Posted by Dinah on July 17, 2004, at 10:44:43
In reply to Re: Thanks all - Not finished yet... » Dinah, posted by SLS on July 17, 2004, at 6:41:29
Scott, I would never find your questions other than helpful, or mind answering them. I very much value your input.
> Going into REM sleep early is one of the hallmark features of endogenous depression. I don't think it is a valid symptom to use to make a differential diagnosis between depression and narcolepsy. If that's the only thing they see, they have done nothing more than to confirm the work that has been conducted in depression research since the 1960s.
Well, it's sort of a silly story, involving the (too my untrained eye) egos of different schools of medicine. I get what I call "involuntary naps" or "forgetting sleeps" when I'm upset - *only* when I'm upset. Sometimes just five or fifteen minutes, sometimes hours, but I *have* to take them. I do manage to get somewhere safe. My car (not driving), a stairwell, or all the way home. I happened to mention them to my migraine neurologist because one was averted by a tryptan, and she referred me to the sleep neurologist. Since I really respected her, I went. Based on that and the fact that when I'm really tired I hear background chatter as I fall to sleep (no words, just background stuff like in a restaurant) and the fact that I had sleep paralysis while on a short trial of Neurontin, and probably also an astonishing prevalence of sleep disorders on my mother's side of the family, he said that clinically I presented as narcolepsy, never mind that I didn't have any of the other symptoms. So he scheduled a sleep lab. My therapist and I think that it's just dissociation, sleep as an escape. But the neurologist said that therapists don't know anything about narcolepsy, and *all* of my dissociative symptoms were probably expressions of narcolepsy. So he had some ego involved, I think, in getting a certain result from the sleep study. That being said, I do have trouble with extreme daytime sleepiness sometimes, and I'm not really aware of being depressed.
>
> > Anyway, I hate to say it, but I'm mainly agreeing to take it because I'm curious,
>
> Do you really get hypomanic? I didn't know you were bipolar II. When was your last hypomanic episode? What are the things you experience that distinguish you as being bipolar?Officially, I'm cyclothymic. I'm happy with that diagnosis, although since I had three episodes of major depression, I've always wondered if I "fit". My hypomanic episodes are almost always, but not always, triggered by medication changes or sleep deprivation. They fall into the good sort of hypomania and the bad sort. In both I have a level of energy usually unknown to me, I get obsessed with something, I get by on 2-4 hours sleep without feeling sleepy. In the good sort, I also feel really intelligent - the me I used to be. My thoughts are clear, I can see and process several things at once, I notice things others have missed. I generally get some sort of obsessive "enthusiasm" where I spend a bit too much, but it's offset by the fact that I'm wonderfully productive, either at work or at home. The bad sorts are bad. I get hysterical over things that don't ordinarily bother me and constantly feel like *everything* is overstimulating and I want to rip my skin off. Not a pleasant situation. I take the occasional Risperdal (.25 mg) at these times. It certainly doesn't qualify as mania, but my family and friends can tell and I certainly can. Mild hypomania, I suppose.
> > The only psych meds I'm on are Depakote (125 mg)
>
> That is a worthless dosage for a bipolar if you ask me. I have an open mind, though.Well, sometimes I take 250 for migraine prophylaxis, but since it didn't do much to improve it, the doctor and I decided to stick with the 125 mg. I laughingly tell my psychiatrist that it's a placebo dose, but I *do* notice a difference when I'm off it, so I stay on it. He tells me that people process drugs differently, and it's not necessarily a placebo, but they *would* tell you that if they were giving you a placebo dose, wouldn't they. :)
It might have something to do with the fact that my liver enzymes have been elevated since the mid-nineties, when they first started testing me. They can't find anything wrong, but that would indicate a liver that wasn't functioning at top efficiency, wouldn't it?
>
> > and Klonopin (1 mg).
>
> What's that for?Ah, my beloved Klonopin. My first psych med, for anxiety and panic attacks. I've done a lot of CBT therapy work, but I still find the Klonopin helpful.
>
> > Although I'm reasonably certain my Glucophage has an adverse effect on my mood and generally makes me feel cr*ppy.
>
> Ouch. I didn't know Glucophage could do that. That stinks.
>
They don't tell you that side effect, but if you do research you can find it. And I did the research because it made *me* feel that way. My (tongue in cheek) guess is that it works by making you feel sort of crummy and not feel like eating. And punishing you horribly if you eat a fat rich meal. :)> > Now I have to decide whether or not to actually consider the CPAP machine. I think I'm too lazy to do the cleaning involved and I'll end up with Legionnaires disease or something.
>
> Since I've got you over here on the Med board...
>
> What is your diagnosis and why? There is so much I don't know about you.The sleep study revealed mild sleep apnea that is probably a major contributing factor in my nighttime panic attacks.
>
> What drugs are you taking and at what dosages?That was all of them. Depakote 125 mg. Klonopin 1 mg. Glucophage 500 mg. Lipitor 10 mg. Frova (tryptan) as needed for migraines. Risperdal .25 mg as needed (probably less than 20 times a year) for its tranquilizing effect.
My diagnoses are major depression, moderate, recurring, cyclothymia, OCD, probably some other anxiety disorder thrown in, and some serotonin related physical disorders - migraine and IBS, and diabetes :(. My therapist (who doesn't diagnose, so I don't have this diagnosis) would probably add dissociative disorder, not otherwise specified, but I tend to think of dissociation as a nifty coping skill and don't see it as a disorder.
>
> How are the drugs you are taking right now helping?Not bad. A fair compromise for effectiveness and side effects. I use therapy more than meds to control my symptoms.
>
> What are your residual symptoms? What are you experiencing right now that still needs to be treated?Hmmm.... My mood cycles are still a problem. I like the good hypomanias. But the meltdowns (sometimes, but not always, accompanied by bad hypomania) are probably my main problem. I get totally hysterical, unreasonable, nonfunctional, shaking crying etc. over some stressor that ordinarily wouldn't bother me. I'm not sure how much that's physical and how much it's a child's temper tantrum when I've had too many stressors. I handle the stressors ok, but then melt down? Or it's physical and related to the mood cycles. I'm not sure which. But it can last a week, or even longer, sometimes shorter - only a few days.
The lesser, but still important, remaining problem is my periods of low productivity. It's hard to stay awake. I'm apathetic. It's extremely difficult to motivate myself to do anything. My brain feels sluggish and stupid (and I *hate* feeling stupid). My family, neighbors, and bosses get angry because everything gets behind. It's not the crisis sort of thing that the meltdowns are, so I might not give this symptom as much weight. But if I lose my job and find it difficult to find another, I expect it'll move up the scale. Moodwise, I don't find it accompanied by any negative thoughts or negative feelings or distress.
That's probably far more than you wanted to know about my condition. :) But answering your questions was very helpful to me, because I tend not to look at the big picture. I tend to think however I'm feeling now is how I always felt. So I thank you, and think I'll print this post out as a reminder of what needs to be done. And check it with the perceptions of my family and friends as well. I'm pretty sure I'm remembering my husband's complaints correctly. (smile)
If I somehow managed not to answer any question, please let me know. And if you have any ideas I'd be happy to hear them. As I said, I have immense respect for your judgement.
I'm going to try the Provigil today so that if it has a negative effect, it won't mess up work too much. Thanks for the good luck wishes.
poster:Dinah
thread:366935
URL: http://www.dr-bob.org/babble/20040714/msgs/367112.html