![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 85 to 109 of 125. Go back in thread:
Posted by linkadge on March 20, 2006, at 20:36:44
In reply to Re: Never thought I'd hear this..... » linkadge, posted by SLS on March 20, 2006, at 15:30:35
"* I have no emotional investment in needing to believe that either one of us is bipolar."
No, no, I understand. I came off 20mg of celexa (been on it for about 5 years) almost overnight. Symptoms started with panic attacks, severe mood swings thoughout the day, rage attacks, rebound sexual function, periods of extreme emotional intensity (it was kindof beutiful). I went back on about half 2-3 weeks weeks later and a lot subsided. A tapered more slowly, and eventually things normalized. Certain things have never improved since stopping the SSRI's. I have some movement problems that are fairly persistant.
Linkadge
Posted by SLS on March 21, 2006, at 7:53:03
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 20, 2006, at 20:36:44
> "* I have no emotional investment in needing to believe that either one of us is bipolar."
>
> No, no, I understand. I came off 20mg of celexa (been on it for about 5 years) almost overnight. Symptoms started with panic attacks, severe mood swings thoughout the day, rage attacks, rebound sexual function, periods of extreme emotional intensity (it was kindof beutiful).That doesn't sound like mania to me. It sounds more like a common cluster of SRI withdrawal symptoms plus a return of emotions that might have been blunted for those years you took the drug. From everything I have read of your experiences with your illness, I never saw anything that jumped out at me as demonstrating bipolarity.
- Scott
Posted by corafree on March 21, 2006, at 8:29:10
In reply to Re: Never thought I'd hear this..... » linkadge, posted by SLS on March 21, 2006, at 7:53:03
Scott re: Linkadge
Linkadge: So what are you going to do? R U stopping any anti-psychotic bipolar stuff?
Scott: You thought it might be ok for me going though this high anxiety period, right?
Are either of you anti-AD (I have been since last bout w/ Eff-XR)?
I awakened feeling all sore and swollen this a.m. just after first night of smallest dose Abilify. I have a ring on my finger that will prob' have to be cut off, as 'circulation is being cut off'.
I've been off everything except for a small dose 'trazodone for sleep' (which is an AD unfortunately)! The county has no Rozerem or any sleep med on its formulary, just traz and wouldn't give me Restoril. Then, since had a nervous breakdown a year ago, I've been on Valium.
Anyway, you know how you said, Linkadge, 'it was kind of beautiful', .. Well feeling, just 'feeling feelings' again was/is for me too. But then recently, sad feelings have become overwhelming.
My longest stint (10yrs) w/ the best P I've ever seen was while still working. My husband filed for a divorce because I called the police when he said he was going to break my finger.
It was then that I knew I wasn't going to have enough $ to carry on and found out about the 'county system' and how to get in it. Anyway, this P that had known me for 10yrs 'had a little trouble w/ finding anything bipolar about me', so just mentioned it was a possibility, for the sake of my 'receiving county benefits' (which I now disdain).
I've posted to you because there have been people that I've met that are bipolar and they 'seem anxious to have you join they club'. Forgive me if I offend anyone, but I have met a couple that are like that. One person said I should not be on any ADs.
I just don't seem to have enough symptoms of bipolar. It's never been obvious to me or anyone who has know me for a long period of time. There's no fam hx.
I've become very disliking of 'diagnoses'.
I hope this Abilify gets better faster than it gets worse.
(Who cuts off rings, docs or jewelers?)
Scott: Tks for response last night.
cf
Posted by linkadge on March 21, 2006, at 8:54:43
In reply to Re: Never thought I'd hear this..... » SLS, posted by corafree on March 21, 2006, at 8:29:10
There are no hard and fast rules. I would take medication changes at your own pace.
I'm not against medications if they improve the quality of your life.
I guess I am really against misdiagnosis and overmedication.
Linkadge
Posted by detroitpistons on March 21, 2006, at 8:58:01
In reply to Re: Never thought I'd hear this..... » linkadge, posted by SLS on March 21, 2006, at 7:53:03
Scott,
Would you say that the symptoms that I described in an earlier post would describe bipolarity?
