Q: Is this Bipolar Disorder?|
I have not been formally diagnosed with bipolar disorder, but I wanted to
you a brief synopsis of my psychiatric history and tell me what you think.
In march of 1999, I began to have symptoms of depression. I was diagnosed
with dysthymia. I was tried on several medications including SSRI's,
Effexor, and Wellbutrin.
The SSRI's rarely did anything, even after a few weeks of trial. When on
Wellbutrin, I noticed an increase in energy but extreme irritability. With
effexor I had euphoria and increased energy, but no other "hypomanic
symptoms" I can think of for the first week, but then the medication would
peter out and i'd feel crappy again.
In OCtober of 2000 I moved, still feeling dysthymic and not getting much help
from medications. I saw a new psychiatrist who took a cereful history and
felt i had a strong anxious component and some social phobia and started me on
Celexa and Buspar. This combination was horrible, and after several weeks
of worsening symptoms he switched the buspar to a small dose of benzodiazepine.
In February of 2001 I had my first hospitalization for suicidal depression and
was kept on the celexa (20mg) and started on lithium 600mg. This worked so
well that within days I was euphoric, required no sleep, and had tons of energy.
Five days after starting the lithium they decided to try to increase the
dose to 900mg (my level on 600mg was 0.44). After about 10 days I had
severe side effects such as nausea, diarrhea, clouding of thought, tremors, and
just felt "drugged." The dose was dropped down to 600mg again,
and for the first time in as long as I can remember, I felt
"appropriate" in my mood and felt pretty normal. It was great.
The psychiatrist mentioned I "may have" bipolar disorder (type II) due
to my response to effexor, wellbutrin, and lithium with a quick episode of
euphoria and increased energy that occurs within days of the medication (when
they are supposed to take 2+ weeks to work) that then peters out. When
starting lithium, this euphoria was extreme, and I had so much energy I cleaned
my house for the first time in forever. However, I didn't have flight of
thoughts or what classically falls into a hypomanic or manic phase (as near as I
What do you think? Does this sound like bipolar illness or more double
dpression? I am currently on Celexa 20mg and lithium 600mg, but we are
going to try to increase the dose to 750mg via sustained release tablets.
Dear Dr. E' --
As mentioned in my direct reply to your email on my website, where you provided
yet more history, this story does indeed make a "bipolar component"
very likely, and direct treatment toward the use of mood stabilizers and even
perhaps the avoidance of antidepressants (which I would hold responsible for
that euphoric phase after lithium was started: I don't think I've ever seen
lithium alone do that, but the Celexa in the picture at the time could
Published March, 2001