Friday, May 16, 2008

Bipolar Medication (2): My First Medication-Induced Mania

In 1993--and perhaps now, although I haven't researched it lately--the common feeling was that once you started antidepressants you should remain on them. However, I didn't feel comfortable remaining on drugs I didn't need. To me, it would have been like telling a diabetic to remain on insulin even if her blood sugar was normal without it.

But, as I mentioned in yesterday's post, in 1994 I had a third depressive episode and I was emotionally exhausted, so I agreed to remain on Zoloft for six months. I was now taking Klonopin as a sleeping pill because no matter how busy my days were, I couldn't fall asleep or remain asleep at night.

Even with the Klonopin, one night in February I was awake until 5:00 a.m., fell asleep for two hours, and got up at 7:00. The following material is excerpted from my eBook, Bipolar Depression Unplugged: A Survivor Speaks Out (This is copyrighted material; please do not reproduce it).

At 8:30 a.m., I dialed Pasha's (Ice Maiden) beeper number. She returned the call within moments. When I told her the problem, she said, "Stop the Zoloft. It has pushed you into a mania. You must begin taking lithium immediately. I will call in the prescription to your pharmacy. You need nine to ten hours of sleep each night because sleep deprivation feeds the mania."

"I can’t imagine feeling tired with all this energy‚" I said‚ fairly gushing into the phone.

"Susan‚ listen to me. You need sleep. How much Klonopin are you taking?"

"One tablet."

"How many milligrams?"

"One."

"Double it. If you don’t fall asleep within the hour, take one more. If you are still unable to sleep, call me and I will prescribe a stronger medication."

"Okay," I answered in a subdued tone, somewhat concerned because she sounded worried.

"You will need to take blood tests for the lithium," Pasha said. "Make an appointment with Dr. Abcarian’s lab technician on Friday; I’ll fax the order to his office. The medication must be in your system for four days before we can get an accurate reading. I’ll see you on Monday at 3:30 If you need me before then, dial my beeper number."

Pasha’s tone suggested that our conversation was over so I hung up the telephone although I had no idea what the blood test was for. After taking two milligrams of Klonopin, I slept for a few hours, did some errands‚ picked up the lithium, returned home, and drove my minivan up our driveway and flattened the right front and rear tires against a small protruding lip of concrete that I’d circumvented for fifteen years. Within a half-hour, the Automobile Club tow-truck driver delivered my van and me to a tire store where they replaced the tires with new ones, and I returned home in less than an hour.

After a play date at a friend’s house, Alex (my son) came home from school. I had cleaned the house, done laundry, straightened his bedroom and had dinner cooking in the oven. We spent the next few hours playing Nintendo. He was pleasantly surprised by my increased energy level. Bernie (my husband) was delighted by my newfound interest in domesticity and we had a Norman Rockwell-like evening.

I slept five hours that night. The next day I bicycled in the morning‚ met a friend for lunch‚ went to the library, and had a manicure and pedicure at my favorite neighborhood nail salon. For dinner, I cooked roast chicken with mashed potatoes and creamed spinach. I made chocolate brownies and smothered them with ice cream‚ chocolate sauce, and whipped cream. Bernie was glad I had cooked, but was surprised by the high caloric content of the meal. Alex was thrilled. So was I.

By the third morning‚ after Alex and Bernie left the house‚ I crashed. That night and the next morning I had a terrible headache. I was nauseous, had diarrhea, and couldn’t stop urinating. I called Pasha’s beeper number.

"How many hours have you slept last night and the night before?" she asked.

"Five each night."

"Why didn’t you call?" she asked with reasonable annoyance.

"I took all the Klonopin you prescribed."

"We’ll switch to Ativan. I’ll call in a prescription to your pharmacy."

I described my other maladies.

"These are all medication-related and will go away in a few days," she said. "I will see you Monday."

