![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 63. This is the beginning of the thread.
Posted by Mr.Scott on December 30, 2004, at 3:16:02
Am I a blind fool for not being able to tell which one of these I have?I would have to say I have a chronic depressive/chronic anxiety condition with occassional Major Depressions. I also have lots of anger issues. My father is a lifelong dysthmic. My doc however says I have bipolar 2. Mood stabilizers offer me no noticeable benefit that I can see. When I take antidepressants I can experience an initial hypomania. But since the ssri's help me so much with my anxiety, I can't tell if they actually worsen my depression by increasing my cycling or if I just am totally upset that they work for my anxiety except that they cause me a number of very unpleasant side effects. I can basically be talked into having any depressive/anxiety/bipolar disorder at this point.
The reason I posed my initial question is because I am stuck between whether or not I should pursue antidepressants or anticonvulsants.
A part of me wants to say to hell with it all and go back to using alcohol and drugs even if it kills me!
Scott
Posted by SLS on December 30, 2004, at 4:31:06
In reply to Dysthymia versus Bipolar type 2, posted by Mr.Scott on December 30, 2004, at 3:16:02
Hi Scott.
It sounds to me as if you might have "double-depression", wherin major depressive episodes are superimposed upon a chronic dysthymia. Both aspects of this mixed condition are capable of producing irritability as a symptom. Dysthymia tends to be stubborn to treatment. You might want to look into trying amisulpride or perhaps even Abilify. If you use Abilify, be prepared to experience some anxiety or irritability initially.
I don't think you have bipolar disorder. You really have to express a hypomanic episode to be eligible for this diagnosis. Episodes can last for as few as 5 days, though. Doctors seem to be quite fond of this diagnosis lately.
- Scott
Posted by King Vultan on December 30, 2004, at 8:33:21
In reply to Dysthymia versus Bipolar type 2, posted by Mr.Scott on December 30, 2004, at 3:16:02
>
> Am I a blind fool for not being able to tell which one of these I have?
>
> I would have to say I have a chronic depressive/chronic anxiety condition with occassional Major Depressions. I also have lots of anger issues. My father is a lifelong dysthmic. My doc however says I have bipolar 2. Mood stabilizers offer me no noticeable benefit that I can see. When I take antidepressants I can experience an initial hypomania. But since the ssri's help me so much with my anxiety, I can't tell if they actually worsen my depression by increasing my cycling or if I just am totally upset that they work for my anxiety except that they cause me a number of very unpleasant side effects. I can basically be talked into having any depressive/anxiety/bipolar disorder at this point.
>
> The reason I posed my initial question is because I am stuck between whether or not I should pursue antidepressants or anticonvulsants.
>
> A part of me wants to say to hell with it all and go back to using alcohol and drugs even if it kills me!
>
> ScottExcessive anger can be a bipolar trait, but I've known lots of people with bad tempers who weren't bipolar. The same is true of heavy drinkers, but I've known hardly any real drug users, apart from those who use marijuana, who I think are so common that they hardly qualify. I've also experienced an extreme lift when first starting on an SSRI-type drug, but only for a few days, and not in many years now. Since I've only had a handful of days in the last twenty years that I could describe as "great", it would seem that I have no real tendency towards hypomania. Those few great days I've had probably wouldn't even qualify for hypomania, but it's been so long that I've long since forgotten what they even felt like. Things are steadily improving for me, however.
I'm no expert and no psychiatrist, but it does seem to me that the BPII diagnosis may be being overused, and that some people get stuck on bipolar-type drugs that aren't necessarily that helpful. If it were me, I would try to look at the criteria for a hypomanic episode and objectively try to determine if I qualify. Also, I'm wondering what are some of the adverse effects you've noticed on SSRIs?
