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Dr. Bob is Robert Hsiung, MD,
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Posted by bipolarspectrum on January 9, 2006, at 13:19:14
In reply to Depressed/agitated/wired - soft bipolar?, posted by 4WD on January 8, 2006, at 22:29:19
Hey 4wd,
You are so bipolar, it is very obvious.. I am the same way as u, the SSRIs make me superagitated and anxious... Wellbutrin sent me into a crazy mania.. Without drugs im suicidally depressed.... You and I are on the bipolar spectrum.. Or, in another classification, bipolar type 4... I'm also gonna guess that there is mental illness in your family... you need to get on the bipolar drugs ASAP!
bps
Posted by HKristina on January 9, 2006, at 15:03:23
In reply to Depressed/agitated/wired - soft bipolar?, posted by 4WD on January 8, 2006, at 22:29:19
Marsha,
Do you hyperfocus on any one thing that seems to precipitate the wired anxiety?I have felt that way, and am also looking for answers. Does it affect your ability to be productive?
Posted by Phillipa on January 9, 2006, at 19:11:56
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by HKristina on January 9, 2006, at 15:03:23
Marsha I'm joining the crowd. Have you ever had psych testing done? The new pdoc I've seen once ordered for me. And I'm afraid I'll be unable to concentrate in order to take the test. And I can't be alone I have panic attacks and fear of abandonment. Fondly, Phillipa
Posted by Berberis on January 10, 2006, at 7:25:44
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by Lucia Francisca on January 9, 2006, at 10:26:53
>A few months ago, my pdoc said the ADs can cause hypomanias and rapid cycling in bipolar patients.
My pdoc told me the same thing. Every SSRI I took caused hypomania and rapid cycling. I still wonder if it truly means you're bipolar just because the AD's have this effect. I'd love to know what percentage of people this happens to.
Posted by Lucia Francisca on January 10, 2006, at 12:19:07
In reply to Re: Depressed/agitated/wired - soft bipolar? » Lucia Francisca, posted by Berberis on January 10, 2006, at 7:25:44
Hi there. Interesting. I thought I read on the web recently that there is now a diagnosis of bipolar, either III or IV?, that is exactly that--bipolar with hypomanias induced by ADs. My situation I think is more that I was bipolar II BEFORE starting the ADs; I had hypomanias, I just didn't call it that, and my pdocs only tried to treat the depression. So, in my situation, I think the ADs just increased the cycling and hypomania incidents. But I would be interested to know if people ONLY had hypomanias because they took ADs, and didn't have them if they didn't take ADs.
How does your personal story relate to all this, if you don't mind my asking?
All the best, Lucia
> >A few months ago, my pdoc said the ADs can cause hypomanias and rapid cycling in bipolar patients.
>
> My pdoc told me the same thing. Every SSRI I took caused hypomania and rapid cycling. I still wonder if it truly means you're bipolar just because the AD's have this effect. I'd love to know what percentage of people this happens to.
Posted by Tomatheus on January 10, 2006, at 18:46:02
In reply to Re: Depressed/agitated/wired - soft bipolar? » Berberis, posted by Lucia Francisca on January 10, 2006, at 12:19:07
> But I would be interested to know if people ONLY had hypomanias because they took ADs, and didn't have them if they didn't take ADs.
Yeah, that's the case with me. I've experienced cycling (hypomanic periods that last about 3-4 days, followed by depressive periods of the same duration with no euthymia inbetween) only in response to taking SSRIs. Or in other words, I had no hypomania before I took any meds, no hypomania after discontinuing SSRIs (unless I started another SSRI), and no hypomania on Wellbutrin or MAOI monotherapy. As far as MAOIs go, I've taken Parnate, moclobemide, and Nardil without a mood stabilizer and still did not experience any hypomanic symptoms. I suspect that in addition to the SSRIs, I would probably would have also cycled on the SSNRIs and TCAs since they all inhibit the reuptake of serotonin and norepinephrine to some extent, but I guess I can't be sure about each and every last SSNRI and TCA.
