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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by crittercuddler on December 25, 2008, at 23:07:49
Earlier today I was feeling completely hopeless, depressed, suicidal, and overwhelmed with anxiety to the point where it was hard to do anything because my mind kept going blank. (For example I was trying to compose an important letter and I just could not do it.)
Well, I decided to take a Zoloft, 25mg, to see what it would do, around noon. As soon as the medicine started to peak I immediately could feel a difference and it has lasted all day. It is like a switch was flipped inside of me. I am in a COMPLETELY different state than I was in earlier (and am usually in).
I know that it is not normal for an anti-depressant to improve symptoms so dramatically, SO QUICKLY.
My depression feels much better. The blank feeling lifted and I was able to finish composing my important letter and go on to write many more emails and even read several chapters in a book. This elevation in my mood comes with a price though. I feel EXTREMELY restless and jumpy. A few times my muscles have jerked in response to me moving them. I feel like I could go and run 4 miles and still not be able to shake this inner restlessness. (And I don't exercise) I feel somewhat agitated, like I could be bothered easily if given the chance (although nothing has bothered me as of yet.) I know that if I tried to sleep there is no way that I could do it without a strong sleeping pill.
Although I feel like I am thinking more clearly because I am obviously being activated, I also am finding that my memory is acting funny. For example,I read several chapters in a book earlier and have had to go back and check what I read because when I have tried to recall it I am having trouble. When I was reading it though it felt like I was comprehending it well. I would even say I was reading fast. Also, when I was watching tv with my dad earlier he asked me a question and I quickly answered, but a second later I realized that I had already forgotten what the question was that he asked me! I asked him to tell me what he asked me. I had remembered answering "yes", but I had already forgotten what I said yes to.This is the same reaction I have had to every anti-depressant I have tried since weaning off Celexa. It is the same reaction that has kept me from being able to get back on an SSRI because after feeling like this (activated) for a week I can't take it anymore.
I just don't understand why I can't take another SSRI without this happening to me, even at tiny doses. I took an SSRI for 4 years and never had this problem. I also don't remember having this problem when I started taking the one I used to take.
I have read that anti-depressants can cause insomnia, agitation, and restlessness in the beginning of treatment, but I am worried that this is not the "normal" degree to which those things can happen. I have also read that it should subside in a couple of weeks. Well, last time I tried Zoloft (mind you at an even smaller dose of 12.5mg) I managed to make it a week and at a week I was not any less anxious, restless, or able to sleep, etc...
Is this anti-depressant induced mania?
If so, why didn't this happen back in 2001 when I took my first anti-depressant?Is it that my serotonin levels are just so low that I am super sensitive to them being raised?
If this is the case why don't I get sleepy instead?Have I been so depressed for so long that I don't know what having energy feels like? I tell myself this can't be the case. I have to know what is normal still, even after being sick for so long, shouldn't I?
I have been taking Trazadone for 4 days now because I had read that the 5HT2A antagonism in it can reduce the insomnia, agitation, and restlessness sometimes encountered when starting and SSRI. Obviously it is not doing anything for me in that regard.
I have been doing this for 3 years. I guess I keep going back to SSRIs because feeling too activated is better than feeling too depressed and too anxious. Oh my God I just don't know what to do.
HELP! Do you think this is mania?
Posted by Phillipa on December 25, 2008, at 23:41:42
In reply to Is THIS anti-depressant induced Mania?, posted by crittercuddler on December 25, 2008, at 23:07:49
I don't know but it's happened to me too hence benzos. Love Phillipa ps 250 of luvox once for two weeks so much energy???? ps but the reading fast and forgetting do it too think that's anxiety???
Posted by softheprairie on December 26, 2008, at 3:45:45
In reply to Is THIS anti-depressant induced Mania?, posted by crittercuddler on December 25, 2008, at 23:07:49
Have you ever tried Luvox/fluvoxamine? It's reputation is that it's usually less activating and less agitating than some other SSRIs (and also not as strong as an antidepressant). I'd guess it would be best for you with a mood stabilizer along board first. But, it (Luvox) is also considered one of the best for OCD, so that may be the best you can get (to address your following thread on bipolar and OCD).
