![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by NikkiT2 on October 26, 2002, at 10:21:03
I'm posting this on behalf of a friend, hope someone can give her a batter answer than I could!!!
_____
Can you help me with a question over response to medication - might it
> indicate bi-polar tendencies or drug dependency/addiction?I'm currently taking 300mg Efexor (Venlafaxine XL) daily in divided dose.
>
> I am finding the current cycle with the medication I am on: I hit a very
low
> patch so I up the dose, I feel wonderful, great, fantastic, on top of the
> world for a while, then it levels off, then I crash again, so I up the
dose
> and the cycle starts again. The whole cycle lasts a few months with the
> 'high' lasting a few weeks.
>
> Also I have noticed the following: if I miss a dose (and I am taking it
split
> throughout the day even though it is an extended release version as this
> seems to help) I really notice it in that my mood drops and I get
lethargic
> and lose all energy and get black thoughts. When I take the dose it takes
at
> least an hour and then it 'kicks in' and I feel great again.
>
> Are these normal responses to a drug that is meant to have a long half
life
> and be a slow release version at that? There have been questions raised as
> to whether I am bi-polar, might this contribute to my experiences? Or is
it
> a kind of dependency, in that I need a 'fix' to keep me happy? I am on a
> high enough dose as it is, I am worried about what will happen when I need
> to increase it again.
>
> I am not seeing a psychiatrist at the moment so there is noone I could ask
> the above who might know.
>
> Thank you very much.
Posted by JonW on October 26, 2002, at 10:31:17
In reply to Effexor and possible Bi Polar, posted by NikkiT2 on October 26, 2002, at 10:21:03
I've pasted a page from the tips below (http://www.dr-bob.org/tips/split/Possible-indications-of-bi.html):
From: rdb@icu.com (Richard David Brand, MD)
Date: Fri, 16 Feb 1996 13:31:10 -0500
Subject: Possible indications of bipolarityI am thinking [a patient] may be bipolar, despite the absence of a clear manic or hypomanic episode, and may try valproate. Leading me toward the change in dx are the following:
selectively better response to venlafaxine
age of onset (too young to have recurrent unipolar depression)
at least on SSRIs, a very rapid switch to euthymia (which for him may actually be hypomania, since his general character is depressive by nature).
--------------------------------------------------------------------------------From: LJGROLD@aol.com (L.James Grold M.D.)
Date: Fri, 16 Feb 1996 20:40:31 -0500
Subject: Possible indications of bipolarityI have come to the same conclusion on several patients with recurrent depressions starting in adolescence. I also have found in such patients that venlafaxine and buproprion with a mood stablizer like divalproex to be very helpful in smoothing out the moods and in preventing more cycles.
--------------------------------------------------------------------------------
From: rdb@icu.com (Richard David Brand, MD)
Date: Sun, 18 Feb 1996 14:01:22 -0500
Subject: Possible indications of bipolarity
Why does a better response to venlafaxine indicate bipolar tendencies?
--Andy CheshireGood question. I asked the same one at the Psychiatric Congress in NYC last Nov. This idea came as anecdotal material from one of the conference speakers. It was his feeling that venlafaxine works better with bipolar illness than the "straight" SSRIs and has less likelihood of causing a manic switch.
--------------------------------------------------------------------------------Date: 29 Feb 96 19:33:28 EST
From: "Kip Doran M.D." <74444.3204@compuserve.com>
Subject: Possible indications of bipolarityI often find that patients who truly have a robust response to an antidepressant in just a few days often turn out to be bipolar.
--------------------------------------------------------------------------------
From: PMBrig@aol.com (Peter M. Brigham, MD)
Date: Thu, 29 Feb 1996 08:08:38 -0500
Subject: Possible indications of bipolarityI have the growing impression that rapid responders who then lose efficacy despite subsequent dose increases often turn out to have occult bipolar disorder and respond when mood stabilizers are added. In retrospect I have come to think in some cases that the rapid initial response was a mild hypomania.
--------------------------------------------------------------------------------
Date: Thu, 29 Feb 1996 11:03:35 -0400
From: scole@world.std.com (Stanley Cole)
Subject: Possible indications of bipolarityThis has been my experience too, that a number of patients with rapid response to SSRIs have ultimately gone on to get worse, appear to be hypomanic and eventually do well with added mood stabilizer. I have had one patient this year who had a remote post-partum depression, a number of successful courses of Prozac over the years, and only this past time demonstrated the picture described above. In fact, after she was stabilized, she wanted to do the experiment of going off the mood stabilizer and eventually demonstrated need for it.
--------------------------------------------------------------------------------
Date: Thu, 9 Jan 1997 18:45:52 +0900
From: fukuda@med.teikyo-u.ac.jp (Rimmei Fukuda)
Subject: Possible indications of bipolarityAt 21:13 97.01.06, Ivan Goldberg wrote:
Among the possible indicators of some degree of bipolarity are:hypersomnia when depressed
winter intensification of depression
family hx of bipolar spectrum disorders
profound lethargy when depressed
irritability as a response to antidepressants
"mini-hypomanias" -- seldom reported by the pt, but often by significant others, if asked.
I agree with Ivan's very beautiful illustration. It is my humble impression that bipolar depression (especially type II) tends to show up with these features rather than melancholia (except for acute double-depression). Patients with the initial dx of atypical depression or dysthymia often reveal bipolarity later.
Clinically I often see many, many of these typically young, mildly dysthymic, not necessarily suicidal, apparently functioning patients with histories of possible hypomania. They are sometimes with conflicts of identity and of human relationship and need psychotherapy or cognitive changes. The worst thing is to medicate them with too much long-term, short-acting benzodiazepine!
Posted by Mr Cushing on October 26, 2002, at 12:04:29
In reply to Effexor and possible Bi Polar, posted by NikkiT2 on October 26, 2002, at 10:21:03
Hey, I found the above post very interesting and I too am Bi-Polar and am taking Effexor XR. However, I can only take it in 75mg a day doses at the moment (this is week 8, I think). If I take anymore then I get really hyper, completely restless, and have this strange glowing sensation throughout my body (like a really nice high). This usually lasts for like 3 days upon which I won't sleep because my body is basically telling me I don't need to sleep.Before getting on this drug I was in a very manic episode of my bi-polar illness. Since it really seemed to take the wild edge off of me, just leaving me with the above side effects, within 2 weeks my Doctor suggested that I try a mood stabilizer with it.
So I've been on Epival (Depakote) for close to 2 weeks now. I know this drug takes a while to get into your system, but I already feel much more level. I no longer get such extreme highs, I've got energy but not "too much" energy, and with just .5mg of Klonopin at bedtime I'm sleeping like a baby.
So adding a mood stabilizer and decreasing your Effexor dosage might help you. I don't know... I'd go check with a certified Shrink first...
Posted by polarbear206 on October 27, 2002, at 15:51:25
In reply to Effexor and possible Bi Polar, posted by NikkiT2 on October 26, 2002, at 10:21:03
High doses of antidepressants used without a mood stablizer will just exacerbate your highs and lows. Mood stablizers should be your MAIN med with a low dose of an antiderpessant if possible. Get a good pdoc for proper diagnosis and medication.
Be well soon!Laura.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.