抗抑郁药物充当帮凶角色？
在认识抗抑郁药物与快速循环之前，还需认识另外一个问题，即抗抑郁药物与躁狂发作之间的关系。虽有些诊断标准，如DSM-IV和CCMD-3，都认为由抗抑郁药物引起的躁狂发作不是双相心境障碍的诊断要件，但是越来越多证据表明，这些由抗抑郁药物引起的躁狂发作的抑郁病人，在随后的追踪观察中，几乎100%的都成为了双相心境障碍，可以说，抗抑郁药物促发了躁狂的发作，同时也提前了必然到来的躁狂的出现。也可简单地说，抗抑郁药物缩短了抑郁与躁狂之间的距离，转相时间短了。 因此，这些现象提出一个尖锐的问题，快速循环可能与抗抑郁药物有联系。[ 本帖最后由 遭遇躁郁之后 于 09-3-1 00:36 编辑 ]
在阳光潜水了一段时间后的感悟
不知道双相病例中误诊的比例多少？ 楼主说的是什么情况的误诊。看不明白？ 同意楼主的观点，我就是吃塞乐特吃成双向的。 我也是吃抗抑郁药吃成双相都 其实关于这个问题，一直在我心理是个巨大的问号！:'( :'(不过后来我想，即便弄清楚了得病的缘由，也没有意义了，只能面对现实，也很无奈的说！:o :D
人们开始注意到一个问题
虽然在早期Kreapelin也描述过这种所谓的循环，但是出现的频度是低的。自从抗抑郁药物问世以后，这种现象便成倍地增加，上个世纪60年代之前，这种类型的疾病的报告不多，但自从抗抑郁药物问世以后，这种快速循环型的在双相障碍中的发生率达20%。1974年，Dunner与Fieve首次创用了这种名称，以致到目前已经将其真正写入诊断标准。为此人们开始注意到一个问题，这就是:抗抑郁药物是快速循环的“元凶”吗？[ 本帖最后由 遭遇躁郁之后 于 09-1-27 19:10 编辑 ] 马来酸氟伏沙明片这种抗抑郁兼强迫症药物，大家服用过吗？ 原帖由 蓝风 于 09-1-23 20:36 发表 http://www.sunofus.org/bbs/images/common/back.gif
楼主说的是什么情况的误诊。看不明白？
上文的误诊是指本来是普通抑郁或焦虑者被大剂量抗抑郁药物或长时间服用抗抑郁药导致躁狂的情形，不一定就是双相。只是一种推测。 今天因郁躁症和与别人纠纷导致的自闭有所改善，主动与两个朋友取得联系:)
献给 fans of English 和双相家属浏览用，现阶段的我是刚开始轻躁
Adolescent Bipolar Disorder: A Mother's Storyby Susan David, Dec 20, 2007
I'm her mother, and alarm bells were ringing; something was very wrong...
My shoulders hunched into themselves as the door slammed. I began to
dread the ensuing scene with a
deep breath and a shoring-up of my draining inner strength. And it was here,
the time of day when the screaming commenced, the crying ensued, and
slamming doors were the norm [标准] in our home. Elizabeth was home from school.
Three-fifteen every day.
She stood in the middle of the family room and stared at me with burgeoning defiance in her big chocolate eyes as she threw her backpack onto the couch. “I want french fries,” she uttered before the bag hit furniture. “I want to go and get french fries.”
“No,” I responded, bracing myself. “We're not going anywhere this afternoon so french fries aren't on the agenda.” I tried to make a weak joke, which I knew wouldn't work. Elizabeth's two sisters had evacuated to their rooms, long used to their sister's erratic behavior and outlandish demands.
“But,” she growled, her voice gaining volume and speed, “I said I want french fries, and I want them now!”
“You're not getting them now. Maybe when...” but of course I was never able to finish my sentence because the wailing and screaming had commenced. “Go to your room,” I was able to yell over her cacophony.
“I hate you,” she screamed at the top of her lungs, “I hate your guts and I hope you die! I hope you all die, I hate this family, you all make me sick, I want french fries!” Her voice was hoarse by now as she ranted and screamed at the top of it. She walked to her room with the verbal abuse still sputtering and spewing: “Everyone hates me! I hate everyone else! I'll kill myself, you'll see, then you'll be sorry! I hate you!”