Todd
Posted by barbaracat on December 30, 2004, at 14:05:14
In reply to Dysthymia versus Bipolar type 2, posted by Mr.Scott on December 30, 2004, at 3:16:02
What are your Major Depressions like? My experience is that there are two noticeable types of depressions that I experience as a BP-II (and I'm 99% sure I am BP-II if not even I). One type of depression is the classic couch potato can't give a rip everything sucks and so do I want to sleep and forget this sh*tty life and everyone hates me anyway and I'm sad and numb and dumb.
The other is a very agitated wailing bleak dark despair. Like an existential angst run through the frightening filters of Edgar Allen Poe. Can't sleep, fret, panic attacks, ultra sensitive, some tinges of visual and auditory psychoses. It's horrible, awful. I'll take the first kind any day. This second kind is Bipolar mixed-states and is definitely different than garden variety dysphoria, depression or hypomania. It's hypomania and depression at the same time. Pressured intense depression.
If you have the first kind, you may be BP-II since lethargic depression is the typical BP depression. But BP has to have some component of a pressured mania, whether hypo or not. If you have irritability, anxiety, distraction and disorganization of the ADD variety and/or pressured thoughts and speech, flights of ideas, starting multiple projects that 'seem like a good idea at the time' and then never finishing, being attracted to liquor cause it relieves the bad feelings quicker than anything, then that is hypomania. Hypomania is NOT always fun. It can manifest as good old ANGER and feeling like constantly wanting to throw something.
If you have the second type of depression, along with hypomanic symptoms, you are probably definitely Bipolar, and if it's I or II is not clear to me. But with mixed-states depression, there is no doubt that you're dealing with a different animal alltogether - and I'm still not sure what it is except lithium helps it.
Lines blur with 'mere' agitated dysphoria and BP disorder and I think the succesful treatment determines what the dx is. I think I can distil hypomania into the word 'pressured'. You can feel anxiety, productivity, pleasure, anger, irritability and all that, but feeling them in the presence of pressure is a good sign of hypomania. Mania, of course, is another thing but you'd have no question as to your dx if you had manic episodes. At any rate, I'm just about 'cured' since taking lithium and St. John's Wort. If you want to read my account of how ST. John's made a huge difference in my life where no other AD worked, go to:
http://www.dr-bob.org/babble/alter/20041212/msgs/435452.html>;
Good luck, my friend. I know how frustrating it is. - BarbaraCat
> Am I a blind fool for not being able to tell which one of these I have?
>
> I would have to say I have a chronic depressive/chronic anxiety condition with occassional Major Depressions. I also have lots of anger issues. My father is a lifelong dysthmic. My doc however says I have bipolar 2. Mood stabilizers offer me no noticeable benefit that I can see. When I take antidepressants I can experience an initial hypomania. But since the ssri's help me so much with my anxiety, I can't tell if they actually worsen my depression by increasing my cycling or if I just am totally upset that they work for my anxiety except that they cause me a number of very unpleasant side effects. I can basically be talked into having any depressive/anxiety/bipolar disorder at this point.
>
> The reason I posed my initial question is because I am stuck between whether or not I should pursue antidepressants or anticonvulsants.
>
> A part of me wants to say to hell with it all and go back to using alcohol and drugs even if it kills me!
>
> Scott
Posted by Mr.Scott on December 31, 2004, at 1:24:49
In reply to Re: Dysthymia versus Bipolar type 2 » Mr.Scott, posted by barbaracat on December 30, 2004, at 14:05:14
WOW! I really want to thank you for sharing that with me. I know it probably took more than a minute to write.
In general I have the first type of depression and I have it almost always. Then If I add an antidepressant I get brief hypomanias 'or' more likely the second kind of depression you noted except that I've never in my life gone without sleep or have had any tinge of psychoses. My natural sleep cycle has me going to bed at 3am and waking at noon. Obviously that doesn't work well so I wake every day feeling like death until coffee number four. I definately have an increasing sense of urgency as the antidepressant goes up.
