SSRI induced mania - OCD and Bipolar?

[mammahen]

Hi,

Be warned - I have to ramble...and moderators, I don't know if I've posted this in the right place.

Our 11 year old daughter has OCD and we have battled to get it under control as the ssri route didn't work due to induced mania. She has been on risperidone since day one. The pdoc first tried her on prozac and it was diasterous. She became out of control - totally manic with no signs of depression. The pdoc took her off immediately and explained that it could either be a reaction to fluoxetine specifically or it could the meds unmasking bipolar. He then tried her on Sertraline at a very low dose, increasing very slowly but it was a no go. Not quite as bad as the prozac but manic nevertheless. Except now it was doing squat for her OCD. We had increased her risperidone to try and counteract the AD but she ate like a horse of course which caused her even more anxiety about her weight so that was reduced back down to 1mg and she was taken off the sertraline and put on 50mg epitec to be gradually increased to 150mg. It stayed like that for a good 4 months or so but did very little for her. She gradually got worse and worse until she was basically disfunctional for most of the day due to paralysing anxiety and fear about everyrhing, medical and guilt obsessions and checking and confessing rituals ruling her every waking moment as well as physical and vocal tics jumping into the equation. As if she didn't feel abnormal enough already. She began developing depersonalisation episodes from the constant fear and anxiety which in turn her OCD grabbed hold of. She would obsess and worry so much about having another episode that she would inevitably push her sel into one long episode. Urbanol wasn't really touching sides. She has now been put on to citalopram 10mg am to start, upped risperode to 1.5 mg and upped the epitec to 200mg pm with 0.5 urbanol in the mornings as well. We are now on day 2 and she is a new person. Full of life, confidence, 80% better fearwise.

I'm sorry to bore u all with the details but I have a few questions for any OCD sufferers or parents of sufferers with comorbid bipolar:

If the ssri's have unmasked BP, can she still be treated with an ssri for Ocd with the mood stabiliser to keep the mania at bay? Is it safe? In my experience ssri's take a whole lot more than 2 days and 10mg to help with ocd. Could this lightning fast 'recovery' actually be the start of mania due to the AD? Are there any other people with ocd and bp that are succesfully treated with ssri's and mood stabiliser combinations. Are these mood stabilier dosages still considered too low to counteract the mania? If she had no BP symptoms before the treatment with Ssri's would she have eventually developed symptoms later? I'm worried that 'unmasking bp with one med and squashing it with another' is actually 'cementing' the disorder into the brain or engraining faulty neuro pathways for want of a better way to explain myself!

Once again I'm sorry for all the rambling and questioning but I'm so desperate for my daughter. She is the bravest little 11yr old I know and trying my hardest to arm myself with enough knowledge to be able to keep afloat as well as stand my ground with the doctors if needs be.

Thanks and love to all you very brave people - parents, spouses as well as sufferers.

Kirsty x

 

[inuyasha8629]

SSRI's uncovered my Bipolar and induced SAD. The SSRI's made me manic. I would not advise any Bipolar patient to take SSRI's.

 

[Darling Deedee]

Hey there,

SSRI's unmasked my bipolar, too. I don't have OCD though but I agree that your 11 y/o is incredibly brave. And so are you.

I don't have anything else to offer except to say that SSRI's can definitely unmask bipolar. I'm on Lamictal now to manage my depression but I don't know that Lamictal would help OCD at all.

*thinking of you*

-Deedee

 

[mothcorrupteth]

Hi,

After my first manic episode in January, I started out on 0.5-mg doses of risperidone until some time in mid-July, when my doc recommended 25 mg sertraline. Although I've never been formally diagnosed with OCD, my mother has commented on many occasions that she thinks I have had some form of it, and as a graduate student in psychology, I think I can agree that I had some anxiety-prompted ritualistic behavior.

The time-course for my meds goes something like this:

In January, my thoughts were jumping all over the place and because I could recognize my own deficits in social cognition and my ritualistic behavior, I was convinced I was Asperger's. However, I conceded to myself and to my psychiatrist that in 20% of cases of Asperger's, the disorder mysteriously leaves in early adulthood, and very often this is accompanied by bipolar episodes. So I consented to take my risperidone every day and did so.