Still, though, there is a school of thought with respect to bipolarity that essentially states that *all* patients who experience any medication-induced hypomania not only lie along the bipolar spectrum, but *must* take mood stabilizers, either alone, or with antidepressants and *cannot* take antidepressants alone under any circumstances. I've obviously found this school of thought to be inconsistent with my experiences. Even though some patients with treatment-induced hypomanic symptoms are certainly well-served by taking a mood stablizer, I don't think that psychiatrists and researchers understand the underlying causes of mood disorders well enough to justify concluding that all patients with "bipolar spectrum" disorders *must* take a mood stabilizer and *must not* ever take an antidepressant alone - not even something with a different mechanism than the drug that triggered the hypomania. Judging from posts I've read on this board and elsewhere, patients who fall within the bipolar spectrum sometimes differ significantly in terms of their hypomanic symptoms (i.e., some "switch" to long-term hypomanic states, others go through rapid cycling; some experience relatively mild hypomania, others experience full-blown mania; some report feeling mostly euphoric during their (hypo)manic states, others report being mostly agitated and irritable; some report hypomanic symptoms both before and after taking ADs, others report hypomanic symptoms only while taking ADs; some can take certain classes of ADs without experiencing hypomania, others cannot). I could probably come up with a few more examples, but I think my point is clear that there are wide variations in the spectrum of disorders that fall between pure unipolar depression and bipolar II disorder. Furthermore, researchers have identified so many different specific biochemical abnormalities that may be involved in the causation of both depression and bipolar disorder that it is likely that at least several different underlying "bipolar spectrum" pathologies exist. If different bipolar spectrum patients have different pathologies (as the research suggests), it is likely that these patients will in turn require different treatments.
As far as the diagnosis is concerned, it doesn't really matter much to me whether my doctor wants to call my disorder depression or bipolar disorder. As others here on Psycho-Babble often point out, getting the optimal treatment is of primary importance.
Tomatheus
Posted by Berberis on January 10, 2006, at 19:41:44
In reply to Re: Depressed/agitated/wired - soft bipolar? » Berberis, posted by Lucia Francisca on January 10, 2006, at 12:19:07
> How does your personal story relate to all this, if you don't mind my asking?
>
Before I ever took AD's I occasionally had periods of high energy, irritability, and agitation. I called it anxiety. In comparing it to the hypomania I experienced on AD's, it felt different. Hypomania felt mostly great...I had greater self-esteem, confidence, became sociable (normally introverted). So my gut tells me I only became bipolar from the AD's. I don't believe its a legitimate diagnosis if meds cause it.
Posted by 4WD on January 10, 2006, at 22:07:32
In reply to Re: Depressed/agitated/wired - soft bipolar? » Lucia Francisca, posted by Tomatheus on January 10, 2006, at 18:46:02
I never experienced mania or hypomania before being on ADs. And I didn't experience it even then until my Celexa dose was upped from 10 to 20. Admittedly while on SSRIs I did seem to have only two speeds- hyper and exhausted. But I didnt experience severe depression during the exhaustion phases. These cycles would be as frequent as daily or even within one day. I don't really think that qualifies as hypomania but that never happened until I was put on SSRIs. Imipramine didn't do that to me.
Posted by Jakeman on January 10, 2006, at 22:59:03
In reply to Depressed/agitated/wired - soft bipolar?, posted by 4WD on January 8, 2006, at 22:29:19
> Is there such a thing as a mood stabilizer that will calm anxiety- the hyper wired scared all the time feeling-kind of mania but which doesn't increase depression? I have both at the same time sometimes and sometimes just one or the other.
>
> How can it be possible to be deeply depressed and also agitated, full of nervous energy and running around in circles (figuratively) at the same time? What do you do about it? Is this a "mixed state"? This only happens on SSRIs or SNRIs. Off ADs, I'm just suicidally depressed.
>
> If this is soft bipolar, does it make a difference in treatment if it's med induced?
>
> MarshaI've been experimenting with Celexa (20mg) and lithium orotate. The lithium effect is very subtle, so I'm not sure what to say. But I have not gotten the wired effect I used to get from SSRI's.
