Posted by SLS on March 2, 2005, at 7:44:23
In reply to Re: SLS? yooo hooo..., posted by Spriggy on March 1, 2005, at 18:00:21
> My only conclusion is that all this stress has triggered bipolar that has already been there and never surfaced.
I think you hit the bullseye.
Because of your family history, the odds are rather high that you are also bipolar.
In adults, depression usually shows up first. It is somewhat difficult to say whether or not your agitation represents a bipolar mixed-state or atypical depression with anxiety, but that really isn't terribly important at the moment. Among other things, you are probably experience the "brain-fog" that many people describe as being a part of their depressions. For some people, the depressive state can become chronic without being interrupted by mania. They lie along a part of the bipolar spectrum that is different from where your father is situated. Your bipolarity might never look anything like your father's, but nonetheless, it might be a good idea to treat the two as having a common diathesis (biology). This would include the use of a mood stabilizer. A mood stabilizer has the potential to enhance the effects of an antidepressant, should one be necessary, and prevent a switch into mania that antidepressants can sometimes induce.
The anxiety you experience is probably a part of the bipolar depression rather than being a separate disorder. That it comes and goes several times a day is not really evidence of a rapid-cycling presentation. The true cycling of discreet bipolar states several times a day is exceedingly rare.
I think you might want to discuss with your doctor a trial of Lamictal. Lamictal is a mood stabilizer with antidepressant properties. 200mg a day seems to be the average effective dosage. If it doesn't work on its own, you can then consider adding lithium or an antidepressant. I suspect that the lithium would be helpful because it is very effective for bipolar I, which is what your father suffers from. Members of the same family very often respond to the same medication.
Weight gain is not an issue with Wellbutrin. Wellbutrin often produces anxiety/agitation/irritability/anger early in treatment, but there is a good chance they will disappear within a few weeks. In the meantime, you might be able to minimize these things by raising the dosage of Klonopin temporarily. Wellbutrin is thought to be an effective drug for treating bipolar depression.
Remeron is one of the drugs that will not act on you like the SSRIs, but often produces weight gain at the lower dosages. This tends to disappear at the higher dosages that are routinely prescribed for depression. I don't know the success rate of Remeron in treating bipolar disorder.
Parnate is the MAO inhibitor (MAOI) thought to be most effective for bipolar depression. Weight gain is unusual with this drug. The negative aspects of this drug is that you must remain on a special diet and be careful which drugs you take along with it. I am currently taking Parnate 70mg. I am not afraid of this drug. I have been on and off it since 1982. You can ask for more information from your doctor or here on Psycho-Babble. If your doctor is one who refuses to use Parnate under any circumstances, you might have to find another doctor who will if you exhaust treatment alternatives. Although tricyclics antidepressants (TCA) have a reputation to induce switches from depression into mania, I would still consider them as an alternative. Desipramine or nortriptyline are the two most often chosen because their side effects are milder than the others and are least like the SSRIs. I'm currently taking nortriptyline 100mg.
For what it is worth, my guess is that you are bipolar in a state of depression with anxiety and not in a mixed-state, nor hourly rapid-cycling. When the depression disappears, so will the anxiety and agitation/irritability. This is only a guess based on what little you have described. A more extensive interview with a doctor might reveal prior manic or hypomanic episodes and a true rapid cyclicity that occurs over the course of months (not hours).
- Scott
poster:SLS
thread:465034
URL: http://www.dr-bob.org/babble/20050227/msgs/465372.html