> > "* I have no emotional investment in needing to believe that either one of us is bipolar."
> >
> > No, no, I understand. I came off 20mg of celexa (been on it for about 5 years) almost overnight. Symptoms started with panic attacks, severe mood swings thoughout the day, rage attacks, rebound sexual function, periods of extreme emotional intensity (it was kindof beutiful).
>
> That doesn't sound like mania to me. It sounds more like a common cluster of SRI withdrawal symptoms plus a return of emotions that might have been blunted for those years you took the drug. From everything I have read of your experiences with your illness, I never saw anything that jumped out at me as demonstrating bipolarity.
>
>
> - Scott
Posted by SLS on March 21, 2006, at 9:44:47
In reply to Re: Never thought I'd hear this..... » SLS, posted by detroitpistons on March 21, 2006, at 8:58:01
Referring to your post:
http://www.dr-bob.org/babble/20060310/msgs/620191.html
> I was recently diagnosed as bipolar II after being on Effexor 225mg. I had an irritable hypomania with a lot of agitation, irritability, racing thoughts, excess energy, etc. I was sort of rapid cycling and a kind of mixed state.
You labelled what you experienced as hypomania. Why?
You seemed to convey in your description that this state was somehow different from the other states you have experienced. Taking into consideration that it emerged while taking Effexor and that you describe excess energy and racing thoughts does seem to indicate a hypomanic episode.
Can you perhaps describe in more detail what you experienced during this possibly hypomanic period?
Is there any history in your family of mental illness? What type?
- Scott
Posted by SLS on March 21, 2006, at 9:58:46
In reply to Re: Never thought I'd hear this..... » SLS, posted by corafree on March 21, 2006, at 8:29:10
> Scott: You thought it might be ok for me going though this high anxiety period, right?
Are things getting any better with the Abilify? You can, of course, take an anti-anxiety drug temporarily while your body is getting used to the Abilify. It shouldn't be for any longer than two weeks. I am reluctant to comment any further without knowing more about your illness and its history. I am not advocating that Abilify is the right drug for you, but the beginning can be very rough. Do you have anything lying around that you can use for anxiety? Perhaps a call to your doctor?
- Scott
Posted by detroitpistons on March 21, 2006, at 10:10:08
In reply to Re: Never thought I'd hear this..... » detroitpistons, posted by SLS on March 21, 2006, at 9:44:47
> > I was recently diagnosed as bipolar II after being on Effexor 225mg. I had an irritable hypomania with a lot of agitation, irritability, racing thoughts, excess energy, etc. I was sort of rapid cycling and a kind of mixed state.
>
> You labelled what you experienced as hypomania. Why?
>That's just what the doctor said.
> You seemed to convey in your description that this state was somehow different from the other states you have experienced. Taking into consideration that it emerged while taking Effexor and that you describe excess energy and racing thoughts does seem to indicate a hypomanic episode.
>
> Can you perhaps describe in more detail what you experienced during this possibly hypomanic period?
>Here's what I said in a prior post:
> Can you describe your manic reaction in more detail?
Well, I started taking the Effexor and was no longer depressed after about 6 weeks, but I still didn't feel "right." I still felt anxious. Over the course of the next couple of months, it became worse. I started noticing that I couldn't concentrate on anything at work (at the time I thought I had suddenly developed ADD). I was easily distracted and I couldn't focus on one thing at a time. My thoughts were racing. I became extremely agitated, nervous, and anxious. I had much less patience and I was easily irritated. I felt like I could blow up on someone at any time, as I had done to one of my bosses in the past (while on Paxil) and nearly got fired. I just felt more impulsive, angry, and aggressive. I had way too much energy. I actually did some cleaning (I normally have a very difficult time cleaning--I wait till something is covered in dust to clean it). None of this was pleasant, however, and at the time, I had thought that mania/ hypomania was supposed to feel good. My doctor explained that this wasn't necessarily the case. I've learned a lot since then. I should also add that I was seeing things out of the corners of my eyes, hearing quick sounds, and feeling sensations in my legs like my phone was going off when it wasn't, for instance. These were relatively mild hallucinations.
> Is there any history in your family of mental illness? What type?
