Posted by McPac on August 26, 2003, at 17:21:16
In reply to Re: BARB!, Naturopath visit results, please read » McPac, posted by BarbaraCat on August 25, 2003, at 11:58:40
**I think your take on the situation is right on. Yes, I do think that taking an AD without an adequate amount of mood stabilizer is a sure recipe for what your describing, if you're bipolar - and some research suggests even if you're not bipolar.
>>>>>>>>>>>>>>> Barb, can you elaborate on this, "and some research suggests even if you're not bipolar"?
However, you state that you 'rarely get the hypomanic highs' which tells me that you equate BP 'manias' as the classic ones, the kind everyone's impressions of mania is (myself included until I found out better). Mania/hypomania is NOT always the bubbly, get things done, madcap high time that we all have associated it with. It's more likely IRRITABILITY and AGITATION.
>>>>>>>>>>> So hard to distinguish when the irrit and agitation and anger is from bipolar and when it is from certain meds...that is the hardest thing to tell! Take Remeron, at 30 mg's I seem to be relatively free from the anger/irrit/agitation....but at 45 mg, DIFFERENT story! Is it the bipolar being affected at the 45 mg dose or is it med side effects (and these ARE side effects that the med can cause and that others do get)? Some will say "it's the bipolar breaking through"....but this is the whole crux of the matter, IS IT the bp breaking through OR is it the med's side effects breaking through? Check this out---I've been on 30 mg of Remeron for about a week now and do NOT feel anger at this dose....I took 5 mg's of Lexapro today and I can feel some agitation/irrit from that! The ssri's really seem to cause that problem for me, some ssri's worse than other ones ..... but that seems like a med side effect, not a bipolar response....another reason that makes it SO hard to tell what is the problem, bipolar or med s/e, is that SO many of these meds do have anger/irrit/agitation as known side effects! I mean, if I took an aspirin or a Tums and then got terribly angry/irrit/agitated I would just think that my bipolar was acting up...but when I take Zoloft, Lexapro, etc., and it happens then I don't know if it's my bp or the med s/e? Even with the Remeron, many folks (others here have said this too during my discussions w/ them) have gotten increased agit/irrit/anger on Remeron due to a s/e. It's in the Remeron literature also. For a while I kept thinking, "well it can't always be the med...it must be me"....but all of the meds that I felt this way on DID have it listed as a possible side effect. It is worse on higher doses also...as I raise the dose, the problems increase. One big problem is that I NEED to take a higher dose---a lower dose isn't enough med to help the dep/ocd.
For me, when I have the classic madcap manias, they last only a short time and then disintegrate quickly into frazzled annoyance and rage. Mainly, I don't get the enjoyable stuff at all
>>>>>>>>>>> Barb, I USED to get a LOT of the fun mini-highs (very enjoyable, very happy, productive,creative).....not much of that anymore!
, but only the trigger fire anger and disorganization on the manic side and the lethargy and life sucks kind on the depressive side. Before lithium I was getting both together in godawful mixed states. I'm not on very much lithium at 600mg because I want to keep my edge so I still have some hypomania of different sorts occasionally, and I still get variations of 'life sucks' (but, really, it does!) depressions. But thank God, no more mixed states. I could live with ANYTHING but not mixed states!
Once again, you MUST understand beyond any doubt that your symptoms of anger, irritability, rage are most likely undertreated manic symptoms.
>>>>>>>>>>>>>> Yes, Barb...I think I'm actually having a type of 'double-whammy' effect--- anger/irrit/agit from bipolar PLUS also getting those same s/e's with some of the meds I've taken! I can definitely understand that those symptoms are bp symptoms...AND I have no doubt that some of the meds that I have taken have also given me those symptoms via med side effects...confusing and very hard to deal with! An AD that worked for dep/ocd/and anxiety WITHOUT also causing the anger/irrit/agit is what I need.
Mainly depression with irritability and agitation (also known as hypomania) IS the description for BPII.
>>>>>>>>>> I USED to get the "happy" mini-highs...now it looks like more of the "angry/agit/irrit" kind....would that still be a bp11? (can't recall the distinction between bp1 and 2).
