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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 34. This is the beginning of the thread.
Posted by antennastoheaven on June 24, 2013, at 3:51:05
Short version:
* I have been depressed for a while, with the main concerns being low energy/motivation and anhedonia.
* I've taken a few SSRIs and an SNRI which all caused some form of hypomanic behavior. No hypomanic behavior otherwise.
* I'm diagnosed bipolar I even though this diagnosis requires a manic episode, and I think I've only exhibited hypomanic behavior. Either way, those symptoms were caused by SSRI medications I was taking, which, according them to diagnostic criteria, means they are NOT actually manic or hypomanic symptoms.
* Bipolar II is for hypomanic episodes, and would be a more accurate diagnosis, but as before, drug-induced hypomanic symptoms do not count as a hypomanic episode.
* I was prescribed Lithium (bad side effects, no good effects) and Lamictal (made me so flat and eventually very suicidal) as a result of the Bipolar I diagnosis.
* Major depression seems to fit best right now, and this seems to be what I'm being treated for in the partial hospitalization program I'm in. This is also the diagnosis assigned to me by a pdoc I was refereed to (for a second opinion) by the pdoc who made the bipolar diagnosis.
* Despite this, the pdoc I'm dealing with in the partial hospitalization program I'm in has mentioned starting me on other mood stabilizers such as Depakote or Tegretol. This doesn't seem like a good idea, even if these are only prescribed in order to control hypomanic behavior induced by other medications she intends to prescribe. I am open to other drug treatments, but am wondering if sticking with Wellbutrin is best, since it keeps me motivated while not really helping with anhedonia.Thoughts? Any holes in my conclusions? Read on for more details...
=====================
I have been depressed for a long time but for most of that time did not receive any treatment. Main symptoms are not being motivated to do things and not enjoying things. For most of the past year I've been taking Wellbutrin; it is effective at increasing motivation, but doesn't help much with the anhedonia. After developing anxiety due to unrelated reasons, I started taking the SSRI Zoloft last September. It totally eliminated my anxiety problems and was great for the first month. But then I found myself unable to do any cognitively demanding tasks, no longer cared about going to work, and was spending a lot of money. I was feeling good about all of this, and feeling happy in general. Seems like hypomania? I felt like this all the time. I did miss a lot of time at work, and eventually realized what the problem was. I stopped taking Zoloft in December.
(As an aside, I think Zoloft also caused minor hallucinations / psychedelic visuals)Zoloft was not the first SSRI (or SNRI) I had used. In 2007 while in college I was briefly on Lexapro (which made me tired and not care about going to class) and Effexor (which made me spend a lot of money and not care about going to class).
My behavior during those last two months on Zoloft, plus the previous experiences on the two other drugs, led me to be diagnosed as bipolar I. According to Wikipedia, this diagnosis is incorrect: "Episodes of substance-induced mood disorder due to the direct effects of a medication, or other somatic treatments for depression, drug abuse, or toxin exposure, or of mood disorder due to a general medical condition need to be excluded before a diagnosis of bipolar I disorder can be made.". Plus, I'm not sure if I would describe my behavior on these drugs as "manic", as hypomanic seems to be more correct, which would make bipolar II the more accurate diagnosis.
But according to the DSM-IV-TR, this SSRI-induced hypomanic behavior is NOT indicative of a hypomanic episode:
"F. The symptoms are not due to the direct physiological effects of a substance(e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).Note: Hypomanic-like episodes that are clearly caused by somaticantidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder."
Besides being on SSRIs, I cannot think of any incidences of hypomanic behavior. The closest thing is an occasional temporary break in my depression usually caused by novelty. Things like going on vacation, getting something new (that I had planned to do for a while) like a new car or HDTV, being around people I enjoy for a while, starting a new job, moving to a new place, etc. would make me feel better for a while.
