Soon to be prescribed an SSRI, afraid of possible mania.

[Rocken]

A few months ago I became ill with constant anxiety and panic attacks. The panic attacks eventually ceased, but the anxiety hasn't and as it's progressed I've developed strange symptoms like facial numbness and general loss of coordination.

My pdoc wants to prescribe an SSRI, but I am very worried about taking it. I have a constant tingling, burning pressure in my chest that often feels quite pleasurable, and at the start of the illness I had what could only be described as euphoric episodes. I read that SSRIs can induce mania and it's especially likely in people who have shown certain indicators. I've also reacted badly to benzos and some other meds, becoming more agitated after taking them instead of less. I've told the pdoc about all of this but she still wants to continue.

I'm just afraid because the agitation now is so powerful that I can't imagine it getting worse, I don't want to have a full psychotic break.

Has anyone had any experiences that might help put some perspective on this? I've been in a very dark place for so long - every time the illness seems like its getting better it gets 10x worse within days - and every avenue of treatment seems like they will either be ineffective or unbearable.

 

Thanks.

[dianthus]

I really don't want to scare you, but what has looked like anxiety to me and my doctors before has turned out to be mixed mania, or at least, after taking an SSRI, turned into mixed mania. When I start having an episode that is marked by agitation, poor sleep quality, and racing thoughts, SSRIs are like rocket fuel. I go batshit manic.

It took two of these episodes years apart to figure out that I'm bipolar and that I can't take SSRIs.

I also have an anxiety disorder and panic attacks, which made diagnosing the bipolar disorder harder. What I can say is that the quality of the anxiety/agitation is different when I'm just anxious versus when I'm anxious/agitated and (hypo)manic. I can generally sleep what's normal for me when I'm just anxious. When it's more than that, I wake up every 30 minutes in what feels like a panic attack, and have to spend an hour or more calming down so I can do the same thing again.

What concerns me about your post is your description of euphoric episodes as well as the tingling in your chest. When I am (hypo)manic, I have a constant "buzzing" feeling in my body. For me, it's not pleasant, but it's not something I experience when I'm just anxious. Your symptoms give me pause.

I would bring these concerns up to your doctor, and mention specifically the euphoria and the pleasant tingling in your chest. I would also ask your doctor to come up with a crisis plan in case you have a bad reaction to the SSRI-- one you can act on in a few days, not wait weeks.

I don't blame you for being concerned. I will tell you that as bad as my manias have been, I've never been psychotic. However, they have made me quite nonfunctional for long periods of time. It may well be that your symptoms are purely anxiety, and the SSRI will help (or do nothing). It's really hard to say until you try. But, as a patient, I'd want to hear that my concerns were heard and that a crisis plan was in place.

[bpladybug]

I think you have good reason to be scared

I won't tell you MY story with SSRI's because it will frighten you more

let's say it was not good, and what I needed was a mood stabilizer such as Lithium

 

you need to have a serious discussion w your psychiatrist

tell them all your concerns / put it on the table

[shesellsseashells]

I've had experiences very similar to those of dianthus.  I recently tried Prozac again, and until I was on an adequate dose of Lamictal, it caused hypomania and mixed episodes.  (Some people experience the same even when on mood stabilizers.)  I think that speaking with your pdoc about your concerns and having an emergency plan in place in case of a mixed or manic episode is a great idea.  (I recently had a mixed episode not related to my SSRI and Risperdal did a great job of quashing it quickly--maybe your pdoc can give you a prescription for something in case you experience an episode?)

 

I hope your symptoms abate soon. 

[melissaw72]

 

My pdoc wants to prescribe an SSRI, but I am very worried about taking it. I have a constant tingling, burning pressure in my chest that often feels quite pleasurable, and at the start of the illness I had what could only be described as euphoric episodes. I read that SSRIs can induce mania and it's especially likely in people who have shown certain indicators. I've also reacted badly to benzos and some other meds, becoming more agitated after taking them instead of less. I've told the pdoc about all of this but she still wants to continue.

 

Out of curiosity, what did your pdoc say the problem was, and why did she still want to continue and prescribe the SSRI?

 

FWIW, I have never had a problem with SSRIs.

[dianthus]

Sylvan is right. I say I can't take SSRIs, but i can take Celexa without a mood stabilizer and be fine. But it doesn't really do much for me for anxiety. You really don't know until you try.

One advantage of AAPs (something a lot of people have mentioned) is that they can work in a matter of days, not weeks, and they can treat anxiety and mania. Ask your doctor if an AAP is possible for you if you haven't already tried one. They don't have to be permanent for you, but they can pull your out of crisis quickly.