Hypomania?

[Kyzr]

Okay, this is related to this post, but since it's even more specifically about Lamictal, I decided to make a new one in this section.

The more I think about it, the more I'm starting to piece together a theory that would argue that Lamictal is causing any hypomania that I may be experiencing.

I'd never had hypomania before I started taking Lamictal. And when my dose was increased to 150mg because of some depression, my anxiety and especially the irritability when off the charts. I thought that it wasn't hypomania, but instead symptoms of depression. Now I'm wondering if it is/was indeed hypomania, but caused by the Lamictal.

I know that I keep making arguments to be off my meds, or at least the Lamictal. And I'm sorry, but I'm just trying to cite my experience prior to Lexapro withdrawal. When I was on it everything was fine, except I was sleeping all the time (and I had no libido...shocker). There were no other symptoms except some situational depression. I'm positive it was situational. It wasn't until I stopped taking it that everything went haywire.

I'm going to see my pdoc tomorrow and I want to make this argument. But like I said in my other post, I'm afraid she'll think I'm way off base. I'm an intelligent human being. I feel like she handles me with kid gloves and with a sort of dumbed down language, even though I've never given her any reason to do so (I don't think).

So... three questions:

Is it possible for Lamictal to throw someone into hypomania? (I've researched it, and it seems the answer would be yes. What is your experience?)

Is it possible for meds to cause you to display bipolar symptoms even if you're not bipolar? (My research would also indicate "yes". Again, what do you think?)

How do I address this with my pdoc? I'm nervous about it and don't want to come across as being unintelligent, uninformed, or just loony.

(I should also add that my mother and boyfriend (the only ones who know about my MI) have argued many times over to me that I do not behave in a way that would be indicative of bipolar.)

(Sorry for being long-winded.)

[kjauron]

Is it possible for Lamictal to throw someone into hypomania? (I'veresearched it, and it seems the answer would be yes. What is yourexperience?)

I experienced some brief hypomania after I hit around 150mg I think, then it went away for several months. I went up to 300mg about a month ago and have been a trainwreck ever since - can't say if the Lamictal has anything to do with it, but I would certainly think it's a possibility.

How do I address this with my pdoc? I'm nervous about it and don't wantto come across as being unintelligent, uninformed, or just loony.

Would your boyfriend (or mother) be willing to go with you? Not sure how close you are with them or how comfortable you'd be with them there, but my husband came with me to my last appointment and it made it a little bit easier to discuss things.

In any case, I guess the only experience I can really share is that it's probably going to take time to work it out. I keep wishing I just had a clean slate or a do-over to try and explain my issues without any other info on record, but once the word bipolar gets thrown out there it seems like anything I say goes under "Yes, that's a typical bipolar thing to say/do/think." So...I guess maybe aim for this appointment to 'start a discussion' rather than 'fix everything' if that makes sense? I really hope it's better than that for you, but last time I tried this I think my expectations were too high and I was pretty let down.

If nothing else, maybe you could say that you're just not sure this feels right, and ask if she has a colleague who might be willing to meet with you for a second opinion?

Good luck!!

[Kyzr]

Thanks Kj. Your input is always so helpful.

I actually could have my mother go with me tomorrow. We're tight and I trust her. (I'm so lucky.) But I'm not actually sure what I'd have her say. I know it seems simple - have her back up my thoughts on the matter. But, sometimes she's not very good at being an advocate for herself with doctors and I'm not so sure she'd be very forthcoming or firm with her thoughts and/or feelings about me...only by virtue of the fact that she's so damned polite. I have thought about taking her in the past, but sort of dismissed the idea after about 30 seconds of consideration. I will talk to her about it and see what she thinks.

Anyone else have any thoughts?

[AnneMarie]

Is it possible for Lamictal to throw someone into hypomania? (I've researched it, and it seems the answer would be yes. What is your experience?)

Is it possible for meds to cause you to display bipolar symptoms even if you're not bipolar? (My research would also indicate "yes". Again, what do you think?)

How do I address this with my pdoc? I'm nervous about it and don't want to come across as being unintelligent, uninformed, or just loony.

