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Does being well on an SSRI alone rule out bipolar disorder?


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Hi all, I have a question that has been bothering me for some time -- I hope it's ok to post it here. I am of course aware that no-one here is a psychiatrist and I’m certainly not asking for a diagnosis, but any thoughts, ideas or experiences on the topic in general would be very welcome.

Three years ago I had a severe depressive episode during which I stopped being able to talk to anyone, lost all my friends, dropped out of school and started to visually hallucinate. I had experienced depressive episodes before but never taken medication. So for the first time, I was treated with an SSRI, which made me hypomanic.

From my history and past experiences, my psychiatrist at the time believed I may have had hypomanic episodes before and was considering that I may have bipolar disorder. I stopped the antidepressant and thankfully did not become depressed again; the hypomania ended and I was euthymic for a year, during which I stopped seeing her.

My pattern for the past eight years has been to have a year during which I am generally well followed by a year when my mental health deteriorates, I become depressed, my anxiety increases, I become self-destructive and have suicidal thoughts, and sometimes go between this and manic symptoms such as (noted by the psychiatrist) motor restlessness, sleeplessness, pressure of speech, elation and grandiosity.

A year after my final appointment with my old psychiatrist, this started to happen again. My life changed completely in terms of everything I did and how I saw it, I slept very little over a stretch of time, started to have otherworldly feelings and impressions and thoughts, and then became depressed again.

I felt like I was going insane, like I was unreal, dead, disconnected from the world and my life. I felt out of control and had suicidal thoughts I couldn't stop.

Eventually I couldn’t cope anymore and begged for help. I went to my new GP and was prescribed a different SSRI. This one didn’t make me hypomanic, but I started to have very frequent (several times a day for some months) visual hallucinations.

After some time of this I finally told my doctor and she switched me to a third SSRI, on which I’ve now been for three months.The visual hallucinations went gradually away and I have been euthymic the whole time. I feel normal, focused, real, grounded and well. I sleep and eat well and my anxiety has decreased substantially. I have also been treated for a vitamin deficiency which I have read can in the long term cause or increase the likelohood of psychiatric symptoms such as depression, mania and even psychosis.

My question is: in being well on an antidepressant alone, would I be wrong to assume that this is definite (or as definite as it can be) proof that I don’t have bipolar disorder – that the previous episodes were not true bipolar episodes but only something similar induced by various factors which aren’t likely to occur again, now that I know to avoid them?

Or should I, despite this, stay on the alert for any hypomanic symptoms arising again?

Edited by amianthus
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You said that one year was good/next year is not good/good/not good etc. 

IMO anything is possible (re: hypomanic symptoms arising) because you still have years when you mental health isn't as good. 

Also IMO I don't think being on a particular group of meds (SSRIs) rules out anything.

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"Or should I, despite this, stay on the alert for any hypomanic symptoms arising again?"

It wouldn't' hurt to be alert for symptoms just in case, you've got nothing to lose by doing it. Plus, should hypomania arise, you'll be on top of it a lot faster.

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SSRIs don't automatically or necessarily induce mania and/or rapid cycling in people with bipolar. Alas, no such clearcut litmus test exists! It's great that you've found a med that works. Don't overthink it, but also don't be afraid to reach out if things start getting speedy.

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Thank you all for the helpful input!

I asked because I had heard that SSRIs generally did induce mania/rapid cycling in people with bipolar and wondered if this possibly could provide a fairly definite answer (that it's not bipolar disorder), but I guess that really would be too simple. Hopefully things remain as they are currently, but I will stay alert.

Edited by amianthus
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I was dx'd BP after getting manic on Celexa.  I'm not on an AD now, but recently I was on Pristiq and it didn't make me swing up.  I started on lithium instead, but my pdoc offered me a different AD.  

Some ADs are more likely to cause (hypo)mania than others.  I don't know SSRI/SNRI/MAIO etc, but I wouldn't worry.

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