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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 39. This is the beginning of the thread.
Posted by Zo on July 9, 2001, at 14:39:44
Any opinions, esp, from people with Bipolar II?
Is an episode of flagrant hypomania-bording-on-mania provoked by (impulsively) going off an AD overnight diagnostic of Bipolar II .. or could it happen to anybody?
The literature seems about evenly divided.. ..
Thanks,
Zo
Posted by Mark H. on July 9, 2001, at 20:19:07
In reply to AD-provoked hypomania - is it diagnostic?, posted by Zo on July 9, 2001, at 14:39:44
> The literature seems about evenly divided.. ..
Hi Zo,
My reading suggests the literature is divided on(but leaning toward) the hypothesis that when STARTING an anti-depressant the occurrence of a hypomanic episode may indicate bipolar disorder, but I haven't seen any references that hypomanic activity as a rebound effect from STOPPING anti-depressants has diagnostic significance. However, other respondents to your post will be better informed than I am and may recall citations regarding withdrawal and diagnosis.
As a person with Bipolar II, I can tell you that when I quit taking Effexor the first time, all of my bodily, emotional and mental systems that had been suppressed by the medication rebounded wildly. I had to put out a memo to my colleagues asking them to cut me some slack while my systems regained some equilibrium. It was far more intense than any hypomania I had experienced.
If you're wondering whether you're Bipolar II, the main things to look at are the cyclicity of your depressive episodes (for instance, my two deep troughs usually come at roughly the same two times each year), the occurrence of one or more hypomanic episodes (that are NOT attributable to withdrawal or other external stimuli), and -- by the book -- the absence of psychotic mania or mixed states (highly agitated depression).
Absent those criteria, I would guess that a hypomanic-like state caused by abrupt withdrawal would not be diagnostic, but hopefully others will have more information.
Best wishes,
Mark H.
Posted by judy1 on July 9, 2001, at 20:44:46
In reply to AD-provoked hypomania - is it diagnostic?, posted by Zo on July 9, 2001, at 14:39:44
I agree with Mark that AD induced mania usually occurs within the first few days of starting an AD and while a dx of bipolar is not given, the consensus is that the tendency towards that disorder exists. I also have seen nothing on a manic episode occuring with abrupt withdrawal of an AD; however it is well known that AD's cause instability and rapid cycling in people dxed with bipolar disorder. I don't think you would see that type of rx in someone with unipolar depression. Hope this helps- judy
Posted by MB on July 9, 2001, at 21:39:17
In reply to AD-provoked hypomania - is it diagnostic?, posted by Zo on July 9, 2001, at 14:39:44
> Any opinions, esp, from people with Bipolar II?
>
> Is an episode of flagrant hypomania-bording-on-mania provoked by (impulsively) going off an AD overnight diagnostic of Bipolar II .. or could it happen to anybody?
>
> The literature seems about evenly divided.. ..
>
> Thanks,
> ZoZo,
I brought this up at http://www.dr-bob.org/babble/20010708/msgs/69535.html I always feel good emotionally (albeit physically wretched) after starting ADs...I love it. They "cure" my depression after the first dose, yet poop out after about ten days. If that's mania (or hypomania) I want it. I thought that is just how "normal" people feel all the time. I thought that was how it feels to be rid of the depresion. How do you know the difference between mania and just normalcy? Sometimes I get rage attacks when starting ADs. I could live without those!!
Posted by Elizabeth on July 9, 2001, at 21:55:34
In reply to AD-provoked hypomania - is it diagnostic?, posted by Zo on July 9, 2001, at 14:39:44
> Is an episode of flagrant hypomania-bording-on-mania provoked by (impulsively) going off an AD overnight diagnostic of Bipolar II .. or could it happen to anybody?
It can happen to non-bipolars.
< insert scolding for abruptly discontinuing ADs here :-) >
-elizabeth
Posted by Elizabeth on July 9, 2001, at 21:59:20
In reply to Re: AD-provoked hypomania - is it diagnostic?, posted by Mark H. on July 9, 2001, at 20:19:07
> My reading suggests the literature is divided on(but leaning toward) the hypothesis that when STARTING an anti-depressant the occurrence of a hypomanic episode may indicate bipolar disorder
It's suggestive, but it doesn't guarantee that you're bipolar. And Zo is right, AD discontinuation can result in hypomania (although that too is not proof of bipolarity).
