What is drug- induced mania like?

Hi, I have never done this before and find this subject very interesting. I suffered from post-partum depression after the birth of my first child six years ago. Since then I have done extensive therapy and have tried Celexa, Wellbutrin and most recently, Lexapro. I am now on Effexor XR and keeping my fingers crossed! The reason I had to go off of the SSRI's was due to the possibility of mania. I did great on 5mg of Lexapro for five months and then it just quit working, so my doctor put me on 10mg. This helped with the depression for about six weeks and then nothing. My doctor upped me to 20mg and right away I started to have problems. I went from being depressed to having absolutely no emotions whatsoever. After the second week, I started to have panic attacks and was so agitated that I felt like having my husband take me to the ER for sedation. I have NEVER had a panic attack and have never felt like my head was going to explode! My doctor then had me stop and start the Effexor XR. I am a nurse, so I am familar with bi-polar etc..., so when she said she thought I might have bi-polar or cyclothymia, I was floored! Does this sound like drug-induced mania? I also cannot sleep while on antidepressants and have to take 50mg of Trazadone at night to sleep. I do have severe mood swings when not on meds. My husband and children never know how I might react from one hour to the next! I also tend to be a very upbeat and charismatic person, but I think that is just who I am. Why would I not want to be that way? I guess I just think I am not so bad. So when I am happy, does that mean that I am manic? Of course when I am depressed it is also obvious. Any replys out there?

Hi,

I'm new and haven't even introduced myself yet, but I saw your post and it sounded somewhat similar to myself so I thought I would reply. I was diagnosed with bipolar 41/2 years ago and am finally starting to get stable on 5 meds, including Wellbutrin and Lorazepam, a tranquilizer. I am also a naturally outgoing, outspoken, energetic, charismatic person. Before I got my mix of meds on the right track there was a dark side to these traits that ppl would normally consider positive. There was rage and anger and intensity so deep it was scary.

At first I was put on Paxil, which didn't help at all, then a varitey of other anti-depressants, and 4 years later I was takin 300mg of Wellbutrin, but also 4mg of Lorazepam to calm myself down in order to relax and to sleep because I was just going a million miles per hour all day. To a stranger it probably apperared I was simply a person with all those positive traits that I mentioned earlier, but really I was manic all the time. It's not natural to go for weeks with no down time. But it feels good to feel so good and people think you are just doing fantastic.

But my doctor noticed and cut my dosage of Wellbutrin in half. I can finally breathe at a normal rate of speed again. Now I get tired like normal people and my body is much more chemically balanced. I do get more done and am much more productive when I am either just my natural self with no meds or am on twice the Wellbutrin, but my body would probably die much sooner.

Relax.

BTW, what is Cyclothymia, I embarassed to say I have never heard of it?

Thanks for responding to me. Cyclothymia is a somewhat milder form of bi-polar. Supposedly you have more frequent highs and lows, and they are not as severe as seen with bi-polar. I guess it can be a prelude to full blown bi-polar. Anyway, the rage issue fascinates me. I can have horrible rage in my mind and body. It scares me sometimes. The rage does seem much less ( or it disappears altogether ) when I am on antidepressants. By the way, I had to stop the Wellbutrin because it caused more rage and anger. Don't you sometimes think that the meds exacerbate certain symptoms, or bring out parts of you that were not an issue before taking them? I don't get why this symptom strongly suggests bi-polar/cyclothymia. I guess I just have to ask my family how I was before meds and I get my answer. So I am nicer and my moods seem more stabilized...is taht bi-polar? I am going to see a psychologist on this issue as recommended by my doctor and mental health counsellor. Talk to you again????

Did you have these symptoms before and while you were pregnant? Do you think bipolar was the cause of your post-partum depression? The reason I ask is because my husband and I want to have children, but obviously having bipolar, this poses a challenge. I am on 5 meds, which ones are safe, I have no idea. Could I manage without them, I have no idea. And the child? How would it effect him/her? Now that I am mid-way over the bipolar hump I am trying to move on with my life. I have spent so many years trying to get myself better, some of the things that are most important to me are slipping by, like babies, a family. I am 29, not getting any younger. Maybe you could give me some advice on this subject?

