Question for bi-polar sufferers who have taken an SSRI

[Mr Blonde]

I would like to hear from anyone who is bi-polar, has taken an SSRI and had it trigger a manic episode.

Specifically, I'd like to hear information on how long it took before symptoms of mania presented, what symptoms presented first, how bad it got, etc...

P.S. Mods, I wasn't sure which forum to place this in, seeing as it's about mental illness and medication, but I figured TDS was maybe the best place... if not feel free to move.

 

[Miss Hollywood]

I am bi-polar and before I was formally diagnosed I was put on Celexa.

At first it helped with the depression a bit but, after awhile it started to change how I felt...I flatlined (had no emotions, just felt completely numb)and then BOOM...went into full blown mania.

I am currently on an anti-psychotic called Geodon (it's similar to Abilify)and it's worked wonders for me. Now my doctor is talking about adding an SSRI but I'm a bit leary about it because I've never had good experiences with them...I have been on and off anti-depressants most of my life. Reason being...NONE OF THEM WORKED FOR ME!

Try going to see a doctor about getting on an AP like Abilify, Seroquel, or Geodon. Seroquel didn't mesh too well with me so I got put on Geodon. You will get worse before you get better...the side effects suck at first but slowly start fading away. I'm finally starting to really respond well to the medications they have me on....but I'm still at the beginning too. They are still trying to figure out what cocktail of meds to give me. Everybody's brain chemistry is different.

Good luck and hang in there! Don't take anymore SSRI's if you are bi-polar..because it will just intensify your current state (if your manic).

 

[paranoid android]

I have bipolar but ive never taken a SSRI. I have however taken effexor which is a SNRI, amitriptyline which is a tricyclic that is basically a SNRI and remeron (mirtazapine) which is a serotonin norepinephrine enhancer. I may be forggeting a few others.

I got really bad mania from effexor the stuff made me completely crazy even on the lowest dose. It started making me manic after about a day on the stuff. The rest wherent so bad but effexor drove me batshit crazy.

I don't take any serotonic anti-depressants anymore because they not only don't work for me but often make me worse. Even tramadol makes me feel really weird but try telling a GP that and they look at you like you have 2 heads 8)

 

[Cloudburst]

The psychiatrist had no idea what the fuck was wrong with me (as is normal with bipolar) and just took the easy route by scripting me SSRIs for years. I would constantly get in ranges. I did not feel pleasant. I would pull the key out of the car in the middle of the road, scare my parents so shitless they'd lock me out and I'd bash the windows in, etc. However I developed bipolar early, about 13, the age explaining the tendency toward rage. It was simultaneously developing with antidepressants so I can't say much.

When I got off them, I felt a wave of orgasmic, otherworldly euphoria. I assumed I was completely cured. Wrong.

 

[paranoid android]

Effexor gave me mixed state mania alot of the time and id go into full blown rage. The doctor just thought it was depression and i thought so too so i put up with almost 2 months of craziness which nearly ended up with me in the slammer a few times. 4 years later i was finally diagnosed bipolar and 3 years later i finally found something that actually worked.

 

[Cloudburst]

Exactly, they mistake the mixed state for worsening depression and just keep boosting the dose until something catastrophic happens. It took me 6 fucking years to get diagnosed myself.

 

[Mr Blonde]

I was put in the psych ward on Sunday, started on citalopram Monday, started feeling VERY fucking hyper the next day, I have had manic episodes before but when I tried telling the psychs at the hospitals that they didn't believe me. They just thought I experienced a 'too elevated' mood from SSRIs despite the fact I had religious grandeur, delusional thoughts, went from introverted to over-the-top extroverted and fucked up my until that point good high school career.

I've stopped taking the citalopram my family is dishing out to me and am keeping it stored up. Have skipped two doses so far and I don't feel like symptoms have worsened, but will see.

 

[Cloudburst]

Can you possibly consult more people before self-prescribing (well, you know what I mean)? There could always be comorbidity like ADHD, OCD, etc. It's really quite complicated and I wouldn't make that decision for myself for now.

