Prozac & No Mania vs. Trying Mood Stabilizers to See if Bipolar?

Hi everyone,

I'm currently trying to determine if I might be Bipolar due to what I believe are several common symptoms. After discussing this with my pdoc she explained that if I was Bipolar I would have gone into a manic episode when she prescribed me Prozac years ago. This didn't happen. I became even more depressed. However, after reading several posts on these threads I'm learning this isn't necessarily so.

Additionally, she offered a script for a mood stabilizer, "To see," if it would help with what I think could be hypomanic symptoms. Not comfortable just, "Trying something to see," I respectfully passed. I've recently begun a mood chart and explained this to her. So together we decided to wait until my next appt. (a few weeks from now) and see how I'm feeling then to decide if revisiting mood stabilizers seemed appropriate. My pdoc's quick offer for mood stabilizers leaves me feeling this might be the only way to confirm or deny this diagnosis. (Either this or she's one to dole out meds like candy).

I have been diagnosed with depression, Generalized Anxiety Disorder and Obsessive Compulsive Personality Disorder. I just began taking Lexapro again and Xanax PRN.Truthfully I'm kinda frightened to try a mood stabilizer. She explained it will have a flattening affect. I don't want to lose my normally positive, bubbly, personality and feel all blunted and flat affected.

Here are my questions:
1). If you are Bipolar and have been on Prozac did it cause you to go into a manic state? What were your experiences with this whether you went into mania or not?
2). Is trying a mood stabilizer the only way to discern this diagnosis? Is this the common practice?
3). If you were in my shoes would you try a mood stabilizer to see if this does the trick?
4). Do you feel flat affected and blunted on mood stabilizers? Specifically, do you notice a change in personality and not feel as happy or expressive before you began taking them?

I'd appreciate any feedback, thoughts, and insights you're willing to provide. Thanks!

Wishing everyone good health and positive, healing, energy,

~*PositiveKarma*~

i'm still plenty dam bubbly.

First of all, mood stabilizers have never really blunted me. Ive been on Lamictal & Seroquel. Seroquel made me tired in the beginning, but after a couple of weeks that went away (apart from at night after I take it). It just helps me sleep now. Im still "up" during the day as long as Im not depressed. It doesnt stop me feeling happy - just stops me getting so "high".

As for Prozac - Ive taken it 2 times.

1st time it picked me up a lot. Probably hypo/mania. Then it "pooped out" & stopped working.

2nd time made me incredibly agitated & I had to come off it quickly.

I dont think it would hurt to try a mood stabilizer - could be just what you need. Good luck!

Mood stabilizers have never blunted my emotions. What they have done is stabilized my mood so I'm don't cycle in and out of episodes quite as often. I still have fun and joy and anger and whatever. It's the episodic nature of things that has leveled off a good deal for me. That's a good thing.

Take a look at the DSM4 criteria for bipolar 2 disorder. That is where the diagnosis comes from, not from how you react to mood stabilizers. That seems really backwards to me. If you want to try a mood stabilizer to see if it relieves some of your symptoms, that would be up to you obviously. They work on more than just bipolar symptoms for many people. Just be sure the diagnosis isn't just based on whether a med works or not.

There is a theory that recurrent, treatment-resistant depression (TRD) is more similar to bipolar disorder than to "regular" (unipolar) depression. Because of this, folks with TRD respond better to an antidepressant plus a mood stabilizer. This may be your pdoc's reasoning?

I know that this I the case for me. I have never had any mania, but antidepressants alone are not nearly as helpful as an antidepressant with a mood stabilizer. I resisted trying a mood stabilizer for a long time due to misconceptions, but I greatly improved when I tried it.

Lots of luck,
EJ

Thank you everyone for your replies. Some very good, thoughtful, information to consider. I truly appreciate this.

Mostly, I'm relieved to learn that a mood stabilizer won't do what I thought it would- change my personality or ability to feel, or express, my emotions. So basically, if I'm understanding this correctly, it just balances your moods more evenly and prevents more frequent cycles of them? Is this correct?

farmergirl: I have read the DSM IV diagnostic criteria for Bipolar II. And this is why I brought this up to my pdoc. I believe I exhibit many of these symptoms, but I'm not sure if they're prevalent/frequent enough (or interfere with my daily functioning) to warrant this diagnosis. Thank you for the reminder that the DSM is the source for diagnosis and not meds alone. Good reassurance to have. I'm not sure, but I think this is why my pdoc offered the mood stabilzer. Dunno. I'll have to ask her when at my next appt.