-e
Posted by judy1 on July 9, 2001, at 22:58:26
In reply to Re: AD-provoked hypomania - is it diagnostic? » Zo, posted by Elizabeth on July 9, 2001, at 21:55:34
Really? Was it a euphoric type of hypomania? What other symptoms did you have and what did your pdoc say- did he suggest you may have bipolar disorder? Just curious- Judy
Posted by Zo on July 10, 2001, at 1:05:09
In reply to Re: AD-provoked hypomania - is it diagnostic? » Zo, posted by Elizabeth on July 9, 2001, at 21:55:34
> > Is an episode of flagrant hypomania-bording-on-mania provoked by (impulsively) going off an AD overnight diagnostic of Bipolar II .. or could it happen to anybody?
>
> It can happen to non-bipolars.
>
> < insert scolding for abruptly discontinuing ADs here :-) >
> -elizabethI can't decide if that was a manic thing for me to have done, or an ADD thing for me to have done. . .but I do remember crying because, while it was nice to hear from him at first, God *would* not shut up. And then of course the crash was hell.
I don't do things like that *any* *more.*
Zo
Posted by Zo on July 10, 2001, at 1:12:08
In reply to Re: AD-provoked hypomania - is it diagnostic? » Elizabeth, posted by judy1 on July 9, 2001, at 22:58:26
> Really? Was it a euphoric type of hypomania? What other symptoms did you have and what did your pdoc say- did he suggest you may have bipolar disorder? Just curious- Judy
Euphoria hardly says it. One, I was instantly cured of Chronic Fatigue Illness. I could cure any slight muscle tension by thinking about it. See above post: at first I thought I was becoming a mystic - then God started visiting every night, and I wanted him to go *home* and leave me *alone.* I went thru my books and rearranged them all in this fabulous new method: by color!
All I can remember is finally crashing so bad, I couldn't drive to see my pdoc, nor really speak on the phone. I became suicidally depressed, he put me on Serzone, which made me a zombie who couldn't speak on the phone. Everything else about that time is a merciful blur. . .and I am just reconsidering, after going off 6 months on Zyprexa, pursuing the BII dx more seriously. .. Anyone who's ever been the least bit manic knows - I felt just too damn *good,* on Zyprexa. The kind of good that is suspect!
:) Zo
Posted by Mr.Scott on July 10, 2001, at 18:52:46
In reply to AD-provoked hypomania - is it diagnostic?, posted by Zo on July 9, 2001, at 14:39:44
The best part of taking an SSRI is discontinuing it. You feel high for a few days because the SSRI suppresses Dopamine function often by over 50% in the brain. When you stop taking them abruptly you essentially take the brakes off the dopamine suppression and throw it into high gear. Works well for a few days but then Depression returns. I don't believe what you are describing indicates bipolarity in any way shape or form.
Mr.Scott
Posted by Elizabeth on July 11, 2001, at 1:42:57
In reply to Re: AD-provoked hypomania - is it diagnostic? » Elizabeth, posted by judy1 on July 9, 2001, at 22:58:26
> Really? Was it a euphoric type of hypomania?
The one well-established case of antidepressant-associated mania (not hypomania) that I experienced was a mixed state (mania with depression) associated with the serotonin syndrome. There have been other times when I have experienced agitation and/or irritability on ADs (notably, Paxil), and this may have been a type of dysphoric hypomania.
> What other symptoms did you have and what did your pdoc say- did he suggest you may have bipolar disorder? Just curious- Judy
We speculated about that. Finally we came to the conclusion that my depression is unipolar (in part, based on the fact that "mood stabilisers" have had no effect on me at all).
-elizabeth
Posted by Elizabeth on July 11, 2001, at 1:45:09
In reply to Re: AD-provoked hypomania - is it diagnostic? » Elizabeth, posted by Zo on July 10, 2001, at 1:05:09
> I can't decide if that was a manic thing for me to have done, or an ADD thing for me to have done.
