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Dr. Bob is Robert Hsiung, MD,
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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
Posted by SLS on March 19, 2006, at 21:12:07
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 19, 2006, at 20:34:26
> Not exactly sure:
>
> There's an article here:
>
> http://pub.ucsf.edu/newsservices/releases/2004010612
>
> Linkadge
Thanks.Forgive me. I was too lazy to Google it for myself.
:-)
- Scott
Posted by tom_traubert on March 19, 2006, at 21:17:22
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 19, 2006, at 20:28:51
> 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.
Absolutely. Most heightened libido ever experienced, in addition the heightening of every emotion. When the crash came, it crashed real hard, which made a stronger case for bipolar dx. But if the brain is going to right itself, settle etc, I'm sure that depression is expected, just as sleep follows waking hours. There has been no major depression apart from directly after the manic episodes. There's been depression, but not like that.
Looking forward to Bipolar III becoming something more probable, something researched to a greater extent.
tt
Posted by SLS on March 19, 2006, at 21:33:40
In reply to Re: Never thought I'd hear this....., posted by tom_traubert on March 19, 2006, at 21:17:22
> Looking forward to Bipolar III becoming something more probable, something researched to a greater extent.
Bipolar III might end up as the official designation for what is now labelled as cyclothymic disorder. In this case, it is proposed that bipolar IV represent depression with antidepressant-induced mania.
-------------------------------------
One proposed scheme:
THE BIPOLAR SPECTRUMBIPOLAR I: Both mania and major depression
BIPOLAR II: Major depression and hypomania
BIPOLAR III: Cyclothymia. Mild depression and hypomania
BIPOLAR IV: Depression and usually no mania. Mania may be triggered by some antidepressants.
BIPOLAR V: Depression and no mania. Some blood relatives have had mania
BIPOLAR VI: Mania and no depression
http://www.bipolarworld.net/Bipolar%20Disorder/Diagnosis/dis.html
---------------------------------------
- Scott
Posted by tom_traubert on March 19, 2006, at 21:39:04
In reply to Re: Never thought I'd hear this..... » tom_traubert, posted by SLS on March 19, 2006, at 21:33:40
That's really interesting, thanks!
Posted by Phillipa on March 19, 2006, at 21:40:58
In reply to Re: Never thought I'd hear this..... » tom_traubert, posted by SLS on March 19, 2006, at 21:33:40
Scott does this mean that if I'm on luvox and increasing the dose is making me more depressed amd the fact that I have taken a bezo for 30 some odd years mean I should stop the antidepressants and stay on what used to work just fine? Love Phillipa
Posted by JahL on March 19, 2006, at 22:00:19
In reply to Re: Never thought I'd hear this..... » tom_traubert, posted by SLS on March 19, 2006, at 21:33:40
>
> One proposed scheme:
>
>
> THE BIPOLAR SPECTRUM
>
> BIPOLAR I: Both mania and major depression
>
> BIPOLAR II: Major depression and hypomania
>
> BIPOLAR III: Cyclothymia. Mild depression and hypomania
>
> BIPOLAR IV: Depression and usually no mania. Mania may be triggered by some antidepressants.
>
> BIPOLAR V: Depression and no mania. Some blood relatives have had mania
>
> BIPOLAR VI: Mania and no depression
>
>
> http://www.bipolarworld.net/Bipolar%20Disorder/Diagnosis/dis.htmlThanks Scott.
It took me three years to have my dx recognised (I had always known what it was) - the main reason being my illness doesn't match any of the traditional descriptions of Bipolar - and I had a particularly nasty response to Lithium. Anything with 5HT action can get me switching however. So I guess I'm BP IV. Cool.
How 'official' is this scheme? Can I go and impress pdocs by quoting a dx they've never even heard of (this is England remember)?
Ta,
J.
Posted by SLS on March 19, 2006, at 22:05:13
In reply to Re: Never thought I'd hear this..... » SLS, posted by Phillipa on March 19, 2006, at 21:40:58
> Scott does this mean that if I'm on luvox and increasing the dose is making me more depressed amd the fact that I have taken a bezo for 30 some odd years mean I should stop the antidepressants and stay on what used to work just fine? Love Phillipa
I really don't know.
If you are having such a bad depressive reaction to Luvox, you might want to consider returning to your previous dosage and contacting your doctor.
The question that inevitably enters one's mind is whether or not an increase in depression is a temporary state that will disappear and be replaced with an antidepressant response. I can't think of a time when that has happened to me. If something made me feel worse early in treatment, I would stay worse until the drug was discontinued.
"Feel worse before feeling better?" I can't say for sure. You are not me (in case you were ever in doubt). With depression, I really haven't seen this happen to anyone, I don't think. That doesn't mean that it never does happen. What I have seen is an increase in anxiety early in treatment with some SSRIs that eventually disappears and is followed by an anti-anxiety effect and/or antidepressant effect. Prozac and Lexapro are probably the two drugs most likely to do this. Of course, Luvox is an SSRI as well.
