Psycho-Babble Medication Thread 281626

Shown: posts 1 to 24 of 24. This is the beginning of the thread.

 

BP Disorder Irritability

Posted by RRCarlo on November 20, 2003, at 10:07:57

I'm new to this board and I'm amazed at the wealth of knowledge here.

I have been diagnosed as having Type-2 Bipolar Disorder. My pdoc has been treating me with 20mg of Celexa once a day and 300mg of Lithobid twice daily. That made sense for a long time because the primary manifestation of my BPD was depression coupled with occasional irritabilty.

Well, that's changed. I won't bore you with my life story but these past six months have been very hard. My mom, who was my best friend, died a month ago. But her death was only the latest in a series of rough passages.

The result of all of this is that it's irritabilty and anxiety, not depression, that's eating me up. In a classic bit of displacment, I've deveoped a phobia around severe weather, which is just peachy since this is the worst year for severe weather in the DC area that anyone can recall. I know it's displacement! I know what I'm really afraid of. But, as i have been told, anxiety and irritability are "lagging indicators." Just knowing the real scoop doesn't make the symptoms go away -- at least not right away.

My pdoc's only repsonse, besides discussions, has been to up my Celexa to 30mgs a day. I'm not sure that's enough since I'm a big man. And it does squat for my irritability.

Any suggestions?

 

Re: BP Disorder Irritability » RRCarlo

Posted by sac on November 20, 2003, at 20:32:38

In reply to BP Disorder Irritability, posted by RRCarlo on November 20, 2003, at 10:07:57

I'm sorry to hear about your circumstance. I too am Bipolar II and currently on Lamictal, Depakote, and Prozac. I was on Celexa for about 6 months but discontinued because I became too fatigued. I was on 20 mgs. and I am a 130lb. female so 30 mgs. does seem on the low side for you. As I recall, you can safely go to 40 mgs. of Celexa. Perhaps, your Pdoc could prescribe a low dose benzodiazepene to use on an as needed basis. Also, Neurontin, which is an anti-seizure medication is also very calming. I was on that a few months ago at 100 mgs. 3 x day to quell some agitation I was having. Just some suggestions. Good Luck to you.

 

Re: BP Disorder Irritability

Posted by amy_oz on November 20, 2003, at 20:59:07

In reply to BP Disorder Irritability, posted by RRCarlo on November 20, 2003, at 10:07:57

I definitely know what you're talking about. Here's whats worked for me.

1. Magnesium.
2. Atypical antipsychotic. now used often to quell a manic episode, whether euphoric or dysphoric. Also excellent for anxiety, irritability etc. Try zyprexa, seroquel, abilify etc.

3. Hardcore exercise. I cannot stress this enough.
I've recently discovered Tae Kwon Do and its a life saver to get rid of frustration, depression and anxiety.

Hope this helps,
Good luck

Amy

 

Re: BP Disorder Irritability » RRCarlo

Posted by femlite on November 20, 2003, at 21:31:50

In reply to BP Disorder Irritability, posted by RRCarlo on November 20, 2003, at 10:07:57

I am BP II. My mania is usually like yours, characterized by agitation and anger at those who get in my way.

I have learned to have faith in the fact that despite the limited view current Psychiatry has of BP, this is a manic phase for me.

A traumatic event can flip your swith and send you from one phase to the other. That trauma is of course the relevent factor. But even knowing it, once its happened you need to moderate it what ever you find that helps.
Neurontin has been usefule and Benzodiazapines on a occation. I Take WB 150 xl and it is still causeing me (or not preventing me) to cycle. We are working with Lamictal, slowly as the side efects require. And Neurontin 2 at night 1-2 throughout the day.
Good Luck

 

Re: BP Disorder Irritability

Posted by RRCarlo on November 21, 2003, at 7:04:39

In reply to Re: BP Disorder Irritability » RRCarlo, posted by femlite on November 20, 2003, at 21:31:50

Thanks for the replies. I wake up every morning with a combination of dread and anxiety. I can't imagine letting this go on indefinitely and I have no reason to believe that it's self-correcting.

