HIV + Bipolar -- What meds are best?

[Seattlem4m]

Hello Everyone,

I was diagnosed in July of last year (reading these posts has been an incredible comfort & strength!) and I need to start meds soon. I've been dealing with bipolar disorder all my life, mostly unmedicated.  I began to address the bipolar stuff seriously about a year ago and I still do not have things manageable, now I get to add HIV meds into the mix. O joy. 

The Quad and Complera both can cause depression and I have been warned away from taking either of them.  Can anyone point me to information on what HIV med is best for people dealing with serious depression?  And also -- what anti-depression drugs work best with HIV drugs? 

Seeing this issue discussed in the Death thread scares the heck out of me and I really want to find solutions soon.  Thank you!! 

[weasel]

   Hi    Seattlem4m  ,

              Well now ..........   

    I am on  Truvada / Norvir / presizta for   HIV / AIDS  , I'v been on meds for 8 years now .

   As for my Bi-polar situation ............
     I now take   Citalapram - Antideprsant ,  Clonazapram - tanqualizer , And  Trazadone  to sleep !

  I feel better now than I did when I was 30 

  Best of luck with your MEDS .   Life is good , at this point I have no major issues
to complain about .

                                               Be well ,  Weasel 

[BT65]

Seattle I have never heard of Complera or Stribild causing depression.  Atripla can tip the depression issue.  I actually take Stribild (the "quad") and have experienced zero depression issues.  On the other hand, I cannot take Atripla (due to the Sustiva component) because of my underlying depression.

Do you trust your doctors?  It seems you're coming to us for advice you should be asking your doctor about.  There are many different meds used for bipolar disorder, and different combinations, that only your doctor can recommend and prescribe.  Sometimes it's frustrating in that a person has to be willing to go through different trials of meds to see what works.  But oh the relief when the right meds are found!

I would recommend having a serious talk with your doctors, both ID and psychiatrist, and be an active partner in your mental as well as physical healthcare.  Good luck!

Betty

[Ann]

I would recommend having a serious talk with your doctors, both ID and psychiatrist, and be an active partner in your mental as well as physical healthcare.  Good luck!

In addition to Betty's sage advice, you should get your ID and psych docs to communicate with each other about your case in general and your meds specifically. Sometimes you have to give permission for your various doctors to share information (I know that's true where I live) so discuss it with both of them.

[Seattlem4m]

Thank you everyone for the helpful replies.   Yes, of course, I am working closely with the doctors as best I can.  This is all new. Here is my situation:

As a self-employed artist, I have never had a “regular” doctor.  With HIV, I learned that I am officially “poor” and eligible for Ryan White funded care as well as our state health insurance plan.  The clinic I go to is amazing - very good communication between doctor-social worker-pharmacist-nutritionist-etc. and I assume psychiatrist.

I am still building trust with my newly assigned doctor; he is in the process of finalizing his degree; he is not comfortable with making any mental health decisions.  The clinic psychiatrist is not covered under the Ryan White Act but I have finally saved up for the cost for one session which is scheduled for late next month.

I also ponied up the cash to talk with a well-respected local HIV/AIDS expert physician about meds with bipolar issues.  Together we picked out Complera.  So I was crestfallen when the clinic pharmacist said he would never recommend Complera for anyone with bipolar issues.   (The 7-page “FDA-Approved Patient Labeling” for Complera does have one line stating to tell your provider if you “have ever had a mental health problem.”)

The doctor & I have decided to try the Quad, but only after I’ve seen the psychiatrist.

I realize I am on “the journey” and that it may take many months to work all this out.  It’s a lonely & scary path for me, so I am trying to get as much info from the greater community on their experience with this issue.  Info on what combinations of specific drugs are working for other people dealing with HIV & bipolar issues would be most helpful for me.

Thanks again!!

