![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 36. Go back in thread:
Posted by dbc on March 20, 2008, at 16:37:25
In reply to Re: Bipolar III caused by antidepressants? » dbc, posted by polarbear206 on March 20, 2008, at 16:00:11
Oh i realize theres been tons of research done over the last 60 years or so into the BP sprectum. All im saying is that Dr. Phelps is the man current pushing for broader uses of the word bipolar and he happens to also be wording what goes into the next DSM bipolar entry.
Posted by cg1973 on March 20, 2008, at 17:08:50
In reply to Re: Bipolar III caused by antidepressants? » cg1973, posted by polarbear206 on March 20, 2008, at 11:59:47
Thanks for your response. It helps to know there are others out there experiencing the same thing. I guess I just don't understand how the differentiate between concentration problems caused by ADD and those cause by some type of mania related to a Bipolar Disorder.
Posted by Maxime on March 20, 2008, at 18:39:17
In reply to Bipolar III caused by antidepressants?, posted by cg1973 on March 19, 2008, at 22:13:09
I am diagnosed with bipolar III. I think it is important to make the distinction otherwise you will end up on mades that make you worse.
In Britain there 8 different types of bipolar disorder (about that I believe).
Antidepressants that made me hypomanic are: effexor and paxil.
I hope you find something that works.
Maxime
Posted by Phillipa on March 20, 2008, at 21:48:17
In reply to Re: Bipolar III caused by antidepressants? » cg1973, posted by Maxime on March 20, 2008, at 18:39:17
Doc here wearning friend off effexor as he now thinks she may have some form of bipolar. On high doses of xanax now. I saw this guy too and he took me off luvox and only benzos and then serzone which scared me away. Phillipa
Posted by B2chica on March 21, 2008, at 12:38:03
In reply to Re: Bipolar III caused by antidepressants? » dbc, posted by polarbear206 on March 20, 2008, at 16:00:11
interesting that you bring up Kraeplin, i did research on him after i got the dx of BP2. i couldn't seem to find anything that really fit what i was feeling. he identified something as aggitated depression. i liked that description. other T's and pdocs tried to tell me that was a type of manic behavior, but my current pdoc has me down as psychotic depression with bouts of hypmania...which i MUCH more agree with. this seems to fit me better.
i think the whole deal of spectrum use needs to be a bit careful cuz the more options at times are good but other times gives the docs more wiggle room to pigeon hole ya.
so if something doesn't sit right in your gut...keep at it. i did. and i'm glad i did. it'll hopefully keep me off some of those meds that made me batty, all because the docs "were sure they'd work because i was bp2", and maybe i am, but they didn't see the big picture like my pdoc now does.
b2c.
Posted by Bob on March 21, 2008, at 13:46:37
In reply to Re: Bipolar III caused by antidepressants? » polarbear206, posted by B2chica on March 21, 2008, at 12:38:03
Sometimes I gotta wonder why all these subtypes and nuances matter for treatment restistant people. We only have a limited number of drug classes and drugs, and all we can really do is try them and see what happens.
I'm severely treatment resistant and am all over the map. Some ADs make me sleep all day and gain weight, others make me go through the roof. Some make me suicial, or give me mixed states. Many mood stabilizers are heavily sedating, while others are severely destabilizing. Benzos are depressogenic and sleep inducing. It never ends, and it's not as simple as avoiding ADs because they make it worse. So again, I wonder what having 12 different types of bipolar really does to solve anyone's problem.
Posted by mike lynch on March 21, 2008, at 14:50:59
In reply to Re: Bipolar III caused by antidepressants?, posted by dbc on March 20, 2008, at 1:26:12
> Its not that ADs are actually changing your neurochemistry its just that they may uncover an existing disorder in patients with complicated problems. BP III doesnt actually exist in clinical use as far as i know.
>Do you have any evidence for this. Are you really saying that SSRI's, medication that are used to treat mood disorder, actually TRIGGER THEM? Is that really any better? In my opinion and experience with these drugs is that they CAUSE them.