As I said, I *know* that my anxieties and phobias are irrational, in fact I'm quasi-ok once the heavy weather starts. But I want to feel human again. The irritability is the kick in the butt. I'm the primary custodial parent for an 11-year-old autistic boy. He's the light of my life. He's in a mainstream class and his homework is a mixture of grade-level (sixth) and skill-adjusted material. He's made real progress but lately I find myself getting irritated. He senses this and says "I'm sorry, Dad." You can imagine the guilt and shame I feel afterwards. If I don't "self-medicate" after that, and I don't, then I guess I'm stronger than I thought.

I'm just hoping -- no, mke that *praying* -- that my shrink understands what changes need to be made in meds. I'm willing to work at the behavioral stuff. I'm working my way through the anxiety and phobia workbook. But I can't find my brain chemistry without help.

 

Re: BP Disorder Irritability » RRCarlo

Posted by ramsea on November 22, 2003, at 7:40:37

In reply to Re: BP Disorder Irritability, posted by RRCarlo on November 21, 2003, at 7:04:39

For a couple of years, until recently, I awoke with what I can undramatically call the horrors--severe dread, anxiety and panic. Despair too. I was taking antidepressants, tried many types, and Ativan (benzo. Sometimes also Seroquel and Neurontin.

The antidepressants were a mistake, as I have BP 1, and they sent me into Mixed States--which are very, deeply, distressing mental states combining hyperexcitement, manic flight of ideas and racing thoughts, reduced need of sleep, and energy to spare---along with all the components of major depression.

It is a shame I didn't receive proper treatment for this condition sooner. Well, I am still here anyway. But I will probably never be scripted anti-depres again. For someone with my condition, though very depressed, the antidepressants serve only to worsen agitation/anxiety/panic and negativity in general. Rather than being very negative and sleeping a lot, or unable to do much, I become very negative and still have a hypomanic/manic desire to do things, interact, and so forth--which can mean causing trouble for myself with others (being rude, hurtful, impatient--I am not violent by nature but can sound too aggressive and unpleasant to others).

It can also lead to substance abuse as it is a pretty near intolerable mental condition. The happy part of this story is my family is still loving me and the lithium has been able to calm my dysphoric mania/hypomania.

The dysphoria is over and I wake up feeling fine--this is about two months of feeling better. I feel like it is a miracle. I take 800 mgs. lithium and 25-50 mgs of Seroquel for sleep. Nothing else. My social anxiety problem still remains, but I am on disability now and just have to live with it. My psych says the fewer drugs I have to take the better--for me anyway.

My solution is of course not likely to be yours, you are unique in your chemistry/situation. But I did want to share that you are not alone with the terrible waking-up thing---it was so very, very intolerable for too long. Yet now I am over it (knock on wood)--and that means you too can find a way to stop this. It wasn't psychological for me, just chemical.

 

Re: BP Disorder Irritability

Posted by RRCarlo on November 22, 2003, at 8:43:57

In reply to Re: BP Disorder Irritability » RRCarlo, posted by ramsea on November 22, 2003, at 7:40:37

I went to my shrink yesterday and I'm encouraged. He switched me from Celexa to Lexapro and will increase my lithobid. (He also wrote a script for klonopin.) In his opinion, my anxiety and irritability largely stem from my depression. And it's true that I've been depressed for quite a while, even with the 20mg Celexa. I've lost interest in almost everything. In my case, it's kinda hard to tell because I'm functional, at least as concerns my obligations. Like I said, I'm hopeful. Stay tuned . . .

 

Re: BP Disorder Irritability » RRCarlo

Posted by Ron Hill on November 22, 2003, at 16:20:23

In reply to BP Disorder Irritability, posted by RRCarlo on November 20, 2003, at 10:07:57

RRCarlos,

Welcome to the neighborhood. We're glad you're here.

I can totally relate to your problems with irritability. I am bipolar II and without medication/supplements I cycle between three main symptoms (with brief periods of normal): Hypomania, depression, and dysphoric mood states (i.e; extreme irritability). My dysphoric mood might be what is commonly referred to as a “mixed state”, but I’m not sure if it falls into that category or not.

The good news is that there are things out there that can help dramatically. As to your question regarding irritability, if you’re looking for a medication I’d recommend giving Neurontin (gabapentin) a trial as an add-on to your Lithobid. I tried 600 mg/day of Neurontin and it helped my irritability. Neurontin must be taken several times a day. One thing I did not like about it was the fact that when a dose was starting to wear-off I’d experience some “rebound irritability” which was worse than if I had not taken the Neurontin to begin with.

