![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 63. Go back in thread:
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
Posted by SLS on January 2, 2005, at 10:06:21
In reply to Re: Dysthymia versus Bipolar type 2 SLS, posted by D minor on January 1, 2005, at 16:52:16
> > 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
>Some of the quantitative diagnostic criteria of the DSM are arbitrary, but are usually based on statistics. For instance, if one were to have three dramatic bipolar mood episodes per year every year, does this make him any less a rapid cycler than someone who has four? I don't know. Perhaps six is a better number. For some people with bipolar disorder, rapid cycling might only be a temporary change in the course of the illness that is perhaps limited to a phase lasting a few years.
There is an inherent contradiction between the observed and accepted existence of "ultra-rapid cyclicity" and "ultradian cyclicity" in which one can alternate between mood states every few days or even every few hours and the DMS requirement that a manic or hypomanic episode last a minimum of 4-7 days. How, then, could your mood state lasting only 24 hours disqualify you from one of these rapid cycling presentations? It can't. Be cognicant, however, that an episode is defined by some investigators as being a period of cyclicity that lasts for at least two weeks. It is this single period a rapid-cycle persists and not the cycles themselves. In other words, if you have been ultra rapid cycling for a period of time lasting more than two weeks, than you will qualify for rapid cycling if you experience more than four of these episodes per year. You can see how there is yet some confusion in the psychiatric field as to what constitutes rapid cycling.
Can you be more detailed and specific in the description of your "manic" days?
Do your manic episodes during these days reach the threshold of mania and not hypomania? Do you become psychotic or lose your ability to function at work or at home or around friends?
- Scott
Posted by King Vultan on January 2, 2005, at 12:44:05
In reply to Re: Dysthymia versus Bipolar type 2 » King Vultan, posted by barbaracat on January 1, 2005, at 16:23:21
> 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've only been on Risperdal for a couple of weeks, and with such a tiny dosage (0.25 mg/day), I personally haven't noticed any adverse effects at all. This is the first AP I've, tried, but the atypical with the lowest side effects appears to be Geodon; in "Psychotropic Drugs", it is listed as having both low weight gain and low sedation, while Risperdal is listed as having moderate weight gain and high sedation. They show Seroquel, by comparison, as having moderate weight gain and moderate sedation, while Zyprexa is listed as having moderate weight gain and high sedation.I guess I have to question how much faith you can have in those descriptions, as which side effects are most prominent and to what degree they are going to affect a person are heavily dependent on dosage. From the data I have, Zyprexa looks like it should be much more sedating than Risperdal at low dosages because Zyprexa has an extremely powerful histamine blockade. Risperdal also blockades histamine H1 receptors, but the effect is comparatively weak at the very low dosages of 0.5 to 1.0 mg/day that I am interested in. It does appear that Geodon has a rather favorable side effect profile compared to most of these other agents, however. It also happens to be a $50 copay on my insurance, while Risperdal is only $25 and can also be easily cut into halves for intermediate dosages and to save money.
Todd
Posted by D minor on January 2, 2005, at 16:29:17
In reply to Re: Rapid cycling definitions: varying concepts » D minor, posted by SLS on January 2, 2005, at 10:06:21
> Can you be more detailed and specific in the description of your "manic" days?
>
> Do your manic episodes during these days reach the threshold of mania and not hypomania? Do you become psychotic or lose your ability to function at work or at home or around friends?On my hyper days I felt really sped up. I could do anything faster. I felt like I could fly. I was exuberant. My brain was so busy it felt like there was a radio in my head. I also felt really sexy. I thought I was doing a better job at work, and I was more creative. As far as psychosis, I've had hallucinations off and on for the past two years, so I really don't know what to make of that. But they're never severe enough to keep me from working. My husband was really conserned. He said it was as if I was high. I'm not sure if all of this qualifies as hypomania. But I reallyl miss those days.
gotta go
dm
Posted by Mr.Scott on January 2, 2005, at 17:13:34
In reply to Re: Rapid cycling definitions: varying concepts » D minor, posted by SLS on January 2, 2005, at 10:06:21
Hi,
Here's my experiences of what I'll call hypomania. Keep in mind no physician has ever claimed to have seen me in a hypomanic state and I've seen the doc for 4 years. He once said I was in a mixed state from what I described.
Here goes....
