Expert: Jennifer - 1/10/2010

Question
QUESTION: I have been diagnosed for almost 10 years now as having chronic recurrent major depressive disorder. At one stage they thought I had OCD and at another time borderline personlity disorder. My psyhcologist thinks I am bipolar. I was recently hospitalised for major depression and am now on Molipaxin 300mg per day, however after a week on that medication I became hypomanic. The psychiatrist I was seeing was on leave at the time and the second psychiatrist told me I needed a mood stabiliser but wasn't willing to prescribe it as I had to leave the hospital in two days (I had already been there almost three weeks) and they would not have been able to monitor the side effects. So now I am home and must face Christmas and family here with my moods swinging very strangely. I am hypomanic this morning and because I suffer from type 1 diabetes by doing too much I make my sugar levels go low and then I do feel tired. I am waking a lot in the night and also having panic attacks at night (believing that someone has broken into the house)

Can someone who is NOT bipolar become hypomanic on antidepressants or does the bipolar have to be there first? What are the risks of me continuing or stopping this medication for the next two to three weeks while everyone is on leave? I have had a serious suicide attempt at one stage and self harming behaviour. Can hypomania lead to any of these or is it only the depression that does that? And how long does hypomania that is induced by anti depressants normally last?

ANSWER: While I am not a medical professional and this particular format is not suitable for making any diagnosis; you absolutely should not discontinue any medication without contacting your doctor to allow them to monitor you if they do in fact decide that you should stop taking a particular medication  

My personal experience in dealing with the resulting rapid-cycling that was caused by the SSRI antidepressants I was prescribed by the first psychiatrist I went to, was the proof that I needed to fine someone who specialized in the treatment of bipolar disorder.  Suicide and self-harm are more commonly seen in the depressive stage.  

I'd recommend that you make contact with your regular doctor about this matter, and don't wait until the holidays are over at the cost of your own health and well-being.  Let me know if I can help you with anything else, and feel free to update me on your situation if you'd like.

---------- FOLLOW-UP ----------

QUESTION: Thanks, I did not stop the medication but swung back to depression on Christmas day despitre having a very pleasant Christmas. I seem to have PMDD too as it is always just before my period that things are at their absolute worst - whether I have overlying depression or not.

I am now on a mood stabiliser, Tegretol but am still slowly increasing the dosage. I have been very tired on this drug - is this a side effect that will continue as I need to start looking for another job and do not feel able to work like this if I am that tired - I resigned my job at the height of depression, but have been unable to keep a job in the past (the longest was two years and I was asked to resign because of severe mood swings that were affecting my work)

I have been married for three years and this is severely affecting my marriage - my husband describes it as a rollercoaster and he is right. What type of information does my husband need and what type of support should he get? By the end of December he and I were almost ready to separate (again) but decided to just try not discussing anything til the week had passed and since then we have been doing slightly better. I was highly suicidal and irrational at the time and this seems better now.

What type of expectations should I have of medication - I appear to be a bit drug resistant as the classic anti depressants have never worked well on me (fluoxetine and effexor mainly) and even the molipaxin which I was on for years til I fell pregnant seems not to be having the effect it was even at triple the dosage. Will my life continue to be a rollercoaster or can it normalise to some extent?

Answer
Your husband should see if there are support groups for family %26 loved ones of someone with bipolar disorder, and the main focus that any he considers attending will be about continuing the relationship and promotes understanding the role of loved ones as a support base and its importance for the person who has bipolar disorder.  If there are no such groups in your area, he can look for a mental health counselor who has substantial experience with Bipolar disorder,and especially in counseling family and friends along with the person diagnosed with the condition individually.

As for what to expect from medication; I went through a few years of trial and error before finally arriving at a good combination that was effective in controlling the worst of my symptoms and have had increased stability over time.  The best thing you can do is to find an mental health provider who is experienced in the treatment and management of medication therapies for bipolar disorder patients.  One thing that most people don't expect is that some medications will eventually become ineffective due to a tolerance having developed.  The main thing to keep in mind is that medication is not a cure, it's simply a way of managing symptoms to establish more stability and decrease the impact on the patient's life from the worst of them as well. Classic antidepressants aren't recommended for the treatment of bipolar disorder if used alone; they tend to cause rapid cycling, if they are being prescribed there should also be other medications prescribed to control the more problematic effects.

In essence, there is no simple answer, but in my own experience the only thing that brought more stability in my life was medication.  I know many other people with bipolar disorder, some who are currently non-compliant with medication treatments, and others who are - it is apparent that the first is continuing to struggle with even the smallest things in their lives, while the latter has gone on to finish college, returning to the workplace after years on disability payments, getting married and having children, etc.  I agree with the mental health provider community that believes medications are the most effective in treatment of bipolar disorder and other serious mental illnesses only because I know from experience that they are right. I have tried denying that there was anything wrong, I have tried nutrition and exercise, I have tried therapy with psychological counselors, all of those failed to do for me what medications have, and medication was the last option I allowed myself to consider.  When I think about all of the time that I lost because I refused to accept the information put before me until all other options were exhausted - it's the very reason why I've volunteered here, and why I encourage people who are bipolar like I am to take control of their lives, advocate for themselves, and the only way to do that is with medication.  We have so much to offer the world around us, from personal relationships to creative abilities to above-average intelligence and more.  Many of the greatest minds, artists, and others have been bipolar; they also had a tendency to self-destruct and to commit suicide.  Whether we're housewives or entrepreneurs that have built our own fortune 500 company, medication ensures that we'll have the chance to see it through.  It may be less 'exciting' when the invigorating highs of hypomania have been eliminated by the meds, but those will end even without meds, and they are replaced by something much more destructive when a person goes that route.  

I hope this helps, and that it encourages you to begin the process of getting your life back to moving on the path ahead.  Let me know if I can help you with anything else, and updates are always something I like to receive from any of those who have asked me questions.