![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 42 to 66 of 125. Go back in thread:
Posted by SLS on March 17, 2006, at 12:17:39
In reply to Re: Never thought I'd hear this....., posted by Sobriquet Style on March 17, 2006, at 11:08:40
> The first line medications which are considered the best because they can stop cyling, are also the ones that cause the worst kind of flat effect in my opinon.
> Now, does the future hold a treatment with the same level of effect that can stop the cyling without the flatness? If I invested in pharmaceuticals, I'd certainly invest in that bipolar medication.
Right now, Lamictal is considered by many to have anti-cycling properties and is recommended for ultra-rapid cycling. I'd like to see how this plays out with the passage of time. Maybe it only works this way in conjunction with other mood stabilizers. The combination of Lithium + Lamictal is supposed to be much more effective as a prophylaxis against bipolar I disorder than lithium alone.
12.5mg of Lamictal?
Isn't it funny how some people respond to such low dosages of drugs. I wish I could get that kind of mileage out of Lamictal. It would be a much less costly habit.
Actually, I had been taking 300mg for several years. I eventually was able to reduce it to 100mg and retain most of the benefit. My reason for reducing the dosage was that I found that the higher dosages impaired my memory and ability to learn new things above and beyond the impairments produced by the depression itself.
- Scott
Posted by SLS on March 17, 2006, at 14:29:49
In reply to Re: Never thought I'd hear this....., posted by SLS on March 17, 2006, at 12:00:02
> You are a wealth of knowledge and understanding. I only wish my <inability> to read and remember things were equal to yours.
I apologize. I didn't mean to play with words. I got mixed up.
"inability" should have been "ability".
:-(
- Scott
Posted by linkadge on March 17, 2006, at 15:22:04
In reply to Re: Never thought I'd hear this....., posted by Sobriquet Style on March 17, 2006, at 11:08:40
Very good point. Depakote made me a zombie. Lithium too. Tegretol and trileptal just me feel worthless. By zombie I mean that I didn't feel like a human being. I did not have a strong sence of self. I just was. Like a robot, nothing to look forward to, nothing to fear. No reason to live, yet no reason to kill myself. Nothing to work for, yet no reason to give up. No pleasure, no pain. It was the "little things" that were just wiped out. There was simply "no point", to doing the things that I once enjoyed.
I agree that normal people can still be alive and happy yet stable. Mood stabalizers always put me two knotches below where I wanted to be.
Linkadge
Posted by linkadge on March 17, 2006, at 16:16:11
In reply to Re: Never thought I'd hear this....., posted by SLS on March 17, 2006, at 12:00:02
>The only thing these models demonstrate is that >psychostimulants can produce in animals the same >behaviors that they produce in man. My belief
>(currently) is that what psychostimulants >produce in a healthy (not bipolar) man is not >mania. Neither do antidepressants produce these >behaviors in animals. They only produce them in >man in association with affective disorder.It totally depends on your definition of mania. If mania is defined simply by symptoms and behaviors then yes, stimulants can cause mania. If you define mania as being the result of a specific geneticly induced biochemical state, then no perhaps stimulants do not produce mania. But because your reaction took place while you were taking drugs, there is no conclusive way to tell if it was your genes or not. As soon as you introduce that new variable, your personal biochemisty has been altered, and you can never be 100 percent certain that this is the way you would have reacted drug free.
>There are probably exceptions, of course. I >contend that the majority of antidepressant->induced manias are those produced in people whom >have a bipolar disorder and not a unipolar >disorder. The citations you produced links to >seem to support this. Unfortunately no single >study was designed to test the specific question >that we are debating: Does an antidepressant->induced mania usually indicate bipolar disorder, >despite a lack of previous spontaneous episodes?
One of the reasons I contend that the drugs are to blame is that doctors have alreadly known that certain antidepressants are more likely than others to cause these reactions. There are people who have had manic reactions to say "wellbutrin", but then never had a similar reaction to an SSRI. The reverse holds true too. Some site that the TCA's are more likely to cause psychotic reactions than the SSRI's.
You need to come visit me, and see me in person some day. Get to know me, and the people who know me. My friends and family, teachers, and doctors have noticed absolutely no manic behavior since stopping offending agents. I have not had a similar reaction before or since. Only time will tell, but keep in touch, I hope to proove you wrong!
