New psychiatrist... mild bipolar with epilepsy?

[RunningGirl85]

This may or may not actually be related much to this forum, but you all are so awesome I had to mention it here. Plus I know few struggle with this dual diagnosis, so you may know what I'm talking about.

So, I saw a new psychiatrist last week. Well, she's a nurse practitioner for psychiatry (which usually seem to know more anyway since they've worked so directly with patients). We talked for bit, and she was awesome/down to earth, so there was a lot of back and forth conversation. She asked me some questions, and found out about my family history of bipolar disorder (it runs on BOTH sides of the family). I actually know a decent amount on the topic too since I was a psychology major, and had wondered about my own moods a couple of times. While you won't see me out on huge spending sprees, or feeling invincible, I definitely cycle through highs and lows on a pretty regular basis... This is where it gets tricky because a lot of people have mood swings to some extent, but apparently mine are a bit more than normal. The highs aren't super highs, but they do include being REALLY talkative (my mom mentioned that when I was talking to her), or being really irritable, and unable to sleep (plus my ears always turn really red when I get like that - which probably has nothing to do with it, but it's weird). This usually goes on for a week or so, then I might feel normal for a week or so, then I get depressed even if nothing is any different (not majorly depressed, but I get there). Anyway, she thinks I might have some symptoms of mild bipolar, so she lowered my dosage of Celexa, since SSRIs can cause a greater chance of developing full bipolar disorder if you have a genetic predisposition to it, and I do. My dad did drugs awhile back which triggered his, and my aunt on my mom's side had a super rough childhood going through foster homes, which is probably what triggered hers. So we're trying to avoid triggering any possibilities in me

Anyway, I've always found the link between bipolar and epilepsy interesting, and wondered about how I ended up with epilepsy while my dad is bipolar. My irritability and depression were there before Keppra too, I think it just kinda made it worse (especially the crying spells). Fortunately, it's also used for bipolar disorder, and Lamictal is also an excellent mood stabilizer, which is why my psychiatrist only reduced my Celexa a little bit instead of lowering down even more (she thinks that the Lamictal will balance it out).

Anyways, anyone else have any thoughts on this? Experiences? I'd be interested to hear more

 

[MuayThaiFighter]

You always ask really good questions, i've wondered about this myself. I had no idea SSRI's could make a person develop bipolar disorder, but that would make sense. I learned that they can make bi polar way worse, depending on what kind you have. I think at some point with a strong advance in technology they can find the link between mood disorders and epilpetic seizures. I figure if the brain re-wires itself, emotions can change in contrast, before and after a seizure.

It seems lamictal is a great mood stabilizer for bi polar. I have a friend who has only had relief on lithium. Though most drugs used for bi polar is usually a good anti epileptic. I worked at a game store with a guy who took depakote for seizures and had good mood stabilization with it. I'm glad the lamictal is helping you out and hopefully as time goes by even better methods to control both aspects are figured out.

 

[jyearta]

Good post.

I wonder about this, my depression gets so bad at times. I try to fight it and talk myself out of it, WE'LL that that doesn't work. I hate having to take any more meds. I taking Prozac that is compounded.

 

[RunningGirl85]

I am a very curious person I wanted (and possibly may still) go into research psychology with a focus on neuropsychology before I was diagnosed with anything, so it's all really interesting to me.

http://www.crazymeds.us/pmwiki/pmwiki.php/MedInfo/BasicMeds#.T7K_let8DwA This webpage is actually pretty cool at talking about the different medications and links and stuff (even though it's not like a doctor's webpage, it still has tons of info).

I also know that sometimes the symptoms of left temporal lobe epilepsy (what I'm dealing with) can also cause the same depression or mood disorders (at least this is what my psychiatrist said)

 

[Cint]

I've suffered terrible mood swings along with E for years. And for years I was seeing a neuropsychiatrist who specialized in this area. His initial treatment at the time was to start patients on tricylic anti-depressant(s) and then he would go to an SSRI. Well for me, neither of those worked, so he eventually put me on a med they use for bi-polar patients, an anti-psychotic. But that caused diabetes, Type 1, for me, so I could not take those meds. Now, I'm back on 200 mgs. of Zoloft and a small dose of Topomax, as some AED's are used as mood stabilizers.(Lamictal,Tegretol, Neurontin, Trileptol) I have a nephew who is bipolar and he takes Depakote. He has tried Tegretol and Klonopin + the good ole Lithium. Some benzo's (Ativan, Klonopin, Xanax,Valium) are also used for bi-polar disorder, but can be habit forming.

