Posted by Ron Hill on June 4, 2003, at 1:44:56
In reply to Re: Would this be considered hypomania? » Ron Hill, posted by katia on June 2, 2003, at 12:44:11
Katia,
Thanks for your detailed post. I love your energy, enthusiasm, and passion. Sorry that I wasted your time and ten bucks on the screening test. Just out of curiosity, what dx did the screening test suggest for you?
Bear in mind that I'm not a pdoc, however, may I say that everything you wrote in your post cries out BIPOLAR. Who wrote the script for the Serzone; a pdoc or a GP? What dx did he or she give you?
If you are bipolar II, and I strongly feel that you are, then the first course of action is to get a first-line mood stabilizer on board. Serzone mono-therapy will do more harm than good in the long-run if you are bipolar. It's too bad that your doctor put you on Serzone without having a moodstabilizer fully in place first. At his point, it appears that it would be difficult for you to completely discontinue the Serzone.
Here is what I would do if I were you. First of all, find a good pdoc that is well qualified in the area of bipolar disorder. While working with your new doctor, start taking a low or moderate dosage of a first-line moodstabilizer (probably either a slow release lithium product or Depakote). It's mostly trial-and-error to find a mood stabilizer that is best suited to you as a unique individual (genetically speaking).
The moodstabilizer will level out your moods, control your hypomania, and in some cases, alleviate the depression. However, the more typical case is that the bipolar patient needs something in addition to the moodstabilizer to satisfactorily treat the depressive side of the disorder.
And this is where the controversy comes in; should an AD add-on be taken by a bipolar patient? Please read the link in my prior post regarding the AD controversy. Some bipolar patients do well with a small dose of an AD added to their moodstabilizer, others do not (I fall into the latter category). Further, some bipolar folks can’t tolerate an SSRI or TCA add-on but do well using an MAOI added on to their moodstabilizer. Therefore, one school of thought would advocate gradual discontinuation of your Serzone as soon as your moodstabilizer is ramped up. Another camp would say to keep the Serzone (or some other AD) on board as an add-on to treat the depressive side of the disorder.
I’ll try not to bore you with my life story, but let me tell you a little because it illustrates the risks associated with a bipolar patient taking ADs without a moodstabilizer. In 1996, I was enjoying my well established career as an engineer but I was having trouble staying focused on my work (even more than usual) after a heart wrenching break-up with an ex-girlfriend. So I went to a pdoc to discuss my distractibility. The pdoc misdiagnosised me as ADHD and sent me home with a script for Ritalin.
For the first few weeks the Ritalin was phenomenal! Almost euphoric. And I could focus like never in the past. However, after about ten weeks, I started having wide mood swings with severe irritability. I went back to the pdoc and told him that it’s (i.e.; Ritalin) been real and it’s been fun, but I need to discontinue the Ritalin due to the mood swings. Instead he talked me into adding Paxil to treat the symptoms brought on by the Ritalin.
To make a long story short, the pstim, and especially the SSRI, pushed me into a full blown mania, I lost my job, and generally speaking, I acted really weird. However, my pdoc must not have caught on ‘cause he just kept writing scripts for Ritalin and SSRIs. After a couple years of trying to “chase a dose” using a variety of SSRIs added to Ritalin, everything pooped-out and I fell into a black hole depression that I could not pull myself out of. Now I had no job and no hope.
Once a person gets their brain chemistry that screwed up, it’s VERY difficult to get it squared away. I’ve told you my tale of woes only to say this: The wrong medicine can end up being much worse than no medicine. However, the other side of that same coin is that the correct medicine can make life much richer, fuller, and more productive.
The good news to my story is that, in 1999, I got hooked up with a good pdoc, he made the correct dx, and he put me on Lithobid (slow-release lithium). The lithium controls my hypomania very well but it does little or nothing for my depressive side. Therefore, we tried one AD add-on after another, but they all failed. A couple years ago, I gave up on ADs and I began to investigate the use of nutritional supplements to treat my atypical depression (anhedonia, anergy, low motivation, hypersomia, apathy, negative self-talk, etc).
As it stands today, I’m doing exceptionally well (thanks in no small part to the information given to me by posters to this board). I feel confident that my current cocktail is going to last long-term, but I have learned over the years that there are no guarantees with any of this stuff.
In case you are wondering, I currently take 600 mg/day of Lithobid for my hypomania, 2.5 mg once or twice a week of Enada NADH in conjunction with 250 mg/day of TMG (both are supplements) for my depression, and 250 mg/day of niacin (vitamin B3) to control my dysphoric mood states (irritability to the tenth power).
In addition to doing a great job on my irritability, niacin has antidepressant qualities. I’m told that niacinamide (another form of vitamin B3) is even better than niacin for irritability. Therefore, I may conduct a trial of niacinamide (either with or without niacin).
Look, I’ve probably given you more information than you wanted. The take home message is: If you are bipolar, then Serzone mono-therapy might not be in your best interest.
Best wishes. If I can help, let me know.
-- Ron
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> thanks for taking so much time to reply. I actually did pay that $10 and found it worthless. The test is so general and groups questions together for a yes/no or in between answer, when sometimes it's talking about three different things, but want one answer to it. I found it to be not at all worth the time or money.
> the other one I've done on the psycheducation website, but it was the same one only for free; but there's nothing like asking real people for feedback esp. regarding mental stuff that affects behaviour stuff. I'm just trying to get at as many sources as possible to figure this out.
>
> While the Serzone seems to be working now - I'm only on 50mg; it was a rough start. I did the whole starter pack and was up to like 400mg a day during the last of the third week. Those three weeks, I definitely got hypomanic. I was getting scared so I stopped it and then within those five or so days, I felt like I was losing my mind. I'd cry and cry and just crash with no logic to it. I felt at times it was the end of the earth and I wanted to rip my skin off. So I'm milking the last of what I have with 50mg a day now for about 11 days. I don't feel depressed; just moody. Like I don't wake up with dread and fear, but feeling like I want to start the day. I'm not sleeping quite as well; but good enough I suppose. Maybe 7 hours a night. It takes me awhile to settle down. Sometimes it does feel like there is a tornado (a small one) in my head.
>
> So I feel like, yes the Serzone is definitely triggering some hypomania; but maybe that's settling down now and that was just a side effect at first and I went too high too quickly.?
> But my other concern is, I consider that I've been depressed most of my life; but I've had periods of a lot of energy; irritability, raciness, "manicness". it's gotten me to many different countries, a many intense "affairs"; cycled through jobs. I've been called "passionate, intense, high maintanence, moody, wild, crazy,etc." and normally most boyfriends (from those intense affairs) have told me that they've never experienced such intensity of feeling before with me (like the roller coaster ride alternating b/t high and low). And most of these relationships lasted a short time and ended dramatically and traumatically. I've been called a "drama queen" way more times than I'd like. And I feel like saying, "no I'm not! I just want peace and solitude, I can't help being this way - it's not what I want!". I'm guessing in retrospect that maybe that was some what fueled by bipolar? I've been far too wild and high strung and then depressed and withdrawn and mainly a mix of the two; depression being a clear cut one on it's own at times. Normally when I feel this high strungness, drinking is involved to "tame" it and then it exacerbates it and I make poor decisions and do things I wouldn't do if my judgment was better. I could write a book about the situations I've been in and many people have told me so. I feel the depression stronger at times (really bad at times) has been underlying all of this.
>
> So there's my story. Any input?
> thanks.
> Katia
>
poster:Ron Hill
thread:102831
URL: http://www.dr-bob.org/babble/20030530/msgs/231283.html