The Blame Game: Antidepressants Cause Bipolar Disorder?!

Previously the older anti-depressants were notorious for triggering or precipitating (hypo)manic episodes in Bipolar patients, newer antidepressants such as SSRIs, bupropion and venlafaxine, do not appear as likely to precipitate mania. Both the mood stabilisers lamotrigine (Lamictal) and Topiramate (Topamax) don’t carry a risk of inducing mania.  In the DSM-IV and DSM-V (Diagnostic and Statistical Manual of Mental Disorders) stipulates that diagnosing a person with Bipolar Disorder has to fit these criteria:

Criteria F: The episode is not attributable to the physiological effects of a substance (e.g. a drug of abuse, a medication, other treatment).
Note: A full hypomanic episode that emerges during antidepressant treatment (e.g. medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence of a hypomanic episode diagnosis(My note: most* antidepressants other than Prozac are out of your system in a week). However, caution is indicated so that one or two symptoms (particularly in creased irritability, edginess, or agitation following antidepressant use) are not taken as sufficient for diagnosis of a hypomanic episode, not necessarily indicative of a bipolar diathesis.

Very sneaky phrasing of words.

It has been asserted that antidepressants can act as triggers for (hypo)manic episodes in people who have a higher likelihood of Bipolar Disorder (depression, history & environmental factors etc.). It has been argued that having a (hypo)manic reaction to an antidepressant is not necessarily a symptom of Bipolar Disorder, arguing it’s a manic reaction to the antidepressant. This form of argument can only be assessed by being aware of what antidepressant you’re taking, newer antidepressants have very little chance of inducing mania (rare side effect : <0.1% chance mostly). I had initially blamed the antidepressant for causing my ‘bipolar symptoms’, this has now been changed, I was on Mirtazapine (given to me because of a family history of Bipolar I – this antidepressant had the <0.1% chance of inducing hypomania, agitation, aggression, risk taking, confidence, confusion and insomnia. All of which I experienced long after the antidepressant had left my system).

Symptoms of (hypo)mania need to persist after the life of the antidepressant: A manic reaction to antidepressants is not a symptom of bipolar, it’s a manic reaction to antidepressants. Therefore people who have a diagnosis of Bipolar Disorder who have a manic reaction to anti-depressants, doesn’t consequently mean that it’s Bipolar Disorder.  Symptoms of bipolar (hypo)mania are sometimes about being more irritable, edge and agitated, but these symptoms don’t mean it’s bipolar, they are generally symptoms of the antidepressant or its withdrawal. Sometimes it’s about surviving psychiatry. A test study about the activation of (hypo)mania states that it occurred approximately 0.2% (3/1299 patients) of Remeron-treated patients in US studies. Although the incidence of mania/hypomania was very low during treatment with mirtazapine, it should be used carefully in patients with a history of mania/hypomania.

The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in people treated with (older)antidepressants for major depressive disorder. Before being prescribed antidepressants your doctor should be aware of your medical history or family history of psychiatric disorders (e.g., bipolar/manic-depressive disorder), history or family history of suicide attempts. To be diagnosed with Bipolar Disorder the new DSM-V has included the criteria that the person has to not only have the presence of elated or irritable mood but also the association of these symptoms with increased energy/activity.

Personal analysis: I’m not sure if I had suffered from hypomania before, every summer I would work out excessively and sleep little, this was only for the past 2years, but after Remeron (Mirtazapine) everything changed. My research was carried out on the premise of proving my psychiatrist wrong in my diagnosis. I had slowly put together my argument until I had looked up my antidepressant and the time it takes to leave my body. I now have to acknowledge that I no longer have an argument; my hypomania lasted well after the antidepressant had left my system and later returned when my mood stabiliser dose was reduced so that I could change medications. If anyone else has doubts about their diagnosis it is well worth the research into the causation of your (hypo)manic episode, if it was from an antidepressant find out how long your episode lasted and the time is takes for the antidepressant to leave your body.

Blame_by_umbra_rockchick

To make up for this realization is the knowledge that I had an awesome day in Luna Park at Sydney, here is some snaps 🙂

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19 thoughts on “The Blame Game: Antidepressants Cause Bipolar Disorder?!”

  1. I have seen anti-depressants trigger hypomania/mania in people who present as depressed. It was quite common, I did not realize that newer meds might be better. I would steer clear of any anti-depressants in my family given that we have bipolar tendencies coming out our yin-yangs. My son who is now 25 presents primarily as someone with an anxiety disorder and he was in a special program maybe 10 years ago. The first thing they wanted to do was give him anti-depressants. I told them previous attempts had been disastrous but they insisted and just like Dr Jekyll and Mr Hyde, I get a call at work and he’s tossing a teacher against the wall.

