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Dr. Bob is Robert Hsiung, MD,
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Posted by cg1973 on March 19, 2008, at 23:58:13
In reply to Re: Bipolar III caused by antidepressants? » cg1973, posted by obsidian on March 19, 2008, at 22:42:45
I would really like to know more about this Bipolar III thing as well. The first thing I'd like to know is how the chemical changes caused by long term antidepressant use managed to get classified as a new form of Bipolar Disorder rather than a potentially AWFUL side effect of the antidepressants! It really scares me because the drug I'm adding to treat the SSRI induced Bipolar III (Geodon) hasn't been used for treating Bipolar that long so who knows what the long term side effects are for it. Am I going to take Geodon and have it work for a while and then, when it stops working, get diagnosed with the yet to be created atypical anti-psychotic induced "Schizophrenia IV"? Where does it end!
Posted by dbc on March 20, 2008, at 1:26:12
In reply to Re: Bipolar III caused by antidepressants?, posted by cg1973 on March 19, 2008, at 23:58:13
Its not that ADs are actually changing your neurochemistry its just that they may uncover an existing disorder in patients with complicated problems. BP III doesnt actually exist in clinical use as far as i know.
BUT theres been studies that show bipolar 1/2 do cause actual neurological changes over time which starts manifesting symptoms and becoming more extreme over time. Theres theories about this being due to glutamate toxicity. (note all mood stabilizers greatly impact glutamate).
Posted by cg1973 on March 20, 2008, at 1:50:04
In reply to Re: Bipolar III caused by antidepressants?, posted by dbc on March 20, 2008, at 1:26:12
Bipolar III, according to the new pdoc, doesn't technically "exist" yet but it's one of the 7-12 types of Bipolar that the DSM V will contain.
Posted by polarbear206 on March 20, 2008, at 11:59:47
In reply to Bipolar III caused by antidepressants?, posted by cg1973 on March 19, 2008, at 22:13:09
> I've been diagnosed with everything under the sun in the last 10 years but finally did "OK" on a combination of Zoloft and Dexedrine for ADD. However, I still have problems with focus and motivation as well as some pretty extreme fatigue. I just saw a new psychiatrist and she suggested that I might have a Bipolar Disorder. I really don't think it's Bipolar because I am rarely anything even close to manic and my ADD seems to be more of the inattentive type but, she insisted. She talked about Bipolar III and said that it's a form of Bipolar that develops due to changes in the brain caused by the long term use of anti-depressants (I've been on Prozac or some other SSRI for 10 years).
> Does anyone have any advice or experience with this Bipolar III disorder? I'm a little skeptical of it.
> Also, doctor prescribed Geodone to take in addition to everything else. I'm completely baffled as to how a medicine to treat mania is going to help me stop being tired but maybe that's just me...
>
>This is one example of how this illness is so misunderstood. You don't have to be manic or full blown hypomanic. You have the same thing going on as I did. The new DSM, which will be out in 2011, will include subtypes of bipolar spectrum disorders. If you go to psycheducation.org you will finds tons of information to the answeres you are looking for. Lamictal (mood stabilizer) added to my AD changed my life. No more overwhelming fatigue and concentration problems. If Geodon doesn't help, there are others. I would consider Lamictal since it is more activating mood stabilizer augmenting your AD. AD's used alone and at higher doses will exacerbate you fatigue and concentration problems. I also went down the stimulant route without it helping. It actually made it worse overtime. The rule of thumb is to keep the AD dose as low as possible when on a mood stabilizer to prevent those breakthrough symptoms you are experiencing. You may or may not need as much zoloft down the road in addition to a drug like Lamictal. Hope this helps
PB
Posted by Phillipa on March 20, 2008, at 12:53:34
In reply to Re: Bipolar III caused by antidepressants? » cg1973, posted by polarbear206 on March 20, 2008, at 11:59:47
How come there can be so many subtypes of bipolar? And why do ad's make anxiety worse for me and not tired? And tried lamictal didn't get over 50 as excess salivation. What do you think of Deplin? And luvox? Love Phillipa
Posted by dbc on March 20, 2008, at 13:20:09
In reply to Re: Bipolar III caused by antidepressants? » polarbear206, posted by Phillipa on March 20, 2008, at 12:53:34
Some doctors think all types of depression fit into the bipolar spectrum. BP 1/2 have clear differences as 2 is much more minor. The guy thats writing the new entry for Bipolar disorders in the next DSM is one of those people that believes most forms of depression fit under the BP spectrum (Jim Phelps). Quite a bit of doctors with more practical and less academic knowledge as mr Phelps disagree with him.
