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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 . . .


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:

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




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