She was finally downstairs in her basement room, wailing to the walls instead of my face. Whew, just another after-school day with my beloved oldest daughter Elizabeth. At twelve years old, she was getting worse instead of better and I knew it.
The other two children tiptoed out of their rooms with wide eyes, but they cautiously walked into the kitchen and started preparing snacks. I smiled as much as I was able. “How was your day?” And we carried on as if nothing unusual had occurred. Nothing had. Elizabeth wandered back upstairs after about half an hour. She nonchalantly walked into the kitchen, prepared a snack, and started talking to me rapid-fire. Nothing unusual for this day; it was like every other one that we spent with Elizabeth. From screaming within five minutes of her homecoming from school to normal behavior in the space of an hour. But normal behavior never lasted.
“Elizabeth, set the table.”
“But I don't want to set the table.”
[ 本帖最后由 遭遇躁郁之后 于 09-3-1 00:45 编辑 ] “I didn’t ask.” I was bracing myself once again. Here we GO again. “It’s your turn so go to it,” I responded with firm authority I didn’t feel.
“NO!” She screamed as close to my face as she dared to get. “I don’t WANT to set it and you can’t MAKE me!”
“Yes I can,” I answered. “Set the table or you don’t eat.” My mouth was set and she knew I meant it. I did.
“Fine!” She screeched as she slammed down dishes. “I’ll set the damn table!”
“That word is unacceptable and you know it,” I told her. “You need to apologize.”
“I’m sorry,” was sneered from twisted lips. I sighed for the countless time that day, rubbed my eyes, and said,
“Go to your room.”
Scream yell scream cry scream yell. Off to her room for about twenty minutes and she was back, calm and smiling.
During dinner her words moved so quickly out of her mouth she seemed to be running a race with herself. When I admonished her to slow down she yelled that she couldn’t and continued to speak so rapidly we couldn’t understand her. Nothing new about this day.
Television was on after dinner and I told all the children to do their homework. “Mine’s done,” Elizabeth responded, still staring at the screen.
“Let me see it.”
“I don’t have to let you see it.”
“I need to know that it’s done.”
“I TOLD YOU IT’S DONE! Are you calling me a liar? I HATE YOU!” Scream rant scream yell.
“Go to your room.”
Scream rant. Silence. After about twenty minutes I went downstairs and opened the door to her room. She’s sobbing.
“What’s wrong,” I asked as I gingerly sat.
“You don’t care, no one does. I hate my life, I hate myself. I wish I could die. I really wish I could die. My friends hate me.” She sobbed into her pillow so much that a wet trail wove its way onto her bed.
“That’s not true, honey.”
“Yes it is. What do you care. You hate me too. You only love THEM.” She raised up to stare at me with angry, tear-filled eyes. “Get out of my room! You hate me and I HATE YOU! GET OUT OF MY ROOM!” She began to scream again. I sighed and rose, leaving my very troubled daughter to collect herself.
There’s nothing quite like feeling powerless in the face of your child. Knowing that something’s very wrong and having no understanding of how to fix it. It’s scary stuff.
She went to bed when the others did, kissing her father and me, clean after a shower. She crawled into her covers, smiling and content. As happened quite often, I was awakened by her middle-of-the-night cries. I went downstairs knowing there was nothing I could do. She would cry inconsolably for thirty minutes, then she would fall back to sleep and remember nothing in the morning. When she was young the doctor called them “night terrors.” Now there was no fear in her wails like when she was younger. There was just a spine-tingling, nerve-jolting sadness that ripped at a mother’s heart.
Once again, feeling powerless in the wake of my child’s desperate sadness, wracking my brains and heart to understand what was happening to her. Not knowing, at the time, that I was living with the onset of adolescent bipolar disorder.