As a result of this bipolar diagnosis, I was treated accordingly. I took Lithium in February/March and it made me feel worse; I don't think it had any direct effects on mood, but it made me feel physically worse and that was enough to discontinue taking it. I started taking Lamictal in March and stepped up to a 100 mg dose in April. This made me totally flat, unmotivated, even more anhedonic, and ultimately suicidal - the closest I've ever been to actually killing myself. The pdoc's response was to increase the dosage to 150 mg (!) which I refused to do and I wanted to immediately reduce the dose with the intention of stopping after a few weeks. She's wanted me to take 50mg ever since.
So here are my conclusions so far - does anyone find problems with these?
* Bipolar I seems like an incorrect diagnosis, since there was no mania, only hypomania, and that this hypomania was caused by other medications. Yet this is the diagnosis in my medical records. The specific ICD9 code provided in my recent disability application was 296.52: "Bipolar I disorder, most recent episode (or current) depressed, moderate"
* Bipolar II seems a little closer, but it still seems incorrect, since hypomanic symptoms are only considered to be hypomanic episodes if they are not adequately explained by other drugs/medications.
* Major depression disorder seems to be the most accurate diagnosis I've yet to receive. I got this one from another pdoc; the one who diagnosed me as bipolar (and filled out my recent disability paperwork) referred me to the other pdoc for a second opinion, and he said I did not seem to be bipolar, and billed me with 296.33 "Major depressive affective disorder, recurrent episode, severe, without mention of psychotic behavior".
I'm a little afraid that the misapplication of the bipolar I diagnosis code may cause problems with my disability applications, especially since the partial hospitalization program is treating me more for major depression related symptoms (this may be in fact the diagnosis they are using for billing purposes).================
In this partial hospitalization program, I'm meeting with a new pdoc and seeing her at least once a week, and she is not sure if I should be diagnosed as bipolar or not. Her only move so far was to restore my use of Wellbutrin (which I had stopped for a month so I could try Emsam, which did not work for me); she has not taken me off the Lamictal 50mg, nor the Abilify 2mg as an adjunct for depression. She mentioned the possibility of trying additional mood stabilizers such as Depakote or Tegretol, neither of which seem like they would be any better than Lamictal (perhaps less suicide-inducing but with more side effects that would have a negative impact on mood). I definitely do not see any point in adding these medications without adding other drugs; it seems the only possible positive effect they could have on me would be to control the hypomanic behavior that might be induced if I took another SSRI. Otherwise I expect that the mood stabilizers would simply make me feel flat and numb again, like Lamictal did. And taking a mood stabilizer to try to reduce the hypomanic effects of an SSRI seems very risky, and with no guarantee that it would result in a positive outcome, even if nothing really bad were to occur.
Thoughts on what I should do next? Is it worth trying another mood stabilizer just for depressive symptoms? Could the addition of a mood stabilizer to a SSRI be 'magical'? Are there other options worth bringing up, such as TCAs or a TeCA like mirtazapine - perhaps non-SSRI serotonergic antidepressants won't cause hypomanic behavior? I've read about people using low doses of SSRIs when larger doses make them hypomanic - perhaps a low dose of Prozac, maybe taken every other day (possible due to Prozac's long half life)? Should I try another MAOI (other than Emsam) - the downside being that I'd have to stop Wellbutrin first and wait for it to go away before starting? Should I just stick with Wellbutirn, which currently works well enough that I feel I could go back to work already?
I don't know how much longer I'm going to be in the partial hospitalization program - the combination of being in a low-stress treatment program and being on a good dose of Wellbutrin again has solved my motivation problem for now, leaving me with just anhedonia. My mood is adequate for now, and the only complaint right now is anhedonia. I may be dropped to a half-day intensive outpatient program shortly (after two weeks in the PHP), and could probably go back to work right now with somewhat reduced productivity. If I'm reading my treatment plan correctly, I may even end up leaving the intensive outpatient program early - after 3 weeks, instead of the 4-6 weeks I was told was typical for patients in the program, assuming the target date for all goals is supposed to be (close to) the date patients are discharged. If I'm going to try any more psychiatric medications, I'd really like to do it ASAP and make changes aggressively, while I'm still off work and still going to a treatment program with easy access to support if things get bad. Otherwise, I figure I should give up on finding new medications through regular pdoc channels and start investigating other treatments - TMS, frequent individual therapy with more CBT, etc.