[RobbyR]

Hi there Seattle, I am not bi-polar but I do suffer from anxiety and OCD, so I can relate to your concerns about meds and other meds for mental health issues. I can say that I have been on Atripla for 2 and a half years with great success, although at times I do get anxiety, but I suffered anxiety before ever starting on meds, so I doubt it has anything to do with the Atripla however. That being said, some people will experience depression on Atripla (I have not). I tried Complera on a trial basis briefly, because of some sleep issues I was having, but I have to say it was a BAD decision! The Complera made my anxiety go through the roof and I felt so depressed I was almost suicidal on it. I stopped it after a couple of weeks and went back to Atripla, and I feel pretty good again now. I am going to be starting anti-anxiety meds soon on an as-needed basis.

I would ask your doctor about your concerns about HIV meds and depression. There are many options out there, and either your doctor or a psychiatrist can give you the best insight about what treatment options you have. Best of luck!

[thunter34]

Hey, Seattle!  Welcome to the forums, and here's my two cents:

I have had - and am continuing to have - great success with Wellbutrin and Depakote for the BPMD.  They go just fine with my HIV line which includes Prezista, Truvada and Norvir.

I'm a bit suprised about your mental health stuff is not covered where you are by the Ryan White.  I guess I am very lucky in that mine is here in ATL.  The biggest help for me has been the Depakote - hands down.  The Wellbutrin gives a lift, but it's the Depakote that has stopped the awful roller coaster ride that had me spiralling out of control in the manic and then sinking hard in the depressive.

My best to you.  Let us know how it goes!

[oksikoko]

The Quad and Complera both can cause depression and I have been warned away from taking either of them.  Can anyone point me to information on what HIV med is best for people dealing with serious depression?  And also -- what anti-depression drugs work best with HIV drugs? 

Howdy. Just throwing this out there: Though, it made me nervous at first (being so new), one of the things I like best about Stribild (the Quad) is that I haven't seen complaints of CNS symptoms or aggravation of pre-existing mental issues. I have, um, a few problems, so I've followed every thread and article I could find on it. Tons of stuff about Atripla (the NNRTI component - Sustiva - takes anecdotal blame), but little about Stribild, which doesn't have an NNRTI.That's not proof of anything, but it's at least something I could hold on to. Maybe your doctor was talking about Complera, which also has an NNRTI?

Now I'm afraid they'll make switch to Atripla because it's cheaper. Really, really, really don't want to, but beggars can't be choosers, eh? :-/

If you do see any reports about Stribild and mental issues, please post if you can.

Thanks and good luck!

[Kendoll]

I take Isentress & Truvada for HIV and for my Bi-Polar, I take Citalopram and Seroquel. The Seroquel took some getting used to but now I swear by it. I feel so much better.

[elf]

I've been talking Fluvoxamine (Luvox) for 6 months now.
No side effects. No changes in behavior.

(I take a small dose, 50mg to boost my melatonin levels.
My GP prescribes it off label to me.
He enters ''Social anxiety disorder (SAD)'', as my diagnosis so I can get the med more easily. I think I have a bit of it, because HIV made me reclusive.

co-administration of melatonin and fluvoxamine increases blood levels of melatonin by 100-200 fold

. )

Luvox is a great medication:
1) it boosts your serotonin (directly) and melatonin (indirectly)
2) does not affect your dopamine (so your ''cravings'' [for food, drink, sex etc] are normal  (other antidepressants affect dopamine and can change one's sex drive)
3) it is a strong sigma-1 agonist (and thus a) eliminates ''highs'' in bipolar disorder; b) extreme ''highs'' in hypomania and mania; c) prevents possible psychotic episodes)
4) reduces ''shallow'' REM sleep, and promotes deep restorative NREM sleep
5) boosts your immune system by stimulating NK cells (natural killer cells) (directly) and IL-2 production (indirectly)

[Pricho01]

Hey there - I get where you are coming from.... I'm on Truvada and Isentress....and my Psych has whacked me onto Olanzapine..... This is working quite well for me atm.

I found Atripla was a nightmare (personally)..... really did a number on my head.

All the very best to you!

Phil