It's also the description for agigatated depression or depressive GAD, but this is splitting hairs.
It sounds like you are BPII to me and if this is true, you absolutely need an effective level of mood stabilizer. If you are getting horrible mixed states, you're more likely BPI (as I now know myself to be), although I don't think this is the case with you, but in any case, you'd STILL need a mood stabilizer. I have my own experiences about too little lithium:A year and a half ago I ran out of lithium and my mail order pharmacy took about 10 days to get the prescription to me, so I was without for over 2 weeks. I was taking Remeron at the time so I thought I was covered at least until I got my lith in the mail. I started having a very enjoyable hypomania so I didn't start taking the lith once I got it back thinking 'oh boy, I sure feel good so I probably don't need it'. The pleasant hypomania didn't last all that long and quickly turned into disorganization, irritability, snappy quick-trigger anger, sarcasm (my poor husband!), spending money I didn't have, sleeplessness, poor judgement. Once I went back to my 600mg things mellowed out within 1 week. Note that I'm only taking 600mg which is way below my therapeutic window, but it's obviously making a big difference.
>>>>>>>>>>>>> I wrote a long post within the last week or so about what lithium does for me---how it keeps this particular dreaded anxiety/depressive condition from returning...only it sounds like I also use lithium the way some use a benzo! I may well have had a terrible mixed state before and just not knew what it was called! Is it a state of TERRIBLE anxiety AND terrible depression COMBINED into one feeling? Barb, bp1 OR 2 and the treatment is the same regardless right?
I went off Remeron because it really made me feel awful and started lamictal along with lithium. About 6 months ago I started having alarming increases in my thyroid TSH levels which is a problem with taking lithium when one is hypothyroid as I am. So I decided to reduce lithium because I was concerned about permanently damaging my thyroid. I got down to 300mg every other day within a 3 week period and experienced the rage, hot temper stuff pretty dramatically. So again, within 1 week of restarting things smoothed out.
I have a few thoughts on this and your experience will shed light. There's always a withdrawal period where things are shaky. I've wondered whether if I just stayed the course I'd eventually smooth out without the lithium.>>>>>>>>>>> I have wondered a LOT! that IF I could find an AD that helped my dep/ocd/anxiety WITHOUT ALSO causing the anger side effects, could I do without the lithium? Apparently I'll never get to find out because the meds that DO help me simultaneously cause the anger/irrit/agit s/e's! I'd LOVE to find out though.....I've wondered if I was taking a benzo like Klonopin if then I could go off the lithium, since it seems I use my low lithium dosage more like a benzo for anxiety than as a mood stab. anyway.
It sounds like you've been on a substandard dose for a while still have symptoms and so your anger/irritability are not due to withdrawal. The other thing is taking an AD at all when you're BP.
>>>>>>>>> I'm forced to Barb---due to @#$%$#! OCD! I DID used to (YEARSSSSSS ago) only take lithium WITHOUT an AD......not good---I was depressed (needed the mood-lift badly) and I NEEDED an AD as an anti-ocd med.......if it weren't for the stupid ocd I would try that! I'd try to boost my mood using natural supps perhaps but the ocd forces me take an AD for it.
What kind are you taking?
I had nothing but problems with all the ADs I ever took, even with lithium as an augmentor.>>>>>>>>>>>> the ad's WORK well for me Barb...it's just that anger/irrit side effect thing...ruins everything. Dr. Heller says that buspar counters that but nobody here seems to know about that.
The only one that helped was nortriptyline, briefly, when I was suicidally depressed after my Mom's death. But once I emerged from that, I stopped nortrip and eventually felt much better without it. Lamictal 125mg and lithium seem to be doing the trick as far as keeping me from destabilizing. One other thing to consider is, are you really BP? Could it be that you're actually unipolar depressed and not getting high enough a dose of your AD? Even if this is true, my personal opinion is that anyone taking an AD should also take it with a mood stabilizer. Sigh, so many variables.>>>>>>>>>> TOO many variables...wayyyyy too many!
