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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Joanna on June 5, 2001, at 19:30:50
My best friend is a bipolar sufferer. He has been going thru a severe deprssive phase and has been prescribed wellbutrin. I read that this can trigger mania - has anyone any experience of this?
Posted by Sulpicia on June 5, 2001, at 22:18:14
In reply to Wellbutrin and bipolar syndrome, posted by Joanna on June 5, 2001, at 19:30:50
> My best friend is a bipolar sufferer. He has been going thru a severe deprssive phase and has been prescribed wellbutrin. I read that this can trigger mania - has anyone any experience of this?
Depends on what you mean by severe. How prone to mania is your friend and how
well is he/she doing on the mood stabilizer, and which one??
FWIW, my 15 y/o with bp II takes lamictal, wellbutrin, and adderall and barely
stays ahead of the depression.Absent further info, without established mood stabilizer, wellbutrin is likely to set off mania.
S.
Posted by Joanna on June 6, 2001, at 11:12:08
In reply to Re: Wellbutrin and bipolar syndrome, posted by Sulpicia on June 5, 2001, at 22:18:14
> Absent further info, without established mood stabilizer, wellbutrin is likely to set off mania.
> S.Whoopee. Dr Doofus strikes again...[we have an idiot doctor.]
Jay's symptoms have always been quite mild. I've know him for approx 20 yrs and for a long time we suspected that he may be bipolar but as he managed well just with lifestyle adjustments and Vit B complex and Vit C supplements he never sought medical help. He was "officially" diagnosed about 3 yrs ago when he needed help with sleeping due to stress, but as he always managed without meds he didn't want to start taking mood stabilisers. For him, the swing to hypomania is the time when he is creative and manages to cram in so much he leaves me way behind. He also has more and more severe headaches and feels very tired as he comes down. Most of the time - for months on end - he's 'normal'.
His current depression is a result of the deaths, in short order, of both parents. He's been through a lot this past year. It was severe enough to disrupt his life to the stage where he relapsed into total apathy. It took a lot of coaxing for me to persuade him to seek help.
He has kept a mood diary for many years now, I guess it's time to pay it closer attention.
Apart from going back to the doctor, have you any further advice?
Thanks for your time :)
Posted by Sulpicia on June 7, 2001, at 1:06:27
In reply to Re: Wellbutrin and bipolar syndrome, posted by Joanna on June 6, 2001, at 11:12:08
> > Absent further info, without established mood stabilizer, wellbutrin is likely to set off mania.
> > S.
>
> Whoopee. Dr Doofus strikes again...
You should copyright that -- it made my day. How true too often.First, I'm not a professional. There are 2 answers to your question actually.
If he is not impaired by bp, it gets dicey recommending pharmacological intervention.
Most people with bp get into serious trouble with their moods: mania can involve spending
huge amounts of $$, promiscuous sex, delusions -- you know, the kind of behavior that
tends to attract NOTICE and consequences. Ditto for the lows: the depression can be crippling.
And it's nearly universal to love the productive and creative potential of the highs. With hypomania
only and relatively mild depression, a patient or a pdoc might consider mood stabilization overkill.
The drugs work to be sure, but they are not without side-effects, and finding an effective one and its
proper dose can be torturous.
On the other hand, bipolar has an 18% mortality rate -- that's roughly the same risk of
dying that you'd have if you caught a localized malignancy in your breast early. While your friend
has a *reason* for being depressed, not everyone who is twice bereaved in rapid succession takes an AD.
Something must have motivated this.
The real problem with not trying to achieve mood stabilization is a phenomenon called "kindling." I'll
have to hunt down the references for you -- and I'm already late finding refs for another person [shame], or
how are you at using Pubmed??
The point as I remember it is that the cycling of bipolar feeds on itself and gets stronger over time: it's
sort of like diabetes and blood sugar -- you want to keep things on as even a keel as possible.
How much does your friend know about bipolar? Who had it in his family?
And now as I re-read your last post, I do see a progression. Perhaps he sees this in his mood charts?
Some education and info might motivate him to try mood stabilizers, especially since the newer ones don't
have so many side-effects.The other possibility, if he refuses pharmacology, is to suggest he look at Andrew Stoll, MD "The Omega Solution" --
the title may be incorrect but his name should pull it up on Amazon.com
Stoll was able to demonstrate that a specific supplement of essential fatty acids helped bipolars prevent relapse, ergo
cycling and destabilization.
The downside is that all the bipolars were on mood stabilizers -- nobody stopped meds. The supplements were an adjuvant
however fabulously successful. There is absolutely NO evidence that EFAs work alone.
