[molloy]

Hello,
I have been diagnosed with generalized anxiety (since this summer) and I am now on my second round of antidepressant, first citalopram, now sertraline at 100 mg for a couple of weeks, and not feeling much better.

What brings me here is that my mood have been very volatile since starting the sertraline, very anxious then calm then anxious, within the same hour. This was worse at the beginning of the treatment so it might just be the med settling in, but both my doc and pharmacist think it's unusual.
Someone suggested in another forum that I might be bipolar type II and thus reacting to the SSRI.
(I should add that I had something akin a manic/hypomanic episode for a couple of months coming off a long depression in 1996, where I was on top of the world and spending a lot of money, but no clearly noticeable mood swing since then.)

My question is: how would one recognize anxiety related to a bipolar condition from an "anxious depression"??, as I understand medication would be different in both case (mood stabilizer instead of antidepressant it seems).

Thanks for your comments!

[Moogieotter]

I have GAD and Bipolar 2. Will share in a bit. Welcome to bipolar land!

[Moogieotter]

Not sure how to exactly answer your question or help you reach a diagnosis. I come from the school of thought that the diagnosis is just another tool to help guide a treatment. You might have had some mild hypomania 19 years ago, but that does not mean bipolar treatments are your best bet.

Zoloft saved my life in 1998 but was too energizing for me. Celexa is also usually somewhat energizing. For anxious depression, I would go with my all time favorite, mister Paxil. For me and many others it's the most calming of the SSRIs. I'd go with a nice strong dose maybe even up to 50mg. If I was still struggling with GAD symptoms, I would add Buspar. It's a nice mild and pro-cognitive agent for anxiety.

If you are indeed Bipolar II, the risk w SSRIs as monotherapy is hypomania/mania, which is why they often stack in a Mood Stabilizer. Lamictal being the most popular lately. I would simply be mindful of serious hypomania issues like reckless behaviour w a bad sleep cycle. Paxil, being more calming for most, is still a great choice.

Some others will disagree, but we seem to have similar challenges. The down sides to Paxil are similar to other SSRIs - lower libido, some withdrawal concerns. Some Paxil treated folks have a little weight gain, which was welcomed in my case as my anxious nausea went away enough to actually eat. If you are indeed Bipolar II, they might treat you with an atypical antipsychotic anyway, which almost always is associated with weight gain.

Once again, Welcome to Bipolar Land. PM me as needed.

moogs

[molloy]

insomnia has been with me for years, but I'll be on the lookout for hypomania.
So far I'm only looking for a bit of relief from the constant anxiety, and I must give sertraline another month before going to something else, but now I'm more educated on the different possibilities. Thanks!