![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 125. This is the beginning of the thread.
Posted by detroitpistons on March 14, 2006, at 8:38:15
Yesterday, I had an appointment with my pdoc. He asked me how things were going, and I told him that I felt better after getting up to 150mg of Lamictal, but I still felt somewhat irritable and prone to mood swings. He raised the Lamictal to 200mg.
Here's the surprising part...I asked him what he thought was the best kind of therapy, and he told me to wait and see what happens with the dosage change first. He said that if it works, psychotherapy would be unnecessary!!
Since moving to a new city, I hadn't started any kind of therapy, and I thought that it would be a good idea. I just didn't expect him to say that, and I was very surprised.
Posted by SLS on March 14, 2006, at 8:59:21
In reply to Never thought I'd hear this....., posted by detroitpistons on March 14, 2006, at 8:38:15
> Yesterday, I had an appointment with my pdoc. He asked me how things were going, and I told him that I felt better after getting up to 150mg of Lamictal, but I still felt somewhat irritable and prone to mood swings. He raised the Lamictal to 200mg.
>
> Here's the surprising part...I asked him what he thought was the best kind of therapy, and he told me to wait and see what happens with the dosage change first. He said that if it works, psychotherapy would be unnecessary!!
>
> Since moving to a new city, I hadn't started any kind of therapy, and I thought that it would be a good idea. I just didn't expect him to say that, and I was very surprised.
I guess you'll know soon what psychological issues remain after the depression goes into remission. Sometimes, depression leaves a real mess in its wake. Therapy can help clean it up after the depression is gone. Sometimes, "issues" mysteriously vanish once the depression is gone. I guess your doctor would like to see you biologically healthy before assessing your psychological health.With depression, things generally are not that simple. I don't think there are very many blanket statements that can be made that covers every person who suffers from it. Let's hope the Lamictal does the trick.
Are you bipolar? What other drugs, if any, are you currently taking.
Good luck.
- Scott
Posted by linkadge on March 14, 2006, at 9:29:32
In reply to Re: Never thought I'd hear this....., posted by SLS on March 14, 2006, at 8:59:21
I would never tell sombody that therapy was unnecessary.
Even if a depression is completely biological, one would be foolish (IMO) to think that the proper medication will change all depression promoting behaviors.
For instance, even after being sucessfully treated for depression, I still retained my workaholic tendancies, many of which were what made me depressed in the first place. I guess I felt, that since it was my "chemistry" that my actions were independant of my mood.
I think thats like telling somebody that, after the right heart medicine, it will be ok to sit on the couch all day long.
Linkadge
Posted by detroitpistons on March 14, 2006, at 12:00:46
In reply to Re: Never thought I'd hear this....., posted by SLS on March 14, 2006, at 8:59:21
> I guess you'll know soon what psychological issues remain after the depression goes into remission. Sometimes, depression leaves a real mess in its wake. Therapy can help clean it up after the depression is gone. Sometimes, "issues" mysteriously vanish once the depression is gone. I guess your doctor would like to see you biologically healthy before assessing your psychological health.
>
> With depression, things generally are not that simple. I don't think there are very many blanket statements that can be made that covers every person who suffers from it. Let's hope the Lamictal does the trick.
>
> Are you bipolar? What other drugs, if any, are you currently taking.
>
> Good luck.
>
>
> - Scott
>I was recently diagnosed as bipolar II after being on Effexor 225mg. I had an irritable hypomania with a lot of agitation, irritability, racing thoughts, excess energy, etc. I was sort of rapid cycling and a kind of mixed state.
I went down to 150mg of Effexor and started the Lamictal (just went up to 200mg today). The doc wants to wait till I'm fully stabilized to think about taking me off of Effexor.
To be honest, I'm not really sure I'm really bipolar because this hypomanic episode happened while on Effexor. But I did take Effexor once before with awesome results (maybe even some euphoric hypomania, but I can't really remember)and then it pooped out. I then tried Paxil and then Lexapro, with diminishing results.
Late last summer, I started becoming depressed again, and saw the doc but by that time I was really spiralling down. The Effexor succeeded in pulling me up, but then a couple months later the hypomania hit me hard. I guess the fact that my depression is recurring along with the fact that SSRI's don't work for me are soft signs of bipolar, but I'm still not completely convinced of the BPII dx.
