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Dr. Bob is Robert Hsiung, MD,
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Posted by Anna P. on March 13, 2000, at 17:10:42
In reply to Re: Zoloft induced hypomania SAD, posted by d'bora on March 12, 2000, at 13:59:08
> Hello all. I was interested to find these postings as I, too, experienced hypomanic symptoms a few years back when I was treated with Zoloft. The Zoloft was prescribed for a long mis-diagnosed recurrent depression due to Seasonal Affective Disorder.
>
> The hypomania brought on by Zoloft manifested first as extreme irritability and later (in spring and summer) as greatly increased energy, mild euphoria and a much reduced need for sleep. This began to happen within the first 6-8 weeks or so of taking Zoloft. I've been through a number of different antidepressants since, none of which had quite that marked an effect.
>
>
Hello d'bora and everyone. After years now I understand what has happened to me. I also thought I have the Seasonal Affective Disorder. I also took Zoloft, and had "seasonal switches". However, I haven't experience mania, so I haven't suspect bipolar. Now , I know there are few types of bipolar. I just loose my energy every spring and fall, and go back to normal during the summer. The loss of energy is significant - I become dysfunctional, and so far no medication have helped.None of the local doctors knew what it is.
Anna P.
Posted by larry on March 13, 2000, at 20:57:06
In reply to Bipolar Disorder- Easy to Miss, Essential to Treat, posted by Chris A. on March 12, 2000, at 23:07:15
I too become irritable on SSRI's. What mood stabilizer do you use? >
That was a title of an article in a primary care journal.
>
> SAD accompanies my bipolar. My first hypomanic episode arrived with the advent of SSRIs following 25 years of recurrent depression. Irritability is the major component of my hypomanias/mania.
>
> Everyone is different. Just make sure you have a really good doc. Personally I think it's better to err on the side of using a mood stabilizer than not. I was in denial about the bipolar for years - still don't like it, but definitely need to bring the ends of the mood closer together.
>
> Good luck in sorting it out.
>
> Chris A.
Posted by d'bora on March 14, 2000, at 6:24:40
In reply to Bipolar Disorder- Easy to Miss, Essential to Treat, posted by Chris A. on March 12, 2000, at 23:07:15
Thanks to all for their input. I am not sure yet if this SAD "spring swing" phenomenon is anything to be worried about with reference to an underlying bipolar disorder. I'm just casting about for information since I saw a possible connection between SAD and bipolar disorders mentioned somewhere, and some of my past behaviours could conceivably be construed as, well, shall we say, the result of poor impulse control! :)
Does the fact that SSRI's trigger hypomania in itself confirm a bipolar disorder? Is it possible for a medication to trigger hypomania in a person who does *not* have an underlying bipolar disorder? Thoughts?
I live in a small community in the far north (howdy, eh!) and have little access to journals, etc., although I could certainly look into an interlibrary loan if I had some titles. I guess what I am most interested in would be information on specific articles that discuss a connection between SAD-like symptoms and bipolar disorders. Any particular journals I should be looking at?
Thanks again for everyone's input, it seems like there are a lot of helpful people in this neck of the woods!
d'bora
Posted by Scott L. Schofield on March 14, 2000, at 8:23:25
In reply to Re: Bipolar Disorder- Easy to Miss, Essential to Treat, posted by d'bora on March 14, 2000, at 6:24:40
>. I am not sure yet if this SAD "spring swing" phenomenon is anything to be worried about with reference to an underlying bipolar disorder. I'm just casting about for information since I saw a possible connection between SAD and bipolar disorders mentioned somewhere, and some of my past behaviours could conceivably be construed as, well, shall we say, the result of poor impulse control! :)
I don’t know very much about SAD (seasonal affective disorder). However, from the bit of reading I have done, including some stuff by N. Rosenthal, manic-like highs, and even acute manias, are definitely features of the illness. The posts appearing in this thread are consistent with this. Intuitively, it would seem that SAD and bipolar disorders share things in common, although I’m not sure it necessarily follows that they should be treated the same way. Perhaps manipulating the circadian rhythms using light-therapy is enough to abolish the manic-swing.
I don’t recall seeing any posts here addressing the details of the different strategies currently used for treating SAD. I hope someone reading this can help out.
