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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Kingfish on July 4, 2001, at 9:44:38
I've experienced extreme irritability and agitation with Wellbutrin and Prozac when I've first taken them (I stopped Wellbutrin after a couple of days and have only been on Prozac for about a week and a half).
It's such a major difference, I can't get over it. The littlest things set me off.
Has anyone experienced this? If so, did it subside?
I'm really frustrated, and am wondering if it's a sign that I shouldn't take "activating" SSRI's, which eliminates a set of options for me because Prozac was prescribed to counteract sedation caused by my mood stabilizer, Topamax, and to alleviate my depression.
Thanks!
- K.
Posted by JahL on July 4, 2001, at 9:53:20
In reply to SSRI's and irritability, posted by Kingfish on July 4, 2001, at 9:44:38
> I've experienced extreme irritability and agitation with Wellbutrin and Prozac when I've first taken them (I stopped Wellbutrin after a couple of days and have only been on Prozac for about a week and a half).
> Has anyone experienced this? If so, did it subside?
All SSRIs (alone) made me significantly more agitated/hostile & to some extent have left me 'permanently' so. Effexor was even worse in this respect. These effects did not subside & became worse with time. I've just been dx'd BP II or III.
J.
Posted by briana on July 4, 2001, at 11:13:24
In reply to SSRI's and irritability, posted by Kingfish on July 4, 2001, at 9:44:38
I've heard that dehydration can cause lithium levels to reach toxic levels, so I've always been really careful when exercising to hydrate with water and Gatorade to replace the salt and fluids I've lost. However, I am going on a bike trip next week where rehydrating to the extent that I am used to might be difficult. I'm wondering how likely it is for someone to get lithium toxicity from dehydration when exercising. I'm also wondering if dosing my meds differently might help minimize this risk. Right now I am taking 1200 mg via 600 bid. Should I take 900 at night and then 300 during the day to minimize the risk, or does it really make no difference?
sorry I couldn't start a new thread; the site would not let me for some reason.
Thanks,
Brie
Posted by Cam W. on July 4, 2001, at 11:49:06
In reply to SSRI's and irritability, posted by Kingfish on July 4, 2001, at 9:44:38
Kingfish (of Amos & Andy, I'm assuming) - For most people the irritability and aggravation caused by Wellbutrin™ (bupropion) and the SSRIs is slightly different.
Usually, with SSRIs the agitation is a start-up side effect, and lasts 2 to 3 weeks, at most. This can be a very pronounced effect in some people. In others, as Jah points out, the irritability lasts as long as the person is taking the SSRI, but for most people, this side effect does lessen. I believe this may be a marker for a certain subtype of depression (ie. perhaps a depression without lower serotonin levels - the breakdown of the HPA axis is not related to serotonin function in this case).
With Wellbutrin, I find that the aggression and agitation are a delayed side effect. Two or three weeks into taking the Wellbutrin, some people really get "owly". It seems that this can even happen before the Wellbutrin has started working. I found myself looking for things to yell at when I started taking this drug. This effect, in most people, lasts for a week or so and then goes away (I have seen a couple people in who the irritability didn't lessen until the Wellbutrin was withdrawn).
It might be wise to continue taking the Prozac for another week or so; just so that you can get rid of most of the start-up side effects and see if the drug will help you. Talk to your doc about this, and see what he/she says.
Good luck - Cam
Posted by sar on July 4, 2001, at 11:49:12
In reply to SSRI's and irritability, posted by Kingfish on July 4, 2001, at 9:44:38
I've always had problems with anger, internalizing it rather than expressing it, and people always say that i'm so "sweet" and that they can't imagine me angry.
so when i started taking prozac, i started gittin pissed off. and i let people know it. i am still in a quandry as to whether i've developed a healthy backbone or have turned into the "crazy bitch" they accuse me of being (after bein' such a "sweetie" for so long).
i will tell you one kind of irrational thing i did. i got mad at bob dylan for the way he treated joan baez and bought one of her CDs instead of his, tho I like his music better, I just didn't think the damn heartbreaker deserved any royalties.
my anger has subsided by augmenting prozac with klonopin. now i feel like hugging everyone and kissing them on the forehead. i feel as docile as a little lamb.
sar
Posted by Mitch on July 4, 2001, at 12:09:34
In reply to SSRI's and irritability, posted by Kingfish on July 4, 2001, at 9:44:38
K.
