Experiences with SNRIs and other medications?

[cyberJudas]

Hi everyone.

Even before my childhood trauma, I had been seeing a therapist and was prescribed Zoloft at age 11. As I was sent through various systems and skimming old psych eval after psych eval, I have noticed that I have been consistently recommended to be evaluated for bipolar disorder, but never properly diagnosed. I definitely agree with the bipolar diagnosis, as I have a family history of bipolar disorder and my experiences consistently align with some form of fluctuation between mania and depression. The only reason I am not self-destructively manic is because of my C-PTSD and the fear it has instilled in me. My current psychiatrist doesn't believe me, but a recent eval with a trauma informed psychologist and clinic have given me a proper diagnosis, finally. Once I move back to the state my university is located in, I will bring that eval to my psychiatrist there who trusts me and has known me long enough to actually believe what I say. I have not seen my current psychiatrist for even 6 months.

Anyways, onto my point after that context. Last spring, I was put onto Lexapro for a few weeks to try a new SSRI, as I had been taking Zoloft for 9 years at that point and felt diminishing returns even with a high dose and being co-prescribed a moderate dose of Abilify, an atypical antipsychotic. My psych then did some genetic testing with me that my insurance thankfully covered, so we could whittle down our options if possible after the Lexapro worked for only 2 weeks. Then my brain realized "Oh, this is just another SSRI, we know how to counteract that excess of serotonin!"

I started an SNRI, Pristiq, 50 mg XR, and have felt a lot more stable and supported by it. I also now take folic acid supplements, as I have a genetic deficiency in my folic acid production, which helps my medication cross the blood-brain barrier. After 2 months on Pristiq, I weaned off my Abilify, as I felt good enough to think "maybe I don't need my antipsychotics!"

That was very wrong! My antipsychotics helped manage my psychotic symptoms, as well as helped regulate my mood much more than the Pristiq did. I describe it as, my SNRI did the stabilizing of my mood and fine tuning of it, while my Abilify did the heavy lifting of either heightening or lowering my mood to an appropriate level. For a few months, I fell into what I describe as a paranoid and delusional depression. I started my Abilify again this past January, and I've been doing a lot better since. Because of the psychotic symptoms I experience under immense stress, and even unprompted when I am off my Abilify, and my mood swings, I would succinctly describe my pre-existing condition before my trauma as Schizoaffective disorder, Bipolar type. In addition, I have Autism and ADHD.

I suppose my question here as well is - does anybody else have any experience with medications that aren't SSRI/SNRIs for managing symptoms of depression and CPTSD? Any experience with mood stabilizers? How do your meds make you feel? I have a very poor frame of reference for this, and I'd like to know if treating my bipolar disorder with proper mood stabilizers and not just SNRI + Atypical Antipsychotics is worth a try. For greater context, I also take Adderall 10mg twice daily, as well as 100mg Testosterone subcutaneous injections weekly for my hormone replacement therapy. I was originally prescribed my Abilify to treat "irritability associated with autism" and boost my SSRI effectiveness, but discovered that the auditory and visual hallucinations I experienced also went away.