Posted by SLS on December 26, 2008, at 7:53:27
In reply to Is THIS anti-depressant induced Mania?, posted by crittercuddler on December 25, 2008, at 23:07:49
How long have you remained well with any one treatment?
- Scott
Posted by crittercuddler on December 26, 2008, at 15:31:41
In reply to Re: Is THIS anti-depressant induced Mania? » crittercuddler, posted by SLS on December 26, 2008, at 7:53:27
Phillipa,softheprairie- I have tried fluvoxamine a handful of times. The longest I took it was for two weeks, a summary of my attempts,
1. First time, also taking Klonopin. I did 25mg for 3 days and then 50mg after that. I was very drowsy. At 2 weeks I was still very drowsy and that concerned me so I stopped it.
2. Tried to start a second time, still taking Klonopin. This time it gave me insomnia. I couldn't tolerate it for more than a few days.
3. Third time I was put on fluvoxamine during my second hospital stay. Went from 50mg to 100mg over two days. Stayed at 100mg for about a week and then up to 150mg for a few days. (quick titration). Had insomnia. Could not sleep at all at the hospital. When I got home I had to use Seroquel every night to sleep. Had cognitive difficulties. I had just completed my benzo withdrawal at this time though so it is hard for me to tease apart what was fluvoxamine and what was benzo related. Although, after stopping the fluvoxamine I was able to get some sleep on my own, so I think benzo withdrawal insomnia was being made worse at the least by it.
4. I guess it was last week I tried it again for 2 days, at 50mg. I was also taking Risperdal .25mg with the fluvoxamine, which I had just started. The first night I slept, the second night I couldn't.
So, I don't know. While it made me drowsy the first time I tried it, it has given me insomnia every time since then.
Posted by crittercuddler on December 26, 2008, at 15:38:48
In reply to Re: Is THIS anti-depressant induced Mania? » crittercuddler, posted by SLS on December 26, 2008, at 7:53:27
Scott,
To simply answer your question, 3 years.
Here is the explanation:
I took Celexa 60mg from Fall of 2001 to Dec. of 2005. (It started to poop out on me in the beginning of 2005.) I do have concerns though that the poop out had to do with it going generic. There are studies that show a difference in generic versus brand name drugs, and recently I found a study on Celexa in particular as being one that is proving to NOT be equivalent. Celexa went generic at the end of 2004, so that coincides with my starting to deteriorate at the beginning of the next year. It is a moot point though because even brand name Celexa gives me the bad activation at 2.5mg now.
Celexa evened out my moods (I had always been very irritable and emotionally labile before taking it). It took the edge off of my obsessions and helped somewhat with my depression. I still struggled a lot with my OCD and depression while on it though, although partial response seems to be the norm.
Posted by SLS on December 26, 2008, at 16:14:32
In reply to Re: Is THIS anti-depressant induced Mania?, posted by crittercuddler on December 26, 2008, at 15:38:48
> Scott,
>
> To simply answer your question, 3 years.
>
> Here is the explanation:
>
> I took Celexa 60mg from Fall of 2001 to Dec. of 2005. (It started to poop out on me in the beginning of 2005.) I do have concerns though that the poop out had to do with it going generic. There are studies that show a difference in generic versus brand name drugs, and recently I found a study on Celexa in particular as being one that is proving to NOT be equivalent. Celexa went generic at the end of 2004, so that coincides with my starting to deteriorate at the beginning of the next year. It is a moot point though because even brand name Celexa gives me the bad activation at 2.5mg now.