 

[lewis_bixby]

Hi fellas,

I'm a 29-year old alcoholic diagnosed with unipolar (major) depression coupled with GAD. I'm currently taking 40mg Cipralex (Lexapro) and 1mg Lorazepam (nightly, before bed). I was on Effexor for 8 months but started experiencing strange side effects (increased anxiety, hypomania) and, as a result, weened myself off of it. I remained unmedicated for almost a year until June 2008, when my PCP put me on 20mg of Cipralex and referred me to a psychiatrist who increased my SSRI doasge and prescibed me the Lorazepam. Frankly, the Cipralex has "pooped out" on me and my shrink suggests trying something else soon (hint: another SSRI), but that's another story.

I'm curious what a "manic" epsiode is like for you guys - i.e. can you always 'sense' it coming on, are there certain situations that can trigger an episode, etc? I've always been interested in how bipolar individuals differ from myself, generally speaking (unipolar depression vs. bipolar depression)? My PCP once told me that most of the time, bipolar patients are in a depressed state, as opposed to a manic state; is this generally true ? Thanks for reading.

 

[Cloudburst]

Hey lewis, welcome!

Bipolar is different for everyone, to the point where there are subcategories (Bipolar I with full blown mania, Bipolar II for mild-moderate mania otherwise known as hypomania), and even within those it is still variable. From my personal experience, mania smacks me in the face immediately, and I am fairly sure onset of episodes tend to be very quick. So many situations can trigger it: sleep deprivation is number one for me, excessive stress - any extreme in a typical life, anywhere from watching your child be born to your mother die can trigger a completely random (roll of the dice) episode. Most bipolars are depressed most of the time, yes. By far the most accurate description of mania I've read was from a sufferer herself who has a Phd, Kay Jamison:

"My thoughts were so fast that I couldn't remember the beginning of a sentence halfway through. Fragments of ideas, images, sentences, raced around and around in my mind like the tigers in a children's story. Finally, like those tigers, they became meaningless melted pools. Nothing familiar to me was familiar. I wanted desperately to slow down but could not. I felt my mind encased by black lines of light that were terrifying to me. My delusions centered on the slow painful deaths of all the green plants in the world - vine by vine, stem by stem, leaf by leaf they died, and I could do nothing to save them. Their screams were cacophonous. Increasingly, all my images were black and decaying."

 

[Mr Blonde]

Can you possibly consult more people before self-prescribing (well, you know what I mean)? There could always be comorbidity like ADHD, OCD, etc. It's really quite complicated and I wouldn't make that decision for myself for now.

I possibly could, however my patience is thin right now; I've talked to two psychologists, my GP, a couple of social workers and three separate psychiatrists and so far everyone thinks anxiety is my major problem however they put me on SSRIs instead of anything else (I'm not just seeking benzodiazepines, something like Buspirone may help as well), and put me into counselling. I'm willing to give counselling one more try however I am convinced there is something bigger at play and manic depression is my major suspect due to the symptoms I have described. One of the other disorders you mentioned may be there though, but never has a medical personnel considered or mentioned it to me.

I also suspect my honesty about my drug use may be something stopping them from investigating other possible disorders.

I'm curious what a "manic" epsiode is like for you guys - i.e. can you always 'sense' it coming on, are there certain situations that can trigger an episode, etc? I've always been interested in how bipolar individuals differ from myself, generally speaking (unipolar depression vs. bipolar depression)? My PCP once told me that most of the time, bipolar patients are in a depressed state, as opposed to a manic state; is this generally true ? Thanks for reading.

In my experience, I can usually tell something is changing before I go into what I consider to be full mania (not sure if hypo or full blown). As I suffer from anxiety a lot, it can sometimes be hard to tell if my anxiety is already bad but usually there is a change in my thoughts and behavior... I become a lot more erratic, more confident, more talkative, the anxiety usually starts to fade away a bit as well.