Thanks for the responses,
Marc
Posted by SLS on March 14, 2006, at 13:00:10
In reply to Re: Never thought I'd hear this..... » SLS, posted by detroitpistons on March 14, 2006, at 12:00:46
> > I guess you'll know soon what psychological issues remain after the depression goes into remission. Sometimes, depression leaves a real mess in its wake. Therapy can help clean it up after the depression is gone. Sometimes, "issues" mysteriously vanish once the depression is gone. I guess your doctor would like to see you biologically healthy before assessing your psychological health.
> >
> > With depression, things generally are not that simple. I don't think there are very many blanket statements that can be made that covers every person who suffers from it. Let's hope the Lamictal does the trick.
> >
> > Are you bipolar? What other drugs, if any, are you currently taking.
> >
> > Good luck.
> >
> >
> > - Scott
> >
>
> I was recently diagnosed as bipolar II after being on Effexor 225mg. I had an irritable hypomania with a lot of agitation, irritability, racing thoughts, excess energy, etc. I was sort of rapid cycling and a kind of mixed state.
>
> I went down to 150mg of Effexor and started the Lamictal (just went up to 200mg today). The doc wants to wait till I'm fully stabilized to think about taking me off of Effexor.
>
> To be honest, I'm not really sure I'm really bipolar because this hypomanic episode happened while on Effexor. But I did take Effexor once before with awesome results (maybe even some euphoric hypomania, but I can't really remember)and then it pooped out. I then tried Paxil and then Lexapro, with diminishing results.
>
> Late last summer, I started becoming depressed again, and saw the doc but by that time I was really spiralling down. The Effexor succeeded in pulling me up, but then a couple months later the hypomania hit me hard. I guess the fact that my depression is recurring along with the fact that SSRI's don't work for me are soft signs of bipolar, but I'm still not completely convinced of the BPII dx.I, too, have experienced mania only while taking antidepressants. That seems to be enough to qualify one as having a bipolar-spectrum disorder. For the most part, I would agree with this diagnosis.
200mg seems to be the "sweet spot" for Lamictal when it is used to treat bipolar depression. For me, Lamictal by itself is not sufficient to treat depression. It does seem to be used more often as an augmenting agent than as monotherapy. However, there have been a few postings here on Psycho-Babble by people for whom Lamictal was sufficient to bring them into remission. Interindividual biologies are so varied as to produce many different responses to the same medication. It is still difficult to predict how any one person will react to any one treatment.
I am not one who believes that psychotherapy is necessary simply because one describes themselves as being depressed, especially if the depression is part of a bipolar diathesis. Some perfectly healthy people are struck with brain disorders in the absence of psychopathology.
I suspect that you have been in psychotherapy long enough to have identified specific issues that need attention - if any do indeed exist. For me, I have used psychotherapy from time to time to help me deal with the effects that bipolar depression has had on my life. It has helped provide me with some tools to "undo" the damage that the biological depression has caused and continues to inflict. I seem to have very few issues that are independent of bipolar disorder. For these, I have used pschotherapy as a precision tool. However, I do believe that issues can be resolved, and not be vortices of perpetual therapeutic need. It has been my experience that during times of remission, I have not had a need for psychotherapy. I pretty much just get up, brush myself off, and start walking and talking. I have fun.
It might be interesting for you to identify your psychological issues and describe them to your doctor. Perhaps he will conclude that you should go for psychotherapy. Perhaps not. Either way, you will have provided him with detail that he didn't have before from which to draw more informed conclusions as to how to approach your recovery from depression and maintenance of mental hygeine.
If I were a doctor, I would never resolve to never tell anyone that they don't need psychotherapy. Some people don't.
:-)
- Scott
Posted by linkadge on March 14, 2006, at 16:15:04
In reply to Re: Never thought I'd hear this..... » detroitpistons, posted by SLS on March 14, 2006, at 13:00:10
I don't agree with the antidepressant induced bipolar diagnosis.
One of the doctors I respect the most, Dr. Manji once said "under the right circumstances, it seems that just about anybody can have a manic episode". The "circumstances" he referrs to are basically drug induced circumstances.