Posted by antennastoheaven on June 24, 2013, at 4:42:16
In reply to Bipolar DX based only on SSRI hypomanic response?, posted by antennastoheaven on June 24, 2013, at 3:51:05
After reading through the DSM-IV-TR criteria more thoroughly, it looks like the criteria for manic episodes are more closely met than the criteria for hypomanic episodes because hypomanic episodes exlucde occupational disruption (which happened to me). So based on that, Bipolar I is more appropriate than Bipolar II.
But since the full criteria for a manic episode aren't met (since the behavior was induced by medications), neither bipolar diagnosis is correct.
Posted by SLS on June 24, 2013, at 5:56:26
In reply to Re: Bipolar DX based only on SSRI hypomanic response?, posted by antennastoheaven on June 24, 2013, at 4:42:16
Having a manic reaction to an antidepressant is most likely a sign of bipolar disorder. The new DSM V is supposed to have this phenomenon listed as a subtype of bipolar disorder, even in the absence of spontaneous mania. The recognition of bipolar disorder significantly changes treatment choices to include mood-stabilizing or anti-manic agents. Your particular presentation should probably be seen as bipolar I disorder. Depakote, Trileptal, and lithium are reasonable choices to be considered. The neuroleptics, Abilify, Seroquel, or Latuda, might be of help as well. As an antidepressant, Wellbutrin is supposed to be less liable to produce mania. Tricyclics are thought to be the most likely to produce a manic reaction. I don't know about Remeron.
My illness is similar to yours, and I have found Parnate and Nardil more effective than Emsam. You might consider taking an MAOI in combination with Lamictal and Abiify. Both have antidepressant propereties, and Abilify might help prevent a manic reaction.
- Scott
Posted by Phillipa on June 24, 2013, at 9:38:58
In reply to Re: Bipolar DX based only on SSRI hypomanic response?, posted by antennastoheaven on June 24, 2013, at 4:42:16
So are you saying that had you never taken an SSRI that you would not have experienced this? And that ahedonia is how you feel with wellbutrin only? Can't the ahedonia be treated with therapy alone? Phillipa
Posted by Phillipa on June 24, 2013, at 9:45:21
In reply to Re: Bipolar DX based only on SSRI hypomanic response? » antennastoheaven, posted by Phillipa on June 24, 2013, at 9:38:58
In other words (and my spelling is horrific) you had low grade depression before the wellbutrin which worked but left a residual of low grade depression? Would just taking the wellbutrin work? And combine with talking to professional or friend? Sometimes I feel two many myself included took or take meds when none or a low dose of one would work better? Hard to know without seeing the person in real life. Phillipa
Posted by antennastoheaven on June 24, 2013, at 13:02:29
In reply to Re: Bipolar DX based only on SSRI hypomanic response? » antennastoheaven, posted by SLS on June 24, 2013, at 5:56:26
> Having a manic reaction to an antidepressant is most likely a sign of bipolar disorder. The new DSM V is supposed to have this phenomenon listed as a subtype of bipolar disorder, even in the absence of spontaneous mania.
Lots of people say having a manic response to a SSRI is evidence of bipolar disorder, but the DSM-IV-TR criteria for a manic episode specifically exclude drug/medication induced symptoms. So the diagnosis still doesn't feel correct to me. Would a bipolar diagnosis be correct if I was manic due to, say, frequent cocaine use? I wouldn't think so, and I don't think things should be different if the drug is a SSRI.
