Posted by Deneb on October 18, 2009, at 13:48:26
In reply to Re: What is the best med for lack of motivation? l » Deneb, posted by delna on October 18, 2009, at 2:46:58
> >Starting my last year of high school I was put on Zoloft, whereby I started having very intense mood swings
>
> Ok, this is exactly what happened to me. I had depression and anxiety and was put on Paxil by a GP and went 'high' for a few weeks. Then I slumped into apathy. The doc kept increasing my dose and I started swinging mood wise. (more about that later)I remember the mood swings were quite severe. I swung very high and very low. When I was high I thought the world was my oyster and that I could do anything. I had thoughts of changing the world. When I was low I was suicidal. There was also some weirdness going on because at some points I was very suicidal, but I was high at the same time.
I also remember awful horrible paranoia my last year of high school. I don't know what was up with that, but I thought all my teachers were talking about me behind my back and I remember I would hide from them when I saw one walking down the hallway. I don't know if it was just a bad case of social anxiety or what.
I tend to have these periods where I zone out and think I am not in reality. Sometimes I will hide or go mute. It is probably anxiety though.
> > I have mood regulation problems. I tend to get really excited and happy one minute and depressed and suicidal the next. It is probably my borderline personality.
>
> Ok this is the scary part. Exactly like me. I too was diagnosed with borderline personality disorder. I'm not trying to diagnose you but I can tell you that eventually it turned out that I had bipolar disorder. Your depressions fit the atypical variety (seen in bipolar) and the fact that you swing makes me suspicious.I attribute my mood swings to the borderline personality. My swings seem dependent on situations most of the time. My mood swings have gotten a lot better now. I think the Risperdal helped me the most. But also my pdoc says I've made a lot of progress in therapy. I don't know whether it was mostly the therapy or the meds. I think one reason why I think my illness is not bipolar disorder is because I don't stay up for days without needing sleep. I've had periods where I don't feel like sleeping for a day and a half, but I always get tired eventually and need to sleep.
> It took some years and a clever pdoc to look at my past and find that I did infact have a history of spontaneous hypomanias and mixed episodes plus all the other indicators of bipolar. Many bipolars are originally misdiagnosed as either depressed or as having BPD. Just to clarify I am not saying that you are actually bipolar- its just that I was, and my clinical picture looked more like yours but eventually the bipolar came out in a big way.
I hope I am not bipolar, as it means I will probably need to be on meds for life. I know my pdoc doesn't think I am bipolar and she has seen me for years. I will keep that possibility in the back of my mind though. Maybe I need a second opinion.
> IMHO I think you need an expert diagnosis. It took years for my diagnosis to change from borderline to depression and anxiety to bipolar II rapid cycling and finally to the dreaded bipolar I rapid cycling.
I think it would be a good idea for me to have a second opinion. I will start about seeing someone else.
>
> I had a therapist too and she told me I was not bipolar (there was no such thing) and I was happy to believe her because it meant no harsh drugs. But actually she ruined things for me because it just delayed my treatment and now I am a pretty resistant case.Sorry to hear that. Does delay in treatment cause treatment resistance?
>
> But from what I see you are already on some 'hardcore' drugs like antipsychotics which personally I only agreed to take when I was confirmed to be bipolar I because I was so terrified of them. A full diagnosis will really help because then you can be treated properly...My pdoc actually did not start the Risperdal. When she was on maternity leave, I saw another pdoc and he started me on Risperdal after I inquired about an antipsychotic to add to the mix.
>
> Sorry if I am confusing your already complex situation but I had to share this because our stories are too similar. It's only at 33 that I got a really thorough diagnosis and it turned out to be bipolar I, even though I spend nearly all my time in the depressive phase (which is common in BP)Sorry to hear of your diagnosis, but it is good you got the right diagnosis finally. Do you have a better time functioning now with the new meds?
>
> Again I am not trying to diagnose you... I just
> think an expert pdoc needs to review your history.
>
>
> >I often wonder if it is necessary to take two SSRI's at the same time. It seems like SSRI overkill to me.
>
> I have never in my life heard of such a treatment rationale. Infact 2 at once is not safe. SSRI's definitely promote apathy- they are infamous for it! You usually augment the first SSRI with Wellbutrin or Provigil or another agent. I know alot of people are taking nortryptiline with success but personally (with no disrespect to others) I would not take it. Firstly if you are indeed bipolar it might make you swing madly as TCAs are infamous for that. But ofcourse if you are not, it can work wonders!Looks like I will need to do some experimenting on myself. I just hope that it doesn't disrupt my life too much.
>
> Now I am on a mood stabilizer (lamictal), provigil and have just started a MAOI (since the SSRI just didn't work and I crashed into depression despite it.)
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> I was torn between Parnate (MAOI which is supposed to be the last word in atypical depression) and Effexor (SNRI, which helped in the past with mood, motivation, anxiety, OCD etc)but chose parnate in the end. The reason being that effexor has a very difficult and long withdrawal period and if it didn't work well I could not switch to Parnate for ages . But SNRI's DO tend to work (at high enough doses) much better than SSRI's- especially for those with motivation problems.I read about the awful Effexor withdrawals and I would be hesitant to try it out for that reason too.
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> parnate is not scaring me at all in terms of food interactions and drug interactions (you just have to be extra careful) but then I have only been on it for 15 days....For me the only side effect that sucks is sedation but I believe that gets better in time and at the right dose. Haven't seen much benefit yet..I eat a lot of weird foods so I am not sure at all that I should try an MAOI. It would mean my Mom has to know I am on a med with serious side effects and she would definitely not like that. She already tells me to cold turkey the meds I am on. She told me to bear through the withdrawal symptoms because meds are bad for you. She likened my meds to narcotics.
>
> Incidentally, what REALLY helped my mood, motivation whilst keeping me stable was low dose Geodon. It was miraculous! Like waking up from a coma. But sadly, I had to give it up (after 2 years) because i had a bizarre reaction to it.
> My pdoc (a psychopharmacologist in NYC) said Abilify was the next best thing (especially if you are sensitive to sedation)But I didn't try it because of fears of TD (which I think I had on Geodon- not sure)Does Abilify have a high incidence of TD? I am looking to maybe try Abilify too. My pdoc doesn't seem to like to change my meds though (I've been on the same meds for years) so I am not sure how she would react to the thought of a new combo. I find what really helped me a lot is the Risperdal. I have a lot fewer severe mood swings now. When I reduce my dose of Risperdal or forget to take it I often start acting up.
>
> Well I hope I haven't rambled on too much and caused confusion......Please forgive me if I have. Your story just hit home for me.Oh no, not at all. Thanks for sharing your story. It was very helpful to me. I need to look at all the possibilities and if I have been misdiagnosed, then it is crucial for me to find my right diagnosis.
poster:Deneb
thread:921259
URL: http://www.dr-bob.org/babble/20091012/msgs/921411.html