About a month ago I began to treat my irritability using l-theanine, a natural amino acid found almost exclusively in green tea. RRCarlos, it is incredible how well it works for me! Here is a link to a thread where I talk about it over on the PB-alternative board:

http://www.dr-bob.org/babble/alter/20031104/msgs/281539.html

My recommendation for you: Read the entire thread on PB-alt and read the article I posted in that thread. Then go to your local nutritional store and buy some and try it. It may or may not help you but, in my opinion, it is certainly worth a trial.

-- Ron
---------------------------------------------

> I'm new to this board and I'm amazed at the wealth of knowledge here.
>
> I have been diagnosed as having Type-2 Bipolar Disorder. My pdoc has been treating me with 20mg of Celexa once a day and 300mg of Lithobid twice daily. That made sense for a long time because the primary manifestation of my BPD was depression coupled with occasional irritabilty.
>
> Well, that's changed. I won't bore you with my life story but these past six months have been very hard. My mom, who was my best friend, died a month ago. But her death was only the latest in a series of rough passages.
>
> The result of all of this is that it's irritabilty and anxiety, not depression, that's eating me up. In a classic bit of displacment, I've deveoped a phobia around severe weather, which is just peachy since this is the worst year for severe weather in the DC area that anyone can recall. I know it's displacement! I know what I'm really afraid of. But, as i have been told, anxiety and irritability are "lagging indicators." Just knowing the real scoop doesn't make the symptoms go away -- at least not right away.
>
> My pdoc's only repsonse, besides discussions, has been to up my Celexa to 30mgs a day. I'm not sure that's enough since I'm a big man. And it does squat for my irritability.
>
> Any suggestions?

 

Re: BP Disorder and AD's » RRCarlo

Posted by Ron Hill on November 22, 2003, at 17:12:44

In reply to Re: BP Disorder Irritability, posted by RRCarlo on November 22, 2003, at 8:43:57

> I went to my shrink yesterday and I'm encouraged. He switched me from Celexa to Lexapro and will increase my lithobid. (He also wrote a script for klonopin.) In his opinion, my anxiety and irritability largely stem from my depression. And it's true that I've been depressed for quite a while, even with the 20mg Celexa. I've lost interest in almost everything. In my case, it's kinda hard to tell because I'm functional, at least as concerns my obligations. Like I said, I'm hopeful. Stay tuned . . .
---------------------------------

RRCarlos,

There is some disagreement in the medical community regarding the proper use (if any) of antidepressants by bipolar patients. Many pdocs say that AD's should be used cautiously with BP I and II patients. Some say that if used, they should be administered in small doses, while still others say a mood stabilizer should be used solo without AD’s. Here is a link to a page on Dr. Phelps' web site that discusses the AD controversy for BP patients:

http://www.psycheducation.org/bipolar/controversy.htm

For me personally, I’ve tried several SSRI’s, SNRI’s, and other types of antidepressants, over the years, but in the end they all left me with apathy, anhedonia and anergy. Of all the SSRIs, Prozac is the least offensive and Paxil is the worst (for me).

I attribute these adverse SSRI side effects to the fact that; “Chief among the brain’s reactions to artificially elevated serotonin levels is a compensatory drop in dopamine.” I took this quote from page 20 of the introduction in a book entitled "Prozac Backlash" by Joseph Glenmullen, M.D. He is a clinical instructor in psychiatry at Harvard Medical School, is on the staff of Harvard University Health Services, and is in private practice in Harvard Square. His credentials look impressive, but he appears to be somewhat extreme in his views regarding the dangers of SSRIs. I thought it was worth the time I spent scanning the available portions of his book on Amazon. You may want to look at it as well (just click on the book title provided above).

There have been numerous discussions on this board regarding the issue of SSRIs adversely affecting dopaminergic pathways and, thereby, inducing atypical depressive symptoms. However, this book is the first place that I personally have seen a doctor state this in print (I'm sure there are others, however, that I have not come across).