(I should also add that my mother and boyfriend (the only ones who know about my MI) have argued many times over to me that I do not behave in a way that would be indicative of bipolar.)

Hi. As you concluded, the answer is yes to questions 1 and 2.

1. The [link=http://www.ncbi.nlm.nih.gov/sites/entrez/]U.S. National Library of Medicine and the National Institutes of Health database of peered reviewed abstracts[/link] is a great source of credible info. If you search Lamictal+mania, you will probably find a few studies to support your conclusion.

2. The criteria for bipolar II from [link=http://en.wikipedia.org/wiki/Current_diagnostic_criteria_for_bipolar_disorder]Wiki[/link]. You can search DSM IV + Bipolar for other links that might print out more nicely.

Criteria for a hypomanic episode DSM-IV-TR

1. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non depressed mood.
2. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
   1. inflated self-esteem or grandiosity
   2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
   3. more talkative than usual or pressure to keep talking
   4. flight of ideas or subjective experience that thoughts are racing
   5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
   6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
   7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)[*]The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.[*]The disturbance in mood and the change in functioning are observable by others.[*]The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.[*]

The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Be clear and objective. Fact focused. No pleas or emotional appeals.

If afterwards you and your family think she's wrong, get a second opinion.

1. 3. Bring a little of the research with you. Tell your doc you are educating yourself. If you feel talked down to, asked her to speak more directly. State your case. Tell her you'd like to bring your mom and boyfriend to your next appt so that they as observers can give you doc input. Idk for sure, but I think it's best to let her know that you are bringing company instead of springing unexpected guests on her.

[kjauron]

How did it go with pdoc today Kyzr?

[Kyzr]

So, I went to the pdoc today..... and the most amazing thing happened: She agreed with everything I said.

I went in (by myself) with the whole argument laid out, very logically point by point, in my head and a plan to make my case that would suggest that I'm not bipolar, that Lamictal is causing hypomania and believe I should come off of the Lamictal. I started out by saying that I really wanted to reevaluate the whole situation and I wanted to be heard without the "bipolar screen". (I'd never said that to her before...but today I did.) And I started laying things out...and she just nodded... and kept nodding... and then agreed... and kept agreeing. And I didn't even have to say everything that I was going to say. It was...... astonishing. Dumbfounding.

So, I'm coming off the Lamictal.

I'm ... still just sitting here with a blank stare, mind-blown, about the whole thing. Don't get me wrong. I'm thrilled. I really am... just... astounded.

So, now ... a couple things to worry about.

I've been on 150mg of Lamictal for a while. At least 2 months now. I've been on Lamictal in general for about 8 months. She said to take 2 days of 100mg, then 2 days of 50mg, then nothing. Doesn't this seem a little quick to you? I'm nervous.

Secondly, this puts me back to square one, in a sense. Like I said before, I went haywire when I stopped taking Lexapro (20mg) a 14 months ago. I stopped taking it because I was sleeping all the time. Now, for about a month, I've been taking only 5mg of Celexa and I'm already sleeping more and need to caffeinate myself all day to stay awake. The Celexa helps, but it makes me sleep. And I'll probably end up on more.

Obviously, first things first: worry about the Lamictal. What do you all think about the rate of discontinuation? I took 100mg today.

(Stacia: Thanks so much for your input...it helped a great deal. Kj: Thanks for checking in on me. You rock.)

[kjauron]

Yay!! I'm so glad that went well for you, that's awesome.

[nalgas]

I personally am terrified by the recommendation to reduce it every two days, although I'm probably a bit biased because of the whole seizure issue, and under normal circumstances would be something less dramatic and more along the lines of "concerned". Unless you're having a severe negative reaction (like a flesh-eating rash), a week in between Lamictal dosing changes is generally a much better/safer idea.

[Kyzr]

Thanks for the comments everyone.

I personally am terrified by the recommendation to reduce it every two days, although I'm probably a bit biased because of the whole seizure issue, and under normal circumstances would be something less dramatic and more along the lines of "concerned". Unless you're having a severe negative reaction (like a flesh-eating rash), a week in between Lamictal dosing changes is generally a much better/safer idea.

