Posted by Elizabeth on January 23, 2002, at 13:05:36
In reply to Re: problems getting buprenorphine, posted by BarbaraCat on January 22, 2002, at 20:59:47
> Actually, it was me who diagnosed myself as Bipolar II (for lack of anything else to call it, and my pdoc basically saying 'Gee, I dunno, might be, couldn't hurt to try.').
< g > I think a lot of BP II diagnoses are made for lack of anything else to call it.
> I've been cycling in and out of very severe depressions beginning in my early 20's and amping up to several episodes a year (I'm 50).
I can't imagine living that long with this. You must be very brave.
> I have mixed very melancholic vegetatives cycling to agitated, panic, bad, bad anxiety, insomnia, crying marathons, utter bleak despair.
Can I ask what you mean by "mixed very melancholic vegetatives?" (It sounds dreadful.)
> I've had classic hypomanic episodes (Oh God, I'd like some more of those, please) but most take the form of agitation, ruminative worry, fear, starting projects, never finishing.
Mixed hypomania, in other words?
> All this compounded by severe muscle pains that have been diagnosed as 'fibromyalgia' (and BTW, I had a Stephen King horror movie kind of childhood).
I had a pretty good childhood, in general, although there were traces of depression even then. (I was first seriously depressed when I was 11, but it wasn't diagnosed until I was 14.)
> I've been on all of the SSRI's and most of the 'novel' ones, buproprion, some TCAs, on and on.
How about mood stabilizers? You said you're on lithium now (only 200 mg, though -- have you had your serum level checked?); how's that going? Have you tried any of the anticonvulsant mood stabilizers? (They're supposed to be better for mixed, atypical bipolar disorders, although of course each case is unique.)
> I wonder about the Bipolar II accuracy and if it's not just jumping on another bandwagon that provides new drug regimens, new hopes, but my symptoms have not been helped by the standard severe depression Rx.
For people who get worse on ADs, it's worth considering the possibility and trying anticonvulsants or lithium, I think. I don't generally get worse on ADs. (Nardil was an exception: I tried taking it twice, and both times it worked for perhaps 6-9 months, then I lapsed into a "mixed" state similar to your mixed hypomanias, and nothing helped.) Most ADs just don't do much for me. Effexor, desipramine (the only TCA I've been able to tolerate -- my serum level was high, and even after I decreased the dose I had what appears to have been a seizure), and Parnate have been the ones that have worked to some degree (without making things worse). I had blood pressure problems that prevented me from getting past 60 mg/day of Parnate (taking too much in a single dose made my blood pressure shoot up). I'm hoping that Effexor -- as high a dose as necessary, with Remeron to minimize side effects if there should be any -- will do the trick.
Opioids might be helpful for people with bipolar disorders (especially those with mixed states, IMO) who can't get stable on mood stabilizers or mood stabilizers + ADs. This is just speculation on my part, but opioids can help with the agitation of mania and the lethargy or anergia that often accompanies bipolar depressions. It's tricky to manage some bipolar disorders -- mood stabilizers may not help with depression, ADs may trigger cycling. Still, I think that mood stabilizers (or MS-AD combinations) are worth a try before you start resorting to opioids -- there's a good chance that you will find a mood stabilizer (or combination) that works for you, and opioids can have very difficult side effects. I don't think that buprenorphine is addictive, but my impression is that people with bipolar disorders are at increased risk for addictions.
> I also have many prolonged bouts of very happy, productive normalcy with delightful snippets of joy and wonder thrown in. So my awful times are not constant, but very randomly cyclical (isn't this the way malaria and other cyclical malaise type illnesses present?)
Many illnesses are, as you say, randomly cyclical (not just viral ones, and not all viral ones). Major depression often cycles randomly, with no apparent pattern or precursor to episodes. (My depression is "randomly cyclical," although in more recent years I've been recovering less fully between episodes. I think this is a risk of inadequately treated depression.)
best,
-elizabeth
poster:Elizabeth
thread:4588
URL: http://www.dr-bob.org/babble/20020116/msgs/91260.html