-- Ron

 

Re: BP Disorder and AD's

Posted by RRCarlo on November 22, 2003, at 17:50:43

In reply to Re: BP Disorder and AD's » RRCarlo, posted by Ron Hill on November 22, 2003, at 17:12:44

Ron, thanks for your generous contribution to this thread. I must admit that I'm so desperate to feel human, to get over the feelings of dread, apathy, and irritability, that I'm gonna give it a shot. If it don't work, then a change of shrinks may be in the offing.

 

Re: BP Disorder II and Irritability

Posted by Smilez on November 22, 2003, at 23:12:54

In reply to Re: BP Disorder and AD's, posted by RRCarlo on November 22, 2003, at 17:50:43

I feel so good seeing others with BPII *and* irritability. ((((hugs to you all fellow sufferers)))) Until recently, I had assumed all BP disorders were the same. It is good to finally have a name for what I have been enduring. BPII

Do you mind if I rant a little here rather than me starting a new thread??

I have always felt tense and edgey, even though my friends said I was usually mellow with occasional "intense" moments. But lately, the littlest things sideswipe me and cause me to become engulfed in fits of rage, slamming things in frustration like phones, books, and even recently, my fist on my wall or doing a primal yell.

My year as been horrid. It includes a divorce to an ex who won't leave me alone, a 26% rent increase, a state mandated demotion with unwanted reassignment (budget cut caused) to a city 50 miles away and the crappiest new neighbors I've EVER had after living here for 10 years.

I gained 31 pounds in just a few months by feeding my rages with food.

I wake up daily feeling hopeless and all too often, suicidally depressed. But by the end of the day I am usually so angry I can't maintain a decent conversation without it coming out.

I became so angry at my new heartless boss that in one meeting with her, I got lost in visions of blowing my brains out all over her desk to "show" her how her petty refusal to allow me transfered nearer to my home (and save me $300 a month in the process) affected my life. Of course, all she saw infront of her was a blubbering employee. (I cry when suppressing rage)

I went running to a doctor immediately after that episode and after several sessions, I was diagnosed as ADD and Bipolar II with irritability.

He wanted me on meds right away (do you blame him?) and I balked. I had been given Paxil several years before and it made things miserable for me. he convinced me to take Wellbutrin and as I am still very very edgy (gritting my teeth all day edgy) he added Topamax. I have had it for two days and haven't take it yet, but I will tomorrow. Being one who was raised homepathic, it kills me just taking ONE pill daily. The thought of two a day bums me out further.

I think the most depressing thing about all this is that he said I need to be on meds for at least two years. :(

Has anyone else here had Wellbutrin/Topamax for BPII?

 

RR

Posted by Smilez on November 22, 2003, at 23:19:02

In reply to Re: BP Disorder Irritability, posted by RRCarlo on November 21, 2003, at 7:04:39

I got so lost in sharing I forgot what I was going to say to you!

I understand and empathize with the guilt you feel when that occurs. I hope that your doctor will find the right therapy/meds for you.

Here is to better tomorrows! =)

 

Re: BP Disorder II and Irritability

Posted by RRCarlo on November 23, 2003, at 7:36:47

In reply to Re: BP Disorder II and Irritability, posted by Smilez on November 22, 2003, at 23:12:54

> I feel so good seeing others with BPII *and* irritability. ((((hugs to you all fellow sufferers)))) Until recently, I had assumed all BP disorders were the same. It is good to finally have a name for what I have been enduring. BPII
>
> Do you mind if I rant a little here rather than me starting a new thread??
>
> I have always felt tense and edgey, even though my friends said I was usually mellow with occasional "intense" moments. But lately, the littlest things sideswipe me and cause me to become engulfed in fits of rage, slamming things in frustration like phones, books, and even recently, my fist on my wall or doing a primal yell.
>
> My year as been horrid. It includes a divorce to an ex who won't leave me alone, a 26% rent increase, a state mandated demotion with unwanted reassignment (budget cut caused) to a city 50 miles away and the crappiest new neighbors I've EVER had after living here for 10 years.
>
> I gained 31 pounds in just a few months by feeding my rages with food.
>
> I wake up daily feeling hopeless and all too often, suicidally depressed. But by the end of the day I am usually so angry I can't maintain a decent conversation without it coming out.
>
> I became so angry at my new heartless boss that in one meeting with her, I got lost in visions of blowing my brains out all over her desk to "show" her how her petty refusal to allow me transfered nearer to my home (and save me $300 a month in the process) affected my life. Of course, all she saw infront of her was a blubbering employee. (I cry when suppressing rage)
>
> I went running to a doctor immediately after that episode and after several sessions, I was diagnosed as ADD and Bipolar II with irritability.
>
> He wanted me on meds right away (do you blame him?) and I balked. I had been given Paxil several years before and it made things miserable for me. he convinced me to take Wellbutrin and as I am still very very edgy (gritting my teeth all day edgy) he added Topamax. I have had it for two days and haven't take it yet, but I will tomorrow. Being one who was raised homepathic, it kills me just taking ONE pill daily. The thought of two a day bums me out further.
>
> I think the most depressing thing about all this is that he said I need to be on meds for at least two years. :(
>
> Has anyone else here had Wellbutrin/Topamax for BPII?
>

