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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Marie416 on April 11, 2002, at 16:06:29
Can someone please tell me the difference. I start off with panic attacks and then feel depression primarily with anxiety then the depression worsens. Starting on effexor made me hyper, once my body got used to it I was just tired all the time. Now I am trying to wean off it while remaining on Wellbutrin. I feel hyper alot too with 2 pills of 150mg Wellbut. and now at 75 mg effex weaning down. If you get hyper while taking a drug does that mean you may be bipolar. When I say hyper I mean racing thought, feel like you want to go go go, just can't relax and feel hungry
Posted by katekite on April 11, 2002, at 17:30:45
In reply to Bi polar or depression/anxiety, posted by Marie416 on April 11, 2002, at 16:06:29
Hypomania is hard to define. There is argument over what consitutes hypomania at the non-euphoric end.
Agitation can look like restless, must be moving, doing stuff.
Whereas pure hypomania would often have components of feeling like you are invincible, that you can do anything, maybe spending too much, or taking risks, maybe feeling more sex oriented. Not just feeling like thoughts are racing but also someone saying you have to slow down that you are talking fast. That suddenly 4 hrs of sleep seems like plenty.
Some "hypomania" is normal for short periods of time, hours, if someone is really excited about something, found 100 bucks, or spurts of energy when an antidepressant actually lifts that long grumpy depression.
Its important to be honest with ones-self about whether you feel you miss the lost sleep, for example. Whether in another mood you would have bought $400 of clothes because they were there. If life is has suddenly become very easy and you actually can hold two jobs and still cook cakes from scratch then that's probably hypomania.
Where it gets tricky is if it is a mixed hypomania, where one isn't happy, maybe is irritable and short tempered as well as having the extra energy. That can look like agitation. Even mixed hypomania should have not only racing/pressured thoughts but also flight of ideas, where tons of different subjects pop into your head. Anxiety/agitation might be more like racing thoughts but all on the same theme.
For example I had agitation on Wellbutrin. Felt like a train was pulling me, just way too much energy, and I didn't like it. I couldn't sleep either. Just worried and obsessed about how awful I felt but could barely sit down, had to be doing stuff. Yuck.
Sooo.... I hope that helps some. I am no expert. Hypomania is supposed to last at least a few days straight. So cleaning and talking for 5 hrs around midnight then collapsing wouldn't count. I don't think. At least not in a strict definition.
Curious to hear what others say, gather as many opinions as you can.
kate
Posted by Ritch on April 12, 2002, at 10:46:21
In reply to Bi polar or depression/anxiety, posted by Marie416 on April 11, 2002, at 16:06:29
> Can someone please tell me the difference. I start off with panic attacks and then feel depression primarily with anxiety then the depression worsens. Starting on effexor made me hyper, once my body got used to it I was just tired all the time. Now I am trying to wean off it while remaining on Wellbutrin. I feel hyper alot too with 2 pills of 150mg Wellbut. and now at 75 mg effex weaning down. If you get hyper while taking a drug does that mean you may be bipolar. When I say hyper I mean racing thought, feel like you want to go go go, just can't relax and feel hungry
Hi,I agree with katekite's summary of the different presentations of hypomania (which fit quite well with some of my presentations). *Technically*, the hypomanias aren't supposed to be triggered by medications, general medical problems (hypohythyroidism, i.e.), alcohol/substance abuse in order for it to be "really" bipolar. That is where my diagnosis gets all tangled up. I *definitely* get drug-induced hypomania (no doubt!). I would say if you were off meds ( and not doing coke or binge drinking .ie.), and physically you were in good shape AND still had *spells* of hypomania that carried on for a day or two-then I would consider the bipolar-maybe cyclothymia.
Mitch
Posted by ST on April 13, 2002, at 19:03:31
In reply to Re: Bi polar or depression/anxiety » Marie416, posted by Ritch on April 12, 2002, at 10:46:21
From what I understand, just because starting a med makes you hyper, it does not mean you may be bipolar. Effexor is a really stimulating AD at first. (I'm on it and now at the stage where it just makes me tired) I've been on Wellbutrin for years and at first I did get a bit hyper. I adjusted after a few weeks. However I AM bipolar - yet with more depressive tendencies that hypomania. Hope this helps!
Posted by Marie416 on April 17, 2002, at 15:11:20
In reply to Re: Bi polar or depression/anxiety, posted by ST on April 13, 2002, at 19:03:31
Thank you everyone for your interpretations. They really made sense. I guess I am not bipolar. Once I had a psych doc ask me if I was feeling with my depression that I was hyper and having racing thoughts . I asked him well yes sometimes but if I was bipolar wouldn't I be thinking everything was great and I could do it all. He said not necessarily, it could be that you feel agitated and unable to sit still. I sat there thinking about it and he said well if you are then we are giving you the wrong medications and that could be why you aren't feeling better. The confusion comes when I was thinking, yeah I have the racing thoughts and the nervous/anxiety feeling about God this will never end and having to keep busy at times to keep me from obsessing over my feelings. But for God's sake at least if I was bipolar give me the highs, at least I would deserve that much. Not to make too light of this. The effexor did the same thing to me, made me hyper every time I increased it and then made me perpetually tired. Now I am weaning off it and taking the Wellbutrin which also made me hyper and now I am still just tired a lot.
Posted by Elizabeth on April 20, 2002, at 10:34:31
In reply to Bi polar or depression/anxiety, posted by Marie416 on April 11, 2002, at 16:06:29
I agree with what everybody else has said. :-)
A lot of people who have panic attacks have difficulty tolerating SSRIs and Effexor -- they feel nervous, agitated, wired, "jumping out of my skin"-ish when they take these ADs. Sometimes TCAs cause this too, although less often. It doesn't necessarily mean you're bipolar.
The jitteriness goes away with time (whereas a bipolar person could get worse and perhaps start rapid-cycling), but often if you're going to treat panic disorder with ADs, you have to start out at a low dose and increase it very slowly. By "low" I mean, say, 12.5 or 18.75 mg of Effexor (half of a 25- or 37.5 mg immediate-release tablet), taken twice a day. By "slowly" I mean "as tolerated" -- if a particular dose makes you a little jittery, for example, you don't want to try raising it until you adjust to that dose. Note that this can be very frustrating and can take a **long** time. Some people are never able to tolerate antidepressants.
Also, Wellbutrin isn't an effective treatment for panic disorder. It is a very jittery, stimulating drug for a lot of people, though. Like Kate, I felt jittery and yucky when I tried Wellbutrin (some of my symptoms also got worse, notably sleep and appetite). Now I take Effexor. I didn't get jittery on it until I increased the dose from 300 to 375 mg/day. I went down to 337.5 for a while, and then when I increased it to 375 afterwards (the dose I'm on now), I was okay.
If one type of treatment doesn't work for you it doesn't necessarily mean the diagnosis is wrong. Unfortunately, it's difficult to predict what will work for whom, even within a diagnostic category. Have you tried anything besides Effexor and Wellbutrin?
best wishes,
-elizabeth
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