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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 Helen Ball on July 21, 2019, at 7:24:40
Hello fellow Babblonians!!
I know there is a wealth of experienced information within this group and am seeking your advice.
I have had a 45 year old history of (at times) severe OCD - resulting in a 20 year compliance to various SSRI's and lately SNRI's. These antidepressant have helped reduce the anxiety associated with my OCD. For the last seven years I have experienced serious depression - hence the journey to find the 'correcting' medication for my depression. For 2.5 years I functioned happily on Prozac 20 mg and Lyrica 75 mg po od. My family doctor has been treating. I finally attended a 'consultation' visit with a psychiatrist who has diagnosed me with suspected Bipolar II (still not convinced), as my depression has lasted this long. She has (I believe), interpreted my irritability as a sign of occasional mania?? Here's the crunch ... she has taken me off all antidepressants. (Stopped Lyrica a year ago as pooped out), and started me (very slowly titrating) on Lamotrogine (Lamictal). It has been seven days. I am only taking 5 mg Lamotrogine. For the last couple of nights I have been experiencing return of anxiety and OCD symptoms - not sleeping - anxious ruminating thoughts - ruminating on my breathing, ruminating obsessively on order and compulsively getting up to straighten, etc.
My questions to you are:
1) Is it possible to be dx. bipolar II because of longstanding depression and irritability?
2) Do you think I should have been taken off SSRI/SNRI because of my OCD? (My daughter who is a psych nurse told me ... "Mom, I think your OCD is going to get worse ... I don't think PDoc should have taken off SSRI/SNRI.
3) Is it possible that long time use of SSRI could in fact cause depression? Too much seretonin?4) What antidepressant/med. do you think would work best with OCD and possible Bipolar II?
Note: Even at 5 mg of Lamictal for a week, my mood appears improved. My anxiety/OCD worse. I was titrating off my Duloxetine and was down to 15 mg. when off completely a week ago and started Lamotrogine (only med.)
If you have the time ... I would appreciate your thoughts re. my questions.
Thanks. I hope you are experiencing some sense of recovery from your own struggles.
Kind regards,
Bones
Posted by joe f on July 21, 2019, at 9:14:32
In reply to Dx.Bipolar II and OCD - Wise to be taken off SSRI?, posted by Helen Ball on July 21, 2019, at 7:24:40
i also have ocd and bipolar 2.......take 250 luvox cr and 2 mg rexulti...works so i don't think taking an ssri is a bad thing if a mood stabilizer is aboard.....was on lamictal once ...thought activating
Posted by TH on July 21, 2019, at 9:20:42
In reply to Re: Dx.Bipolar II and OCD - Wise to be taken off SSRI?, posted by joe f on July 21, 2019, at 9:14:32
I'm afraid I don't have much useful experience to draw on, but I will say that irritability absolutely can be, and often is, a symptom of depression. By itself, I wouldn't think it would indicate Bipolar II!
Do you have a family history of bipolar? Psychiatrists are often quick to diagnose if that's the case.
I believe(?) that without the manifestation of an overt manic episode, it is not possible to distinguish between bipolar II and atypical depression; so much so that there is a reasonable case for them, along with borderline, to be closely related as disorders of the same underlying "cyclothymic temperamental matrix".
Hopefully others will have some more relevant advice. I hope you are able to find some improvement.
Posted by HelenBall on July 21, 2019, at 10:12:15
In reply to Re: Dx.Bipolar II and OCD - Wise to be taken off SSRI?, posted by joe f on July 21, 2019, at 9:14:32
Hi Joe F. Thanks for your response. I actually tried one resulti (borrowed) z... know I am not supposed to do this, and took last week. I was very emotional. Crying. Grieving everything. Saw a truck load of pigs on the way to the market. One had his/her little pink snout poking out of one of the air holes. Bawled my eyes out. I am usually not a crier. Probably not safe to make conclusion with one dose. Do you find Luvox a good fit for your OCD?
Posted by linkadge on July 21, 2019, at 12:22:54
In reply to Re: Dx.Bipolar II and OCD - Wise to be taken off SSRI?, posted by HelenBall on July 21, 2019, at 10:12:15
Hi Helen,
You've raised a lot of issues. To answer your primary question, I don't believe that bipolar II can be diagnosed based on one symptom. As mentioned, irritability can be a symptom of depression.
To understand whether this doctor's decision was sound or not you'd need to look at additional symptoms of bipolar II to see if they match.
Questions / thoughts I would have would be:1) Was Prozac the only SSRI you've taken? If the drug worked well for a period of time, then stopped, my initial thought would be to try another antidepressant (or raise the Prozac dose, if it was on the low side) - unless of course, there were clear symptoms of (hypo)mania.
2) Is the irritability ongoing, or does it occur more episodically? If it is episodic, do other symptoms pop up around the same time?
3) Antidepressants stop working all the time, for a variety of reasons. It is not necessarily indicative of bipolar.
4) There are a number of studies that suggest that bipolar II is *not* effectively treated by mood stabilizers alone. Some studies suggest that antidepressants alone can be effective for some individuals with bipolar II. Others studies suggest that a combination of antidepressant and mood stabilizer is optimal.
5) The emotionality you are experiencing could be a sign of SSRI withdrawal. For Prozac, this may start occurring many days / weeks later as it has a longer half life.
6) I would treat the biggest problem first. Think of your cluster of symptoms pre-medication. If the biggest problem is depression / OCD, then yes I would stick with an SSRI.