Smilez,*take your meds* Don't contemplate, study, dilly-dally, etc. Take them! It's the only way you will know if they're helping. If you don't take them, you *know* what will happen: more of the same.

When I was first diagnosed I was in much of the same state as you. The meds helped a lot. Lately, a rough patch has my depression in high gear, hence the switch to Lexapro.

 

Re: BP Disorder II and Irritability

Posted by tried them all on November 23, 2003, at 17:21:38

In reply to Re: BP Disorder II and Irritability, posted by RRCarlo on November 23, 2003, at 7:36:47

It is heartening to find so many others who have experienced what I have been going through for several years now. I have finally gotten the BPII diagnosis and I hope appropriate treatment, but so many AD's have only made my symptoms worse, most recently a re-trial of serzone which sent me into sobbing depression above 100mgs and into high under that dose. I am now seeing a psychopharmacologist who has me on very slowly titrating Abilify while remaining on 25mg of serzone and bits of clonopin so as not to mix side effects. So far, two weeks into it and on 1/4 of a 5mg tablet things are going well. It was such a relief to find that I was being believed about the irritability/anger/hostility being my mania. It took a lot of work on my part to come up with the information, something that needs a lot more work on the part of the mental health community. Glad to find you all here discussing this.

 

Re: BP Disorder II and Irritability

Posted by RRCarlo on November 23, 2003, at 18:28:54

In reply to Re: BP Disorder II and Irritability, posted by tried them all on November 23, 2003, at 17:21:38

> It is heartening to find so many others who have experienced what I have been going through for several years now. I have finally gotten the BPII diagnosis and I hope appropriate treatment, but so many AD's have only made my symptoms worse, most recently a re-trial of serzone which sent me into sobbing depression above 100mgs and into high under that dose. I am now seeing a psychopharmacologist who has me on very slowly titrating Abilify while remaining on 25mg of serzone and bits of clonopin so as not to mix side effects. So far, two weeks into it and on 1/4 of a 5mg tablet things are going well. It was such a relief to find that I was being believed about the irritability/anger/hostility being my mania. It took a lot of work on my part to come up with the information, something that needs a lot more work on the part of the mental health community. Glad to find you all here discussing this.

My prayers are with you. It's gratifying that, in seeking help for myself, I've helped others.

 

Re: BP Disorder II and Irritability

Posted by Smilez on November 23, 2003, at 19:44:53

In reply to Re: BP Disorder II and Irritability, posted by RRCarlo on November 23, 2003, at 18:28:54

"It was such a relief to find that I was being believed about the irritability/anger/hostility being my mania."

AMEN!!!!!!!!!!!!!!!!!

I thought my doctor was way off because I never have the manic HIGH's. I was surprised to find that irritability is the alternative to the highs some people get.

Now - where do you go to trade in the irritability for the manic HIGHS? =)

 

Re: BP Disorder II and Irritability

Posted by tried them all on November 23, 2003, at 22:39:13

In reply to Re: BP Disorder II and Irritability, posted by Smilez on November 23, 2003, at 19:44:53

That's what I've been asking as well.....if I had to be BP, why couldn't I have a manic high that gave me some energy rather than just a bad attitude. I have tried so many different meds the past couple of years and had miserable side effects from all of them, it's been a roller coaster. The so-called mood stabilizers, especially the GABA-affecting ones, are the worst for me, so it's been even worse in terms of the cycling and I had a horrendous allergic reaction to Eskalith. This website has been a wealth of information for me and particularly encouraging because there are others with similar issues who have also been there and have all sorts of experiences and suggestions.