- Scott
Posted by Chris A. on March 14, 2000, at 13:47:06
In reply to Re: Bipolar Disorder- Easy to Miss, Essential to Treat, posted by larry on March 13, 2000, at 20:57:06
> I too become irritable on SSRI's. What mood stabilizer do you use? >
>Mood stabilizers? I just started Aricept (donzepil) after my ECT treatment yesterday. I am also trying to use some salmon oil - EPA (eicosapentaenoic acid and DHA (Docosahexaenoic acid), but have not tolerated the dose very well. I also find good sleep hygiene essential to keeping my mood in check. My bipolar gets so mixed that I start feeling like a checker board sometimes. I have been through multiple stabilizers - (lithium, Depakote, Tegretol, Klonipin, lamotrigene, verapamil, gabapentin, topirimate, buprenorphrine and nimodipine. I also have to supplement the thyroid.
Chris A.
Posted by Anna P. on March 14, 2000, at 15:24:10
In reply to Re: Bipolar Disorder- Easy to Miss, Essential to Treat, posted by Chris A. on March 14, 2000, at 13:47:06
> > I too become irritable on SSRI's. What mood stabilizer do you use? >
> >
>
> Mood stabilizers? I just started Aricept (donzepil) after my ECT treatment yesterday. I am also trying to use some salmon oil - EPA (eicosapentaenoic acid and DHA (Docosahexaenoic acid), but have not tolerated the dose very well. I also find good sleep hygiene essential to keeping my mood in check. My bipolar gets so mixed that I start feeling like a checker board sometimes. I have been through multiple stabilizers - (lithium, Depakote, Tegretol, Klonipin, lamotrigene, verapamil, gabapentin, topirimate, buprenorphrine and nimodipine. I also have to supplement the thyroid.
>
> Chris A.Chris, what kind of results did you have on them, especially Topamax? Was it helpful, and how about the cognitive problems?
Anna P.
Posted by judy on March 14, 2000, at 19:23:06
In reply to Re: Bipolar Disorder- Easy to Miss, Essential to Treat, posted by Chris A. on March 14, 2000, at 13:47:06
Everytime I read your posts I'm amazed how similar our history is; I've also been on all the mood stabilizers you've listed and been treatment resistant to all. Are you having GI problems with the fish oil? (That's been my experience). You sound great after having just undergone ECT, have you had any negative experiences- especially memory? That's the only treatment being offered to me by shrinks now. I also am in massive denial about this disorder despite numerous hospitalizations for mania and depression- I'm convinced nothing works because I really have some incredibly severe personality disorder. I also started out with a SAD presentation when I lived in Minnesota- up in the spring down in the winter. I was part of a light study that really helped depressions; but I also tend to abuse substances which I realize screws everything up. Anyway I'm rambling, I'm glad you are doing better. Take care.
Posted by Chris A. on March 14, 2000, at 20:40:42
In reply to Re: Bipolar Disorder- Easy to Miss, Essential to Treat, posted by Anna P. on March 14, 2000, at 15:24:10
Anna, (Remember, your mileage may vary - you could get great results),
The Topomax was less than effective. My pDoc ended up sending me away for a inpatient consult. Lithium simply didn't cut it (I cycle and am mixed). Most meds just haven't seemed terribly efficacious for any length of time. I liked Lamictal because I had no side effects with it, but it didn't seem to work for me either. Nimodipine is extremely expensive and inconvenient with every four hour dosing. Verapamil is constipating, (over two years worth). I took a lot of Zantac along with Depakote. I also tried Clozaril which left me dangerously sedated. Buphenorphrine didn't do a thing. Perphenazine left me with signs of TD. What have I left out? Seroquel - somewhat sedating but not bad. Klonopin left me more depressed (if that is possible). Tegretol? - I don't recall what the problem was with it. If I'm purely low my light box helps, but overshoot of mood occurs easily in my case, which results in worse moods in the long run. At this point I might continue with maintenance ECT. We are just completing the acute phase and today has been good, so we'll see what my Pdoc says tomorrow.Hope you find the right combo.
Chris A.
Posted by Chris A. on March 14, 2000, at 21:52:21
In reply to To Chris A., posted by judy on March 14, 2000, at 19:23:06
Dear Judy,
Less than a third of the recommended dose of fish oil and it starts feeling like those fish are swimming back up! Dr. Steven Dubovsky, my favorite BP consultant, told me that a potential benefit of Aricept is that it could counteract some of those adverse GI side effects. I have that in writing or wouldn't believe it! I've just started the Aricept, so I'll
let you know in a couple of weeks. There are some slight short term problems with memory and ECT, but I don't plan on them lingering and they're not too bad. We didn't do any treatment closer than four or five days together. Now we're down to once a week. The idea of stabilizing the mood on Aricept and fish oil sounds attractive, but it's nice to know the ECT is there. At least it is convenient for me. I assume they'll use curare for the muscle relaxant now that I'm taking Aricept. Dubovsky also mentioned ziprasidone when I last saw him, but I don't know if it's on the US market yet.
