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Dr. Bob is Robert Hsiung, MD,
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Posted by linkadge on January 14, 2006, at 17:48:50
In reply to Re: Depressed/agitated/wired - soft bipolar? » Phillipa, posted by 4WD on January 12, 2006, at 21:03:11
I don't consider myself bipolar mainly because off meds I have no issues with agitation etc. But some meds induce a very significant agitation, and akathesia in me. Celexa was by far the worst offender for me in this regard.
Zoloft caused the least start up agitation.
I too did fine on 10mg of celexa, and had problems when it was increased. I simply considered it a significant akathesia that made me so agitated.
I personally wouldn't jump to the bipolar diagnosis. I would define it as akathesia, and significant start-up anxiety. (Especially if it was a very negative experience).
I am not a fan of the drug induced bipolar diagnosis, because it blames the patient, when the drugs are often to blame.
Some people are more sensitive to this akathesia than others.
Take Care.P.S. Just cause coffee makes you nervous doesn't mean you have an anxiety disorder.
Linkadge
Posted by linkadge on January 14, 2006, at 17:50:47
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by linkadge on January 14, 2006, at 17:48:50
For intance, in healthy vaulenteers 5-ht2c agonists can induce agitation, irritability and other strange things.
Linkadge
Posted by 4WD on January 14, 2006, at 21:43:04
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by linkadge on January 14, 2006, at 17:48:50
> I don't consider myself bipolar mainly because off meds I have no issues with agitation etc. But some meds induce a very significant agitation, and akathesia in me. Celexa was by far the worst offender for me in this regard.
>
> Zoloft caused the least start up agitation.
>
> I too did fine on 10mg of celexa, and had problems when it was increased. I simply considered it a significant akathesia that made me so agitated.
>
> I personally wouldn't jump to the bipolar diagnosis. I would define it as akathesia, and significant start-up anxiety. (Especially if it was a very negative experience).
>
> I am not a fan of the drug induced bipolar diagnosis, because it blames the patient, when the drugs are often to blame.
>
> Some people are more sensitive to this akathesia than others.
>
>
> Take Care.
>
> P.S. Just cause coffee makes you nervous doesn't mean you have an anxiety disorder.
>
>
> Linkadge
>
>All good points. Actually, I don't care what the diagnosis is. I just want relief.
The agitation and fear weren't startup effects, though. I was having them the whole time I was on Celexa (almost a year this go round). They just got worse when I increased it. And the hyper excess bad energy was at a level I've never experienced before.
Why do you think the med induced bipolar diagnosis blames the patient? Seems to me it puts the blame right where it should go - on the med.
Hope you are doing well, Linkadge. HOw's your Mom?
Marsha
>
>
>
Posted by 4WD on January 14, 2006, at 21:51:28
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by linkadge on January 14, 2006, at 17:50:47
And since I have to take an AD to keep out of the pit of clinical depression, and since AD's make me wired and if a mood stabilizer allows me to take an AD without getting all terrified and jittery, then if they want to call me med induced bipolar, I'll live with it. I do know that every SSRI I've ever been on has made me edgy and jittery. Before meds, I was just sunk in apathy and misery and no energy at all.
I don't know what happened 15 months ago that swung me into that state of terror (other than switching from Effexor to other ADs, and several traumatic family events) but whatever it was, I'm pretty sure I didn't suddenly become bipolar at the age of 48. Unless, I had been soft bipolar all those years, and not recognized it - just thinking the nervousness was part of my makeup.
I don't know. It's beyond me to figure out.
Marsha
Posted by linkadge on January 15, 2006, at 9:48:26
In reply to Re: Depressed/agitated/wired - soft bipolar? » linkadge, posted by 4WD on January 14, 2006, at 21:43:04
Of course I am unable to know your whole situation.
I experienced some continual fear on SSRI's, and I have a theory for that too.
Anyhow, I suppose relief is the key, I just wouldn't want you to be over drugged because of a bad drug reaction.
When I was on SSRI's, they induced so many behavioral changes that I thought I had every disease under the sun. Since SSRI's I was diagnosed with everything, OCD, schitsophrenia, bipolar, psychotic depression, you name it.I remember when I jumped from 10mg to 20mg of celexa, I began to suspect my roomates had put LSD in my orange juice! Thats what landed me on lithium.