 

Re: BP Disorder II and Irritability » tried them all

Posted by Smilez on November 23, 2003, at 23:00:15

In reply to Re: BP Disorder II and Irritability, posted by tried them all on November 23, 2003, at 22:39:13

Did you ever try the combination of Wellbutrin and Topamax? Tonight is my first night on the addition of the topamax and I amon my way to bed. I feel like a veggie.

It's actually a nice change. :)

I wouldn't want to feel like this every single day or at work, but it will definitely help with my insomnia tonight.

oh - and I am ADD + BPII and being new to all this, I don't really know which of the two meds are for which ailment yet but I am learning a lot here one day at a time. Like "cycling" (isn't that just the same as a sequence of nasty swings?) and GABA's.

I do appreciate this site very much

 

Re: BP Disorder II and Irritability

Posted by tried them all on November 24, 2003, at 8:13:03

In reply to Re: BP Disorder II and Irritability » tried them all, posted by Smilez on November 23, 2003, at 23:00:15

Yes, cycling is that up and down roller coaster of moods. I cannot take Wellbutrin because it causes some bad side effects, as well as the fact that it tips me into manic behavior of being so talkative that it drives everyone crazy and that doesn't really work well in public! As for Topamax, same deal with SE's and it, too, is one of the anti-seizure meds being touted as mood stabilizers which have that GABA neurotransmitter as its focus. I get particularly confused and forgetful on them, as well as sometimes bruising from nowhere and a bit of coordination problems. The only good thing about Wellbutrin is its effect on Dopamine, which seems to be the effect I need.....hence my current trial with Abilify. I really got a lot out of an above posting about the blocking of Dopamine by SSRI's.....always knew I had extreme trouble with SSRI's but didn't understand why. Being new to all this, Smilez, you are lucky to have access to this group of well-seasoned people; I had no idea about sites like this until about a year ago and didn't get up the courage to post until about two weeks ago.

 

Re: BP Disorder II and Irritability » tried them all

Posted by Smilez on November 24, 2003, at 8:27:25

In reply to Re: BP Disorder II and Irritability, posted by tried them all on November 24, 2003, at 8:13:03

I do consider myself lucky to have found it. I am the world's biggest chicken when it comes to meds. I would never make a good hypochondriac. I HATE meds. I haven't even owned a bottle of cold medicine in years.

Woke up this morning after taking my 1st Topamax 25g last night and feeling groggy after a night of bizarre dreams and feeling like I should get up or did get up or might up but couldn't/wouldn't/didn't. DOes that make sense?

Oh! I was so groggy I went to be da few hours earlier than normal and then found my LOUD neighbors had their TV blaring. So - I sat stupified, groggy, gelled, while inside I was very angry. At least I never threw anything at the wall. lol


Now, I have to take my morning wellbutrin 200SR. That scares me. UP down UP down. Right?

Well, I'll give it a real try this week and if I prefer my anxiety, then I will just have to quit and try to keep the rages in control.

 

Re: BP Disorder II and Irritability

Posted by tried them all on November 24, 2003, at 10:42:14

In reply to Re: BP Disorder II and Irritability » tried them all, posted by Smilez on November 24, 2003, at 8:27:25

Don't give up, if this combo doesn't work there are so many others to try. I found that Topamax and wellbutrin together made me more, not less, irritable and hostile. Topamax caused lack of coordination, bruising, early waking, shakiness in my hands and racing in my thoughts. I have tried some of the meds over the years more than once, because sometimes changes in body chemistry, etc make you respond differently, although usually in my case to the negative. If you need better med advice, search around until you can find the best doc you can and remember it's about you getting better.

 

Re: BP Disorder II and Irritability » Smilez

Posted by ramsea on November 25, 2003, at 4:16:11

In reply to Re: BP Disorder II and Irritability » tried them all, posted by Smilez on November 24, 2003, at 8:27:25

Topamax is a godsend for some people but I have read a lot of clinical reports that are clearly ambiguous. For example, there is not enough agreement among doctors that Topamax is useful for treating bipolar for it to be approved as a bipolar medication, so it will remain off-label. At the same time, Lamictal was approved for treating Bipolar depression. Perhaps you've read the Topamax threads already. Some people find it increases their bad temper, and the dumbing-down SEs are too much for them.