>Not that I know of, but my mom has bad anxiety and has had depression, although I don't think she really gets it anymore because her lifestyle and routines are extremely stable, so she doesn't really experience any triggers. I suspect that other people in my family may have had mood or personality disorders, but none would have been formerly diangnosed. Nobody in my family would ever acknowledge, admit, or seek help for any mental problems.
Posted by SLS on March 21, 2006, at 10:41:50
In reply to Re: Never thought I'd hear this..... » SLS, posted by detroitpistons on March 21, 2006, at 10:10:08
Sorry that I didn't recall seeing this post. I remember now.
:-)
It is difficult to say for sure from your description whether it was a mixed-state hypomania or a partial relapse into depression. Partial relapses often involve anxiety and irritability. Even racing thoughts can be part of certain depressions.
However, the following passage might be revealing:
> I had way too much energy.
In what way?
> I actually did some cleaning (I normally have a very difficult time cleaning--I wait till something is covered in dust to clean it).
Did you pace yourself or did you race from one task to another? Did you find that you were not completing all the tasks you began? Were you organized or disorganized? How many hours of sleep did you get? Increased libido? Did you find yourself driving too fast? Did you find that other people were too slow and that you were quicker and smarter?
Those are just a few things that are often associated with hypomania.
> I should also add that I was seeing things out of the corners of my eyes, hearing quick sounds, and feeling sensations in my legs like my phone was going off when it wasn't, for instance
I'm not entirely sure what these things demonstrate, but they seem to indicate an altered state.
- Scott
Posted by corafree on March 21, 2006, at 14:30:35
In reply to Re: Never thought I'd hear this..... » SLS, posted by detroitpistons on March 14, 2006, at 12:00:46
Detroit Pistons:
I first started Effexor when it only came in house shaped tabs and it was fairly effective for a few years. No bad side effects, was stabilizing, I handled my responsibilities, was working.
When Effexor-XR came out, I thought it would be convenient.
I began it and never, ever, had I experienced such a really high .. high. I was out of control w/ excitability and blabbery humor. I knew this was too crazy and d.c.'d it. (After seeing your post, I thought I'd share this.)
I thought to myself, then, and still, this must be the way a person who is bipolar 'manic' feels.
I stopped the Effexor-XR in about a month.
Some time later, I tried it again and there were none of the above side effects. It was so odd. Same drug. Same me (maybe).
Crises occurred and it would bottom out for a while. Then I'd go off. Then I'd go back on for awhile to numb myself. So, in all, I've prob' been on it from beginning to end, maybe five times.
I stopped it after a nervous breakdown last year, finally realizing (Duh; it was about time!) that every time on it, I'd experienced no 'real true human feelings'.
I'll never go there again and I mean it wholeheartedly.
What a tricky drug it has been for me.
I'd say 'nothing' has ever caused me to feel that 'way too tremendous high' in my life like Effexor-XR did just that once.
I started Abilify last eve and awoke w/ aching, coughing, a little shortness of breath, swelling in my hands, eyes burning. Called for emerg appt; unsuccessful. Told by another P to cut in half (I have smallest dose.) and take until mid next month when appt w/ my P.
After hearing this, I called a nurse line. In talking, realized it was more than a side effect; more an allergic reaction. I'm discontinuing it.
I had the same type reaction to Trileptal.
And, to Lamictal, I had very severe headaches.
None of these anti-psychotics (right?) have agreed w/ me.
Is it always anti-psychotics that are used to treat bipolar? Or, is it anti-psychotics and mood stabilizers?
My dx, if must be one, two, or some, feels like GAD, PTSD, and some Borderline traits (I used to be very outgoing, friendly, and caring for others' feelings. Now I have a lot of difficulty in relationships, politically incorrect and hurt others/myself, and am brutally honest.)
I've often had people who are bipolar, want to diagnosis me the same. I see from this link that there's this theory we are all somewhat bipolar.
When you're in the middle of a big change in your life, that's kind of the last thing you need to hear.
So far anything used to treat bipolarity has some properties that I cannot tolerate.