In March and April, I passed through a grinding depression that made it difficult for me to concentrate for longer that a couple of seconds. I became more ritualistic, more obsessed with things like whether I forgot my keys. It was about this time that I bought Dr. Mondimore's 2006 book on bipolar disorder and read about the benefits of omega-3s, at which point I began taking 3000 mg of fish oil per day (that's 900 mg omega-3). My mood improved modestly, but because this effect was confounded with the continued effects of risperidone, I can't verify fish oil's effectiveness.

In May, I took an OTC antihistamine by Equate that threw me into a hypomanic state while I was at a conference in Denver. Because the symptoms of hypomania felt different with my recovering cognitive abilities, at first I thought it was thyroid problems or hyperglycemia. Then I read an abstract online that alluded to the possibility that some antihistamines triggered mania. So I cut the antihistamines cold turkey, passed through one week of mild depression on the rebound, and felt much better in the weeks that followed.

By July, I had made a lot of progress, but I was still having a lot of anxiety over returning to grad school and working on my dissertation. So I asked my psychiatrist about benzodiazepines. He responded that they have the weakness of tolerance effects and that in his opinion the risk of SSRI-induced mania was overstated, and that even though we think of sertraline as an antidepressant, it can have anti-anxiety effects, too. So I told him I'd give it a try, and...

It's a totally different world for me. I never realized how much I was missing out on. Before, even with risperidone, I had a really difficult time figuring out what other people think or feel (one of the other reasons I had suspected Asperger's). Now, I can anticipate it, and I'm taking a lot of pleasure in thinking of others, making others feel comfortable. And there's more breadth and depth to my thought. I don't have the tendency to fixate my thoughts on one idea that seems very intense to me, and I don't compulsively wash my hands or make sure I have my keys before the front door is closed or write useless subroutines into my computer programs (I used to have the illogical obsession that if I didn't write these subroutines, then there wouldn't be a safety net in the program if my main programming failed). Life is wonderful for the first time since I was 12 or 13.

mammahan, the level of detail you have provided is entirely appropriate and helps us respond in a more informed manner to your questions, so don't worry. Bipolar can present differently in different people. I inherited it from my mom, but she's never had half of the symptoms I've had, even though we both let it go untreated for the same number of years. And her symptoms started when she had me, and my symptoms started in junior high school. Don't let people tell you that this drug definitely works or that drug definitely doesn't work. Psychiatry is a lot of guesswork to start with, and the fact that bipolar is different in different people makes the guesswork that much harder. It's possible sertraline plus risperidone can work for your daughter (it worked for me!), but it's also possible that a different combination could work. And, to get at the answer to the question you actually asked, yes it's safe.

 

[inuyasha8629]

mammahan, the level of detail you have provided is entirely appropriate and helps us respond in a more informed manner to your questions, so don't worry. Bipolar can present differently in different people. I inherited it from my mom, but she's never had half of the symptoms I've had, even though we both let it go untreated for the same number of years. And her symptoms started when she had me, and my symptoms started in junior high school. Don't let people tell you that this drug definitely works or that drug definitely doesn't work. Psychiatry is a lot of guesswork to start with, and the fact that bipolar is different in different people makes the guesswork that much harder. It's possible sertraline plus risperidone can work for your daughter (it worked for me!), but it's also possible that a different combination could work. And, to get at the answer to the question you actually asked, yes it's safe.

Yes, I agree that there are different combinations of medication that works for different people. In my case, the mixture of Lamictal, Geodon and Seroquel has kept me sane over the years, it just takes some dosage adjustments every once-in-a-while. Over the years I've taken so many different medications...but one that always turned bad was any SSRI or any related medications, such as Celexa and Lexapro. Prozac induced Social Anxiety Disorder in my case, and it hasn't gone away, either. Other medicine's that were effective, but has too many side-effects for me were Abilify and Concerta. I took the Abilify for my Bipolar, but it made me gain a lot of weight. Concerta I took for ADHD and it just spun me out of control. But the "cocktail"(as my mom calls it) I have right now works wonders for me. It all depends on the person; I agree with that.