1st Circuit Court of Appeals Judge Resigns After Developing Hypomania on Lexapro: Bizarre Behavior
Paragraphs three through six read: "Following surgery, he found himself feeling depressed, a scenario experienced by some heart patients, he later learned. The depression was compounded by the death of a good friend, he said."
"Next, came a period of his taking an antidepressant, Lexapro, that he found helpful. But, he said, he stopped the medicine, on his own, too quickly."
"What happened next, he said, was later diagnosed as an episode of hypomania, an expression of bipolar disorder."
"During the episode that lasted approximately three months, Downing spent money wildly, alienated family, friends and employees and resigned from the judicial bench, about the time he was hospitalized and treated."
Paragraphs twenty -one and twenty-two read: " 'In his (Downing’s) case, he was irritable and also, maybe the word is ‘expansive’ in his affects, (showing) euphoria, elation and excitement,' Blanche said."
“ 'He had never had a history of this before,' Blanche said."
Paragraph twenty-four reads: "Blanche, though, describes the episode as a case of antidepressant-induced hypomania, attributing it to a second antidepressant that Downing was later prescribed by another physician."
Bob Downing, former 1st Circuit Court of Appeal judge, whose sudden resignation from the bench last summer was surrounded by confusion, can sort out the events on a kind of timeline.
First, there was his heart stent surgery in the spring of 2009.
Following surgery, he found himself feeling depressed, a scenario experienced by some heart patients, he later learned. The depression was compounded by the death of a good friend, he said.
Next, came a period of his taking an antidepressant, Lexapro, that he found helpful. But, he said, he stopped the medicine, on his own, too quickly.
What happened next, he said, was later diagnosed as an episode of hypomania, an expression of bipolar disorder.
During the episode that lasted approximately three months, Downing spent money wildly, alienated family, friends and employees and resigned from the judicial bench, about the time he was hospitalized and treated.
“It was a short period. It seemed like an eternity,” Downing, 61, said recently from an office at the law firm of Dué, Price, Guidry, Piedrahita and Andrews, where he’s working in an “of counsel” status.
In that capacity, Downing said that attorneys with the firm will work with him on cases he brings in, but he is not on salary at the firm. Downing handles personal injury cases.
Now being treated with medication for what was likely a one-time event and back to feeling like himself, Downing said he recently decided to speak out about his experience for several reasons.
“For people who have open heart surgery or stents, watch out for depression,” Downing said.
One in five people experience an episode of depression after having heart surgery, according to the website, http://www.psychcentral.com, an independent mental health and psychology network run by mental health professionals.
Downing also advises people taking antidepressants to stay in touch with their doctor.
And, he said, “If you start feeling really wonderful and start spending a lot of money, you need to see a counselor,” Downing said.
Hypomania is “a condition similar to mania but less severe,” according to MedicineNet.com, a physician-produced online health-care publishing company.
“The symptoms are similar, with elevated mood, increased activity, decreased need for sleep, grandiosity, racing thoughts and the like,” the company reports at its medical dictionary website, http://www.medterms.com.
“It is important to diagnose hypomania, because, as an expression of bipolar disorder, it can cycle into depression and carry an increased risk of suicide,” the site reports.
Bipolar disorder is marked by periods of elevated or irritable mood the mania alternating with depression, according to the National Institutes of Health.
The mood swings between mania and depression can be very abrupt, it reports.
“Whether it’s hypomania or mania is a matter of severity,” said local psychiatrist Dr. Robert Blanche, who is Downing’s physician.
“In general, it’s an elevated or an irritable mood that’s not normal for the person,” Blanche said.
“In his (Downing’s) case, he was irritable and also, maybe the word is ‘expansive’ in his affects, (showing) euphoria, elation and excitement,” Blanche said.
“He had never had a history of this before,” Blanche said.
Downing theorizes that his stopping his antidepressant too quickly, on his own, led to the episode.
Blanche, though, describes the episode as a case of antidepressant-induced hypomania, attributing it to a second antidepressant that Downing was later prescribed by another physician.
“Medications can commonly cause hypomania, and it’s not really understood why,” said Dr. Mark Townsend, a professor of psychiatry at the LSU Health Sciences Center in New Orleans.
Antidepressants can bring on hypomania, as can steroids, he said.
“There’s really not a diagnostic category for antidepressant-induced hypomania” in the current Diagnostic and Statistical Manual of Mental Disorders, Blanche said, but he predicted there will be one in the manual’s next edition.
Blanche said the only way to arrest the condition of hypomania is for the person to go into the hospital so that their medications can be adjusted.
During his own hospitalization, Downing was prescribed a mood stabilizer, Depakote, classified as an anti-seizure medicine and the medicine most commonly prescribed for mania by psychiatrists, Blanche said.
The medicine acts to bind up what can be described as “excitatory” chemicals in the brain, Blanche said.
Ultimately, though, that can result in a depletion of those chemicals and a person can slide into a depression, Blanche said.
“If (a patient) is on a mood stabilizer, you can introduce an antidepressant,” he said.
Downing said that his current antidepressant, Wellbutrin, is working well for him.
After living through a hypomanic episode, some patients choose to stay on the medicine, Blanche said.
“Some people will actually choose to stay on the medicine, just because they don’t want it to ever happen again,” he said.
