Expert: Ivan Goldberg, M.D. - 7/31/2010

Question
QUESTION: Hi!

Sorry if my previous question was confusing! The whole issue is rather confusing! lol

I have Neurological issues, which take the form of Migraine Aura and Temporal Lobe Epilespy.

My Shrink has advised, that due to recent reactions to Cipramil .. that it is 'typical' of an organic mood disorder, Bipolar. As antidepressants can draw out organic mood disorders in people with Neurological conditions.

I was wondering if you know anything of this link, Neurological issues .. particularly TLE and organic mood disorders?

Epilim has been suggested to me for the TLE, Auras and Mood Disorder. I was wondering if Epilim would be effective and I was also wondering if Epilim would help anxiety, or just 'mood'.

Hope that is a bit clearer!

Thank you.

ANSWER: I have seen many individuals with TLE and in my exprerience such people are hardly ever confused with people with a true mood disorder. People with TLE often have "mood swings" lasting minutes and usually accompanied by EEG changes. People with bipolar disorder usually have "mood swings" lasting for days to weeks that are not accompanied by EEG changes.

Citalopram certainly can push people into manic, hypomanic. rapid cycling, and mixed states.

Valproate can be used as a treatment for people with TLE, and bipolar disorder. It has some antianxiety activity but is  a much better anticonvulsant and mood stabilizer than anti-anxiety agent.

Best regards . . .

Ivan
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---------- FOLLOW-UP ----------

QUESTION: Thank you for your answer!

In order to be 'pushed' by Citalopram does an underlying organic mood disorder have to already be in place? The way it was discibed to me is, the fact I was pushed, means there is something, apparently in my case bipolar (in a lesser degree) lurking beneath the surface ..

It seems my last two attempts on Cipramil pushed me in to two different 'moods'. I was told, the being unable to sleep was technically 'high or mania' and the second time I went down is technically what ever the opposite in biploar is (Im not good with my terminology!). Characterist of bipolar.

Do you agree with that? So much information was offered to me (for the first time in 12 years!) and it took me a few days to process it all, so I just want to check if I have interpreted it correctly!

Thank you again, very very much!

Answer
Hi again

I find it hard to understand that insomnia is the equivalent of a manic state. Citalopram induces mania in some people . . . the insomnia is a pharmacologic effect of the drug and  has nothing to do with mania. It just stops some people from sleeping. Citalopram, although a moderately good antidepressant, induces depression in some people. This again has nothing to do with mania,  bipolar disorder, or TLE.

There is no way that I can make a diagnosis by way of the internet, but I am, not convinced that people with a history such as yours necessarily have either TLE or bipolar disorder.

Have you considered seeing an expert psychiatrist for a second opinion regarding your diagnosis and treatment?

Best regards . . .

Ivan
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