After a brief nap‚ I felt great again. I caught up on some phone calls and joined a friend for lunch. After I came home‚ I gardened for a while before I was hit by the most severe headache I’d ever experienced. I spent the rest of the day in a semi-comatose position wondering anew why this illness was preying on me and whether it would ever end.

(to be continued)

Did your antidepressant medication cause your manias or hypomanias? Is there any antidepressant that's really worked for you? Did your doctor put you on a mood stabilizer before trying an antidepressant?

22 comments:

Jazz said...

Susan--
Let's see...Fall of '03 I was put on Depakote, a mood stabilizer, along with trazodone, which is an antidepressant, but was prescribed to help me sleep. Like your doctor, my psychiatrist didn't feel five hours of sleep was enough. After a few weeks on Depakote, Lexapro (an antidepressant) was added for anxiety (I had a really stressful situation going on at home, and was extremely anxious about it). The Lexapro didn't push me into mania, but in the spring of '04 I crashed into depression, and by the end of summer '04 I was manic again. So while the antidepressant didn't push me into mania, I think it had a lot to do with my moods cycling so fast.

The only drug that has induced a manic reaction in me was prednisone, a steroid I took one summer when my allergies were absolutely unbearable. I was trying to write my dissertation at the time, and was desperate. I didn't get manic to the point of being psychotic or needing to be hospitalized, but I don't think I slept more than three hours total for an entire week. And I got a heck of a lot of work done on the dissertation!

Gianna said...

I have to question accepting a bipolar diagnosis when it's a drug (anti-depressant) induced phenomena...

I know lots of people who've gone on to recover completely in such circumstances and they've shed the label.

I too was diagnosed based on a drug reaction---mine was an illicit drug, but I feel the same about that...why do they assume a drug induced mania means we're bipolar...especially if that is the only time one has been manic?

Of course later use of antidepressants made me extremely agitated which led me to one drug after another treating side effects...ugh!! To many people fall into this without realizing it...the drug side effects are called the disease...

the only real disease is in the doctors imagination.

Nancie said...

Susan,

My antidepressant is Fluoxetine (Prozac). I was on Fluoxetine for 3 months last year and then I experienced hypomania.

It was through that episode that my Doctor realized that I am prone to bipolar and she immediately took me off the anti-depressant and I was given a mood-stabiliser (Lamictal or Lamotrigine) and anti-psychotic (Seroquel or Quetiapine). These 2 worked well for me so far. I don't need my anti-depressant now unless I fall into severe depression again. Fluoxetine will lift me up to a more functional level so that I can then do regular exercise and other helpful thing to get better.

Thanks for this great discussion. Thanks too for all your support and encouragements.

Take care. And hope you have a wonderful weekends!

Hugs,
Nancie

Bipolar Wellness Writer said...

Dear Jazz,
What happened to you is what ultimately happened to me with the rapid cycling. In retrospect, even when I thought the Zoloft was working, it was actually producing hypomanias and beginning to change my personality. And each subsequent depressive episode was worse than the last.

A few years later--all I did was cycle from depression to hypomania and back. But, by then, every psychiatrist I went to said, "This is the progression of the illness."

And none of the alternative remedies helped in the least. It wasn't until 2003 when I saw a doctor of integrative medicine that I started getting better. And by then, it had been a decade!

Susan

Bipolar Wellness Writer said...

Gianna,
You and I agree on this. While I'm not anti-medication for others, taking it almost destroyed my life. Over the years, I got worse and worse. It changed my personality. It produced medication-induced erratic behavior that ruined my career. The side effects were unbearable, and so much more.

The most terrifying thing of all was that once I was so sick I could barely survive--in essence--my psychiatrists gave up on me (without telling me). They blamed my decline on the progression of the illness, they suggested ECT and hospitalization (neither of which I did), they said I was medication-resistant, and then they diagnosed me as a rapid-cycler.