Thanks,
Scott
Posted by Mr.Scott on December 31, 2004, at 1:34:51
In reply to Re: Dysthymia versus Bipolar type 2, posted by King Vultan on December 30, 2004, at 8:33:21
Hi Todd,
Thanks for your response. I meet the criteria for hypomanic once in a blue moon, but ALWAYS induced temporarily by antidepressants or stimulants. NEVER have I experienced it in the absence of a chemical with the potential to cause it. Other side effects I get from SSRI's include muscle stiffness and aches, constipation, mild facial swelling, weight gain (I weighed 190 on 100mg of Zoloft, and now weigh 155 on 25mg), Severe cholesterol increase (more than doubling from Zoloft!), agitation & general tension, increased sense of restlessness. I attribute these to ExtraPyramidal Symptoms on top of a depression which essentially makes the condition worse. My doc disagrees and says it's activation of bipolar disorder. The fact that the symptoms include muscle aches & stiffness have always led me to believe it was dopamine related and EPS and not manic activation. Also mood stabilizers alone have only allowed me to sink into hellish depressions!
Scott
Posted by ed_uk on December 31, 2004, at 7:23:41
In reply to Re: Dysthymia versus Bipolar type 2 » King Vultan, posted by Mr.Scott on December 31, 2004, at 1:34:51
Hi Scott,
Have you ever tried any anti-depressants which don't cause EPS eg. desipramine or nortriptyline. How do you do on these drugs?
Regards,
Ed.
Posted by Mr.Scott on December 31, 2004, at 14:11:33
In reply to Re: Extrapyramidal Symptoms » Mr.Scott, posted by ed_uk on December 31, 2004, at 7:23:41
Good point!I immediately experienced anxiety, agitation, and the last time I took 25mg of imipramine (last year). I'm not sure if it goes away or if the initial hell burns out into a rapid cycling. However this last time I took 25mg of Imipramine my depression worsened into such an agitated hell I decided to drink again to get some relief and that inevitably led to a major cocaine relapse and a host of other'inappropriate and dangerous behaviors' I couldn't even think of doing right now. After that binge weekend I took large doses of Lithium, depakote, and trileptal just to get over the coke effects, withdrawal and general agitation. When I returned to work on Monday, everyone said I seemed to be in a much better mood. Was it the coke or the mood stabilizers? I don't know, but I guess it sounds bipolarish... It's just not entirely clearcut like most bipolars I know or read about.
Scott
Posted by Mr.Scott on December 31, 2004, at 14:19:11
In reply to Re: Dysthymia versus Bipolar type 2 » Mr.Scott, posted by SLS on December 30, 2004, at 4:31:06
Hi SLS,
I missed your post until just now. Thank you for stopping to post. I think you are right about something being superimposed on dysthymia. My antidepressant response makes it unclear to me however whether it's depression or bpII. Hopefully, I can be helped. This has been killing me now for 15 years. And in the last 5 it has become less and less clear that it's just depression on top of depression. I'll mention these atypicals to my doc.
Scott
Posted by ed_uk on December 31, 2004, at 14:42:02
In reply to Re: Extrapyramidal Symptoms » ed_uk, posted by Mr.Scott on December 31, 2004, at 14:11:33
Hello,
Have you ever tried Remeron or Trazodone?
Ed.
Posted by barbaracat on December 31, 2004, at 18:07:52
In reply to Re: Dysthymia versus Bipolar type 2 » barbaracat, posted by Mr.Scott on December 31, 2004, at 1:24:49
Have you considered that you're Bipolar IV? Hypomanic symptoms brought on by ADs? Sounds like you might be to me and the treatment is a bit different. Here's a thorough website about the different subtypes of BP. It really doesn't sound to me like you're in the BP-II pocket at all.
http://www.psycom.net/depression.central.lieber.html
Also, Wellbutrin has been used successfully in alot of cases of BPIV or in med resistant BP in general. It was too stimulating for me, a classic BP-II, however. I'm doing really well on lithium, SJT and fish oil.