>Yes, but they are also active in models of >schizophrenic psychosis. They don't seem to me >to be specific for mania. Despite this, I will >concede that it is possible to "light up" the >manic areas of the brain in a healthy individual >if, as Dr. Manji said, the conditions are right. >The key question is, what are these conditions? >Does using an SSRI as monotherapy qualify? That >is what we are talking about here, as we are >also talking about numbers. What is the >percentage of people whom experience mania as a >reaction to an SSRI that are bipolar? How do we >determine this? Again, I think this issue can be >resolved by performing a longitudinal study of >people whom have had this reaction using life >charting and prospective observation. At this >time, I would argue that if there are other >features of bipolarity present (including family >history), then a manic reaction to an >antidepressant indicates treating the person as >if they were bipolar. I believe the chances of >getting them well is enhanced by doing so.
That may be the safest course to take, but I think there are a lot of peope who will fall through the cracks. Antidepressant treatments vary widely on their abilities to enhance dopaminergic function. TCA's show the strongest ability to increase the sensitivity of limbic dopamine receptors. They increase the sensitivity of d3 receptors in the neucleus accumbens, even in normal controll rats. Anticholinergics can also cause mania, and psychotic reactions in healthy people. In addition TCA's dose dependantly lower the seizure threshold in normal mice. So theres 3 reasons.
1. Anticholinergic, deleriant like effects.
2. Lowered seizure threshold
3. Increased limbic sensitivity to dopamine
in pleasure centres.
>It took at least 6 months to emerge. This is in >contrast to stimulant-induced hyperlocomotive or >psychotic states.TCA's effects on limbic dopamine receptors is acutally time dependant.
D2, and D3 expression often increases significantly after many months of treatment. This happened in normal mice. The receptors increased their expression well above baseline, these were not stressed or depressed rats. They were rats that were about to have robuslty enhanced dopaminergic response.
>The abstracts on the web page you cited >demonstrate this and refer to the patients as >being bipolar.Doctors just lable anything that resembles bipolar as being bipolar. It makes their lives easier. But does it make our lives easier. People just don't fit into these categories. Lets turn this arugment around. If I can induce depression in somebody with drugs, does that mean they have unipolar disorder? Of course not. How about a combination of PCPA, cyproheptadine, atenolol, haldol, and dilanin, and reserpine, valium, naltrexone, and acutaine :) That would make any normal person jump off the nearest bridge. Does that mean that these drugs unleashed a underlying unipolar disorder?
>I think this question relates to matters of >threshold (sensitivity) and inertia (length of >episode). How much exposure (dosage; time) is >necessary for the manic event to occur? I >imagine the threshold is lower for someone who >is bipolar.
No arguments there.
>There might not even be a threshold (too high a >threshold) for someone who is healthy. How long >will the reaction persist after the provocative >medication is discontinued?I think that in order for somebody to be considered "bipolar", their threshold needs to be low enough so that normal, life circumstances can trigger manic episodes.
>I should think that
>in someone who is bipolar, the longer the mania >is allowed to continue, the greater is its >inertia and tendency to persist after drug >discontinuation. The interesting question is >whether or not an inertia can be kindled in >someone whom is not bipolar. I imagine the >rodent studies can be used as a model for this.Normal rats can be kindled. And that kindling can go on for a long time unless intervention has occured.
>You are a wealth of knowledge and understanding. >I only wish my inability to read and remember >things were equal to yours.I don't aruge with fools :)
>By saying "how these drugs work", are you >admitting that they do indeed work?You got me! I think they must do something for somebody. I guess what I am saying is that if we don't exactly know how they help, than how can we know for sure that they don't harm?
Linkadge
Posted by Sobriquet Style on March 18, 2006, at 6:23:57
In reply to Re: Never thought I'd hear this....., posted by SLS on March 17, 2006, at 12:17:39
>Right now, Lamictal is considered by many to have anti-cycling properties and is recommended for ultra-rapid cycling. I'd like to see how this plays out with the passage of time.
Yes, this is promising.
>12.5mg of Lamictal?
Its a very small amount isn't it. I could be considered to be treatment resistant in some respects, although I hate to use the word treatment resistant, medication resistant is probably more accurate...I just hate the word risistant to be honest. I've found that as i'm not the best responder to psychiatric drugs (other drugs are a different story) I like to keep the dosages at a minimum. Before I've pushed dosages up high, only to be left with alot of increased and unwanted side effects, with really not much improvement for the condition I'm originally treating. It just gets so confusing with all the added side effects to deal with, I've found that keeping the dosage low, i manage to maintain the benefit that I was more or less getting at higher dosages, with less side effects.