I believe in that statement wholeheartedly. Bipolar is may be due to overactivity in certain regions of the brain, but thats what these drugs do! Antidepressants dose dependantly increase neuronal excitability.
I had been labled as bipolar after a high dose of celexa left me agitated, with insomnia and mood swings.
I didn't believe in that diagnosis because I never had any kind of experience like that prior to the drugs, and havn't since.
I thought it was just basically a patch job diagnosis to fill in the blanks of psychiatry's shortcomings and grey areas.
If too much coffee makes you anxious does that mean that you automatically have an anxiety disorder ? (Well I suppose if caffiene was a prescription drug.)
I've stopped the ADs on my own initiative and have never had anything like what the drugs induced.
Remember, that ordinary (non bipolar animals) can be made to exhibit some of these strange behaviors when subjected to high doses of SS/NRI's
If the lamictal helps, then take it, but I wouldn't jump to conclusions based on what drugs do to you. After all, when you're on an antidepressant, you're on drugs.
Linkadge
Posted by Phillipa on March 14, 2006, at 21:29:39
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 14, 2006, at 16:15:04
Stange conversation. I think everyone could benefit from some type of psychotherapy. Sometimes someones elses onpinion can help someone make decisions in their life that they couldn't make like switching careers without the help of someone else. Love Phippipa
Posted by detroitpistons on March 14, 2006, at 21:49:58
In reply to Re: Never thought I'd hear this..... » detroitpistons, posted by SLS on March 14, 2006, at 13:00:10
Different points of view here about the bipolar diagnosis...Only time will tell what the real deal is. I'm just very impatient and I want an answer now...If I ever have any kind of manic/ hypomanic episode with no drugs involved, then I will become a true believer in the bipolar II diagnosis. The only problem is that I don't know when I'll ever not be on drugs. I've resisted taking them before thinking that I had become more savvy and could keep depression from spiraling out of control, but I failed. Now I'm too scared to try that again. Each time I think I've conquered it without drugs, it always comes back to bite me in the *ss.
I don't think psychotherapy can ever be a bad thing. But problems and hangups seem to go away or diminish when I'm feeling well (which hasn't been often in the past few years), and they seem too hard to talk about when depressed. I can barely think when I'm depressed. The last time I was depressed and in therapy, I would feel somewhat better after a session (and sometimes worse). Any good feelings that I may have had after therapy seemed to evaporate fairly quickly. I think that's the biological nature of it.
Posted by cecilia on March 15, 2006, at 1:43:36
In reply to Re: Never thought I'd hear this..... » SLS, posted by detroitpistons on March 14, 2006, at 21:49:58
Psychotherapy can definitely be a bad thing. It's far more addicting than any drug ever made and can have far worse side effects. I wasted an enormous amount of money on therapy that made me more depressed. Cecilia
Posted by SLS on March 15, 2006, at 7:40:42
In reply to Re: Never thought I'd hear this..... » SLS, posted by detroitpistons on March 14, 2006, at 21:49:58
> Different points of view here about the bipolar diagnosis...
Some pretty heady people are now proposing that there is an affective-spectrum within which both bipolar and unipolar exist along a continuum. They propose that they really aren't separate disorders.
Another proposition that has been around for a long time is that there should be a bipolar III diagnosis for people who experience mania only in association with a biological intervention such as drug treatment. Here, mania can be quite severe, and even psychotic. Manic events are not limited to hypomania as they are in bipolar II. Supposedly, we will see this bipolar III diagnosis in the next DSM.
Although there might be a few instances where someone without a bipolar disorder can be induced to experience mania, my guess is that this represents a small minority of manic reactions to antidepressants. One way to help clarify this issue would be to identify the other signs and symptoms that cluster together to indicate bipolarity, and to determine the coefficient of correlation to determine the degree of association. For instance, with me:
1. Early age of onset - 10-13 years old
2. Ultra-rapid cyclicity - invariable 11-day period
3. Dexamethasone non-suppression
4. Reverse vegetative profile
5. Positive responses to lithium and valproateeAlthough far from convincing, there are other features of my illness that indicate bipolarity. Here, there is a strong association between bipolar features and manic reactions to antidepressants.