Anyhow I knew it was the drug, and I knew I didn't want to take lithium for drug induced psychosis.
So I've been off SSRI's and I'm doing better. My moods have been stable for almost a year. I know not everyone can make that step, I just wanted you to know what I went through.
It depends on the way your doctor handles it. If he tries to make it out to be your fault that the SSRI did this, then thats bad, because I don't really believe in bipolar 2 (or 3 or whatever). I think there is a group of people out there who are more sensitive to the various side effects of SSRI's.
Mom is so-so. I'm not too bad, (school stress but otherwise ok)Thanks for asking :)
Linkadge
Posted by linkadge on January 15, 2006, at 9:50:48
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by 4WD on January 14, 2006, at 21:51:28
Have you tried a TCA? A little while ago there was a thing called agitated depression (which as since been sucked into the bipolar spectrum)
But they were/are great for agitated depression.
Linkadge
Posted by zeugma on January 15, 2006, at 12:22:54
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by linkadge on January 15, 2006, at 9:50:48
> Have you tried a TCA? A little while ago there was a thing called agitated depression (which as since been sucked into the bipolar spectrum)
>
> But they were/are great for agitated depression.
>
> LinkadgeI've always found it strange that patients had longer memories than pdocs.
Someday people will decide that the bipolar spectrum has been extended too far. Most likely when the patents of new drugs that treat what used to be called 'agitated depression' have run out.
-z
Posted by linkadge on January 15, 2006, at 16:55:03
In reply to Re: Depressed/agitated/wired - soft bipolar? » linkadge, posted by zeugma on January 15, 2006, at 12:22:54
I just remember that in certain states, the difference between a TCA and an SSRI was like night and day.
For me, the TCA's usually improved sleep and appetite immediately whereas the SSRI's made those symptoms worse for a good 2+ weeks, (which intensified depression, anxiety and panic etc).
I think there is a group of people who are depressed, but still motivated, (sometimes motivated by obsession - or just running on stress hormones) and that the SSRI's don't correct the HPA axis dysregulation fast enough, at least for me they didn't.
For example with me, I became so afraid of falling behind in school, that even though I wanted to kill myself every day, I would still be doing my homework incessantly. Nobody thought I was depressed - (to be depressed you must have given up). I never give up, I just become more suicidal.
Linkadge
Posted by 4WD on January 15, 2006, at 18:25:29
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by linkadge on January 15, 2006, at 9:50:48
> Have you tried a TCA? A little while ago there was a thing called agitated depression (which as since been sucked into the bipolar spectrum)
>
> But they were/are great for agitated depression.
>
> LinkadgeYeah, I've been wondering about the difference in med induced anxiety and agitated depression. But I wasn't agitated until SSRIs.
I've thought of going back to imipramine. I did well on that many years ago. The side effects were pretty intense though. It was almost 20 years ago and I still remember the dry mouth, nasal congestion, flushed face and anorgasmia. I think I had insomnia too.
If I take the Depakote and the agitation/fear goes away, does that mean it IS med-induced dysphoric mania? I'm kind of looking at this med trial as a diagnostic tool.
Marsha
Posted by linkadge on January 16, 2006, at 8:25:04
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by 4WD on January 15, 2006, at 18:25:29
>If I take the Depakote and the agitation/fear >goes away, does that mean it IS med-induced >dysphoric mania? I'm kind of looking at this med >trial as a diagnostic tool.
I would have to say no, simply due to the fact that depakote can be used as an adjunctive in severe anxiety, since it has a really strong gaba effect.
But along those lines, if it works then so be it, you could continue to take it.
Linkadge
Posted by ed_uk on January 16, 2006, at 13:26:47
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by 4WD on January 15, 2006, at 18:25:29
Hi Marsha
You could try imipramine again at a low dose, or maybe one of the more sedating TCAs given as a single dose in the evening.
Ed
Posted by 4WD on January 16, 2006, at 20:57:03
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by linkadge on January 16, 2006, at 8:25:04
> >If I take the Depakote and the agitation/fear >goes away, does that mean it IS med-induced >dysphoric mania? I'm kind of looking at this med >trial as a diagnostic tool.
