Opposite Reaction to Bipolar and SSRI Meds

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Green Lantern
Regular Member


Date Joined Apr 2006
Total Posts : 105
   Posted 9/18/2006 3:32 PM (GMT -6)   
My understanding from my PDoc is that some bipolar meds and SSRIs are supposed to help decrease anxiety.  However, since December 2005, I have been on Zoloft, Lamictal (bipolar), Paxil, Wellbutrin, Zyprexa (anti-psychotic) and now Lexapro.  With all of these meds, except for Lexapro, my anxiety symptoms became much worse.  Since I have been on Lexapro (40mg) and Lithium (600mg) I have also been taking 2mg Xanax 3x day, so I wonder if the Xanax is masking any increase in anxiety caused by the Lexapro and Lithium.  Just curious if anyone else has experienced this opposite reaction to any of these meds.  Thank you.
Generalized Anxiety Disorder, Depression


CounterClockwise
Veteran Member


Date Joined Jul 2006
Total Posts : 1529
   Posted 9/18/2006 4:43 PM (GMT -6)   
Hi Green Lantern,

Yes, meds can cause an increase in anxiety (usually short-lived, but with bipolar anything's possible, eh?!). There's a good site called Remedyfind.com (I think!) that has useful info on meds and it might be worth checking there to see what others on these meds are saying. The tricky thing is that with bipolar you very often (in fact I think always) have to take a combination of meds, where one med works on one aspect but might up something else (e.g anxiety) which then needs to be controlled by another med (which, however, might also be helping you with other symptoms not brought on by a med). Nicely confusing, but as long as the combo works, not something to worry about too much, I reckon!

Did you know that there's a bipolar board on this site? There might be some folks there that could help you with these questions too. -- You'd be really welcome!

Best wishes,
Rosie x
********************

People are not like fish: they do not work well battered.

When I'm not in my right mind, my left mind gets pretty crowded...

********************

 
Co-Moderator, Bipolar Forum


Green Lantern
Regular Member


Date Joined Apr 2006
Total Posts : 105
   Posted 9/18/2006 5:01 PM (GMT -6)   
Thank you.  The problem is, I don't think I'm bipolar.  I've never had the manic episodes associated with bipolar.  My last diagnosis was depression and GAD, but now I've got them really confused, because every thing they think should work has the opposite effect on me.  My biggest problem is the anxiety and I don't want to take something that works on depression, but makes me more anxious, only to have to take the ludicrous doese of Xanax I'm on.  Anyway, that's why I haven't posted in the bipolar forum, because they can't figure out whats wrong with me.  I just wish I could find the combo you talk about that actually works for me.
Generalized Anxiety Disorder, Depression


CounterClockwise
Veteran Member


Date Joined Jul 2006
Total Posts : 1529
   Posted 9/18/2006 5:47 PM (GMT -6)   
Hi Green,

Well, there are a lot of anti-depressants out there that work for anxiety (though differently with different people as I'm sure you know!). If you're not bipolar, you could certainly do without the lithium, but I can understand your doc being concerned not to rush into anything on this because untreated bipolar can be terrible.

When you say you've never had manic episodes, have you considered all the different types, and the possibility of mixed states? What caused you to be diagnosed bipolar in the first place? I know sometimes these diagnoses are got wrong, but it's so important to be sure. Have yu discussed your concerns with your doc?

Rosie x
********************

People are not like fish: they do not work well battered.

When I'm not in my right mind, my left mind gets pretty crowded...

********************

 
Co-Moderator, Bipolar Forum


Green Lantern
Regular Member


Date Joined Apr 2006
Total Posts : 105
   Posted 9/20/2006 1:26 PM (GMT -6)   
The PDoc who originally interpreted my psych test when I was in rehab first suggested the bipolar thing.  When I went to see another PDoc in person, I told him about this suggestion, so I think he had some pre-conceived notions.  He asked me all the standard questions about grandiosity, etc.  The only time I had manic type symptoms was when I was leading a high-pressure tight timeline project at work and working long hours and sleeping less.  He thought I may be bipolar mixed, but when I reacted so badly to Lamictal for bipolar he started rethinking things.  The anxiety was the worst part of it all, but he was afraid to give me benzos since I'm an alcoholic.  Finally after trying every SSRI and other types of meds that didn't stop the anxiety, he finally gave me Xanax.  That is the only thing that I can positively say works.  My Pdoc is basically stumped now and referred to a neuropsychiatrist that hooks your brain up to an EEG and based on that analysis, he can make a diagnosis and offer the right combination of meds.  Sounds a little out there, but I'm willing to try.  I'll let you know what happens.

