Severe Depression + Meds = Acute Mania

[Zinnia]

Hi,

I'm new to this site. I'm looking for support and insight so that I can support my boyfriend who suffers with bipolar disorder. I'm wondering if anyone else here has had the experience of being treated for depression only to have medication trigger a severe manic episode and subsequent diagnosis of bipolar? How have you dealt with that and have you had problems trusting a doctor or taking medication again?

My boyfriend had struggled with periods of depression all of his life (as do other members of his family) when several years ago a therapist he was seeing for severe depression referred him to a psychiatrist who immediately prescribed an SSRI medication after only a brief session. (I'm not mentioning the medication because I don't want to get side-tracked in blaming a specific drug here). The side-effects began almost immediately with escalating mania. Ultimately they resulted in delusions, hallucinations and a full-on psychotic break resulting in police arrest and forced hospitalization. After this acute mania, he was diagnosed as bipolar. He was on several medications (I don't know which ones) after being released from the hospital but stopped taking them not long after.

As I mentioned that was several years ago (I did not know him then). He has not had any acute mania since but he has had bouts of depression. Recently he has decided that he should resume treatment with a doctor. He has so much terror, shame and humiliation about what happened to him before and so much fear and anxiety about trusting a doctor or risking taking any sort of medication. Deciding to see a doctor again is a HUGE step for him and I want to do everything I can to support him and help him find the right doctor.

[paula]

Hi Zinnia

Yeah, I have heard that if you treat depression with bipolar meds and visa versa. Depression or symptoms of depression are prescribed anti-depressants.

What’s the Difference Between Bipolar Disorder and Depression?

By JOHN M. GROHOL, PSY.D.

February 22, 2007

Page:« 1 2View All»

A common question asked of clinicians is, “What’s the difference between bipolar disorder (also known as manic depression) and plain old depression? It’s a simple question to answer, because depression can either be a stand-alone diagnosis, or a part of another disorder, like bipolar. Therefore a mental health professional is going to examine whether there are other symptoms present (or have occurred in the past), to see if the depression is just depression, or whether it’s a part of a larger disorder.

Bipolar Includes Mania & Depression

If bipolar disorder includes a depressed mood, what else does bipolar include? We can find the answer to this question by looking at the old name for bipolar disorder, manic depression. The old name is pretty descriptive — bipolar is a combination of mania and depression, alternating in cycles.

What is mania? If we examine the symptoms associated with mania, we see that it includes the following:

Inflated self-esteem or grandiosity

Decreased need for sleep (e.g., one feels rested after only 3 hours of sleep)

More talkative than usual or pressure to keep talking

Flight of ideas or subjective experience that thoughts are racing

Attention is easily drawn to unimportant or irrelevant items

Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

If three or more of these symptoms are present, then a person is considered to have a “manic episode” (or, if it is of less severity and length, a “hypomanic episode”). A manic episode also needs to have lasted for at least a week (a hypomanic episode, just four days) in order to be diagnosed. If an individual has signs that suggest he or she is having or has had a manic or hypomanic episode, in addition to episodes of severe depression, then typically that individual will quality for a bipolar diagnosis.

Depression Has no Mania

In ordinary depression, which clinicians refer to as “major depression” (sorry, there’s no equivalent “minor depression”), no manic or hypomanic episode is prevalent and the individual has no record or indication of having a manic or hypomanic episode in the past. A depressive episode is characterized by the following symptoms:

Depressed mood most of the day, nearly every day

No interest or pleasure in all, or almost all, activities most of the day, nearly every day

Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.

Insomnia (inability to sleep) or hypersomnia (sleeping too much) nearly every day

Psychomotor agitation or retardation nearly every day

Fatigue or loss of energy nearly every day

Feelings of worthlessness or excessive or inappropriate guilt nearly every day

Diminished ability to think or concentrate, or indecisiveness, nearly every day

Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Five or more of these symptoms for longer than two weeks are needed in order to qualify for a depressive diagnosis, with no accompanying manic episode.

