GP's recommended antidepressants?!

Hello again everyone.

You may have seen from a previous post that I've very recently been diagnosed with Bipolar Disorder - tentatively Bipolar II, but I'm waiting to see a specialist psychiatrist who'll do a more thorough assessment and then work out my treatment plan. I was originally diagnosed with Seasonal Affective Disorder about five years ago, but the timing doesn't fit anymore and it now looks like I may never have had that.

The last time I saw my GP she set up the appointment with the psychiatrist for me, but said that - if I felt I needed them - I could go back onto my SAD antidepressants (amitriptyline) while I was waiting (I'm in a pretty bad depressive state at the moment).  I've done that, but have since read that antidepressants can actually have adverse effects by increasing cycle speed and throwing a Bipolar person in the depressed state all the way back up to manic.  Although the hypomanic state is certainly more enjoyable at the time than the depressed state, I don't want to be back there because I'm not out of the trouble I caused for myself last time, and I certainly don't want to risk full mania!

So does my GP know something about this that I haven't found in any of the research I've done, or is this an ignorant and risky mistake?  And also - now that I have started taking them again - has anyone got any idea whether it's safer to stay on them now or come off them again?!

Any advice would be much appreciated!

[Soggymoggy]

Oh, PS - since I started back on the amitriptyline, I'm not sleeping much again.  It's only been a few days, so I don't know if it's too early to see adverse effects anyway; do you think this is just a coincidence with the hot weather and everything, or an early warning sign that I'm about to flip back into hypo/mania?

[paranoid_cataclysm]

I would not trust a GP when it comes to a diagnosis of the mind and would rather a psychiatrist do this.  For example, I first saw a GP for my schizophrenia before I was diagnosed with it by a psychiatrist and psychologist and the GP diagnosed me with bipolar disorder, which was the only mental illness the GP had this questionnaire for to diagnose with, and then the GP told me I needed a real diagnosis from a psychiatrist or psychologist.  I am lucky the GP didn't know crap about bipolar disorder apparently and only put me on an antipsychotic and not some antidepressants and mood stabilizers I wouldn't even need to begin with.  Yes it's true bipolar disorder with no mood stabilizer and only an antidepressant can cause mania.  I read amitriptyline can have the side effect of insomnia; maybe this is what is causing your insomnia?  You could always try a mood stabilizer if they come to the conclusion you have bipolar disorder and see if that helps but chances are you might not be able to tell you're manic when you are because it has somewhat of a lack of insight involved in it for some people.

[paranoid_cataclysm]

Are you sleeping less because you have less of a need for sleep or are you sleeping less and feel you need sleep really badly?

[Soggymoggy]

Hi, thanks for your response.

I'm sleeping a lot less and not missing it at all - which is exactly what happened last time I was hypomanic.  It's not the amitriptyline; that normally makes me sleep more.

Do you think I should come off the amitriptyline, or would that be dangerous too now that I'm back one it?

Thanks!

[paranoid_cataclysm]

Only thing you can really do is wait until you get in to see a psychiatrist and see what he/she says as adjusting medications by yourself can be dangerous.

[adel_ezz]

Ok your question is easy to answer. There are old veterans in BP like me and there are the new comers like you who have a robust brain not easily destructable. But after a few antidepressants will become like us with a corrupted brain once you have a full blown mania.

Now the statistics tell you 50-70% of BP patients take antidepressants. Are they ignorant of the consequences ? of course not. They make use of a pretext that a GP give it to them so they take advantage of it or the majority prefer the shorter benefits and release to the long harming effect. It's like the proverb which says " give me life today and it doesn't matter if you kill me tomorrow" and that is why they use AD's. Others will iterate, and say who can predict that i shall be Ok or bad tomorrow, so better exploit the instant where i am living now and forget about tomorrow. AND that's is the fallacy of our perished philosophy unfortunately.

Antidepressants are the worse thing to feed a BP pt upon. I am not joking. Some of the stupid pdocs will tell you but there are some pts who benefit from it. Of course they do but only instanteneously. But eventually it will harm them like it did for me. In my family all the quarells between my parents is "don't we remember 2006 the turn of the road" when i stopped the AP's and lived on an AD for 4 months to develop mania later. Now with all the AP's i take and with a minute AD and i developped mania right away, because the brain is never back to its initial status. AD's are the point of no return.