Anyway, if you see some similarities here, maybe you could share your treatment plan.
tks, cf
Posted by corafree on March 21, 2006, at 14:45:55
In reply to Re: Never thought I'd hear this..... » corafree, posted by SLS on March 21, 2006, at 9:58:46
Scott:
I just posted to Detroit Pistons. Pretty much explained 'me'.
Since the nervous breakdown, I'm on Valium 10mg 3x a day, so I'm okay.
Seems again I'm anti-psychotic intolerable.
I gave Trileptal more than a week and my eyes still burned (even treating them w/ plain saline solution) constantly.
I wanted to see a P asap but they shut the door in my face.
An idea .. tricyclics, maybe. Am awaiting to hear back from one of our friends here.
I think I tried Elavil in the past and had a mild initial adverse reaction (was working .. had to be at my desk at 5:45a), and didn't give it even a week.
Checked Net and looks as if Pamelor may be an option.
All these newer ADs .. I just don't trust them I guess. Especially after the ongoing frustration with Effexor-XR.
I'm really happy to have met you here. Don't think we've communicated in past.
My memory isn't all that great. I have a busted back and am on a narcotic 3x a day.
It's cool how comfortable I feel when I'm posting here. I almost forget about the way this 'county system' is really dropping the ball. Maybe this is their way of letting you know right up front that you are a lesser person!
But like I said, just typing how I feel and sharing it w/ so many people that care is the best therapy I have, until I find someone to help guide me, and I think I need to go back. I've never had that kind of therapy. I believe I've hidden from uncomfortable feelings for many years. This isn't traditional therapy anymore. Not a lot of Ts prob' even do it. I'm not even sure what to call it. I do know that the T they staffed me w/ out here is not a good match.
While online, my cell has been right beside me here. I have still not gotten a return call from 'the system' .. and that's to my 9 or 10 messages left.
What are they saying to me???
Oh Racer ... it was you that shared your life in the 'system'. I tried to call my medicare advantage plan insurance earlier re: Ts. My phone line is being changed. I'll call them in a.m. I'm afraid it looks like it will be $30 a visit. I receive $895 a month in SSD. But, I do have $2,000 in savings. Probably would be worth it. Sure would have liked to do something other than pay med or psych bills w/ that tho.
bestwishesandtksagain, cf
Posted by linkadge on March 21, 2006, at 15:53:28
In reply to Re: Never thought I'd hear this..... » SLS, posted by detroitpistons on March 21, 2006, at 10:10:08
Btw, I tried effexor twice, and it sent my anxiety through the roof both times.
Constantly elevated heart rate, always jumpy.
Anyhow, the doctor finally pulled me off it and put me back on an SSRI which didn't work but also didn't have those side effects.
Linkadge
Posted by linkadge on March 21, 2006, at 16:01:46
In reply to Re: Never thought I'd hear this..... » SLS, posted by corafree on March 21, 2006, at 14:45:55
Effexor was first marketed as prozac with a punch. Even before I started effexor, I heard from a mother's friend to be carefull since it can be stimulating.
I am really sensitive to meds that have effect on the norepinephrine pump. SSRI's did absolutely zip for me, but the TCA's and effexor all effected me in strange ways.
I have heard a lot of accounts of it increasing anxiety.
Linkadge
Posted by SLS on March 21, 2006, at 16:08:37
In reply to Re: Never thought I'd hear this..... » detroitpistons, posted by linkadge on March 21, 2006, at 15:53:28
Hi Link.
> Btw, I tried effexor twice, and it sent my anxiety through the roof both times.
>
> Constantly elevated heart rate, always jumpy.How did you react to MAOIs?
- Scott
Posted by detroitpistons on March 21, 2006, at 16:52:04
In reply to Re: Never thought I'd hear this..... » detroitpistons, posted by corafree on March 21, 2006, at 14:30:35
Hi Cora,
> When Effexor-XR came out, I thought it would be convenient.
>
> I began it and never, ever, had I experienced such a really high .. high. I was out of control w/ excitability and blabbery humor. I knew this was too crazy and d.c.'d it. (After seeing your post, I thought I'd share this.)