Do you have ADD too? Either way, it's impulsive -- you didn't think too far into the future when you decided to do it. Anyway, like I said, bipolars are notorious for going off their mood stabilisers because many of them *like* being manic.
> I don't do things like that *any* *more.*
Good choice!
-elizabeth
Posted by Zo on July 11, 2001, at 2:40:15
In reply to Re: AD-provoked hypomania - is it diagnostic? » Zo, posted by Elizabeth on July 11, 2001, at 1:45:09
> Do you have ADD too? Either way, it's impulsive -- you didn't think too far into the future when you decided to do it. Anyway, like I said, bipolars are notorious for going off their mood stabilisers because many of them *like* being manic.
Do I have A - look, a bird! - DD?!
This was before I got dxed and on Dex - when I was famous for sweeping, instant decisions. Which usually - not always, but usually - involved shooting self in own foot.
Posted by judy1 on July 11, 2001, at 10:37:56
In reply to Re: AD-provoked hypomania - is it diagnostic? » judy1, posted by Elizabeth on July 11, 2001, at 1:42:57
> We speculated about that. Finally we came to the conclusion that my depression is unipolar (in part, based on the fact that "mood stabilisers" have had no effect on me at all).
>
> -elizabethHmmm, I am dxed bipolar 1, (by several leading experts- it's one of those real no-brainer dx) and I have never responded to a mood stabilizer. Well maybe that came out wrong, when I am manic depakote and zyprexa are very effective in stopping the episode, but I haven't found any mood stabilizer (and I have been on every one- including experimental ones- and in combo) and NONE have prevented future episodes. So if you are referring to no response as far as preventing episodes, that makes me wonder- Take care, judy
Posted by judy1 on July 11, 2001, at 10:45:49
In reply to Re: AD-provoked hypomania - is it diagnostic? » judy1, posted by Zo on July 10, 2001, at 1:12:08
When God starts speaking to me (and this has happened more than once), my diagnosis becomes manic episode, severe, psychotic and the 'big gun meds' come out- so I would hardly characterize what you are describing as 'hypomanic' in nature. So yes, my pdoc would say you are bipolar 3- which is the dx given to people with med-induced manic episodes. And which really makes a diffrence in treatment. Best of luck- Judy
Posted by Elizabeth on July 11, 2001, at 16:15:37
In reply to Re: AD-provoked hypomania - is it diagnostic? » Elizabeth, posted by judy1 on July 11, 2001, at 10:37:56
> > We speculated about that. Finally we came to the conclusion that my depression is unipolar (in part, based on the fact that "mood stabilisers" have had no effect on me at all).
>
> Hmmm, I am dxed bipolar 1, (by several leading experts- it's one of those real no-brainer dx) and I have never responded to a mood stabilizer. Well maybe that came out wrong, when I am manic depakote and zyprexa are very effective in stopping the episode, but I haven't found any mood stabilizer (and I have been on every one- including experimental ones- and in combo) and NONE have prevented future episodes. So if you are referring to no response as far as preventing episodes, that makes me wonder- Take care, judyI'm not sure I completely understand your response. But as I said, the conclusion that I'm "unipolar" was based *in part* on the fact that mood stabilisers haven't been helpful for me. I've also never had a clear-cut manic, mixed, or hypomanic episode that wasn't associated with the "serotonin syndrome" (I also had a couple of not-so-clear-cut hypomanias that were med-related and might have been better described as agitation or jitters).
That's disappointing that you can't find a mood stabiliser that prevents future episodes. Are you saying that Depakote + Zyprexa stops an episode in its tracks, but you may have a future episode even if you continue on the same doses of these two meds?