Posted by polarbear206 on March 20, 2008, at 15:59:02
In reply to Re: Bipolar III caused by antidepressants?, posted by dbc on March 20, 2008, at 13:20:09
> Some doctors think all types of depression fit into the bipolar spectrum. BP 1/2 have clear differences as 2 is much more minor. The guy thats writing the new entry for Bipolar disorders in the next DSM is one of those people that believes most forms of depression fit under the BP spectrum (Jim Phelps). Quite a bit of doctors with more practical and less academic knowledge as mr Phelps disagree with him.
Who are you refering too, may I ask? I hope you are researching scholarly sites, such as pubmed.org, (search Akiskal for one) and NIMH to name some. It's not just a "guy" that catagories BP in the DSM. Do some research on the history of the DSM. You can go as far back as Kraeplin for some better understanding. I'll leave it that we can agree to disagree on this topic.
Posted by polarbear206 on March 20, 2008, at 16:00:11
In reply to Re: Bipolar III caused by antidepressants?, posted by dbc on March 20, 2008, at 13:20:09
> Some doctors think all types of depression fit into the bipolar spectrum. BP 1/2 have clear differences as 2 is much more minor. The guy thats writing the new entry for Bipolar disorders in the next DSM is one of those people that believes most forms of depression fit under the BP spectrum (Jim Phelps). Quite a bit of doctors with more practical and less academic knowledge as mr Phelps disagree with him.
Who are you refering too, may I ask? I hope you are researching scholarly sites, such as pubmed.org, (search Akiskal for one) and NIMH to name some. It's not just a "guy" that catagories BP in the DSM. Do some research on the history of the DSM. You can go as far back as Kraeplin for some better understanding. I'll leave it that we can agree to disagree on this topic.
Posted by dbc on March 20, 2008, at 16:37:25
In reply to Re: Bipolar III caused by antidepressants? » dbc, posted by polarbear206 on March 20, 2008, at 16:00:11
Oh i realize theres been tons of research done over the last 60 years or so into the BP sprectum. All im saying is that Dr. Phelps is the man current pushing for broader uses of the word bipolar and he happens to also be wording what goes into the next DSM bipolar entry.
Posted by cg1973 on March 20, 2008, at 17:08:50
In reply to Re: Bipolar III caused by antidepressants? » cg1973, posted by polarbear206 on March 20, 2008, at 11:59:47
Thanks for your response. It helps to know there are others out there experiencing the same thing. I guess I just don't understand how the differentiate between concentration problems caused by ADD and those cause by some type of mania related to a Bipolar Disorder.
Posted by Maxime on March 20, 2008, at 18:39:17
In reply to Bipolar III caused by antidepressants?, posted by cg1973 on March 19, 2008, at 22:13:09
I am diagnosed with bipolar III. I think it is important to make the distinction otherwise you will end up on mades that make you worse.
In Britain there 8 different types of bipolar disorder (about that I believe).
Antidepressants that made me hypomanic are: effexor and paxil.
I hope you find something that works.
Maxime
Posted by Phillipa on March 20, 2008, at 21:48:17
In reply to Re: Bipolar III caused by antidepressants? » cg1973, posted by Maxime on March 20, 2008, at 18:39:17
Doc here wearning friend off effexor as he now thinks she may have some form of bipolar. On high doses of xanax now. I saw this guy too and he took me off luvox and only benzos and then serzone which scared me away. Phillipa
Posted by B2chica on March 21, 2008, at 12:38:03
In reply to Re: Bipolar III caused by antidepressants? » dbc, posted by polarbear206 on March 20, 2008, at 16:00:11
interesting that you bring up Kraeplin, i did research on him after i got the dx of BP2. i couldn't seem to find anything that really fit what i was feeling. he identified something as aggitated depression. i liked that description. other T's and pdocs tried to tell me that was a type of manic behavior, but my current pdoc has me down as psychotic depression with bouts of hypmania...which i MUCH more agree with. this seems to fit me better.
i think the whole deal of spectrum use needs to be a bit careful cuz the more options at times are good but other times gives the docs more wiggle room to pigeon hole ya.
so if something doesn't sit right in your gut...keep at it. i did. and i'm glad i did. it'll hopefully keep me off some of those meds that made me batty, all because the docs "were sure they'd work because i was bp2", and maybe i am, but they didn't see the big picture like my pdoc now does.
b2c.
