BP or Antidepressant-induced Mania
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Q:  BP or Antidepressant-induced Mania

Hi there;

I was diagnosed with bipolar a month ago after a paxil induced mania/psychosis that was relatively severe.  I am 29 years old and have had three manic states, each a result of Paxil but didn't realize this until the last mania landed me in the hospital.  I have never had a severe depressed state.  Is it possible that I am not actually bipolar and that this was just drug-induced-mania and won't ever happen again now that I no longer take Paxil?  I was paxil-free for 2 years and never had any symptoms at all during that time. Could it all be from Paxil, or is it that paxil just triggered it and now I'm going to have to deal with it forever.  My doctor told me that I would have to take medications for the rest of my life, and I find that to be kind of unacceptable (denial?) at this point.  Thanks for any answers you might be able to provide.

Dear Christine -- 
You are touching on an area of controversy.  No one really knows whether it's best to regard this as "bipolar" in the typical sense, where yes we would be thinking about long term mood stabilizers; or to see it as (sometimes dubbed "Bipolar III") antidepressant-induced mania that will not recur without another antidepressant.  

So, for starters, obviously it wouldn't be good to take another antidepressant without great caution and a mood stabilizer on board first, which hopefully would address the depression which might be making people want to give you an antidepressant in the first place. 

Second, if you're on a mood stabilizer now and have had three manic states, one with hospitalization, it might be prudent to hang out on a mood stabilizer for a while.  Maybe 6 months, maybe a bit longer.  Probably (note this is less firm than the last paragraph) best not to taper right away. 

Then comes the really tough part: how long until you try a taper? (which most people talking like you're talking are going to try at some point, so I just emphasize the "taper" part, more on that in a minute, and then try to help the person decide when, usually looking for a period where it looks like some pretty stress-free sailing is coming, or at least no obvious stressors are on the horizon.  That can take a while right there as most people don't just hang around in low-stress environments all the time. 

So whenever the taper finally comes, unless I could convince you on the basis of your history it was not a good idea, which I might try but would still be prepared for you to taper anyway, I'd emphasize two things: one, taper means taper -- like, over a year?  at least 6 months, for sure.  Secondly, set it up so that you have a "safety net" around in case something bad starts happening to your mood: friends who'll call either your doc' or whoever is needed to keep you safe, if you won't follow their advice and get help.  

Between now and then you can have a series of conversations with your doctor so that she knows why you want a chance at "off", and you know exactly why she's making such a point of "stay on".  

Dr. Phelps

Published May, 2002 


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