I am depressed most of the time, mania has been rare for me. I've had manic episodes perhaps three or four times in the past three years.

 

[skillz~4~thrillz]

I was diagnosed bc I went to therapy and outpatient rehab at 24,I was initially diagnosed with severe depression.so i get clean-no drugs at al-except coffee and cigs-but after all the withdrawals and truly being in a deep depression on my couch for 3 weeks.so I get chem detox from alcohol-librium,and since I had been backing off the OCs,the librium helped with all my withdrawal...so I am clean for 30 days max and as the drugs left me raw to physical and mental anguish i has been trying to even out with a rainbow of fruit flavors since 12.my doc upped my SSRI,can't remember which one-that was 10 years ago.But once I felt better,I felt a LOT better,then I felt delightful and seductive.I had vampire vision with stone angels moving all over town following me.long story short...I ended up being in full blown delusional mania for 8 days maybe and finally my body shut down and my brain reset itself from the 3 days I spent asleep.I saw my therapist on day 4-this is post crack nap-and i tell her all these things that were so real and yet now I doubted myself.Being bipolar,herself,she was on the job.It took us a few years to get the meds cocktail right and they continue to change as my body does-some meds I plateau on.some are harsh on a writer's brain.I told my shrink I was not an earth person...I miss the flights of my mind.it is when my art/writing/photos are at their absolute best...so she lets me have a short leash.I know how to manipulate my meds to induce a hypo manic state and ride it out for 3 days max.after that I HAVE to sleep or I'll be screaming that jesus wasn't the savior-I WAS.no shit.full blown mania w/ delusions,no one can explain it unless you have been there.The higher you get the further you fall.you see and hear things that aren't there.delusions of grandeur-my bday is 9/11-that was 2001.I turned 25 the day the towers were hit and I was maybe 20 days clean.well during my mania I thought I killed all those people bc I told god if he was real I needed something really big on my b-day.and at 9am i am watching in horror thinking I was such a bad person that god was punishing me for being so assuming and arrogant for asking for personal gratification on my bday.my shrink tried to tell me,god or no god-you are not that powerful or important.she was trying to get me back down to earth so i would let go of the guilt.for the next cpl weeks I spent crying bc I thought I was an evil person and the guilt,it was eating me alive.but the mania subsided and I leveled out.I have seasonal mood swings so we keep an eye on me during the manic season.I know this is more info than you need,but feel free to PM me anytime Mr.Blonde-great name and your avatar is my all time fav album ever.my new puppy is named Syd Barrett "Floyd"...i am a die hard Pink Floyd fanatic.
so word up on that...lol
much peace and love...............skillz

 

[paranoid android]

Hi fellas,

I'm a 29-year old alcoholic diagnosed with unipolar (major) depression coupled with GAD. I'm currently taking 40mg Cipralex (Lexapro) and 1mg Lorazepam (nightly, before bed). I was on Effexor for 8 months but started experiencing strange side effects (increased anxiety, hypomania) and, as a result, weened myself off of it. I remained unmedicated for almost a year until June 2008, when my PCP put me on 20mg of Cipralex and referred me to a psychiatrist who increased my SSRI doasge and prescibed me the Lorazepam. Frankly, the Cipralex has "pooped out" on me and my shrink suggests trying something else soon (hint: another SSRI), but that's another story.

I'm curious what a "manic" epsiode is like for you guys - i.e. can you always 'sense' it coming on, are there certain situations that can trigger an episode, etc? I've always been interested in how bipolar individuals differ from myself, generally speaking (unipolar depression vs. bipolar depression)? My PCP once told me that most of the time, bipolar patients are in a depressed state, as opposed to a manic state; is this generally true ? Thanks for reading.

