Posted by olysi79 on February 6, 2005, at 2:08:52
In reply to Re: meds for agitated depression? » med_empowered, posted by SLS on February 5, 2005, at 16:29:02
Hey Scott,
I think you are right on this. Spriggy needs to document every single one and also look for a history of hypomania with a psychiatrist.I am BP II and have had these awful episodes.
Initially I had always assumed it was a unipolar agitated thing. the first time I ever tried an SSRI for a teary depression, I absolutely flipped and went into a mixed state. I still had no idea what had happened. Eventually When I went into a relatively stable state, I was able to tolerate SSRIS for my OCD a few years later. However, if anything that's mixed starts (an episode occurred in 04, my first in years), I have to be so careful or an SSRI will make me rapid cycle intensely (euphoria alternating with despair and anxiety) or a mix. Those mixed ones are hard to treat so like you said, Spriggy needs to take stock of everything that he/she has taken and look at individual reactions to each one. Hopefulyl everything will work out.
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> Hi.
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> Here's a case where a thorough interview with the patient is necessary to come to a differential diagnosis. Is the illness an agitated unipolar depression, for which a TCA has the best chance of treating, or bipolar disorder, where a TCA is, by traditional thought, contraindicated?
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> I am not a doctor, and Spriggy has not described in much detail how the disorder manifests, but it sounds to me more like agitated unipolar depression than bipolar disorder mixed-state. Spriggy states that SSRIs make the depression worse. I guess it would be a good exercise to list specifically which SSRIs have been tried as well as Effexor. Perhaps Remeron would offer an alternative. Perhaps nortriptyline. Lamictal sounds like a good idea. If Spriggy were to enter an anxious suicidal state, I would look to the temporary use of Zyprexa. It can make a good bridge to the next treatment. Zyprexa possesses anxiolytic and antidepressant properties and is usually a rather clean drug in terms of cognition.
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> - Scott
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poster:olysi79
thread:453592
URL: http://www.dr-bob.org/babble/20050202/msgs/453865.html