> Only time will tell what the real deal is.
Yes.
> I'm just very impatient and I want an answer now...
The answer that I would give is that you must not ignore your manic reaction to medication and treat as if you were bipolar. It can't hurt. You would continue to explore antidepressants, but begin to apply mood stabilizers as augmentation strategies.
> If I ever have any kind of manic/ hypomanic episode with no drugs involved, then I will become a true believer in the bipolar II diagnosis.
It is possible that you are bipolar, but not bipolar II.
Can you describe your manic reaction in more detail?
It is possible that you will need some sort of biological treatment indefinitely. One can only guess. However, it does seem that you need it right now. The immediate goal is to find something that works.
- Scott
Posted by SLS on March 15, 2006, at 7:42:24
In reply to Re: Never thought I'd hear this....., posted by cecilia on March 15, 2006, at 1:43:36
> Psychotherapy can definitely be a bad thing. It's far more addicting than any drug ever made and can have far worse side effects. I wasted an enormous amount of money on therapy that made me more depressed. Cecilia
I guess choosing the wrong therapist or the wrong psychotherapeutic method can be as destructive as choosing the wrong drug.
- Scott
Posted by detroitpistons on March 15, 2006, at 9:27:15
In reply to Re: Never thought I'd hear this..... » detroitpistons, posted by SLS on March 15, 2006, at 7:40:42
> Some pretty heady people are now proposing that there is an affective-spectrum within which both bipolar and unipolar exist along a continuum. They propose that they really aren't separate disorders.
>Dr. Phelps
> Although there might be a few instances where someone without a bipolar disorder can be induced to experience mania, my guess is that this represents a small minority of manic reactions to antidepressants.
>I think I've read this elsewhere as well. I think it is the opinion of certain doctors too. If it's true, then I am more than likely bipolar. If I am bipolar, then I've had several episodes of depression before ever getting hypomanic. I understand that this is entirely possible. Earlier in my life, I remember certain features of hypomania--the irritable kind. There were times where I would push people away because of my irritability and anxiety and constant worry. But I don't ever remember being highly agitated, having racing thoughts, severe insomnia, etc. I do remember short periods where I had trouble sleeping. Of course, just because I don't remember doesn't necessarily mean it didn't happen.
> Manic events are not limited to hypomania as they are in bipolar II. Supposedly, we will see this bipolar III diagnosis in the next DSM.
>I agree that the next DSM will be more robust and inclusive and better recognize the bipolar spectrum.
> One way to help clarify this issue would be to identify the other signs and symptoms that cluster together to indicate bipolarity, and to determine the coefficient of correlation to determine the degree of association. For instance, with me:
>
> 1. Early age of onset - 10-13 years old
>I think I had my first major depressive episode in my early twenties. I've read that first episodes in the late teens/ early twenties is a soft sign of bipolar. In my teens and prior, I think I had mostly anxiety and dysthymia. I may have also been a bit cyclothymic.
> Can you describe your manic reaction in more detail?
Well, I started taking the Effexor and was no longer depressed after about 6 weeks, but I still didn't feel "right." I still felt anxious. Over the course of the next couple of months, it became worse. I started noticing that I couldn't concentrate on anything at work (at the time I thought I had suddenly developed ADD). I was easily distracted and I couldn't focus on one thing at a time. My thoughts were racing. I became extremely agitated, nervous, and anxious. I had much less patience and I was easily irritated. I felt like I could blow up on someone at any time, as I had done to one of my bosses in the past (while on Paxil) and nearly got fired. I just felt more impulsive, angry, and aggressive. I had way too much energy. I actually did some cleaning (I normally have a very difficult time cleaning--I wait till something is covered in dust to clean it). None of this was pleasant, however, and at the time, I had thought that mania/ hypomania was supposed to feel good. My doctor explained that this wasn't necessarily the case. I've learned a lot since then. I should also add that I was seeing things out of the corners of my eyes, hearing quick sounds, and feeling sensations in my legs like my phone was going off when it wasn't, for instance. These were relatively mild hallucinations.
> It is possible that you will need some sort of biological treatment indefinitely. One can only guess. However, it does seem that you need it right now.
>I'm up to 200 mg of Lamictal and it has calmed me down a lot.
