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Dr. Bob is Robert Hsiung, MD,
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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
Posted by judy1 on July 12, 2001, at 21:23:59
In reply to Re: AD-provoked hypomania - is it diagnostic? » judy1, posted by Elizabeth on July 12, 2001, at 19:42:45
> 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).
I couldn't agree more with your assessment (as does my pdoc). But Noa did point out in an earlier post that some of the docs that 'go into left field' do get other one's thinking, which never hurts.> 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.)
I've gotten manic twice on lamictal and on EVERY class of AD's- which had the added effect of increased cycling.> 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.
I have not tried clozapine, the side effects frighten me and I'm not very consistant when it comes to constant monitoring of meds (probably some denial going on here). I also have not tried Geodon, but have not read any real positive things on the board, and quite honestly I am terrified of 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!
Well, not really, I happen to have an extremely sympathetic and bright shrink, if it works we use it,Thank you so much for your input- judy
Posted by judy1 on July 12, 2001, at 21:40:03
In reply to Sorry To Interrupt, posted by Mr.Scott on July 12, 2001, at 17:20:45
Hi,
Are you being treated for anxiety? One of the drugs my pdoc likes to use for me (Bipolar with comorbid panic disorder) is klonopin, a very effective long acting benzo and some docs consider a somewhat effective mood stabilizer. I find depakote to be very depressing (which probably is not what you're looking for) but extremely effective in manic episodes. Like Elizabeth mentioned lamictal is effective both as a mood stabilizer and AD in BP2s. I would see a specialist in bipolar disorder before going down that trail, and make sure your anxiety is under control (I think that can help depression a great deal) I wish you all the best, and sorry I think I get to be the Queen of nuts. Take care, Judy
Posted by MB on July 13, 2001, at 2:44:25
In reply to Re: AD-provoked hypomania - is it diagnostic?, posted by AMenz on July 12, 2001, at 13:27:30
> Zyprexa is not a benzo. It is to my understanding an antipsychotic, and so is Risperdal.It's not a benzodiazepine, but it is a thienobenzodiazepine. I have no idea what all that means, but I looked it up, and that's what it says about Zyprexa.
Posted by Zo on July 13, 2001, at 16:50:27
In reply to AD-provoked hypomania - is it diagnostic?, posted by Zo on July 9, 2001, at 14:39:44
And here I thought we had such a close relationship! LOL
It appears my pdoc has just *assumed* I've defined myself as BP II - and how did he describe his dx yesterday? "The way you come in here, like a whirlwind . . . it's *obvious!*"
I don't mean to make him sound glib; he's treated me for 10 years, and he and my therapist are colleagues. He is *very* astute. It's just been hard to tease out and medicate the strands of ADD, CFS-FM, TLE and Bipolar II, never mind the fact that I refuse to identify solely as *any* pathology or illness.
Thanks for a fabulous thread, everybody!
Zo
Posted by AMenz on July 14, 2001, at 0:10:03
In reply to Re: AD-provoked hypomania - is it diagnostic? » AMenz, posted by Elizabeth on July 12, 2001, at 19:47:57
Point taken.> > 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 15, 2001, at 18:15:42
In reply to Re: AD-provoked hypomania - is it diagnostic? » Elizabeth, posted by judy1 on July 12, 2001, at 21:23:59
> some of the docs that 'go into left field' do get other one's thinking, which never hurts.
Sometimes they have that effect. Other times they are just regarded as quacks and their ideas aren't taken seriously at all. (Akiskal is not really all that "out there," and he seems to be well respected. I have a great book about chronic depression which he co-edited (and wrote one of the articles).)
> I've gotten manic twice on lamictal and on EVERY class of AD's- which had the added effect of increased cycling.
Mania on Lamictal? There's one I'll remember.
> I have not tried clozapine, the side effects frighten me and I'm not very consistant when it comes to constant monitoring of meds (probably some denial going on here).
Maybe lethargy too. I have problems with that kind of thing as well. With clozapine it's crucial -- the blood dyscrasias are completely reversible, but you have to identify them if they happen.
> I also have not tried Geodon, but have not read any real positive things on the board, and quite honestly I am terrified of TD.
I've really been impressed by the decrease in EPS among psych patients in general in recent years. I strongly suspect that it's due to the switch to atypicals.
> > Bad luck that they're both controlled substances!
> Well, not really, I happen to have an extremely sympathetic and bright shrink, if it works we use it,Ahh, if only they all had that attitude!