In your situation, if you can be patient until you meet a pdoc, good and fine. But to take amitriptyline is very risky especially it's a tricyclic like anafranil the one which conquered me. Look i gain nothing in warning you, but the duty implies that i tell you the truth.

When you meet your pdoc, try to discuss lamictal (MS) because it has AD qualities. Or take (still i object) a mood stabilizer to accompany your amitriptyline, or take a minor AD like an SSRI instead, weaker

good luck

i forgot to tell you you should 1st be correctly diagnosed before you start any meds

[Soggymoggy]

Hi Adel,

Woah, there's no pretext here - my GP prescribed ADs to help with depression, I didn't know any better so I started taking them!

From everything I've read (including your own experience, thank you) it sounds like I'd better stop taking them.  I've only been back on them for a few days, so shouldn't be any issues with withdrawal or anything.

Just one other thing; my GP has been quite happy to diagnose me with BP, and has said almost certainly it's type II (pending on whether the psychiatrist thinks the brief bout of paranoia in my hypomanic phase was the result of a "mixed state" or an actual delusion).  I haven't read anything to make me disagree with her diagnosis, and she's left it to the psychiatrist to treat - but from what a few of you are saying I shouldn't even be allowing her to diagnose me?

Can someone just clarify this point for me please?

[Soggymoggy]

Oh, sorry Adel - something I just realised.  The reason I've been prescribed amitriptyline instead of an SSRI for my "SAD", is that I hallucinate on SSRIs.  I've always just thought that was a weirdo side-effect, but what you said has just made me wonder - do you think that could be the ADs pushing me into a manic phase?  Why would that happen with SSRIs but not with tricyclics?

Aargh, this is so complicated!

[moonpanda]

That's kind of a tough situation! I think if you speak with your doctor, letting him/her know your concerns, and asking how to safely come off the medication until you can be assessed by a psychiatrist.

From what I've read, tricyclics are even more likely than SSRIs to trigger mania, and if you are starting to see warning signs like decreased need for sleep, then I think it might be a good idea to just back away from that med for now. This risk can be balanced out by adding a mood stabilizer, and since your diagnosis has been confirmed, your psychiatrist will very likely add one of those to the mix to make sure you can become happy once again, but not "too happy".

About the hallucinations with SSRIs... you've got me there. It could be a side effect, it could be a strong episode of mania. At the time of the hallucinations, how was your mood? Did you have any other symptoms of mania when the hallucinations appeared? That might help you and your doctors distinguish a difference, and they might just decide to avoid adding SSRIs once you're on a mood stabilizer.

Also, just to let you know, a lot of mood stabilizers can have an antidepressant effect (such as Lamictal), so in some instances you won't even need to take an AD to boost you up. However, every person responds differently to medication, so this is something you and your doctor will need to fiddle with!

And about the GP diagnosing you, I think for the time being it's safe to accept the diagnosis, but just take it with a grain of salt until you meet with a person who specializes in psychiatric matters. GP's probably see psychiatric problems quite often, as the GP can sort of be the first line of defense, so to speak. Also, psychiatric problems can manifest in physical ways, which might bring patients to see them first. However, when it comes down to dissecting the nuances of different mood disorders, a psychiatrist is more qualified to make the most accurate diagnosis and to suggest the most accurate treatment.

It's good that you're trying to inform yourself so that you know what the treatments may cause in terms of side effects, exacerbation of mood symptoms, etc. It is all complicated, but you're on the track to figure it all out!

[Soggymoggy]

Hey moonpanda,

Thanks for your reply - good to hear from you again.

When I was on the SSRIs I certainly wasn't "happy", but that's probably because I was spending my time divided between nightmares and hideous hallucinations; seeing a rottweiler snarling at you around the bathroom door while you're in the shower before trying to put on a dressing gown with extra sleeves will do that to you.

Hm. Lots of stuff to think about, thanks. xx

[adel_ezz]

i didn't say SSRI are better but just softer or you can say not as strong like tricyclics, i mean you become with the latter more prone to getting manic, but of course both cause mania for bipolars if not accompanied by an MS. EVEN THOUGH