If you find something that works like a miracle, let me know, since we seem to be so much alike. The only thing I have figured out is the sleep - Ambien works like a charm. At points I felt like I must be a really stubborn, pain-in-the-neck type person when the depression and dysphoric hypomania persist. Perhaps I should just tell my regular pDoc that I am here to aid him in character development.Take care,
Chris A.
Posted by Cam W. on March 14, 2000, at 23:45:23
In reply to Re: To Judy, posted by Chris A. on March 14, 2000, at 21:52:21
To All - I have recently read that the active ingredient for relief of bipolar disorder symptom, the omega-3-fatty acid are in very low concentrations in commercially available fish oil preparations. One has to take very high doses, resulting in much G.I. upset and a noticeable "fishy" odor exuding from the skin. I will concede that omega-3-fatty acids may relieve some of the symptoms of bipolar disorder, but I would like to see a few well designed studies to prove this. The studies I have read to date have had some serious methodological problems. Waiting with bated breath - Cam W.
Posted by Chris A. on March 15, 2000, at 0:33:55
In reply to Re: Main problem with fish oil in bipolar., posted by Cam W. on March 14, 2000, at 23:45:23
Cam,
Thanks for so kindly keeping us up to speed. I've had the misfortune (as have some others on the forum) to have tried the mood stabilizers rather thoroughly. That's why we're down to this fishy business. After having swallowed 720 mgs. of nimodipine a day for several months, fifteen capsules of fish oil should be a cinch - except for that little eructation problem. The limited studies on Omega 3s are definitely far from conclusive, but are very encouraging for those of us who have been desperately looking for help. Actually, I'm more concerned about mercury poisoning than the fishiness, so am careful about my source of oil. Hopefully a concentrated preparation of Omega3s will be generally available soon (anyone looking for a good business opportunity?!!). Aricept (donzepil) and ECT are not exactly first line treatments either. I'm also doing my trial under top-notch medical supervision. My consultant seemed hopeful than the donzepil might help with the GI side effects.Thanks for your dedicated caring and solid help to me and so many on this list.
Chris A.
Posted by Janice on March 15, 2000, at 12:25:39
In reply to Re: Bipolar Disorder- Easy to Miss, Essential to Treat, posted by Chris A. on March 14, 2000, at 13:47:06
Hello Chris,
I've been following your posting, and plan to buy the book you recommended by Dr. Mordimond. I haven't yet, but am curious as to what exactly is 'good sleep hygiene'.
In the past, I've tried to go to bed and get up at the same time every day. It's very difficult to follow but I do my best.
Just recently (last week-end), I started waking 1 1/2 hours earlier on my 'depressed days' of my cycle. So far I think it may work.
So is this good sleep hygiene?
Please keep us up to date with the ECT. I'm really hoping that this will give you the relief you need.
thanks, Janice
Posted by Janice on March 15, 2000, at 12:37:07
In reply to Re: Bipolar Disorder- Easy to Miss, Essential to Treat, posted by d'bora on March 14, 2000, at 6:24:40
Hi d'bora,
I explained in a thread below (the world must be round) about my family. How we all cycle seasonally, but 2 of us go manic.
the first cycle I developed was the SAD one(at 16). At 21 I developed a rapid cycling bipolar disorder.
I believe there is some indication that the earlier in life one develops bipolar (SAD and rapid cycling), often seems to determine the nature, course and severity of the person's bipolar illness.
Maybe you should read that thread. As Cam W says, ADs (and recreational drugs) can take the brakes off of a bipolar disorder that was previously lying dormant.
Good luck, Janice.
If i were you, depending on your age, etc. and other factors, I'd most definately keep an eye on it.
does that (howdy, eh) mean you are Canadian?