-e
Posted by Elizabeth on July 15, 2001, at 18:18:02
In reply to Re: AD-provoked hypomania - is it irrelevant?!, posted by Zo on July 13, 2001, at 16:50:27
> I don't mean to make him sound glib; he's treated me for 10 years, and he and my therapist are colleagues. He is *very* astute. It's just been hard to tease out and medicate the strands of ADD, CFS-FM, TLE and Bipolar II, never mind the fact that I refuse to identify solely as *any* pathology or illness.
I'm like that too: I'm very individualistic and don't like being categorised.
Your pdoc actually sounds kind of funny, though.
-elizabeth
Posted by Mr. Scott on July 15, 2001, at 20:08:00
In reply to fuzzy bipolar » Mr.Scott, posted by Elizabeth on July 12, 2001, at 19:52:31
Thanks Elizabeth! For some reason I could not see your reply until today 7/15/01. I'll stick out the Depakote as a test.
I am very agitated right now, I am a worrier capable of dreaming up all kinds of scenarios, but I almost feel as if the Prozac I'm taking destabilizes me.
Mr.Scott
Posted by Mr. Scott on July 15, 2001, at 20:11:02
In reply to Re: Sorry To Interrupt » Mr.Scott, posted by judy1 on July 12, 2001, at 21:40:03
Thanks Judy,
I'm a big fan of Klonopin as it works well for all the things you've mentioned. And I have A LOT of ANXIETY!! I just get scared of the benzo's..
Posted by judy1 on July 15, 2001, at 22:19:40
In reply to Re: Sorry To Interrupt, posted by Mr. Scott on July 15, 2001, at 20:11:02
There is no reason to be afraid of benzos- I'm asssuming you're concerned about dependency? Accordding to my pdoc, the vast majority of his patientss on benzos are so med phobic that they eventually ask to taper down (and once the proper dose is found and the panic ceases, then you never need to increase because they don't lose their anxiety reducing properties). I really blame docs that don't understand the action of benzos for unnecessarily frightening their patients- like I said I have been on them for years and have never increased my dose. Take care, judy
Posted by Mr.Scott on July 16, 2001, at 10:08:10
In reply to Re: Sorry To Interrupt » Mr. Scott, posted by judy1 on July 15, 2001, at 22:19:40
Thanks Judy!!
I am taking a small dose of Klonopin as I write. Nothing else has ever worked very well for my anxiety, agitation, restlessness whether it's my own anxiety, SSRI induced side effects, or some mixed bipolar state.
Posted by Zo on July 16, 2001, at 18:08:55
In reply to Re: AD-provoked hypomania - is it irrelevant?! » Zo, posted by Elizabeth on July 15, 2001, at 18:18:02
>
> I'm like that too: I'm very individualistic and don't like being categorised.
>
> Your pdoc actually sounds kind of funny, though.
>
> -elizabethHe is. Thank god. If one didn't have a gallows humor, at times. . .perish the thought. (Is that a pun?)
And, to answer my own thread, from medscape:
Hypomania During Antidepressant Treatment
Another burning question, vital for private practice, pertains to hypomania that becomes first manifest upon pharmacologic challenge with antidepressants. DSM-IV and ICD-10 have regrettably deleted them from inclusion as a bipolar condition. This is a regrettable decision, because an extensive literature pre-DSM-IV was strongly in favor of including such patients within the rubric of bipolar disorders, and new reports have been published since then. These studies were recently exhaustively reviewed in a US-European consensus [13] on the bipolar spectrum. The unanimous decision was that these patients represented a variant of bipolar disorder judged by the fact that during prospective course they often pursue an unmistakable bipolar course. An excess of familial bipolarity is another line of strong evidence for their inclusion in the bipolar spectrum.
Posted by Elizabeth on July 16, 2001, at 21:27:08
In reply to Re: fuzzy bipolar, posted by Mr. Scott on July 15, 2001, at 20:08:00
> I am very agitated right now, I am a worrier capable of dreaming up all kinds of scenarios, but I almost feel as if the Prozac I'm taking destabilizes me.
That's very possible if you're bipolar, or if you have panic disorder.
best,
-elizabeth
Posted by Elizabeth on July 16, 2001, at 21:31:34
In reply to Re: AD-provoked hypomania - More info » Elizabeth, posted by Zo on July 16, 2001, at 18:08:55
Yeah, I know. All I'm saying is that you can't conclude that someone is bipolar because they became hypomanic on ADs. ADs can trigger a *first* manic episode, and if all ADs tried do this, you'll need a mood stabiliser. But I've only become hypomanic on one or two ADs, and never spontaneously, so most docs I've talked to have felt that I probably am not bipolar. (No family history of mania, either.)
-elizabeth
This is the end of the thread.
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