So here it is: the list of (most of) the medication I’ve been on before landing on my current medication cocktail. I’ve been toing and froing about about posting this one, I can’t quite put my finger on why. Maybe because it’s like looking into my actual chemical soul or sommat? Whatever.

I’m posting this for the people that want an honest ‘real person’ opinion of what some bipolar medications feel like and their pros and cons (more cons than pros in number usually, but ‘this works’ generally out weights the cons).

As a general rule: don’t drink while on these medications.

Why? it reduces their effectiveness or prevents their proper elimination from the body leading to undesirable side-effects, is likely to hinder your efforts to take your medication on time, if at all. Then specifically for the ‘anxiety’ medications listed below: DO NOT DRINK WHEN TAKING THESE MEDICINES. I’ve got hundreds of reasons why. Just take my word for it. Don’t.

Current Regime

My current daily bipolar medication. Current and previous ARV medications are left out, for now.

Sodium Valporate (Depakote)

Anti-convulsant

While I haven’t necessarily thought to myself “wow this worked a treat”, but I think I give it less credit than it deserves.

I have no real medical reason to put this as Lithium adjacent. Maybe because it’s often pitched as a “Lithium alternative”. It’s side effects are similar too (see cons – a list longer than most others on this page). As it it’s efficacy.

It is typically prescribed for acute manic episodes – in my case it’s a maintenance adjunct therapy used in combination with other medications. In support of the adjunct is it’s ability to increase the mean half-life of another of my medications, Lamotrigine, which resulted in reducing the dosage of that medication. Here’s a fascinating podcast about this drug, it’s history and its similarity to Lithium.

Pros

• Affordable and available on PMB medication list.
• Often a Lithium (i.e. spawn of Satan and God) replacement.

Cons

• 20 minutes after taking this your mouth will be so dry you’ll think you swallowed a dusty cat.
• Can damage your liver.
• Pungent and increased sweatyness.
• Foamy, foul smelling urine.
• Sex-drive: Zero.
• Weight gain. And water retention. And bloatedness.
• Usually given in high doses (like 600mg+) making taking your meds daunting and seriously consider cessation.

I was prescribed this after I’d calmed down after appearing at the ER with severe mania, and have been on it ever since. I think it’s worth mentioning that I didn’t feel like this had any noticeable effect on my mood to begin with. Until I stopped taking it for a month because I got fat. I won’t make that mistake again. Rather fat than penniless and alone. I consider this the glue that holds my medication cocktail together and helps them all work in harmony. The elimination of this at the time resulted in my going right back to the rapid-cycling me of yesteryear.

Quetiapine (Seroquel XR)

Anti-psychotic

I don’t know why this one gets a bad rap in movies like Silver-linings Playbook. Maybe it’s because of the negative connotations with ‘psychotic’. Or maybe it was the litigation in the US when unqualified doctors prescribed it for off-label use. Anyway, I don’t care. This works for keeping the crazy out.

Pros

• Immediate Release is affordable and available on PMB medication list (IR)
• No real side effects once past the initial side effects.

Cons

• Everything is edible after taking this. Everything.
• Do not operate heavy machinery while taking this. Seriously don’t. I almost fell asleep driving to the corner shop once.
• Sometimes a pro, but usually a con: seriously vivid dreams.
• Soft stools. Don’t ask.
• The XR version is (still) proprietary and very expensive.

Since I’ve been taking this drug the paranoia and hallucinations during mania have stopped, I’m able to sleep eight hours a day, I wake up with clarity of thought I never knew possible and (hypo)manic episodes, while they still happen, are significantly muted. Tip: go to sleep immediately after taking this before you eat yourself out of house and home.

Lamotrigine (Lamical)

Anti-convulsant

The phrase, “this drug saved my life” comes to mind. This is indicated for treatment of both mania and depression. My experience here is that it particularity resolves, delays or de-amplifies depressive bipolar episodes (distinction here between bipolar depression and regular depression). A few weeks taking this one had a phenomenally positive effect on me insofar as I was able to get out of bed, do the dishes, have a shower, make a sandwich – and generally have a regular day.

Pros

• Affordable and available on PMB medication list.
• No real side effects once past the initial severe side effects.

Cons

• Impossible to swallow without getting caught halfway down your gullet, and tastes like ass.
• Possibly fatal skin rash and other severe side effects at initial administration.

I won’t beat around the bush: the side effects when you start taking this or change dosage are severe but they do subside after a few weeks. Stay the course all through the knocking into tables, falling all over the place, sore throat, sensitivity to light, and (really bad in my case) blurred, double vision and diarrhea. Oh, and smelly urine for life. If this sounds awful, it’s because it is, but: push through the initial phase and this will change your life.

Bupropion (Wellbutrin XL)

Atypical Anti-depressant

This has been the single most effective drug for me to treat ongoing mild anxiety and mild depression. Unlike other antidepressants I’ve tried this one seems to revive my interest in things I generally like doing. Discontinuation of this once immediately had the effect of dulling my interest in any and everything.

