Question:
I am currently taking Prozac. I am not currently on any mood stabilizer and surprise, surprise I am cycling pretty good. My therapist was very concerned, but I still can't get in to see the Pdoc until January 14th. I was wondering if anyone here has ever tried an antidepressant without a stabilizer successfully.
Answer:
Have you been formally diagnosed as a manic depressive? If you were like
me, and got misdiagnosed as unipolar, then it is not safe to just take
an SSRI. Prozac can make you cycle rpaidly, like you said, and can
possibly send you to a full blown manic episode. I suggest that you talk
to you pdoc RIGHT AWAY and tell him it's a damn emergency. Geez....pdocs
can be so stupid at times!!!! I don't know whether it is stupidity or
superiority complex or what. Keep pushing, Julez. Don't give up until
you get to see the pdoc. I have been formally dx'd but I haven't been treated by the pdoc yet. He is
a new one and I can't get in any sooner than 1/14 ... this is ridiculous, I
agree.
The prozac was given to me by my MD for a major depressive episode. Both my
Doctor and my therapist think I am manic depressive. Both my father and my
sister are manic depressive... although my father is also schizophrenic.
I am afraid of most of the meds anyway.. but I am getting worse as I get
older (29 now) and knew I needed help.
pdoc diagnosed me with major depression, gave Zoloft... I felt better....
became manic... became delusional... ended up in hospital... diagnosed with
bipolar disorder. hi, im pretty new too...
i was mixed and they put me on paxil. initially i was white manic (which
was a nice switch) and when i went up to 20mg, it was rapid cycling from
hell...then started in with other stuff... but i think it's sort of a
dangerous thing to just take a a/d.. This is essentially what happened to my husband, only it was Prozac, not
Zoloft. Our therapist then said that the evidence of SSRIs causing manic
breaks is anecdotal. Anyone have any studies to quote? BACKGROUND: The likelihood and character of antidepressant-induced mania
remain important but poorly understood factors in the treatment of bipolar
depression.
METHOD: We examined the response to naturalistic treatment of 29 bipolar I
patients who experienced a total of 79 depressive episodes. Treatment
consisted primarily of mood stabilizers used alone (N = 31) or in
combination with antidepressants (N = 48). Intensity of baseline mood
stabilizer therapy, adequacy of added antidepressant therapy, intensity of
ensuing mania or hypomania, and course of illness prior to study were
measured, and selected comparisons were made between treatment groups.
RESULTS: Postdepressive mood elevations (i.e., switches) that occurred
during or up to 2 months after each depressive episode were present in 28%
(22/79) and judged to be severely disruptive in only 10% (8/79) of
episodes. Examining only the first episode per patient, a history of a
greater number of past manic episodes was associated with a higher risk of
switching (p < .023). Antidepressant treatment combined with mood
stabilizer therapy was not associated with higher rates of postdepressive
mood elevation than mood stabilizer therapy alone. At a descriptive level,
subjects treated with tricyclic antidepressants (TCAs) and monoamine
oxidase inhibitors (MAOIs) were associated with a higher switch rate than
those treated with fluoxetine; TCAs were also associated with more intense
switches.
CONCLUSION: The frequency and severity of postdepressive mood elevation
associated with acute or continuation antidepressant therapy may be reduced
by mood stabilizers. Such elevations may be more likely in patients with a
strong history of mania.
Serotonin reuptake inhibitors (SRIs) are now considered the first-line
treatment for depression, but they have not been well studied in bipolar
disorder. Recently, some authors have recommended that patients at risk for
antidepressant-induced mania be treated with SRIs rather than tricyclic
antidepressants (TCAs). Clinical information about 11 patients who
developed mania during treatment with SRIs is described. These patients
were found to have personal or family histories of hypomania or mania, but
these disorders were not usually recognized at the time of the patients'
initial treatment for depression. The SRI-induced manic episodes were also
quite severe, having psychotic features or requiring patients to be
secluded for extreme agitation, but patients responded completely to
antimanic treatment. The risk of treatment-emergent mania with SRIs is not
trivial, especially among patients at risk for bipolar disorder. Additional
research is needed to compare the actual rate of drug-induced mania with
SRIs and TCAs in patients with different bipolar subtypes, while
controlling for concurrent antimanic drug use.
OBJECTIVE: The longitudinal course of 51 patients with treatment-refractory
bipolar disorder was examined to assess possible effects of heterocyclic
antidepressants on occurrence of manic episodes and cycle acceleration.
METHOD: Using criteria established from life charts, investigators rated
the patients' episodes of mania or cycle acceleration as likely or unlikely
to have been induced by antidepressant therapy. Discriminant function
analyses were performed to assess predictors of vulnerability to
antidepressant-induced mania or cycle acceleration. Further, the likelihood
of future antidepressant-induced episodes in persons who had had one such
episode was assessed.
RESULTS: Thirty-five percent of the patients had a manic episode rated as
likely to have been antidepressant-induced. No variable was a predictor of
vulnerability to antidepressant-induced mania. Cycle acceleration was
likely to be associated with antidepressant treatment in 26% of the
patients assessed. Younger age at first treatment was a predictor of
vulnerability to antidepressant-induced cycle acceleration. Forty-six
percent of patients with antidepressant-induced mania, but only 14% of
those without, also showed antidepressant-induced cycle acceleration at
some point in their illness. CONCLUSIONS: Mania is likely to be
antidepressant-induced and not attributable to the expected course of
illness in one-third of treatment-refractory bipolar patients, and rapid
cycling is induced in one-fourth. Antidepressant-induced mania may be a
marker for increased vulnerability to antidepressant-induced cycle
acceleration. Antidepressant-induced cycle acceleration (but not
antidepressant-induced mania) is associated with younger age at first
treatment and may be more likely to occur in women and in bipolar II
patients.
For me-- clinic diagnosed me with major depression, gave Prozac... I
*think* I felt better for a week or two... became very agitated,
thoughts started racing, all that stuff... became delusional... was
spiralling further and further out of control... couldn't get anyone
at the clinic to hear what was happening to me, tho I tried
*repeatedly*... they had set up an appointment for me with a private
psychiatrist, a whole month later, and expected me to wait until then
for any real help... in some moment of sanity, I realised my problems
could be med-induced... stopped taking the Prozac... as the stuff left
my system, the psychosis went and I came down... and crashed into the
deepest depression of my life... clinic privatised me, when I was way
down there in the pit... private pdoc put me on a small dose of Aropax
(what US folks call Paxil)... I went hypomanic for a week or two, then
stabilised as mildly depressed... private pdoc unexpectedly had to go
on early maternity leave... she passed me, and all her other clients,
onto one of her collegues... had one appointment in about 3 months...
crashed bigtime again-- as badly as I had after the psychotic
episode... pdoc put me on another antidepressant drug called Aurorix
(moclobemide-- fairly common here in Australia, doesn't seem to be
used much anywhere else), really cautious with the dosing... I
*didn't* go manic-- possibly because of the Neurontin I had on board
(I also have epilepsy, and my meds had been fiddled with between tries
with antidepressants)... as I write this, I'm slowly recovering.