Eliza: Huh, I never knew about this. Think I'll have to research this. How do mood stabilizers help you, please? Maybe this info will be helpful to me. So are you saying then that people who have Treatment Resistant Depression (TRD) still remain depressed even when on antidepressants? If so, this isn't the case with me- they help. It was just the Prozac which increased my depression. The reason why I asked about Bipolar is because of my suspected symptoms, not because I don't respond to antidepressants. Interesting though and still worth a look. Thank you for this.

Also, another question. Do mood stabilizers help with racing thoughts and cyclic episodes of insomnia? These are probably two areas of my greatest concern. I have noticed my racing thoughts seem curbed since going back on Lexapro. But my sleep cycles- not so much. But then again, it's only been a couple weeks since I started taking them.

Thanks again everyone for your replies. I look forward to more. Have a wonderful day!

~*PositiveKarma*~

1) Yes, it did. Very much so and more mixed by the end. I don't really feel like going into was Prozac was like but, it was horrible!!!! I'd wake up after a few hours sleep and laugh and cry or just sit up, saying I was crazy and ...whatever.
2) Not that I know of? There is such a thing as mania induced by antidepressants that isn't bipolar disorder. Seems like an awful way to diagnosis. Mine was based on symptoms that happen when I'm not on any meds. Psychiatrist made a point to ask if this was when not on meds many times explaining how Prozac and Zoloft (I tried that one too), basically any antidepressant, can induce mania in people who don't have bipolar.
3) A mood stabilizer helping doesn't diagnose anything. Even lithium is used to treat unipolar depression sometimes. Yes, try. That's how psychiatry works. Try and see if it helps.
4) No personality change, bipolar isn't who I am. Mood stabilizer makes my mood swings a lot less extreme but, I definitely don't have a flat affect. Im just calmer, like waves rather than tsumani.

Sleep help? Eh-ish and depends on if you're on something more sedating too...racing thoughts yes.

Just so you know, mood stabilizers are also used for people who have straight depression and not bi-polar. So whether or not you respond to this medication will not tell you if you have bi-polar.

TRD is defined as failing 2 sufficient trials of antidepressants(adequate dose and duration). For me, mood stabilizers have lessened my intense suicidal depression. They make me feel like myself.

Interestingly, I had a similar reaction to Prozac, but I did better on another drug in the same class, Lexapro (although it alone was insufficient to make me well).

Take care,
EJ

If you try that website I told you about in the bipolar forum (psycheducation.org/), he goes into great detail about mood stabilisers; how they work and side effect profiles etc. He also explains about reactions to antidepressants. He says that it can't hurt to try a mood stabiliser (although they have side effects like every drug), but responding positively is not diagnostic. As others have said, unipolar depression can respond to mood stabilisers too.

When I tried prozac it made me really mixed (although I didn't call it that at the time) and I had to come off it because I was very suicidal. Have antidepressants ever made you feel psychomotor agitation, extremely irritable or suicidal? Have they ever worked 'too well' causing manic symptoms? Does your depression episodes resemble bipolar depressive episodes more than unipolar depressive episodes e.g. psychotic symptoms, psychomotor retardation etc? All of these 'soft signs' of bipolarity are talked about on the website I mentioned.

As far as diagnosis goes, why are you feeling the need to have it down on paper - do you 'need' to know for whatever reason or do you just want appropriate treatment? If your pdoc is willing to prescribe mood stabilisers what does it matter what the label is if the treatment is available and works?? This guy says it's not about saying you're bipolar or not, but finding out if you're 'bipolar enough' to benefit from mood stabilisers. (My pdoc won't prescribe without the label and she doesn't agree with this guy's approach, although it is well-respected and found in many journal articles)

Check out that website and all the best,

*Willow*

Prozac made me hypomanic at 10 and full-on manic at 20, but I'm still not technically considered bipolar. I have cycles without mood stabilizer so I'm closer to bipolar than MDD, and have benefitted from lamictal (though the normal conservative titration schedule was not conservative enough for me).