>
> I would have to say no, simply due to the fact that depakote can be used as an adjunctive in severe anxiety, since it has a really strong gaba effect.
>
> But along those lines, if it works then so be it, you could continue to take it.
>
>
>
> Linkadge
>So far I'm having no side effects from the Depakote (but I only went up to 500mg last night - 250 mg the 3 nights before that). No real positive effects yet either.
Do you know how long it should take to help? I do think the severity of the depressed part of it might be a little less. OTOH I think I'm experiencing some depression from stopping Celexa and the Effexor not having kicked in yet. It's not suicidal, it's just unutterably sad at the moment.
Yeah, I think if I could take Depakote for anxiety instead of Klonopin, I'd rather.
Thanks,
Marsha
>
Posted by 4WD on January 16, 2006, at 21:02:38
In reply to Re: Depressed/agitated/wired - soft bipolar? » 4WD, posted by ed_uk on January 16, 2006, at 13:26:47
> Hi Marsha
>
> You could try imipramine again at a low dose, or maybe one of the more sedating TCAs given as a single dose in the evening.
>
> EdYeah, that's kind of what I'm thinking. Desipramine (side effects & not as effective as imipramine) is out, nortriptyline is out (increased anxiety) amitriptyline is out (sudden fits of rage)and Sinequan is out (completely screwed up my perceptions). What would be the next option?
And I guess I could take some drug for the inevitable horrible dry mouth.
If this doesn't work, I think that's the route I'll be going.
Why are TCA's less likely to set off dysphoric mania or mixed states or increased agitation/fear than SSRIs?
Thanks,
Marsha
Posted by 4WD on January 16, 2006, at 21:25:20
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by linkadge on January 16, 2006, at 8:25:04
> >If I take the Depakote and the agitation/fear >goes away, does that mean it IS med-induced >dysphoric mania? I'm kind of looking at this med >trial as a diagnostic tool.
>
> I would have to say no, simply due to the fact that depakote can be used as an adjunctive in severe anxiety, since it has a really strong gaba effect.
>
> But along those lines, if it works then so be it, you could continue to take it.
>
>
>
> Linkadge
If depakote increases gaba then why would it have a rep as sometimes increasing depression?Marsha
Posted by linkadge on January 17, 2006, at 9:41:37
In reply to depakote and gaba » linkadge, posted by 4WD on January 16, 2006, at 21:25:20
Good question, and I don't really know.
I think that gaba may be low in depression, but not as low as it is in mania or epilepsy. So if the dose is too high, an anticonvulsant may decrease neuronal activity too much.
Depakote also has effects on certain ion channels, such as blocking calcium and sodium chanels. It also decreases PKC.
I have to admit, that too much brought be down fairly quickly, but the right dose seemed to help.
Linkadge
Posted by detroitpistons on January 17, 2006, at 10:39:43
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by linkadge on January 15, 2006, at 16:55:03
"I think there is a group of people who are depressed, but still motivated, (sometimes motivated by obsession - or just running on stress hormones) and that the SSRI's don't correct the HPA axis dysregulation fast enough, at least for me they didn't.
For example with me, I became so afraid of falling behind in school, that even though I wanted to kill myself every day, I would still be doing my homework incessantly. Nobody thought I was depressed - (to be depressed you must have given up). I never give up, I just become more suicidal."Holy sh.it, that's me!! When I was in school, I was the exact same way. Anybody who says that you need to be laid up in bed and not shower for a week in order to be clinically depressed is FULL OF SH.IT. FEAR and anxiety are what keep me going. In school, it was the fear of getting bad grades. Now, it's the fear of not being able to get by and pay the bills and lose my "career."
Great post.
> I just remember that in certain states, the difference between a TCA and an SSRI was like night and day.
>
> For me, the TCA's usually improved sleep and appetite immediately whereas the SSRI's made those symptoms worse for a good 2+ weeks, (which intensified depression, anxiety and panic etc).
>
> I think there is a group of people who are depressed, but still motivated, (sometimes motivated by obsession - or just running on stress hormones) and that the SSRI's don't correct the HPA axis dysregulation fast enough, at least for me they didn't.