If only I could stay away from alcohol. I'm drawn like a moth to a flame in that regard, especially with it being everywhere over the holidays. I overindulged last night and feel like ka-ka this morning. A good lesson.
Oh yes, I can't speak for your experience, but Remeron was awful stuff for me. It worked fine for a few months, pooped, and I had to keep ratcheting it up. In the meantime, it's a notorious porky med. I found myself getting up 3am and haunting the freezer for Dove bars, anything sweet. I never do that. Put on 30 pounds. I do not recommend Remeron. It doesn't sound to be like you need Serotonin and excess Serotonin may be one of your problems. It would be interesting giving Wellbutrin with it's Dopamine kick a try.
Posted by Ritch on December 31, 2004, at 18:24:45
In reply to Re: Extrapyramidal Symptoms » ed_uk, posted by Mr.Scott on December 31, 2004, at 14:11:33
>
> Good point!
>
> I immediately experienced anxiety, agitation, and the last time I took 25mg of imipramine (last year). I'm not sure if it goes away or if the initial hell burns out into a rapid cycling. However this last time I took 25mg of Imipramine my depression worsened into such an agitated hell I decided to drink again to get some relief and that inevitably led to a major cocaine relapse and a host of other'inappropriate and dangerous behaviors' I couldn't even think of doing right now. After that binge weekend I took large doses of Lithium, depakote, and trileptal just to get over the coke effects, withdrawal and general agitation. When I returned to work on Monday, everyone said I seemed to be in a much better mood. Was it the coke or the mood stabilizers? I don't know, but I guess it sounds bipolarish... It's just not entirely clearcut like most bipolars I know or read about.
>
> Scott
Scott, those symptoms are very much like mine. I think there is a big difference between BPI episodes and this chronic BP-IIish stuff.. I know the "spectrum" thing is big deal now, but they just seem like two very different illnesses altogether. I've known some BP-I's and they just don't have the same symptoms I have. I've seen them really high and I can relate to that racing consciousness, but it just comes out of the blue and goes ON and ON, then they seem OK for months at a time. Definitely a different expression.
Posted by barbaracat on December 31, 2004, at 20:45:14
In reply to Re: Extrapyramidal Symptoms » Mr.Scott, posted by Ritch on December 31, 2004, at 18:24:45
HI Rich,
You brought up a point I've been wondering about for awhile. I've got a dx of BP-II but suspect I may be BP-I. I do horribly on SSRIs like a good little BP-II, but don't BP-I's as well? Some of my manic episodes have been corkers, complete with the singing of angelic hosts, and other not so nice hallucinations. My depressions, the mixed-state kind, are horrendous, simply ghastly, and I've heard somewhere that these mixed states are the province mainly of BP-I. Yes, I do have nice little hypomanias which are tons of fun, and these are the majority - but oh boy, those other ones. There's nothing 'hypo' about those others and no doubt something quite spectacular is occurring.I also used to have longish periods of normalcy in between when I was younger, but once I hit menopause, everything intensified and mixed states depression became my constant companion. I was on SSRI's of all various forms and potencies cause nothing was helping and no one knew that I was bipolar. I can't imagine we missed it since I'd had so many episodes that now are pretty unmistakable, however, mixed states depression was not yet in the common lexicon, so it was treated as major depressive disorder with SSRIs - bad bad idea.
I'd like your thoughts on the differences you've noticed with your BP-I acquaintences vs. BP-II (that's you, right?). I don't know anyone personally in my boat at all and it would help. The main reason this interests me is the fact that I've had a miraculous response to lithium and it seems like this is typical of BP-I's. Other supposed BP-II's I know are still struggling with finding a good mood stabilizer and lithium has not helped very many BP-II's, or those with cyclothymia. So maybe there's something else going on with BP-I, not just a matter of degree of symptoms, but a matter of different chemistry and response to treatment. - Barbara
> Scott, those symptoms are very much like mine. I think there is a big difference between BPI episodes and this chronic BP-IIish stuff.. I know the "spectrum" thing is big deal now, but they just seem like two very different illnesses altogether. I've known some BP-I's and they just don't have the same symptoms I have. I've seen them really high and I can relate to that racing consciousness, but it just comes out of the blue and goes ON and ON, then they seem OK for months at a time. Definitely a different expression.
