What Diagnosis Would Explain these Strange Symptoms?
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Q:  What Diagnosis Would Explain these Strange Symptoms?

Your site is fascinating and provides a huge amount of information. I have a diagnosis of bipolar disorder. I was diagnosed shortly after having an 'adverse reaction' to an SSRI. I DID develop symptoms of mania, but alongside this, i also developed some other strange symptoms such as: intense pressure behind my eyes, dizziness, loss of 'spirituality', feeling as though i was possessed, feelings of thoughts being 'controlled', intense adrenalin rushes which lasted for hours at a time and made me feel completely insane, changes in personality, inability to feel love or compassion. I had NOT had any symptoms of mania before taking SSRIs and the symptoms appeared within a couple of days of starting the medication. The above symptoms also included or alternated with very very fast thoughts, bursts of intense euphoria and no need for sleep - and outrageous/out of character behaviour. My question is: how do you know whether or not someone has bipolar disorder after developing mania on antidepressants, or if they simply had a bad reaction to the medication. I agree that i developed symptoms of mania but what diagnosis would explain the other strange symptoms that i had. THEY aren't related to bipolar disorder.  

One thing that you are very correct in is your theory of antidepressants causing rapid cycling. I was only on them for a few weeks, but after i stopped taking them, my mood was so unstable - i was having huge shifts in energy and mood during the space of hours. I had NEVER had this before i took ADs. It truly feels as though they have caused some form of 'brain damage'. Any ideas?


Dear Julia --
 Thank you for this account.  It's a classic description of what I have been worrying about for years.

You raise a couple of questions:

A. What about those other symptoms/experiences that don’t look like “bipolar”?
B. Brain damage?

A. Let's take these one at a time.

·         intense pressure behind my eyes -- not sure, could be a side effect of sorts, I suppose.

·         dizziness -- pretty common SRI side effect.

·         loss of 'spirituality', inability to feel love or compassion -- I lump these together because they both might be part of a common reaction to an SRI, which has been called "apathy", a loss of ability to experience intense emotions of any kind.

·         feeling as though i was possessed, thoughts of being controlled -- this might actually fit with "mania", especially if that mania was approaching delusional proportions, which is possible.

·         intense adrenalin rushes which lasted for hours at a time and made me feel completely insane -- not sure exactly how to explain this, but I do hear about it from people with bipolar disorder, describing what happened when they took an antidepressant once, and explaining why they never wanted to take it again.

·         changes in personality -- that fits pretty well with an induced mania.

So overall I would say that there is nothing too terribly mysterious about what you experienced. Most or all of it can be explained on the basis of what can happen when someone with bipolar disorder (or the potential it) takes an antidepressant. As you may know, there is intense controversy amongst psychiatrists as to how often this happens. Some think it is really uncommon. In my practice it seems quite common, but of course I have a very selected set of patients who come see me because they have not done well on typical treatments, which often include an antidepressant (or several, or many).

B. Brain Damage?
 I wish I could just dismiss this idea. In your case, I think you ought to presume that this is not "brain damage", meaning some kind of irreversible change.  In my experience, it
can often take months for the changes induced by an antidepressant to go away. But you should presume that they will.

Why this presumption? Well, if you were to presume anything else, you'll spend the next several months worrying about that. There is really no way to tell. Organized psychiatry has never identified a long-lasting damage associated with taking an antidepressant -- which means that lots of pretty brain he people have been watching patients for years, and never recognized such a syndrome (never mind about the psychiatrists out there that are not so brainy, or not really watching) .

As you may know, a psychiatrist named Glenmullen has made a big deal describing “brain damage” he associates with antidepressants. I think that is somewhat irresponsible of him, and invoking that term, because after all, what exactly does it mean? The main concern I have about antidepressants is their potential for inducing symptoms of bipolar disorder that might not have emerged without the provocation of the antidepressant (or maybe might have emerged only many years later).  Once that happens, will this newly emerged "bipolar disorder" go away, if the antidepressant is removed? On that issue, I'm not so sure. It's not really "brain damage", though.

Thank you for your question. I hope things go well from here.

Dr. Phelps


Published in August, 2009


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