> The recognition of bipolar disorder significantly changes treatment choices to include mood-stabilizing or anti-manic agents. Your particular presentation should probably be seen as bipolar I disorder. Depakote, Trileptal, and lithium are reasonable choices to be considered. The neuroleptics, Abilify, Seroquel, or Latuda, might be of help as well.
What would you expect those drugs to do for someone with no naturally occurring mania? These drugs seem to be useful mainly for controlling manic symptoms, which I only had as a result of certain drugs.
It seems with severe anhedonia, any drug that reduces brain activity (be it an anticonvulsant or neuroleptic) is not going to be helpful, unless these drugs are taken only to reduce side effects of other drugs. And taking one drug to reduce manic behavior of other drugs seems risky.
> My illness is similar to yours, and I have found Parnate and Nardil more effective than Emsam. You might consider taking an MAOI in combination with Lamictal and Abiify. Both have antidepressant propereties, and Abilify might help prevent a manic reaction.
Lamictal made me much more depressed (suicidal) so I do not want to take it. I'm already on Abilify and I found its antidepressant effects to be short-lasting and minimal at doses that I'm comfortable taking (higher doses cause akathisia)
Posted by antennastoheaven on June 24, 2013, at 13:59:57
In reply to Re: Bipolar DX based only on SSRI hypomanic response?, posted by Phillipa on June 24, 2013, at 9:45:21
> In other words (and my spelling is horrific) you had low grade depression before the wellbutrin which worked but left a residual of low grade depression? Would just taking the wellbutrin work? And combine with talking to professional or friend? Sometimes I feel two many myself included took or take meds when none or a low dose of one would work better? Hard to know without seeing the person in real life. Phillipa
The depression has been bad enough for me to miss work before Wellbutrin. On Wellbutrin I am productive again, but don't feel good and still experience anhedonia most of the time. The variety of other drugs I've used (neuroleptics, anticonvulsants, SSRIs) all made things worse in some way, often enough to miss work. I've only experienced mania as a result of SSRIs - which was bad for me and not sustainable, but I did feel good while it was going on.
I am thinking of just sticking with Wellbutrin from now on and doing more individual therapy once I am no longer in this partial day treatment program.
Posted by Beckett on June 24, 2013, at 16:49:16
In reply to Re: Bipolar DX based only on SSRI hypomanic response? » Phillipa, posted by antennastoheaven on June 24, 2013, at 13:59:57
Antidepressants give me hypomania. I am classified by my doctor as bipolar II. Recurrent depression is a problem. I don't need mania control, but I feel I need stabilization to lessen the frequency of my depressions. I take lithium which you mentioned does not work for you.
Do you currently feel more dysthymic than depressed? Maybe you are on enough medication for now. Anhedonia is difficult to deal with. Recently my doc consented to add a small amount of adderall and it has helped immensely. I tried all sorts of meds over the past year plus to deal with anhedonia. Good luck to you.
Posted by antennastoheaven on June 24, 2013, at 17:06:23
In reply to Re: Bipolar DX based only on SSRI hypomanic response? » antennastoheaven, posted by Beckett on June 24, 2013, at 16:49:16
Dysthymia seems like an accurate description when I'm on Wellbutrin and not on any numbing drugs. Otherwise, I fit he criteria for major depression all the time - constant depression that can be lessened temporarily with novelty. I am also diagnosed with ADD and have Adderall, which I don't currently use, and wouldn't want to use every day just so I could enjoy things.
Also (secretly) diagnosed with schizoid personality disorder which has an anhedonia/lack of interest component.
Posted by linkadge on June 24, 2013, at 17:13:37
In reply to Re: Bipolar DX based only on SSRI hypomanic response? » Beckett, posted by antennastoheaven on June 24, 2013, at 17:06:23
Nobody knows the answers to these questions. The only reason psychiatrists like to label such reactions as bipolar, is because it essentially puts the blame for the outcome back on the patient.