~Jake
Posted by summerflowers on January 12, 2006, at 1:58:26
In reply to Depressed/agitated/wired - soft bipolar?, posted by 4WD on January 8, 2006, at 22:29:19
> Is there such a thing as a mood stabilizer that will calm anxiety- the hyper wired scared all the time feeling-kind of mania but which doesn't increase depression? I have both at the same time sometimes and sometimes just one or the other.
>
> How can it be possible to be deeply depressed and also agitated, full of nervous energy and running around in circles (figuratively) at the same time? What do you do about it? Is this a "mixed state"? This only happens on SSRIs or SNRIs. Off ADs, I'm just suicidally depressed.
>
> If this is soft bipolar, does it make a difference in treatment if it's med induced?
>
> Marsha Hi Marsha,thats exactly how I feel.Trying to figure it out is confusing.Iv looked around,and soft bipolar was a close match.Tricylics didnt work,and SSRIs made me feel overactive,doing crazy things,but still depressed or something.??????Wish I knew exactly what it is!!Yes-depressed,agitated,wired.Matches so many conditions!!
Posted by 4WD on January 12, 2006, at 20:07:29
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by summerflowers on January 12, 2006, at 1:58:26
> > Is there such a thing as a mood stabilizer that will calm anxiety- the hyper wired scared all the time feeling-kind of mania but which doesn't increase depression? I have both at the same time sometimes and sometimes just one or the other.
> >
> > How can it be possible to be deeply depressed and also agitated, full of nervous energy and running around in circles (figuratively) at the same time? What do you do about it? Is this a "mixed state"? This only happens on SSRIs or SNRIs. Off ADs, I'm just suicidally depressed.
> >
> > If this is soft bipolar, does it make a difference in treatment if it's med induced?
> >
> > Marsha Hi Marsha,thats exactly how I feel.Trying to figure it out is confusing.Iv looked around,and soft bipolar was a close match.Tricylics didnt work,and SSRIs made me feel overactive,doing crazy things,but still depressed or something.??????Wish I knew exactly what it is!!Yes-depressed,agitated,wired.Matches so many conditions!!
Saw my pdoc today. He said it sounds like bipolar and I got put on Effexor and Depakote. Which is fine with me. Anything to get rid of this wired, hyper, full of despair and anguish feling.Marsha
Posted by Phillipa on January 12, 2006, at 20:54:40
In reply to Re: Depressed/agitated/wired - soft bipolar? » summerflowers, posted by 4WD on January 12, 2006, at 20:07:29
Marsha please let me know how you do. If you want my E-mail I'll babble it to you. Fondly, Phillipa
Posted by 4WD on January 12, 2006, at 21:03:11
In reply to Re: Depressed/agitated/wired - soft bipolar? » 4WD, posted by Phillipa on January 12, 2006, at 20:54:40
> Marsha please let me know how you do. If you want my E-mail I'll babble it to you. Fondly, Phillipa
I'll be posting here, you can bet. And I have you email. I just have been feeling so bad lately I haven't been around much.
Marsha
Posted by linkadge on January 14, 2006, at 17:48:50
In reply to Re: Depressed/agitated/wired - soft bipolar? » Phillipa, posted by 4WD on January 12, 2006, at 21:03:11
I don't consider myself bipolar mainly because off meds I have no issues with agitation etc. But some meds induce a very significant agitation, and akathesia in me. Celexa was by far the worst offender for me in this regard.
Zoloft caused the least start up agitation.
I too did fine on 10mg of celexa, and had problems when it was increased. I simply considered it a significant akathesia that made me so agitated.
I personally wouldn't jump to the bipolar diagnosis. I would define it as akathesia, and significant start-up anxiety. (Especially if it was a very negative experience).
I am not a fan of the drug induced bipolar diagnosis, because it blames the patient, when the drugs are often to blame.
Some people are more sensitive to this akathesia than others.
Take Care.P.S. Just cause coffee makes you nervous doesn't mean you have an anxiety disorder.