Thanks for your response, Scott. It was very insightful.
Posted by linkadge on March 15, 2006, at 9:32:25
In reply to Re: Never thought I'd hear this....., posted by cecilia on March 15, 2006, at 1:43:36
Psychtherapy, addicting ? Wow, I wouldn't have imagined that.
Linkadge
Posted by linkadge on March 15, 2006, at 9:52:07
In reply to Re: Never thought I'd hear this..... » detroitpistons, posted by SLS on March 15, 2006, at 7:40:42
The only thing wrong with labling antidepressant induced mania as bipolar is that it can force a patient to take heavy, and perhaps unnecssary medication.
The thing that scares me the most, is that patients who have manic reactions to medications are often placed directly on mood stabalizers, before trying the grosly simplistic: simply tapering the antidepressant.
My mother experienced a manic reaction to *high* doses of TCA's. They immediately put her on lithium and told her she would need to take that for the rest of her life.
But we will never know now. Perhaps simply discontinuing or lowering the antidepressant would have brought relief, and perhaps would have meant for her a better life.
After lithium, things went downhill. I would also argue *against* the notion that a positive responce to mood stabalizers means that a person is bipolar. The reason being is that Dr. Manji's work again shows that lithium, depakote, and antipsychotics are able to block the behavioral reactions of mice to amphetamines and high dose antidepressants. I.e. you take a normal (non-bipolar) mouse, you can make it manic with drugs, and you can block the manic reaction with mood stabalizers and antipsychotics. Does that imply anything about the mouse, other than the fact that it has just got a "raw-deal"?
Think of it this way. You can induce a seizure in just about anyone with the right drugs. Why is is so inconcievable that a manic episode is not just a branch of the same phenomina ?
I am not against psychiatric drugs, but after being put in the hospital, you come to realize that half the inpatients are people who went manic on high dose antdidepressants, and are now having to go through a subsequent trial of mood stabalizers.
I think its one of the biggest attempts by psychiatry to sweep their lack of knowledge under the carpet.
Linkadge
Posted by linkadge on March 15, 2006, at 9:57:44
In reply to Re: Never thought I'd hear this..... » SLS, posted by detroitpistons on March 15, 2006, at 9:27:15
"Although there might be a few instances where someone without a bipolar disorder can be induced to experience mania, my guess is that this represents a small minority of manic reactions to antidepressants."
I would argue against the notion of "a few instances" The bipolar diagnosis is growing *very* rapidly. There are more than a few instances of people with no prior history of mania experiencing manic reactions to antidepressants, we will never know if these people had bipolar or not.
Hindsight is always 20-20.
Linkadge
Posted by detroitpistons on March 15, 2006, at 10:11:19
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 15, 2006, at 9:52:07
> The only thing wrong with labling antidepressant induced mania as bipolar is that it can force a patient to take heavy, and perhaps unnecssary medication.
>Link,
I see your point, but at least the Lamictal I'm on is fairly benign compared to the antidepressants as far as side effects go. I don't like being a walking pharmacy (and I take far less than some of the other people on this board--I'm relatively lucky), but if the side effects aren't too bad, then I have less of a hangup.
> The thing that scares me the most, is that patients who have manic reactions to medications are often placed directly on mood stabalizers, before trying the grosly simplistic: simply tapering the antidepressant.
>That's what I thought. I expressed this to my doctor, but he didn't want to take me off of Effexor quite yet. But I do have reservations about this doing this. I'm scared that if I go off, I will sink into depression again. It always comes back.
> After lithium, things went downhill. I would also argue *against* the notion that a positive responce to mood stabalizers means that a person is bipolar. The reason being is that Dr. Manji's work again shows that lithium, depakote, and antipsychotics are able to block the behavioral reactions of mice to amphetamines and high dose antidepressants. I.e. you take a normal (non-bipolar) mouse, you can make it manic with drugs, and you can block the manic reaction with mood stabalizers and antipsychotics. Does that imply anything about the mouse, other than the fact that it has just got a "raw-deal"?
>Good point based on research. I will have to look up Dr. Manji.
> Think of it this way. You can induce a seizure in just about anyone with the right drugs. Why is is so inconcievable that a manic episode is not just a branch of the same phenomina ?