>My reason for reducing the dosage was that I found that the higher dosages impaired my memory and ability to learn new things above and beyond the impairments produced by the depression itself.
I've found this aspect too. My learning and overall intelligence has been damaged enough by depressive episodes. I found too that being on the high end scale of the drugs and topamax and at any dosage! appeared to be leaving me the same level of loss of intelligence and learning that the illness was itself. Catch 22. The conclusion I've come to is to stick with the lower dosages.
~
Posted by Sobriquet Style on March 18, 2006, at 6:27:19
In reply to Re: Never thought I'd hear this..... » Sobriquet Style, posted by linkadge on March 17, 2006, at 15:22:04
>Mood stabalizers always put me two knotches below where I wanted to be.
I think replying on drugs alone to be exactly where you want to be, is a false hope in the long run, but I know exactly what you mean.
~
Posted by Sobriquet Style on March 18, 2006, at 6:36:25
In reply to Re: Never thought I'd hear this..... » Sobriquet Style, posted by linkadge on March 17, 2006, at 15:22:04
Posted by SLS on March 18, 2006, at 7:29:51
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 17, 2006, at 16:16:11
> >The only thing these models demonstrate is that >psychostimulants can produce in animals the same >behaviors that they produce in man. My belief
> >(currently) is that what psychostimulants >produce in a healthy (not bipolar) man is not >mania. Neither do antidepressants produce these >behaviors in animals. They only produce them in >man in association with affective disorder.
> It totally depends on your definition of mania. If mania is defined simply by symptoms and behaviors then yes, stimulants can cause mania.There's the catch. Manji found that stimulants alone were not a valid model for mania because mood stabilizers would not attenuate the behaviors.
> If you define mania as being the result of a specific geneticly induced biochemical state, then no perhaps stimulants do not produce mania.
After reading Manji's work, I think that there are valid animal models for mania, but they have not been fully elucidated or evaluated yet. His adding of a BZD to AMPH probably works because the BZD produces disinhibition.
> But because your reaction took place while you were taking drugs, there is no conclusive way to tell if it was your genes or not.
I disagree. As in animal models, the specificity of a reaction to a given drug can be determined by producing strains sensitive to the assay.
> As soon as you introduce that new variable, your personal biochemisty has been altered, and you can never be 100 percent certain that this is the way you would have reacted drug free.
It is how the alteration is expressed that demonstrates state-specific or trait-specific reactions that are reflective of that state or trait.
You once wrote that MAOIs were most likely to produce a manic reaction. If my case is representative of the majority, I would have to agree with you.
> That may be the safest course to take, but I think there are a lot of peope who will fall through the cracks. Antidepressant treatments vary widely on their abilities to enhance dopaminergic function.
At this point, I think it is important to remember that the changes seen downstream of the primary site of action of a drug is only an association. In other words, the changes seen at secondary sites might be a facilitative or compensatory consequence for the activity produced by manipulating the primary site.
> TCA's show the strongest ability to increase the sensitivity of limbic dopamine receptors.
At this point, I think it is important to remember that the changes seen downstream of the primary site of action of a drug is only an association. In other words, the changes seen at secondary sites might be a facilitative or compensatory consequence for the activity produced by manipulating the primary site.
> They increase the sensitivity of d3 receptors in the neucleus accumbens, even in normal controll rats.
Sometimes, neuronal excitability increases rather than downregulating with increased activity. It is a positive feedback loop. Use it or lose it. The D3 receptors might show increased tone to reflect the increase in NE signaling from sites upstream.
> Anticholinergics can also cause mania, and psychotic reactions in healthy people.
Unless they are really occult bipolar. :-)
I'll have to take your word for it. Psychotic reactions I can see. I still have to question what criteria were used to determine the reactions to be manic rather than non-manic psychotic.
> >It took at least 6 months to emerge. This is in contrast to stimulant-induced hyperlocomotive or psychotic states.
> TCA's effects on limbic dopamine receptors is acutally time dependant.
> D2, and D3 expression often increases significantly after many months of treatment. This happened in normal mice. The receptors increased their expression well above baseline, these were not stressed or depressed rats. They were rats that were about to have robuslty enhanced dopaminergic response.This would be a good argument to support your contention that antidepressants can produce mania in non-bipolar individuals.
