Posted by Tomatheus on January 10, 2006, at 18:46:02
In reply to Re: Depressed/agitated/wired - soft bipolar? » Berberis, posted by Lucia Francisca on January 10, 2006, at 12:19:07
> But I would be interested to know if people ONLY had hypomanias because they took ADs, and didn't have them if they didn't take ADs.
Yeah, that's the case with me. I've experienced cycling (hypomanic periods that last about 3-4 days, followed by depressive periods of the same duration with no euthymia inbetween) only in response to taking SSRIs. Or in other words, I had no hypomania before I took any meds, no hypomania after discontinuing SSRIs (unless I started another SSRI), and no hypomania on Wellbutrin or MAOI monotherapy. As far as MAOIs go, I've taken Parnate, moclobemide, and Nardil without a mood stabilizer and still did not experience any hypomanic symptoms. I suspect that in addition to the SSRIs, I would probably would have also cycled on the SSNRIs and TCAs since they all inhibit the reuptake of serotonin and norepinephrine to some extent, but I guess I can't be sure about each and every last SSNRI and TCA.
Still, though, there is a school of thought with respect to bipolarity that essentially states that *all* patients who experience any medication-induced hypomania not only lie along the bipolar spectrum, but *must* take mood stabilizers, either alone, or with antidepressants and *cannot* take antidepressants alone under any circumstances. I've obviously found this school of thought to be inconsistent with my experiences. Even though some patients with treatment-induced hypomanic symptoms are certainly well-served by taking a mood stablizer, I don't think that psychiatrists and researchers understand the underlying causes of mood disorders well enough to justify concluding that all patients with "bipolar spectrum" disorders *must* take a mood stabilizer and *must not* ever take an antidepressant alone - not even something with a different mechanism than the drug that triggered the hypomania. Judging from posts I've read on this board and elsewhere, patients who fall within the bipolar spectrum sometimes differ significantly in terms of their hypomanic symptoms (i.e., some "switch" to long-term hypomanic states, others go through rapid cycling; some experience relatively mild hypomania, others experience full-blown mania; some report feeling mostly euphoric during their (hypo)manic states, others report being mostly agitated and irritable; some report hypomanic symptoms both before and after taking ADs, others report hypomanic symptoms only while taking ADs; some can take certain classes of ADs without experiencing hypomania, others cannot). I could probably come up with a few more examples, but I think my point is clear that there are wide variations in the spectrum of disorders that fall between pure unipolar depression and bipolar II disorder. Furthermore, researchers have identified so many different specific biochemical abnormalities that may be involved in the causation of both depression and bipolar disorder that it is likely that at least several different underlying "bipolar spectrum" pathologies exist. If different bipolar spectrum patients have different pathologies (as the research suggests), it is likely that these patients will in turn require different treatments.
As far as the diagnosis is concerned, it doesn't really matter much to me whether my doctor wants to call my disorder depression or bipolar disorder. As others here on Psycho-Babble often point out, getting the optimal treatment is of primary importance.
Tomatheus
poster:Tomatheus
thread:596894
URL: http://www.dr-bob.org/babble/20060108/msgs/597680.html