>
>
> For example with me, I became so afraid of falling behind in school, that even though I wanted to kill myself every day, I would still be doing my homework incessantly. Nobody thought I was depressed - (to be depressed you must have given up). I never give up, I just become more suicidal.
>
>
> Linkadge
>
>
>
>
>
>
>
Posted by linkadge on January 17, 2006, at 13:34:53
In reply to Re: Depressed/agitated/wired - soft bipolar? » linkadge, posted by detroitpistons on January 17, 2006, at 10:39:43
Thats a good word, fear. Fear is a horrable emotion to have to live with 24/7. It chips away at your sence of humanity. It makes your quality of life zero.
No diagnosis has sat well with me except maybe really bad generalized anxiety. The benzo's help but I ended up stopping them because I was too dumb on them.I tell my doctor. If you're going to give me a treatment, don't give me a treatment that is going to sabatage my best attempt at dealing with the stressors.
Linkadge
Posted by linkadge on January 17, 2006, at 13:35:17
In reply to Re: Depressed/agitated/wired - soft bipolar? » linkadge, posted by detroitpistons on January 17, 2006, at 10:39:43
Glad to find someone who could relate.
Linkadge
Posted by detroitpistons on January 17, 2006, at 14:19:37
In reply to Re: Depressed/agitated/wired - soft bipolar? » detroitpistons, posted by linkadge on January 17, 2006, at 13:35:17
> Glad to find someone who could relate.
>
> Linkadge
Yes, it is.That's the first time I've every heard someone describe "functional" anxiety/depression in that way...
I remember reading something at a very good, and well respected website that had a strong effect on me. In the author's opinion, basically you shouldn't even consider psychiatric meds unless you are staring at the ceiling with a bottle of Jack Daniels for weeks at a time (this statement was later modified)...I started believing that. I thought that as long as I could function in life, I shouldn't be taking meds. Also, people in my family started questioning me about it, implying that I didn't need them and I should stop taking them. I was believing all of this. I tried getting off of meds, and then I crashed into another depression.
That's when I realized, that enough is enough and that I had to take them, and that you don't need to be "staring at the ceiling, etc" to justify taking psych meds. My quality of life was crap. Sure, I got good grades in school, and later on in life I could get myself out of bed in the morning and go to work (although my jobs have not gone too well--I got fired from one, and nearly fired from another). Having FEAR as your primary motivation in life is not fun...No thanks, I'll take the meds if they work well.
Posted by linkadge on January 17, 2006, at 15:46:18
In reply to Re: Depressed/agitated/wired - soft bipolar?, posted by detroitpistons on January 17, 2006, at 14:19:37
Sucess is also another big misconception. Sucess never made me happy.
I needed to have a reason to let go. Because I hated the way I felt so much in the present, it made my goals seem like a necessity.
When I started to get better, I started to care about myself more. I started to like who I was. When that happened, I didn't need sucess so much.
Linkadge
Posted by ed_uk on January 17, 2006, at 16:11:39
In reply to Re: Depressed/agitated/wired - soft bipolar? » ed_uk, posted by 4WD on January 16, 2006, at 21:02:38
Hi Marsha
I'd be tempted to return to imipramine. You can take as little as 5mg at first and increase gradually. The 10mg tablets are useful for titration.
>And I guess I could take some drug for the inevitable horrible dry mouth.
Yes, there are a couple of meds which might help.
Ed
Posted by 4WD on January 17, 2006, at 22:40:10
In reply to Re: Depressed/agitated/wired - soft bipolar? » 4WD, posted by ed_uk on January 17, 2006, at 16:11:39
> Hi Marsha
>
> I'd be tempted to return to imipramine. You can take as little as 5mg at first and increase gradually. The 10mg tablets are useful for titration.
>
> >And I guess I could take some drug for the inevitable horrible dry mouth.
>
> Yes, there are a couple of meds which might help.
>
> Ed
Ed,When I was on imipramine in 1986-87, I was taking 50mg t.i.d. And doing well (except for pretty bad side effects). Is it possible that such a low dose would help without such bad SEs?
Do you know why SSRIs are so much more likely to cause anxiety than TCAs? This seems to be the significant issue here.
I thought serotonin was supposed to the "calming" neurotransmitter. Of course, dopaminergic drugs make me nervous and so so noradrenergic ones.
