Q: Early Morning Energy & Agitation, Afternoon Depression & Tiredness
I once was suffering from depression and was given an anti-depressant.
Immediately I changed over the next day or two. I do not remember a whole week. Apparently I became agitated, violent and then disappeared
for a week with no memory of anything. I never took any again. For the next 22
years I relied on 222's and speed pills to make me feel good.
Then One Summer/Spring, I began to feel strange. I started to get bored, began
spending my time with physical pleasurable activities, mountain biking, hiking,
drinking, sex. Stopped wanting to be at home and hated having to be there. Would
cry all the time. Then I became paranoid and thought all kinds of things I never
thought before. Some were that I wanted to kill myself and some were
hallucination type paranoia. I began treatment and was tried on almost
everything they have. Three serious suicide attempts later, I have mostly been
kept on Lamotrigine, Seroquel, Fluoxetine. I still cycled between long desperate
depression and short but often hypo-mania, but in either mood, still continued
to hallucinate and feel suicidal but just at a lower level.
About 3 months ago, I added (they added) Ritalin and Clonazapam to the other
meds. Now I have been at a constant steady state of somewhere I have not been
before. It's like I feel partly suicidal, constant feeling of slight psychosis
and still depressed and flat but also very flightly and energetic but extreme
agitation from morning until about 5pm each day. Two weeks ago I stopped the
Lamotrigine, Seroquel and Fluoxetine because of stresses that required my full
alertness and energy. All this week with just Ritalin when I wake up and
Clonazepam at night I am very different. Early in the day I am full of energy
and then it wears off by early afternoon to an agitated tired depression, then at
night I take my Clonazepam and go to sleep.
Where am I heading with this. Am I in a dangerous place here? With this routine.
I am not having any psychosis that I am aware of, whereas before I always was.
But the afternoon depression and tiredness and the early morning energy and
agitation is making me a bit uncomfortable.
Dear Liz --
As you can imagine, I must be careful here not to criticize the medication
choices made so far, as I don't know the many details your treating doctors do,
and did when they were choosing and adding things. But to try to answer your
The first thing that comes to my mind is the
observation that here you are now not on an antidepressant, and things are
better than they were (fluoxetine). If the story goes as it sounds, you may have
been on that antidepressant the whole time (or at least much of the time) you
were on the lamotrigine and Seroquel. So you'd not really be able to evaluate
those latter two medications were working, as there was an antidepressant around
at the time. Antidepressants are thought by many mood experts to have the
capacity to make bipolar disorder worse (e.g. see my
Controversies page; Controversy #2). So you'd have to wonder if maybe you're
better now (relatively better, anyway) because you don't have an antidepressant
on board anymore. The reason for wondering this is because that means you might
have to consider going back to something like "square one" with the routine mood
stabilizers (including lamotrigine and Seroquel but also
And the reason for considering this move back to square
one is that things don't sound so great right now. Better than they were, but
still weird. Dangerous? Not as much as before, sounds like, but clearly not good
as far as being able to get on with your life. The good news is that if you can
do as well as you're doing now with just these medications, you might be able to
do quite well with the general approach now usually recommended for bipolar
disorder: rely on the mood stabilizers, watch out for the antidepressants, and
use the non-medication approaches thoroughly also. This general strategy is
outlined on my website pages
about Bipolar II,
in the Treatment section (whether you're Bipolar I or Bipolar II won't matter
much at this point as far as treatment goes). Check it out. You can use this to
help you in your discussion with your doctor about where to go from here. Good
luck with that.
Published Sept., 2006