Posted by SLS on July 22, 2019, at 13:36:10
In reply to Re: Dx.Bipolar II and OCD - Wise to be taken off SSRI?, posted by linkadge on July 21, 2019, at 12:22:54
This is an excellent post, Linkadge.
- Scott> Hi Helen,
> You've raised a lot of issues. To answer your primary question, I don't believe that bipolar II can be diagnosed based on one symptom. As mentioned, irritability can be a symptom of depression.
>
> To understand whether this doctor's decision was sound or not you'd need to look at additional symptoms of bipolar II to see if they match.
> Questions / thoughts I would have would be:
>
> 1) Was Prozac the only SSRI you've taken? If the drug worked well for a period of time, then stopped, my initial thought would be to try another antidepressant (or raise the Prozac dose, if it was on the low side) - unless of course, there were clear symptoms of (hypo)mania.
>
> 2) Is the irritability ongoing, or does it occur more episodically? If it is episodic, do other symptoms pop up around the same time?
>
> 3) Antidepressants stop working all the time, for a variety of reasons. It is not necessarily indicative of bipolar.
>
> 4) There are a number of studies that suggest that bipolar II is *not* effectively treated by mood stabilizers alone. Some studies suggest that antidepressants alone can be effective for some individuals with bipolar II. Others studies suggest that a combination of antidepressant and mood stabilizer is optimal.
>
> 5) The emotionality you are experiencing could be a sign of SSRI withdrawal. For Prozac, this may start occurring many days / weeks later as it has a longer half life.
>
> 6) I would treat the biggest problem first. Think of your cluster of symptoms pre-medication. If the biggest problem is depression / OCD, then yes I would stick with an SSRI.
>
> 7) Given your symptoms, you might be better served by an SSRI (perhaps try ones other than Prozac). If hypomania symptoms occur, then think about adding a mood stabilizer. Something like abilify or Seroquel might work well at reducing hypomania symptoms while still allowing you to take the SSRI. A SSRI lamotrigine combination can also work well for some.
>
> Linkadge
Some see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1105343
URL: http://www.dr-bob.org/babble/20190513/msgs/1105363.html