Questions:
• What are you being treated for?
• What do you experience with your illness?
• What treatment worked best?Hang in there.
- Scott
Posted by SLS on March 19, 2006, at 22:19:58
In reply to Re: Never thought I'd hear this....., posted by JahL on March 19, 2006, at 22:00:19
Hi JahL.
This schema is not at all official. However, it is accepted among some authors and is derived from the work of Young and Klerman (1992).
http://www.mentalhealth.com/rx2/bp-can1.html#Head_3
I think Hagop Akiskal, MD promotes a similar classification system.
- Scott
> > One proposed scheme:
> >
> >
> > THE BIPOLAR SPECTRUM
> >
> > BIPOLAR I: Both mania and major depression
> >
> > BIPOLAR II: Major depression and hypomania
> >
> > BIPOLAR III: Cyclothymia. Mild depression and hypomania
> >
> > BIPOLAR IV: Depression and usually no mania. Mania may be triggered by some antidepressants.
> >
> > BIPOLAR V: Depression and no mania. Some blood relatives have had mania
> >
> > BIPOLAR VI: Mania and no depression
> >
> >
> > http://www.bipolarworld.net/Bipolar%20Disorder/Diagnosis/dis.html
>
> Thanks Scott.
>
> It took me three years to have my dx recognised (I had always known what it was) - the main reason being my illness doesn't match any of the traditional descriptions of Bipolar - and I had a particularly nasty response to Lithium. Anything with 5HT action can get me switching however. So I guess I'm BP IV. Cool.
>
> How 'official' is this scheme? Can I go and impress pdocs by quoting a dx they've never even heard of (this is England remember)?
Posted by Phillipa on March 19, 2006, at 22:31:15
In reply to Re: Never thought I'd hear this..... » Phillipa, posted by SLS on March 19, 2006, at 22:05:13
Scott 1. Anxiety and panic. 2. Anxiety panic now fatigue 3. Benzos have been on all of them. Never could tolerate an Ad. Love Jan
Posted by Phillipa on March 19, 2006, at 22:33:32
In reply to Re: Never thought I'd hear this..... » JahL, posted by SLS on March 19, 2006, at 22:19:58
Ps Scott what I'd do just for one day of energy. Love Jan let alone hypomania or mania.
Posted by SLS on March 19, 2006, at 22:39:01
In reply to Re: Never thought I'd hear this..... » SLS, posted by Phillipa on March 19, 2006, at 22:31:15
>
> 1. Anxiety and panic.
>
> 2. Anxiety panic now fatigue
>
> 3. Benzos have been on all of them. Never could tolerate an Ad. Love JanAs has been suggested along another thread, you might be experiencing extreme anxiety and agitation as a reaction to the Luvox. It might subside over the next few days. The addition of fatigue is probably a side effect of the Luvox. You might be feeling depressed as an emotional reaction to your current discomfort and treatment uncertainty. Are you obsessing over things that might be going wrong inside your body? Is that why Luvox was chosen?
What is it about antidepressants that you cannot tolerate?
- Scott
Posted by Caedmon on March 19, 2006, at 23:16:44
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 14, 2006, at 16:15:04
I suppose it's a semantic game. People aren't necessarily "bipolar" or "not bipolar", it's not an either-or situation. I have *symptoms* of bipolarity; the extent of my symptoms directs my Tx. If you want to call it bipolar, that's fine, or if not, then whatever.
Posted by corafree on March 20, 2006, at 0:39:29
In reply to Re: Never thought I'd hear this..... » JahL, posted by SLS on March 19, 2006, at 22:19:58
This is too much info to handle ... joking, sort of.
I guess I'd have to stand in the Bipolar IV group. (I envision all these groups in a high school auditorium wearing different colored vests.)
Seriously, I remember one time I was put on Zoloft. I took one either that morning or the eve before. I arrived at the meeting point for a camping trip. Anyway, for about an hour, I was actually singing and dancing around, "We're going camping. We're gonna' have lots of fun and make a fire! It's gonna' be real cold and we're not gonna' care!"
I went on and on for about an hour, full of energy and optimism. My son and everyone got a real kick out of it.
But, when that hour ended, it really ended, ended. I hit rock bottom for about three days straight. It was the biggest 'drag of a camping trip' I've ever had.
I've referred to it here before as being like being in the movie 'Awakenings'.
Just saw new P and will p/u Abilify tomorrow. Never tried it before. I brought it up and P said he was thinking of it also, it and Lamictal. I'd been on Lamictal and shared a side effect I would not tolerate. So, if anyone has been down Abilify Road, that could 'choose their words carefully re: their reaction', I'd be interested in hearing those 'carefully chosen words'. (Forgive me, but I'm so easily responsive to suggestion!)