-Antidepressant induced or stimulant induced-
-Lexapro 2002-Feeling of a rush of energy inside that feels wonderful! Lot's of mental energy. Music playing in the mind all the time. Creative wheels moving. Listening to super loud music in the car and really 'feeling' it diferently than usual. Giddy...Making tons of jokes and being slap happy. A little relentless, but others find amusing not annoying. Internal desire to make plans for the future and a feeling that I need to get moving and quit being so depressed. A feeling that things are going to be different this time (although due to repeated experience this has gone away and is now replaced with fear). Desire for lots of sex! Feel more charismatic and charming. A feeling that it's absolutely okay to be me, and that anything is possible! Rekindle old flames disregarding previous experiences. Maybe buy too many presents or a couple of unneeded items for myself. Nothing Too extravagant though. Sleep is not affected except maybe at the very beginning of an Antidepressant trial. Inevitably this feeling starts to go away. Maybe after 2 days or 1 week. I notice side effects from the antidepressant. Could be facial swelling, muscle aches, constipation, fatigue, or whatever! Agitation albeit mild replaces initial excitement and euphoria. Now I begin to feel more angry, anxious, agitated. I'll fantasize about morbid things. At this point the Antidepressant gets lowered or canned entirely.
-Prozac & Wellbutrin Combo 1996-
Was on Prozac alone which gave my the positive feeling above, except it actually lasted 6-9 months! Then it pooped out and I started using more and more alcohol, amphetamines, cocaine, etc to keep it alive. I developed a constant dysphoria and a bad drug habbit. Went to rehab and detoxed. Came home and relapsed and Wellbutrin + Clonazepam was added to Prozac. My mood literally shifted every few hours one night from 'driven happiness' to 'driven dysphoria' I smoked tons of cigarettes this night and talked as is everything was going to be okay. Later that night I became agitated and could not sleep. I began to feel that there was no point and I proceeded to attempt suicide by using alcohol, pills, razor blades, and Carbon Monoxide. Apparently I wasn't all that serious because while bleeding in the garage I phoned an old girlfriend and gave away where I was inadvertantly. The garage door was completed broken through 15 minutes later and I was in a coma for 2 or 3 days.
-Imipramine 2003-
Already seriously depressed and newly participating in 12 step group (6mos). My doc tells me I'm in a mixed state and recommends ECT. Feels like an agitated depression and that SSRI's can't help due to side effects. I see another doc who poo poos ECT and says everyone is bipolar. He gives me Impramine. This agitates me further and I say F*** It! I go out drinking and coking for an entire weekend keeping company with unsavory fellows in a motel I had just met on the street in a bad part of Chicago. I come back to work on Monday and employees and partner note that I seem to be doing better! (to come down I used 3 different mood stabilizers and slept all day and night Sunday). Eventually I decide 'to try' ECT. Results are questionable. "I guess maybe it helped a little."-Initial and seperate Nardil, Ritalin, and Prozac trials-
Similar experience as Lexapro, except these last longer. Prozac 6-9months. Nardil 3 months. Ritalin 2 months. All end with tremendous dissapointment and more depression. Some with drug relapses.Keep in mind there have been hundreds more smaller scale events like these that lasted only a day or two where I was activated, hostile, highly productive, anxious or even obsessed with intense violent thoughts.
Mostly I feel depressed and anxious and obsessed with one thing or another though. Winters are awful it seems literally must sleep all the time and have NO energy. I have a history of ADD/conduct disorder and had a penchant for antisocial activities in my youth. I was always angry/fearful/ and threatening as a youth. Early involvement with sex & drugs. Currently I am in recovery from all street drugs and alcohol, but I crave often and it takes a lot of energy I really don't have right now to fight them off! Today I'm just unhappy...tired...scared...and still unf***ing clear as to what my diagnosis is!
Scott
Posted by Ritch on January 2, 2005, at 18:00:29
In reply to Are these Hypomanias » SLS, posted by Mr.Scott on January 2, 2005, at 17:13:34
>...Here's my experiences of what I'll call hypomania.
Those fit my experiences, especially the giddy, full of jokes part. It is like being stoned on pot and not smoking anything. Everything's funny. When that's happening, do you ever get any short-lived "surges" where you kind of just start "rocketing"? I especially notice these when taking SSRI's at anything close to standard doses. Another thing that gets me concerned is the feeling that *everything* is important and interrelated to everything else. A term I like to use is "glowing with significance". I start getting superstitious-"there are NO accidents", etc.