Linkadge
Posted by linkadge on January 14, 2006, at 17:50:47
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by linkadge on January 14, 2006, at 17:48:50
For intance, in healthy vaulenteers 5-ht2c agonists can induce agitation, irritability and other strange things.
Linkadge
Posted by 4WD on January 14, 2006, at 21:43:04
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by linkadge on January 14, 2006, at 17:48:50
> I don't consider myself bipolar mainly because off meds I have no issues with agitation etc. But some meds induce a very significant agitation, and akathesia in me. Celexa was by far the worst offender for me in this regard.
>
> Zoloft caused the least start up agitation.
>
> I too did fine on 10mg of celexa, and had problems when it was increased. I simply considered it a significant akathesia that made me so agitated.
>
> I personally wouldn't jump to the bipolar diagnosis. I would define it as akathesia, and significant start-up anxiety. (Especially if it was a very negative experience).
>
> I am not a fan of the drug induced bipolar diagnosis, because it blames the patient, when the drugs are often to blame.
>
> Some people are more sensitive to this akathesia than others.
>
>
> Take Care.
>
> P.S. Just cause coffee makes you nervous doesn't mean you have an anxiety disorder.
>
>
> Linkadge
>
>All good points. Actually, I don't care what the diagnosis is. I just want relief.
The agitation and fear weren't startup effects, though. I was having them the whole time I was on Celexa (almost a year this go round). They just got worse when I increased it. And the hyper excess bad energy was at a level I've never experienced before.
Why do you think the med induced bipolar diagnosis blames the patient? Seems to me it puts the blame right where it should go - on the med.
Hope you are doing well, Linkadge. HOw's your Mom?
Marsha
>
>
>
Posted by 4WD on January 14, 2006, at 21:51:28
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by linkadge on January 14, 2006, at 17:50:47
And since I have to take an AD to keep out of the pit of clinical depression, and since AD's make me wired and if a mood stabilizer allows me to take an AD without getting all terrified and jittery, then if they want to call me med induced bipolar, I'll live with it. I do know that every SSRI I've ever been on has made me edgy and jittery. Before meds, I was just sunk in apathy and misery and no energy at all.
I don't know what happened 15 months ago that swung me into that state of terror (other than switching from Effexor to other ADs, and several traumatic family events) but whatever it was, I'm pretty sure I didn't suddenly become bipolar at the age of 48. Unless, I had been soft bipolar all those years, and not recognized it - just thinking the nervousness was part of my makeup.
I don't know. It's beyond me to figure out.
Marsha
Posted by linkadge on January 15, 2006, at 9:48:26
In reply to Re: Depressed/agitated/wired - soft bipolar? » linkadge, posted by 4WD on January 14, 2006, at 21:43:04
Of course I am unable to know your whole situation.
I experienced some continual fear on SSRI's, and I have a theory for that too.
Anyhow, I suppose relief is the key, I just wouldn't want you to be over drugged because of a bad drug reaction.
When I was on SSRI's, they induced so many behavioral changes that I thought I had every disease under the sun. Since SSRI's I was diagnosed with everything, OCD, schitsophrenia, bipolar, psychotic depression, you name it.I remember when I jumped from 10mg to 20mg of celexa, I began to suspect my roomates had put LSD in my orange juice! Thats what landed me on lithium.
Anyhow I knew it was the drug, and I knew I didn't want to take lithium for drug induced psychosis.
So I've been off SSRI's and I'm doing better. My moods have been stable for almost a year. I know not everyone can make that step, I just wanted you to know what I went through.
It depends on the way your doctor handles it. If he tries to make it out to be your fault that the SSRI did this, then thats bad, because I don't really believe in bipolar 2 (or 3 or whatever). I think there is a group of people out there who are more sensitive to the various side effects of SSRI's.
Mom is so-so. I'm not too bad, (school stress but otherwise ok)Thanks for asking :)
Linkadge
Posted by linkadge on January 15, 2006, at 9:50:48
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by 4WD on January 14, 2006, at 21:51:28
Have you tried a TCA? A little while ago there was a thing called agitated depression (which as since been sucked into the bipolar spectrum)
But they were/are great for agitated depression.