Pros

• If you don’t stop entirely, you’ll smoke considerably less

Cons

• Not available on PMB chronic medications
• (Very) expensive
• Mild, but not debilitating, tinnitus and/or ringing in the ears at times

If a friend was prescribed this and asked if I would recommenced it? Resounding yes. That said some of the initial side effects may be off putting: headaches, tremor and increased heart-rate were evident when I started on this but are no longer.

Latest (As Necessary – PRN): 20/06/2020 –

Clobazam (Urbanol)

Tranquiler | Benzodiazepine

This is only available in South Africa, seemingly. Why, I don’t know but I intend to find out. My gut tells me that it’s over prescribed here by GPs as a catch all anxiety medication. If you’re prescribed this be sure to really interrogate whether there is not something that is more specifically indicated that can be tried first (see Rivitral, later).

Ever used a sledge hammer to crack an egg? This is the same but for anxiety: it’ll get the job done but it’ll leave a mess if you’re not careful. My efforts to find something as effective as this have, with the exception of Rivitril, been fruitless.

Pros

• Without a shadow of a doubt this works as indicated
• Cheap as chips
• Apparently helps with alcohol withdrawal (probably because you can’t tell the difference between being drunk and being on this medication).

Cons

• Relief for anxiety that you know is coming – think slow and steady wins the race
• Habit-forming
• Catastrophic consequences when mixed with alcohol
• Related to above: can induce serious rage and hyperactivity
• Lethargy, confusion and disorientation in increased dosages

This one time I took this on a Saturday early afternoon and woke up on Monday confused as to why work was calling on a weekend. You should take Urbanol if your intention is to feel like a zombie, totally devoid of emotion, lacking in empathy, and pathologically pessimistic.

On principle I don’t care for Urbanol simply because I can see (and feel) it’s high likelihood for dependence and/or addiction. But principle falls away when practice yields the result: it works for severe anxiety and when taken in preparation of stressful situations.

Fluanxol

Anti-psychotic | Thioxanthene

Has had precisely zero effect for it’s intended purpose for me as an Urbanol replacement in treating mild anxiety. In fairness to the drug, it’s not widely indicated for anxiety and was prescribed off-label (in South Africa). Ended up taking Urbanol anyway. Intention is to ditch this and Urbanol entirely for Rivitril (PRN) again.

Pros:

• Able to assess easily and early on whether it works or not

Cons:

• Itchyness
• Dry mouth (seems to be a thing with theses kinds of meds)

Haven’t really taken this for long enough to have an opinion on it’s effectiveness for the treatments it’s indicated for. Long and short of it: it was prescribed for anxiety and it didn’t work.

Once-off Emergency Care

Ziprasidone HCl (Geodon)

Atypical Anti-psychotic

Indicated to “quickly treat agitation in people with schizophrenia”. This thing means business in injection form. It’s also indicated elsewhere for the treatment of severe manic symptoms of bipolar disorder. Long and short this will knock you six-love.

Pros

• Unlikely to rush back for a dose.
• You’ll be out for the count while your body gets it’s shit together.

Cons

• Being injected by a non-disposable straw in the ass.
• Incomprehensible speech (not great when trying to answer, “how’re you feeling?”).
• The frustration of feeling like you should move but unable to commit the mind to do so.

Would rather not have this ever again unless I’m about to physically harm myself or others.

Flunitrazepam (Hypnor)

Tranquilizer | Benzodiazepine

Never. Ever. Again. This was prescribed for a ride in an ambulance to a mental health facility. How this is legal I don’t know.

Pros

• Zero. Niks. Nadda.

Cons

• Total loss of muscle control

That’s it. I can’t say much more about this because I was out like a light 10 minutes after being injected in the leg with it and stayed that way for 24 hours+ after.

Abandoned

Clonazepam (Rivitral, Klonopin)*

Tranquiler | Benzodiazepine

Between this and Urbanol; I’d choose this. To start, it’s actually indicated for the treatment of seizure disorders (many bipolar medications are too). Second is that it is specifically indicated for panic disorders: which speaks more to the variety of ‘anxiety’ I have.

Pros

This is a difficult one to list the “pros” without sounding like a crack head but it is what it is. It works and if it makes one feel high and get through a manic episode without too severe consequences then so be it.

• Cheap AF.
• Widely researched and cautiously prescribed in South Africa.
• Euphoria is pretty rad.
• IDGAF is a nice place to be when the world around you is out of your control.

Cons

• Incessantly bad rap on TV making one feel like a crack head for taking it. Take it as prescribed and don’t be a jackass.
• Loss of interest
• Drowsiness and feeling 🤷‍♀️ meh

I’ve been told this is less addictive than Urbanol. Less addictive is a far cry from ‘not addictive’ so think carefully about taking this. I can see why this could be addictive but it’s addictive for different reasons than Urbanol is.