>...Keep in mind no physician has ever claimed to have seen me in a hypomanic state and I've seen the doc for 4 years.
I've been nearly that high and had appointments and found it relatively easy to "hide" that-I didn't have to really try. If you aren't feeling miserable, it's fairly easy to stick to a topic or two and in no time you are out of there anyway. If the doc had to hang out with me throughout the day, they might get a better idea.
>...He once said I was in a mixed state from what I described.
The Prozac+Wellbutrin thing certainly sounds like it to me.
>...(to come down I used 3 different mood stabilizers and slept all day and night Sunday).
When I have an impulsive hostility episode I boost up the Depakote and add some Trileptal for a day or two to settle it down. It would settle down on its own after a few days, but I don't want to risk things.. the unpredictability of events makes me too panicky.. kind of like driving on icy roads.
>...Keep in mind there have been hundreds more smaller scale events like these that lasted only a day or two where I was activated, hostile, highly productive, anxious or even obsessed with intense violent thoughts.
Definitely sounds like rapid-cycling bipolar to me. I'm taking practically nil doses of antidepressants over the last year or two... and I must say that I've felt more stable during this time time than ever. Can't seem to completely ditch SSRI's though. It is like they are a substance abuse problem in themselves!
Posted by Mr.Scott on January 2, 2005, at 21:52:46
In reply to Those are hypomanias » Mr.Scott, posted by Ritch on January 2, 2005, at 18:00:29
Thanks for confirming... I guess then I need to pull back the antidepressants ever so slowly...
-->do you ever get any short-lived "surges" where you kind of just start "rocketing"?Yes...And I love them! And I believe the people around me do too because I'm so optimistic, charismatic, and productive.
-->Another thing that gets me concerned is the feeling that *everything* is important and interrelated to everything else. A term I like to use is "glowing with significance". I start getting superstitious-"there are NO accidents", etc.
Sure. That nothing happens in God's world without a reason feeling. Like the Tsunami incident is no big deal because the sacrifice of these people will actually serve mankinds greater interst. 1)A new system of detection will be created and ultimately save millions in the long run, 2) This is natures way of correcting for overpopulation, 3)That capitalism which is somehow related to nature will step forward and is only possible because drug companies charge us so much money. And on and on and on. Everything is connected and okay and it all makes sense. Until my mood changes anyways...
Scott
Posted by barbaracat on January 3, 2005, at 0:22:01
In reply to Re: Those are hypomanias » Ritch, posted by Mr.Scott on January 2, 2005, at 21:52:46
I sure do love those hypomanias! Everything clicks, has significance, stop lights all turn green for me and if they should turn red, well, there's some wonderful adventure waiting for me at that red light. I become absolutely incorrigibly fun, naughty, charismatic, daring. A bus-full of crabby people I've never seen before stuck in traffic in crappy weather in November? No problem! Get them all to sing Christmas carols and have them all loving it. Nothing can stand in the way of making anything happen and all is delightful.
At my best I'm an energy catalyst, filled with sparkling ideas and aware of the higher purpose of the Universe - these are not false impressions but real true impressions whereby I believe my brain is supercharged and open to psychic realms. The premonitions I've had from this state have been amazingly right-on. A psychic antenna becomes more sensitized. Unseen gates open.
At the early manageable stages there's no ADD-like disorganization, like what comes later. I have great creative ideas and plans and boundless energy. Start digging major excavations for a waterfall garden, drag out the sewing machine to make dance costumes, sign up for all kinds of interesting classes and workshops, host a large dinner party. And it all fits together seamlessly with no disorganization. It all gets done without barely breaking a sweat. Music sounds better, nature is more lovely. Life glows. My dancing is hot, so is playing my music instruments. A true Renaissance Woman. This is living and it's not weird. It's fun.
At that point, as long as I don't start abusing alcohol and drugs and get enough sleep, I can actually coast down naturally and it ends there. But hey, who wants that kind of fun to stop. Alcohol is like pouring kerosene on fire, but oh boy, do I ever love that extra buzz. Then I'm out dancing all night and I'd be catting around if it weren't for my husband who keeps a careful eye on me during these times.