Posted by allisonm on March 16, 2000, at 12:27:49
In reply to Good sleep hygiene-rapid cycling bipolar (Chris A), posted by Janice on March 15, 2000, at 12:25:39
Janice,
I laughed when I first heard the term from my doctor. Good sleep hygiene, from what I gather from my psychiatrist, is basically making sure you are getting enough rest -- going to sleep early enough so that when you get up in the morning you are rested, etc.
allisonm
Posted by Chris A. on March 16, 2000, at 18:16:04
In reply to Good sleep hygiene-rapid cycling bipolar (Chris A), posted by Janice on March 15, 2000, at 12:25:39
Janice,
It sounds like you already practice good sleep hygiene. For those who are susceptible, just one night of deprivation can precipitate mania or hypo-mania. I didn't sleep at all Sunday night, which is a no-no for me. I had an ECT treatment early Mon. a.m., so it all worked out. One doc suggested that I have a policy of never going to bed after midnight. I need to renew that policy because it was definitely good advice for me! Sleep and mood are so intricately related. Mondimore devoltes a chapter to the relationship.I feel somewhat spacey. My hubby says that is to be expected with ECT, but he seems to think it's better than suicidal depression/mixed states. My pDoc say he still expects there to be ups and downs. I would like life to be smooth sailing. My treatments now are weekly. I'm not too fond of the feeling of my left hand not knowing what my right hand is doing! Thanks for your concern.
Chris A.
Posted by awb on May 17, 2000, at 13:25:42
In reply to Re: Main problem with fish oil in bipolar., posted by Chris A. on March 15, 2000, at 0:33:55
My husband tried fish oil capsules and quit because of the fishy after-taste. What we do now is eat lots of salmon and other fish and he takes flax oil tablets daily. Flax is very high in omega 3's. His doctor is aware of this and seems ok with it.
Posted by Jase on May 23, 2000, at 16:05:58
In reply to Re: Zoloft induced hypomania SAD, posted by d'bora on March 12, 2000, at 13:59:08
I have been on Wellbutrin/Zyban for 4 months, and have started experiencing hypomania episodes. But it is not a bad thing at all, and even before I was on any meds or depressed even I would do stuff like that.
My hypomania has made me more responsible and deciding to go back and finish up college. And to also get rid of my dead-end, evil boss job. I can do SO much better! And, I finally realize I am cute. :) Anyway, that has been my hypomania experience, oh. I also went on a shoping spree and bought tons of shoes! I could afford it though besides how can you not buy new shoes????
Jase
Posted by Newshound on June 7, 2000, at 17:58:21
In reply to Re: Main problem with fish oil in bipolar., posted by awb on May 17, 2000, at 13:25:42
Hello to all who've posted concerning fish oils and bipolar disease. (And hello to everyone else, too.)
I'm bipolar II (no ups, lots of downs), on lithium. I'm looking for a source (manufacturer?) of HIGHLY concentrated fish oil (EPA only or EPA / DHA) that has no cholesterol and no vitamin A or D. (Product with no cholesterol is said to be free of chemicals like PCB's, because of the way it's distilled. Don't think the process -- "molecular distillation" has any effect on elements like mercury or lead, unfortunately.)
Can anybody help ?
Thanks to all who post to be helpful to others.
Newshound
Posted by Abby on June 7, 2000, at 19:53:10
In reply to Re: Omega-3 source, posted by Newshound on June 7, 2000, at 17:58:21
> Hello to all who've posted concerning fish oils and bipolar disease. (And hello to everyone else, too.)
> I'm bipolar II (no ups, lots of downs), on lithium. I'm looking for a source (manufacturer?) of HIGHLY concentrated fish oil (EPA only or EPA / DHA) that has no cholesterol and no vitamin A or D. (Product with no cholesterol is said to be free of chemicals like PCB's, because of the way it's distilled. Don't think the process -- "molecular distillation" has any effect on elements like mercury or lead, unfortunately.)
> Can anybody help ?
> Thanks to all who post to be helpful to others.
> NewshoundTry omegabrite www.omegabrite.com They recommend 3 pills a day, but to get the same dosage as the Harvard study, you need more like 8 or 9
Posted by stacie on November 16, 2000, at 2:37:30
In reply to Re: Omega-3 source--a suggestion, posted by Abby on June 7, 2000, at 19:53:10
Has anyone tried a medically supervised treatment with flax seed oil, or flax seed oil capsules to replace fish oil? I switched from fish oil to flax oil out of concern about mercury and lead contamination.