Me too. The idea of seizures terrifies me. But I've never had them. So as far as I know right now, I'm not and won't be prone to having them. Epilepsy sucks and I'm sorry that anyone has to deal with it.

So, yeah, I guess discontinuing so quickly gives me cause for concern as well. She said 2 days at 100mg, then 2 days at 50mg, then done. Today I took my third day of 100mg. She also said that if I start to feel weird, just, I may need to go back up. So, I'm going a little slower than prescribed. I have enough left now for 3 days of 50mg, but I still have refills available. My prescription insurance is decent, so I may just go ahead and have it refilled in the case that I do need to go back up temporarily.

Thanks again for all the help. Much appreciated.

[Kyzr]

I'm doing much better. My mood is far more stable. I'm still alittle irritable and have noticable anxiety, but it's significantlyreduced despite some pretty major anxiety-producing life situationscurrently going on. It seems like coming off Lamictal is going to begood. Fingers crossed....never can tell what's going to happen.

I'm on day 3 of 50mg. So, I'm doing it much slower than pdoc firstsuggested. Although, she did say I could go slower if I felt morecomfortable that way.

But here's my problem. Just as my experience with SSRIs in the past, I am SO TIRED. Lamictal had a tendency to make me need sleep less...and be more alert and awake overall. So, now that I'm tapering, I think the sleepiness from the Celexa is coming through. I'm caffeinating all day long to stay awake. And yesterday, I was just dragging so badly at the gym. It was awful trying to get through everything - not typical for me.

Ideas? Thoughts? Help?

[Mayteana]

I'm doing much better. My mood is far more stable. I'm still alittle irritable and have noticable anxiety, but it's significantlyreduced despite some pretty major anxiety-producing life situationscurrently going on. It seems like coming off Lamictal is going to begood. Fingers crossed....never can tell what's going to happen.

I'm on day 3 of 50mg. So, I'm doing it much slower than pdoc firstsuggested. Although, she did say I could go slower if I felt morecomfortable that way.

But here's my problem. Just as my experience with SSRIs in the past, I am SO TIRED. Lamictal had a tendency to make me need sleep less...and be more alert and awake overall. So, now that I'm tapering, I think the sleepiness from the Celexa is coming through. I'm caffeinating all day long to stay awake. And yesterday, I was just dragging so badly at the gym. It was awful trying to get through everything - not typical for me.

Ideas? Thoughts? Help?

Off the top of my head:

- Switching to a different SSRI (or cymbalta, effexor, pristiq, etc)

- Adding Wellbutrin

- Trying a different class of AD (like TCA's)

That's all I got right now. I'm glad to see that the talk with your pdoc went so well!

~ May

[kjauron]

Glad to hear you're doing so much better!! No suggestions on the tired thing I'm afraid, as the only thing I ever suggest is diet and exercise, which it seems you've got covered. 5 Hour Energy? I wonder if it could be a short-term effect of coming 'down' from hypomania you may have been having?

[Kyzr]

Glad to hear you're doing so much better!! No suggestions on the tired thing I'm afraid, as the only thing I ever suggest is diet and exercise, which it seems you've got covered. 5 Hour Energy? I wonder if it could be a short-term effect of coming 'down' from hypomania you may have been having?

Hee hee.... I suppose 5 hour energy could work, but those things taste horrrible.

I'm afraid this is a typical reaction for me with SSRIs. In fact, dropping Lexapro because of excessive sleep is what started the whole year of hell in the first place. So, I dunno.

I tried Wellbutrin about a year ago with disastrous results... so unfortunately, I think that's out. I've tried Paxil, but not Effexor, Pristiq, or Cymbalta. In fact, my gdoc tried to give me Pristiq about a month after it came on the market as she was telling me that I'm narcoleptic... so I dumped (tapered) the Lexapro on my own and the sleeping stopped....about a month later, I started seeing a pdoc because I was alllll haywire from the SSRI withdrawal. If I somehow end up on Pristiq and have success with it, I may just want to shoot myself by virtue of the fact that I could have avoided a whole year of absolute fucking misery by listening to my gdoc in the first place. (Even if I still trust a pdoc more with psychopharmaceuticals than a gdoc.)

