Q: I'm Cycling Again
Hello Dr. Phelps,
I am thrilled to find you and this site. Wonderful and innovative
information. I am 44 (female), diagnosed with BP II 3 years ago. I
was previously diagnosed with depression 4 years prior to that, and Prozac
finally sent me into a severe hypomanic state. Believe I have had this illness
many years (strong family history). I soon became quite ill--hypomania
including irritability, agitation, some paranoia, insomnia, rapid thoughts, poor
judgement, then swings to severe depression quite frequently. I was
finally diagnosed and treated successfully with Eskalith 1350 mg along with
Celexa 40mg, as they feel my depression history is more severe and longer.
I get very bad tremors if I take the full lithium dose, so I tend to
decrease it most of the time by 250 mg and am just fine. But, every few months I
cycle mostly to mild hypomania, and occasionally beginnings of depression.
This corrects itself quickly when my doctor increases Celexa for a few
days. Now, I am cycling again to more pronounced hypomania, with
occasional irritability but mostly terrible insomnia for 4 days now, and some
mild agitation. I eventually sleep but am up for many hours. This
has happened several times before and my doctor thinks it is only stress (it is
not--my life is quite happy now otherwise). Please tell me what you think.
I wonder if the Celexa should be decreased slowly or stopped. My doctor is
reluctant to do this. Any thoughts on using light therapy? Thanks!!!!!
Dear Mary --
As you can imagine, it would be inappropriate of me to tell you to do something
different than what your doctor recommends, based on a paragraph. So I'll
offer a few ideas to consider and try to discuss with your doctor.
There seems to be an emerging consensus among mood
experts that one way, perhaps the best way, to address "rapid cycling"
is to slowly taper any antidepressant in the picture; for an example , read this
Harvard-trained expert. I often add another mood stabilizer in
the meantime. However, I also look for every antidepressant modality that
can be brought to bear that doesn't seem to cause cycling. Light therapy
probably could induce cycling, but seems to do so less than antidepressants, so
is an excellent option. (In any case, don't just stop the Celexa: you must
have a game plan with your doctor). Exercise, although it's very difficult
to integrate into most people's lives (though it shouldn't be), may be the best
antidepressant, as it seems almost certain not to cause or exacerbate
Published October, 2001