I don't see anything convincing enough to conclude one way or another based on the biological experiments and attendant inferences we have thusfar explored. I find your points compelling but not convincing. There is just so much to consider when it comes to the brain and behavior. I think if it were that easy to induce a true manic reaction in a non-bipolar subject with antidepressants, we would see much more of it. It is crucial to be able to differentiate mania from other forms of psychoses and hyperlocomotive states. If we see it happen to 5% of people diagnosed as being unipolar, that about matches the rate of bipolar disorder seen in the general population. However, I really don't know what that rate is. I doubt it has ever been studied, but it does seem to be rather low based upon the frequency with which it is reported.
I'm still processing all of this stuff. Thanks for sharing your knowledge and understanding.
- Scott
Posted by linkadge on March 18, 2006, at 9:07:30
In reply to Re: Never thought I'd hear this....., posted by Sobriquet Style on March 18, 2006, at 6:27:19
No not that I wasn't doing other things to try help my mood. I am saying that mood stabalizers locked me into a position 2 notches below where I wanted to be. Ie normal things that lifted my mood didn't do anything.
Linkadge
Posted by linkadge on March 18, 2006, at 9:40:22
In reply to Re: Never thought I'd hear this..... » linkadge, posted by SLS on March 18, 2006, at 7:29:51
>There's the catch. Manji found that stimulants >alone were not a valid model for mania because >mood stabilizers would not attenuate the >behaviors.
I would disagree with that statment.
The following was taken from:
----------------------------------------------
http://www.bpkids.org/site/PageServer?pagename=lrn_004
----------------------------------------------MANJI: Everything I said about antidepressants would apply to stimulants and maybe even more so. Enough stimulants seem to be capable of triggering manic-like episodes in anyone. In the lab, most of our animal models of mania are based on using stimulants. That is to say, we use repeated amphetamine administration to make the animal become sensitized so it shows high degrees of motor activity and hedonic [pleasure-seeking] behavior.
Interestingly, you can prevent this manic response to stimulants by pre-treating the animal with lithium. This is how we model human mania for our animal experiments. So if we have a new biochemical pathway that may work, one of the models we use is to treat animals with stimulants to make them hyperactive and then use this drug.
------------------------------------------------
>I disagree. As in animal models, the specificity >of a reaction to a given drug can be determined >by producing strains sensitive to the assay.
Sure you can produce animals more sensitive to the stimulant properties of a drug. But again, this does not conclude that the animal would have ever become manic without the drugs.
>It is how the alteration is expressed that >demonstrates state-specific or trait-specific >reactions that are reflective of that state or >trait.
We are just not smart enough yet to develop a concrete model of exactly how genes and drugs interact.
>You once wrote that MAOIs were most likely to >produce a manic reaction. If my case is >representative of the majority, I would have to >agree with you.
They are broad spectrum drugs, and they often cause profound changes in sleeping patterns.
>At this point, I think it is important to >remember that the changes seen downstream of the >primary site of action of a drug is only an >association. In other words, the changes seen at >secondary sites might be a facilitative or >compensatory consequence for the activity >produced by manipulating the primary site.
Ok so its an association, just like the association that some forms of severe psychosis are associated with similar biochemical alterations.
>Sometimes, neuronal excitability increases >rather than downregulating with increased >activity. It is a positive feedback loop. Use it >or lose it. The D3 receptors might show >increased tone to reflect the increase in NE >signaling from sites upstream.
Not saying I know why it happens.
>I'll have to take your word for it. Psychotic >reactions I can see. I still have to question >what criteria were used to determine the >reactions to be manic rather than non-manic >psychotic.Well they tend to make people giddy, euphoric, delerious, and can cause hallucinations.
>I find your points compelling but not >convincing.I'm sure you've naturally considered such possibilites before. :)
>There is just so much to consider when it comes >to the brain and behavior. I think if it were >that easy to induce a true manic reaction in a >non-bipolar subject with antidepressants, we >would see much more of it.We see an awefull lot of it. Enough of it that doctors are doing some of these stange things like revising the DSM, formulation new theories about the unification of bipolar and unipolar. Increase in SSRI/mood stabilizer combinations. New categories of bipolar. Statistically increased rates of suicide and agression in children treated with AD's. Bipolar has been called the "diagnosis du jour", this is a consequence of SSRI's inducing questionable behaviors. There is plenty of evidence available. Its just what picture you "want" to see.
>It is crucial to be able to differentiate mania >from other forms of psychoses and >hyperlocomotive states. If we see it happen to >5% of people diagnosed as being unipolar, that >about matches the rate of bipolar disorder seen >in the general population. However, I really >don't know what that rate is. I doubt it has >ever been studied, but it does seem to be rather >low based upon the frequency with which it is >reported.