If I let the motor keep revving it's like a point of no return and I start fracturing and unravelling and can't keep any ball in the air, and I still can't rest or sleep. If a clinical biolical depression sets in (as opposed to just crashing and sleeping) and the revving is going on at the same time as the depression, the result is this wailing anguish where all those sublime (many times complete with auditory hallucinations of angelic choirs - heck who says they're even hallucinations??) insights and visions turn into nightmare landscapes where we're all doomed. The psychic antenna only picks up Scare Tactics. I truly feel like I'm lost in Mordor without Sam during a mixed state depression. I feel mortified and ashamed at all the promises I made and can't keep, all the fun behavior that now seems lewd and cheap. I feel physically sick, achy, toxic. And I can't sleep, which is true hell. No escape into oblivion. It's quite psychotic stuff but antipsychotics do squat. I don't understand this kind of depression I get. It's not gray. It's jagged intense blacks and blood red. I don't know where it comes from and haven't met many who have shared it. To me, it sounds more like BP-1 but I'm not even sure of that.
This is what it was like for me almost constantly, emphasis on the depression, until I started taking lithium. I have not had a single mixed state since about 2 years now. Thank whatever Grace who has made this so.
I can still make myself feel pretty awful if I drink way too much and mix the alcohol with a opiate - my favorite buzz substance. This can burn out my circuits and destabilize me into feeling pretty awful.
My garage is an archeological dig filled with layers and remnants of unfinished grand projects, boxes of clothes and shoes I never wore. Oh, if only I had a fraction of that money now! Oh, if only I could coax up a manageable hypomania rev up enough energy and fun to slog through that mess and clean it up. Oh, if only I could ride a mild hypomania whenever I wanted and not whenever IT wanted.
There's something pure magic in the wonderful aspects of bipolar. It seems like more than just chemistry to me, it's more like a divine gift. Wish I understood it better. - Barbara
Posted by Mr.Scott on January 3, 2005, at 1:30:53
In reply to Re: Those are hypomanias, posted by barbaracat on January 3, 2005, at 0:22:01
Hey Guys,
at least in theory then my approach of using:
25-37.5mg of Zoloft
25mg Lamictal
.5mg clonazepamis not working and may even be keeping me in a destabilized place. The problem is that my depression & anxiety are clear & present. Oviously I'll discuss this with my new psychopharmacologist on Wednesday, but would you suggest keeping a working dose of Antidepressant in place and adding depakote or Lico3, or slowly getting the Zoloft out and away and relying entirely on Lamictal at increased doses, or finally... maybe rely entirely on mood stabilizers like Dep and Lic03? What I can say is that the mood stabilizers alone have not given me great relief from depression or anxiety. And while Antidepressants have helped they also have hurt me just as much if not moreso.
What's your take on the next best approach?
BTW...This has been the most helpful interaction I've probably ever had on this board or in general in helping me understand what I'm dealing with. And while I know it isn't over or cured now, at least I think I can accept whats going on and work with a new (highly reputable & overly expensive) Psychopharm expert who I'll be seeing on Wednesday. He is reputed anyways to be the best in the area who still takes new patients. My current psychiatrist of 4 years is potentially getting the boot for not seeing this and treating it after so many thousands of dollars and hundreds of hours.
Scott
Posted by Mr.Scott on January 3, 2005, at 1:33:16
In reply to Re: Those are hypomanias, posted by barbaracat on January 3, 2005, at 0:22:01
Hi again,
So what is your day to day like? Do you still experience ups and downs but just not the mixed stuff? I guess is what I'm asking is over a 4-6 week period what kind of mood stability have you obtained?
Scott
Posted by banga on January 3, 2005, at 1:35:37
In reply to Re: Those are hypomanias, posted by barbaracat on January 3, 2005, at 0:22:01
Hello!
I was just perusing your exchanges....I dont know if you are going by the DSM IV definitions, to distinguish mania, hypomania and mixed episodes--but in a nutshell, mania and hypomania differ in two aspects alone--duration, and its effects on your life. Manic episodes-last at least 1 week--- or less if they necessitate hospitalization. This then makes it flexible--if it is really out of control, or if you have hallucinations that split you from reality (i.e., you werent hospitalized but maybe it might have been a good idea)--its a manic episode. And mania is defined as MARKEDLY interfering with functioning in social or work life. Hypomania lasts 4 days or longer, and is not strong enough to interfere significantly with your daily functioning. The symptoms are the same, it's their intensity that differs the two.
