Can psychosis change into bipolar disorder?

[DrowningInSellotape]

Wondering if anyone could advise - my DD (17 yrs) is on olanzapine and fluoxetine. Just a small dose of olanzapine but it has helped very much with some psychotic symptoms she was showing. The symptoms were possibly triggered initially by some illegal drug use (small amount for a short time) which has now stopped. Fluoxetine for depression.

What I've noticed now though is that she is having times when she seems actually high. Acting over-excited about relatively small things, saying she had an utterly amazing dance class earlier, etc. etc. , really really Up and loud.

Then getting paranoid about 7 hours later and having a really bad bout where she is convinced she's being watched by CCtv, and fixating on other unlikely things. Being really really scared. this can be at like 3am.

Then, say 24 hours later, being really really down. Crying, sad, saying she has nothing to look forward to.

Obviously this will all be mentioned at her next psych. appointment but does is sound more like bipolar now?
Please does anyone have any experience?
Next psychiatric appointment is January.

It doesn't read like bipolar but that is only based on what i have read etc, but i think bipolar is described more by longer periods of mania and then falling into depression for long periods. This is also what my Dr told me when i asked about it myself. (i suffer from anxiety and depression and can have "up" periods).

17 is quite young to be on fluoxetine and these are things that i would flag up with the Dr if i'm honest as SSRIs (fluoxetine is one) can have a higher level of side effects in younger people. Again, when i first started on an SSRI i had similar side effects and the paranoia was just awful.

It must be difficult for you to watch your DD suffer this She is lucky to have such a supportive and understanding mum.

My ExH was psychotic and was later given a BiPolar diagnosis. I'm not sure it was a "change" IYSWIM, more he was suffering from both at the time.

[Thanks]

That should be OP, it must be difficult for you both.

Psychosis can be part of bipolar, and anti depressants can trigger mania, so it is worth speaking to her CPN or whoever is your first port of call.

Don't know, but you can have the sort of bi-polar that is rapid-cycling. I have a friend who has it, it's got a name, but I can't remember sorry.

But rapid cycling bipolar means you go through at least four episodes within a year, not within 24 hours.

It must be very scary for your daughter, OP. I think she should try to get her psych assessment brought forward.

There is one that is more frequent than that Imperial, I think RD Laing (sp) the psychiatrist used to suffer from it.

She sounds delusional if she believes cctv is watching her. That's psychosis. Could she be reacting to the antidepressants, or taking more drugs?

As moopynoodle says, could she be taking drugs and you're seeing the high, then the comedown?

Oh your poor daughter - 17 is so young to be mentally ill although psychosis does often present in teenage or young adulthood. I'm no medic but because of my own MH issues I've had to research it a fair bit. The thing is that psychosis can be part of bipolar, and the elated mood does sound a bit suspicious. However I agree that you should try to bring her psychiatric appointment forward. Does she have a CPN - services for young people are very thin on the ground sadly.

Have a look at the YoungMinds website - lots of information on there.
You sound very together - are you coping ok, or just being brave.

SSRIs can cause mania in some patients who aren't bipolar. Citralopram and Prozac both sent my sister manic with serious consequences. Mention it to her pyschiatrist.

I have a diagnosis of ultra rapid cycling bipolar 2. I don't have mania but hypermania where I'm like an annoying, over excited child at Christmas. I then crash out within a few hours into utter depression.

My highs and lows last 4-5 days ish. At my worst I was high and low within a week. I'm now pretty stable.

Just for those who say it can't be bipolar because it's too rapid that's not entirely right. Such rapid cycling is rare, mine was triggered by prescription ssri medication.

Citilopram was the trigger for me. It was horrid! I'm currently in a 'mild' hyper manic phase but it's manageable and I know it'll end soon. (I'm sure some may argue it's not hyper mania if I'm aware of it!)

Thank you all for the and kind thoughts.
I've brought the psychiatrist appointment forward to December, a couple of weeks time from now.
NanaNina thank you for asking - I think I'm OK. I've been dealing with it for a while now, occasionally it gets a bit much but I'm ok.

The olanzapine seems effective for the paranoia. Psych. had told her that she can take an extra olanzapine if she feels it coming on. This works within about 30 minutes.