* * * * * * * * * *
Elizabeth was not diagnosed with adolescent bipolar disorder until the was fifteen years old. Before then she was being treated for ADHD [儿童注意缺陷多动障碍（Attention-deficit/hyperactivity disorder，ADHD）是最常见的儿童时期神经发育障碍性疾病，中国精神疾病诊断分类称为儿童多动症，该症以注意障碍、冲动行为、容易分心以及活动过度为主要特征，估计在学龄儿童的发病率为3%-5%。，男女发病率之比约为4：1-9：1。
ADHD是由George Still于1902年首先系统描述，近100年来，有关该病的名称已超过25种，包括儿童轻微脑损伤、轻微脑功能异常、多动症等，70年代学者发现注意缺陷在该症中的核心作用，该症命名为注意缺陷障碍，对于同时伴有多动症状者，命名为注意缺陷障碍伴多动，1994年美国精神障碍诊断统计手册第四版（DSM-IV）命名为ADHD。值得注意的是近年来随着现代认知心理学的研究进展，学者们对注意缺陷的核心作用也提出了疑问，认为该症的核心缺陷可能存在于机体对信息的加工或传出（反应）过程，亦可能是机体综合信息能力存在缺陷从而对运动反应选择性抑制差。
【病因与发病机制】
ADHD的病因和发病机制至今并不明了。目前多数学者认为该病是遗传因素与环境共同影响所致，是神经系统发育障碍性疾患。], but the medication wasn’t doing her any good, I knew that. Her behavior had gone from bad to worse.
At thirteen she became obsessed with boys and I found a notebook filled with detailed descriptions of oral sex and how-tos for condom use that curled my straight hair. I sat her down for a long, detailed discussion about sex and why she was FAR too young for such activities. I didn’t know how much she’d done, but I figured it was mostly talk. Who really knows, though. I quivered on the inside.
Then I was called to the school when she was caught taking caffeine pills with a group of girls. I marched her off to the doctor for an in-depth discussion about substance abuse and what can happen to stupid little girls (my words, not the doctor’s) who abuse drugs, even caffeine pills.
She began to cut herself around fourteen. The screaming fits had increased in their frequency and I NEVER let her be around boys after school hours if I wasn’t present. There’d been an “issue” at a church when she was found “making out” with a boy, and I was beside myself, wondering what in the world had become of my oldest child. She was considered academically gifted and had a singing voice most would kill to possess. She was personable, friendly, outgoing. But she was alienating people with her hyperactive behavior and unpredictable ways.
I didn’t know about the cutting until she was almost fifteen, when she reached over to grab something and her many bracelets-she wore them almost up to her elbow-slipped and I gasped.
Once again we visited her doctor. He was a kindly man who always wore a bow tie and spoke softly, sweetly. Elizabeth loved him. He asked me to leave the room and he questioned her about sex. No, she said, she hadn’t done that yet. He asked her about the cutting. She responded that she just got so sad. She didn’t know why.
He wanted to prescribe an anti depressant [抗抑郁病药] , but I refused for some reason. I wanted a psychiatrist to evaluate her first. I put off contacting the psychiatrist for about a month, getting ridiculously bogged down by nonsense, until I came across another notebook of Elizabeth’s. This one detailed about seven plans for how she’d commit suicide. Very, very detailed. With my legs buckling out from under me, I wobbled to the telephone and made the appointment.
They gave me questionnaires to fill out and some to give her teachers to fill out. This gifted child was performing worse and worse in school, by the way. I was always worried about Elizabeth. Every day brought this feeling of weight in my chest. What will I get called about today? Will Elizabeth lower herself to attend classes? Will she get into an altercation with another student? I never knew what each day would bring.
Once I had to pick her up from the mall. She was detained by mall security for stealing a three dollar bracelet. They’d had to drag her screaming and kicking to the office where the security officer sat in fuming silence, nursing a bruised shin. “We’ve never had anyone react like that,” he spoke to me in a haughty, wounded tone. We simply were going to escort her to this office and call you, but she went berserk and we had to cuff her.” I apologized profusely all the way out the door and commenced yelling at my daughter through gritted teeth all the way to the car.
Was she grounded? Constantly. Privileges were not the norm for her because she was always doing something to get them revoked. We never knew what the next challenge would be. And so it was that we filled out questionnaires and took Elizabeth for her first psychiatrist’s visit.