If you have ever had a manic episode, you are by DSMIV Bipolar I. If you have never had a full manic episode but have episodes of hypomania, youre Bipolar II. A mixed episode is if you simultaneously meet FULL criteria for a manic episode and full criteria for a depressive episode for at least a week.
Sorry if you knew all that and are going by some other diagnostic system--just it seemed someone was wondering whether they are Bipolar I or II--.
Technically, going by the DSM system, probably most of us fall under "Bipolar Disorder not otherwise specified" or "Major depressive disorder NOS", as the DSM criteria are pretty strict.
And having said all that, if you go by the less clear-cut classifications going around these days, I still am not sure if I have just Major Depression or rather Bipolar in a softer form--
Sorry for butting in , good comments by all;
And good luck to all of you!
Posted by SLS on January 3, 2005, at 9:11:17
In reply to Those are hypomanias » Mr.Scott, posted by Ritch on January 2, 2005, at 18:00:29
What has been your experience with Lamictal?
I'm glad you have found a certain stability lately. I'm sure it can make things easier to plan for.
Stay well.
- Scott
Posted by Ritch on January 3, 2005, at 9:30:05
In reply to Re: Those are hypomanias-Ritch Barbaracat » barbaracat, posted by Mr.Scott on January 3, 2005, at 1:30:53
> Hey Guys,
>
> at least in theory then my approach of using:
> 25-37.5mg of Zoloft
> 25mg Lamictal
> .5mg clonazepam
>
> is not working and may even be keeping me in a destabilized place. The problem is that my depression & anxiety are clear & present. Oviously I'll discuss this with my new psychopharmacologist on Wednesday, but would you suggest keeping a working dose of Antidepressant in place and adding depakote or Lico3, or slowly getting the Zoloft out and away and relying entirely on Lamictal at increased doses, or finally... maybe rely entirely on mood stabilizers like Dep and Lic03? What I can say is that the mood stabilizers alone have not given me great relief from depression or anxiety. And while Antidepressants have helped they also have hurt me just as much if not moreso.
>
> What's your take on the next best approach?
>
> BTW...This has been the most helpful interaction I've probably ever had on this board or in general in helping me understand what I'm dealing with. And while I know it isn't over or cured now, at least I think I can accept whats going on and work with a new (highly reputable & overly expensive) Psychopharm expert who I'll be seeing on Wednesday. He is reputed anyways to be the best in the area who still takes new patients. My current psychiatrist of 4 years is potentially getting the boot for not seeing this and treating it after so many thousands of dollars and hundreds of hours.
>
> ScottScott, Let us know what your new psychopharm says, ok? Your symptoms are close to a lot of mine and others' symptoms here, and I am really curious. As far as your med mix goes.. I really am not sure. I haven't tried Lamictal. I cycled like crazy on Zoloft, though, and I've noticed that SSRI's seem to take away one "flavor" of anxiety and add a different "flavor" back. I've thought in the past that combining Lamictal + Depakote together might work well for me, but that combo has its problems because of rash and blood levels of the meds, etc. I *have* tried Depakote + Lithium in the past and it does really help, but I just can't tolerate Lithium (for various reasons). I've tried Depakote + Trileptal and found the T to have AD effects and really takes down the hostility (even better than the Dep surprisingly). But, I have trouble with tolerating the nausea from the T. I suppose I'm more treatment intolerant than resistant. I hope you have some luck with this new doctor!
Posted by Ritch on January 3, 2005, at 9:43:28
In reply to Re: Those are hypomanias » Ritch, posted by SLS on January 3, 2005, at 9:11:17
> What has been your experience with Lamictal?
>
> I'm glad you have found a certain stability lately. I'm sure it can make things easier to plan for.
>
> Stay well.
>
>
> - Scott
>Scott, no experience with it yet. I've had some allergic skin things happen to me in the previous several years that make me leary of it, and pdoc doesn't want to mess with it given my relatively stable state. What seems to be key to that is drastically reduced dosage of antidepressants, I'm down to just about 300 micrograms of Celexa every day (.3mg liquid). Any more and I get wiggy, if I stop I start getting GAD/panic symptoms. So, the SSRI is purely for anxiety. I also take 5mg of Stratterra when I start getting into the low part of my 2-3 week cycles and it seems to work for that. When I feel myself getting a little high I just add a little more Depakote. It seems to work. Thanks for your concern!
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