As cloudburst said bipolar episodes are different for everyone. I generally get alot more depression then mania but all the same ive spent atleast a month or so at a time being manic, hypomanic or mixed state on and off. Sometimes i can feel it coming on and sometimes i can't. Usually if i can feel a manic episode coming on i just don't feel right if it's going to be a mixed state one but often with mania or hypomania i won't really notice that much. I will just seem really hyper and look like im on coke or something. I can usually tell after abit that im not level because even hypomania is pretty bad for me after awile.

I know people who mostly get mania though so yeah everyone is different.

 

[Cloudburst]

Sometimes it is quite difficult to tell if I'm manic or mixed since mania itself is extremely unpleasant on its own added with the lack of self-judgment.

 

[Mr Blonde]

I was diagnosed bc I went to therapy and outpatient rehab at 24,I was initially diagnosed with severe depression.so i get clean-no drugs at al-except coffee and cigs-but after all the withdrawals and truly being in a deep depression on my couch for 3 weeks.so I get chem detox from alcohol-librium,and since I had been backing off the OCs,the librium helped with all my withdrawal...so I am clean for 30 days max and as the drugs left me raw to physical and mental anguish i has been trying to even out with a rainbow of fruit flavors since 12.my doc upped my SSRI,can't remember which one-that was 10 years ago.But once I felt better,I felt a LOT better,then I felt delightful and seductive.I had vampire vision with stone angels moving all over town following me.long story short...I ended up being in full blown delusional mania for 8 days maybe and finally my body shut down and my brain reset itself from the 3 days I spent asleep.I saw my therapist on day 4-this is post crack nap-and i tell her all these things that were so real and yet now I doubted myself.Being bipolar,herself,she was on the job.It took us a few years to get the meds cocktail right and they continue to change as my body does-some meds I plateau on.some are harsh on a writer's brain.I told my shrink I was not an earth person...I miss the flights of my mind.it is when my art/writing/photos are at their absolute best...so she lets me have a short leash.I know how to manipulate my meds to induce a hypo manic state and ride it out for 3 days max.after that I HAVE to sleep or I'll be screaming that jesus wasn't the savior-I WAS.no shit.full blown mania w/ delusions,no one can explain it unless you have been there.The higher you get the further you fall.you see and hear things that aren't there.delusions of grandeur-my bday is 9/11-that was 2001.I turned 25 the day the towers were hit and I was maybe 20 days clean.well during my mania I thought I killed all those people bc I told god if he was real I needed something really big on my b-day.and at 9am i am watching in horror thinking I was such a bad person that god was punishing me for being so assuming and arrogant for asking for personal gratification on my bday.my shrink tried to tell me,god or no god-you are not that powerful or important.she was trying to get me back down to earth so i would let go of the guilt.for the next cpl weeks I spent crying bc I thought I was an evil person and the guilt,it was eating me alive.but the mania subsided and I leveled out.I have seasonal mood swings so we keep an eye on me during the manic season.I know this is more info than you need,but feel free to PM me anytime Mr.Blonde-great name and your avatar is my all time fav album ever.my new puppy is named Syd Barrett "Floyd"...i am a die hard Pink Floyd fanatic.
so word up on that...lol
much peace and love...............skillz

Thank you for sharing your experiences with me; and cheers for the tip of the hat regarding Pink Floyd, they truly are one of the greatest bands of all time. :D

Sometimes it is quite difficult to tell if I'm manic or mixed since mania itself is extremely unpleasant on its own added with the lack of self-judgment.

Very true.

 

[Mariposa]

Hi fellas,

I'm a 29-year old alcoholic diagnosed with unipolar (major) depression coupled with GAD. I'm currently taking 40mg Cipralex (Lexapro) and 1mg Lorazepam (nightly, before bed). I was on Effexor for 8 months but started experiencing strange side effects (increased anxiety, hypomania) and, as a result, weened myself off of it. I remained unmedicated for almost a year until June 2008, when my PCP put me on 20mg of Cipralex and referred me to a psychiatrist who increased my SSRI doasge and prescibed me the Lorazepam. Frankly, the Cipralex has "pooped out" on me and my shrink suggests trying something else soon (hint: another SSRI), but that's another story.