I am currently taking
Neurontin/Klonopin + Zoloft/Nortriptyline
for BPII and Social Anxiety/Panic. I have also had trouble with AD's (and Buspar) causing hostility. The worst ones for me were Effexor, Prozac, Desipramine and Buspar (BIGTIME). The ones that gave me the least trouble with anger were Zoloft, Serzone, Celexa, amitriptyline, nortriptyline.I have heard people here say that irritability will subside with time, but with bipolar in the mix I have found that not to be true. Any AD that I have ever taken that me grouchy from the getgo never let up much on my temper. I have also had situations where you start something and it *didn't* make me grouchy and after a week or so it DID(buspar/desipramine).
Given bipolar I think you can almost go with a *first impression* and save yourself a lot of time. I would give something else a try. If you are looking at an *activating* SSRI the only other one besides Prozac is Zoloft (and for *some* people-Celexa). That's what I take and it makes me feel calm and alert (very low dose though).
Another possibility would be to add another mood stabilizer (that is "activating") to your Topamax instead of an AD. Have you tried Lamictal? I have found that Neurontin has an AD effect for me (at low doses).
Also some folks find *low* doses of Tegretol, Trileptal, or Gabitril somewhat activating as well. I noticed a distinct mood elevation with Trileptal (75mg) or Gabitril (4mg).
Mitch> I've experienced extreme irritability and agitation with Wellbutrin and Prozac when I've first taken them (I stopped Wellbutrin after a couple of days and have only been on Prozac for about a week and a half).
>
> It's such a major difference, I can't get over it. The littlest things set me off.
>
> Has anyone experienced this? If so, did it subside?
>
> I'm really frustrated, and am wondering if it's a sign that I shouldn't take "activating" SSRI's, which eliminates a set of options for me because Prozac was prescribed to counteract sedation caused by my mood stabilizer, Topamax, and to alleviate my depression.
>
> Thanks!
>
> - K.
Posted by Else on July 4, 2001, at 12:44:07
In reply to Re: SSRI's and irritability, posted by JahL on July 4, 2001, at 9:53:20
> > I've experienced extreme irritability and agitation with Wellbutrin and Prozac when I've first taken them (I stopped Wellbutrin after a couple of days and have only been on Prozac for about a week and a half).
>
> > Has anyone experienced this? If so, did it subside?
>
> All SSRIs (alone) made me significantly more agitated/hostile & to some extent have left me 'permanently' so. Effexor was even worse in this respect. These effects did not subside & became worse with time. I've just been dx'd BP II or III.
>
> J.This has got me thinking. I get very agitated and irritated on SSRIs, hypomanic when I start Wellbutrin, unbearably insomniac and irritable on Effexor (and really anxious and I don't stop talking but I feel like s--t.) Could this mean I am bipolar in some way. I know there are irritable manias but I don't think I've ever had anykind of real *episode*. I'm certainly never euphoric (except for a few minutes earlier this year when the Wellbutrin started working.)
Posted by kid_A on July 4, 2001, at 13:01:15
In reply to Re: SSRI's and irritability, posted by Else on July 4, 2001, at 12:44:07
After starting effexor I've become more hostile in certain situations than I normally would be... Things iritate me that perhaps shouldnt... I'm much more agressive than I should be even in situations where I really should keep my mouth shut...Anyways... I do have anxiety problems at times, but I dont think that qualifies as bipolar... So hopefully these rages will stop...
Posted by briana on July 4, 2001, at 17:29:33
In reply to New thread/probs posting -- lithium toxicity, posted by briana on July 4, 2001, at 11:13:24
Is response to therapeutic lithium doses a diagnostic sign of bipolar disorder? Can one have a good response to lithium doses in the 1200 mg range and NOT be bipolar?
