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The question was submitted 01/11/2007

Subject: Aropax

Dear Doctor, I was on aropax 20 mg a day for about 10 years. At first it worked well for depression. Some time later - I think within the first 2 years or so I began to develope a bi polar mood instability whilst on aropax. Early this year I was taken off aropax and unsuccessfully tried on other anti depressants - e.g. Lexapro, Effexor and the problem maker - Trofenal Tricyclic (spelling?) The Trofenal caused me an extreme anxiety attack which I am still recovering from - that's since June this year. I am now being treated for anxiety, deppression and bi polar 2. I am now on lithium, xanax and serequal but I still feel depressed and am still suffering from anxiety.

My question and concern is that I have been diagnosed bi polar as a result of the aropax. I have been informed that aropax can cause mood instability. Is this true? For about 4 weeks I was drug free in between the changes of medications, I felt OK with no mood swings. It wasn't until I decided to take trofenal - that everything went to crap. (I'm in a stressful job and lost confidence in myself to stay feeling good). If I am Bi polar shouldn't I be feeling better with lithium? I would rather the highs and lows than being low all the time, although the anxiety is the worst of all.

Answer from DepNet

Dear Aropax,

Thanks for your inquiry. It raises a number of important points.

Probably the most important is that the majority of people diagnosed with bipolar 2 start off with depression and then slowly (sometimes over years) the bipolar diagnosis becomes more obvious. Most of these people spend much more time with depressed mood than elevated mood.

Believe it or not you might have developed (and been diagnosed with) bipolar 2 even if you had never taken aropax. We are unable to prove it one way or the other. There is some debate about whether antidepressants (like aropax) can cause mood instability and many experts doubt that this is the case. We simply don’t know.

The next point is that anxiety and depression/bipolar go together much of the time. We call this co-morbidity and many studies have shown that over 50% of people who suffer from mood disorder also suffer from anxiety.

If we leave out your medication history and simply look at your symptoms (the progression from depression to bipolar 2 to co-morbid anxiety) then I’m afraid the pattern is one we see over and over again. It occurs both in people who have taken medication and in people who have not. It is also one that causes many people a lot of suffering and it is extremely important that you find a specialist to help you with this problem. A suitable specialist is one who will be happy to answer all your questions about the illness as well as medication choices and potential side effects.

As far as your question regarding lithium is concerned it’s important to know that:
1. Lithium dose has to be carefully adjusted using blood tests to measure the level and,
2. Not everyone responds to lithium and some people do much better with other mood stabilizers. Again it an issue to discuss with the doctors looking after your problem.

Good luck and thanks for raising these important issues.

The answer was published on DepNet 05/11/2007