>Also interesting. Seizures induced in mice produced the kindling effect. The mice continued to have seizures even after they were artificially induced, if I remember correctly. That makes me think that antidepressants can possibly make people worse in the long run. This is up for debate.
> I think its one of the biggest attempts by psychiatry to sweep their lack of knowledge under the carpet.
>Another good point. So much is unknown. Psychiatry mostly uses the shotgun approach in my opinion. That's the best it can do at this point. The good thing is that research is being vigorously conducted to better understand the brain and mood disorders. But at this point, we are basically all guinea pigs. Perhaps in a hundred years, depression and bipolar disorders may have take the couse of polio--Once dangerous, but now conquered.
Marc
Posted by linkadge on March 15, 2006, at 15:11:01
In reply to Re: Never thought I'd hear this..... » linkadge, posted by detroitpistons on March 15, 2006, at 10:11:19
"That makes me think that antidepressants can possibly make people worse in the long run. This is up for debate."
That is a growing theory.
Theres nothing wrong with your approach. Get stable, and get something that helps.
I guess I am just urging you to keep in these things in mind, although I gather that you already are.
Take Care.
Linkadge
Posted by cecilia on March 15, 2006, at 22:33:35
In reply to Re: Never thought I'd hear this..... » cecilia, posted by linkadge on March 15, 2006, at 9:32:25
Therapy is addicting for a lot of people. Even when it isn't helping, the more money and emotional emergy you put into it the harder it is to fold your cards and walk away. Emotionally the whole process can put you into a childlike state and just like a child will beg to stay with an abusive parent, many people will attach like glue to a therapist who doesn't help them at all. Cecilia
Posted by Dr. Bob on March 16, 2006, at 1:28:28
In reply to Psychotherapy addicting, posted by cecilia on March 15, 2006, at 22:33:35
> Therapy is addicting for a lot of people...
Sorry to interrupt, but I'd like to redirect follow-ups regarding therapy to Psycho-Babble Psychology. Here's a link:
http://www.dr-bob.org/babble/psycho/20060312/msgs/620831.html
Thanks,
Bob
Posted by SLS on March 16, 2006, at 6:23:57
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 15, 2006, at 9:52:07
> The only thing wrong with labling antidepressant induced mania as bipolar is that it can force a patient to take heavy, and perhaps unnecssary medication.
This is where I think it is important to determine whether or not there are any other signs of bipolarity. It is a judgment call. The other consideration is that an algorithm be used in such cases such that "heavy" medication be used only if "lighter" treatments fail. Again, this is a judgment call.
> The thing that scares me the most, is that patients who have manic reactions to medications are often placed directly on mood stabalizers, before trying the grosly simplistic: simply tapering the antidepressant.
When I first became manic on antidepressants, I had been in remission - my only true remission - for about 6 months. Lithium was introduced and the antidepressants withdrawn. To make a long story short, I never responded to those same antidepressants again. The antidepressant response could not be recaptured. This is the risk taken when one discontinues effective drugs. Perhaps this applies to reduced dosages as well.
> I would also argue *against* the notion that a positive responce to mood stabalizers means that a person is bipolar.
Clinicians' experiences seem to controvert your conclusion.
> The reason being is that Dr. Manji's work again shows that lithium, depakote, and antipsychotics are able to block the behavioral reactions of mice to amphetamines and high dose antidepressants.
And...
> I.e. you take a normal (non-bipolar) mouse, you can make it manic with drugs, and you can block the manic reaction with mood stabalizers and antipsychotics.
Stereotypy is not mania. The rats do not become manic.
> Think of it this way. You can induce a seizure in just about anyone with the right drugs. Why is is so inconcievable that a manic episode is not just a branch of the same phenomina ?
The question is not whether or not such a thing is possible, it is what are the odds that a manic reaction to therapeutic dosages of antidepressants indicate bipolarity. My guess is that the odds are heavily in favor of bipolarity.
- Scott
Posted by linkadge on March 16, 2006, at 9:45:03
In reply to Re: Never thought I'd hear this..... » linkadge, posted by SLS on March 16, 2006, at 6:23:57
>This is where I think it is important to >determine whether or not there are any other >signs of bipolarity. It is a judgment call. The >other consideration is that an algorithm be used >in such cases such that "heavy" medication be >used only if "lighter" treatments fail. Again, >this is a judgment call.