I'm curious what a "manic" epsiode is like for you guys - i.e. can you always 'sense' it coming on, are there certain situations that can trigger an episode, etc? I've always been interested in how bipolar individuals differ from myself, generally speaking (unipolar depression vs. bipolar depression)? My PCP once told me that most of the time, bipolar patients are in a depressed state, as opposed to a manic state; is this generally true ? Thanks for reading.

Welcome! I share your diagnoses and have panic disorder as well as a drinking issue (mostly resolved). Bipolar has been ruled out in my case. I also share your curiosity about what it might be like to have a manic episode.

It is my understanding that SSRIs are contraindicated for bipolar disorder as they increase mania. That class of drugs just doesn't agree with me from past experience as the side effects in the induction phase scare the crap out of me.

I know several people with bipolar IRL and sometimes I wonder if they have it "easier" than we unipolars. When I am having a major depressive episode, I totally lack motivation, tend to over-drink in an attempt to relieve the depression and anxiety, and cry incessantly - making it difficult for me to do the things in my life that need to be done.

Mr Blonde - I have found buspirone to be utterly useless and my doctor agrees. I take 5 mg Valium before bed and 1 mg Xanax PRN or panic attacks. I have no documented history of drug abuse and presently use nothing illegal. Will you let us know how it works out for you? If you do start on an SSRI, very often early in SSRI therapy you can work out a small benzo script to deal with the side effects.

Skillz, your history is absolutely fascinating. I can't even imagine what the episode you describe must have been like - eek! Glad you seem to be making your way out of the darkness. I enjoy your contributions too.

 

[Cloudburst]

I know several people with bipolar IRL and sometimes I wonder if they have it "easier" than we unipolars. When I am having a major depressive episode, I totally lack motivation, tend to over-drink in an attempt to relieve the depression and anxiety, and cry incessantly - making it difficult for me to do the things in my life that need to be done.

It depends on severity, type of depression and type of bipolar, and comorbidity like anxiety/panic and drugs and OCD (which do all have much higher rates than unipolars, though there are always opposite situations and the like). Plus take into consideration that a huge proportion of "bipolar" people are misdiagnosed.

I had SEVERE unipolar about 2 years before bipolar started. I'm talking full-blown suicide attempts, constant thoughts of suicide, cutting, constantly crying, etc.

Bipolar is unquestionably worse though both through my experiences (I had the same comorbidity and severity as I did with depression and with statistics). Depressives have a suicide rate of 2-9% (the common statistic is severely overstated and just ripped off from other sources now that researchers have looked into it again). Bipolar suicide is up to 20%, making it the most lethal mental illness. Bipolar I is pretty guaranteed to necessitate hospitalization at some point (5x in 2 years in my case). Psychotherapy essentially doesn't work. It lasts your entire lifetime and physically degrades the brain. I have on several occasions stated I would rather have depression. This is not to dicksize (albeit in a weird way, people do even for this type of thing), and believe me, I know how debilitating and inexplicably horrible depression can be, but as impossible as it is to imagine, it can get much worse. Bipolar (I at least) is up there with schizophrenia. If it came down to a simple yes or no question, then yes, bipolar is definitely much worse.

Check out the Devil and Daniel Johnston. It's a good movie anyway even without this context. This is better than any book on it that I've read.

 

[Mr Blonde]

Mr Blonde - I have found buspirone to be utterly useless and my doctor agrees. I take 5 mg Valium before bed and 1 mg Xanax PRN or panic attacks. I have no documented history of drug abuse and presently use nothing illegal. Will you let us know how it works out for you? If you do start on an SSRI, very often early in SSRI therapy you can work out a small benzo script to deal with the side effects.

Thanks for your words Mariposa... they made it clear to me that they don't consider benzodiazepines suitable for me, probably because I was honest about my drug use and addictions and also because in Australia they don't seem to be as comfortable using them as in America. They only gave me 50mg to take 5mg a night to sleep, isn't helping at all.

