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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by tboybmx on July 24, 2008, at 15:21:00
This is the second time I was told I might be Bipolar. The first time was when I started Lexapro after five days I stopped because I was feeling Paranoid and wierd sensations throughtout body and also kept telling my Doc I felt very Tense and agitated while on it those 5 days. The second time is now I'm Taking Zoloft for Panic Disorder with Agoraphobia, and once again I have times when I just had to get out and buy something then all of a sudden I felt like crying and then it stopped. Another occassion I felt like GRRRRRRR for a while then felt like crying then it stop. Any Info is appreciated.
Posted by linkadge on July 24, 2008, at 21:18:47
In reply to CAN SSRI's CAUSE BIPOLAR TO SHOW UP OR JUST SIDE A, posted by tboybmx on July 24, 2008, at 15:21:00
This is a good question. There are many differing opinions on the issue.
It is important first to separate the reactions that would be considered 'manic reactions' from those that are 'akathesia reactions'. Akathesia is a common start up side effect from SSRI antidepressants. Some people think it is from the ability of SSRI's to suppress dopaminergic function in certain neural structures. Individuals with preexisting compromised dopaminergic function may be very sensitive to the effects of SSRI's.
Symptoms of akathesia are extreme restlessness and a feeling of being uncomfortable in ones own skin. Other start up side effects can include extreme anxiety.
As for antidepressants causing bipolar there is a lot of discrepency. One side believes that antidepressants cannot cause manic reactions in normal people they only unleash such symptoms in an underlying bipolar disorder.
The other side argues that antdipressants can cause manic reactions in otherwise normal people that mimic the symptoms of bipolar. There are studies that suggest this can be true. For instance, users of the antidepressant nardil often report feeling euphoric for the first few months. It is a side effect that can show up even in unipolar patients. Wellbutrin and parnate can also cause euphoria in patients and even test subjects. There are currently rodent studies underway to try and determine exactly why antidepressants can sometimes cause mania.
I have had manic and psychotic reactions to antidepressants. I stopped them and it subsided. I havn't had such symptoms before, or since, therefore I conclude it was the drug.
I personally agree with the latter theory. I think that drugs effects can be unpredictable and should never be taken as a sign of any underlying disorder. I think if one is bipolar then there should be a clear history of manic epsiodes when drug free. I think that doctors are trying to cover their behinds by suggesting that their drugs cannot cause such side effects.
That being said, it certainly *could* be a sign of bipolar. Many bipolar patients do present to their doctors in the depressed phase, and an antdidepressant could definately trigger mania. So, I think it is a possability, I just don't think that antidepressant induced mania is *always* as sign of bipolar disorder.
Linkadge
Posted by Marty on July 25, 2008, at 10:17:12
In reply to Re: CAN SSRI's CAUSE BIPOLAR TO SHOW UP OR JUST SIDE A, posted by linkadge on July 24, 2008, at 21:18:47
In the next DSM (DSM-V coming around 2011) the Bipolar disorder spectrum will be enlarged to include, in part, a type (Bp-4?) which will describe people with bipolar feature that ONLY SWITCH INTO (HYPO)MANIA WHEN GIVEN SOME MEDS.Note that this will NOT include Bipolar patient who CAN switch in mania WITHOUT meds as the majority of Bipolar can switch into mania when on some med and many has their first manic episode after being given an antidepressant to treat their first depression.
It is likely that nobody will receive this Bp4 diagnostic after only 1 or 2 med induced switch into mania has it takes many years to confirm the the sufferer doesn't switch into mania without a change in meds.
My Pdoc, which is the most respected Bipolar disorder specialist in Canada and the president of the psychiatrist association of Quebec, already told me he thought that I was Bp4.
It took me 7 years and 25+ med trial before he dare to tell me about it.
The first time I had a switch into hypomania when after I had a TOXIC psychosis (MDMA/Metamphetamine at a rave party) the general practinioner I saw prescribed me Paxil 40mg for 2 weeks than switched me to 60mg(!) ... 1 month later I had a new job in the 80,000$, a new 45k sport car and a new girlfriend swith I propose to while a short trip to Mexico! ... 1 month before I was crippled into bed suffering from intense depersonalization/derealization and psychosis-grade social phobia which induced me severe panic attack while seeing people ON TV having social relation/situation .... an illegal Drug pushed me into psychosis and depression and a prescription one pushed me into mania .. a more than common story these days... so I guess Bp4 will be a big thing when it become official.
Big kudos for the DSM people for 'having the balls' to include it into the next version as you can bet it's one diagnostic the pharma company will(already) hate big time!
/\/\arty
Posted by linkadge on July 25, 2008, at 16:15:01
In reply to Re: CAN SSRI's CAUSE BIPOLAR TO SHOW UP OR JUST SIDE A » linkadge, posted by Marty on July 25, 2008, at 10:17:12
>It is likely that nobody will receive this Bp4 >diagnostic after only 1 or 2 med induced switch >into mania has it takes many years to confirm >the the sufferer doesn't switch into mania >without a change in meds.