It can cause weight loss, and I think therein lies its biggest appeal. If you find you are feeling generally worse, it could be the Topamax doesn't agree with you. Try something else, like Lamictal, which is often weight neutral. Or Trileptal, and others. Wellbutrin is another drug that can definitely increase anxiety and agitation. Maybe it won't do this to you. But if you find you are feeling worse, urgently tell your doctor. There are many other options to try. I can't take Wellbutrin--it makes me quite definitely hypomanic/manic in a dysphoric way. This is not an infrequent side effect. It is best used with patients who are lethargic and slow. Your doctor may be hoping to improve the ADD with it. But do be aware that it commonly enough worsens or causes agitation, anxiety, "all wired up" feeling, irritability and distress.

A little response to your comments about "fun" manic states--I know you were kidding. But to relieve your mind, I can get manic, clinically speaking, and it is not fun. Oh, at the time there is a sense of super-normal powerefulness, perhaps,but ruining your family, community reputation, and career is not fun, and even at the time there's something in the back of my mind that is aware that something is less than okay--spiralling out of control. Basically, it's a bit of tragedy. So anytime you envy the so-called euphoric manic high, don't bother. It's usually the case that I don't properly recall events anyway, even if they were wonderful, so what is the good of that? A moment of euphoria which I can't even remember.

One way to see these matters, I think, is that irritability on its own isn't hypo/manic. In order to qualify as hypomanic or manic it must be quite extreme, and matched with attributes of so-called euphoric hypo/mania. So it isn't really a different category of mood state if it is at bipolar level (and even bipolars will have ordinary irritability too)---it's just a deeply unpleasant overexcited state. The key word might be overexcitement.

When we are irritable, for a long period of time (could be over a week), and hyper or overexcited, with racing thoughts, flight of ideas, etc., it may well be a hypomania discharging itself through irritability. If we are in a bad temper but pretty cool, pretty in control and "normal" for us, we may just be needing an attitude adjustment. For it to be bipolar I would imagine it would need some aspect of hyper/overcitement and "spiralling out of control", and "all wired-up about to snap", to qualify. Just a thought.

A Mixed State to be a diagnosis must have a certain number of criteria met from Major Depression and Mania. It is then considered to be "true" mania, and if someone suffers a Mixed Episode they will apparently be diagnosed Bipolar 1. Perhaps the equivalent exists with Bipolar 11, only the criteria might be Major Depression and Hypomania.

The main thing of course is that the actual suffering is dealt with, whatever it is called. Please don't give up with the first try. It takes time, usually, to get the right mix.

 

Re: BP Disorder II and Irritability » ramsea

Posted by Smilez on November 25, 2003, at 8:08:35

In reply to Re: BP Disorder II and Irritability » Smilez, posted by ramsea on November 25, 2003, at 4:16:11

Thanks for a WEALTH of information!! I had received a little discouraging news yesterday afternoon and all I can describe my reaction is "way over the top" and "spun". Out of control - sobbing - rage - suicidal - and it hit me right in the veggie section of my grocery market.

Of course I raced home and was fine by the time I called my doctor. He said to give the meds a little more time. Then I looped again two hours later, not wanting to go to sleep, afraid and angry at what today might bring.

I think last night was the closest I ever came to committing myself and it was so shortly into my meds. I do hope that when the doctor says to give it a little time to work that he knows what he is doing.

I copied and pasted your entire message for future reference. Thanks again!!

 

Re: BP Disorder II and Irritability » Smilez

Posted by ramsea on November 25, 2003, at 10:17:08

In reply to Re: BP Disorder II and Irritability » ramsea, posted by Smilez on November 25, 2003, at 8:08:35

Thanks for the reply, I'm glad that you found the note useful. It sounds like you really are right in the thick of it. It does get better, and the first 3 weeks can be the worst with an anti-depressant. However, if you begin to feel worse, please ask someone for help. It's always possible we need a different medicine. Keep in touch.


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