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SSRI start-up S/Es vs. induced hypomania


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[cross-posted in Bipolar Spectrum Disorder forum]

My new pdoc just started my on low-dose (2.5 mg) Lexapro to help with anxiety and depression. That's along with 0.75 mg Klonopin and 225 mg Lithium.

The issue is that a bipolar spectrum disorder might be in the mix for me. If you're interested in the details, read below at the '*', but suffice it to say that I have one possible episode of high-dose AD-induced hypomania. (If it was hypomania, it was on the fairly mild side of the spectrum.) And I am often fairly sensitive to psychotropics in general, with most meds making my anxiety worse. And all of the "mood stabilizers" I've tried have made me more depressed (or anxious in the case of Li). Hence the low-dose Lexapro trial.

So, I'm five days into Lexapro at this point. Two days ago I was groggy and out of it. Yesterday and today I feel all wound up. Mentally I'm kind of irritable and jumpy. Physically I feel like my muscles are tight and tingly, my veins are bulging a bit and my head is kind of buzzing. But at times the energy can be a little positive. Like actually getting a couple of things done that I haven't had the energy to do before.

Because of the worry about soft bipolarity I'm a little concerned that this is a hypomanic reaction. At the same time, I wonder if this might be just part of the start-up side effects -- I'm generally med sensitive.

I'm wondering if there's a way to differentiate between the two. I.e., could hypomania occur so early? Or is it more likely something like akathisia that can come from starting an SSRI? Would an increase in energy very early in the course of treatment be indicative of hypomania?

Any input would be greatly appreciated.

Best,

cache-monkey

* I may have had a mild hypomanic reaction to a fairly high-dose Celexa and Wellbutrin in the past. I'm not sure, though, whether it was hypomania because I was not reckless, or grandiose, and didn't have racing thoughts and the like. I just felt very very good for the first time in a long while. It's still a question to me as to whether it was "too good".

Also a number of meds have made me worse (Wellbutrin, Serzone, BuSpar, Lamictal) primarily along the agitation dimension. Even the Lithium does this to an extent. Outside of Lamictal, the other anticonvulsants that I've tried (Trileptal and Depakote) make me more depressed and cognitively slow very quickly. And all of the atypical APs have given me horrendous akathisia.

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Those are possible side effects from an ssri. I too am very med sensetive and get some strange startup symptoms.  Underneath those irritating things my brian feels better and more calm. Eventually I am left with the good stuff and most of the weird crap fades away.

Unless you were/are a very touchy BP I cannot imagine 2.5 mgs could flip you into hypomania that fast.  Of course I am not a professional so this is only my laymans opinion.

Don't be too afraid of feeling good, unless you feel out of control good.

Keep posting.

CC~

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At only five days into such a low dose of Lexapro you're probably not getting a great deal of effect yet. What may be happening is that your anxiety is increasing -- either as a result of the Lexapro, or your own anxiety at starting a new medication.

I had what was probably an episode of hypomania, thanks to an inadequately supervised Prozac experience. Believe me, it couldn't be mistaken for feeling "too good." Unless "too good" includes sleeping four hours a night, having the attention span of a flea with ADHD, quitting a job for no good reason, getting the worst grades of your life, and then moving to a 3rd world country to marry your "true love."

Fiona

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Oh my goodness Fiona!

And that was ONLY considered a hypomania?

I know for some of us who have never had those exoticly higher times, that just the overwhelming "I feel SO good" thing freaks us out a bit. We can become certain there is something wrong. It is very hard to explain to people when we don't understand it ourselves.

It is good to be reminded by people who  know what exactly mania is all about.

Once agian Im sure Ive never had it.  Wanting to go roll down a hill and laugh out loud doesn't cause many problems. Well, except for the strange looks.

Splurging your last twenty buck is not the same thing as going bankrupt.

Getting horny and jumping hubby's bones isn't being overly promiscuous.

CC~

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Oh my goodness Fiona!

And that was ONLY considered a hypomania?

It was relatively brief -- I took the Prozac for about four or five months and then I drifted slowly out of the hypomania over the next six or seven months. By which time I was already living in said 3rd world country.

It is good to be reminded by people who  know what exactly mania is all about.

It's my only experience. I'm definately unipolar depressed, except for that one bad reaction. And if the pdoc involved had seen me more than once after prescribing the Prozac, he would have noticed it. I actually just never showed for the second appointment with him, and never received so much as a phone call asking where the hell I was.

Of course, there were other things going on in my life. I was trying to escape my mother, and moving out of the country seemed like a great way to do so (it was). I certainly stayed there, in a bad relationship, far longer than I otherwise would have if I hadn't been trying to stay as completely away from things at "home" as I could.

In retrospect, while there are things I would change (did I mention an abusive 'true love'?), I'm glad I spent those 18 months living there. I don't regret a moment of the year I spent teaching there. And as an experience, I just wouldn't trade it for anything. It's helped me shape my life in a good way.

Fiona

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Fiona you are so well grounded despite your hardships. I admire that greatly.

I pretty much try to forget my past, it seems so far away like some dramatic movie of the week, no one would believe that many things happened to one person anyway. I did my therapy and purged it. Like you I draw on it only when it might help someone.

You are an asset to this forum.

CC~

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At only five days into such a low dose of Lexapro you're probably not getting a great deal of effect yet. What may be happening is that your anxiety is increasing -- either as a result of the Lexapro, or your own anxiety at starting a new medication.