>I felt really good on Effexor the first time. For the first time I actually was content and at ease, and I had virtually no anxiety. I had confidence, which I had always lacked. I felt empowered and in control of my life. Maybe I was a bit manicky at times. I did some impulsive things (perhaps even grandiose), and I'd talk and move fast at times. One person actually asked me, "are you on drugs?", LOL! I was just revved up that day, so it could have been pure coincidence, but she wasn't joking.
> I thought to myself, then, and still, this must be the way a person who is bipolar 'manic' feels.
>I thought I was finally experiencing the way I was "supposed" to feel because I'd been depressed or dysthymic for so long.
> I stopped the Effexor-XR in about a month.
>
> Some time later, I tried it again and there were none of the above side effects. It was so odd. Same drug. Same me (maybe).
>Same exact thing with me. My second time on Effexor is nothing like the first time...Much more pleasant then.
> I stopped it after a nervous breakdown last year, finally realizing (Duh; it was about time!) that every time on it, I'd experienced no 'real true human feelings'.
>I found that to be the case moreso when I was on Paxil. It totally dulled my senses. I still felt sort of depressed. Effexor doesn't seem to do that to me. The difference may be the norepinephrine reuptake inhibition. Maybe it was too much this time, because I became extremely agitated.
> And, to Lamictal, I had very severe headaches.
>
> None of these anti-psychotics (right?) have agreed w/ me.
>Lamictal was actually an epilepsy drug (anticonvulsant) when it was first approved. Later it was approved as a mood stabilizer for the treatment of bipolar disorder.
> Is it always anti-psychotics that are used to treat bipolar? Or, is it anti-psychotics and mood stabilizers?
>Atypical antipsychotics like Zyprexa or Abilify are very often used for bipolar disorder, often in conjunction with a mood stabilizer. They are sometimes used to augment antidepressants for people who are fairly treatment resistent.
> I've often had people who are bipolar, want to diagnosis me the same. I see from this link that there's this theory we are all somewhat bipolar.
>I can see why people would do that. When the idea that I may have bipolar II was first introduced to me, I'd look for bipolar traits in other people.
> When you're in the middle of a big change in your life, that's kind of the last thing you need to hear.
>I understand...Tell them to shove it. Just kidding! I guess they want to increase membership in the bipolar club.
> So far anything used to treat bipolarity has some properties that I cannot tolerate.
>So far, Lamictal has been pretty good. It's counteracted most of the agitation brought on by the Effexor. It's pretty bad when you need to keep adding drugs to offset the bad effects of the other drugs. I guess that's one of the biggest difficulties for all of us here. But I'm pretty lucky because right now I'm only on Lamictal and Effexor. I take trazadone to sleep, and a teensy bit of xanax as needed....It would make sense that if I was having bad effects with Effexor, then maybe I should stop taking Effexor, right? My doctor didn't see it that way. He would prefer to assume for now that I'm bipolar II based of the symptomology (regardless of cause). He didn't want to take me off the Effexor quite yet because of the suicidal ideation I was having when I was depressed. He felt this was the safest way to go to prevent relapse.
Marc
Posted by linkadge on March 21, 2006, at 21:18:23
In reply to Re: Never thought I'd hear this....., posted by SLS on March 21, 2006, at 16:08:37
I only tried parnate, but I would like to try nardil at some point.
Parnate was a mixed bag. I think it helped somewhat, but I had a spontainious hypertensive crisis so I had to discontinue.
I think that it did give me a slightly elevated heart rate. It actually kindof made my mood dark in some ways. I didn't find it was a mood brigtener. It helped anhedonia much more than say, sadness.
Doctors here in canada either prescribe them or refuse to. I remember inquiring about one, but the doctor refused straight out, he wanted me go back on zoloft, for the thousanth time.
Linkadge
Posted by detroitpistons on March 21, 2006, at 23:40:42
In reply to Re: Never thought I'd hear this..... » detroitpistons, posted by SLS on March 21, 2006, at 10:41:50
> > I had way too much energy.
>
> In what way?I couldn't sit still. For example, it's not uncommon for me to come home from work, have some dinner and watch TV. Sitting down and watching TV was something that became very undesirable. It was too "slow." I couldn't relax.