>
Posted by barbaracat on December 31, 2004, at 20:53:36
In reply to Dysthymia versus Bipolar type 2, posted by Mr.Scott on December 30, 2004, at 3:16:02
Have you looked into pyroluria? There's a lot of stuff on it in the Alternative board and it may be worth looking into. It's a metabolic disorder that essentially strips off the nutritional cofactors that make neurotransmitters. Some of your symptoms sound like it.
The Pfeiffer Institute has done alot of work with different metabolic factors into mood disorders. They've found that around 30%of bipolars, ADD and Schizophrenics have this condition and it's one that confounds most diagnosis or treatment. You might just go over to Altnative or do a Google search, or if you want you can get back to me, we can move over to Alternative and I can point you to some resources. One question: how to you tan? Do you burn? in red and white blotches? Have white spots on your fingernails?
Feel internal pressure?
Posted by Mr.Scott on January 1, 2005, at 4:45:30
In reply to Re: Extrapyramidal Symptoms » Mr.Scott, posted by ed_uk on December 31, 2004, at 14:42:02
Hi,
I remember trying Remeron and feeling sedated and ravenous yet also possibly anxious. It's been a while so I forget. Trazodone is a fairly unexplored med for me. I only remember it being sedating at around 50mg for insomnia.
Scott
Posted by Mr.Scott on January 1, 2005, at 4:59:15
In reply to Re: Extrapyramidal Symptoms » Ritch, posted by barbaracat on December 31, 2004, at 20:45:14
Thinking about what you said to Ritch...and how there was a change in your experience of the illness. Just kind of thinking out loud here in this post.
I may be wrong, but I suspect that overusing antidepressants might have changed something in me. My inability to tolerate meds that I once could and that once helped, and an increased sensation of being 'out of it' and agitated all at once only happened in the last few years. I never actually did okay on antidepressants except until SSRI's when they first came out, nardil later. But now I am so cynical about them I don't know if I could 'let them' work. My experience of SSRI's 'working' also sent me boldy into major substance abuse. So maybe I was hypomanic. So confusing...to not really know what normal really is. Since the age of 17 it's never been very consistent and it's always been painful.
One thing I am sure of is that I was depressed and unable to stop using cocaine on Prozac at one point, and that the addition of Wellbutrin to help with cravings caused my to rapid cycle into a dysphoric hypomania in which I attempted suicide (circa 1996). That was the one time I was truly OUT OF CONTROL!
Scott
Posted by Mr.Scott on January 1, 2005, at 5:02:13
In reply to Re: Dysthymia versus Bipolar type 2 » Mr.Scott, posted by barbaracat on December 31, 2004, at 20:53:36
Hi Barbaracat,I'll do a search right now! I have had the white spots all my life, although they seem less now then when I was younger. Tell me where to go and I'll follow! What sort of internal pressure?
