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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Taylor123 on May 12, 2003, at 13:42:23
Hey all, Hope everything is going well for you.
After a long battle with depression, I was started on Effexor (now well on 225mg and 600mg Lithium)But when I started it, I became hypomanic. I believe this to be a "side-effect" of the drug, as opposed to a latent illness that was provoked by the drug.
Does anyone have any opinion about diagnosing BP II disorder on the basis of AD-induced hypomania?
I know that the DSM V criteria says that AD-induced mania must be EXCLUDED, so why then have I been given that diagnosis?
Thanks all
Take care
Posted by djmmm on May 12, 2003, at 16:32:13
In reply to Diagnosis of BP II after AD-induced Mania, posted by Taylor123 on May 12, 2003, at 13:42:23
> Hey all, Hope everything is going well for you.
>
> After a long battle with depression, I was started on Effexor (now well on 225mg and 600mg Lithium)But when I started it, I became hypomanic. I believe this to be a "side-effect" of the drug, as opposed to a latent illness that was provoked by the drug.
> Does anyone have any opinion about diagnosing BP II disorder on the basis of AD-induced hypomania?
> I know that the DSM V criteria says that AD-induced mania must be EXCLUDED, so why then have I been given that diagnosis?
> Thanks all
> Take careThis may help
http://www.canmat.org/gpsfps/nine/c/bipolarbottom.html
Posted by gregg on May 12, 2003, at 17:02:43
In reply to Diagnosis of BP II after AD-induced Mania, posted by Taylor123 on May 12, 2003, at 13:42:23
> Hey all, Hope everything is going well for you.
>
> After a long battle with depression, I was started on Effexor (now well on 225mg and 600mg Lithium)But when I started it, I became hypomanic. I believe this to be a "side-effect" of the drug, as opposed to a latent illness that was provoked by the drug.
> Does anyone have any opinion about diagnosing BP II disorder on the basis of AD-induced hypomania?
> I know that the DSM V criteria says that AD-induced mania must be EXCLUDED, so why then have I been given that diagnosis?
> Thanks all
> Take careTaylor,
Yeh, my wife had the same experience. Personally, I think that doctors just don't like to admit that their treatment is causing harm, so they blame it on the illness.
There is an "unofficial" term of Bipolar Type III that covers those with only AP-induced mania. In my wife's case, they first put her on Depakote to treat her supposed "Bipolar-II". The Depakote made her gain around 100 pounds. Later, she found that she didn't have the hypo-mania problem if she used Wellbutrin instead of an SSRI.
As you correctly note, the DSM says that drug-induced symptoms aren't supposed to count toward the diagnosis, but that doesn't seem to stop most PsyDocs.
gregg
Posted by Taylor123 on May 12, 2003, at 19:38:11
In reply to Re: Diagnosis of BP II after AD-induced Mania, posted by gregg on May 12, 2003, at 17:02:43
Gregg,
Thanx for the feedback.
I hope that your wife is doing well now, and that she has no more episodes of hypomania. i guess getting the right drug is so important.
I feel somewhat frustrated because I am now on Lithium as well, and feel that this has almost solidified my diagnosis, by being on a "mood stabiliser", and remaining well. Perhaps I should have just tried a different AD?
Please keep me informed if you find out any info on emerging research into bipolar "activation" by AD's.
Kind regards
Taylor
Posted by Taylor123 on May 12, 2003, at 19:42:04
In reply to Re: Diagnosis of BP II after AD-induced Mania, posted by djmmm on May 12, 2003, at 16:32:13
Thanx for the link djmmm.
It is informative to realise that the spectrum of bipolar is identified, but it really doesn't answer the question of why one has to be labelled with a condition, which could be the direct result of medication.
After all, do they label people with 'steroid-induced psychosis' as having a psychotic disorder?
Umm...Take care!
Posted by garylee on May 13, 2003, at 12:22:34
In reply to Diagnosis of BP II after AD-induced Mania, posted by Taylor123 on May 12, 2003, at 13:42:23
Hi Taylor
Please read a post of mine.
http://www.dr-bob.org/babble/20030505/msgs/226324.html
Cheers
Gary
Posted by Taylor123 on May 13, 2003, at 16:48:17
In reply to Re: Diagnosis of BP II after AD-induced Mania, posted by garylee on May 13, 2003, at 12:22:34
hi Gary,
Thanx for the link. Very interesting.
I have a question...
I am on high dose effexor and med. dose lithium. Do you think that they are cancelling each other out, and that perhaps I don't need to be on any of them?
I definatly needed the effexor first up, because of severe depression, but that has just lead to another diagnosis (namely BPII)
Should I attempt to come of them?
I know it's a question for my pdoc... but it's nice to get some peer feedback.
Cheers
Taylor
Best wishes
Posted by garylee on May 13, 2003, at 19:59:19
In reply to Re: Diagnosis of BP II after AD-induced Mania-Gary, posted by Taylor123 on May 13, 2003, at 16:48:17
Hi Taylor
Effexor affects the reuptake of Serotonin and norepinephrine, while (as far as I know) Lithium increase Serotonin synthesis, so as they both enhance serotonin I cannot see them cancelling each other out. Besides, the two meds may increase/decrease serotonin in different areas of the brain, but that is a much bigger story.
My only thought was that high dose of both drugs could *potentially* cause 'Serotonin Syndrome', which is not very nice! Please read the passage below:
"The drugs which we know most frequently contribute to this condition are the combining of MAOIs with Prozac (this should also include the other SSRIs) or other drugs that have a powerful effect upon serotonin, i.e., clomipramine (Anafranil), Trazadone (Deseryl), etc. The combination of lithium with these selective serotonergic agents has been implicated in enhancing the serotonin syndrome. The tricyclic antidepressants, lithium, MAOIs, SSRIs, ECT (electric shock treatment), tryptophan, and the serotonin agonists (fenfluramine) all enhance serotonin neurotransmission and can contribute to this syndrome."
This is only a thought of mine, but it would be better to talk to your doc. As for needing the meds at all, ask yourself these two questions: Are you depressed? Do the meds help? If both are yes then keep taking them. Keep tinkering around with doses and newer meds etc and talk with you doc, find what's right for you.Cheers
Gary
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