[nancyannee]

Hello Zinnia, as I said in an earlier post, your BF is very lucky to have you by his side.

to answer your question about mania being induced by meds.... from my experience, (the few times I was actually being treated) the docs were very careful with my anti-depressants because they did not want to trigger my mania. At times I felt like they (docs) would rather I stayed in a depressed state instead of potentially bringing on more manic behavior. As I got no relief in the meds, I stopped taking them. I am glad your BF is going to get treatment. I come to this site to find the courage I need to ask for help...yet again...*sigh*

good luck!

nancy:)

[Guest ASchwartz]

Hi Zinnia,

I agree that it is a good thing that your boy friend want to re enter treatment for his Bipolar disorder. The choice of psychiatrist is important because prescribing medications is an art. Some psychiatrists are excellent and some are.......well, lest than excellent.

Your boy friend should also have Cognitive Behavioral Therapy for his disorder.

What is it like for you to deal with his problems??

Allan:)

[Zinnia]

Hi Paula, thanks for the information.

Hi nancyannee thanks for sharing your personal experience, I really appreciate that. It really does help to know that others are going through similar things and that we are not alone!

Hi Allan,

Thank you for your suggestion of CBT. I have been reading a lot lately about finding the right therapist, types of therapies, schools of thought etc. I feel like it is not just about skills and education and experience and approach but it is a little like dating - you have to find the one you are comfortable with.

Dealing with my boyfriend's problems is difficult. Maybe the hardest thing was realizing how much suffering he hid from me. Really understanding what has been going on with him is a process. I have felt like a failure because I didn't see what was going on earlier. I feel guilty. Sometimes I feel powerless. When he is depressed I hurt because I hate to see him suffering and I can't make it go away. He does not seem to get really manic - or at least does not show any outward signs. He hid his risk taking behavior from me and never told me about the racing or obsessive thoughts until recently. I have anxiety about whether or not he is actually fine when he says he's fine. I feel like his illness lies.

But through all of these feelings I know how much I love him. With me and others who love him to support him and by finding a good doctor (who he trusts this time), he can make it through - because even though he does not give himself credit, I know how strong he is. Despite struggling with so much for so long, alone, he has survived. I know that while his illness is part of him and is part of his life and will always be a part of his life, it does not define him. He is not his illness.

I have always believed that there is nothing shameful about asking for help. Easier said than done, I know. So I also realize that if I were the one suffering I would want the person who loves me most to be the strongest that they can be so that they can be there when I need to lean on them. So finally getting up the courage to post here is part of that. Also I found an in-person support group for loved ones of people with mental illness. I have some anxiety about that - not sure if it is for me - but I'm going to try it and see! I'm also trying to find a therapist for myself to help me process my feelings and give me professional advice specific to my situation.

I don't think I'm naive. I know this is a long journey but I have hope.

[jb-living?]

Hello Zinnia,

I am very new to this site, and am also lookig for help and support. But my story sounds like your boyfriend's situation to some degree. After being

diagnosed with recurring major depression when I finally sought help, I was put on SNRI's which unfortunately did not seem to help much. I never had any true manic episodes, but while in the midst of a change in meds, I had a very scary hystreical episode and went to the hospital again. The psychiatrist there asked me a lot more questions about how I felt and acted when I was not depressed. How would I describe myself, my social life, my outlook on life. He diagnosed me with Bi Polar II (2). It does not produce the manic states associated with regular Bi Polar disorder, but does still have severe depressive states. It is not as familiar to some doctors, but it might be good to see if he can find a doctor who is, and has had experience treating it.

I know a website which has a fair amount of info on Bi PolarII, and don't know if I am allowed to post it here. If I find out that I can do so, I will. Otherwise if you want the info, just private message me, and I will share the site with you.

Thanks for your post, and for being willing to help and support your boyfriend, I know from experience how much that means.

jb