Any mental health professionals on here please?

[Theordinary]

Hello, I'm after some advice about someone close to me who has Bipolar 2. Previously unmedicated for 9 or so years and remained quite well. Usual ups and downs but nothing dramatic. Has now been put in escitalopram and aripiprazole for a depressive episode relating to some life situational stuff. Had previously been on Quetiapine some years ago and gained weight and became sluggish. The side effects were too much and made them a shadow of their former self. Also they still had bad depressive episodes on this. Fast forward to now, after 6 months on these meds they are low in mood, apathetic, no motivation to exercise having previously been used to vigorous daily exercise. BP and cholesterol have gone through the roof too. They feel fat, unhealthy and miserable. Please tell me we are not being unreasonable to think they must come off these meds and try an alternative. The psychiatrist (NHS) is very anti coming off meds and would be quite happy for them to be on them forever. They managed for years with just exercise and meditation and no meds. Any advice on what we should do? Thanks. Obviously I understand that we will take proper medical advice untimately but just wanting people's thoughts. Thanks.

There are not many alternatives that would be less likely to cause weight gain and metabolic issues than what they already have. Aripiprazole and escitalopram are usually pretty weight neutral. Are you sure it's not depression itself causing lack of motivation rather than meds?
You could ask about lamotrigine instead for BPAD 2 that's non sedative and weight neutral.

If they want to stop meds they could gradually withdraw them and see what happens. You can't force a psych to prescribe an alternative but you don't have to take what they suggest if you don't agree.

What about a therapy route instead of medication. CBT for depression?

@ThePure thanks for taking the time to reply to me. I have heard good things about Lamotrigine actually and did wonder about that. The person concerned does suffer with tics too, which have got slightly worse recently. I'm going along for the appointment soon so I think it's worth a discussion about trying that. I know that the combination of escitalopram and aripiprazole can cause hypertension and raised lipids in some people. If they were gaining benefit overall, I would say it would be worthwhile continuing but actually they are worse off than before In many respects.

I've worked with a few people for whom aripiprizole was not good. Terrible terrible thoughts and jitters - one had the worst restless legs ever. I witnessed the change from olanzapine to aripiprizole and it was marked. Took a while to convince the psychiatrist it was the meds and ultimately that came from the patient. Some psychiatrists don't like to think it's the meds.

@Littleorangeflowers thanks for your reply. They definitely didn't get on with it the Aripiprazole. We had quite a positive meeting and the psychiatrist has agreed that it would be a good idea to try lamotrigine instead. They did try and tell us that Aripiprazole is completely metabolic neutral and doesn't cause raised lipids or hypertension. That's not in line with what I've read about it or the experience the patient has had. We took the data which was kind of difficult to dispute.

👍🏻🙏🏻I'm glad it went well