If you’re after numbness for long periods of time in preparation for a known stressor then I’d take Urbanol. In my case though I’m not particularly concerned nor have anxiety about about an event that will happen in the near future. I am concerned and have severe anxiety/panic about events in the immediate future or are currently underway. Largely, this happens when I become aware that I am heading for a manic episode. So panic starts to set in as I think about the consequences previous episodes have had on my life.

So, I think the distinction between ‘severe anxiety’ and ‘panic disorder’ are important when considering a drug in this class.

* I intend to ditch the Urbanol and switch it for this again soon.

The rest of these medications are anti-depressants I’ve been prescribed over the years – mostly pre-bipolar diagnosis. All of them, bar the first two, I can say with confidence I would not take again. Generally antidepressants can trigger manic episodes – many of these did. The first two I’d consider taking if I ever find myself in circumstances that merit taking them again.

Duloxetine HCl (Cymbalta)

When this was prescribed to me it was pitched as, “the anti-depressant of choice for high functioning individuals.” I was flattered, and started immediately. Seemed to do what it said it would do on the box.

Pros

• Very sociable
• Less irritable
• Improved sex drive (I’ll count this as a good thing here)
• Seemed to improve productivity

Cons

• Killed sex drive
• Insomnia (you can see where this is going)
• Persistent headache
• If I could have eaten cigarettes I would have

Over time though the cons outweighed the pros. Those pros though and the insomnia set off alarms that it may have induced hypomania. I’ll never be sure if that was the case though so, yeah.

A word of caution when coming off this drug: DO NOT STOP TAKING THIS MEDICATION COLD TURKEY / SPEAK TO YOUR DOCTOR BEFORE CESSATION. A few days after I stopped taking this i would feel like I being shocked by an electric fence every couple of hours for a few minutes and what I’d call pretty severe dysphoria.

Methylphenidate (Ritalin)

If anyone tells you this this drug did nothing for them, or they didn’t enjoy its effects they’re lying. This was a frequent entrant before my bipolar diagnosis. I can’t really blame the people that prescribed it to me: I was definitely a textbook ADHD candidate growing up and continue(d) to appear like this between depressive events – which was typically when I’d see someone about the ADD (and surprise! I’d walk our with ADD). So ja, this one was prescribed erroneously in my opinion.

Pros

• You’ve never been so focused on a single task in your life: if you’re washing the dishes YOU’RE WASHING THE FUCKING DISHES.
• You’ve never partied so hard in your life.
• Loss of appetite (?)

Cons

• Irritable to the point of outbursts of anger
• Akathisia out the wazooo
• Uncomfortably increased heart-rate
• Sex drive overdrive without the happy ending

Yeah I can’t say too many bad things about Ritalin. It did what it was designed to do, brought me back down to earth generally when I was using it as prescribed. That last bit is important. Like most anti-depressants (yes, it’s an anti-depressant) don’t mix with alcohol – even though your body is telling you to get shitfaced and party all night.

Alprozolam (Xanax)

Look, this one really lives up to the hype. If feeling calm and serene is what you’re after then this will do the trick. Why’d I stop? I felt distinctly that life was passing me by and I was a merely an observer.

Pros

• Has an immediate calming effect
• Great for panic-type anxiety things
• Euphoria is nice… see cons.

Cons

• Dependence could be a thing
• Memory loss? Can’t recall.

Another one to avoid when mixing with alcohol. As a medication for panic attacks I can see why it would be prescribed. For long terms use? Nah. There’s only so much of life you can let pass you by because you were too zoned to make a meaningful contribution at the time.

Fluoxetine (Prozac)

I can’t say I felt that this had any particular effect on me. People rant and rave about this – I don’t get the hype.

Lorazepam (Ativan)

Without a shadow of a doubt did this medication induce mania. More than once. Probably ore aligned to inducing the most rapid of cycling I have ever had.

Cons

• Induced rapid-cycling mania (Bad. Real bad)

If asked if someone with bipolar disorder should take this? Mostly no. In most cases Ativan, like most antidepressants, is prescribed long term. When taken as a ‘once off’ I reckon it would be beneficial to bring some semblance of stability during a (hypo-)manic phase. Maybe if given as an IV. Personally, I think it’ll do more harm than good in the long term. It did for me anyway.

Sertraline (Zoloft)

Hard no for this in treating bipolar from me. Of all the anti-depressants I reckon this one does too good a job of lifting depression (as apposed the rest which feel like they’re more anxiety treatments). It’s works perhaps a little too well and it might just push it that little bit too far – it did for me.

Pros

• It’ll get you out of a slump

Cons

• Mania (and all the things the come with that):
• Insomnia
• Hyper-vigilant
• Irritability the point of frustration and rage
• Paranoia…

So yeah, full blown mania. Sure you’re feeling great, you’re out of bed, the sun is shining… until you’re all of those things and buying a trip overseas at 3 in the morning.