Linkadge
Posted by zeugma on January 15, 2006, at 12:22:54
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by linkadge on January 15, 2006, at 9:50:48
> Have you tried a TCA? A little while ago there was a thing called agitated depression (which as since been sucked into the bipolar spectrum)
>
> But they were/are great for agitated depression.
>
> LinkadgeI've always found it strange that patients had longer memories than pdocs.
Someday people will decide that the bipolar spectrum has been extended too far. Most likely when the patents of new drugs that treat what used to be called 'agitated depression' have run out.
-z
Posted by linkadge on January 15, 2006, at 16:55:03
In reply to Re: Depressed/agitated/wired - soft bipolar? » linkadge, posted by zeugma on January 15, 2006, at 12:22:54
I just remember that in certain states, the difference between a TCA and an SSRI was like night and day.
For me, the TCA's usually improved sleep and appetite immediately whereas the SSRI's made those symptoms worse for a good 2+ weeks, (which intensified depression, anxiety and panic etc).
I think there is a group of people who are depressed, but still motivated, (sometimes motivated by obsession - or just running on stress hormones) and that the SSRI's don't correct the HPA axis dysregulation fast enough, at least for me they didn't.
For example with me, I became so afraid of falling behind in school, that even though I wanted to kill myself every day, I would still be doing my homework incessantly. Nobody thought I was depressed - (to be depressed you must have given up). I never give up, I just become more suicidal.
Linkadge
Posted by 4WD on January 15, 2006, at 18:25:29
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by linkadge on January 15, 2006, at 9:50:48
> Have you tried a TCA? A little while ago there was a thing called agitated depression (which as since been sucked into the bipolar spectrum)
>
> But they were/are great for agitated depression.
>
> LinkadgeYeah, I've been wondering about the difference in med induced anxiety and agitated depression. But I wasn't agitated until SSRIs.
I've thought of going back to imipramine. I did well on that many years ago. The side effects were pretty intense though. It was almost 20 years ago and I still remember the dry mouth, nasal congestion, flushed face and anorgasmia. I think I had insomnia too.
If I take the Depakote and the agitation/fear goes away, does that mean it IS med-induced dysphoric mania? I'm kind of looking at this med trial as a diagnostic tool.
Marsha
Posted by linkadge on January 16, 2006, at 8:25:04
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by 4WD on January 15, 2006, at 18:25:29
>If I take the Depakote and the agitation/fear >goes away, does that mean it IS med-induced >dysphoric mania? I'm kind of looking at this med >trial as a diagnostic tool.
I would have to say no, simply due to the fact that depakote can be used as an adjunctive in severe anxiety, since it has a really strong gaba effect.
But along those lines, if it works then so be it, you could continue to take it.
Linkadge
Posted by ed_uk on January 16, 2006, at 13:26:47
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by 4WD on January 15, 2006, at 18:25:29
Hi Marsha
You could try imipramine again at a low dose, or maybe one of the more sedating TCAs given as a single dose in the evening.
Ed
Posted by 4WD on January 16, 2006, at 20:57:03
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by linkadge on January 16, 2006, at 8:25:04
> >If I take the Depakote and the agitation/fear >goes away, does that mean it IS med-induced >dysphoric mania? I'm kind of looking at this med >trial as a diagnostic tool.
>
> I would have to say no, simply due to the fact that depakote can be used as an adjunctive in severe anxiety, since it has a really strong gaba effect.
>
> But along those lines, if it works then so be it, you could continue to take it.
>
>
>
> Linkadge
>So far I'm having no side effects from the Depakote (but I only went up to 500mg last night - 250 mg the 3 nights before that). No real positive effects yet either.
Do you know how long it should take to help? I do think the severity of the depressed part of it might be a little less. OTOH I think I'm experiencing some depression from stopping Celexa and the Effexor not having kicked in yet. It's not suicidal, it's just unutterably sad at the moment.
Yeah, I think if I could take Depakote for anxiety instead of Klonopin, I'd rather.
Thanks,
Marsha
>
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