-elizabeth
Posted by judy1 on July 11, 2001, at 19:01:15
In reply to Re: AD-provoked hypomania - is it diagnostic? » judy1, posted by Elizabeth on July 11, 2001, at 16:15:37
Oh, sorry I probably didn't read the entire thread. I know genetics are a big component in making the dx as is having actual episodes, although Akiskal says recurring depressive episodes may be indicative of bipolar disorder. Yes, unfortunately while depakote (oral loading) stops mania 'in it's tracks' and zyprexa is very effective for psychosis, I continue to have breakthrough episodes while on therapeutic doses. With depakote it's almost always depression which is unrelenting. Because I have TD on AP's (atypical and typical), I won't stay on them for more time than my active symptoms and my pdoc agrees. While there are reports of zyprexa being an effective mood stabilizer, I have had breakthrough manic episodes. So as I've stated before we (my pdoc and I) treat fires. The only medications that have been consistantly helpful to me is klonopin for panic disorder and opioids for depression. Take care, judy
Posted by Zo on July 12, 2001, at 1:42:45
In reply to Re: AD-provoked hypomania - is it diagnostic? » Elizabeth, posted by judy1 on July 11, 2001, at 19:01:15
Judy,
I'm nearly 100% positive that Zyprexa was setting off hypomania for me - besides making me eat like a horse - and have found a few references that it can in fact trigger the mania it's supposed to be treating. . I don't get that nice little high from Geodon or Risperdal, for example.
So maybe it hasn't been "breakthrough" mania in your case. . .
Zo
Posted by judy1 on July 12, 2001, at 10:34:44
In reply to Re: AD-provoked hypomania - is it diagnostic? » judy1, posted by Zo on July 12, 2001, at 1:42:45
Hi Zo,
Thanks for the info- I'll talk to my pdoc about it. I know a lot of us on this board react differently to the same med, and isn't zyprexa a form of a benzodiazepine- thio or something- maybe Cam or someone better at structures can help here? And yes while I also 'eat like a horse', I find it a very sedating drug (like Mellaril). Risperdal, on the other hand was very stimulating. But I also know that xanax can trigger mania, and if zyprexa is a form of a benzo, then you have a very valid point. Thanks again, judy
Posted by AMenz on July 12, 2001, at 13:27:30
In reply to Re: AD-provoked hypomania - is it diagnostic? » Zo, posted by judy1 on July 12, 2001, at 10:34:44
I have never heard of Xanax trigerring mania since it is an anxiolytic. I got through manic attacks for years by taking copious quantities of Xanax.
Zyprexa is not a benzo. It is to my understanding an antipsychotic, and so is Risperdal.
It's antidepressants that trigger mania in Bipolars, at least.
Hi Zo,
> Thanks for the info- I'll talk to my pdoc about it. I know a lot of us on this board react differently to the same med, and isn't zyprexa a form of a benzodiazepine- thio or something- maybe Cam or someone better at structures can help here? And yes while I also 'eat like a horse', I find it a very sedating drug (like Mellaril). Risperdal, on the other hand was very stimulating. But I also know that xanax can trigger mania, and if zyprexa is a form of a benzo, then you have a very valid point. Thanks again, judy
Posted by Mr.Scott on July 12, 2001, at 17:20:45
In reply to Re: AD-provoked hypomania - is it diagnostic? » judy1, posted by Zo on July 12, 2001, at 1:42:45
Sorry to interrupt the outstanding exchange, however I have a question and want to catch you all here while I can.
Should Bipolar disorder be obvious even if it's type II? I have been depressed for many years now, and usually get feeling very good from antidepressants until they stop working after a while. I have had periods of excessive anxiety and panic, and was thought to be ADHD as a child, but have never had a clear manic episode. Being aggressive and acting out as a child as well as early substance abuse is as close as I can put myself to a BP dx.
I have probably felt pretty close on cocaine and alcohol and antidepressants combo, but that was over 5 years ago, and now the only thing I think I notice is chronic unrelelenting depression and associated anxiety. Still the doc wants me to try Depakote, but I think he's barking up the wrong tree.
Any Thoughts from you tried and true BP's?
I think I'm just a depressed, anxios, and obsessive nut.