> > I actually did some cleaning (I normally have a very difficult time cleaning--I wait till something is covered in dust to clean it).
>
> Did you pace yourself or did you race from one task to another? Did you find that you were not completing all the tasks you began? Were you organized or disorganized? How many hours of sleep did you get? Increased libido? Did you find yourself driving too fast? Did you find that other people were too slow and that you were quicker and smarter?
>I would pretty much race from one thing to another without completing the first thing. I was disorganized and had a hard time remembering what I had been doing a moment ago. I was sleeping less and not feeling tired. Normally, I need 7-8 hours of sleep. During this time, I could sleep 5 hours and still feel fine. My libido wasn't increased, but Effexor may have had something to do with that. But I've never had a high libido. In fact, I think I have a pretty low libido, even when not on AD's.
Driving too fast? Don't even have the option with the traffic here. Although, one day the traffic was so bad and I was so frustrated, that when I finally got the chance (far enough out of the city where traffic had dissipated), I went up to 130 mph out of frustration.
I thought that I was quicker than other people in mundane ways (like they would be too slow crossing the street when I was trying to turn), but I didn't necessarily feel smarter than other people, simply because I could barely concentrate on any one thing at any given time. I felt as though I was cognitively impaired.
Posted by SLS on March 22, 2006, at 6:38:01
In reply to Re: Never thought I'd hear this..... » SLS, posted by detroitpistons on March 21, 2006, at 23:40:42
This sounds like hypomania to me. I guess it takes one to know one.
:-)
- Scott
> > > I had way too much energy.
> >
> > In what way?
>
> I couldn't sit still. For example, it's not uncommon for me to come home from work, have some dinner and watch TV. Sitting down and watching TV was something that became very undesirable. It was too "slow." I couldn't relax.
>
> > > I actually did some cleaning (I normally have a very difficult time cleaning--I wait till something is covered in dust to clean it).
> >
> > Did you pace yourself or did you race from one task to another? Did you find that you were not completing all the tasks you began? Were you organized or disorganized? How many hours of sleep did you get? Increased libido? Did you find yourself driving too fast? Did you find that other people were too slow and that you were quicker and smarter?
> >
>
> I would pretty much race from one thing to another without completing the first thing. I was disorganized and had a hard time remembering what I had been doing a moment ago. I was sleeping less and not feeling tired. Normally, I need 7-8 hours of sleep. During this time, I could sleep 5 hours and still feel fine. My libido wasn't increased, but Effexor may have had something to do with that. But I've never had a high libido. In fact, I think I have a pretty low libido, even when not on AD's.
>
> Driving too fast? Don't even have the option with the traffic here. Although, one day the traffic was so bad and I was so frustrated, that when I finally got the chance (far enough out of the city where traffic had dissipated), I went up to 130 mph out of frustration.
>
> I thought that I was quicker than other people in mundane ways (like they would be too slow crossing the street when I was trying to turn), but I didn't necessarily feel smarter than other people, simply because I could barely concentrate on any one thing at any given time. I felt as though I was cognitively impaired.
>
>
Posted by SLS on March 22, 2006, at 6:39:42
In reply to Re: Never thought I'd hear this..... » SLS, posted by linkadge on March 21, 2006, at 21:18:23
In my experience, Nardil had much more of a "mood brightening" effect than Parnate.
- Scott
> I only tried parnate, but I would like to try nardil at some point.
>
> Parnate was a mixed bag. I think it helped somewhat, but I had a spontainious hypertensive crisis so I had to discontinue.
>
> I think that it did give me a slightly elevated heart rate. It actually kindof made my mood dark in some ways. I didn't find it was a mood brigtener. It helped anhedonia much more than say, sadness.
>
> Doctors here in canada either prescribe them or refuse to. I remember inquiring about one, but the doctor refused straight out, he wanted me go back on zoloft, for the thousanth time.
