I find myself in a medical dilemma and don’t know where to turn. My fiancée recently graduated from dental school and went to Africa to volunteer. A year prior, she had an anxiety episode, as she was unsure about finishing her medical degree or not (anxiety/depression). The doctor put her on cipralex and within a short time she was back to normal. Over time she reduced her intake to the lowest 10mg and she was able to successfully graduate as a dentist. She then went off cipralex cold turkey, 3 weeks prior to going to Africa to volunteer in a local hospital.
Over there, she suddenly was experiencing anxiety, paranoia, and insomnia, which led into an acute psychosis. She was immediately hospitalized and air lifted to the nearest western style hospital, which was in Nairobi. She was put on Zyprexa and was told to restart her cipralex again. A week later she was much better and we were able to fly her back to Toronto, Canada where the doctors immediately told her she has bipolar and removed her from the cipralex again. 10 days after this, her symptoms of anxiety and paranoia returned.
My question is, is there a way to identify bipolar more concretely? Could this all not be part of the withdrawal side effects of the cipralex with the combination of witnessing horrific events in the hospital in Africa? I appreciate your time and would love your input.
It must be really frustrating to have seen your fiancée feeling better and then have the medications changed, and she gets worse. The diagnosis of bipolar disorder is based on a checklist of symptoms that doctors are looking for. But it is important to realize that similar symptoms can be secondary to other illnesses or conditions or events in the body and brain. In your fiancée’s case there were other possible causes of her paranoia and insomnia – such as coming off of her medication abruptly, moving far away from everything she knew, and being traumatized by exposure to severe pain and suffering that she had not seen before. You are absolutely correct that these could have been part of her presentation and that bipolar wasn’t the only possible explanation.
We don’t have any more concrete or specific methods of identifying bipolar disorder or differentiating it from other conditions. One of the difficulties in your fiancée’s situation was the lack of continuity of care – every time she changed caregivers and settings there was a whole new set of eyes upon her and not a lot of information shared from the previous treaters. Unfortunately, this course of events is common even in the absence of such extreme changes of location and treatment teams. Lack of effective communication between treaters causes many of the difficulties encountered by patients being treated for mental illness.
In an effort to prevent some of these types of episodes, I tell my patients that I typically try to avoid major medication changes (such as stopping a medicine or starting a new one) before major life changes or events and particularly before traveling far away. Of course, it isn’t always possible, but the stressors of big life changes can be difficult on the brain and body, so I don’t like to add medication changes to the mix if I can help it and if my patient is in agreement.
Stopping “mood” medications cold turkey, especially antidepressants and anti-seizure medications is usually a bad idea. As we say in Bipolar Disorder for Dummies
In terms of stopping the Cipralex because of the bipolar diagnosis itself, that brings us back to the issues of how challenging psychiatric diagnoses can be. Given the complexity and difficulty of getting an accurate diagnosis, rigid treatment choices based on such diagnoses should probably be avoided.
We did a post on our Bipolar Blog called “Beware of Diagnosis by Prescription,” which you may find helpful. We also provide a sample chapter from the book, Chapter 5, “Getting a Psychiatric Evaluation and Treatment Plan,” in which we emphasize the obtaining a thorough medical and psychiatric evaluation as a key first step in obtaining effective treatment.
I hope your fiancée is feeling better soon!
Related Posts
You can leave a response, or trackback from your own site.
Symptoms Of Bipolar Depression | Best Stress & Anxiety Relief (April 8, 2009)
My brother went into a small depression after he broke his relationship with his Girlfriend. The doctor put him on cipralex and within a year he was back to normal. after one year and as per his doctor’s instructions. he stoped taken the cipralex. after 2 monthes from stopping this medication he starts feeling again the insomnia, anxiety, his apetite is reduced he can’t eat and he spent his time in thinking and thinking in i donno what ideas came to his mind.
he went back to his doctor and he put him again under Cipralex for at least 5 monthes.
N.B he is facing some stressfull moment in his life due to work reason.
do u think that the withdrawl of cipralex has caused this effect so he has to go back to it? and until when a person should take this medication couldn’t be stopped one day???
My brother and I both suffer from unipolar depression, and both went through a situation where we were MISdiagnosed as bipolar, taken off antidepressants and put on bipolar meds. This med change made us act as if we were bipolar. It was very frustrating for us and our families, and was a major medical ordeal, involving months of treatment and time off work, hospitalization for him, because he even became suicidal. It is so frustrating for us because these alleged physicians took one little aspect of our personalities and decided we were bipolar, then made us sicker.
Thankfully we are both healthy now, and back on good antidepressants. Our families are fully informed and aware of what medications and diagnoses we have and need, and never again will we allow a doctor to push us around.
Some anti depressants actually provide chemicals naturaly produced in the brain. Once the brain realises it doesnt need to produce these chemicals it can remain dormant in their production so when the chemical or anti depressant is removed it may take the brain a long time to adjust so all drug changes should be taken slowly to prevent the drug actualy causing problems on removal.Cold turkey is never a good move. It is possible to cause a temporary illness with mental health drugs.
My Doctor just told me that I have BiPolar II, yet I still don’t believe that I have ever gone ‘manic’. My good mood usually comes about when I taper off the more sedating medications- I feel like I can be who I have been in the past- not a ‘queen’. My transitions from one to another antidepressants almost always have me in the hospital because I have such withdrawal- is it bipolar? or does my body need a few weeks to adjust?
Last reviewed: 3 Sep 2009
Copyright © 1992-2010 Psych Central. All rights reserved.
Site last updated: 21 Mar 2010
|