Scott
Posted by Ritch on January 1, 2005, at 10:13:42
In reply to Re: Extrapyramidal Symptoms » Ritch, posted by barbaracat on December 31, 2004, at 20:45:14
>...I'd like your thoughts on the differences you've noticed with your BP-I acquaintences vs. BP-II (that's you, right?). I don't know anyone personally in my boat at all and it would help. The main reason this interests me is the fact that I've had a miraculous response to lithium and it seems like this is typical of BP-I's. Other supposed BP-II's I know are still struggling with finding a good mood stabilizer and lithium has not helped very many BP-II's, or those with cyclothymia. So maybe there's something else going on with BP-I, not just a matter of degree of symptoms, but a matter of different chemistry and response to treatment. - Barbara
I think the main difference that I've personally seen is the striking difference in *chronicity* of symptoms. "BP-II" people seem to have more chronic dysthymic symptoms and seem to rapid-cycle and also have a lot more comorbid anxiety problems that are sometimes tough to weed out from the bipolar symptoms. In my case, I wouldn't be surprised if the correct dx term would be something like "Multimodal Affective Disorder" or "Bipolaroid Anxiety Disorder" :) The folks that I've known that are BP-I's can have so many months of "euthymic" clear-headed functioning it just boggles my mind. I don't think I go more than a few days in a row at most where I feel "normal". .... As far as treatment goes I found lithium useful in the past for the years that I took it, it just seems that anticonvulsants work *better* for me. They say that Li doesn't help rapid-cyclers as much, and I would have to agree with that somewhat. .. As far as BPII going to BPI with time.. there have been hypomanic episodes in the past where it seemed that all I would have to do is stop meds and it turn into something fullblown, but it seems that anxiety is a limiting factor to that.. My symptoms tend to flux or morph from hypomania into hostility then into PANIC, and when things start getting mixed and agitated I can't stand it and I treat it aggressively to get a lid on it. The BPI people I've known just get this pure EUPHORIC nonstop racing derailment that just goes and goes and they feel great. Not so with me.
Posted by King Vultan on January 1, 2005, at 11:57:51
In reply to Re: Dysthymia versus Bipolar type 2 » King Vultan, posted by Mr.Scott on December 31, 2004, at 1:34:51
I guess my suggestion would be to consider an atypical antipsychotic, if you haven't tried one already. Agitation and restlessness on SSRIs and other drugs that increase serotonin transmission may be caused by stimulation of the 5-HT2A receptor, which all of the atypicals blockade. Judging how well even a tiny dose (0.25 mg/day) of Risperdal is working for me in reducing my own agitation, I'm rapidly coming to the conclusion that one of my major issues is that I simply have too many 5-HT2A receptors. All of the atypical antipsychotics also blockade dopamine D2 receptors at higher dosages, which I believe can help prevent mania or hypomania; although, I am not an expert on bipolar disorder.
I must admit to not understanding the pharmacology of mood stabilizers and tending to look askance at them, and I used to feel the same way about atypical antipsychotics, but I've become convinced that this is a very useful class of meds, even in some instances for people who are neither bipolar nor schizophrenic. I have long term unipolar depression, with associated social phobia and ADD symptoms, and while Parnate works relatively well for these things, I still find myself suffering from a chronically low libido and an agitation/anxiety/getting ahead of myself that is fairly distracting and impairs my ability to enjoy activities. I'm looking forward to my next visit with my psychiatrist to discuss going up in dosage on the Risperdal, perhaps to 0.5 mg/day, given how noticeable the positive effects have been at this dosage, with no detectable side effects.
Todd
Posted by Mr.Scott on January 1, 2005, at 15:16:03
In reply to Re: BP I vs BPII » barbaracat, posted by Ritch on January 1, 2005, at 10:13:42
I've said it before and I'll say it again..."You and me both!"
The only thing that would not be 100% identical to your descriptions, would be the substance abuse that I sought relief in for many years. It just felt so good to relieve all that anxiety and angry despair. Then that became a dead end prospect...One thing I should note...is that I can force myself into distraction sometimes through work and social activities so that all this crap stays in the backround. That seems to be my greatest source of relief today aside from paltry doses of this that and the other which inevitably cause side effects as I approach therapuetic doses.