If the drugs cause the bipolar, then the drugs are flawed. If the patient has 'latent bipolar', then its not the drugs, or psychiatry's fault.
I suppose there are also legal ramifications for the decision to blame the patient.
If crack makes you manic, are you bipolar? No, so why is this the case with SSRIs?
Posted by linkadge on June 24, 2013, at 17:23:00
In reply to Re: Bipolar DX based only on SSRI hypomanic response?, posted by linkadge on June 24, 2013, at 17:13:37
No no. SSRI's don't make bipolar..
Why? I dunno....they're not supposed to?
Linkadge
Posted by Beckett on June 24, 2013, at 18:10:59
In reply to Re: Bipolar DX based only on SSRI hypomanic response? » Beckett, posted by antennastoheaven on June 24, 2013, at 17:06:23
> Dysthymia seems like an accurate description when I'm on Wellbutrin and not on any numbing drugs. Otherwise, I fit he criteria for major depression all the time - constant depression that can be lessened temporarily with novelty. I am also diagnosed with ADD and have Adderall, which I don't currently use, and wouldn't want to use every day just so I could enjoy things.
>
> Also (secretly) diagnosed with schizoid personality disorder which has an anhedonia/lack of interest component.If you have ADD, are you currently leaving it untreated? That can add to depressive symptoms. We all have our personal feelings about how we want our treatments, but maybe a little adderall would help you out of the hole. Personally, and differently than you expressed, I don't have a problem .anymore about taking a little stimulant in order to feel like a
living person (that's how bad I was.)Oh, P.S. the categorization of bipolar is very odd in my opinion. Though I believe bipolar depression is more difficult to treat than unipolar depression. Treatment is more limited and the depression is stubborn and deep.
Posted by polarbear206 on June 24, 2013, at 18:23:01
In reply to Bipolar DX based only on SSRI hypomanic response?, posted by antennastoheaven on June 24, 2013, at 3:51:05
Perhaps you could tolerate and get a good response from an AD if you took it in conjunction with a mood stabilizer. Wellbutrin is a poor AD. I wouldn't obsess about being Bipolar or not. I will tell you that you don't have to to
have hypomania with bipolar. It can present as anxiety, agitation, irritability. There is a broad spectrum to affective disorders. Keep in mind.The bread won't rise without the yeast.
Posted by antennastoheaven on June 24, 2013, at 19:05:09
In reply to Re: Bipolar DX based only on SSRI hypomanic response? » antennastoheaven, posted by Beckett on June 24, 2013, at 18:10:59
I don't have any ADD issues right now because I'm not working... ADD is only really a problem when concentration is required and I work in a cognitively demanding field. Wellbutrin alone is sufficient to deal with motivation issues and any minor attention issues that might occur in everyday life.
I don't want to take too much Adderall because I want it to be more effective once I do go back to work.
Posted by antennastoheaven on June 24, 2013, at 19:22:39
In reply to Re: Bipolar DX based only on SSRI hypomanic response?, posted by polarbear206 on June 24, 2013, at 18:23:01
> Perhaps you could tolerate and get a good response from an AD if you took it in conjunction with a mood stabilizer. Wellbutrin is a poor AD. I wouldn't obsess about being Bipolar or not. I will tell you that you don't have to to
> have hypomania with bipolar. It can present as anxiety, agitation, irritability. There is a broad spectrum to affective disorders. Keep in mind.
>
> The bread won't rise without the yeast.I think Wellbutrin is a great antidepressant for those with certain symptoms. It certainly works for dealing with my motivation issues. For me, there are no bothersome side effects, and I can stop Wellbutrin at any time. The first few days off it are rather low, if only because I was feeling so well before.
I am thinking about mood stabilizers in conjunction with other antidepressants, and I think it's risky. It makes me think of speedballing (mixing stimulants and depressants, most commonly cocaine with heroin). Of course combining a mood stabilizer and antidepressant is not nearly as dangerous, but there are still questions of balance. Not to mention I'd be taking TWO drugs with their own set of side effects, and both would most likely have noticeable side effects. The fact that both anticonvulsants and SSRIs tend to be cognitively impairing is a huge problem; a combination of both could make me feel good yet not manic, but unable to actually get any hard work done.