Thanks,
Brie
Posted by JahL on July 4, 2001, at 18:08:00
In reply to Re: SSRI's and irritability, posted by Else on July 4, 2001, at 12:44:07
> > > I've experienced extreme irritability and agitation with Wellbutrin and Prozac when I've first taken them (I stopped Wellbutrin after a couple of days and have only been on Prozac for about a week and a half).
> >
> > > Has anyone experienced this? If so, did it subside?
> >
> > All SSRIs (alone) made me significantly more agitated/hostile & to some extent have left me 'permanently' so. Effexor was even worse in this respect. These effects did not subside & became worse with time. I've just been dx'd BP II or III.
> >
> > J.
>
> This has got me thinking. I get very agitated and irritated on SSRIs, hypomanic when I start Wellbutrin, unbearably insomniac and irritable on Effexor (and really anxious and I don't stop talking but I feel like s--t.) Could this mean I am bipolar in some way. I know there are irritable manias but I don't think I've ever had anykind of real *episode*. I'm certainly never euphoric (except for a few minutes earlier this year when the Wellbutrin started working.)In my case I've never had any kind of episode either. What qualifies me for BPII/III is; spells of hypomania/euthymia & general worsening on ADs, general irritabilty/agitation/hostility, anxiety, social phobia, psychomotor retardation, dysphoria as opposed to depression & profound insomnia. These are all possible markers for BP. I guess if you exhibit enough symptoms it is possible you are BP, though none on their own could be considered suggestive of this.
Maybe the real Q is have you tried a mood-stabilizer?
J.
Posted by JahL on July 4, 2001, at 18:13:34
In reply to Re: SSRI's and irritability » Else, posted by JahL on July 4, 2001, at 18:08:00
> In my case I've never had any kind of episode either. What qualifies me for BPII/III is; spells of hypomania/euthymia & general worsening on ADs, general irritabilty/agitation/hostility, anxiety, social phobia, psychomotor retardation, dysphoria as opposed to depression & profound insomnia. These are all possible markers for BP. I guess if you exhibit enough symptoms it is possible you are BP, though none on their own could be considered suggestive of this.
>
> Maybe the real Q is have you tried a mood-stabilizer?
>
> J.I meant to add that the whole 'soft' Bipolar dx is a contentious one. Here in the UK I've seen about 7 psychiatrists. Only the last 2, both specialist psychopharmacologists, recognised my BP tendencies (& indeed the actual BP sub-categories).
I guess the dx is only useful if it leads you to the correct medication.
Posted by Else on July 4, 2001, at 21:49:55
In reply to Re: SSRI's and irritability » Else, posted by JahL on July 4, 2001, at 18:08:00
> > > > I've experienced extreme irritability and agitation with Wellbutrin and Prozac when I've first taken them (I stopped Wellbutrin after a couple of days and have only been on Prozac for about a week and a half).
> > >
> > > > Has anyone experienced this? If so, did it subside?
> > >
> > > All SSRIs (alone) made me significantly more agitated/hostile & to some extent have left me 'permanently' so. Effexor was even worse in this respect. These effects did not subside & became worse with time. I've just been dx'd BP II or III.
> > >
> > > J.
> >
> > This has got me thinking. I get very agitated and irritated on SSRIs, hypomanic when I start Wellbutrin, unbearably insomniac and irritable on Effexor (and really anxious and I don't stop talking but I feel like s--t.) Could this mean I am bipolar in some way. I know there are irritable manias but I don't think I've ever had anykind of real *episode*. I'm certainly never euphoric (except for a few minutes earlier this year when the Wellbutrin started working.)
>
> In my case I've never had any kind of episode either. What qualifies me for BPII/III is; spells of hypomania/euthymia & general worsening on ADs, general irritabilty/agitation/hostility, anxiety, social phobia, psychomotor retardation, dysphoria as opposed to depression & profound insomnia. These are all possible markers for BP. I guess if you exhibit enough symptoms it is possible you are BP, though none on their own could be considered suggestive of this.