Scott
------------------------------------------
I think the main difference that I've personally seen is the striking difference in *chronicity* of symptoms. "BP-II" people seem to have more chronic dysthymic symptoms and seem to rapid-cycle and also have a lot more comorbid anxiety problems that are sometimes tough to weed out from the bipolar symptoms. In my case, I wouldn't be surprised if the correct dx term would be something like "Multimodal Affective Disorder" or "Bipolaroid Anxiety Disorder" :) The folks that I've known that are BP-I's can have so many months of "euthymic" clear-headed functioning it just boggles my mind. I don't think I go more than a few days in a row at most where I feel "normal". .... As far as treatment goes I found lithium useful in the past for the years that I took it, it just seems that anticonvulsants work *better* for me. They say that Li doesn't help rapid-cyclers as much, and I would have to agree with that somewhat. .. As far as BPII going to BPI with time.. there have been hypomanic episodes in the past where it seemed that all I would have to do is stop meds and it turn into something fullblown, but it seems that anxiety is a limiting factor to that.. My symptoms tend to flux or morph from hypomania into hostility then into PANIC, and when things start getting mixed and agitated I can't stand it and I treat it aggressively to get a lid on it. The BPI people I've known just get this pure EUPHORIC nonstop racing derailment that just goes and goes and they feel great. Not so with me.
Posted by barbaracat on January 1, 2005, at 16:23:21
In reply to Re: Dysthymia versus Bipolar type 2 » Mr.Scott, posted by King Vultan on January 1, 2005, at 11:57:51
Have you noticed any weight gain? Do you have early morning grogginess? I tried Seroquel (which I understand is a powerful histimine antagonist) and it was tough to wake up. I imagine all ATs are different from each other and I certainly don't understand their action. Have you tried others?
> I guess my suggestion would be to consider an atypical antipsychotic, if you haven't tried one already. Agitation and restlessness on SSRIs and other drugs that increase serotonin transmission may be caused by stimulation of the 5-HT2A receptor, which all of the atypicals blockade. Judging how well even a tiny dose (0.25 mg/day) of Risperdal is working for me in reducing my own agitation, I'm rapidly coming to the conclusion that one of my major issues is that I simply have too many 5-HT2A receptors. All of the atypical antipsychotics also blockade dopamine D2 receptors at higher dosages, which I believe can help prevent mania or hypomania; although, I am not an expert on bipolar disorder.
>
> I must admit to not understanding the pharmacology of mood stabilizers and tending to look askance at them, and I used to feel the same way about atypical antipsychotics, but I've become convinced that this is a very useful class of meds, even in some instances for people who are neither bipolar nor schizophrenic. I have long term unipolar depression, with associated social phobia and ADD symptoms, and while Parnate works relatively well for these things, I still find myself suffering from a chronically low libido and an agitation/anxiety/getting ahead of myself that is fairly distracting and impairs my ability to enjoy activities. I'm looking forward to my next visit with my psychiatrist to discuss going up in dosage on the Risperdal, perhaps to 0.5 mg/day, given how noticeable the positive effects have been at this dosage, with no detectable side effects.
>
> Todd
>
Posted by barbaracat on January 1, 2005, at 16:32:48
In reply to Re: Dysthymia versus Bipolar type 2 » Mr.Scott, posted by King Vultan on January 1, 2005, at 11:57:51
Have you noticed any weight gain? Do you have early morning grogginess? I tried Seroquel (which I understand is a powerful histimine antagonist) and it was tough to wake up. I imagine all ATs are different from each other and I certainly don't understand their action. Have you tried others?
> I guess my suggestion would be to consider an atypical antipsychotic, if you haven't tried one already. Agitation and restlessness on SSRIs and other drugs that increase serotonin transmission may be caused by stimulation of the 5-HT2A receptor, which all of the atypicals blockade. Judging how well even a tiny dose (0.25 mg/day) of Risperdal is working for me in reducing my own agitation, I'm rapidly coming to the conclusion that one of my major issues is that I simply have too many 5-HT2A receptors. All of the atypical antipsychotics also blockade dopamine D2 receptors at higher dosages, which I believe can help prevent mania or hypomania; although, I am not an expert on bipolar disorder.