I care about having a bipolar diagnosis because the diagnostic label makes a difference as to how you are treated. Being prematurely diagnosed and treated as bipolar has caused significant impairment in my life; I probably wouldn't have been prescribed the mood stabilizers without this diagnosis. Lithium made me unproductive and physically miserable for the few weeks while I was on it. Lamictal made me feel so depressed that I wanted to kill myself, thus making me miserable for a month. And I had to figure out that it was the drug making me feel this way all on my own; the pdoc's next idea was to INCREASE the dose. I felt better shortly after backing down on the dose. These drugs made me miss at least a few weeks of work, skip out on fun experiences, and generally caused two rather bad months of my life. One psychiatrist didn't want to give me one treatment because ishe was afraid it may cause mania (nevermind that only SSRI/SNRIs have caused mania and the drug considered was dopaminergic).
Posted by SLS on June 24, 2013, at 22:07:12
In reply to Re: Bipolar DX based only on SSRI hypomanic response?, posted by linkadge on June 24, 2013, at 17:13:37
> If crack makes you manic, are you bipolar? No, so why is this the case with SSRIs?
If?
Does crack make one manic?
- Scott
Posted by SLS on June 24, 2013, at 22:14:19
In reply to Re: Bipolar DX based only on SSRI hypomanic response?, posted by linkadge on June 24, 2013, at 17:23:00
> No no. SSRI's don't make bipolar..
Perhaps not, but they do seem to uncover it.
Would you agree that there are difference in brain biologies between individuals that causes one person to become manic on a SSRI and another not? Might an occult bipolar diathesis explain some percentage of these cases of SSRI-induced mania?
- Scott
Posted by SLS on June 24, 2013, at 22:24:24
In reply to Re: Bipolar DX based only on SSRI hypomanic response? » Phillipa, posted by antennastoheaven on June 24, 2013, at 13:59:57
> I am thinking of just sticking with Wellbutrin from now on and doing more individual therapy once I am no longer in this partial day treatment program.
Perhaps this is for the best. I think matters become overly complicated with your current approach towards treatment.
- Scott
Posted by SLS on June 24, 2013, at 22:42:27
In reply to Re: Bipolar DX based only on SSRI hypomanic response?, posted by antennastoheaven on June 24, 2013, at 19:22:39
> > No no. SSRI's don't make bipolar..
>
> Perhaps not, but they do seem to uncover it.
>
> Would you agree that there are difference in brain biologies between individuals that causes one person to become manic on a SSRI and another not? Might an occult bipolar diathesis explain some percentage of these cases of SSRI-induced mania?
>
>
> - Scott
http://voices.yahoo.com/rare-bipolar-disorder-types-iv-v-vi-75"Bipolar IV is identified when antidepressant medication causes a hypomanic or manic phase. The most common class of antidepressants that cause this reaction are SSRI's (selective serotonin reuptake inhibitors).Doctors who suspect bipolar disorder in depressed patients sometimes prescribe SSRI antidepressants to expose manic and hypomanic symptoms. The patient who develops this type of bipolar disorder normally only suffered from depression with no signs of mania before treatment."
Check out the classification proposals of Klerman and Akiskal. These ideas are nothing new.
- Scott
Posted by antennastoheaven on June 24, 2013, at 22:45:57
In reply to Re: Bipolar DX based only on SSRI hypomanic response? » antennastoheaven, posted by SLS on June 24, 2013, at 22:24:24
> Perhaps this is for the best. I think matters become overly complicated with your current approach towards treatment.
What is that supposed to mean?