Posted by dbc on March 21, 2008, at 15:14:27
In reply to Re: Bipolar III caused by antidepressants?, posted by mike lynch on March 21, 2008, at 14:50:59
> Do you have any evidence for this. Are you really saying that SSRI's, medication that are used to treat mood disorder, actually TRIGGER THEM? Is that really any better? In my opinion and experience with these drugs is that they CAUSE them.<
Thats the exact use of BP 3 despite it not being in the DSM. Its almost always hypomania induced by SSRIs/SNRIs. Its use is very vague and controversial, its sort of like the term pre-diabetes. Do we really know what that means and who is using it in a clinical environment. Psychiatry is so hit and miss i think people just end up seeing trends in certain medications and call it something new despite it not being officially used and sometimes it helps DXing a patient.
Posted by dbc on March 21, 2008, at 15:21:23
In reply to Re: Bipolar III caused by antidepressants?, posted by mike lynch on March 21, 2008, at 14:50:59
What i was really getting at is yes anti-depressants tend to do weird things to people that are bipolar. Such as mood cycling, hypomania, etc. Its not the meds fault that this is happening its just the doctor had no clue the person might be bipolar. The BP spectrum is vague at best but the treatments are all the same and mood stabilizers are the main drugs of choice for them rather than anti-depressants.
Posted by Bob on March 21, 2008, at 15:54:43
In reply to Re: Bipolar III caused by antidepressants?, posted by dbc on March 21, 2008, at 15:21:23
The BP spectrum is vague at best but the treatments are all the same and mood stabilizers are the main drugs of choice for them rather than anti-depressants.
So what happens when someone like me comes along who has a strange BP variant and responds badly to ADs, but then goes into a sedated unipolar type depression on "mood stabilizers"? In my experience, the mood stabilizers I am able to tolerate such as Lithium or Depakote turned me into a Rip Van Winkle zombie with not motivation or energy. Oddly, there are a number of ADs that do this also.Seems that any drug that is moderately activating I cannot tolerate, and the ones I can tolerate end up as strong sleep meds.
Posted by 49er on March 21, 2008, at 17:39:29
In reply to Bipolar III caused by antidepressants?, posted by cg1973 on March 19, 2008, at 22:13:09
Hi,
Due to board rules, I can't really say what I think of what your psychiatrist said.
Read the book, the antidepressant solution by Joseph Glenmullen, who is not antimeds. Bipolar can't be diagnosed on the basis of med reactions and it uncovering hiddern BP tendancies. It would have to done on basis of a very careful interview.
Many people have bad reactions to antidepressants but once the meds are removed, they are fine. I am not trying to tell you what you should do but just pointing out whey I feel your psychiatrist is wrong.
I probably would have been diagnosed BP by your doctor. But thankfully, my psychiatrist never fell for that line of reasoning. Anyway, as I taper off of my meds, I feel alot better.
Anyway, trust your intuition.
Finally, ADHD is frequently misdiagnosed as BP. So keep that in mind.
49er
Posted by Quintal on March 21, 2008, at 19:32:32
In reply to Re: Bipolar III caused by antidepressants?, posted by 49er on March 21, 2008, at 17:39:29
Just my two pen'orth on the bipolar specturm. I was diagnosed with plain bipolar disorder aged 19 based on self-reported symptoms, and treated on and off for the next four years with nearly every drug under the sun. At age 24 my pdoc discharged me, and wrote in the notes something to the effect that in his opinion, I was little more than a personality disordered malingerer. He said that he had never seen any sign of 'bipolar symptomology' in me and the fact that I'd taken nearly thirty antidepressants without having a manic episode bolstered this view. In the following year I came more or less to accept the grain of truth in his assessment and tried my best to get on with life med free. In a way it was a delicious irony that I suffered my first psychotic episode while med free, almost two years after he discharged me. With a bit of prompting from me and my father, this was diagnosed as a manic episode. So according to the DSM that would make me Bipolar I, although no one has said such.
I live in the UK and as far as I'm aware the only bipolar categories in current use are Bipolar I and Bipolar II. There is also a condition called cyclothymia, which closely resembles what is now being described as Bipolar III, but there are no elaborate subdivisions as has been suggested here. My take on that particular problem is that there as many different forms of bipolar disorder as there are people with bipolar disorder, and beyond a certain point this endless dividing and categorising becomes futile, and a little silly to be honest - as they all merge into each other at some point. For example, my 'Bipolar I Disorder' is indistinguishable from Paranoid Schizophrenia during the acute phase, although we normally think of Schizophrenia as being a very different kettle of fish. I'm not a fan of the Kraepellian approach, although I acknowledge it does have its uses.