The mania before the paranoia and then the depression after it, is different though. The mania, if that's what it is, is a relatively new thing. Or thinking about it, maybe it's not. She's always been a "life and soul of the party" type character, always full of energy, very social and bubbly. The depression part has been going on for a while, hence the fluoxetine prescription. It has been gradually increased over the past months because she has still been getting bouts of depression - but acute bouts for short periods of time, rather than the long periods of depression in "straightforward" depression (that's what I have).

I am 95%certain she's not taking any illegal drugs. Interesting that the fluoxetine may have triggered akind of mania?

Efexanor (venlafaxine) triggered mania in me. I now seem to go very manic for short periods if I over indulge in booze or some other things and then I feel utterly shit the next day.
So yes it could be the anti-depressants but could also be something else.
On the paranoia side of things, I have had the occasional paranoid thought but I have never taken them seriously iyswim?

I had psychosis followed by post psychotic depression, the whole cycle lasted around 9 months.

Then almost exactly a year later, the same thing happened again.

At that point, my psych changed my drugs and started mentioning bipolar. He watched and waited for a while before officially diagnosing bipolar. I really wasn't sure if it was the right diagnosis, but having been through some ups and downs and also mixed periods (hideous btw) I think psych I right.

Everyone is different though. Glad she is seeing psych sooner.

Clinical mania as in bi-polar is over long periods and isn't just elevated mood or overactivity it usually includes grandiosity and delusions which often lead to out of character behaviour for a consistent period of time.

Hypomania (as in sub - mania) is elevated mood and overactivity, talking too much etc but again should be seen for several days consistently to be diagnosed as Hypomania.

i think the key is that none of us , as well meaning as we are, can diagnose your dd. You have done the right thing getting her appointment brought forward. If you are worried in the meantime then don't hesitate to get her seen asan emergency.

Thank you for sharing your experiences and sharing thoughts everyone. YesI will seewhat the psychiatrist says.

Bipolar in adolescents/young adults will not necessarily look the same as it does in older adults, I'm sure it is more usual to have that kind of ultra rapid cycling (ultradian?) or general instability rather than the discrete episodes you see in older people.

hello again, DD has not had any more episodes of what seemed to me like bipolar BUT today she had a bad episode of hearing voices and then passed out! only for a minute or so, but collapsed onto the kitchen floor.

Psych appointment is on Tuesday but in the meantime has anyone heard of any connection between this sort of thing and fainting? I am beyond worried and just wondered if anyone knows.

I thought I would give an update for all you kind people who posted.

Saw psych today - he did not give any diagnosis of anything, he never does (DD is only 17 and has been seeing psych for under a year). The good news is that he says she is managing her meds well, (e.g. takes an extra olanzapine when she knows something triggering is imminent) and it's great that she is working hard at college and doing really well (after a really bad year last year).

He said it's now time for a mood stabilizer as well as the olanzapine and fluoxetine, and has now prescribed lamictal. A quick google tells me this is used for bipolar, but he didn't mention bipolar. He says Dd's episodes dont last as long as they used to and that's good. (my last post re. the fainting is a red herring - turns out she hadn't eaten that morning and fingers x it was a one off).

Hi Sellotape, thanks for the update. Glad to hear that your DD's psych was quite positive. From my experience psych drs don't like to give a formal diagnosis in teenagers. It can be frustrating, but there are so many other hormonal changes happening in teenagers its hard to make a diagnosis correctly without waiting to see which (if any) of the symptoms go away in adulthood.

I'm on lamotrigine and I don't have bi-polar. I take it as a mood stabiliser as I don't get on with all of the other ones that I've tried before. My diagnosis is Borderline Personality disorder. I cycle through periods of hypermedia, depression, anxiety, paranoia all with in a day. At the moment I'm pretty stable, but when I'm unwell then things can be very intense.

From what I've found the tablets taste utterly vile if you take them with squash or juice, but nowhere near as bad if you take them with plain water

Thanks for the info MummySparkle, and I'm glad that at the moment you are quite stable.

DD took her first Lamotrigine last night (with water - she says it was kind of "chalky" but not too bad) and says she feels on more of an even keel already. I can't believe it has worked that quickly but she seems fairly sure. Fingers crossed.