Posted by kaleidoscope on May 11, 2007, at 16:07:46
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES, posted by linkadge on May 11, 2007, at 11:30:26
Hi
>What bothers me about all of this bipolar spectrum stuff, is that it is a response to a lot of the *side effects* of psychiatric medications.
A major concern for me is that rather that stopping the offending medications, *adding* additional drugs (and diagnoses) seems to be the current fashion. These additional medications have significant toxicity of their own.
A little scenario........
Mr. X, a 30 yr old male, is prescribed Lexapro by his doctor for the treatment of a moderate depressive episode following the sudden death of his father. This is Mr. X's first depressive episode. Two weeks later he is much improved. By the third week however, he is getting increasingly irritable, restless and agitated. His family are very concerned about this. He has never behaved like this before. A psychiatrist is consulted and the diagnosis of Bipolar II is made. Lexapro is discontinued abruptly and Depakote is started. One week later, Mr. X's agitation has greatly decreased but depressive symptoms are prominent. Now that Mr. X is on a 'mood stabiliser', his psychiatrist considers it appropriate to start another antidepressant. Effexor XR is chosen. After four weeks on 75mg, Mr. X is still depressed. The dose is increased to 150mg. Two weeks later, Mr. X's depression has improved but sexual dysfunction is reported.......hence the addition of Wellbutrin. Unfortunately, Wellbutrin induces irritability so Zyprexa is started. Zyprexa is effective at controlling the aggression but weight gain occurs. Topamax is added but it causes substantial cognitive impairment and......
On Depakote, Effexor, Wellbutrin, Zyprexa and Topamax, Mr. X is not only unhappy but has no money.Scenario two..........
Mr. X, a 30 yr old male, is prescribed Lexapro by his doctor for the treatment of a moderate depressive episode following the sudden death of his father. This is Mr. X's first depressive episode. Two weeks later he is much improved. By the third week however, he is getting increasingly irritable, restless and agitated. His family are very concerned about this. He has never behaved like this before. A psychiatrist is consulted immediately. The pdoc advises that since major psychiatric symptoms emerged following the use of Lexapro, Lexapro is likely a causative factor and should therefore be discontinued. To reduce the possibility of symptoms being exacerbated by abrupt withdrawal, Lexapro is tapered over a period of five days. Bipolar disorder is not diagnosed because:
A. Mr. X has never suffered a spontaneous manic or hypomanic episode.
B. Mr. X, age 30, has never suffered psychitric symptoms prior to his current depressive episode.
C. Mr. X has no family history of bipolar disorder.
D. Mr. X's drug-induced symptoms do not clearly fullfill the criteria for either mania or hypomania.One week after stopping Lexapro, Mr. X's agitation has decreased substantially but depressive symptoms are still present. Mr. X is warned of the possibility that future antidepressant intake may cause similar side effects to Lexapro. Nevertheless, Mr. X requests further antidepressant treatment. His pdoc chooses bupropion SR: 150mg in the morning - increasing to 150mg twice a day after one week. Five weeks later, Mr. X is doing well on monotherapy, with no significant side effects.
Ed
poster:kaleidoscope
thread:757178
URL: http://www.dr-bob.org/babble/20070509/msgs/757841.html