[Sam_I_Am]

Hi guys,
I have just received a "tentative" diagnosis of Bipolar NOS, most likely Bipolar II. The bipolar hypothesis was there before I began seeing this new Dr 2 months ago, but it wasn't really "official" yet. I had, I guess what one could consider a mild hypomanic episode 4 years at age 21-- lasting about four months, then leading into a depressed or mixed state (more like an agitated depression, and then a regular depression). I have had depressive episodes before and after that, beginning at an early age (11 or so.) I've been on Zoloft for 2.5 yrs, at different doses, most recent being 75mg. I never really felt "better" on the Zoloft but I felt much worse when I tried to taper off-- no major side effects or manic effects, but I did have some hypomania/agitation on other SSRIs. I was still having quite a bit of symptoms (mainly, hypersensitivity to criticism, anxiety, "rage attacks," some depression.) So my last PDoc suggested trying Lamictal and built the dose up to 100mg over the course of 6 weeks. I noticed a drastic improvement in all of these symptoms even after a few days on 25 mg-- this is really the only med that I ever found "helpful" (aside from the benzos but just for knocking me out...can't function on a daily basis with them.) That was Feb 08. Stayed on the Zoloft because I felt comfortable and didn't want to change anything. Over the past 4 mos or so, I have been experiencing some rapid mood swings and increased sensitivity. I began seeing a new Pdoc (due to insurance changes), and he presented the whole "bipolar spectrum" hypothesis, which considering my Hx, makes sense to me. The plan was to go a little higher on the Lamictal, so we built up to 150 over 3 weeks. Then, to taper off the Zoloft, as he suspected that it may interfere with Lamical's mood stabilizing properties somewhat and be contributing to the moodiness (even though I didn't become immediately hypomanic on it.) Well, I had a little agitation/anxiety with the Lamictal increase, which was tolerable. Going from 75 to 50 mg on Zoloft was OK, actually felt a little better-- held at 50 for 2 weeks. But since getting to 25 mg, which I started last Monday, I have been slowly having some pretty distressing symptoms: crying over every little thing, feeling guilty and "judged" over every little thing, intense impatience and frustration when things aren't happening "fast enough" (which will then sometimes lead to crying), some rapid yet cloudy thoughts, anxiety and obsessive worrying, wanting to scream at the top of my lungs, not wanting to be around people but sometimes also talking a lot, fleeting suicidal thoughts (don't worry, won't act on them), and a subjective feeling of "being out of control" (or I worry that I'm going to lose control and "go crazy"). On the physical front, started experiencing some nauseanafter 6 hours after the first 25mg dose and just felt generally run down and tired all week, mild headaches and very caffeine sensitive. The mood symptoms started around Thursday and are getting progressively worse. I do know that some of these mood things can be symptoms of Zoloft withdrawal, and the timing of the physical symptoms correlates with the dose decrease. I'm just wondering if anyone has ever experienced these symptoms after a Zoloft (or other SSRI) decrease, especially someone with a bipolar spectrum diagnosis? Could it be that this is all just the withdrawal symptoms, or is this a sign that I really "need" Zoloft, that it was doing more for me than we thought it was? Or, I've read things about stopping antidepressants (or decreasing dose) sometimes triggering hypomanic or mixed states in people with bipolar tendencies-- could that be what's going on here, because it definitely feels very mixed-state-esque. (Of course, I'm fairly new to the whole bipolar thing, so I don't know if that would even qualify.) So I guess my questions are: 1.) Has this happened to anyone else in a similar situation?, 2.) Could this mean that I really do need the Zoloft, that it was in fact treating those symptoms...or by contrast, that I should NOT take Zoloft (after a taper obviously) as it is de-stabilizing me?, and 3.) is what I am describing even a mixed or hypomanic state? or if not, what the heck is it?, and 4.) Any advice on how to cope until I see pdoc next week?

<3,
Sam

P.S. I also posted this in the medication section-- I hope that didn't violate any spoken or unspoken rules of this site, to "cross-list". (I rarely use this site.) If so, I apologize-- I wasn't really sure which it was most appropriate to.