>
> Celexa evened out my moods (I had always been very irritable and emotionally labile before taking it). It took the edge off of my obsessions and helped somewhat with my depression. I still struggled a lot with my OCD and depression while on it though, although partial response seems to be the norm.How about using Trileptal as a mood-stabilizer and to treat impulse control and aggression? Then, you might be able to add Lexapro or the SRI of your choice without sequalae. Know, however, that when treating OCD, one needs to wait longer for a SRI to produce improvements as compared with depression. Additionally, it often takes higher dosages to elicit a response. Prozac 60-120mg is an example of the extended range that is needed to treat OCD with this drug.
- Scott
Posted by crittercuddler on December 26, 2008, at 18:41:48
In reply to Re: Is THIS anti-depressant induced Mania? » crittercuddler, posted by SLS on December 26, 2008, at 16:14:32
Scott-
I tried one dose of Trileptal. I know, you want to clock me upside the head don't, you!!!???? It was a low dose. I think 150mg. I felt really weird that night and it scared me. I kept feeling unaware of where I physically was in the bed (kind of like a disorientation, i kept waking up and feeling like I couldn't orientate to my surroundings and my place in space i.e. my bed) My doctor wanted to do it because he is thinking an anti-seizure med might help me tolerate an anti-depressant.
The fact that an SSRI evened out my moods in the past has always made me think I couldn't have bipolar. Still, with the present circumstances, I am starting to wonder. I don't know if my mood is still labile and if I am still really irritable un-medicated. I can't ever make it long enough to find out. It is definitely a possiblity.
Posted by crittercuddler on December 26, 2008, at 18:47:22
In reply to Re: Is THIS anti-depressant induced Mania? » crittercuddler, posted by SLS on December 26, 2008, at 16:14:32
I should mention....
For those who are familiar with my other threads and how I can't tolerate an SSRI at all anymore, I have to say that I forgot to mention this important bit of info....
I was able to tolerate Lexapro for a month when I took it with Gabapentin. I didn't have any of the problems that I have with activation, insomnia, restlessness, muscle jerking. It was a mini-miracle. So, I guess you are wondering why I stopped it? Well, my depression was not improving after one month. I am aware that OCD symptoms take longer to respond and respond at higher doses, but depression I would think should have been getting better by that point. I took 10mg for 3 weeks and then 15mg for one week. I think depression should have responded to that dose. All it really seemed to do was take the edge off my suicidal desires.
I feared staying on it too long and having to wean off of it so I only gave it a month. I have weaned off of it before after just 2 weeks and had withdrawal symptoms which weren't nice. But, at four weeks, knowing this, I still quit cold turkey. Big mistake. Duh.
I often wonder if I should have stuck it out. It has been the most success I have had in 3 years of trying to tolerate an anti-depressant. I tried the Gabapentin along with Zoloft this fall to see if I could replicate the results and I could not. I was activated despite the Gabapentin.
If I take Gabapentin alone I feel drunk, blank, and out of it. That would be with a 300mg dose. If I take it with an anti-depressant that feeling goes away.
I don't want to take Gabapentin though because it works on GABA. That is another reason why I stopped the Lexapro/Gabapentin combo. I am scared/hesitant to take anything that has an effect on GABA afte my benzo experience. I know Gabapentin works differently, but still.
The good news was that I stopped the Gabapentin for a week before stopping the Lexapro and I did fine, no activation.
This was in July, which was my first month benzo free. (I completed my taper June 15)
Posted by desolationrower on December 26, 2008, at 23:10:04
In reply to Re: Is THIS anti-depressant induced Mania?, posted by crittercuddler on December 26, 2008, at 18:47:22
It might help thinking about how symptoms delevoped for you. For some people this can help figure out what is the disease that is causing the others. So one person might have OCD as manic-side sypmtom of their bipolar, and others may have mood disturbed becasue of how OCD is disrupting to life functioning. So thinking about how symptoms first showed up and what things are more constant personality traits might help. Trying also to find 'objective' ways of judging how you are reacting or what 'normal' is for you could help, by things like hours slept, what family notices about how you are acting, things like that. some people keep a record, so they write down each week or so what their meds were, and how wel they were doing on various factors.
i noticed when i started citalopram i felt more like ADHD hyperactive and less like inattentive for the first week. what you mentioned doesn't sound like red-flags going up for bipolar; you might want to look through the bipolarity signs stuff at http://www.psycheducation.org/index.html and see how you score on some of the checklists.