Go figure.
Marsha
Posted by ed_uk on January 18, 2006, at 9:38:10
In reply to Re: Depressed/agitated/wired - soft bipolar? » ed_uk, posted by 4WD on January 17, 2006, at 22:40:10
Hi Marsha
>When I was on imipramine in 1986-87, I was taking 50mg t.i.d. And doing well (except for pretty bad side effects). Is it possible that such a low dose would help without such bad SEs?
10mg is very unlikely to help - it's a good starting dose though. Starting TCAs at low doses reduces the severity of the side effects. You won't necessarily need 150mg/day though, some people are helped by lower doses eg. 75mg.
>Do you know why SSRIs are so much more likely to cause anxiety than TCAs?
Part of the problem is that people tend to take high(ish) doses of SSRIs right from the start eg. 20mg Prozac. People usually start TCAs at a low dose and work their way up to a therapeutic dose gradually.
>I thought serotonin was supposed to the "calming" neurotransmitter.
SSRIs consistently produce an initial increase in anxiety. After several weeks treatment, an anti-anxiety effect is often observed, especially in patients with OCD or panic disorder. Some find the SSRIs always aggravate their anxiety though - this is especially common in bipolar disorder, but is *not* 'diagnostic' of bipolar disorder.
Regards
Ed
Posted by 4WD on January 18, 2006, at 21:51:36
In reply to Re: Depressed/agitated/wired - soft bipolar? » 4WD, posted by ed_uk on January 18, 2006, at 9:38:10
> Hi Marsha
>
> >When I was on imipramine in 1986-87, I was taking 50mg t.i.d. And doing well (except for pretty bad side effects). Is it possible that such a low dose would help without such bad SEs?
>
> 10mg is very unlikely to help - it's a good starting dose though. Starting TCAs at low doses reduces the severity of the side effects. You won't necessarily need 150mg/day though, some people are helped by lower doses eg. 75mg.
>
> >Do you know why SSRIs are so much more likely to cause anxiety than TCAs?
>
> Part of the problem is that people tend to take high(ish) doses of SSRIs right from the start eg. 20mg Prozac. People usually start TCAs at a low dose and work their way up to a therapeutic dose gradually.
>
> >I thought serotonin was supposed to the "calming" neurotransmitter.
>
> SSRIs consistently produce an initial increase in anxiety. After several weeks treatment, an anti-anxiety effect is often observed, especially in patients with OCD or panic disorder. Some find the SSRIs always aggravate their anxiety though - this is especially common in bipolar disorder, but is *not* 'diagnostic' of bipolar disorder.
>
> Regards
>
> EdEd, thank you so much! I have been trying to find answers to those questions for years and no one has ever been able to explain it to me. I guess the trick is to manage the depression somehow while you work your way up to a therapeutic dosage. If I remember correctly i was started on 100mg of imipramine and pushed up to 150 in a couple of weeks.
So I guess you are saying that if I had started on a lower dosage and gone up much more gradually the side effects would never have been as intense?
No SSRI except low dose (37.5) Effexor has ever had an axiolytic effect for me, no matter how long I took it. I'm glad to know this is not a definitive indicator of bipolar. I really don't want to be rapid cycling bipolar/mixed states because it is apparently one of the hardest Dxs to treat. I'd rather just think I'm "allergic" to SSRIs and SNRI and Wellbutrin. Of course that only leaves the TCAs or MAOIs.
Don't you want to quit pharmacy school and be a pdoc? I'd come to England for treatment...
Marsha
What area of England btw?
Posted by ed_uk on January 19, 2006, at 14:45:39
In reply to Re: Depressed/agitated/wired - soft bipolar? » ed_uk, posted by 4WD on January 18, 2006, at 21:51:36
Hi
> If I remember correctly i was started on 100mg of imipramine and pushed up to 150 in a couple of weeks.
100mg is a very high starting dose. I'd recommend starting at 10mg and increasing in steps of 10mg as tolerated.
>So I guess you are saying that if I had started on a lower dosage and gone up much more gradually the side effects would never have been as intense?
They would probably have been milder - though still present.
>What area of England btw?
I live in Yorkshire.
Regards
Ed
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