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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by cache-monkey on November 8, 2005, at 1:09:31
Hey all,
Been a while since I posted here. I've been through some pretty rough times. Moving, a new job, a lot of stress, and meds that weren't helping much. My new pdoc just started my on low-dose (2.5 mg) Lexapro to help with anxiety and depression. That's along with 0.75 mg Klonopin and 225 mg Lithium.
The issue is that a bipolar spectrum disorder might be in the mix for me. If you're interested in the details, read below at the '*', but suffice it to say that I have one possible episode of high-dose AD-induced hypomania. (If it was hypomania, it was on the fairly mild side of the spectrum.) And I am often fairly sensitive to psychotropics in general, with most meds making my anxiety worse.
So, I'm four days into Lexapro at this point. Yesterday I was groggy and out of it. Today I feel all wound up. Mentally I'm kind of irritable. Physically I feel like my muscles are tight and tingly, my veins are bulging a bit and my head is kind of buzzing. But I'm also quite energized in some positive ways.
Because of the worry about soft bipolarity I'm a little concerned that this is a hypomanic reaction. At the same time, I wonder if this might be just part of the start-up side effects -- I'm generally med sensitive.
I'm wondering if there's a way to differentiate between the two. I.e., could hypomania occur so early? Or is it more likely something like akathisia that can come from starting an SSRI? Would an increase in positive energy very early in the course of treatment be indicative of hypomania?
Any input would be greatly appreciated.
Best,
cache-monkey
* I may have had a mild hypomanic reaction to a fairly high-dose Celexa and Wellbutrin in the past. I'm not sure, though, whether it was hypomania because I was not reckless, or grandiose, and didn't have racing thoughts and the like. I just felt very very good for the first time in a long while. It's still a question to me as to whether it was "too good".Also a number of meds have made me worse (Serzone, BuSpar, Lamictal) primarily along the agitation dimension. Even the Lithium does this to an extant Outside of Lamictal, the other anticonvulsants that I've tried (Trileptal and Depakote) make me more depressed and cognitively slow very quickly. And all of the atypical APs have given me horrendous akathisia.
Posted by fuchsia on November 8, 2005, at 6:21:18
In reply to AD start-up S/Es vs. induced hypomania, posted by cache-monkey on November 8, 2005, at 1:09:31
> So, I'm four days into Lexapro at this point. Yesterday I was groggy and out of it. Today I feel all wound up. Mentally I'm kind of irritable. Physically I feel like my muscles are tight and tingly, my veins are bulging a bit and my head is kind of buzzing. But I'm also quite energized in some positive ways.
>
> Because of the worry about soft bipolarity I'm a little concerned that this is a hypomanic reaction. At the same time, I wonder if this might be just part of the start-up side effects -- I'm generally med sensitive.
>
> I'm wondering if there's a way to differentiate between the two. I.e., could hypomania occur so early? Or is it more likely something like akathisia that can come from starting an SSRI? Would an increase in positive energy very early in the course of treatment be indicative of hypomania?I don't think akathisia feels that positive.
In my experience a quick positive response _is_ associated with hypomania. I have bipolar II and I used to respond within a week to a/ds.
Posted by cache-monkey on November 8, 2005, at 11:46:54
In reply to Re: AD start-up S/Es vs. induced hypomania, posted by fuchsia on November 8, 2005, at 6:21:18
>
> > So, I'm four days into Lexapro at this point. Yesterday I was groggy and out of it. Today I feel all wound up. Mentally I'm kind of irritable. Physically I feel like my muscles are tight and tingly, my veins are bulging a bit and my head is kind of buzzing. But I'm also quite energized in some positive ways.
> >
> > Because of the worry about soft bipolarity I'm a little concerned that this is a hypomanic reaction. At the same time, I wonder if this might be just part of the start-up side effects -- I'm generally med sensitive.
> >
> > I'm wondering if there's a way to differentiate between the two. I.e., could hypomania occur so early? Or is it more likely something like akathisia that can come from starting an SSRI? Would an increase in positive energy very early in the course of treatment be indicative of hypomania?
>
> I don't think akathisia feels that positive.
>
> In my experience a quick positive response _is_ associated with hypomania. I have bipolar II and I used to respond within a week to a/ds.
>
>Thanks for the input. It seems that the positive energy was just for a couple hours last night. Today I'm just feeling a little more anxious again.
I'm not sure what this means. I guess I'll just have to wait and see, but it's kind of hard with the possible, but not really confirmed, BPII concern.
~cache-monkey
Posted by ed_uk on November 8, 2005, at 15:50:46
In reply to AD start-up S/Es vs. induced hypomania, posted by cache-monkey on November 8, 2005, at 1:09:31
Hi CM,
Welcome back to babble :-)
Ed
Posted by cache-monkey on November 8, 2005, at 16:12:46
In reply to Re: AD start-up S/Es vs. induced hypomania » cache-monkey, posted by ed_uk on November 8, 2005, at 15:50:46
> Hi CM,
>
> Welcome back to babble :-)
>
> EdThanks, Ed! :)
~c-m
Posted by Phillipa on November 8, 2005, at 21:37:39
In reply to Re: AD start-up S/Es vs. induced hypomania » ed_uk, posted by cache-monkey on November 8, 2005, at 16:12:46
Why would wellbutrin make a person feel hypomanic? Especially since it's the one AD for bipolar illness? Never been dx'd with bipolar before always anxiety/depression. But it seems diagnoses are changing. i don't have energy and desire to do things. Like to sleep late, and tire very easily. No feeling better ever on any AD. And lexapro gave me the same side effects you describe. Fondly, phillipa
Posted by cache-monkey on November 9, 2005, at 19:25:55
In reply to Re: AD start-up S/Es vs. induced hypomania, posted by Phillipa on November 8, 2005, at 21:37:39
Hi Phillipa!
> Why would wellbutrin make a person feel hypomanic? Especially since it's the one AD for bipolar illness?
Well, I was on a combination of high-dose Wellbutrin and high-dose Celexa. And I'm still not sure whether I was actually hypomanic on that combo vs. having achieved remission from depression and wanting to make up for "lost time".
> And lexapro gave me the same side effects you describe.
Did you stay on it a while to see if they settled down?
Thanks,
cache-monkey
Posted by Phillipa on November 9, 2005, at 21:32:25
In reply to Re: AD start-up S/Es vs. induced hypomania, posted by cache-monkey on November 9, 2005, at 19:25:55
Cachemonkey no I didn't. Wasn't on them at the same time. After one week of wellbutrin l50mg my old pdoc thought I was hypomanic and put me in the hospital. Lexapro 5mg I took a few weeks ago. And by about the fourth day even with valium my legs were twitching so bad I had to go off of it. Fondly, Phillipa
This is the end of the thread.
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