Right now I just feel worse and worse, my mind feels like I'm in a bad acid trip I'm having mild hallucinations, delusions but I can snap out of them, anxiety, paranoia, I can't go to university... does this sound like a mixed episode to anyone who has had them? I haven't ever had a mixed episode before...

ETA: Also no one I have talked to is willing to consider anything other then anxiety or depression for some reason, and they always strongly put it down to anxiety that feeds my depression or some shit like that yet won't prescribe anything other then SSRIs and make me see psychologists. I'm going to the psychologists again next week hopefully that helps but in my experience it didn't, the only benefit was being able to get all the feelings off my chest but now I can do that with my family and talk to them, so at least now I guess they are aware of what I am going through.

 

[paranoid android]

I know several people with bipolar IRL and sometimes I wonder if they have it "easier" than we unipolars. When I am having a major depressive episode, I totally lack motivation, tend to over-drink in an attempt to relieve the depression and anxiety, and cry incessantly - making it difficult for me to do the things in my life that need to be done.

I would say that it's definetely not easier and if anything it tends to be more dangerous then unipolar depression. Also it's tricker to treat the depressive phase of bipolar disorder because prescribing any anti-depressant runs the risk of mania or worse still mixed state mania.

When my bipolar is not controlled i can't get anything done either. The energy i get when in a hypomanic, manic or mixed state is not focused and is often self destructive. I have a drinking problem too which is mostly in remission and also a problem with opiates which is now under control. I tend to drink alot when im suffering from any bipolar related mood swing and i'll do pretty much any drug i can get my hands on.

Ive gone months where ive been really depressed to the point where getting out of bed is a real chore and i'll avoid that if possible. When im like that i'll get up only long enough to have a smoke, go to the bathroom or get something to drink. Eating is not high on my list of priorities when im like that and neither is showering even which i'll manage to do every few days if i can drag my ass out of bed for long enough.

So yeah it's certainly no easier thats for sure. I do know a few people with bipolar that get only hypomania that seem to like their hypomanic episodes though. I am not one of these people unfortunatly as hypomania tends to make me really irritable after a day or so. My official diagnoses is i think bipolar NOS with some psychotic features. In other words i don't fit nicely into any of the DSM catagories of bipolar disorder.

 

[Lark]

Before my doctor (a psychiatrist) and I figured out I was bipolar, I was put on the then "new" drug Lexapro. It was supposed to be a better version of Celexa, with fewer side effects. I am a psychiatric nurse (oh, the irony) and on my two days off I began titrating the dose. On the third night, I was working the graveyard shift and at about midnight I broke into a cold sweat. Then I started to shake and felt confused. My heart was pounding so hard that it was hurting my ribs.

There was another nurse on duty and we got some books out and tried to figure it all out. We couldn't. Right after I got off work at 7 AM, I called my doctor and got in to see him. He felt that I should possibly be admitted to the hospital for IV benzos to take the mania down. (So that's what mania is like to me: unbearable.) I had Serotonin Syndrome. (Googling that might be helpful.)

I slept and took prescription benzos for a few days. I am now terrified of SSRIs and I take the SNRI listed above: Effexor. The thing about Effexor is that withdrawal symptoms begin so quickly and so harshly: headache, dizziness [terrible dizziness], confusion, etc. My psychiatrist told me that he usually spends a YEAR on a patient to wean them off of Effexor. I trust my doctor deeply because he was around in the bad old days of psychiatry and he trained at the Menninger Clinic. I have learned a great deal from him, both professionally and personally.

So now I'm on Effexor, Klonopin as needed (and I don't abuse it, just have no desire to) and Seroquel. I am also in personal counseling with another psychiatrist in the practice. I sometimes feel like I'm fighting so hard for my life, because I have felt suicidal many times. I seem stable now, and I'm grateful.

Best to all on this issue.