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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Bipolar Disorder

I have been on Saphris for about 8 months and I have gained 40 lbs!!! What is a goos anti-depressant for bi-polar? I am also on Cymbalta and that does not help everything that I am feeling. I have been searcing and Wellbuetrin.

What is your professional opinion????

Thank you.
posted on Wed, 12 Mar 2014
Twitter Tue, 4 Nov 2014 Answered on
Twitter Fri, 2 Jan 2015 Last reviewed on
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Psychiatrist,  's  Response
Hello,
I would like to tell you that Saphris is an antipsychotic which was launched with the claims that it caused minimal metabolic syndrome as compared to olanzapine. And there have been mixed reports regarding that. However in clinical practice we usually see patients complaining of weight gain with this drug and eventually developing metabolic syndrome.
Cymbalta is a serotonin nor-epinephrine re-uptake inhibitor (SNRI). This class of drugs are not recommended as antidepressants in bipolar depression as they can cause a manic switch.
However, Wellbutrin (Bupropion) is an antidepressant which cause least manic switches when compared to other antidepressants. Therefore its a better antidepressant and is preferred over others in bipolar depression.
Its initial dose would be 150mg every morning. It can be increased or maintained depending upon response.
However a cover of mood stabiliser (like divalproex) is still recommended.

Thanks.
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Psychiatrist,  Dr. Shubham Mehta's  Response
Hello,
Welcome to HCM.
Saphris (asenapine) is a newer atypical antipsychotic and it can cause weight gain. Dietary modifications like low fat meal and regular exercises are advised on saphris.

Wellbutrin is a good antidepressant for bipolar depression as it has least propensity to cause manic switches. Also it does not causes weight gain.
Another safer anti-depressant is sertraline (zoloft).

Cymbalta should be avoided in bipolar depression due to risk of withdrawal symptoms and manic switches.

Hope this helps.
Thanks
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Suggest Treatment For Bipolar Disorder

Hello, I would like to tell you that Saphris is an antipsychotic which was launched with the claims that it caused minimal metabolic syndrome as compared to olanzapine. And there have been mixed reports regarding that. However in clinical practice we usually see patients complaining of weight gain with this drug and eventually developing metabolic syndrome. Cymbalta is a serotonin nor-epinephrine re-uptake inhibitor (SNRI). This class of drugs are not recommended as antidepressants in bipolar depression as they can cause a manic switch. However, Wellbutrin (Bupropion) is an antidepressant which cause least manic switches when compared to other antidepressants. Therefore its a better antidepressant and is preferred over others in bipolar depression. Its initial dose would be 150mg every morning. It can be increased or maintained depending upon response. However a cover of mood stabiliser (like divalproex) is still recommended. Thanks.