Gah. The sleeping thing really is getting in the way of productivity.

[Kyzr]

So, today is day 2 with no Lamictal at all. And I'm probably having some very, very mild mood swings. I don't think anyone can tell, because it's all happening in my head for the moment.

But, I actually think a big contributor to the "swings" is that I'm just SO FUCKING TIRED. I hate you, SSRIs. I'm so, so tired. I just want to sleep. And this is exactly where I was a year ago... which is why I started taking other meds to begin with....and all of those just made me CRAZY, suicidal, anxious with panic attacks, moody, hypomanic, depressed, weepy...on and on. Most of which I'd never felt before w/o meds.

So, now I'm mostly fine except that I'm exactly where I started. I feel exactly how I did then : "I should just stop taking meds altogether!" And I'm feeling like I've just thrown away more than a year of my life being horribly miserable....just to get back to square one. And after I've been off the Lamictal for a little while, I'll want to see if I can get off the Celexa to find out what I'm like with nothing..... but I'm afraid that the withdrawal will happen all over again.

I don't know what to do. I just feel angry and frustrated....and kinda dumb about it all, for some reason. And, I know I'm mostly okay because my situational life-related stress is very high right now and I'm handling it okay....and I'm staying calm and not freaking out. But the frustration of being in this place again does make me want to cry because it's been such a horrible year and I feel like I'll never escape it.

I have a pdoc appointment in a couple weeks, and I could call....but there's really nothing we can do for the moment except add another drug. And I don't want to do that at all. I just want to see how I am without for a while. So, it seems like it's just a waiting game while I'm sooooo tired. I've had 3 cups of coffee today. I never drink that much coffee....and I'm still sleeeeepy. I don't have time to be so sleepy. I don't have time to be unproductive.

I guess there's probably not much more help you guys can offer, but I needed to vent. Because I just hate this.

[Kyzr]

Also, I'm freaking starving all the time.

That's all.

[Kyzr]

I had been on Paxil for a few years...and then I went through a horrible relationship and break-up, and somehow switched to Lexapro. I was on Lexapro for a year and a half. Both had always made me yawn quite a bit....and made me slightly lethargic. But for the last 6 months of the Lexapro, I SLEPT. I would sleep 12 hours at night and then nap for 2 - 3 hours during the day. I went to my gdoc, because I wasn't seeing a pdoc. She told me I had narcolepsy and sent me to a neurologist. She also gave me samples of Pristiq. Her excitement at giving me the Pristiq made me so nervous that I didn't touch it. I knew I wasn't narcoleptic. So, I tapered the Lexapro on my own....and I almost immediately stopped sleeping. But, then I started having withdrawal from the Lexapro. So, I started seeing a pdoc. She gave me Wellbutrin. It was a disaster...I THINK it may have given me akasthesia - tremors, horrid ringing in the ears, bruxism, muscle tension, bleeding gums, on and on. So, I stopped for a couple weeks and I felt relatively normal...and then she put me on Lamictal.

BEFORE Paxil, the first thing I was ever on.... I was just.. a little depressed. And I was in grad school and stressed and in a stressful relationship..and my previous gdoc (he's since left the practice for disability) said, "here, have some Paxil." So, I did. And I was on 10mg of it for ... probably 3 years.

And therein lies the reason why I think, for ME, starting meds in the first place may have been a bad idea.

That's not to say that I don't have issues.... it's also not to say that I don't or won't ever need meds. I'm just saying... I dunno what the fuck is going on, but I'm afraid I did it to myself and may now be fucked forever.

[Kyzr]

And I did throw a small temper tantrum this afternoon after my post.

But I'm PMSing. So who the hell knows?

[kjauron]

I'm afraid I did it to myself and may now be fucked forever.

C'mon, you're smarter than that. Seems like you're going through some pretty awful setbacks recently, but it won't be forever.

I can't remember, have you done much therapy, or has it mostly just been the med hopping?

[Kyzr]

I feel like I ought to be smarter than that. But I guess I do question whether or not it's possible to cause your brain to have problems that wouldn't otherwise be there by taking meds you shouldn't have taken in the first place.