Posted by Bob on March 21, 2008, at 13:46:37
In reply to Re: Bipolar III caused by antidepressants? » polarbear206, posted by B2chica on March 21, 2008, at 12:38:03
Sometimes I gotta wonder why all these subtypes and nuances matter for treatment restistant people. We only have a limited number of drug classes and drugs, and all we can really do is try them and see what happens.
I'm severely treatment resistant and am all over the map. Some ADs make me sleep all day and gain weight, others make me go through the roof. Some make me suicial, or give me mixed states. Many mood stabilizers are heavily sedating, while others are severely destabilizing. Benzos are depressogenic and sleep inducing. It never ends, and it's not as simple as avoiding ADs because they make it worse. So again, I wonder what having 12 different types of bipolar really does to solve anyone's problem.
Posted by mike lynch on March 21, 2008, at 14:50:59
In reply to Re: Bipolar III caused by antidepressants?, posted by dbc on March 20, 2008, at 1:26:12
> Its not that ADs are actually changing your neurochemistry its just that they may uncover an existing disorder in patients with complicated problems. BP III doesnt actually exist in clinical use as far as i know.
>Do you have any evidence for this. Are you really saying that SSRI's, medication that are used to treat mood disorder, actually TRIGGER THEM? Is that really any better? In my opinion and experience with these drugs is that they CAUSE them.
Posted by dbc on March 21, 2008, at 15:14:27
In reply to Re: Bipolar III caused by antidepressants?, posted by mike lynch on March 21, 2008, at 14:50:59
> Do you have any evidence for this. Are you really saying that SSRI's, medication that are used to treat mood disorder, actually TRIGGER THEM? Is that really any better? In my opinion and experience with these drugs is that they CAUSE them.<
Thats the exact use of BP 3 despite it not being in the DSM. Its almost always hypomania induced by SSRIs/SNRIs. Its use is very vague and controversial, its sort of like the term pre-diabetes. Do we really know what that means and who is using it in a clinical environment. Psychiatry is so hit and miss i think people just end up seeing trends in certain medications and call it something new despite it not being officially used and sometimes it helps DXing a patient.
Posted by dbc on March 21, 2008, at 15:21:23
In reply to Re: Bipolar III caused by antidepressants?, posted by mike lynch on March 21, 2008, at 14:50:59
What i was really getting at is yes anti-depressants tend to do weird things to people that are bipolar. Such as mood cycling, hypomania, etc. Its not the meds fault that this is happening its just the doctor had no clue the person might be bipolar. The BP spectrum is vague at best but the treatments are all the same and mood stabilizers are the main drugs of choice for them rather than anti-depressants.
Posted by Bob on March 21, 2008, at 15:54:43
In reply to Re: Bipolar III caused by antidepressants?, posted by dbc on March 21, 2008, at 15:21:23
The BP spectrum is vague at best but the treatments are all the same and mood stabilizers are the main drugs of choice for them rather than anti-depressants.
So what happens when someone like me comes along who has a strange BP variant and responds badly to ADs, but then goes into a sedated unipolar type depression on "mood stabilizers"? In my experience, the mood stabilizers I am able to tolerate such as Lithium or Depakote turned me into a Rip Van Winkle zombie with not motivation or energy. Oddly, there are a number of ADs that do this also.Seems that any drug that is moderately activating I cannot tolerate, and the ones I can tolerate end up as strong sleep meds.
Posted by 49er on March 21, 2008, at 17:39:29
In reply to Bipolar III caused by antidepressants?, posted by cg1973 on March 19, 2008, at 22:13:09
Hi,
Due to board rules, I can't really say what I think of what your psychiatrist said.
Read the book, the antidepressant solution by Joseph Glenmullen, who is not antimeds. Bipolar can't be diagnosed on the basis of med reactions and it uncovering hiddern BP tendancies. It would have to done on basis of a very careful interview.
Many people have bad reactions to antidepressants but once the meds are removed, they are fine. I am not trying to tell you what you should do but just pointing out whey I feel your psychiatrist is wrong.
I probably would have been diagnosed BP by your doctor. But thankfully, my psychiatrist never fell for that line of reasoning. Anyway, as I taper off of my meds, I feel alot better.