NOW THIS IS IMPORTANT: these supplements are essential fatty acids distilled from fish oil [in capsules, don't panic]: the 2
bioactive substances are EPA and DHA. People with bipolar must take a supplement with A RATIO OF EPA TO DHA OF AT LEAST
3EPA TO 1DHA. One of the earliest discoveries about these supplements was that DHA given with insufficient ratio of EPA
plunged bipolars into severe depression.Perhaps this is something he could explore with a pdoc -- other than Dr. D. -- it would be ideal if he
were to educate himself about bipolar with a pdoc's help. Then perhaps he might be more willing to accept
pharmacological intervention.
Would he like to lurk at a good bipolar forum?
he might benefit from reading the posts at:
http://neuro-mancer.mgh.harvard.edu
he should then select the bipolar forum from the list.I'm not sure what else to suggest. It's disquieting to think that he'd be untreated
until all hell breaks loose.
He's lucky to have a friend like you.
Liz
Posted by Ron Hill on June 7, 2001, at 10:16:26
In reply to Re: Wellbutrin and bipolar syndrome, posted by Joanna on June 6, 2001, at 11:12:08
Joanna,
I agree with Sulpicia (L). IMHO, for a BP patient, it is extremely important to have a mood stabilizer in place prior to taking an AD (or stimulant). I base this recommendation/opinion on the medical literature that I have read on the subject and on my personal experience.
I am BP II currently taking Lithobid (600 mg/day), Paxil (10 mg/day), and Wellbutrin (100 mg/day). My meds are currently working extremely well (PTL). However, I was initially misdiagnosed as ADHD and prescribed Ritalin. The Ritalin pushed me into mania big time and it also began to make me cranky after a couple of months. In an attempt to fix the crankiness, my ex-pdoc added an SSRI antidepressant (Paxil). The Paxil pushed me further into mania, but the mania felt so good that I could not be convinced by the people around me that something was very very wrong. And my ex-pdoc did not recognize my mania but instead kept writing scripts for Ritalin and Paxil (can you say malpractice?).
To make a long story short, I lost my job as an environmental engineer, ran up $70K of credit card debt, cashed in and spent my retirement account, got a second mortgage on my house and spent it, etc. The thing about mania (hypomania) is that these actions actually seemed logical at the time.
I mention all this only to say that I have a BIG CONCERN about putting a BP patient on an AD (and/or a stimulant) without first having a mood stabilizer fully in place.
-- Ron
---------------------------------
> > Absent further info, without established mood stabilizer, wellbutrin is likely to set off mania.
> > S.
>
> Whoopee. Dr Doofus strikes again...[we have an idiot doctor.]
> Jay's symptoms have always been quite mild. I've know him for approx 20 yrs and for a long time we suspected that he may be bipolar but as he managed well just with lifestyle adjustments and Vit B complex and Vit C supplements he never sought medical help. He was "officially" diagnosed about 3 yrs ago when he needed help with sleeping due to stress, but as he always managed without meds he didn't want to start taking mood stabilisers. For him, the swing to hypomania is the time when he is creative and manages to cram in so much he leaves me way behind. He also has more and more severe headaches and feels very tired as he comes down. Most of the time - for months on end - he's 'normal'.
> His current depression is a result of the deaths, in short order, of both parents. He's been through a lot this past year. It was severe enough to disrupt his life to the stage where he relapsed into total apathy. It took a lot of coaxing for me to persuade him to seek help.
> He has kept a mood diary for many years now, I guess it's time to pay it closer attention.
> Apart from going back to the doctor, have you any further advice?
> Thanks for your time :)
Posted by Joanna on June 7, 2001, at 20:39:16
In reply to Re: Wellbutrin and bipolar syndrome » Joanna, posted by Sulpicia on June 7, 2001, at 1:06:27
Jay is pretty clued up as to bp. He is the only one in his family to have had this. We did a lot of reading, him more than me. Having talked it through, he wants to save the mood stabilisers for the future when he may really need them. At the moment he also doesn't feel up to coping with possible side-effects. He always made a point of stressing that I'm to tell him and make a note in the diary if he is behaving bizarrely rather than what is normal for him when he is high. To date, he has never done anything outrageous. As I said, he took steps to make lifestyle changes to minimise risk of serious consequences.
Do you know anything about vitamins? I read the posts above and it bears out what Jay says: it was recommended to him by our herbalist/ healthfood guy to take mega potency complete vit B complex and at least 1000mg vit C. Since he started them the cycle has been noticeably less marked. Jay's going to ask about the fish oils - if anyone can find out about it the herbalist will.> I'm not sure what else to suggest. It's disquieting to think that he'd be untreated
> until all hell breaks loose.He has taken steps to try to minimise the possibility of that. If things get worse he will go for pharmacological help but he wants things to be like they are for as long as possible. Can't say I blame him, with people like Dr D about...