That seems fair enough.
>When I first became manic on antidepressants, I >had been in remission - my only true remission - >for about 6 months. Lithium was introduced and >the antidepressants withdrawn. To make a long >story short, I never responded to those same >antidepressants again. The antidepressant >response could not be recaptured. This is the >risk taken when one discontinues effective >drugs. Perhaps this applies to reduced dosages >as well.
I would argue that the moment you went manic, was the real moment that the true antidepressant responce was gone forever.
>Clinicians' experiences seem to controvert your >conclusion.
Theres no way to proove that. So if a anti-manic agent blocks the antidepressant effect, and calms the person down (like it should) then we are to conclude that a person is bipolar. It is the logic that is used that is flawed. You can "respond" to a mood stabalizer insofar as it blocks the cycling that the antidepressant produced does not mean you would be cyling on your own.
>Stereotypy is not mania. The rats do not become >manic.Nor do they become depressed? If we throw away the mania model then we must throw away the depressed mouse model. Manic mice show many similarities to manic people. Decreased sleep, increased sexual persuit, increased risk taking, increased hedonic activities, agressivness, hyperlocomotion. As well, biochemically they exhibit similarities. Increased catecholamine release, PKC overexpression, certain patterns of epileptiform activity.
>The question is not whether or not such a thing >is possible, it is what are the odds that a >manic reaction to therapeutic dosages of >antidepressants indicate bipolarity. My guess is >that the odds are heavily in favor of bipolarity.My guess is that they are not. A lot of Dr. Manji's work shows that antidepressants activate some of the same pathways that are turned on in mania. For instance. TCA's increase PKC expression (dramatically). OTOH, PKC inhibitors are effective antimanic agents. Another thing that you have to consider is that antidepressants may me inducing *undetected* cylcing and hypomania in a lot of people.
Another thing to consider is that cumulative sleep deprivation can cause psychosis/mania in just about anyone, that is fairly documented. The TCA's can block certain sleep stages for a very long time. They're dirty drugs.
My mother had one manic episode (in reaction to a TCA which she took for about 6 months, and claimed it was the only time she felt good :)). I just don't see how that justifies a lifetime of lithium.Its my own personal experiement to prove this thing wrong. Maybe I will fail, and then I will accept treatment. I am going to proove that a single manic episode in responce to an antidepressant does not imply bipolar. So far (over 1 year off all treatment) has said to me that I don't cycle at all, but those are strong drugs.
Linkadge
Posted by SLS on March 16, 2006, at 9:51:49
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 15, 2006, at 15:11:01
Are there any widely accepted rodent models of mania as there are with depression?
I think we can exclude stereotypy. If anything, it might represent schizophrenia or OCD. I don't think hyperlocomotion is valid either. Stimulants can produce increased activity in humans without producing mania. I would like to know what Dr. Manji considers to be an animal model of mania.
- Scott
Posted by SLS on March 16, 2006, at 10:36:57
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 16, 2006, at 9:45:03
> I would argue that the moment you went manic, was the real moment that the true antidepressant responce was gone forever.
There may be some truth in your hypothesis. It almost fits the sequence of events that led up to the depression subsequent to my second manic reaction. I'll describe at greater length the specifics at some point in the future. I hope you are wrong, of course, but you may not be.
I am hoping that it was the subsequent pulsing of antidepressants that produced the treatment resistance. Unfortunately, my doctor at the time decided to try the newly-approved Prozac when I relapsed into depression. Then it was Parnate monotherapy. Then it was Nardil monotherapy. Then...
> > Stereotypy is not mania. The rats do not become manic.
> Nor do they become depressed?They exhibit their depressive behaviors in the absence of drugs.
> If we throw away the mania model then we must throw away the depressed mouse model.
This is the thing. To my knowledge, a rodent model of mania in the absence of drugs does not yet exist.
> Manic mice show many similarities to manic people. Decreased sleep, increased sexual persuit, increased risk taking, increased hedonic activities, agressivness, hyperlocomotion. As well, biochemically they exhibit similarities. Increased catecholamine release, PKC overexpression, certain patterns of epileptiform activity.