-d/r
Posted by crittercuddler on December 27, 2008, at 15:09:51
In reply to Re: Is THIS anti-depressant induced Mania?, posted by desolationrower on December 26, 2008, at 23:10:04
d/r-
I have read Dr. Phelps book "Why am I still depressed?" and have visited his website. After reading his book it made me even more concerned that I may have bipolar type 2.
I believe my moods were up and down and I was irritable before I started having OCD thoughts at age 12. I don't think OCD is a manic symptom though, if I do have bipolar. I am pretty sure I have full blown OCD all on its own. My mood is definitely a casualty to my OCD. It is very depressing and frustrating to always be paralyzed by some irrational fear. Often people will have co morbidity where they have OCD and bipolar. My therapist also told me that bipolar can look like OCD and vice a versa. Who knows. :-( I just want to get better.
I have tried to do some mood charting, but I didn't do well with it because of OCD issues. Perhaps if I make it more simple, like you said. My problem is I get way too detailed with it, I begin to worry that I am not charting accurately and it will mess everything up, etc, etc, catastrophize, catastrophize.
Well, thank you for the suggestions.
Posted by SLS on December 27, 2008, at 15:44:34
In reply to Re: Is THIS anti-depressant induced Mania?, posted by crittercuddler on December 27, 2008, at 15:09:51
Can you better describe exactly what you experience as OCD?
- Scott
Posted by crittercuddler on December 27, 2008, at 16:05:49
In reply to Re: Is THIS anti-depressant induced Mania? » crittercuddler, posted by SLS on December 27, 2008, at 15:44:34
Scott if you give me your email address I can send you some Word documents that I typed up recently in order to be considered for a scholarship for intensive inpatient treatment. (At a facility like Rogers Memorial in Wisconisin) Trying to explain it here would be hard.
my email crittercuddler@sbcglobal.net
Posted by SLS on December 27, 2008, at 16:48:10
In reply to Re: Is THIS anti-depressant induced Mania?, posted by crittercuddler on December 27, 2008, at 16:05:49
> Scott if you give me your email address I can send you some Word documents that I typed up recently in order to be considered for a scholarship for intensive inpatient treatment. (At a facility like Rogers Memorial in Wisconisin) Trying to explain it here would be hard.
>
> my email crittercuddler@sbcglobal.net
I guess my concern is that you might be OCPD, or perhaps simply ruminative in your depressed state, and not truly a candidate for OCD diagnosis and treatment.Have you ever tried Anafranil (clomipramine)? It is a tricyclic, and still the gold standard for treating OCD.
What about adding Namenda (memantine)?
- Scott
Posted by SLS on December 27, 2008, at 16:53:10
In reply to Re: Is THIS anti-depressant induced Mania?, posted by crittercuddler on December 27, 2008, at 16:05:49
Some people confuse the intrusive thoughts that often occur with depression with OCD.
You know, it might make sense to give Nardil a try. It is singularly the broadest spectrum of the antidepressants. It treats depression, generalized anxiety disorder, panic disorder, social anxiety, social phobia, and OCD.
Look into it.
- Scott
Posted by crittercuddler on December 27, 2008, at 18:15:57
In reply to Re: Is THIS anti-depressant induced Mania? » crittercuddler, posted by SLS on December 27, 2008, at 16:53:10
I am 100% positive I have OCD. I was diagnosed in 2001, started having symptoms when I was 12 though. My thoughts, obsessions, mental complusions, etc.. fit the recognized thought patterns to a tee.
Many people will be surprised to learn that OCD can be much more than being phobic about germs. Obsessions and compulsions can manifest themselves in so many other ways.