Posted by antennastoheaven on June 24, 2013, at 22:48:48
In reply to Re: Bipolar DX based only on SSRI hypomanic response? » linkadge, posted by SLS on June 24, 2013, at 22:14:19
> > No no. SSRI's don't make bipolar..
>
> Perhaps not, but they do seem to uncover it.By definition in DSM-IV-TR, SSRI induced mania is not a manic episode and insufficient to make a bipolar diagnosis.
Would symptoms resembling ANY non-substance-related mental disorder be considered valid for a diagnosis of that disorder, if those symptoms were a result of intoxication?
> Would you agree that there are difference in brain biologies between individuals that causes one person to become manic on a SSRI and another not? Might an occult bipolar diathesis explain some percentage of these cases of SSRI-induced mania?
I'm not aware of any evidence that suggests that SSRI-induced mania and natural bipolar mania are caused by the same mechanism. Manic behavior can be caused by intoxication from a number of drugs; what makes SSRIs special?
Posted by Phillipa on June 24, 2013, at 22:49:25
In reply to Re: Bipolar DX based only on SSRI hypomanic response?, posted by antennastoheaven on June 24, 2013, at 22:45:57
Follow your plan it's well thought out and obviously you are well versed. Phillipa
Posted by antennastoheaven on June 24, 2013, at 23:01:33
In reply to Bipolar DX based on SSRI hypomania » linkadge » antennastoheaven, posted by SLS on June 24, 2013, at 22:42:27
> "Bipolar IV is identified when antidepressant medication causes a hypomanic or manic phase. The most common class of antidepressants that cause this reaction are SSRI's (selective serotonin reuptake inhibitors).Doctors who suspect bipolar disorder in depressed patients sometimes prescribe SSRI antidepressants to expose manic and hypomanic symptoms. The patient who develops this type of bipolar disorder normally only suffered from depression with no signs of mania before treatment."
And that mania disappears after discontinuing the SSRI. What makes this different than any other form of intoxication?
Reading on, the article describes "Bipolar V", which is supposed to be a diagnosis for those with depressive symptoms who have a family history of bipolar disorder (but do not have any manic/hypomanic/mixed symptoms). This seems extreme to me.
> Check out the classification proposals of Klerman and Akiskal. These ideas are nothing new.
I think this is only a proposal for a reason. Drug intoxication is probably best described as intoxication.
Posted by creepy on June 24, 2013, at 23:49:59
In reply to Bipolar DX based only on SSRI hypomanic response?, posted by antennastoheaven on June 24, 2013, at 3:51:05
The DSM may not say it, but many docs consider SSRI induced hypomania to be a sign of bipolar.
Lamictal never got to 200mg+, right? below that point its mostly an antidepressant not much of a mood stabilizer. Id bet you went mixed / agitated on it before you got to a stabilizing dosage. Titrating up on lamictal can be very difficult. Anxiety, agitation, etc. Maybe adding a benzo or an AAP during titration might help?
You might also consider the atypical antipsychotics. Antagonizing serotonin receptors might give benefit without triggering hypomania.
unfortunately theres only a couple 'atypical' antidepressants that work like that. Nefazodone, vilazodone, trazodone. some TCAs like amitriptyline do as well.
Posted by SLS on June 24, 2013, at 23:52:00
In reply to Bipolar DX based on SSRI hypomania » linkadge » antennastoheaven, posted by SLS on June 24, 2013, at 22:42:27
Sorry.
Please use the following link URL:
http://voices.yahoo.com/rare-bipolar-disorder-types-iv-v-vi-754271.html?cat=70
"Bipolar IV is identified when antidepressant medication causes a hypomanic or manic phase. The most common class of antidepressants that cause this reaction are SSRI's (selective serotonin reuptake inhibitors).Doctors who suspect bipolar disorder in depressed patients sometimes prescribe SSRI antidepressants to expose manic and hypomanic symptoms. The patient who develops this type of bipolar disorder normally only suffered from depression with no signs of mania before treatment."
- Scott
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