Thats true and unfortunately, many patients will still be given mood stabilizers to treat the AD induced mania. Sometimes these patients don't do well. They don't like mood stabilizers alone since they don't help the depression and the AD alone causes mania, so they end up on both classes of meds. Hopefully they will develop diverse targets for unipolar disorder to see if some of these patients might have fewer side effects on an AD with completely different mechanism. I think the AD's that mess the most with sleep seem to be the ones most capable of inducing mania.
Some people think the AD induced mania is really just a form of disinhibition. The SSRI's can diminish executive function and can sometimes cause reckless or thoughtless behavior. Perhaps thats why wellbutrin has a lower switch rate to mania. It would likely enhance prefrontal cortex function that might leave the user in more control of their moods and behavior.
>My Pdoc, which is the most respected Bipolar >disorder specialist in Canada and the president >of the psychiatrist association of Quebec, >already told me he thought that I was Bp4.I don't even think it should be called bipolar really. I have had manic like responces to certain antidepressants. One of the reasons I think it was a form of extreme executive dysfunction is because I was prescribed ritalin which completely aborted it. You wouldn't expect that with BPI.
>It took me 7 years and 25+ med trial before he >dare to tell me about it.
There is so much that they just don't admit to. They are covering the wellfare of their buisness. It is only feasable to release the side effects of a class of drugs when there is a newer class which is supposed to be better.
>The first time I had a switch into hypomania >when after I had a TOXIC psychosis
>(MDMA/Metamphetamine at a rave party) the >general practinioner I saw prescribed me Paxil >40mg for 2 weeks than switched me to 60mg(!) ... >1 month later I had a new job in the 80,000$, a >new 45k sport car and a new girlfriend swith I >propose to while a short trip to Mexico! ... 1 >month before I was crippled into bed suffering >from intense depersonalization/derealization and >psychosis-grade social phobia which induced me >severe panic attack while seeing people ON TV >having social relation/situation .... an illegal >Drug pushed me into psychosis and depression and >a prescription one pushed me into mania .. a >more than common story these days... so I guess >Bp4 will be a big thing when it become official.Yes, my story was not that severe. Like I said before, when you're on drugs (legal or illegal) you are on drugs. Its really hard to know what combinations can do. The famous BP molecular biologist Dr. Manjii said (in reference to the ability of drugs to precipitate mania), "given the right conditions, it seems that anybody can have a manic episode".
Its just like seizures. There is no such thing as immune to seizures. There are high and low thresholds but given the right conditions andbody can have a seizure.
Linkadge
Posted by Bob on July 26, 2008, at 22:05:56
In reply to Re: CAN SSRI's CAUSE BIPOLAR TO SHOW UP OR JUST SIDE A » Marty, posted by linkadge on July 25, 2008, at 16:15:01
> >It is likely that nobody will receive this Bp4 >diagnostic after only 1 or 2 med induced switch >into mania has it takes many years to confirm >the the sufferer doesn't switch into mania >without a change in meds.
>
> Thats true and unfortunately, many patients will still be given mood stabilizers to treat the AD induced mania. Sometimes these patients don't do well. They don't like mood stabilizers alone since they don't help the depression and the AD alone causes mania, so they end up on both classes of meds. Hopefully they will develop diverse targets for unipolar disorder to see if some of these patients might have fewer side effects on an AD with completely different mechanism. I think the AD's that mess the most with sleep seem to be the ones most capable of inducing mania.
>
> Some people think the AD induced mania is really just a form of disinhibition. The SSRI's can diminish executive function and can sometimes cause reckless or thoughtless behavior. Perhaps thats why wellbutrin has a lower switch rate to mania. It would likely enhance prefrontal cortex function that might leave the user in more control of their moods and behavior.
>> Linkadge
>
>
This is somewhat like the predicament I have found myself in more than once, except instead of mania, it's usually irritated panic and akathisia. So, I've often been on combinations of depressing "mood stabilizers" in combination with initially activating anti-depressants. Eventually, the AD poops out and I'm severely fatigued, depressed, anhedonic, and drowsy.Meds I've taken that produced any kind of hypomania (I've never experienced full blown mania) would always fade out into depression.
- Bob
Posted by Bob on July 26, 2008, at 22:11:18
In reply to Re: CAN SSRI's CAUSE BIPOLAR TO SHOW UP OR JUST SIDE A » Marty, posted by linkadge on July 25, 2008, at 16:15:01
>
> There is so much that they just don't admit to. They are covering the wellfare of their buisness. It is only feasable to release the side effects of a class of drugs when there is a newer class which is supposed to be better.