Anyway, trust your intuition.
Finally, ADHD is frequently misdiagnosed as BP. So keep that in mind.
49er
Posted by Quintal on March 21, 2008, at 19:32:32
In reply to Re: Bipolar III caused by antidepressants?, posted by 49er on March 21, 2008, at 17:39:29
Just my two pen'orth on the bipolar specturm. I was diagnosed with plain bipolar disorder aged 19 based on self-reported symptoms, and treated on and off for the next four years with nearly every drug under the sun. At age 24 my pdoc discharged me, and wrote in the notes something to the effect that in his opinion, I was little more than a personality disordered malingerer. He said that he had never seen any sign of 'bipolar symptomology' in me and the fact that I'd taken nearly thirty antidepressants without having a manic episode bolstered this view. In the following year I came more or less to accept the grain of truth in his assessment and tried my best to get on with life med free. In a way it was a delicious irony that I suffered my first psychotic episode while med free, almost two years after he discharged me. With a bit of prompting from me and my father, this was diagnosed as a manic episode. So according to the DSM that would make me Bipolar I, although no one has said such.
I live in the UK and as far as I'm aware the only bipolar categories in current use are Bipolar I and Bipolar II. There is also a condition called cyclothymia, which closely resembles what is now being described as Bipolar III, but there are no elaborate subdivisions as has been suggested here. My take on that particular problem is that there as many different forms of bipolar disorder as there are people with bipolar disorder, and beyond a certain point this endless dividing and categorising becomes futile, and a little silly to be honest - as they all merge into each other at some point. For example, my 'Bipolar I Disorder' is indistinguishable from Paranoid Schizophrenia during the acute phase, although we normally think of Schizophrenia as being a very different kettle of fish. I'm not a fan of the Kraepellian approach, although I acknowledge it does have its uses.
Q
Posted by cg1973 on March 21, 2008, at 23:09:51
In reply to Re: Bipolar III caused by antidepressants?, posted by dbc on March 21, 2008, at 15:21:23
I'm sure there's still debate on this but my doctor's (she's a neurologist and a psychiatrist) exact words were, "Bipolar III results from changes in the brain chemistry due to the long term use of anti-depressants"
I'm glad someone referenced board rules before I broke them myself expressing an opinion about the pharmaceutical companies.
Posted by cg1973 on March 21, 2008, at 23:17:26
In reply to Re: Bipolar III caused by antidepressants?, posted by 49er on March 21, 2008, at 17:39:29
My intuition says it's AD/HD and not Bipolar. Then again...how to put this...since we're only now at a point in time where long-term side effects of SSRIs are becoming available, I wouldn't be completely surprised if it did turn out that they had the possibility of changing brain chemistry for the worse over time. That would fit with the feeling I have had for awhile that, despite treatment, therapy, soul searching, etc. things seem to get worse as I get older.
Also, I've taken lots of different things for the AD/HD and haven't had anything work that well. And, as much as I hate to admit it, I've been more productive with the Geodon added in the last two days than I had been in months.
Posted by dbc on March 22, 2008, at 11:52:29
In reply to Re: Bipolar III caused by antidepressants?, posted by cg1973 on March 21, 2008, at 23:09:51
> I'm sure there's still debate on this but my doctor's (she's a neurologist and a psychiatrist) exact words were, "Bipolar III results from changes in the brain chemistry due to the long term use of anti-depressants"
>
Thats ridiculous and a giant leap in logic and probably an anti-medication statement.Let me play this game. My neurologist thats also a psychiatrist says theres no hard evidence to support such a claim. She also says to "put one left foot in and then put one left foot out, put one left foot in and you shake it all about".
Posted by cg1973 on March 22, 2008, at 21:12:06
In reply to Re: Bipolar III caused by antidepressants?, posted by dbc on March 22, 2008, at 11:52:29
Okay, apparently I'm a liar??? And no, she's not anti-medication. She gave me different medication. I was just repeating her quote. I have no desire to "do battle" over this. Please stop being so hateful. Goodbye to this entire community.
Posted by dbc on March 22, 2008, at 21:25:43
In reply to Re: Bipolar III caused by antidepressants? » dbc, posted by cg1973 on March 22, 2008, at 21:12:06
Dont take me to seriously sir. Its not something to leave the board over. Im just grumpy in the morning and jump to conclusions.
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