    Now he prefers to self medicate and hard liquor generally has a similar effect. Triggering violence that is.

    Liked by 1 person

    1. It seems like doctors don’t always weigh up the risks enough when handing out medication. Sorry to hear about the troubles your son is going through, its frustrating when it could’ve been avoided 😦

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  2. My personal experience suggests that, if there is an evident historical pattern of hypo/manic episodes, then antidepressents should only be given under strict regular supervision. I once missed a weeks worth of antipsycotic meds, which also helped depression. After becoming depressed, I was given a bog standard srri and and it sent me into a full blown manic episode. I think it depends on what type of BpD the patient has too.

    Liked by 1 person

    1. That is extremely common with people who go on the antidepressants after having a previous hypomanic episode. I hadn’t had any episode of hypomania until the medication, that’s why they revised the criteria in the DSM. It gets so annoying when psychiatry is just full of so many areas of grey. Starting to think (from even what you’ve said) that there needs to be more comprehensive screening for bipolar before starting antidepressants, would save a lot of drama.

      Liked by 1 person

      1. I absolutely agree that there needs to be a bipolar screening. Just the chemistry of srri’s should suggest that if the depression is clinical i.e. caused by a lack of Seratonin production, and then you are given a drug which stimulates Seratonin production and recycles it, you are going to end up flooding the brain with something it has been starved of!!! Still, in the UK there are so many mental health cuts, they may just have enough time to work it out 😉

        Liked by 1 person

  3. Cool photos! I’ve swallowed all kinds of antidepressants in the past 20 years and the only one that gave me problems was venlafaxine (effexor), which sparked off such a major manic episode that I completely fucked up my relationship, career etc. I’m on 2 antidepressants now and am fine with both.

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    1. Are you taking antimanic medication as well? Most newer antidepressants don’t, guess everyone is more susceptible to certain ones. Guess that’s why I blame it. It is good to know people can be safely on it as well.

      Liked by 1 person

  4. Howdy mywonderland,

    Thanks for dropping by to “like” my post. I stopped by to see what you’re blogging about.

    Since this post of yours is titled as a question, I’ll give you my answer for it.

    Please allow me to present an alternative view. It sounds like your view comes from your personal (and valid) experiences, from drug marketing literature and possibly from doctors (who get their info predominately from marketing literature).

    When taking advise from any medical professional, you must keep in mind that their information (and all drug research) is funded and owned by pharmaceutical companies. Since the pharmaceutical companies owns the research data, they regularly de-select, select and present only the “facts” which promote sales of their products. Almost all post-graduate medical “education” is paid for by drug companies.

    I’m a psychiatrist with 25 years of experience working directly with people. Most of them were or had been taking psychiatric drugs. I spent the last 8 years of my professional career working in a psychiatric urgent walk-in clinic where I helped manage acute situations.This means that I’ve seen things not commonly presented by standard drug marketing literature.

    Yes. All antidepressants, including the newer ones, can and do trigger symptoms that could easily be mistaken for and categorized as mania or hypo-mania. And just having a psychiatric drug “out of your body” doesn’t remove it from the list of possible causes of mania-like symptoms and true-blue mania.

    No. All medical professionals are not aware of this.

    Psychiatric drugs (like most drugs) change how your brain/body works. It can take a long time for your brain/body to re-adjust/re-find/re-create your personal physiologic “normal”. No one knows how long this might take. Stopping any psychiatric drug you’ve been taking for any reason increases your risk of having an acute episode in the coming months. Abrupt discontinuations are known to pose a higher risk than a slow (months) taper.

    I’ve seen many people experience shaking, agitation, pacing, sleeplessness, headaches, anxiety, tingling, restlessness,confusion, racing thoughts and psychosis (hearing voices) both from TAKING antidepressants AND from WITHDRAWAL from antidepressants. I’ve also seen this from other psychiatric drugs commonly used as mood stabilizers.

    The symptoms caused by the drug or the withdrawal from the drug can look/feel/act like the symptoms currently called “mania” and/or “hypo-mania”. These can occur can well beyond the few days to weeks it takes for a drug to technically get out of your system.

    It’s good to remember that even the PDR (official drug catalog) clearly states that the mechanism of action of antidepressant is “unknown”.

    It’s good to remember that those who write and update the DSM (diagnostic manual) generally have pharmaceutical financial conflicts of interest.

    It’s also good to remember that the F.D.A. (Federal agency in charge of approving drugs as safe and effective) accepts pharmaceutical funding. So does the APA (professional club for psychiatrists. So does NAMI (“consumer” support group).

    Good luck in your search for “clean” information. You’ll need it.

    All the best.