I would disagree. I don't think that there would be multi-million doller research into the question as to whether SSRI's induce rapid cycling, if the statistics "fit nicely" into the presumed rate of bipolar.
>I'm still processing all of this stuff. Thanks >for sharing your knowledge and understanding.
Take Care
Linkadge
Posted by SLS on March 18, 2006, at 10:21:19
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 18, 2006, at 9:40:22
> MANJI: Everything I said about antidepressants would apply to stimulants and maybe even more so. Enough stimulants seem to be capable of triggering manic-like episodes in anyone. In the lab, most of our animal models of mania are based on using stimulants. That is to say, we use repeated amphetamine administration to make the animal become sensitized so it shows high degrees of motor activity and hedonic [pleasure-seeking] behavior.
>
> Interestingly, you can prevent this manic response to stimulants by pre-treating the animal with lithium. This is how we model human mania for our animal experiments. So if we have a new biochemical pathway that may work, one of the models we use is to treat animals with stimulants to make them hyperactive and then use this drug.
I stand corrected!I still think the majority of manic reactions to antidepressants indicates bipolar diathesis.
I respect Dr. Manji enough to give him the last word. :-)
To be continued...
- Scott
Posted by SLS on March 18, 2006, at 18:00:27
In reply to Re: Never thought I'd hear this....., posted by SLS on March 18, 2006, at 10:21:19
Hi Linkadge.
I was able to contact Dr. Manji.
He had some interesting things to say regarding the phenomenology of bipolar disorder and recurrent depressive disorders.
Anyway, I asked him the following question:
"Does experiencing a manic reaction to an antidepressant indicate bipolarity or
can someone be unipolar and display such a reaction?"
His response:"I don't believe that there is a definitive answer, but I tend to treat individuals with antidepressant-induced manias as having a bipolar diathesis."
I imagine we both could have guessed at the answer he was to give.
I continue to find the question of antidepressant-induced manias as having tremendous heuristic value in coming to a better understanding of mood illness. I still have much to ponder.
Thanks again for sharing so much of your knowledge and hypotheses.
- Scott
Posted by SLS on March 18, 2006, at 18:19:07
In reply to Re: Never thought I'd hear this....., posted by SLS on March 18, 2006, at 10:21:19
Posted by linkadge on March 19, 2006, at 9:21:31
In reply to Re: Never thought I'd hear this..... » SLS, posted by SLS on March 18, 2006, at 18:00:27
Hey, good for you! That rules! You actually emailed "the" Dr. Manji.
He really seems like a down to earth kind of guy.
Linkadge
Posted by linkadge on March 19, 2006, at 9:34:10
In reply to Re: Never thought I'd hear this..... » SLS, posted by linkadge on March 19, 2006, at 9:21:31
I wonder what Dr. Bob's response would be to that question :) ???
Linkadge
Posted by SLS on March 19, 2006, at 10:13:52
In reply to Re: Never thought I'd hear this..... » linkadge, posted by linkadge on March 19, 2006, at 9:34:10
Dear Linkadge,
This is a bit off topic, but...
I would strongly urge you to continue your formal education with the same ferocity that you pursue your personal interest in neuroscience while your brain and mind are young, strong, and resilient. You are truly gifted. I hope you come to resolve soon those obstacles and the pain that you currently suffer and that detract from your quality of life.
I had to drop out of school after my sophomore year. I was 20 at the time. I could no longer read, learn, and remember. Most of what I have come to learn has been through selective skimming and repetition. Something has to be of great interest to me in order to focus hard enough to comprehend what I'm reading. Caffeine has helped. I imagine you have some difficulties too, but to the extent that you are still able to, you should use what you have to further your formal education. My lack of formal education denies me the foundation to understand more fully the medical literature and limits my ability to synthesize new ideas. Knowledge is the framework from which comes understanding, and, hopefully, the achievement of the goals you have set for yourself.
- Scott
Posted by linkadge on March 19, 2006, at 11:47:03
In reply to Re: Never thought I'd hear this..... » linkadge, posted by SLS on March 19, 2006, at 10:13:52
Hey, thanks for the compliment, though I don't know if I can agree with it all:) I really tend to get into arguments about things I have recently read about.
I hope that your decision doesn't haunt you for the rest of your life. Formal education is a forced rat swim test.
Narrowminded professers and teachers often automatically equate "I can't handle this emotionally" with "I can't handle this intelectually", and nothing can be farther from the truth.