Also seen in non-manic humans taking amphetamines and cocaine, no?
I admit that I really don't know enough about this stuff. However, the question raised is whether or not a manic reaction to therapeutic dosages of antidepressants indicates bipolar disorder. I guess the best way to assess this question is via a longitudinal investigation of people who have experienced this reaction, both retrospectively and prospectively.
I'm trying to find some stuff on the Net that would indicate which animal model of mania is currently accepted. I know that Dr. Manji has suggested models to be used to evaluate treatments for mania, but this still does not represent an induction of a mania in association with an antidepressant. I have not read about a rodent displaying hyperlocomotion, hypersexuality, etc. as a reaction to an antidepressant. As a matter of fact, Dr. Manji demonstrated that amphetamine alone was not sufficient as a model of mania, despite its capacity to produce hyperlocomotion and stereotypy. He needed to create a hyperlocomotive state using a combination of amphetamine + chlordiazepoxide to produce a state that was responsive to valproate.
http://www.psychogenics.com/pdf/biploar-disorders.pdf
Can amphetamine alone switch someone from depression into mania?
The irony is this: Dr. Manji evaluates the validity of an animal model of mania by determining whether or not it is attenuated by a mood stabilizer. This is tantamount to diagnosing bipolar disorder by evaluating response vs non-response to a mood stabilizer.
- Scott
Posted by linkadge on March 16, 2006, at 10:56:49
In reply to Re: Never thought I'd hear this..... » linkadge, posted by SLS on March 16, 2006, at 9:51:49
I am aware of some animal models of mania. Rapid cycling, for instance, could easily be detected in animal. (Ie. they are hyperactive/hypersexual for days, and then seem to crash and not move for days)
I do know that there are big bucks put into reasearch nowadays to see how SSRI's can influence these behaviors, as well as influencing genes that have been linked with instability.
I know that there are animal models used which are often sucessfull at findind potential mood stabalizing agents. A dexamphetamine-chlordiazepoxide model was used to identify keppra as a potential mood stabilizer.
Methamphetamine is often used to replicate an animal model of mania with psychotic features.
There is some evidence that the GRK3 (G protein receptor kinase) enzyme is involved in mania, and perhaps psychosis. Expression is elevated in mania, and the state is readily reproducable in mice by administration of stimulants (don't know about antidepressants)
PACAP is another (enzyme?) that is influcenced oppositly by antidepressants and mood stabalizers, and is under investigation.
http://neurotransmitter.net/bipolargrk3.html
Pertaining to SSRI induced mania and rapid cylcing.
http://neurotransmitter.net/admania.html
Linkadge
Posted by SLS on March 16, 2006, at 11:23:33
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 16, 2006, at 10:56:49
Hi.
The links you gave here seem to be very helpful. Thanks. I'll have to look at them later.
Again, I think that the majority of manic reactions to antidepressants are indicative of a bipolar diathesis and that using amphetamines in animals is not a valid reproduction of this process.
- Scott
> I am aware of some animal models of mania. Rapid cycling, for instance, could easily be detected in animal. (Ie. they are hyperactive/hypersexual for days, and then seem to crash and not move for days)
>
> I do know that there are big bucks put into reasearch nowadays to see how SSRI's can influence these behaviors, as well as influencing genes that have been linked with instability.
>
> I know that there are animal models used which are often sucessfull at findind potential mood stabalizing agents. A dexamphetamine-chlordiazepoxide model was used to identify keppra as a potential mood stabilizer.
>
> Methamphetamine is often used to replicate an animal model of mania with psychotic features.
>
> There is some evidence that the GRK3 (G protein receptor kinase) enzyme is involved in mania, and perhaps psychosis. Expression is elevated in mania, and the state is readily reproducable in mice by administration of stimulants (don't know about antidepressants)
>
> PACAP is another (enzyme?) that is influcenced oppositly by antidepressants and mood stabalizers, and is under investigation.
>
> http://neurotransmitter.net/bipolargrk3.html
>
> Pertaining to SSRI induced mania and rapid cylcing.
>
> http://neurotransmitter.net/admania.html
>
>
> Linkadge
>
>
>
>
>
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