    Alice

    PS You may decide not to post this. That’s okay.

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    1. I would never not post this :). To be honest I got all my information from peer reviewed psychology journals from my uni, but I should have established and realised that they present an agenda based research initiative. You’ve given me a lot to think about, maybe I can start to re-question my psychiatrist and be eventually off mood stabilizers. I tapered off one mood stabilizer only to start getting hypomanic symptoms again until they upped my dose of another, guess that could go both ways though – medication reaction induced or actual bipolar diagnosis. Its so difficult when everything we read will always be bias an agenda based, I don’t think we can achieve complete objectivity in anything. Thank you so much for your post, you’ve given me a lot to think about. Its very insightful to get a professional opinion and experience based response, its hard when I’m blindly going through research to understand everything better. Thanks for taking the time to write this.

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      1. It sounds like you’re doing everything you can to educate yourself about this. Good.

        You might want to check out Robert Whitaker’s book
        “Anatomy of an Epidemic” for an alternate view on the medication world. Probably a library would have it. He’s an investigative reporter. It reads well.

        http://www.madinamerica.com/2011/11/anatomy-of-an-epidemic/

        Yes. Research. It used to be funded by tax dollars. But not so much any more. Mostly it’s paid for by the pharm companies so they own the outcome data. And since they own the data they can decide which to publish and which not to publish. And they do. A “researcher” who publishes data without permission from the paying owner can be successfully sued. But pharmaceutical companies can also be (and have been) successfully sued for suppressing important drug information.

        So long as drug research and the FDA approval process is paid for by drug companies, things will be a confusing.

        Sorry. I wish there was a clean source of reliable data I could direct you to.

        All the best,
        Alice

        Liked by 1 person

      1. No “pain”,
        Are you asking if “early onset bipolar” exists? I guess you might be asking if bipolar disorder can begin in childhood? If you are, I’m the wrong person to answer it. I have only worked with adults.
        Sorry. Good luck.
        Alice

        Liked by 1 person

  5. I’m no psychiatrist but have several years working with mental illness and also have Bipolar myself. I almost completely disagree with diagnosing Bipolar Disorder in children or teens. I say almost completely because there are those cases where it is certainly Bipolar and not just teenage angst but it could take years of mood charts to tell the difference. However, I tend to stand behind the view that people, especially children, need to have therapy before trying medication. So many diagnoses overlap symptoms with each other and the treatments of each diagnosis are so different that to just throw meds at a person without them having therapy is almost certainly bound to be disastrous. Especially when they’re kids. They aren’t even fully developed but somehow it is okay to go ahead and mess with their brain chemistry, not knowing what on earth the outcome will be. This could seriously mess up their brains for life. As for if it’s possible for children or teenagers to have Bipolar disorder, I certainly believe it is possible because I had my first manic episode at 16 and went undiagnosed until many years later. However, people need to be more careful with children because it could be any number of things, and maybe things that don’t even warrant a diagnosis. Of course, it is made even more difficult to form a solid belief on this because earlier treatment equals a better outcome. Had I been diagnosed at 16 and gotten proper treatment, so much trauma and chaos could’ve been prevented in my life. But yes, I certainly believe it exists, it just needs to be treated with a very slow approach to be certain, and sadly I don’t see that very frequently. Screw the pharmaceutical companies dude.

    Liked by 1 person

    1. “Screw the pharmaceutical companies dude” – Definitely 🙂
      I agree about the early onset bipolar, its just too difficult to determine and you don’t want to be giving kids medication which could possibly affect them later. There is just so much mixed research. I’m starting to believe that the neuro chemicals in your brain just change as you get older, affected by environmental experiences and genetics, therefore children can be ruled out. I do think teenagers definitely can – honestly just trying to wrap my head around all the possibilities is ridiculous, becomes a series of unanswered questions that exist in areas of ‘grey’.
      Thanks for your comment! Very interesting that you started at 16 – its good reinforcement to have people give their experiences instead of just reading research. 🙂

      Like

      1. Research is great but it only gets you so far. I’m all for researching things and I have gotten a lot of good information that way, but have learned far more from reading blogs, books etc written by people living with MI in one way or another. I also think that on concentrating solely on research or professional opinions you tend to lose sight of the people it is affecting, and I’m all about people!
        Psychology and psychiatry is all about shades of grey, that much is definitely true. Trying to come to a concrete belief or conclusion is dang near impossible because there’s always room for doubt even when you think you’ve formed an opinion.
        Environmental factors and any type of traumatic experiences actually change the brains of developing children, so I definitely believe that plays into it a lot; right up there with genetics. But yeah, trying to figure it all out will drive you bonkers if you’re not already there =)

        Liked by 1 person

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