I've had 3 different therapists.

The first one was in grad school (2003ish)...and she was all but worthless. Very nice woman, but didn't really help me. She just kinda sat there and did the closed-mouth yawn thing.... like when you have to yawn, but you try to keep your jaw closed because it's at an inappropriate time to yawn. I can't decide if it's lame of me to only be able to remember that about her or if it's lame of her for being that unmemorable.

The second one was around 2006. She was okay... pretty honest, I guess. But I sort of felt like I was being judged all the time. And she put me in this group that she ran. I'm still not sure what the group was for really....I think it had something to do with building relationship skills. But there was not one person in the group with whom I felt I connected or shared much life experience. Again, they were all very nice people...and I tried to contribute thoughtfully, but I really got very little out of it. (This makes me sound like such an asshole. Sorry. )

My current therapist is awesome. I love her. She's been very helpful, but because of my current life situation, I don't see her as much as I'd like. The last time I saw her was in May. I do, however, have an appointment with her next week. And will hopefully see her with greater frequency over the coming weeks and months. It is possible, though, that after the next 4-8 months, I'll be moving out of the area. So, I'll hold on to her as long as possible and see her as often as monetarily possible. I really do feel like many of my issues could be handled in therapy.... and that I've made some progress with her, but I also feel like I've been in a med crisis for a year - the entire time I've known her- and it's difficult to have forward movement when you're so focused on feeling miserable.....trying to wake up in the morning withOUT sobbing for no reason, for example.

Thanks for still listening and replying. It really helps even just to know that you're all there. I appreciate it so, so very much.

[JoannaMarco]

My pdoc tried me on lamictal twice and was shocked that each time it caused hypomania. I am seeing a new pdoc who explained that lamictal induced hypomania is quite common. Of course, he has put me on geoodn and its making me nuts also, so what the fuck. I think I am going to say the hell with it and go back to paxil.

[Kyzr]

Thanks Joanna.

Yeah... I started out on Paxil in the very beginning. It was the first thing I was on and didn't do too badly for me, but that was before I started having the SSRI sleeps.

I've been off Lamictal for about a week and a half...and I'm nowhere near as irritable as I was. I have the standard situational irritation...but, that's just because I'm an asshole.

So, now I'm positive that it was making me hypomanic.

[JoannaMarco]

What are the SSRI sleeps?

[Kyzr]

SSRIs have a tendency to cause lethargy. For me... it makes me sleep 12 hours at night and need naps during the day. And when I'm awake, I'm a zombie that yawns a lot. It's as frustrating as being moderately depressed. I'm not suicidal, but I'm cranky and pissy because I can't concentrate or think or do anything without just being sleepy. And all of that causes me to be situationally depressed. ......if that makes any sense.

That's The Sleeps.

(Right now... I'm on a very low dose, but it's still causing me problems. Not quite as bad as I've described. Kinda close though.)

[JoannaMarco]

It makes sense and I do recall needing a lot more sleep when I was on Paxil. I remember when I first started taking lamictal and I didn't need 10 hours of sleep . . . it was so nice. And I had energy, which I hadn't had in years. But it wasn't very long before I couldn't sleep at all, couldn't sit still and my mind was racing like crazy. Now, on the geodon and lexapro, I am having "anxious depression," which is I guess a mixed state bi-polar thing. Its so bad that I look forward to the plain old depression coming back. I'm so tired of worrying about all the awful ways things could go wrong that the idea of just accepting that everything will go wrong seems like a break from the trama. You know?

[Kyzr]

Yeah, as I titrated up on the Lamictal, I definitely needed less sleep. It was great, but I think I was experiencing some rapid cycling with mixed states. Irritability was my big thing. And even though I was able to sleep less, I didn't really feel energetic or more productive or anything like that. In fact, I think I probably had some ADD type symptoms - was difficult for me to be productive, easily distractable and had a hard time staying on track. It was just nice to only need 5 or 6 hours of sleep a night rather than 8. Now I'm just tired a bunch. (Although, I think it might be getting a little better. Can't tell for sure.)