Good books on the disorder are written by
Jonathon Grayson
Fred PenzelAlso I have heard some other good reads are
Brain Lock
Rewind, Replay, RepeatI have read up on OCPD and I don't believe I have that. Neither do my doctors.
The only MAOI I have taken was Emsam, the new transdermal patch. I used the lowest patch dosage (6mg) for 3 weeks. I stopped it because I started feeling lazy/apathetic. I tolerated it better than any other anti-depressant though. I had NO side effects on it. It was great. I was surprised.
Why do you think that was? I have read the regular MAOIs are usually the hardest to tolerate, often giving people issues with insomnia. I wonder if it is because even with the high dose of selegeline used for the patch that selegeline is still acting more like a MAO-B inhibitor than an MAO-A inhibitor. They say at high doses selegeline will inhibit both A and B, thus allowing it to be an anti-depressant... but I have often wondered.
MAOIs haven't really shown efficacy in OCD have they? I read that they can help the specific problem of being concerned with symmetry that some people with OCD have, but that is all. So, I don't know about Nardil. Plus wouldn't it likely give me more side effect problems than the SSRIs?
Posted by SLS on December 27, 2008, at 18:39:37
In reply to Re: Is THIS anti-depressant induced Mania?, posted by crittercuddler on December 27, 2008, at 18:15:57
> MAOIs haven't really shown efficacy in OCD have they?
Yes. Nardil in particular. However, one really should try to work up to 75-90mg when treating OCD. 60mg is generally too low. The study you probably looked at really didn't use Nardil to its maximum potential. You can always try adding memantine.
> Plus wouldn't it likely give me more side effect problems than the SSRIs?
What side effects are you most concerned with?
What side effects do you receive from SSRIs?
- Scott
Posted by crittercuddler on December 27, 2008, at 19:09:32
In reply to Re: Is THIS anti-depressant induced Mania? » crittercuddler, posted by SLS on December 27, 2008, at 18:39:37
Bad restlessness
Bad Insomnia
Feeling very HOT and DRY
short term memory problems
concentration difficulties
jitteriness/tremor
noctural myoclonus (over and over again to the point where I can't fall asleep)
light myoclonic jerks during the day
generally feel weirdThe nocturnal myoclonus has been happening ever since I got off of Klonopin. I am 6 months off.
I get these same symptoms even at tiny doses like 2.5mg or 5mg. I have gone as long as two weeks on 5mg of Celexa and the above issues did not go away.
I have had my CYP450 enzymes tested, they are fine.
About Namenda, I am going to try NAC instead.
Posted by SLS on December 27, 2008, at 19:17:19
In reply to Re: Is THIS anti-depressant induced Mania?, posted by crittercuddler on December 27, 2008, at 19:09:32
I hope the NAC works for you.
Is this a treatment that will take several months to produce an improvement? What dosage will you be taking?
- Scott
Posted by crittercuddler on December 30, 2008, at 10:41:58
In reply to Re: Is THIS anti-depressant induced Mania?, posted by SLS on December 27, 2008, at 19:17:19
I am not sure how long it takes. Another member suggested I take 1.5-3g daily. I have some 600mg capsules and I was taking 2 a day. (not enough) I have temporarily stopped while I am trying to get adjusted on other prescription medications.
With all the adverse effects I am always getting I never know what to attribute what to. So, I am taking it out of the mix while I deal with the big guns.
Posted by SLS on December 30, 2008, at 11:46:55
In reply to Re: Is THIS anti-depressant induced Mania?, posted by crittercuddler on December 30, 2008, at 10:41:58
> I am not sure how long it takes. Another member suggested I take 1.5-3g daily. I have some 600mg capsules and I was taking 2 a day. (not enough) I have temporarily stopped while I am trying to get adjusted on other prescription medications.
the mix while I deal with the big guns.
Sounds like a good plan. Logical.
- Scott
This is the end of the thread.
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