Sir:

I have not been formally diagnosed with bipolar disorder, but I wanted to give

you a brief synopsis of my psychiatric history and tell me what you think.

In march of 1999, I began to have symptoms of depression.  I was diagnosed with dysthymia.  I was tried on several medications including SSRI's, Effexor, and Wellbutrin.



The SSRI's rarely did anything, even after a few weeks of trial.  When on Wellbutrin, I noticed an increase in energy but extreme irritability.  With effexor I had euphoria and increased energy, but no other "hypomanic symptoms" I can think of for the first week, but then the medication would peter out and i'd feel crappy again.



In OCtober of 2000 I moved, still feeling dysthymic and not getting much help from medications.  I saw a new psychiatrist who took a cereful history and felt i had a strong anxious component and some social phobia and started me on Celexa and Buspar.  This combination was horrible, and after several weeks of worsening symptoms he switched the buspar to a small dose of benzodiazepine.



In February of 2001 I had my first hospitalization for suicidal depression and was kept on the celexa (20mg) and started on lithium 600mg.  This worked so well that within days I was euphoric, required no sleep, and had tons of energy.  Five days after starting the lithium they decided to try to increase the dose to 900mg (my level on 600mg was 0.44).  After about 10 days I had severe side effects such as nausea, diarrhea, clouding of thought, tremors, and just felt "drugged."  The dose was dropped down to 600mg again, and for the first time in as long as I can remember, I felt "appropriate" in my mood and felt pretty normal.  It was great.



The psychiatrist mentioned I "may have" bipolar disorder (type II) due to my response to effexor, wellbutrin, and lithium with a quick episode of euphoria and increased energy that occurs within days of the medication (when they are supposed to take 2+ weeks to work) that then peters out.  When starting lithium, this euphoria was extreme, and I had so much energy I cleaned my house for the first time in forever.  However, I didn't have flight of thoughts or what classically falls into a hypomanic or manic phase (as near as I can tell).



What do you think?  Does this sound like bipolar illness or more double dpression?  I am currently on Celexa 20mg and lithium 600mg, but we are going to try to increase the dose to 750mg via sustained release tablets.

Dear Dr. E' -- 
As mentioned in my direct reply to your email on my website, where you provided yet more history, this story does indeed make a "bipolar component" very likely, and direct treatment toward the use of mood stabilizers and even perhaps the avoidance of antidepressants (which I would hold responsible for that euphoric phase after lithium was started: I don't think I've ever seen lithium alone do that, but the Celexa in the picture at the time could have).  

Dr. Phelps


Published March, 2001