My shoulders were slumped once more, hers were tense. We both chewed on our fingernails until her name was called. I had turned in the paperwork days prior, so I hoped the doctor was prepared to help. Anything to make our lives less chaotic would be a good thing. Our home was a practice in eggshell-walking. No one wanted to set off Elizabeth. And ANYTHING could set off Elizabeth.
The doctor smiled. She was a little older than me with strawberry blonde hair and kind blue eyes. She seemed like a nice, practical person. “I really don’t have to talk to you all much,” she smiled. “Your mother was so detailed with the paperwork. I can diagnose you now.” She sobered slightly and leaned towards Elizabeth. “You have bipolar disorder type II. Do you know what that is?” Elizabeth shook her head no, and my mouth dropped open in amazement.
“B-but,” I sputtered. “I didn’t think she could have that.” I’d blurted before thinking, and then I blushed. My internet and library investigations had been caught. The doctor smiled at me next. “Why is that?”
“She doesn’t crash,” I responded. I thought of a bipolar “crash” as the kind we see on television. The doctor nodded her head.
“You might think that. But Elizabeth has adolescent bipolar disorder, and that’s a bit different. First of all, adolescents rapid-cycle. They can go through ups and downs as much as 300 times in a day. And the crash of depression actually manifests as extreme irritability in young people. In fact, aggression is part of both the ups AND the downs.” This was sounding more and more like my Elizabeth! It turns out that with adolescent bipolar disorder, mixed episodes are also quite common, which meant that we couldn’t tell whether she was “up” or “down,” but it didn’t matter. Her moods were out of whack because of her brain chemistry. Talk about a SIGH of RELIEF! The answer for Elizabeth’s erratic behavior was good compared to the not-knowing.
Also, type II means that she doesn’t experience classic mania, which is the feeling of invincibility and super humanness-the kind we see on television-but she experiences “hypo-mania,” which is the rapid-fire speaking, racing thoughts, giddy behavior. She did it ALL. Both Elizabeth and I gazed at each other with thankfulness. The answer.
* * * * * * * * * *
One would think that The Answer would be the end of this story. One would be wrong. Elizabeth was put on several different medications to combat her brain chemistry, but they’ve had to be “tweaked,” changed, and re-vamped several times since she was fifteen, and she’s eighteen now. The constant changes in her brain due to growth are mostly to blame for the fact that she doesn’t remain stable for a very long period of time.
We’ve been battling her bipolar disorder since we didn’t know what it was or how to treat it. We can now give her disorder a name, but sometimes that doesn’t make life any easier; how ironic is that? She can’t seem to focus or concentrate, but any ADHD meds create manic episodes with her. Sexual acting-out is a symptom of bipolar disorder, as is impulsive behavior of all kinds. School is an endless challenge for my gifted child. I don’t know if she’ll graduate this year or what she’ll do in the years to come.
Right now her adolescent bipolar disorder is moving into the adult disorder, so the poor girl is dealing with both, almost. She’s still aggressive and irritable, but now she’s going from sleeping constantly to staying up for days at a time. That’s a clear cycling symptom, something she didn’t have before.
Elizabeth’s brain-the part of her that was her best friend from infancy-the mechanism that gave her a first word at eight months of age and gave her the gift of reading at age four, has become her worst enemy. How does a person deal with that knowledge? Not easily.
And I, her mother, have to stand by quite often and watch her self destruct. I can give her meds, explain her situation to teachers and other parents and “be there” for her, but I can’t take this on and I can’t “fix” it. I have to watch her and know that I can’t help for the most part. She has to learn to cope. She has to deal with the disorder. I CAN’T FIX IT. And THAT makes me crazy.
[ 本帖最后由 遭遇躁郁之后 于 09-3-1 01:15 编辑 ] 真希望我们国家的医学方面的科学家们加强一些关于精神类疾病的研究，还有一个很重要的方面就是药物治疗的副作用中是不是会导致另外一种精神疾病的产生，其概率是多少，我认为都应该好好的研究研究，否则会有多少人因为抑郁症吃药而变成双相或者躁狂啊？ 有原文出处，加到yeeyan双相组里去吧
http://www.yeeyan.com/groups/recommends/1516
等有谁有空闲，翻出来，方便大众
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