Linkadge
Posted by SLS on March 19, 2006, at 12:19:56
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 19, 2006, at 11:47:03
> Hey, thanks for the compliment, though I don't know if I can agree with it all:) I really tend to get into arguments about things I have recently read about.
That's OK. I tend to get into arguments about things I don't have enough recent information about.
- Scott
Posted by tom_traubert on March 19, 2006, at 18:02:17
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 16, 2006, at 9:45:03
> Its my own personal experiement to prove this thing wrong. Maybe I will fail, and then I will accept treatment. I am going to proove that a single manic episode in responce to an antidepressant does not imply bipolar. So far (over 1 year off all treatment) has said to me that I don't cycle at all, but those are strong drugs.
>
>
> LinkadgeI support you fully, and understand the difficulties.
I was correctly diagnosed ocd pure obsessionial in 1992. No doubt there, the meds anafranil and klonopin saved my life.
However, I was diagnosed bipolar in 1994 after experiencing a major manic episode that directly followed abrupt withdrawal of 275mg Anafranil and 1.5 mg Klonopin. After a few terrible months, I was back on the same medications and was able to finish school, but then in 1998 it happenend again, another manic episode that followed the withdrawal. After that, I was put on Zyprexa to bring me down (did it ever!) as well as Depakote, Zoloft,and klonopin etc etc and it made me a zombie, a depressed suicidal zombie. 2 months later I tapered myself off all the drugs and stayed off all drugs for over 6 years. Now, those 6 years were a lot of work, and the anxiety levels didn't stop, I wrote and wrote and wrote, fillled the spiral notebooks, exercised, did everything I could trying to manage, and I did, to a point. But the whole time, I was (and am) terrified of another manic episode. What kept me going was the description of withdrawal effects in the book "Your Drug May Be Your Problem" which I'm sure this board is familiar with. I disagree categorically with the authors total dismissal of all psychotropic medications, but it was reassuring to know that some people experienced manic episodes as a result of tricyclic (Anafranil) withdrawal.
Last year, though, it became too much, I thought I was having another manic episode and the panic would not relent. (you can refer to my exasperated posts) I started and am currently on 1 mg of Klonopin/day and hooked up with a brilliant CBT therapist. The pdoc suggested Lamictal, but I wanted to see what Klonopin and CBT alone could do. I didn't take it out of the equation, but I haven't gone up in dosage on the Klonopin or taken anything else. So far, pretty good for almost a year.
I am intrigued, to say the least, of this board's opinion of "Bipolar III" (maybe I should start a new thread) as my pdoc was the first person to bring it to my attention. The real interesting angle, which I never thought of, is this: which came first, the manic episode, or the withdrawal? Meaning, I started drinking, smoking pot, missing dosages, becoming hypomanic, then going off meds completely and plunging into a major psychotic manic episode. It happened the exact same way both times. Did the antidepressants bring about the hypomanic behavior that served as a catalyst for withdrawal that served as a further catalyst for mania? If I stayed on the meds would I have gone manic nonetheless?
I am still terrified of another manic episode, it is my number 1 anxiety-causing issue, and I'm working on it, and I'm making progress. But it would sure be nice to know that the meds had a larger part in my mania than anything else. I just want a clearer reference point.
Thanks for listening, and any feedback is much appreciated,
tt
Posted by linkadge on March 19, 2006, at 19:28:15
In reply to Re: Never thought I'd hear this..... » linkadge, posted by tom_traubert on March 19, 2006, at 18:02:17
>However, I was diagnosed bipolar in 1994 after >experiencing a major manic episode that directly >followed abrupt withdrawal of 275mg Anafranil >and 1.5 mg Klonopin. After a few terrible >months, I was back on the same medications and >was able to finish school, but then in 1998 it >happenend again, another manic episode that >followed the withdrawal. After that, I was put >on Zyprexa to bring me down (did it ever!) as >well as Depakote, Zoloft,and klonopin etc etc >and it made me a zombie, a depressed suicidal >zombie. 2 months later I tapered myself off all >the drugs and stayed off all drugs for over 6 >years. Now, those 6 years were a lot of work, >and the anxiety levels didn't stop, I wrote and >wrote and wrote, fillled the spiral notebooks, >exercised, did everything I could trying to >manage, and I did, to a point. But the whole >time, I was (and am) terrified of another manic >episode. What kept me going was the description >of withdrawal effects in the book "Your Drug May >Be Your Problem" which I'm sure this board is >familiar with. I disagree categorically with the >authors total dismissal of all psychotropic >medications, but it was reassuring to know that >some people experienced manic episodes as a >result of tricyclic (Anafranil) withdrawal.