What I feel now is that by giving me medication in the first place, they started me on a path that led to a downward spiral in every way. They assumed no responsibility for my decline and had no idea what to do.

I felt like I was like a guinea pig in a nightmare science experience.

Susan

Bipolar Wellness Writer said...

Dear Nancie,
At last we have a success story where medication actually has made someone's life better. I'm so glad to hear it! You're welcome for the support, and I hope your weekend is good as well.

Hugs back to you!

Susan

Meredith said...

After a bunch of medication shuffles, I've remained mostly stable since diagnosis, which is super crazy rare from what I understand. Lamictal, Klonopin and Seroquel are currently my drugs of choice (mostly literally choice, actually, because my pdoc actually listens) and aside from some side effects, they're doing pretty damned well.

Bipolar Wellness Writer said...

Dear Meredith,
Another important success story! Glad to hear it. Having written this blog for 15 months now, it's rare indeed.

Years ago, when I was desperately trying to find medication myself and studying every site where people talked about medication, I finally ended my search without success, and remained offline for three years. I decided the World Wide Web should be renamed the World Wide Wound--at least for BIPs!

Susan

Coco said...

Hi Susan, I started the anti-depressants in 1994, and no hypomania for me until 2004.
I think my last (and I do mean LAST..haha) pregnancy triggered the cycling. I didn't get an official diagnosis until recently. I'm tapering Effexor, who's to say whether it's a contributing factor. They want me on Lamictal, but I won't take it. I did for 2 weeks but I just can't do it. I want me back.

Bipolar Wellness Writer said...

Coco,
I sure know the feeling. I felt like I wasn't myself for almost 14 years. It's just been in the last year that I feel like my "old self" in so many ways. And when I'm feeling a bit blue, I grieve the years I lost!

Susan

P.J. said...

I'm on my first anti depressent, Celexa. (except for 6 months on Paxil 4 years ago). I'm also on Valporic Acid, a mood stabilizer. So, with so many anti depressent horror stories, and being at the beginning of this disorder, how do I avoid that downward spiral of getting worse from happening to me??? I've never had a "real" hypomanic episode, like way out there, but I've heard and read that a/d can send people into them. Help!

Bipolar Wellness Writer said...

Dear P.J.,
I'm not a doctor, and I would urge you to talk about this with your doctor. But, from my own experience, none of the four most common mood stabilizers--Lithium, Tegretol, Depakote or Lamictal worked. Valproate is also called Depakene and I've tried it as well.

So, given that the mood stabilizers didn't work, then it only makes sense that the antidepressant pushed the illness into a hypomania.

But...maybe with you, it will be different. I know that medication works for Marja, so you might want to ask her about her experience.

There are a few online sites run by doctors: Internet Mental Health, PsychEducation.org, Dr. Bob (he's a psychologist), and Depression Central.

I believe that the people reading this blog were attracted to it because I believe in alternative wellness activities.

There are other blogs/sites that are more traditional. John McManamy of McMann's Depression and Bipolar Website uses medication, so do the women who write About: Bipolar Disorder. Also, you can go to the NAMI and DBSA sites and they'll provide another viewpoint.

Susan

veronikarona said...

my x-boyfriend was diagnosed 1 month after we broke up (out of the blue, he told me "he suddenly knew it wasn't meant to be forever), he was diagnosed as bi-polar. it's been 3 months now that he's been on lithium that seems to be working for him though he is not in therapy. After he told me, i was concerned for him and so maintained contact with him. But i now feel that it's a one way relationship, he seems to be completely self-absorbed with little acknowledgement of the fact that his leaving had a profoundly painful impact on me. While i've tried to talk about it several times with him, he's unwilling to go there. I know the best thing for me is to not be in contact with him but my question is: does being on medication actually address the personality traits associated with being bi-polar ie. self absorption or do these continue until they are acknowldedge and/or addressed in therapy?

marja said...