>
> Maybe the real Q is have you tried a mood-stabilizer?
>
> J.Initially, in the hospital my diagnosis was «atypical bipolar» whatever the hell that means. I took a drug overdose (Elavil, Chloral Hydrate, Vodka, some Parnate, probably some other stuff too). Anyway I had a weird reaction afterwards and the whole time I was in the hospital I was very cheerful and my thoughts were racing. I saw another doctor after I left the hospital who said I was in a state of excitment (I thought I was just in a good mood) and upped the Depakote I had been given at the hospital. My current doctor has rejected the initial diagnosis on the basis that I have no family history of manic-depression and diagnosed me as borderline, which I always thought was excessive. I'm am really not that troubled. In any event, the symptoms you have listed correspond to my problems exactly, right down to the social phobia, irritability, racing thoughts, everything. Also, my doctor insists on keeping me on some kind of anti-convulsant. Even though he rejected the diagnosis of bipolar, he upped my depakote to 2000mg a day (for my anxiety, he said). Now I'm on Neurontin for social phobia but it also happens to be an anti-convulsant so God knows what he's thinking. As for me, I pretty much always though I was overly anxious and nervous as hell, nothing else to it.
And very chatty and hysterical.
Posted by Else on July 4, 2001, at 21:55:10
In reply to Re: SSRI's and irritability » JahL, posted by JahL on July 4, 2001, at 18:13:34
< snip >
>
> I guess the dx is only useful if it leads you to the correct medication.The correct medication is clonazepam. I know this for a fact. But you know how it is with doctors and benzos. Although, on those pills, my behavior can become *excessive*. I get bossy, loud, very cheerful but it's really the only thing that makes me feel o.k.. Otherwise I feel bad all the time. Not depressed, just plain bad.
Posted by Elizabeth on July 4, 2001, at 22:05:35
In reply to SSRI's and irritability, posted by Kingfish on July 4, 2001, at 9:44:38
> I'm really frustrated, and am wondering if it's a sign that I shouldn't take "activating" SSRI's, which eliminates a set of options for me because Prozac was prescribed to counteract sedation caused by my mood stabilizer, Topamax, and to alleviate my depression.
You're bipolar, then? The antidepressants might be triggering dysphoric hypomania, which often manifests as irritability. Whatever the reason, I'd suggest starting on a lower dose of Prozac or Wellbutrin, and increasing the dose slowly.
-elizabeth
Posted by JahL on July 5, 2001, at 15:38:12
In reply to Re: SSRI's and irritability » JahL, posted by Else on July 4, 2001, at 21:55:10
> > I guess the dx is only useful if it leads you to the correct medication.
>
> The correct medication is clonazepam. I know this for a fact. But you know how it is with doctors and benzos.Ain't that just weird (not to mention screwed up)?
Here in the UK it's almost impossible to get anything off-label, even relatively std meds such as Olanzapine & Lamictal, yet I can get Clonazepam all day long. My brother's just got a 4 month supply to take on his travels. I thought pdocs didn't view it in quite the same light as other benzos.
I find Clonazepam augments my Lamictal & helps with night-waking.
Re: yr other post mentioning Borderline P. Disorder. Don't swallow it. They tried it on me. Personally speaking I think it's an oft-used ploy of besumed pdocs who use it to explain their inability to treat adequately. That's not to say it doesn't exist. I don't know.
J
Posted by chiaratara on July 5, 2001, at 17:31:20
In reply to SSRI's and irritability, posted by Kingfish on July 4, 2001, at 9:44:38
BIG TIME!
I tried both and I felt "snappish." I couldn't tolerate either of them. I was consistently aggravated and agitated. I would cut people off in traffic and was generally "not nice."
Try other AD, like paxil, and serzone. They mellowed me out quite a bit.
Posted by Else on July 5, 2001, at 19:21:24
In reply to Re: SSRI's and irritability » Else, posted by JahL on July 5, 2001, at 15:38:12
>
> > > I guess the dx is only useful if it leads you to the correct medication.