You raise some very interesting points. I have had a very similar course of illness. My first major "break" came when I abruptly came off celexa 20mg. The accounts you detail are true. Mania has been a doctumented side effect of antidepressant withdrawl. I remember reading acounts of SSRI withdrawl manias that were so strong they were unresponsive to multiple mood stabilizers. They subsided over time.
There are plenty of possible reasons for this. First you're probably going to experience significant rem rebound and cholinergic activation, which can cause psychosis it itself. Secondarily you are going to go through a major realignment of serotonin and dopamine. Coming off clomipramine probaby shot dopamine relase very high for a while, since SSRI's can dam up dopamine release. Thirdly SSRI's, and I believe clomipramine also affect a powerfull gabergic neurosteroid called allopregnalone (sp.) So coming off of them abruptly can lead to a rebound in excitory neurotransmission.
By the way your experience sounds, I am guessing that it was not pleasant. Ie not a euphoric mania, but (if it was anything like mine) a fearfull, dysphoric mania. The fact that you are scared to death of this happening again sends me a message. One psychitrist told me that if you "fear" becoming manic, then it is probably not bipolar.
>Last year, though, it became too much, I thought >I was having another manic episode and the panic >would not relent. (you can refer to my >exasperated posts) I started and am currently on >1 mg of Klonopin/day and hooked up with a >brilliant CBT therapist. The pdoc suggested >Lamictal, but I wanted to see what Klonopin and >CBT alone could do. I didn't take it out of the >equation, but I haven't gone up in dosage on the >Klonopin or taken anything else. So far, pretty >good for almost a year.
Glad you're doing better. I've had some bad panic attacks that involved near psychosis. The fact that you're experiencing this cluster of manic/panic symtpoms also sends a message. Most manic people are out spending a lot of money in kind of a state of fearlessness. Sounds to me more like a "mixed state".
>I am intrigued, to say the least, of this >board's opinion of "Bipolar III" (maybe I should >start a new thread) as my pdoc was the first >person to bring it to my attention. The real >interesting angle, which I never thought of, is >this: which came first, the manic episode, or >the withdrawal? Meaning, I started drinking, >smoking pot, missing dosages, becoming >hypomanic, then going off meds completely and >plunging into a major psychotic manic episode. >It happened the exact same way both times. Did >the antidepressants bring about the hypomanic >behavior that served as a catalyst for >withdrawal that served as a further catalyst for >mania? If I stayed on the meds would I have gone >manic nonetheless?
Good question. It has been my contention this year to simply test it out. If I am bipolar then I will go manic anyway, without drugs. Well, so far no manic episodes no cyling, no nothing, just back to my original problems, dysthemia, insomnia, anxiety etc. I think it is fully possible for a bipolar person to get prescribed AD's and for a whole lot of bad things to result, but I just never "believed" that was me. Its funny you mention some of the other substances. Yes when I was on AD's I was doing a lot of strange things too. Coffee galore, benzo's, some marajuanna, but a lot of that has subsided after discontinuation. I began to think that a lot of this was simply self medication to try and break with the medication's side effects.
I know that SSRI's gave me some really bad apathy, and akathesia, and that perhaps I was trying to counteract these feelings.
>I am still terrified of another manic episode, >it is my number 1 anxiety-causing issue, and I'm >working on it, and I'm making progress. But it >would sure be nice to know that the meds had a >larger part in my mania than anything else. I >just want a clearer reference point.No, the way you describe it, your "experiences" happened directly after sudden changes in medication. I would personally atribute it to that. These meds are very powerfull, and can do many things upon initiation and withdrawl.
If you have to "wrack your brain" for hints of past bipolarity, then I would personally lean away from that diagnosis.
I have another theory that SSRI's may acutally increase the desire to do illegal substances, to try and restore some ballance in to the dopaminergic system.
Just some thoughts, you thoughts ?
Linkadge
Posted by tom_traubert on March 19, 2006, at 19:57:27
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 19, 2006, at 19:28:15
> I have another theory that SSRI's may acutally increase the desire to do illegal substances, to try and restore some ballance in to the dopaminergic system.
>
>
>
> Just some thoughts, you thoughts ?Thanks for the informed response. Yes, I should have mentioned coffee. Caffeine junkie, actually working in a coffeehouse at the time of the 2nd episode, and smoking cigarettes. I'm not learned in the specific brain chemistry, although I probably should be, but everyone I know who is on high levels of meds smokes and drinks coffee like a fiend. I've quit both, except for the occasional cigar.