I'm on a mood stabilizer, two anti-psychotics and fluoxetine. The fluoxetine is not affecting me - pushing me into hypomania. So my doctor is keeping me on it indefinitely. I trust him and am not afraid.

Bipolar Wellness Writer said...

Dear Varonikarona,
I'm sorry, but I can't speak for your boyfriend. What I can say is that medication--when it's working--is supposed to level out a person's moods. But, in terms of dealing with personality issues, a person needs to go to therapy.

Susan

Bipolar Wellness Writer said...

Dear Marja,
Thanks for sharing your story. I'm sure it will be helpful to many readers to know that your medication works!

Susan

Gianna said...

I just want to say I used to think meds saved my life...I thought that for a long time. I was on meds pretty much for 20 years and now in retrospect I see they debilitated me and destroyed my life. This took 15 years to become apparent to me. I'm skeptical of people who think drugs save them. People on neuroleptics (specifically atypicals--the new ones---die 25 years earlier on average.) CNS systems are destroyed, diabetes, heart disease and kidney failure are just a few of the potential long term side effects. Frankly I fear people really don't understand what they are doing to their bodies. I have a very hard time glibly saying "whatever works for you is fine with me"--because I don't really buy they are working." Even though I say that I don't judge people who choose drugs, I chose them for 20 years but have lived to regret it profoundly.

All I can say is I hope all of you who sing their praises will be okay after 20 years of use.

I'd also like to say that I've found many alternatives that work for many people and it's never too late to look at alternatives rather than buy all the hype put out by big pharma and psychiatry.

I really do wish the best for all my brothers and sisters who have been diagnosed and medicated.

Bipolar Wellness Writer said...

Dear Gianna,
Thank you for presenting this point of view. I think we agree that ultimately people need to make their own choices. I only wish that 15 years ago, I could have read the spectrum of views that has been presented this week.

Susan

Jazz said...

Susan wrote: I only wish that 15 years ago, I could have read the spectrum of views that has been presented this week.

I wish that for myself, too, Susan. It would have saved me a lot of pain and self doubt.

I think it's important that we are putting these views out here so that people searching for info have something to look at besides all that pharma hype. In the end, everyone is responsible for making their own decision about what is right for them...but I think it's important for people to know that mainstream treatments aren't the only way to go, and can actually do a great deal of harm.

Bradley said...

Knowing that many meds can cause some wild effects in the beginning that eventually go away, I tend to be pretty patient and hang on for the ride and see what happens. Geodon was one exception. It made me completely psychotic. And that is no exaggeration. I had to be taken off it immediately.

I've been on a cocktail of Seroquel, Depakote, Lamictal, Neurontal and Cymbaltya which doesn't have me completely stable, but has made a dramatic difference. Just this week I've been taken off Seroquel and placed on Abilify to see if that helps stop the weight gain.

Whatever course you take, there's many success stories out there. I hope you are one of them.

Bipolar Wellness Writer said...

Dear Jazz,
Sorry to respond so belatedly. I appreciate your presenting this point of view. I wish I knew what to tell P.J., but I truly don't.

If I had known 15 years ago what I know now, I would have done things entirely differently.

But, when I was diagnosed, I couldn't get the kind of information we can provide because the Internet was in its infancy. And once I did get online, there were very few blogs. And once there were bipolar blogs, they were so negative I couldn't read them without getting depressed.

So, it's kind of amazing how much has changed in 15 years. And yet, so few people write about this illness in a way that gives us the perspective we need to make decisions.

Alas...

Susan

Bipolar Wellness Writer said...

Dear Bradley,
Sorry it's taken me a few days to respond, and thanks for letting us know what you're taking, and how it's working for you.

Unlike you, I must admit that I don't read a lot of success stories. What I primarily see is a lot of people who are either very ill, obsessed with this illness to the exclusion of everything else, or cycling from one mood to another.

Perhaps you're reading sites I'm not or maybe we just define success in different ways!

Susan