Reader’s Question

My daughter has changed. It’s all about her. Anything I say is always contradicted. She is into so many projects that she has no time for family. She has a son, a husband, and a horse. The horse is the most important thing in her life. This behavior is notable since the medication 75.m. She is just not the same. It breaks my heart.

Our Clinical Psychologist’s Reply

The information in this question is very limited, but there is a theme here. Your daughter has “changed”, suggesting that her current behavior and personality is significantly different than in the past. Comments regarding “It’s all about her” and references to multiple projects is also important. The last mention that her change was notable after her medication (not identified) was changed is very important.

The theme created by these comments is that of SSRI-Induced Hypomania. With my best guess, I think you’re referring to a change in your daughter’s antidepressant medication which slowly produced a significant change in her behavior and emotional state. As a result of this sudden change, she has become overly energetic, selfish, physically hyperactive, involved in multiple projects, and is prone to confront and argue with everyone around her. This might very likely be hypomania.

Antidepressants, especially Selective Serotonin Reuptake Inhibitors (SSRI), can produce a state of hypomania by accident. Hypomania is being “too happy” or “hyper” and includes:

• a “high” mood,
• irritability,
• decreased need for sleep,
• preoccupation with self and personal pleasure,
• talkativeness,
• a sense that thoughts are racing,
• multiple projects and activities,
• excessive interest and participation in pleasurable activities, and
• difficulty focusing and attending

Importantly, if I am correct, this is not a personality change in your daughter, it’s a neurochemistry change. What can you do?

• Review her recent changes in medication. Was she taking an antidepressant? Hypomania can be related to some medications, but is not likely in others. A change in a physical medication such as blood pressure, diabetes, etc. may not produce hypomania. Look for an antidepressant. Also consider that she might be taking more than prescribed.
• Discuss the situation with her husband. A family strategy may be needed to approach your daughter as after all, from her point of view, she’s feeling and doing great!
• 80% of antidepressant medications are prescribed by non-psychiatrists, typically family and OB/GYN physicians. Non-psychiatric physicians may not be able to recognize a hypomanic state, as a brief contact with a patient who quickly claims “I’m feeling Great” may be interpreted as a good medication response. Ask the husband to contact the physician about these possible side effects of the medication. She may need to see a psychiatrist if true hypomania is present.
• Hypomania can be dangerous. The hypomanic mood may produce spending/gambling sprees, foolish business deals, multiple projects that fail due to a lack of follow-through, and even sexual indiscretions. If this is SSRI-Induced Hypomania, your daughter may develop bizarre plans such as taking her horse to Hollywood or deciding to ride horseback across your country for some philosophical purpose.
• It’s important that you bring your observations to her attention. Assure her that you want her to be happy, but not dangerously happy as a side effect of her medication — there’s a big difference.

The above comments are based on the assumption that your daughter is being prescribed an antidepressant, that a recent increase in her antidepressant has changed her personality/behavior as described, and that her new behaviors represent a significant change from her pre-medication personality.