Posted by RiFi on March 12, 2012, at 20:30:08
continued from above...
Long version:
Firstly, I should state that Serotonin Syndrome can be life threatening, so call your doctor if youre feeling some of the of the symptoms I described above and go to emergency if youre feeling many of them.Ive had Bipolar II since child but was only diagnosed 3 years ago. For the past 20 yrs Ive tried almost every anti-depressant under the sun and it wasnt until my diagnoses that I finally understood why so many of them started out so well but ended in disaster. Im currently on Cymbalta (an SNRI which is typically an absolute no no with bipolar because of the tendency of many SNRIs and indeed SSRIs to kindle mood instability, especially those prone to rapid cycling. But I have severe interstitial cystitis and its the only medication thats ever brought me relief from the constant pain, without sending me completely tropo). I also take Lamictal (which seems to suit me) and Seroquel (which has been an absolute gift for my lifetime of severe insomnia). Unfortuantely though, this drug combination hasnt been quite enough to keep me stable or functioning.
Over the last 2 years I have trialed at least 5 add-on mood stabilisers, the last one being Tegratol. Each time I started a new mood stabilser I'd feel better within hours my mood would lift and my energy and motivation would significantly increase. Id think Wow, so this is how the other half lives! This drug is great - I finally feel not only happy but functional! The positive effects would last for about 3 days, then sadly, anxiety would kick in, my mood would drop, and a few days later I'd have an enormous emotional crash.
So last week I began another trial, this time with Lithium of a tiny, tiny dose of 50mg. I was prepared for the feeling of tiredness and flatness etc that people so often describe with Lithium, but within 4 hours of taking it I felt the very familiar lift in mood, energy levels and motivation. My heart sank and my mind boggled (surely not Lithium??) because I knew hypomania was making another unwelcome appearance.
I scoured the PubMed jounals looking for documented cases of Lithium induced hypomania and found nothing. So then I searched for Lithium-induced anxiety, and thats when I found 2 documented cases of Lithium potentiating the effect of anti-depressants, leading to Serotonin Syndrome. If you go to drugs . com, youll find a myriad of drug families than can potentiate anti-depressants effects leading to raised levels of serotonin, norepinephrine and/or dopamine. So next time youre adding on a new drug, you might want to do the homework most psychiatrist don't!
PS I realise now Ive experienced at least two episodes of Serotonin Syndrome in the past (but luckily stopped taking the offending drug immediately). As many of the symptoms of hypomania and Serotonin Syndromes overlap, its not always easy to tell them apart. From my experience, its when you start to feel physical (stiffness, aches, flu-like symptoms) and fairly extreme psychological changes that you should sit up and take notice.
Sorry for the long, long blurb but Im hoping the details might help others work out a possible cause for paradoxical drug effects.
poster:RiFi
thread:1012906
URL: http://www.dr-bob.org/babble/20120302/msgs/1012920.html