Generalized Anxiety Disorder, Depression


CounterClockwise
Veteran Member


Date Joined Jul 2006
Total Posts : 1529
   Posted 9/20/2006 2:54 PM (GMT -6)   
Hm, tricky one Green. The problem of whether to tell a new doc your previous history or to get them to start the diagnosis from scratch. I think, on balance, I'd have done as you did: always good for them to have as much detail about your past treatments as they do about your presenting symptoms -- and, let's face it, some docs rather enjoy being able to prove others wrong. I do find it a bit bizarre that your current pdoc can't make a diagnosis, though. Are you sure he's not still thinking bipolar? He may have taken you off the Lamictal (some people do have bad reactions to this even if they are bipolar), but he's got you on lithium, right? I don't know of that being used in the treatment of anything other than bipolar.

The EEG may be a good idea -- don't know much about those...! At least you'll be seeing a specialist who should be able to help. There's every chance this will be the key to your treatment, but if it's not I'd change pdocs and find one that's willing to go back to the start and revisit your diagnosis. You need a firm yes or no on the bipolar front -- and if it's a firm yes (whatever type of bipolar you have, and, as you know, there are *many*), you need to work out a treatment plan for that. If it's not, then you can start addressing with your doc what the issue really is.

By the way, you say you're an alcoholic -- are you still drinking, or are you using the term as many recovering/recovered alcoholics do (i.e. once an alcoholic, always an alcoholic)? If you are still drinking there's every chance that the drinking is heightening your anxiety and otherwise interfering with your diagnosis and meds. If you are still in that place, please push treating that to the top of your agenda: it will only compromise your attempts to address the other things if you don't. Pleanty of people here have struggled with alcoholism and I'm sure would be very happy to talk to you about this.

All best,
Rosie x
********************

People are not like fish: they do not work well battered.

When I'm not in my right mind, my left mind gets pretty crowded...

********************

 
Co-Moderator, Bipolar Forum


Green Lantern
Regular Member


Date Joined Apr 2006
Total Posts : 105
   Posted 9/21/2006 2:00 PM (GMT -6)   
Thanks Rosie,
 
I've been sober for 9 months now.  I think I've probably always had the mental symptoms, but medicated with drugs and alcohol for the last 23 years, I'm 35 now.  I think he is using the lithium to make sure I don't have any mania from the Lexapro.  He also says it can enhance the effects of SSRIs.  The weird thing is, when he upped my dosage of lithium form 300mg 2x day to 300 and 600, I became even more anxious, mind racing etc.  I think he is having trouble with a diagnosis for three reasons:  1.  I don't have a lot of history to draw on where I wasn't drinking every day.  2.  None of the meds seem to have the effect on me that pdocs are trained to expect.  3.  Any manic symptoms, spending money, fiighting, more self-confidence, risky behavior, all happened when I was drinking.  I have a lot of confidence in this pdoc, he specializes in addictions, but even he suggested the EEG thing with other pdoc and has mentioned other pdocs he could refer me to to get a fresh start.  Thanks for your replies.
Generalized Anxiety Disorder, Depression


CounterClockwise
Veteran Member


Date Joined Jul 2006
Total Posts : 1529
   Posted 9/21/2006 6:10 PM (GMT -6)   
Hi Green,

Good for you for being off the booze for 9 months. -- Takes a lot of doing, I know: well done!!! :)

If your doc is worried about you having mania from the Lexapro, he's still thinking you're bp, since only bp needs a-ds offsetting with anti-mania drugs. If you're not bp and the a-ds are causing heightened anxiety beyond a couple of weeks, you're probably on the wrong a-ds.

I can totally understand where the drinking is causing confusion. -- Have you thoroughly investigated with your pdoc which came first (self-medicating with alcohol or bp)? Self-medicating this way is a common symptom of bp. Then again, alcohol can lead to similar symptoms. So it's crucial that you establish which came first. You say that the manic symptoms all happened when you were drinking -- can you be absolutely certain on that? If so, then, although it's still possible that the alcohol triggered bp, it does reduce the chances of this being the diagnosis.

Bp can be very hard to medicate. Remember that none of the meds, bar lithium, was designed to treat bp (and even lithium has a peculiar history). Essentially, anti-psychotics are designed for seizures, a-ds for depression. And bear in mind that a-ds work differently even for people with anxiety and/or depression (e.g. I take citalopram these days -- great for me, anxiety-inducing for others; and past meds I've taken have given me all sorts of side effects but have been life-savers for others). This means that sometimes it takes a lot of trial and error to find the right combo for bp.

It sounds like your pdoc is very wise -- takes a lot of wisdom to know your limits. If he's suggesting referrals, take that route: this pdoc knows he's confused, and knows that there might be wisdom out there that you could benefit from.

Rosie x
********************

People are not like fish: they do not work well battered.

When I'm not in my right mind, my left mind gets pretty crowded...

********************

 
Co-Moderator, Bipolar Forum


Howlyncat
Elite Member


Date Joined Jan 2005
Total Posts : 24909
   Posted 9/22/2006 6:09 PM (GMT -6)   
Kudos for the not drinking for all this time..........I am a sober alcoholic since 1979 and I stil go to the odd meeting for the fellowship and I talk to my sponser occasionally we are the best of friends ......I wish you all the best Green and Rosie has given great really geat input ............Take care and remember

One Day At A Time


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