>
>
>
>
> Linkadge
>
Posted by SLS on March 22, 2006, at 7:05:10
In reply to Re: Never thought I'd hear this..... » linkadge, posted by SLS on March 22, 2006, at 6:39:42
Stimulants and mania:
-----------------------------------------------
Panel Weighs New Warnings on ADHD Drugs
By ANDREW BRIDGES
Associated Press WriterMarch 22, 2006, 4:36 AM EST
WASHINGTON -- A month after advisers told the government some attention deficit hyperactivity disorder drugs should bear stronger warnings of cardiovascular risks, officials are asking a second panel whether to add warnings about psychosis or mania.
Small numbers of reports of adverse psychiatric events, including hallucinations, in children are associated with all of the increasingly popular drugs used to treat ADHD, according to recently released Food and Drug Administration documents.
The FDA is asking its pediatric advisory committee to review those reports and then recommend how to communicate the potential risks to doctors and parents. It's asking the same about a report of increased risks of heart attack, stroke and hypertension associated with some ADHD drugs.
The panel was to meet Wednesday.
Last month, the FDA's Drug Safety and Risk Management advisory committee voted to recommend adding "black-box" warnings to stimulants used to treat ADHD, alerting doctors, patients and parents of the uncertainty regarding the risk the drugs may pose to the cardiovascular system. The warnings are the most serious that prescription drugs may bear.
The FDA is not required to follow the recommendations of its advisory committees, but usually does.
The latest reviews show that psychosis or mania can occur in some juvenile patients at normal doses of any ADHD drug. The reviews included roughly 90 studies of the drugs as well as reports from doctors, parents and others.
The ADHD drugs include Ritalin, manufactured by Novartis Pharmaceuticals Corp. and in generic form by other companies; Adderall, made by Shire Pharmaceuticals Inc.; and Strattera, produced by Eli Lilly and Co.
FDA officials say patients and doctors should be aware that the small number of psychiatric events could represent side effects of the drugs, although they cannot point to a definitive link. However, they noted a "complete absence" of similar reports in children treated with dummy pills during dozens of clinical trials of the drugs. In many children, the events ceased once they stopped taking the drugs -- and resumed if they restarted.
McNeil Consumer & Specialty Pharmaceuticals said in briefing documents that it is customary to weigh the "therapeutic benefits and potential risks" of treatment and warned of the negative effects of leaving ADHD untreated. The unit of Johnson & Johnson makes Concerta, a long-acting form of methylphenidate, the drug in Ritalin.
In the United States, nearly 3.3 million people age 19 and younger used an ADHD drug in 2005, according to Medco Health Solutions Inc., a prescription drug benefit program manager.
-----------------------------------------------There are a couple of ways to look at this. I would like to here some comments before offering any of my own.
- Scott
Posted by linkadge on March 22, 2006, at 15:03:39
In reply to Re: Never thought I'd hear this....., posted by SLS on March 22, 2006, at 7:05:10
I think there are two possibilities. I think that a drug can certainly activate preexisting mental health issues in people. But on the other hand, the drugs are strong, and they have side effects. So I think it is possible for some of those side effects to mimick other conditions.
Linkadge
Posted by tessellated on March 22, 2006, at 16:29:29
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 22, 2006, at 15:03:39
I actually partook in surgically implantedamphetamine capsules into rats, then treat the behaviors with thorazine....
Amphetamines are short ticket to depression for me, and often psycosis is present with any chronic abuse of a mphetamines due to the hyper sensive of the dopamine reptors...]
its really curious also the way scientist/mathematicians/weather guys go crazy...
http://salmon.psy.plym.ac.uk/year1/schizophrenia.htm#developing_animal_model_schizophrenia
Posted by corafree on March 22, 2006, at 17:20:33
In reply to Re: Never thought I'd hear this....., posted by SLS on March 22, 2006, at 7:05:10
Was working my way from bottom up and thought quickly throw in my 2cents.
Ex-boyfriend w/ mania, manic depression, age 46, was on Ritalin as a child. It controlled his racing mind. Unfortunately, so does meth'. He manages his life very well on meth', though just as w/ his illness, he 'comes down for a few to more days' after.
He is a very good artist.
He was put on Depakote, gained 100lbs all around his mid section (self-esteem gone) and stopped drawing/painting/sculpting (artist gone).