> >
> > The correct medication is clonazepam. I know this for a fact. But you know how it is with doctors and benzos.
>
> Ain't that just weird (not to mention screwed up)?
>
> Here in the UK it's almost impossible to get anything off-label, even relatively std meds such as Olanzapine & Lamictal, yet I can get Clonazepam all day long. My brother's just got a 4 month supply to take on his travels. I thought pdocs didn't view it in quite the same light as other benzos.
>
> I find Clonazepam augments my Lamictal & helps with night-waking.
>
> Re: yr other post mentioning Borderline P. Disorder. Don't swallow it. They tried it on me. Personally speaking I think it's an oft-used ploy of besumed pdocs who use it to explain their inability to treat adequately. That's not to say it doesn't exist. I don't know.
>
> JI think Borderline personnality disorder does exist because in group therapy I've seen people who fitted the description perfectly. They were apparently much more confused and unstable than me about their sense of self (EXTREMELY labile and unsure of themselves) and had mostly been sexually abused as children (I wasn't). Some researchers think it's a form of chronic PTSD which makes sense given that the symptoms are very similar.
Anything can look like BPD though. The diagnosis I would choose personnally for myself is Generalized Anxiety Disorder, among others. I am relentlessly anxious and it wears me out. I don't think the diagnosis matters as much as the actual symptoms you are trying to control, even if they don't fit neatly into any particular category. I would be pretty much beyond caring if my treatment didn't depend on the diagnosis I got stuck with. (Frankly, I'd rather get stuck with GAD because then I would be prescribed clonazepam by my pdoc instead of going behind his back and getting it from my GP. How sneaky of me). I really do ramble on, don't I?
OH yeah. I need to ask. What is the deal with meds in the UK? It sounds even worse than Canada where, as I've mentionned before, your options seem to be limited to Paxil, Risperdal and Epival(valproate). I had to insist to get a shot at Effexor (it was dreadful but worth a try) and Wellbutrin. But I keep reading about how you can't get decent treatment in the UK. What about that?
Posted by Elizabeth on July 6, 2001, at 0:57:04
In reply to Re: SSRI's and irritability/What's up with the UK? » JahL, posted by Else on July 5, 2001, at 19:21:24
> I think Borderline personnality disorder does exist because in group therapy I've seen people who fitted the description perfectly.
Sure. On the other hand, some doctors seem to have gotten carried away about diagnosing this condition (for example, did you know that the vast majority of adolescent girls are "borderlines?" < g >).
> Some researchers think it's a form of chronic PTSD which makes sense given that the symptoms are very similar.
It's sort of similar to PTSD. A construct that somebody came up with is "complex PTSD," which bears a marked resemblance to BPD.
> The diagnosis I would choose personnally for myself is Generalized Anxiety Disorder, among others.
And you think BPD is vague!
> I am relentlessly anxious and it wears me out.
The way I would describe people with GAD is that they ruminate. They regularly have initial insomnia because they can't "shut their thoughts down" in order to go to sleep.
> I would be pretty much beyond caring if my treatment didn't depend on the diagnosis I got stuck with. (Frankly, I'd rather get stuck with GAD because then I would be prescribed clonazepam by my pdoc instead of going behind his back and getting it from my GP. How sneaky of me).
You can't get Rivotril from your pdoc for anxiety? That's weird. Why not?
-elizabeth
Posted by Else on July 6, 2001, at 19:47:30
In reply to Re: diagnoses and stuff » Else, posted by Elizabeth on July 6, 2001, at 0:57:04
>
> The way I would describe people with GAD is that they ruminate. They regularly have initial insomnia because they can't "shut their thoughts down" in order to go to sleep.
>>
> You can't get Rivotril from your pdoc for anxiety? That's weird. Why not?
>
> -elizabethIt would not surprise me at all that most teenage girls could be considered BPD. I think BPD has replaced hysteria as a one-size-fits-all diagnosis for women. The description you make of GAD suits me exactly. I can't shut down, physically or mentally. There have been times I forced myself to drink alcohol even though I felt like throwing up just because I wanted my stupid ruminating thoughts to stop. I even took anti-histamines as tranquilizers because they would make me unable to think. Given that I would prefer being hit over the head than take Benadryl, that pretty much says it all.