Posted by Joelle on November 20, 2000, at 12:28:43
In reply to Omega 3 flax to replace fish oil. » Abby, posted by stacie on November 16, 2000, at 2:37:30
I take flax seed oil daily because it is healthy for you and it has had no ill effect on me. Flax is a natural product with NO herbal effect. It simply is food.
Joelle
> Has anyone tried a medically supervised treatment with flax seed oil, or flax seed oil capsules to replace fish oil? I switched from fish oil to flax oil out of concern about mercury and lead contamination.
Posted by annie8 on November 26, 2000, at 18:24:09
In reply to Re: Omega-3 source--a suggestion, posted by Abby on June 7, 2000, at 19:53:10
Hi I was wondering more about the lead issue with omega 3 pills, I take them, is there some danger there? why are you taking them.. I would love more info about this issue..
thanks!
> > Hello to all who've posted concerning fish oils and bipolar disease. (And hello to everyone else, too.)
> > I'm bipolar II (no ups, lots of downs), on lithium. I'm looking for a source (manufacturer?) of HIGHLY concentrated fish oil (EPA only or EPA / DHA) that has no cholesterol and no vitamin A or D. (Product with no cholesterol is said to be free of chemicals like PCB's, because of the way it's distilled. Don't think the process -- "molecular distillation" has any effect on elements like mercury or lead, unfortunately.)
> > Can anybody help ?
> > Thanks to all who post to be helpful to others.
> > Newshound
>
> Try omegabrite www.omegabrite.com They recommend 3 pills a day, but to get the same dosage as the Harvard study, you need more like 8 or 9
Posted by AndrewB on November 27, 2000, at 10:31:12
In reply to Can I find out more about omega 3 topic?, posted by annie8 on November 26, 2000, at 18:24:09
Annie,
From what I have read mercury, not so much as lead, is the issue of concern with fish oils.
Mercury levels are highest in fish oils derived from big (long living), warm water fish (i.e. swordfish). Conversely, fish oil from small, cold water fish such as salmon is relatively safe as far as mercury levels go.
It was my impression molecular distillation did remove the mercury and other heavy metals. That is what I was told at a health food store anyway. Tell me if I have been lead (no pun intended) astray on this point.
Levels of vitamins A & D are lower in the gel cap forms than the liquids.
For an absolutely safe source of EPA/DHA use the marine algae derived products. More expensive though. Great for vegetarians. Presumably no vitamin A, D or cholesterol but check the this out. A health food store sometimes supplies relevant literature or will contact the manufacturer to verify.
Flax seed oil has ALA (alpha lipoic acid), the third of the omega 3 fatty acids. The body can but may or may not convert this to EPA and DHA, therefore experts like Dr. Stoll recommend you stay away from flaxseed as a primary source of EPA/DHA.
AndrewB
Posted by annie8 on December 2, 2000, at 14:42:43
In reply to Re: Can I find out more about omega 3 topic?, posted by AndrewB on November 27, 2000, at 10:31:12
hi there, thank you so much, that was EXCELLENT info...
take care> Annie,
>
> From what I have read mercury, not so much as lead, is the issue of concern with fish oils.
>
> Mercury levels are highest in fish oils derived from big (long living), warm water fish (i.e. swordfish). Conversely, fish oil from small, cold water fish such as salmon is relatively safe as far as mercury levels go.
>
> It was my impression molecular distillation did remove the mercury and other heavy metals. That is what I was told at a health food store anyway. Tell me if I have been lead (no pun intended) astray on this point.
>
> Levels of vitamins A & D are lower in the gel cap forms than the liquids.
>
> For an absolutely safe source of EPA/DHA use the marine algae derived products. More expensive though. Great for vegetarians. Presumably no vitamin A, D or cholesterol but check the this out. A health food store sometimes supplies relevant literature or will contact the manufacturer to verify.
>
> Flax seed oil has ALA (alpha lipoic acid), the third of the omega 3 fatty acids. The body can but may or may not convert this to EPA and DHA, therefore experts like Dr. Stoll recommend you stay away from flaxseed as a primary source of EPA/DHA.
>
> AndrewB
Posted by RG on March 9, 2001, at 16:05:46
In reply to Re: Zoloft induced hypomania SAD, posted by Jase on May 23, 2000, at 16:05:58
Is this true, that antidepressants can trigger hypomania? This is the first I've heard about it. I was prescribed Zoloft when I was 17, and took it only a few months before stopping abruptly. My actions afterward are what I would consider manic.
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