Thanks for all the help, both you and Ron :)
Posted by AMenz on June 8, 2001, at 0:43:22
In reply to Re: Wellbutrin and bipolar syndrome » Sulpicia, posted by Joanna on June 7, 2001, at 20:39:16
Without a mood stabilizer with someone who already has had hypomanic symptoms you are risking full blown mania. Better learn what the symptoms are so you can have an intervention. You may not have alot of time. Sleeplessness, talking extremely fast and without interruption (pressed speech)grandiosity, spending, agitation or severe irritability can all be symptoms of mania.
In case it starts any tranquilizer followed by a quick visit to Dr or emergency room is what should be done.
Since he wont take the mood stabilizers has he considered working through the depression or is it just too severe. The natural things to do are the opposite of what you feel like doing. Sleeping normally not hypersomnia, regular meals, and keeping going despite feeling poorly.
Grief will precipitate bipolars and unipolars into serious depressions.
Look through the site for sleep and depression for interesting info.
> Jay is pretty clued up as to bp. He is the only one in his family to have had this. We did a lot of reading, him more than me. Having talked it through, he wants to save the mood stabilisers for the future when he may really need them. At the moment he also doesn't feel up to coping with possible side-effects. He always made a point of stressing that I'm to tell him and make a note in the diary if he is behaving bizarrely rather than what is normal for him when he is high. To date, he has never done anything outrageous. As I said, he took steps to make lifestyle changes to minimise risk of serious consequences.
> Do you know anything about vitamins? I read the posts above and it bears out what Jay says: it was recommended to him by our herbalist/ healthfood guy to take mega potency complete vit B complex and at least 1000mg vit C. Since he started them the cycle has been noticeably less marked. Jay's going to ask about the fish oils - if anyone can find out about it the herbalist will.
>
> > I'm not sure what else to suggest. It's disquieting to think that he'd be untreated
> > until all hell breaks loose.
>
> He has taken steps to try to minimise the possibility of that. If things get worse he will go for pharmacological help but he wants things to be like they are for as long as possible. Can't say I blame him, with people like Dr D about...
> Thanks for all the help, both you and Ron :)
Posted by super on June 8, 2001, at 9:04:48
In reply to Re: Wellbutrin and bipolar syndrome, posted by AMenz on June 8, 2001, at 0:43:22
Joanna,
Like the others, I would be wary of Jay taking Wellbutrin without a mood stabilizer. But I saw a p-doc once who said she had treated bipolars w/ just Wellbutrin. When I told me regular p-doc this, she said she thought that would be malpractice. I'm interested to know if it works though. I would love to be able to get off my mood stabilizer (not like it has a lot of side effects, except for the nice one of preventing migraines--I just hate taking pills.)
super
> Without a mood stabilizer with someone who already has had hypomanic symptoms you are risking full blown mania. Better learn what the symptoms are so you can have an intervention. You may not have alot of time. Sleeplessness, talking extremely fast and without interruption (pressed speech)grandiosity, spending, agitation or severe irritability can all be symptoms of mania.
>
> In case it starts any tranquilizer followed by a quick visit to Dr or emergency room is what should be done.
>
> Since he wont take the mood stabilizers has he considered working through the depression or is it just too severe. The natural things to do are the opposite of what you feel like doing. Sleeping normally not hypersomnia, regular meals, and keeping going despite feeling poorly.
>
> Grief will precipitate bipolars and unipolars into serious depressions.
>
> Look through the site for sleep and depression for interesting info.
>
> > Jay is pretty clued up as to bp. He is the only one in his family to have had this. We did a lot of reading, him more than me. Having talked it through, he wants to save the mood stabilisers for the future when he may really need them. At the moment he also doesn't feel up to coping with possible side-effects. He always made a point of stressing that I'm to tell him and make a note in the diary if he is behaving bizarrely rather than what is normal for him when he is high. To date, he has never done anything outrageous. As I said, he took steps to make lifestyle changes to minimise risk of serious consequences.
> > Do you know anything about vitamins? I read the posts above and it bears out what Jay says: it was recommended to him by our herbalist/ healthfood guy to take mega potency complete vit B complex and at least 1000mg vit C. Since he started them the cycle has been noticeably less marked. Jay's going to ask about the fish oils - if anyone can find out about it the herbalist will.
> >
> > > I'm not sure what else to suggest. It's disquieting to think that he'd be untreated
> > > until all hell breaks loose.
> >
> > He has taken steps to try to minimise the possibility of that. If things get worse he will go for pharmacological help but he wants things to be like they are for as long as possible. Can't say I blame him, with people like Dr D about...
> > Thanks for all the help, both you and Ron :)
This is the end of the thread.
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