Fortunately, the condition “is one of the most treatable conditions in psychiatry,” added Blanche, who serves as the psychiatrist at the East Baton Rouge Parish jail and is the medical director of an emergency psychiatric treatment center affiliated with the Earl K. Long Medical Center.
Downing’s experiences this summer seem to have had all the markings of manic episodes of bipolar disorder.
“Around the first of June 2010, I started feeling really good, started talking a lot more, making big plans,” Downing said.
Around that time, he went to speak at a law conference in Carmel, Calif.
“I went to Yosemite, it was beautiful. I would wake up at 3 o’clock, 4 o’clock, 5 o’clock (thinking) ‘You need to retire, buy some foreclosed properties, fix them up and make money to help people in India dig wells,” Downing said.
“I was making grandiose plans,” he said.
Usually frugal, he started spending money, too, he said.
Before the episode was over, he had run up debts of almost $100,000, buying such things as a 1971 Rolls Royce, three Harley-Davidson motorcycles and a 1952 police car, he said.
He also bought a $1,000 commercial pressure washer, a large lawn tractor and expensive new tools to help put a formerly homeless man into business, he said.
“He just wasn’t himself,” said his wife, Pam Downing.
The couple will have been married 30 years on March 29.
“When the person is in that condition, you really can’t reason with them,” Blanche said.
“The amazing thing about it is that it robs the person of their insight,” he said.
In contrast, people are “painfully aware” of the other aspect of bipolar disorder depression, Blanche said.
Physicians and employers may miss a condition like hypomania, said Townsend, because, like most people, “we like happy people, perky people.”
“There’s a little more-rapid thinking, (rapid) speech, a decreased need for sleep” in someone with mania, he said.
“When it becomes a condition is when it affects functioning,” Townsend said.
“It’s wonderful that the judge is willing to be an advocate for bipolar disorder” awareness, Townsend said, referring to Downing.
“It’s very common, and people with it can be very productive members of our society. It’s all around us,” he said.
Downing’s symptoms brought along misunderstandings among friends and family members and conflicting ideas on the cause and solution of the situation, he and family members said Downing said he refused to seek treatment.
Finally, at one point, his eldest daughter, Kathryne Hart, 27, after consulting with a physician, sought to have her father committed to a hospital. Hart’s efforts came after Downing threatened suicide if there was any more talk about his going to see a doctor.
“She was very brave,” Downing said.
But Downing wasn’t at home as expected when sheriff’s deputies arrived to bring him to the hospital.
Pam Downing, who supported Hart in the decision, had taken the couple’s son, Wes Downing, then 24, to visit a relative in Missouri and to get away from the stressful situation at that time. The Downings also have another daughter, Kiera Downing, 26.
Shortly afterward, a group of Downing’s friends brought Downing to see Blanche, who then admitted Downing into a psychiatric hospital, and Downing began the recovery process, Kathryne Hart said.
Hart said that the threat of her father taking his life was something she couldn’t ignore.
When she was in middle school, she said, two fellow students killed themselves within a week of each other.
“I couldn’t take that chance,” she said. “I was going to do anything to save him.”
The family said it took about a month after his hospitalization for Downing to begin seeming like himself again and to understand what had happened.
Downing said he has struggled with guilt over the debt he accrued during the manic episode.
He’s taken heart, he said, from something he read in the book “Words to Lift Your Spirit” by Dale Brown:
“When we do experience failure in our jobs or in our personal lives, we must not shackle ourselves with guilt, because it can lead to the silent suffocation of our spirit.”
Downing said that his speaking about his experience is a way to bring something positive from it.
“He’s 100 percent better,” Hart said. “He’s completely back to normal. He’s reconciled with all of us.”
“Something like this either tears a family apart or makes it stronger,” Pam Downing said.
For them, the experience has made the family stronger, she said, adding that they received a lot of support from the pastors of their church, First Presbyterian.
Downing, who receives a pension for his years of public service, served as a district judge for 15 years and as a 1st Circuit Court of Appeal judge for 10 years.
Over the years, he also worked in various volunteer programs for prison inmates, such as a Bible study and a program that prepared inmates for getting jobs when they were released.
He also previously served on the boards of Cenikor, a treatment community to help people end substance abuse, and the Baton Rouge Marine Institute, now AMIkids Baton Rouge.
Looking back on the events of last summer, he said, “Twenty-five years in public service and, then, at the end of my career, people are going, ‘What’s happening? Something’s wrong.’”
Looking ahead to the future, Downing said, “I’ve been a positive person most of my life. I can see light at the end of the tunnel.”
Bipolar disorder, classified as a mood disorder, affects about 5.7 million Americans or approximately 2.6 percent of the U.S. population.
The disorder, which affects men and women equally, involves periods of mania elevated or irritable mood alternating with periods of depression. There are two types. Bipolar disorder type I involves periods of major depression and was formerly called manic depression. Bipolar disorder type II involves hypomania, with symptoms that aren’t as extreme as the symptoms of mania.
In most people with bipolar disorder, there is no clear cause.
The following, though, may trigger a manic episode in people vulnerable to the illness:
Life changes such as childbirth.
Medication such as antidepressants and steroids.
Periods of sleeplessness.
Recreational drug use.
Symptoms of the manic phase can last from days to months and include:
Agitation or irritation.
Noticeably elevated mood.
Poor temper control.
Source: The National Institutes of Health
Capitol news bureau writer Michelle Millhollon contributed to this story.