Mr.Scott
Posted by Elizabeth on July 12, 2001, at 19:42:45
In reply to Re: AD-provoked hypomania - is it diagnostic? » Elizabeth, posted by judy1 on July 11, 2001, at 19:01:15
> Oh, sorry I probably didn't read the entire thread. I know genetics are a big component in making the dx as is having actual episodes, although Akiskal says recurring depressive episodes may be indicative of bipolar disorder.
Akiskal is a very smart guy and has some great, original ideas, but in some cases I think he goes a little too far into left field. In particular, he seems to broaden the definition of "bipolar disorder" to the point where almost everyone would be considered bipolar (much like depression is now).
> Yes, unfortunately while depakote (oral loading) stops mania 'in it's tracks' and zyprexa is very effective for psychosis, I continue to have breakthrough episodes while on therapeutic doses. With depakote it's almost always depression which is unrelenting.
Mood stabilisers won't necessarily stop depression. Consider an AD -- Lamictal and lithium have AD as well as antimanic effects, and Wellbutrin and MAOIs are supposedly less likely than other ADs to trigger mania. (Tricyclics are considered the worst.)
> Because I have TD on AP's (atypical and typical), I won't stay on them for more time than my active symptoms and my pdoc agrees.
Huh. Does this happen with every AP? Have you tried all of the newer ones? Although this is seldom worthwhile, you might consider clozapine if Zyprexa, Seroquel, Risperdal, and Geodon all cause extrapyramidal symptoms or TD.
> The only medications that have been consistantly helpful to me is klonopin for panic disorder and opioids for depression.
Bad luck that they're both controlled substances!
-elizabeth
Posted by Elizabeth on July 12, 2001, at 19:46:32
In reply to Re: AD-provoked hypomania - is it diagnostic? » Zo, posted by judy1 on July 12, 2001, at 10:34:44
> I know a lot of us on this board react differently to the same med, and isn't zyprexa a form of a benzodiazepine
Chemically it is somewhat related to the benzodiazepines (Valium, Ativan, etc.). Pharmacologically it has no relationship to them.
> And yes while I also 'eat like a horse', I find it a very sedating drug (like Mellaril).
Not an unusual combination. Both side effects (sedation and appetite stimulation) are attributed (at least to some degree) to histamine (H1) blockade.
> But I also know that xanax can trigger mania
It can cause certain types of disinhibition. I'm unclear on the hypomania issue. OTOH, it is an antidepressant for some people, and *any* effective AD has the potential to trigger mania.
-elizabeth
Posted by Elizabeth on July 12, 2001, at 19:47:57
In reply to Re: AD-provoked hypomania - is it diagnostic?, posted by AMenz on July 12, 2001, at 13:27:30
> I have never heard of Xanax trigerring mania since it is an anxiolytic. I got through manic attacks for years by taking copious quantities of Xanax.
Benzos help a lot of people with hypomanic symptoms; however, Xanax is also an antidepressant (as is Deracyn (adinazolam), another benzo that is not available in the USA), and there have been reports of hypomania.
-elizabeth
Posted by Elizabeth on July 12, 2001, at 19:52:31
In reply to Sorry To Interrupt, posted by Mr.Scott on July 12, 2001, at 17:20:45
> Sorry to interrupt the outstanding exchange, however I have a question and want to catch you all here while I can.
I don't think there's any need for apologies. As far as I'm concerned, anyone's free to join in a thread.
> Should Bipolar disorder be obvious even if it's type II?
Bipolar II is kind of controversial, and as I mentioend in a previous post, some researchers want to make it even broader and less specific than it already is.
> I have been depressed for many years now, and usually get feeling very good from antidepressants until they stop working after a while.
That happened to me on Nardil (but not any other AD). I don't think I was hypomanic, though -- just nondepressed.
> Being aggressive and acting out as a child as well as early substance abuse is as close as I can put myself to a BP dx.
Especially with the early onset, that sounds like an ADHD (impulsive-hyperactive type) or character-spectrum disorder, not bipolar. (IMHO)
> Still the doc wants me to try Depakote, but I think he's barking up the wrong tree.
I'd give it a chance. It's not good for bipolar only. If you're worried about side effects, you might consider Lamictal instead.
-elizabeth
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