an anti-depressant (sertraline or fluoxetine or bupropion) to your treatment regimen, once diagnosed.

I hope this information helps. Feel free to write back to me anytime, I would be glad to help you.

Best wishes.
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