View Full Version : bipolar and anti depressants


Fuzzy12
11-21-12, 09:45 AM
From what I've read so far, anti depressants are more likely to induce switching to manic or hypomanic episodes in patients with bipolar disorder.
But then there have been cases where unipolarly depressed patients became manic/hypomanic. I don't remember exactly but I think according a study I read, 30-40% of bipolar patients experienced switching with anti depressants and about 10% of patients with unipolar depression experienced switching with anti depressants.

So doesn't this mean, that if you have experienced a hypomanic episode induced by your anti depressant you are likely to be bipolar but aren't necessarily so? (Sorry, if I'm stating the bleeding obvious.)

But then if you need evidence of only ONE manic or hypomanic episode for a diagnosis of bipolar disorder, isn't the risk of a misdiagnosis rather high (If you happen to be among the 10% of patients with unipolar depression who experienced switching)????

On another note, I found a really interesting website (http://www.psycheducation.org/bipolar/controversy.htm) that discusses studies about the use of anti depressants for bipolar patients. It talks about the risk of inducing manic/hypomanic episodes, kindling (i.e. worsening of manic/hypomanic episodes triggered by these episodes) and if anti depressants work in bipolar depression at all.

EDIT:

One more question: Are there any signs indicating that a manic/hypomanic episode is coming on? Like increased restlessness, mood swings, etc.?? I mean, does it start slowly and then increase?

And one more question:

Are mania or hypomania triggered by any external factors, for example an exciting event or do they always happen completely at random?

And one more :doh:

Does caffeine make your mania/hypomania worse or maybe even induce it (perhaps when you are vulnerable already)??

Abi
11-21-12, 06:26 PM
1. Is there s a risk of misdiagnosis?

Yes.

2. Are traditional antidepressants effective in bipolar depression?

Usually yes. We take them in combination with mood stabilisers like Depakote, Lithium, Lamictal or Tegretol to offset their mania-inducing effects.

3 Are there any signs indicating that a manic/hypomanic episode is coming on? Like increased restlessness, mood swings, etc.?? I mean, does it start slowly and then increase?

Usually yes, though it's taken me years to learn to identify them.

4. Are mania or hypomania triggered by any external factors, for example an exciting event or do they always happen completely at random?

Could be either one.

5. Does caffeine make your mania/hypomania worse or maybe even induce it

No, at least in my experience.

crystal8080
11-21-12, 07:07 PM
1. Is there s a risk of misdiagnosis?

Yes.

2. Are traditional antidepressants effective in bipolar depression?

Usually yes. We take them in combination with mood stabilisers like Depakote, Lithium, Lamictal or Tegretol to offset their mania-inducing effects.

3 Are there any signs indicating that a manic/hypomanic episode is coming on? Like increased restlessness, mood swings, etc.?? I mean, does it start slowly and then increase?

Usually yes, though it's taken me years to learn to identify them.

4. Are mania or hypomania triggered by any external factors, for example an exciting event or do they always happen completely at random?

Could be either one.

5. Does caffeine make your mania/hypomania worse or maybe even induce it

No, at least in my experience.

I am working on learning my triggers and early warning signs. Sometimes something sets it off, sometimes its random. I am trying to learn how to manage what is manageable.

From my last appointment I learned a few of my early warning signs together with my doctor, and that they don't always happen in the same order, or send me in the same direction. Its very complicated.

I just started an antidepressant, was very nervous about it since I don't have good experiences with them. But I am actually feeling a lot better, and I finally feel stable again.

keliza
11-21-12, 07:52 PM
In order of appearance...

1. The odds of a person with bipolar disorder (BD) switching from depression to mania while taking antidepressants WITHOUT an adjunct mood stabilizer* is about 50%, so flip a coin. The odds of someone with unipolar depression (AKA major depressive disorder, MDD) are less than 5%. So if someone flips to mania when taking an antidepressant there is a greater likelihood that they have BD, not MDD, yes. It doesn't mean definitely, and occasionally other things can induce mania with antidepressants as well (like having a comorbid substance abuse disorder, for example). But most of the time the switch is caused by bipolar disorder.

* = With an adjunct mood stabilizer, the odds of switching are much less. By mood stabilizer I mean a medication indicated to decrease the frequency and intensity of mood episodes. The only drug specifically marketed as a mood stabilizer and nothing else is Lithium. Most other mood stabilizers are either anti-epileptic drugs like Depakote, Lamictal, and Trileptal, or atypical antipsychotics like Seroquel, Risperdal, Zyprexa, Abilify, etc. These drugs have mood stabilizing properties even though they aren't specifically marketed as mood stabilizers. Some people will still switch even with a mood stabilizer, but many won't.

2. Most psychiatrists will require that you have had at LEAST one manic/hypomanic episode not induced by medication before they will definitively diagnose BD. That or all the other symptoms must be so indicative of BD that there is no shadow of a doubt that this manic/hypomanic episode would have occurred eventually, even if not caused by antidepressant use.

3. Are there signs that a manic episode is coming on? Sometimes. Sometimes I get a slow, creeping feeling over a few days, a feeling of irritability and wanting to get out of my own skin. It's almost like PMS but more wired. Then I wake up one day and boom, manic. Or it just happens all at once without any sort of warning. I've had episodes where I was fine, took a nap, and 2 hours later woke up manic. Just like that.

4. Mania and hypomania can be triggered by external factors, yes. Lack of sleep is NOTORIOUS for causing manic episodes. In fact, the link between sleep disturbances and mood episodes is so strong that many researchers have begun to wonder if bipolar disorder is on the cusp between a mood disorder and a sleep disorder. A study found differences in the melatonin receptors in the eyes of bipolar patients versus NT controls, which seems to indicate that exposure to light and the brain's circadian rhythms have at least a small role to play in the complex puzzle that is bipolar disorder. Also, stimulants (Adderall, Ritalin, cocaine, caffeine, etc.) can trigger mania in certain individuals. But it's never 100% across the board - some people with bipolar disorder can't even have a cup of coffee without risking mania, while others drink a whole pot of it a day and are fine.

5. Yes, caffeine can exacerbate or even induce manic episodes. It's not a guarantee though, like I said. Depends on the person.

Zaashy
11-29-12, 02:18 PM
I approached my doctor and I told him I'm super depressed and have symptoms of ADHD.
After a long chat he suspected based on family history that I might be bipolar. So he gives me anti-anxiety and anti-depressant without any bipolar meds. He said I must wait and see
how I react to the anti-depressants before prescribing BPD meds. He suspects it could just be depression. Now I'm frustrated because my symptoms caused my depression and not the
other way around.

Atleast now I know that ant-depressants won't cover it up so thanks guys.