My personal hit is that you're not on enough lithium or whatever mood stabilizer you choose, and you're destabilizing with the AD. One more thought. A high level of testosterone is also associated with anger and aggression.
>>>>>>>>>>> The anger only comes from the meds....without the offending meds, there is no anger problem.
Can you possibly have the mixed blessing of having too much of a good thing? A hormone panel test would tell.
Have you read "Why your depression isn't getting better" by Michael Bartos, MD? He describes what you're going through very well and states without any doubt that BPs most definitely and absolutely require a mood stabilizer, should reconsider using ADs at all, and NEVER use ADs without a mood stabilizer.
Here's the website:Also, here's the recommended book page of a website I like very much. The entire website is great. You might find something that helps:
http://www.mcmanweb.com/book-16.htm
thanks!
And finally, you've been suffering with this for a long time now, Mac. I can only imagine how hard it must be. Why not just up your lithium and see?
>>>>>>>>> Barb, I am upping the lithium dose (600 mgs/day will do the trick).....oh, I'll feel better---it WILL help the anger/irrit thing...but it STILL doesn't tell me if it's just countering the AD's side effects OR if it is helping bipolar symptoms---since the bipolar symptoms AND the ad s/e's are the SAME!
If you start feeling better, I'll bet you can start lowering your dose of ADs and you'll get an even better response.>>>>>>>>>>>> Yep, if not for my stupid ocd...THAT would get WORSE!
But only after the withdrawal subsides. What does your pdoc say in all this?
>>>>>>>>>>>> Don't go to one now Barb......never liked my previous ones, they just weren't worth much at all.....can't get anything accomplished in 5 minutes w/ them anyway (the "alotted" time, lol).......actually, I was going to go to this one but he moved out of state recently.
He/she should be very aware and up on this whole AD/mood stabilizer issue. If he/she is not, why not?>>>>>>>>>>>>I went for years, total JOKE...the 5-minute, worthless visits..."NEXT"..."NEXT"....lol......I ALWAYS felt WORSE when I was going! Hated it for many reasons. I'd rather drop dead than go,lol
BarbaraCat
> Okay, for years I've taken AD's and lithium together....I've always taken a much smaller amount of lithium than most bipolars (I am likely bipolar, though very rarely get even the mini-highs (hypomania), I'm VERY much just the depression part)....anyway, I would, for YEARS, take only 600 mgs/day of Lithium along w/ my anti-dep (and this worked very, very well).......over the last couple of years, I have tried to even DEcrease that small lithium dose, taking only 300 mg/day of lithium w/ my AD...my lithium level is PUNY, something like .016 or .02 last time I checked it...in other words downright microscopic for a bipolar......anyways, over the last couple of years (since lowering my lithium dose to these PUNY levels) I have felt like total crap much of this time--- I have had a lot of AGITATED feelings with ANGER problems....and when I try to switch AD's, as soon as I get to just a moderately high dose, the agitation/anger/irritability gets MUCH worse....for a while I kept thinking that it's just the AD's that are causing the anger....but NOW I'm seriously thinking that it's the PUNY, DEcreased lithium dose, THAT WHEN COMBINED WITH the AD's, that is the problem....in other words, that the AD's are 'destabilizing' me or making me feel agit/angry but it's BECAUSE I'm on TOO LITTLE of a mood stabilizer....Isn't that a signal or tip-off to bipolar in many cases---that if someone is trying different AD's and having really bad effects and no success (and often feel even worse!) that they may be bipolar and need a mood stab. WITH their AD? I think my agitation/anger/irrit on the AD's is telling me that I need to increase my mood stab....(I KNOW that one AD (Prozac) was DEFINITELY a TERRIBLE drug for me, TERRIBLE anger/rage......but now, as more and more seem to cause problems, I think my PUNY lith. dose is a BIG part of the problem.....would most bipolars get totally messed up (agit/anger/irrit) if they were only taking an AD WITHOUT their mood stabilizer? Sorry for that rambling post, lol, what do you think Barb?
poster:McPac
thread:9730
URL: http://www.dr-bob.org/babble/20030823/msgs/254416.html