What is an antidepressant-induced hypomanic symptom?

Question

Hello doctor,

The patient, who was diagnosed with OCD eight years ago, initially managed the condition with therapy and no medication. However, after trying Sertraline, they experienced hypomanic symptoms and stayed on it for two years due to its benefits and depression relief. The patient feels that Sertraline permanently altered their brain chemistry.

I was diagnosed with bipolar II disorder and prescribed a mood stabilizer, Divalproex sodium. However, the effectiveness of Divalproex sodium has significantly reduced over the last six months, causing irritability, overstimulation, and emotional dysregulation.

I am not sure what to do now because out of the other options, Carbamazepine was not as effective, and lithium caused thyroid problems. Lamotrigine was activating for me and had no antimanic properties for me. Then, the antipsychotics made me trend towards agitation and did not have a calming effect at all. Some even triggered high sexual activity. I have undergone a complete blood count, metabolic panel, and thyroid test.

What else can I do in my situation to try to reset my brain to how it was before Sertraline? Is there no other option for me given that I do not respond to antipsychotics the way typical bipolar patients do?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

As per your mentioned symptoms and history, you are going through bipolar mood disorder type 2, which is an antidepressant-induced hypomanic symptom.

I would suggest you stop antidepressant medicine.

As you have tried many medicines, all medicines have side effects, and some medicines are not effective.

In your case, I would suggest you go for Endoxifen (selective estrogen receptor modulator) medicine, which has good results in controlling aggression and irritability and also has a good mood stabilizer effect.

I would also suggest you try Cariprazine (atypical antipsychotics), which also has a good mood stabilizer effect.

In addition, I would suggest you go for electroconvulsive therapies (ECTs) too for faster results, and sometimes after ECTs, certain medicines will start effective.

One more method is repetitive transcranial magnetic stimulation (RTMS), which is also brain stimulation therapy you can go for.

But one of the best options is Endoxifen. Sometimes bipolar type 2 patients do not respond to typical antipsychotic treatment.

I hope I have answered your question.

Let me know if I can assist you further.

Regards.

Answer 2

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

Yes, it is available in the cold-climate country also. But it is available in different brand names. It has Endoxifen (selective estrogen receptor modulator) as a main ingredient.

It is not possible for its permanent effect. But we need to control its symptoms with a mood stabilizer.

Yes, once its effect starts with antidepressants, we need to control. Just after stopping medicine, it will not improve. So, just relax and start the medicine.

I would suggest that you are not having primary bipolar mood disorder. It would be an antidepressant-induced hypomanic symptom. So, it is not severe and not a major problem.

I hope I have answered your question.

Let me know if I can assist you further.

Regards.