Can Husband’s Behavior Be SSRI-Induced Hypomania?

Reader’s Question

I hope you can help me or direct me in the right direction. My husband has been seeing a therapist for a year now, who has started him on Paxil. But it seems this is just a drug and nothing to diagnose his problem. He has been depressed, yes. But that is only one aspect of his personality “disorder” (the term he says his therapist has given him). He drinks heavily to self medicate. Two bottles of wine a night is not uncommon. He has silly behaviours..like laughing for no logical reason, at inappropriate times, or acting out much like a 12 year old boy who knows he is too big for you to stop. Like trying to catch my little half-ounce finches in their small cage. I repeatedly asked him to stop but he kept at it…eventually giving them heart attacks and killing them.

He claims he has ADHD, which makes sense because he gets bored easily and is unable to stay focused on a conversation for any length of time. He was very shy and antisocial until he started taking Paxil, but even now that he is venturing out socially, he behaves inappropriately in such situations. He will go to sleep but can start up strange conversations with his eyes open during his sleep. He swears he was sleeping, but when this happens, I swear he is awake…or at least he appears so. He needs to be in “control” and is unable to understand that naughty behaviours are not about rules but respect. For example: I have no peripheral vision due to a head injury some years ago and ask my family to please keep their belongings picked up off the floor or I am apt to fall over them. He complains this is like his mother setting stupid rules and nobody is going to tell him what to do. Realisticaly, this is not a rule, but respect for my having to pick up after him and also, more importantly, about my hurting myself when I fall over his things left scattered about on the floor.

Please understand my musband is a 52 year old man and no little boy. Do I approach his therapist even if this would anger him? Should he change therapists? Of course, I cannot make him change. But if I knew more about his behaviours, or what makes someone act like this, I would know better how to deal with him. What personality “disorder” falls under these symptoms?

Thank you for any help or direction you can give me.

Our Consulting Clinical Psychologist’s Reply

You’re likely to be dealing with several factors here. The depression seems to be doing well — maybe even too well, which I’ll talk about. He also has a drinking problem. Two bottles of wine a night is a significant drinking problem — and this level of alcohol use will also influence his antidepressant. ADHD symptoms alone won’t create this immature, “big kid” behavior you are seeing in the home.

Unlike being depressed, your husband has a good mood that might be too good — a bit too happy and euphoric. Chasing the finches around the room at 52 is not a good sign. These inappropriate behaviors may suggest another condition.

Paxil is in a class of antidepressants called SSRI’s — Selective Serotonin Reputake Inhibitors (SSRI). In some patients using these medications, a rather unusual situation can develop. It’s called SSRI-Induced Hypomania. Hypomania is a state of mild-to-moderate euphoria or being too happy. When this happens, the patient becomes hyperactive, has motor-mouth, acts inappropriately, can become childish/immature in behavior, seeks excitement, may be hypersexual, and feels on top of the world. If you feel he may be acting “goofy” — this is likely the cause.

I would ask his permission to discuss this situation with his therapist. If that fails, you may want to send the therapist a note expressing your concerns. I would also suggest discussing the alcohol problem with him as well. It may be that his self-medication is part of his attempt to calm his hyperactive mood at night — allowing him to sleep.

SSRI-Induced Hypomania can create serious social, family, and work difficulties for your husband. This same type of behavior is probably being seen at work as well. I’ve seen folks lose their job for this reason.