Bipolar Disorder and Hallucinations
Recently I wrote about triggers, and discussed the recognizing those situations and events that can trigger a bipolar episode. Currently I’m finding myself in a different situation, that of recognizing symptoms that might signal an impending mania.
My biggest concern right now is the hallucinations I’ve been seeing. I frequently see movement from my peripheral vision, but the last several days it’s escalated. It peaked last night on my way to a support group meeting. I saw several things in the 15 minutes it took me to drive to the meeting. In fact, the last one was so vivid of a person by the side of the road it caused me to shout an obscenity in frustration. Today I got rid of a major stressor, and it’s been better. But as I’m writing this I saw a large insect fly across the room. It wasn’t, of course, real. It was yet another hallucination.
This has me seeking knowledge about hallucinations and bipolar disorder. I’ve done a little research, but haven’t found much information. The little information I have come across indicates this is rare, but usually indicates or predicts a mania. I can’t believe it’s that rare. There have to be more people out there who have experienced this.
From The American Journal of Psychiatry, Hallucinations During Lamotrigine Treatment of Bipolar Disorder:
There are two published cases of psychotic symptoms, including hallucinations, during lamotrigine treatment of epilepsy, and two of 108 patients experienced hallucinations during combined treatment with lamotrigine and valproate. To our knowledge, this is the first report of lamotrigine-induced hallucinations in a subject without neurological illness. The repeated dose-related occurrence of this phenomenon suggests a causal association. Because self-reported abstinence from alcohol was not confirmed by alcohol blood levels, the contribution of alcohol cannot be definitively excluded. Although hallucinations may be part of bipolar disorder, they occurred here in the absence of a manic or depressive episode. Psychotic symptoms arising during initiation of pharmacotherapy in bipolar disorder should not be automatically attributed to the illness, and abnormal perceptual experiences should be monitored in future studies.
This article talks about hallucinations for patients taking Lamotrigine (Lamictal). I take Lamictal, and have written about the effects of the medication on me when trying to sleep. It is not quite hallucinogenic, but close. Lamictal is very effective, and amazingly side-effect free for many people. But this is a sneaky-strong med, and this article confirms that. I can’t help but wonder if my Lamictal use makes me more prone to the hallucinations I’m experiencing.
From the Blackwell Synergy’s “Bipolar Disorders" Hallucinations in bipolar disorder: characteristics and comparison to unipolar depression and schizophrenia:
Results: At admission, the cross-sectional prevalence of current hallucinations among 4972 hospitalized subjects ranked: schizophrenia (61.1%), bipolar mixed (22.9%), bipolar manic (11.2%), bipolar depressed (10.5%), unipolar depressed (5.9%). The most frequent hallucinations across all patients were auditory, followed by somatic and visual hallucinations. There were only minor age or sex differences in risk of hallucinations. Compared with patients diagnosed with schizophrenia, hallucinations among patients with BPD were less severe, more visual and less often auditory. Characteristics of hallucinations were similar among manic and both bipolar- and unipolar-depressed subjects. Among patients with major affective disorders, those with hallucinations were less well-educated, had higher anxiety scores, less insight into the illness, and their hospitalizations averaged 17% longer. Across all diagnoses, hallucinations, particularly olfactory, were significantly associated with delusions. Hallucinations in BPD were most often accompanied by persecutory delusions; delusions of grandeur were least associated with hallucinations.
I’m not surprised that mixed episodes have twice the instances of hallucinations. You’re bouncing around so much it has to lend itself to extreme symptoms.
I recognize that the presence of these hallucinations is most likely signaling an extreme mood change. I’m hoping to avoid a mania or mixed episode. Knowing what might be coming helps me to take steps to avoid it, and also to make plans to work through it.
Does anyone else experience hallucinations as a precursor to a mood change? Auditory, visual, or other? I’d be interested in your experiences. Leave a comment and tell us about it.