I had what was probably an episode of hypomania, thanks to an inadequately supervised Prozac experience. Believe me, it couldn't be mistaken for feeling "too good." Unless "too good" includes sleeping four hours a night, having the attention span of a flea with ADHD, quitting a job for no good reason, getting the worst grades of your life, and then moving to a 3rd world country to marry your "true love."

Fiona

<{POST_SNAPBACK}>

Fiona,

Thanks for the reply. For me the "possible hypomania" was about feeling really good about myself and doing a lot of partying and socializing. Although that was a period of my life where I was very into the partying, largely as a form of escape. The high dose meds just sort of made me feel like I could finally be one of the "cool kids" like I'd always wanted to. Definitely some repressed issues at play there.

Is it common for an SSRI to increase anxiety at first, and then eventually have it reduce to a lower level than pre-treatment?

Thanks,

cache-monkey

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Is it common for an SSRI to increase anxiety at first, and then  eventually have it reduce to a lower level than pre-treatment?

That is exactly a common thing with ssri's.

One of the reasons for early lack of compliance.

Hang in there and let us know how you are doing.

CC~

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Is it common for an SSRI to increase anxiety at first, and then then eventually have it reduce to a lower level than pre-treatment?

<{POST_SNAPBACK}>

Yes, this is somewhat common -- just keep taking the meds and it should level out.

Also, you may be having some anxiety of your own about starting a new med and once you've taken it a bit with no disaster, you'll find that anxiety goes away.

Fiona

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Ditto, hang in there!  I'm onto my 2nd day of a dosage increase of Paxil and my anxiety has gone like this:

day 1: much much worse

day 2: just worse

days 3 + 4: judging from what happened during my last increase, things should start to improve from here.

I mentioned this pattern to my pdoc and he said that though not everyone has this reaction, it does happen, especially if you're a little med sensitive.  I definitely am- i've experienced this pattern with 2 other SSRIs!

As an aside, my pdoc also said that getting worse while taking these drugs is also a good indicator that you actually need them, as people with no chemical imbalance wouldn't experience a worsening of their symptoms from taking ADs.

Just some thoughts, i'm glad to 'talk' to others experiencing the same thing!

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I think that my worries are coming from two sources here. First is that I had an experience with Serzone where I never ended up feeling better in the anxiety department, I just kept feeling worse. The other, which is more pernicious, is that part of me feels like I'm just broken. I.e. that I'm never going to (and probably don't deserve to) feel better. Hopefully the therapy that I'm re-starting (moved recently) will help me learn to think differently...

This has definitely been a rough adjustment period to the med, though. Today I feel a little (but just a little) bit less anxious and out of it. Reading you posts help me to believe that this could be just the downswing before heading to a better place than when I started.

So, thanks for the encouragement.

Best,

cache-monkey

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How are you going cache?  Keep your chin up ;)

Btw, CC- do you find that you need lower doses of ADs to get a positive effect?  I'm actually improving well now on only 10mg Paxil.  I know that's a really tiny dose, but I have a theory that the fact that i'm very med sensitive means that i also respond at lower than normal levels...?

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Oh how funny is that?!

Yes as a matter of fact I have gone back down to 10mgs myself and am feeling much improved. I think it is good for me to go up to twenty and get my brain good and soaked in the stuff and then drop back down to the ten for maintenance.

It seems to work that way for me.

Some of us are just "special" cases.  ;)

I do know to pay attention and my hubby is aware also to look for the signs we missed last time that would signal I needed to move it up for a soaking again.

I am still convinced I went through unrecognized post partum because the ten mgs was enough to keep me from crashing but not enough to keep me well. Thus I thought it just wasn't working anymore. DOH.

Its working fine, I have to be open to the tweaking. Now I know.

CC~

So glad you are doing well with it ccc!

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Cache:  Sorry to hear it's not working too well for you so far.  Maybe you could call your pdoc to see what he/she suggests?  I guess it's totally up to you as to whether you can tolerate a faster dosage increase...i found that when i tried to increase my dose of zoloft (though i'm not taking that anymore) too quickly the anxiety was absolutely unbearable.  I then worked up to it more slowly and eventually tolerated it better.  These things just seem to be so individual though ;)

CC: it really is good to hear you've experienced something so similar to me.  Right now my anxiety is so much better than pre-paxil, but i'm still really agitated and my OCD is worse.  Fingers crossed the side effects and OCD fix themselves, as this drug has worked the best for my anxiety of anything so far!  I'm tempted to reduce the dose for a little while and then try increasing it back to 10mg once hopefully i'm more tolerant of the drug, but i think i'll try to stick it out a little longer first.

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ccc 10 mgs is divine for simple GAD but if your OCD is worse you might really think about going higher when you are ready to try that. Usually the higher doses of paxil is what is used for OCD. (sometimes 40 to 60 mgs)

In what way are you aggitated? Is this a side effect or were you aggitated before meds? How long have you been on the paxil now?

Cache are you being so cautious because you are afraid of going hypomanic? Or is it med fear based, just overly sensetive? 2.5 is really really really low. LOL but you know that.  5mgs is usually what they use for ultra sensetive types. Most people start out at 10 with few problems.  It might take forever and day to feel anything at 2.5 if you ever do at all. Just my opnion of course! You can always go  back down if you want to try 5 and see how it goes.

CC~

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