I should prob' post Abilify on med board.
bestwishes, cf
Posted by linkadge on March 20, 2006, at 15:10:48
In reply to Re: Never thought I'd hear this....., posted by SLS on March 19, 2006, at 20:59:24
The problem with calling my antidepressant withdrawl "mania", acutal mania is that, when I went back on a bit of celexa, and then tapered off more slowly, all of the symptoms improved.
You would expect that if one is bipolar that the opposite would happen, (ie coming off the drug would reduce mania, and going back on would increase mania).
Just the fact that my problems slowly disolved back into my baseline send the message to me that it was the drug.
Linkadge
Posted by linkadge on March 20, 2006, at 15:20:47
In reply to Re: Never thought I'd hear this..... » linkadge, posted by Caedmon on March 19, 2006, at 23:16:44
This is the thing. Everybody's mood fluctuates to a certain extent. However, not everyone benefits from mood stabilizers.
I guess I am not so much angry about the lable, as I am about what it implies for the patient.
These drugs are not perfect. But whenever there is a problem at hand, psychiatry likes to put the blame on the patient. Ie. the drugs are perfect, and the flaw lies with the patient.
Now thats fine and dandy, but being put on mood stabalizers for extended periods of time, when much simpler measures could be taken is not so fine.
Linkadge
Posted by linkadge on March 20, 2006, at 15:26:47
In reply to Re: Never thought I'd hear this..... » SLS, posted by corafree on March 20, 2006, at 0:39:29
All of these categories also serve the drug companies. We can prescribe SSRI's for everything from a bad hair day to major depressive disorder.
With the extension of the bipolar spectrum or whatever, we are probably going to see mood stabilizers prescribed a lot more.
I personally see cause and effect. Cause: SSRI's being prescribed like candy - effect, mood stabilizers being prescribed like candy.
Just like with stimulants, as prescriptions for stimulants increase, so with that of benzo's and beta blockers etc to try and reduce the negative effects of the stimulants.
Linkadge
Posted by SLS on March 20, 2006, at 15:30:35
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 20, 2006, at 15:10:48
Hi.
> The problem with calling my antidepressant withdrawl "mania", acutal mania is that, when I went back on a bit of celexa, and then tapered off more slowly, all of the symptoms improved.
I think that's what one would expect from a rebound-mania.
> You would expect that if one is bipolar that the opposite would happen, (ie coming off the drug would reduce mania, and going back on would increase mania).
It might depend upon how long you waited to add back the drug once the mania appeared. I really don't know. It was the discontinuation of the drug that triggered the mania, not its introduction or chronic administration.
How did you go about discontinuing the drug the first time the mania was triggered?
How long did you wait before reintroducing the drug?
My guess is that if the drug is reintroduced immediately, the mania would subside. Conversely, should the drug be reintroduced after an extended period of mania, the mania might get worse.
* I have no emotional investment in needing to believe that either one of us is bipolar.
- Scott
Posted by corafree on March 20, 2006, at 15:57:16
In reply to Re: Never thought I'd hear this..... » linkadge, posted by SLS on March 20, 2006, at 15:30:35
You said ...
>* I have no emotional investment in needing to believe that either one of us is bipolar.<
I agree completely. I feel this way also.
cf
Posted by linkadge on March 20, 2006, at 20:36:44
In reply to Re: Never thought I'd hear this..... » linkadge, posted by SLS on March 20, 2006, at 15:30:35
"* I have no emotional investment in needing to believe that either one of us is bipolar."
No, no, I understand. I came off 20mg of celexa (been on it for about 5 years) almost overnight. Symptoms started with panic attacks, severe mood swings thoughout the day, rage attacks, rebound sexual function, periods of extreme emotional intensity (it was kindof beutiful). I went back on about half 2-3 weeks weeks later and a lot subsided. A tapered more slowly, and eventually things normalized. Certain things have never improved since stopping the SSRI's. I have some movement problems that are fairly persistant.
Linkadge
Posted by SLS on March 21, 2006, at 7:53:03
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 20, 2006, at 20:36:44
> "* I have no emotional investment in needing to believe that either one of us is bipolar."
>
> No, no, I understand. I came off 20mg of celexa (been on it for about 5 years) almost overnight. Symptoms started with panic attacks, severe mood swings thoughout the day, rage attacks, rebound sexual function, periods of extreme emotional intensity (it was kindof beutiful).That doesn't sound like mania to me. It sounds more like a common cluster of SRI withdrawal symptoms plus a return of emotions that might have been blunted for those years you took the drug. From everything I have read of your experiences with your illness, I never saw anything that jumped out at me as demonstrating bipolarity.
- Scott
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