Posted by antennastoheaven on June 24, 2013, at 13:02:29
In reply to Re: Bipolar DX based only on SSRI hypomanic response? » antennastoheaven, posted by SLS on June 24, 2013, at 5:56:26
> Having a manic reaction to an antidepressant is most likely a sign of bipolar disorder. The new DSM V is supposed to have this phenomenon listed as a subtype of bipolar disorder, even in the absence of spontaneous mania.
Lots of people say having a manic response to a SSRI is evidence of bipolar disorder, but the DSM-IV-TR criteria for a manic episode specifically exclude drug/medication induced symptoms. So the diagnosis still doesn't feel correct to me. Would a bipolar diagnosis be correct if I was manic due to, say, frequent cocaine use? I wouldn't think so, and I don't think things should be different if the drug is a SSRI.
> The recognition of bipolar disorder significantly changes treatment choices to include mood-stabilizing or anti-manic agents. Your particular presentation should probably be seen as bipolar I disorder. Depakote, Trileptal, and lithium are reasonable choices to be considered. The neuroleptics, Abilify, Seroquel, or Latuda, might be of help as well.
What would you expect those drugs to do for someone with no naturally occurring mania? These drugs seem to be useful mainly for controlling manic symptoms, which I only had as a result of certain drugs.
It seems with severe anhedonia, any drug that reduces brain activity (be it an anticonvulsant or neuroleptic) is not going to be helpful, unless these drugs are taken only to reduce side effects of other drugs. And taking one drug to reduce manic behavior of other drugs seems risky.
> My illness is similar to yours, and I have found Parnate and Nardil more effective than Emsam. You might consider taking an MAOI in combination with Lamictal and Abiify. Both have antidepressant propereties, and Abilify might help prevent a manic reaction.
Lamictal made me much more depressed (suicidal) so I do not want to take it. I'm already on Abilify and I found its antidepressant effects to be short-lasting and minimal at doses that I'm comfortable taking (higher doses cause akathisia)
poster:antennastoheaven
thread:1045773
URL: http://www.dr-bob.org/babble/20130617/msgs/1045789.html