I feel so bad for him. What an awful choice to have to make?! I've oftened wondered why he has never been tried on an ADHD drug? They introduce it to him as a child, then they just d.c. it!
What if tapped into something that has never stopped emitting its contents???
Everyone seen the movie, Mr. Jones, w/ Richard Gere?
Maybe I've said the above here before. (The ole' memory prob' .. on narcotic re: spinal column injuries)! cf
Posted by SLS on March 23, 2006, at 7:54:53
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 22, 2006, at 15:03:39
> I think there are two possibilities. I think that a drug can certainly activate preexisting mental health issues in people. But on the other hand, the drugs are strong, and they have side effects. So I think it is possible for some of those side effects to mimick other conditions.
>
> Linkadge
I agree.
I think we need some numbers here.1. What percentage of ADHD childen being treated with a stimulant develop this manic/psychotic syndrome?
2. What percentage of children diagnosed as ADHD are bipolar?
3. What percentage of ADHD adults treated with stimulants develop this manic/psychotic syndrome?
4. What percentage of non-ADHD adults treated with stimulants develop this manic/psychotic syndrome?
• There might be a difference between #1 and #3. Perhaps the young brain is more susceptible to this manic/psychotic reaction to stimulants.• There might be a diffence between #3 and #4. Perhaps ADHD confers greater susceptibility to the manic/psychotic reaction.
• If #1 = 5%, then the rate of occurrence of the manic/psychotic reaction is equal to the occurrence of bipolar disorder in the general population. If this is true, then it is possible that the only children who react this way to stimulants are those who have a comorbid bipolar disorder.
• If #2 > 5%, then there is a positive association between ADHD and bipolar disorder. One might then expect a rate of occurrence of the manic/psychotic reaction to be greater in these children than that seen in the general population.
• Etcetera...
Problems arise with:1. The accurate diagnosis of pediatric ADHD versus bipolar disorder versus comorbidity.
2. The lack of differentiation between mania and a non-manic psychosis.
The same question arises: Does a manic/psychotic reaction to stimulants in pediatric ADHD indicate comorbid bipolar disorder?I'm sure that this is true of a certain percentage of these reactions.
Is this association exclusive? Probably not. My guess is that a certain percentage of these reactions occur in the absence of bipolar disorder. The question is, does it happen more frequently in children than in adults? Is there something about the young developing brain that is still in the process of pruning that confers a greater risk of hosting this manic/psychotic reaction?
I have a bunch more questions and possible scenarios conceived, but not the mental energy to list them. Maybe you can track down some of the statistics I mentioned.
My guess is that the published report exaggerates the risk or conveys the wrong message about the potential risk of the manic/psychotic reaction occurring in ADHD children because it does not take into account the comorbid occurrence of bipolar disorder. Nor does the report specify how common or uncommon this reaction really is. If the rate of occurrence approaches the rate of bipolar disorder, then stimulants cannot be blamed for anything other than unmasking a disorder that already existed in those affected. This might not always be a bad thing.
We need those statistics.
- Scott
Posted by Tony P on March 24, 2006, at 2:39:10
In reply to Re: Never thought I'd hear this..... » linkadge, posted by SLS on March 23, 2006, at 7:54:53
A fascinating thread ... I'm one of those diagnosed with _maybe_ BP3 (or 4 depending how the classification shakes out) -- certainly I react badly to most of the common AD's. Paxil made me sweat nails, Celexa gave me an out-of-body experience, Wellbutrin pushed me manic (according to my family -- I felt _fine_ ;), and Effexor induced terror. Luckily my pdoc, while convinced I fit somewhere on the BP spectrum, is open to trying alternatives (after 2 years on Lamictal I'm experimenting with tianeptine at the moment).
...to go back to the original post, I've read of studies showing that AD therapy alone and counselling/psychotherapy alone each have about a 30-50% remission rate in depression, but AD + counselling is much more successful than either alone. Sorry no references -- I plead guilty in advance to quoting the conventional wisdom here. Perhaps others have citations.
What matters, of course, is treating people. You can go ahead and diagnose me as bipolar mixed treatment-resistant cyclothymic XVII as long as the treatment makes me feel better and function better!
Hopefully,
Tony
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