7) Given your symptoms, you might be better served by an SSRI (perhaps try ones other than Prozac). If hypomania symptoms occur, then think about adding a mood stabilizer. Something like abilify or Seroquel might work well at reducing hypomania symptoms while still allowing you to take the SSRI. A SSRI lamotrigine combination can also work well for some.
Linkadge
Posted by joe f on July 21, 2019, at 12:46:58
In reply to Re: Dx.Bipolar II and OCD - Wise to be taken off SSRI?, posted by linkadge on July 21, 2019, at 12:22:54
luvox at 250 is very good for ocd
Posted by HelenBall on July 21, 2019, at 13:05:28
In reply to Re: Dx.Bipolar II and OCD - Wise to be taken off SSRI?, posted by TH on July 21, 2019, at 9:20:42
Thanks TH. I should have mentioned symptoms also included extreme suspicious feelings towards loved one - over events that occurred many years ago and had for all intents and purposes been resolved many years ago.
My brother has bipolar disorder and takes SSRI and Epival. His daughter diagnosed with bipolar or borderline. My son has schizophrenia- first episode at 18 years and stable and happy on clozapine.
Thanks again for taking the time to respond and wishing you the best on your own personal journey.
Posted by joe f on July 21, 2019, at 15:10:16
In reply to Re: Dx.Bipolar II and OCD - Wise to be taken off SSRI?, posted by HelenBall on July 21, 2019, at 13:05:28
thank you
Posted by linkadge on July 21, 2019, at 18:04:05
In reply to Re: Dx.Bipolar II and OCD - Wise to be taken off SSRI?, posted by HelenBall on July 21, 2019, at 13:05:28
Given irritability and suspiciousness, this could be bipolar(ish) or perhaps some form of prodromal schizoaffective disorder. That being said, you appear to have good insight into your symptoms, which may be more a sign that they are mood congruent (i.e. they dissipate with mood fluctuations).
Luvox is particulaly good for psychotic depression - depression accompanied by disortions of reality. This might be an option to pursue - perhaps in conjunction with a low dose antipsychotic (like abilify or seroquel - which can improve depression too).I personally find that antipsychotics mix a bit better with antidepressants, than do the mood stabilizers, but your mileage may vary.
Coming off an antidepressant and onto a mood stabilizer can be no fun. That being said, if you really do have bipolar, you should notice better control of moods with a mood stabilizer.
Linkadge
Posted by Hordak on July 21, 2019, at 18:17:15
In reply to Dx.Bipolar II and OCD - Wise to be taken off SSRI?, posted by Helen Ball on July 21, 2019, at 7:24:40
It's very irresponsible to take you off of all antidepressants. Having Bipolar doesn't exclude OCD and other comorbidities... she could have added Lamotrigine without discontinuing your other med regimen.
1) I don't know.
2) No, absolutely not! Your daughter is right.
3) It's possible. Poop-Out and / or homeostasis.
4) Clomipramine ("Anafranil) => https://psychotropical.com/clomipramine-potent-snri-anti-depressant/
You can combine Clomipramine and Lamictal... ;=)
Posted by Hordak on July 21, 2019, at 18:26:48
In reply to Dx.Bipolar II and OCD - Wise to be taken off SSRI?, posted by Helen Ball on July 21, 2019, at 7:24:40
Oh and yes: visit https://www.reddit.com/r/depressionregimens/
Posted by SLS on July 22, 2019, at 13:36:10
In reply to Re: Dx.Bipolar II and OCD - Wise to be taken off SSRI?, posted by linkadge on July 21, 2019, at 12:22:54
This is an excellent post, Linkadge.
- Scott> Hi Helen,
> You've raised a lot of issues. To answer your primary question, I don't believe that bipolar II can be diagnosed based on one symptom. As mentioned, irritability can be a symptom of depression.
>
> To understand whether this doctor's decision was sound or not you'd need to look at additional symptoms of bipolar II to see if they match.
> Questions / thoughts I would have would be:
>
> 1) Was Prozac the only SSRI you've taken? If the drug worked well for a period of time, then stopped, my initial thought would be to try another antidepressant (or raise the Prozac dose, if it was on the low side) - unless of course, there were clear symptoms of (hypo)mania.
>
> 2) Is the irritability ongoing, or does it occur more episodically? If it is episodic, do other symptoms pop up around the same time?
>
> 3) Antidepressants stop working all the time, for a variety of reasons. It is not necessarily indicative of bipolar.
>
> 4) There are a number of studies that suggest that bipolar II is *not* effectively treated by mood stabilizers alone. Some studies suggest that antidepressants alone can be effective for some individuals with bipolar II. Others studies suggest that a combination of antidepressant and mood stabilizer is optimal.
>
> 5) The emotionality you are experiencing could be a sign of SSRI withdrawal. For Prozac, this may start occurring many days / weeks later as it has a longer half life.
>
> 6) I would treat the biggest problem first. Think of your cluster of symptoms pre-medication. If the biggest problem is depression / OCD, then yes I would stick with an SSRI.
>
> 7) Given your symptoms, you might be better served by an SSRI (perhaps try ones other than Prozac). If hypomania symptoms occur, then think about adding a mood stabilizer. Something like abilify or Seroquel might work well at reducing hypomania symptoms while still allowing you to take the SSRI. A SSRI lamotrigine combination can also work well for some.
>
> Linkadge
This is the end of the thread.
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