>
> Linkadge
>
>Wow! This is so true! It's disgusting since they're playing with people's welfare, but I can't see who will ever be able to change it. The amounts of money involved are almost incomprehensible.
Another arena in which this phenomenon becomes evident is in study abstracts. If the study is investigating a novel drug for depression or mood disorders, they will often immediately distance themselves from current treatments by describing all their flaws and shortcomings in order to justify the need for their new treatment.
Posted by Bob on July 26, 2008, at 22:14:12
In reply to Re: CAN SSRI's CAUSE BIPOLAR TO SHOW UP OR JUST SIDE A » linkadge, posted by Marty on July 25, 2008, at 10:17:12
>
> In the next DSM (DSM-V coming around 2011) the Bipolar disorder spectrum will be enlarged to include, in part, a type (Bp-4?) which will describe people with bipolar feature that ONLY SWITCH INTO (HYPO)MANIA WHEN GIVEN SOME MEDS.
>
> Note that this will NOT include Bipolar patient who CAN switch in mania WITHOUT meds as the majority of Bipolar can switch into mania when on some med and many has their first manic episode after being given an antidepressant to treat their first depression.
>
>
> /\/\arty
So how does this BP 4 differ from the BP III I've been hearing about?- Bob
Posted by chiron on July 27, 2008, at 0:17:10
In reply to Re: CAN SSRI's CAUSE BIPOLAR TO SHOW UP OR JUST SIDE A » linkadge, posted by Marty on July 25, 2008, at 10:17:12
That is really cool about the BP4 in the DSM.
Qustion - so where do I fit into all of these theories. My dr doesn't think I really fit into a category, but probably BPII.
Prozac started probably @ 13. A lot of SSRIs and some occasional Wellbutrin for many years to follow. Always depressed. Meds helped a little. Chronic depression w/ some agitation.
My mom's side of the family has the more meloncholy type and take the SSRIs.
My father's side has more of the aggitated, bipolar stuff.
I think I have a combo of both.
So after 20ish years of mostly SSRIs, I noticed that I had evolved into 'cycling'.I never knew how I was going to feel the next day, or even later in the day.
Also, an introduction of Adderall = 1 week of bliss until the ups & downs were becoming out of control.
What I believe from my experiences & from what I have read-
1) With my crazy gigantic mixture of genes "& stuff", I had the tendencies for both a "regular" depression & the cycling. Was the cycling "recessive"? Was it revealed earlier and I just didn't notice it? But my experience matches the theory that prolonged use of SSRIs can lead to bipolar.
2) So if my brother with the "regular" more of a meloncholic depression continues taking prozac for years more, will he end up cycling? I don't really see it, although it could be possible
3)If my bipolarish agitated brother(hasn't been dx) went on ADs he might become worse.
I guess I agree with all thoughts.
Posted by Amigan on July 27, 2008, at 14:49:40
In reply to CAN SSRI's CAUSE BIPOLAR TO SHOW UP OR JUST SIDE A, posted by tboybmx on July 24, 2008, at 15:21:00
As a side-note, i don't think that agoraphobia can be treated effectively with a SSRI, unless it's borderline.
Posted by blueboy on July 28, 2008, at 10:08:44
In reply to CAN SSRI's CAUSE BIPOLAR TO SHOW UP OR JUST SIDE A, posted by tboybmx on July 24, 2008, at 15:21:00
In my personal experience, SSRI's and SSNI's had horrible effects on me and did absolutely no good.
Nardil certainly helped the depression, but put me in a permanent hypomanic state and with serious side effects. Nevertheless, I stayed on it for almost two years, because the AD effect was so good.
I was finally diagnosed Bipolar II and I'm now titrating up on Lamictal. I don't know how much good it is doing or will do, but at least I'm not having any side-effects.
Posted by Cerulean Romance on July 31, 2008, at 9:03:09
In reply to CAN SSRI's CAUSE BIPOLAR TO SHOW UP OR JUST SIDE A, posted by tboybmx on July 24, 2008, at 15:21:00
Oh. You want information? Yes. Information. Your psychiatrist is trying to kill you. SSRI medication is not a viable option for patients who might be affected with bipolar disorder. I earnestly suggest seeing a different doctor because staying on with this guy might be suicide by shrink, and I am perfectly serious. The jerk should at least have the decency to stay current. Let me guess: the daffy duck has been treating you out of a little handbook that he hasn't updated in over a decade, right?
Posted by B2chica on August 4, 2008, at 10:04:40
In reply to Re: CAN SSRI's CAUSE BIPOLAR TO SHOW UP OR JUST SIDE A » Marty, posted by Bob on July 26, 2008, at 22:14:12
BP3 is supposed to by Cyclothymia...(i think)
at least that's what i've been told.
a milder form of bipolar, smaller waves of depression and hypomania, and shorter durations.b2c.
This is the end of the thread.
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