Q
Posted by cg1973 on March 21, 2008, at 23:09:51
In reply to Re: Bipolar III caused by antidepressants?, posted by dbc on March 21, 2008, at 15:21:23
I'm sure there's still debate on this but my doctor's (she's a neurologist and a psychiatrist) exact words were, "Bipolar III results from changes in the brain chemistry due to the long term use of anti-depressants"
I'm glad someone referenced board rules before I broke them myself expressing an opinion about the pharmaceutical companies.
Posted by cg1973 on March 21, 2008, at 23:17:26
In reply to Re: Bipolar III caused by antidepressants?, posted by 49er on March 21, 2008, at 17:39:29
My intuition says it's AD/HD and not Bipolar. Then again...how to put this...since we're only now at a point in time where long-term side effects of SSRIs are becoming available, I wouldn't be completely surprised if it did turn out that they had the possibility of changing brain chemistry for the worse over time. That would fit with the feeling I have had for awhile that, despite treatment, therapy, soul searching, etc. things seem to get worse as I get older.
Also, I've taken lots of different things for the AD/HD and haven't had anything work that well. And, as much as I hate to admit it, I've been more productive with the Geodon added in the last two days than I had been in months.
Posted by dbc on March 22, 2008, at 11:52:29
In reply to Re: Bipolar III caused by antidepressants?, posted by cg1973 on March 21, 2008, at 23:09:51
> I'm sure there's still debate on this but my doctor's (she's a neurologist and a psychiatrist) exact words were, "Bipolar III results from changes in the brain chemistry due to the long term use of anti-depressants"
>
Thats ridiculous and a giant leap in logic and probably an anti-medication statement.Let me play this game. My neurologist thats also a psychiatrist says theres no hard evidence to support such a claim. She also says to "put one left foot in and then put one left foot out, put one left foot in and you shake it all about".
Posted by cg1973 on March 22, 2008, at 21:12:06
In reply to Re: Bipolar III caused by antidepressants?, posted by dbc on March 22, 2008, at 11:52:29
Okay, apparently I'm a liar??? And no, she's not anti-medication. She gave me different medication. I was just repeating her quote. I have no desire to "do battle" over this. Please stop being so hateful. Goodbye to this entire community.
Posted by dbc on March 22, 2008, at 21:25:43
In reply to Re: Bipolar III caused by antidepressants? » dbc, posted by cg1973 on March 22, 2008, at 21:12:06
Dont take me to seriously sir. Its not something to leave the board over. Im just grumpy in the morning and jump to conclusions.
Posted by undopaminergic on March 23, 2008, at 7:07:53
In reply to Re: Bipolar III caused by antidepressants?, posted by dbc on March 20, 2008, at 1:26:12
>
> BUT theres been studies that show bipolar 1/2 do cause actual neurological changes over time which starts manifesting symptoms and becoming more extreme over time. Theres theories about this being due to glutamate toxicity. (note all mood stabilizers greatly impact glutamate).I'm actually pursuing an anti-glutamte route at this point, but for somewhat different reasons, based on research, clinical trials, as well as my my own experience with memantine and amantadine - the latter of which produced an intense but temporary antidepressant and stimulant response that may be the all-time high of my life so far.
NMDA glutamate receptor antagonists are known to produce euphoria in some people who use them (mostly ketamine and phencyclidine/PCP) recreationally, and at certain doses, both ketamine and MK-801 (a very selective and potent NMDA-antagonist) have been shown to elicit an amphetamine-like locomotor stimulant respone in laboratory animals. Furthermore, several clinical studies indicate that intravenous ketamine results in rapid improvement of depression - an effect that lasts at least a week after the injection.
For example: "The behavior of mice given amphetamine was qualitatively indistinguishable from that of mice given 0.3 mg/kg MK-801." - see http://www.nature.com/npp/journal/v22/n4/abs/1395451a.html
It may be that in some people suffering from an apparent dopamine deficit, the impairment of dopaminergic neurotransmission is actually a consequence of excessive glutamatergic activity that may be corrected with glutamate antagonists.
The NMDA-receptor antagonists, including amantadine and memantine (or possibly low doses of PCP or MK-801 for the adventurous) perhaps in combination with anticonvulsants such as lamotrigine and carbamazepine may thus be interesting choices on their own or as augmentation to a dopaminergic regimen.