I also know that sometimes the symptoms of left temporal lobe epilepsy (what I'm dealing with) can also cause the same depression or mood disorders (at least this is what my psychiatrist said)

Yes, there is a connection as the left side of the brain is more prone to becoming anxious, tense.

http://www.ninds.nih.gov/news_and_events/news_articles/pressrelease_braindamage_050592.htm
The cerebral hemispheres — those large, wrinkled, oval-shaped lobes that dominate any picture of the human brain — are responsible for most complex mental activities. The hemispheres tend to specialize, with specific cognitive functions controlled by one side. For example, the left hemisphere is responsible for language in most people, while the right hemisphere usually controls spatial skills, such as reading a map.

Normally, Dr. Fedio says, the brain's two hemispheres work in tandem to judge emotions around us so we can make the right response. "The right brain functions like radar, scanning for the blip on the screen — signs of negative emotion or danger — and alerts the left side. The left hemisphere analyzes the situation, determines the risk, and formulates logical strategy.

"But in our research," Dr. Fedio continues, "we found that with damage to the left brain, the right brain become overstimulated and runs out of control. The patient becomes anxious, pessimistic, and tense."

And more info from the American Epilepsy Society:

http://www.aesnet.org/go/press-room/press-release-archive/news-releases?mode=view&id=164
SAN DIEGO, December 4, 2012—Depression is one of the most common psychiatric disorders among people with epilepsy. A review of studies shows that between 32% and 48% of people suffer from depression, impacting quality of life and family functioning more even than seizure frequency.
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Another study by researchers from Cleveland Clinic aimed at quantifying and hence predicting depression and anxiety among women with epilepsy, a group with higher prevalence of mood disorders, anxiety disorders and suicide risk, using the MINI, a validated psychiatric diagnostic interview, was also presented (Abstract #2.284 ). 87 women with epilepsy were interviewed in Cleveland Clinic’s Epilepsy Monitoring Unit. The researchers found that onset of epilepsy among older age women was a significant predictor of major depressive disorders.

 

[kirsten]

I have been diagnosed with bipolar 2, after a fashion. My psychiatrist says I have the symptoms, but it is impossible to know for certain whether my mood swings are the result of my TLE or actual bipolar. She medicates my mood swings with antipsychotics because my moods haven't responded to anticonvulsants alone, and standard mood stabilisers simply don't work for me. I do know that those with temporal lobe epilepsy are highly likely to suffer extreme mood swings, with hypo and hypermania potential, and depressive episodes. Here is an interesting little bit of information about temporal lobe epilepsy and mood:

I once experienced a mood swing so sudden and extreme that I became reasonably convinced that my epilepsy had significant involvement. I remember my mood switching to the opposite extreme in a second. I've only ever had such a sudden mood change once. Usually my mood changes more gradually, over hours or days.

I am an oddball when it comes to meds. SSRIs are contraindicated in bipolars because they trigger mania, but I don't respond to any other antidepressant so I take minute dosages of an SSRI.

 

[Cint]

One word of caution with antipsychotics, as I am speaking from experience. Some can cause diabetes. Zyprexa brought on Type 1 Diabetes for me.

From:http://www.diabeteshealth.com/read/...do-antipsychotic-medications-cause-diabetes-/

Weighing the Risks - Do Antipsychotic Medications Cause Diabetes?

A study appearing the April 2002 issue of American Journal of Psychiatry, found there was an association of diabetes with the use of SGAs. The study used data from a large national sample of patients with a diagnosis of schizophrenia to compare the prevalence of diabetes. Patients treated with SGAs received prescriptions for Clozaril (clozapine), Zyprexa (olanzapine), Risperdal (risperidone) or Seroquel quetiapine).