Bipolar depression

[KurtCobainLover]

I have bipolar (was diagnosed 7 years ago following a breakdown), I'm currently on lithium, lamotrigine and aripiprazole which seems to control the hypomania really well and I can't remember the last time I went high but the issue now is that I've become depressed and am starting to feel unwell again which is scary.

I had a call with my GP last week and he sent a request for advise to the mental health team to see if he can prescribe an antidepressant which scares me a bit because they've always sent me high in the past. He hasn't heard back yet and I'm getting worse so don't know what to do. Should I call the GP again or just try and ride it out and hope that it doesn't get worse?

I thought if you were on lithium you had to be under the care of the community mental health team consultant? You need specialist from a psychiatrist not GP assistance. There are options for handling bipolar depression but only a specialist consultant would be able to help you with that.

I would call your CMHT and ask for a telephone appointment with your consultant first. If you have been discharged from CMHT then you need to ask your GP to do a referral to CMHT for you to then be able to speak to them about treatment options.

I was discharged back to GP care once my lithium levels were stable and was hoping that I'd never have to be referred to them again - I've been bouncing backwards and forwards between their care and GP for 7 years and really thought this time I'd stay stable.

I'll call the GP and see if I can get an appointment to discuss being referred to them again. I guess with my history that would be safest thing.

I’m with you there, but I thought advice had changed so that being on lithium meant automatically staying with CMHT. Maybe just in my area.

In my experience, dealing with bipolar, lithium etc is just way beyond a GPs expertise. I don’t have a community nurse assigned so couldn’t get my blood test results so my GP practice (which is amazing) does my bloods but I have an annual appointment with consultant and call consultant if I have any issues (for me, usually with sleep) in between. My consultant and I message via email mostly which has worked really well but I suspect some districts don’t give our consultant’s email addresses.

Not wanting to need their help has stopped me from going to them as soon as I can sometimes. I do think it sounds like you need their help. Hopefully a quick medication review can sort it for you.

I agree with PP, that is a decision for the CMHT, not the GP, who frankly shouldn't be meddling with your drugs without the direction of the consultant. I'm surprised s/he thought it appropriate in view of what you have said as well tbh.

Thanks both, I’ve submitted an online form to the GP explaining if gotten worse and asking to be referred back to the CMHT.

There’s just been locums for the last couple of years including one that reduced all my medications and then seemed surprised when I got ill again so I don’t have a lot of faith in the CMHT but hopefully this time it will be better.

I can see if your confidence has been knocked in the CMHT why your GP might see if they can act as liaison- which it sounds like they were doing as they were asking CMHtT to consider medication review. It is best doing it direct if you can though, as you’re speaking directly to the people making the decisions. Hope you have better experience with the current consultant. It’s harder to advocate for yourself when you’re feeling unwell. All the best.

The GP called this afternoon and said he’s done an urgent referral for a meds review rather than a request for advice. From past experience it’ll take about 8 weeks for them to see me so it’s a case of holding on until then and keeping in touch with the GP in the meantime. I have the number for the local crisis service I can call if things get really scary like they did last time.

Crikey. That’s terrible. I really don’t think you should wait 8 weeks. The longest my consultant has ever taken to responded to a message from my GP or me is the next day and usually she emails me the same day. Call the crisis service early rather than later. It’s hard to be spiralling up or down and trying to will yourself to stop spiralling.

I’m on lithium and am just under GP care. I was discharged from CMHT years ago.

I was too, until I got ill again and then I was slotted straight back into the CMHT.

I was more shocked that the GP wanted to alter OPs meds, even more so when she said she had had a bad experience with that exact problem previously.

When I was GP led care only he was pretty damn quick to get me back to the psychiatrist and refused point blank to alter my antidepressants as requested, saying that was a role for the CMHT.

Well my GP heard back from the mental health team and they don't see any reason to call me in for a meds review and are happy for the GP to stay in charge of my care. They sent him a list of antidepressants to try at a low dose to see if they help so this morning I started with a half a tablet of sertraline (have to go up to a whole tablet after a week) so now I'm hoping I don't go into hypomania. Bipolar sucks.

Is there anyway that it is noted on your file that you would rather deal with your GP that CMHT direct? As your on a mood stabiliser then it is possible to successfully use some antidepressants, is my understanding. Hope you’re feeling better soon and watch out for those early signs of hypomania.

It does suck. I'm so sorry.

Five days on and I'm getting worse - is this normal when you start antidepressants? I'm spending all my time sleeping or watching crap on the TV. I can't remember the last time I showered. The house is a mess which isn't fair on my children (their bedrooms are clean and tidy with fresh bedding but that's all I've managed to do).

I have a GP appointment on Thursday morning and I'm scared, the last time I felt like this was just before a major crash where I lost everything (my job, nearly my home and the DC had to stay with their dad for 6 weeks).

I don't know what to do - I'm not feeling very safe at the moment.

Do you have the home treatment/crisis team number? If you do I'd give them a ring tonight. If not I think 111 option 2. I understand.

Hiya - yes I’d say from experience it is definitely a case of worse before you feel better. Mostly the side effects wear off within a week or two and then you start to feel better. Not the case every time obviously, sometimes you need to try another drug. I found sertraline made me feel very anxious/panic type feelings first week or two. Would the doctor give you diazepam as a short term treatment till side effects level out? Worth an ask I’d say as they did for me x