>
> I must admit to not understanding the pharmacology of mood stabilizers and tending to look askance at them, and I used to feel the same way about atypical antipsychotics, but I've become convinced that this is a very useful class of meds, even in some instances for people who are neither bipolar nor schizophrenic. I have long term unipolar depression, with associated social phobia and ADD symptoms, and while Parnate works relatively well for these things, I still find myself suffering from a chronically low libido and an agitation/anxiety/getting ahead of myself that is fairly distracting and impairs my ability to enjoy activities. I'm looking forward to my next visit with my psychiatrist to discuss going up in dosage on the Risperdal, perhaps to 0.5 mg/day, given how noticeable the positive effects have been at this dosage, with no detectable side effects.
>
> Todd
>
Posted by Ritch on January 1, 2005, at 16:33:55
In reply to Bipolaroid Anxiety Disorder » Ritch, posted by Mr.Scott on January 1, 2005, at 15:16:03
> The only thing that would not be 100% identical to your descriptions, would be the substance abuse that I sought relief in for many years.
You're not the lone ranger with regards to tinkering with non-prescription substances! When I went off lithium in my late '20's for a few years, alcohol crept in to medicate the agitative depressions (or mixed episodes). If I'm not on an antimanic medication I start craving alcohol(esp. in a mixed or primarily depressive episode). Also, oddly enough, ADHD meds reduce cravings (desipramine, stimulants).
> One thing I should note...is that I can force myself into distraction sometimes through work and social activities so that all this crap stays in the backround. That seems to be my greatest source of relief today aside from paltry doses of this that and the other which inevitably cause side effects as I approach therapuetic doses.
>
> ScottI also feel compelled to stay busy and use the energy productively and not get idle. I've had people ask me things like: "Don't you ever just do ... NOTHING?". I think some of this is panic disorder in some indirect way coming through. My Mom is just like that and she had epilepsy and panic attacks. When she gets idle she starts getting uptight and agitated. I'm the same way, if there isn't a chore or a project or SOMETHING, I just start pacing all around, and start focusing on somatic symptoms and feeling panicky.
Posted by D minor on January 1, 2005, at 16:52:16
In reply to Re: Dysthymia versus Bipolar type 2 » Mr.Scott, posted by SLS on December 30, 2004, at 4:31:06
> Hi Scott.
>
> It sounds to me as if you might have "double-depression", wherin major depressive episodes are superimposed upon a chronic dysthymia. Both aspects of this mixed condition are capable of producing irritability as a symptom. Dysthymia tends to be stubborn to treatment. You might want to look into trying amisulpride or perhaps even Abilify. If you use Abilify, be prepared to experience some anxiety or irritability initially.
>
> I don't think you have bipolar disorder. You really have to express a hypomanic episode to be eligible for this diagnosis. Episodes can last for as few as 5 days, though. Doctors seem to be quite fond of this diagnosis lately.
>
>
> - Scott
>
Hi to both Scotts!Mr. Scott, I know how you feel about being confussed about diagnosis. I was initially diagnosed with unipolar psychotic depression. But a new doc recently diagnosed me with BP. I don't know if I believe him.
The main reason for my doubt is this: I have never been "hypomanic" for more than a day at a time. I felt really "high" for a day, then really depressed for a few days with a few normal days in between for about two weeks. When I started Depakote that all stoped. So my question to SLS is, can you be hypomanic for just one day? I know the DSM says 5 days. Or does duration not matter when you're rapid cycling?
Thanks,
dm
Posted by barbaracat on January 1, 2005, at 17:33:21
In reply to Re: Dysthymia versus Bipolar type 2 » barbaracat, posted by Mr.Scott on January 1, 2005, at 5:02:13
OK, hoist yer petard over to my post in Alternative for info on pyroluria:
http://www.dr-bob.org/babble/alter/20050101/msgs/436445.html
> Hi Barbaracat,
>
> I'll do a search right now! I have had the white spots all my life, although they seem less now then when I was younger. Tell me where to go and I'll follow! What sort of internal pressure?
>
> Scott
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