My brain wont shut down. Mostly it's worries but I also go over events that happenned during the day, regretting that I did this, or didn't do that. I also rehearse conversations that I plan to have with so and so, mostly my doctor. I try to predict objections he might have and figure out how I might counter them. All the while, I am aware that this is stupid and useless but I can't stop. At times I thought I was obsessive-compulsive but my thoughts don't really have that repetitive quality. They are just about whatever.
My pdoc told me once he would NEVER prescribe benzos for me. He didn't say why but I presume it's because I was hospitalised for a drug overdose (a suicide attempt, with TCAs, chloral hydrate and alcohol but not benzos, mind you). I tell him benzos are the only drugs that work for me and he looks at me condescendingly like all I want is to get high.
Posted by AMenz on July 7, 2001, at 10:50:39
In reply to SSRI's and irritability, posted by Kingfish on July 4, 2001, at 9:44:38
SSRI's seem to really be very bad for bipolars, causing as they do a build up of seratonin. This irritable feature I don't believe is a sign of depression but a kind of dysthimic hypomanic state.
Irritability is really a huge interpersonal problem. I suffered from an explosive temper for years. The elimination of this feature is the single biggest help I've received from mood stabiliaers.
In answer to your question I have experienced irritability on Buspar, Zoloft, anything related to serotonin level.
> I've experienced extreme irritability and agitation with Wellbutrin and Prozac when I've first taken them (I stopped Wellbutrin after a couple of days and have only been on Prozac for about a week and a half).
>
> It's such a major difference, I can't get over it. The littlest things set me off.
>
> Has anyone experienced this? If so, did it subside?
>
> I'm really frustrated, and am wondering if it's a sign that I shouldn't take "activating" SSRI's, which eliminates a set of options for me because Prozac was prescribed to counteract sedation caused by my mood stabilizer, Topamax, and to alleviate my depression.
>
> Thanks!
>
> - K.
Posted by Elizabeth on July 7, 2001, at 21:23:01
In reply to Re: diagnoses and stuff, posted by Else on July 6, 2001, at 19:47:30
> It would not surprise me at all that most teenage girls could be considered BPD. I think BPD has replaced hysteria as a one-size-fits-all diagnosis for women.
Yes. Especially young, moody women.
> My brain wont shut down. Mostly it's worries but I also go over events that happenned during the day, regretting that I did this, or didn't do that. I also rehearse conversations that I plan to have with so and so, mostly my doctor. I try to predict objections he might have and figure out how I might counter them. All the while, I am aware that this is stupid and useless but I can't stop.
Yeah, that's GAD.
> My pdoc told me once he would NEVER prescribe benzos for me. He didn't say why but I presume it's because I was hospitalised for a drug overdose (a suicide attempt, with TCAs, chloral hydrate and alcohol but not benzos, mind you).
I suppose your pdoc doesn't know that compared with TCAs, chloral, and EtOH, benzos are really benign.
> I tell him benzos are the only drugs that work for me and he looks at me condescendingly like all I want is to get high.
Jeez. Can I recommend that you start looking for a more clueful pdoc?
-elizabeth
Posted by Kingfish on July 9, 2001, at 16:49:34
In reply to SSRI's and irritability, posted by Kingfish on July 4, 2001, at 9:44:38
> I've experienced extreme irritability and agitation with Wellbutrin and Prozac when I've first taken them (I stopped Wellbutrin after a couple of days and have only been on Prozac for about a week and a half).
>
> It's such a major difference, I can't get over it. The littlest things set me off.
>
> Has anyone experienced this? If so, did it subside?
>
> I'm really frustrated, and am wondering if it's a sign that I shouldn't take "activating" SSRI's, which eliminates a set of options for me because Prozac was prescribed to counteract sedation caused by my mood stabilizer, Topamax, and to alleviate my depression.
>
> Thanks!
>
> - K.
This is the end of the thread.
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