DOES DEPRESSION (UNIPOLAR) EVER BECOME MANIC DEPRESSION (BIPOLAR)?
Every psychiatrist needs to be aware that a not-so-small percentage of people who seem to be unipolar eventually blossom into bipolarity. This is less rare than one might expect. After following a group of patients at the University of Tennessee Mood Clinic for a period of several years. Dr. Hagop S. Alaska and his colleagues found that 14% of the patients originally considered ”neurotic depressives”—the old term for those afflicted with dysthymia— developed hypomania, and an additional 4% became manic; a total of 18% of the seemingly unipolar patients became bipolar. No wonder so many patients are misdiagnosed. The disease spectrum itself changes shape, and psychiatrists often fail to be good historians or medical detectives. They miss the mild highs, and as a result the patient is misdiagnosed as unipolar depressive, either major or dysthymic, or as having a personality disorder with subclinical depressive symptoms.
How do these bipolar depressed patients react to the older standard antidepressants? Often quite well. Over the past three decades, there are many dramatic responses, both with lithium alone and with lithium combined with the standard antidepressants. But even though people may feel more even-tempered and energetic with older antidepressants, symptoms such as constipation, blurred vision, and weight gain can be very bothersome; and they are all the more unbearable for people whose depression wasn’t that bad. The MAOIs present the additional difficulty of prohibiting tyramine-containtng substances such as cheese, Chianti wine, chocolates, and other foods and some over-the-counter medications.
In the vast majority of people, the side effects of Prozac are extremely mild or nonexistent.
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Tags: Anti Depressants