But Anafranil is a tricyclic, yes? Are SSRI and tricyclic interchangeable terms?
The smoking pot and the drinking were definitely part of trying to connect with a "normal" life, i.e. what I felt my youth was missing out on due to my illness. There was also a deep deep shame of feeling how I felt, as if I could have/should have been stronger or better equipped to handle my emotions. That lasted a long time and it's such vile garbage, but it's a tough one too. You don't want to fall into a powerless victim's mentality but you don't want to delude yourself either. Those are semantics, but either way, shame is a silent killer--causes you to engage in patterns/behaviors that will make it worse. I've let go of that.
So, it seems that it's a constant guessing game, a measuring of emotions to see where they fall. Am I too happy? Am I too upset? Am I hypomanic or am I just busy? It's exhausting and the search, the analysis can cause what it's trying to correct, or at least perpetuate it. The ocd and anxiety kick in, but CBT really cuts through a lot of the b.s.
Thank you for your support--just hearing the opinion that the mania is more meds-related unleashes so much emotion for me. The difficulty is that the mania was fantaastic at first, then pure delusional with frightened paranoid spells and fits of uncontrollable anger. And the first time it lasted a good 2 months after withdrawal, which would lean my thoughts in the other direction, that since it lasted so long, I am truly bipolar. But like you said, if it comes it comes, and you have to take it from there. I've agreed with myself that I'll go on other meds if necessary, but man I'm got to try every other safe avenue first.
Good luck and please write any and all thoughts, this topic never ever bores me.
Thanks again.
tom
Posted by SLS on March 19, 2006, at 20:10:59
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 19, 2006, at 19:28:15
> Thirdly SSRI's, and I believe clomipramine also affect a powerfull gabergic neurosteroid called allopregnalone
How does allopregnalone work? Does it act to increase the sensitivity of GABA-A receptors?
Thanks.
- Scott
Posted by linkadge on March 19, 2006, at 20:28:51
In reply to Re: Never thought I'd hear this....., posted by tom_traubert on March 19, 2006, at 19:57:27
Again, I would say that 2 months does not mean anything. If this was a witdrawl reaction, it can take a long time for the brain to reset itself.
Sometimes the drugs bottle a lot of things up. They are emotional anesthetics. Many people actually consider the SSRI's to be like mood stabilizers since they can tend to make people feel flat, apathetic, and zombie like.
Coming off a SSRI (or TCA in your case) can be emotionally liberating. I went a little loopy coming off an SSRI simply because there were so many bottled up emotions that were suddenly unleashed. Anger, fear, rebound obsessivness, joy, love. I also had a rebound sexual desire that was very strong, since I very little sexual desire on the medications.
My withdral reactions lasted about 2 months after which I began to feel more normal. The brain just can't reset itself overnight. Coming of SSRI's was hard. After a drop in 10mg, I was so angry, I just wanted to smash everything in my room. They bottle up a lot.Its like that Seinfeld Episode..."serenity now.....insanity later" :)
Thats just my oppinion. But I do know that such reactions are not totally uncommon, I have a few friends that went totally loopy too coming off antidepressants. But it did subside, and they got better.
Take Care
Linkadge
Posted by linkadge on March 19, 2006, at 20:34:26
In reply to Re: Never thought I'd hear this....., posted by SLS on March 19, 2006, at 20:10:59
Not exactly sure:
There's an article here:
http://pub.ucsf.edu/newsservices/releases/2004010612
Linkadge
Posted by SLS on March 19, 2006, at 20:59:24
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 19, 2006, at 20:28:51
> Again, I would say that 2 months does not mean anything. If this was a witdrawl reaction, it can take a long time for the brain to reset itself.
For someone who is not bipolar, I would expect a "reset" to take less than 2 months. More like 2 weeks. It takes about 2 weeks for receptor turnover and a change in the expression of genes encoding for certain cytosolic enzymes and membrane proteins.
> My withdral reactions lasted about 2 months after which I began to feel more normal. The brain just can't reset itself overnight.My first mania lasted for 2 months after the discontinuation of antidepressants. It is interesting that all three of us should have experienced a mania lasting for the same period of time. I would say that there developed an inertia of bipolar dysregulation. Unfortunately, when the mania subsided, I was left in a depressed state.
I guess what I'm saying is that there might be a bipolar thing going on here. Sorry...
Then again, it's hard to argue with Linkadge. His rationales are quite compelling. He's got me re-thinking things.
- Scott
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