Opposite Reaction to Bipolar and SSRI Meds

Hi Green Lantern,

Yes, meds can cause an increase in anxiety (usually short-lived, but with bipolar anything's possible, eh?!). There's a good site called Remedyfind.com (I think!) that has useful info on meds and it might be worth checking there to see what others on these meds are saying. The tricky thing is that with bipolar you very often (in fact I think always) have to take a combination of meds, where one med works on one aspect but might up something else (e.g anxiety) which then needs to be controlled by another med (which, however, might also be helping you with other symptoms not brought on by a med). Nicely confusing, but as long as the combo works, not something to worry about too much, I reckon!

Did you know that there's a bipolar board on this site? There might be some folks there that could help you with these questions too. -- You'd be really welcome!

Best wishes,
Rosie x

Hi Green,

Well, there are a lot of anti-depressants out there that work for anxiety (though differently with different people as I'm sure you know!). If you're not bipolar, you could certainly do without the lithium, but I can understand your doc being concerned not to rush into anything on this because untreated bipolar can be terrible.

When you say you've never had manic episodes, have you considered all the different types, and the possibility of mixed states? What caused you to be diagnosed bipolar in the first place? I know sometimes these diagnoses are got wrong, but it's so important to be sure. Have yu discussed your concerns with your doc?

Rosie x

Hm, tricky one Green. The problem of whether to tell a new doc your previous history or to get them to start the diagnosis from scratch. I think, on balance, I'd have done as you did: always good for them to have as much detail about your past treatments as they do about your presenting symptoms -- and, let's face it, some docs rather enjoy being able to prove others wrong. I do find it a bit bizarre that your current pdoc can't make a diagnosis, though. Are you sure he's not still thinking bipolar? He may have taken you off the Lamictal (some people do have bad reactions to this even if they are bipolar), but he's got you on lithium, right? I don't know of that being used in the treatment of anything other than bipolar.

The EEG may be a good idea -- don't know much about those...! At least you'll be seeing a specialist who should be able to help. There's every chance this will be the key to your treatment, but if it's not I'd change pdocs and find one that's willing to go back to the start and revisit your diagnosis. You need a firm yes or no on the bipolar front -- and if it's a firm yes (whatever type of bipolar you have, and, as you know, there are *many*), you need to work out a treatment plan for that. If it's not, then you can start addressing with your doc what the issue really is.

By the way, you say you're an alcoholic -- are you still drinking, or are you using the term as many recovering/recovered alcoholics do (i.e. once an alcoholic, always an alcoholic)? If you are still drinking there's every chance that the drinking is heightening your anxiety and otherwise interfering with your diagnosis and meds. If you are still in that place, please push treating that to the top of your agenda: it will only compromise your attempts to address the other things if you don't. Pleanty of people here have struggled with alcoholism and I'm sure would be very happy to talk to you about this.

All best,
Rosie x

Hi Green,

Good for you for being off the booze for 9 months. -- Takes a lot of doing, I know: well done!!!

If your doc is worried about you having mania from the Lexapro, he's still thinking you're bp, since only bp needs a-ds offsetting with anti-mania drugs. If you're not bp and the a-ds are causing heightened anxiety beyond a couple of weeks, you're probably on the wrong a-ds.

I can totally understand where the drinking is causing confusion. -- Have you thoroughly investigated with your pdoc which came first (self-medicating with alcohol or bp)? Self-medicating this way is a common symptom of bp. Then again, alcohol can lead to similar symptoms. So it's crucial that you establish which came first. You say that the manic symptoms all happened when you were drinking -- can you be absolutely certain on that? If so, then, although it's still possible that the alcohol triggered bp, it does reduce the chances of this being the diagnosis.

Bp can be very hard to medicate. Remember that none of the meds, bar lithium, was designed to treat bp (and even lithium has a peculiar history). Essentially, anti-psychotics are designed for seizures, a-ds for depression. And bear in mind that a-ds work differently even for people with anxiety and/or depression (e.g. I take citalopram these days -- great for me, anxiety-inducing for others; and past meds I've taken have given me all sorts of side effects but have been life-savers for others). This means that sometimes it takes a lot of trial and error to find the right combo for bp.

It sounds like your pdoc is very wise -- takes a lot of wisdom to know your limits. If he's suggesting referrals, take that route: this pdoc knows he's confused, and knows that there might be wisdom out there that you could benefit from.

Rosie x