I find it interesting that the Wellbutrin caused you to have more rage and anger. Maybe it was making you more manic which brought out the intensity of your anger side too. It seems like to me that the intensity of the ups mathes the intensity of the downs. Just a theory though, not a psych.

When your happy do you have euphoria? I get euphoric.. And when I was on anti-depressants I got really euphoric. Trouble getting to sleep and waking Early. With psychosis (hearing things, seeing things, delusions) Its possible you could be having a manic reaction (could be termed cyclothymic). If you did have one you would probably be euphoric or was euphoric when you started anti-depressants. I don't think that means you have bi-polar disorder according to the DSM. One of the side effects of anti-depressants is insomnia. I doubt the panic attacks are linked to mania but there obviously linked to the ssri's. How was your mood before the anti-depressants? Just depressed? Any history of mania before that?

The thing that tips me off that it most likely isn't drug induced mania is the time frame you described. When antidepressants bring out an underlying disorder (such as bipolar I or II) it usually happends very quickly. SSRI's like Lexapro and Paxil take around 4 weeks to exert there antidepressant effect. Any type of remission of depressive symptons in less than a week is a textbook sign red flag.
Since you have been on 2 different classes of antidepressants and it took well over the classic time frame to be "substance induced disorder with manic symptoms". This is not necessarily a bad thing. With psychiatry making a diagnosis is very complicated. It took over 2.5 years and 4 psychiatrists to come to, at least at this point, a classification (or label). It was called a diagnosis by elimination. It sucks when you can't figure out whats going on until everything else is ruled out. I'm only a doctor of pharmacy not a shrink but I would suggest since you are genuinly interested in getting help, use this. Again it sucks telling doctor after doctor your symptoms and all they can do is guess at another disorder. You may feel like a ginny pig but if thats what it takes....

I have found that paxil and prozac kick me into a manic state within about 5-6 days...effexor, on the other hand, seems to have a calming effect yet diminishes my sex drive...is it being suggested I have an underlying bipolar disorder??? I've noticed throughout my life that most women I've been in a relationship with have called me moody, and sometimes I have many of the symptoms listed as cyclothymia...

I shouldn't have implied that if you have a quick onset of hypomania or mania after initiating an antidepressant, that you have bipolar. I'm not a doctor (well not a MD) but upon first impression it sounds you more likely have "Antidepressant Induced Mood Disorder with Hypomanic Features". But.... when you mention that you may have other symptoms that may point to you indead point to a mood disorder that falls with in the Bipolar family.

Who are you getting the mediaction from?
Primary Care Physician and/or Psychiatrist?

If you are seeing you PCP for this you might want to tell him all your symptoms and try to get refered to a psychiatrist.
If it is your psychiatrist does he/she know about your response the mediaction and all the other details that are concerning you?
If he does I'm surprised he tried a second medication in the same family of drugs. But Effexor is a little different. It works on two neurochemicals in the brain. One is the same as Paxil and Prozac but not as strongly. So that maybe a possible reason for your differences in your response. But if you do get diagnosed with a bipolar type of disorder you will most likely be taken off Effexor.

As far as your unfortunate decreased libido thats not so easy to treat/deal with. There are couple of approaches. The easiest is taking an impotance drug like Viagara, Levitra or Cialis. But....these won't increase your desire but help once you get started if that makes sense. The other option is to look at your response (for the original reason you were put on Effexor) and see if its at the desired level. Are your symptoms better, worse, the same, as before you started the medication. If it has improved your doctor may decrease your dose if you are on a higher one and observe what the smallest strength that works for you is. Side effects are mostly due to higher doses of a medication (the main exception being a drug allergy).

A third option is switching to a medication that doesn't work on Serotonin (ie. Paxil, Prozac & Effexor-even though its to a lower degree). The most likely choice is Wellbutrin which I'm sure you have seen ad's for, every where.

All these sugestions are based on the assumption that you DON'T have any other serious underlying mood disorder. Therapy is very different for these disorders.

Hope this helped and you haven't gone cross eyed or fallen asleep on your computer buy now. Any questions or concerns you can email me. Address in profile. Good Luck.

~Mixer

Thanks 4 your response...wellbutrin effects me the same as paxiland prozac...weird I guess...can't stand 'em!