Posted by Phillipa on March 23, 2008, at 19:54:13
In reply to Re: Bipolar III caused by antidepressants?, posted by undopaminergic on March 23, 2008, at 7:07:53
My anesthesia for surgery was partly ketamine, versed and one other med no depression relief. Any reason it was IV? Phillipa
Posted by mike lynch on March 24, 2008, at 1:03:53
In reply to Re: Bipolar III caused by antidepressants?, posted by dbc on March 21, 2008, at 15:21:23
> What i was really getting at is yes anti-depressants tend to do weird things to people >that are bipolar. Such as mood cycling, hypomania, etc. Its not the meds fault that this is happening its just the doctor had no clue the person might be bipolar. The BP spectrum is vague at best but the treatments are all the same and >mood stabilizers are the main drugs of choice for them rather than anti-depressants.
What makes you think the doctor missed the bp diagnosis? Is it that far out of the realm of possibility that manipulating neurotransmitters via the use of SSRI's *caused* the onset of hypomania?
If the patient had BP to begin with, then it WOULDN'T be the medications fault would it? Thus their wouldn't be a DSM consideration for bp3 which is caused exclusively by medication. But that is the whole basis for it.
I have been on nearly every ssri there is, and everyone of them caused hypomania. And I WAS NOT bipolar in anyway before. The MEDS cause it.
Posted by undopaminergic on March 25, 2008, at 4:00:46
In reply to Re: Bipolar III caused by antidepressants? » undopaminergic, posted by Phillipa on March 23, 2008, at 18:54:13
> My anesthesia for surgery was partly ketamine, versed and one other med no depression relief. Any reason it was IV? Phillipa
Probably no other reason than that being a common manner of ketamine administration for medical purposes (recreational users may be more likely to snort or ingest it).
It's unfortunate that it provided no relief for you. Possibly, the Versed may have interferred, not to mention that nothing seems to work for everyone (in one study, 71% of treatment-resistant depressives responded).
Posted by Phillipa on March 25, 2008, at 18:16:45
In reply to Re: Bipolar III caused by antidepressants?, posted by undopaminergic on March 25, 2008, at 4:00:46
So does that mean I'm really not depressed just sad and bored? Phillipa
Posted by KarenRB53 on March 25, 2008, at 20:38:34
In reply to Re: Bipolar III caused by antidepressants? » cg1973, posted by Maxime on March 20, 2008, at 17:39:17
> I am diagnosed with bipolar III. I think it is important to make the distinction otherwise you will end up on mades that make you worse.
>
> In Britain there 8 different types of bipolar disorder (about that I believe).
>
> Antidepressants that made me hypomanic are: effexor and paxil.
>Prozac is the one that made me hypomanic. What meds are you on now?
Karen
> I hope you find something that works.
>
> Maxime
Posted by undopaminergic on March 27, 2008, at 2:08:07
In reply to Re: Bipolar III caused by antidepressants? » undopaminergic, posted by Phillipa on March 25, 2008, at 19:16:45
> So does that mean I'm really not depressed just sad and bored? Phillipa
That the ketamine didn't cheer you up? I don't think any far-reaching conclusions should be drawn from it.
Posted by KarenRB53 on March 27, 2008, at 7:30:30
In reply to Re: Bipolar III caused by antidepressants? » polarbear206, posted by B2chica on March 21, 2008, at 12:38:03
> interesting that you bring up Kraeplin, i did research on him after i got the dx of BP2. i couldn't seem to find anything that really fit what i was feeling. he identified something as aggitated depression. i liked that description. other T's and pdocs tried to tell me that was a type of manic behavior, but my current pdoc has me down as psychotic depression with bouts of hypmania...which i MUCH more agree with. this seems to fit me better.
>
> i think the whole deal of spectrum use needs to be a bit careful cuz the more options at times are good but other times gives the docs more wiggle room to pigeon hole ya.
>
> so if something doesn't sit right in your gut...keep at it. i did. and i'm glad i did. it'll hopefully keep me off some of those meds that made me batty, all because the docs "were sure they'd work because i was bp2", and maybe i am, but they didn't see the big picture like my pdoc now does.
>
>
> b2c.
What medications does your doctor have you on for aggitated depression? Hope you don't mind my asking.Karen
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.