![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 26 to 50 of 63. Go back in thread:
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!
Posted by Ritch on January 3, 2005, at 9:51:59
In reply to Re: Those are hypomanias, posted by banga on January 3, 2005, at 1:35:37
> 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!
No problem, thanks for printing the info. I've read that before. I suppose I'm curious about the "qualitative" aspects of the symptoms more than the "quantitative". Without meds I've definitely exceeded the "4 day limit", even the "1 week limit", but the intensity was low enough that I could still drive (maybe 10-15mph over the speed limit), get work done, talk to people on the phone (get hung up on a couple of times though). Another thing I might mention is the "atypical" nature of it. I did get a dx a few years back from a neurologist that simply put me down as "atypical bipolar". The continuousness requirement of the "episodes" I think can be misleading. It is kind of like the breaker box is generally running hot for a week or so, but you only have to go and reset a breaker here and there for a few days in a row, but you don't get pitched into jail or get fired, etc......
Posted by Mr.Scott on January 3, 2005, at 12:52:43
In reply to Re: Those are hypomanias-Ritch Barbaracat » Mr.Scott, posted by Ritch on January 3, 2005, at 9:30:05
I've noticed that SSRI's seem to take away one "flavor" of anxiety and add a different "flavor" back.
Bingo!Scott
Posted by banga on January 3, 2005, at 13:54:20
In reply to Re: Those are hypomanias-Ritch Barbaracat » Ritch, posted by Mr.Scott on January 3, 2005, at 12:52:43
> I've noticed that SSRI's seem to take away one "flavor" of anxiety and add a different "flavor" back.
>
>
> Bingo!
>
> ScottThat is SOOO true!
Posted by banga on January 3, 2005, at 14:05:25
In reply to Re: Those are hypomanias » banga, posted by Ritch on January 3, 2005, at 9:51:59
>
> No problem, thanks for printing the info. I've read that before. I suppose I'm curious about the "qualitative" aspects of the symptoms more than the "quantitative". Without meds I've definitely exceeded the "4 day limit", even the "1 week limit", but the intensity was low enough that I could still drive (maybe 10-15mph over the speed limit), get work done, talk to people on the phone (get hung up on a couple of times though). Another thing I might mention is the "atypical" nature of it. I did get a dx a few years back from a neurologist that simply put me down as "atypical bipolar". The continuousness requirement of the "episodes" I think can be misleading. It is kind of like the breaker box is generally running hot for a week or so, but you only have to go and reset a breaker here and there for a few days in a row, but you don't get pitched into jail or get fired, etc......
Also, in terms of "episodes" and impairing functioning, you have to ask what about cumulative effects on life? If I look across my life and how much the cumulative effect of my depressive episodes and anxiety has had on my life....even if most of the time I was "functioning" (getting to classes, etc.) the quality of my achievements suffered, as did my confidence to push forward certain life and career goals.... if I look back at what I could have done if dysthymia and anxiety didnt seep away my abilities and confidence, where my life owuld be today...
( and that's ignoring the fact that I have in fact been at times extremely impaired and even hospitalized--just I believe even if I didnt have these episodes, the lifelong drag on my life would still have been present)
so does one call that "impairing" life significantly or not?
But on a side note, if people are hanging up on you at certain times, I would consider that affecting your social life quite a bit, even if it is temporary....
Posted by barbaracat on January 3, 2005, at 15:39:26
In reply to Re: Those are hypomanias » barbaracat, posted by Mr.Scott on January 3, 2005, at 1:33:16
Since starting lithium 2 years ago, those horrible nightmare days are gone. Even after the mixed-states/manic episodes stopped, I was still getting garden variety lethargic depressions and weepiness. When I first started lithium I was trying all sorts of different ADs (NOT SSRI's!), with it, mainly lamictal (worked at first then pooped and I got the rash), because the depression was so hard-wired into my system it took time to let it go. It was like I didn't know any other way to be.
I was on nortryptaline after my Mom died and it helped alot but dried me out too much. SJW is the first AD that has made a huge difference in lightening my mood and I love it, but it was lithium that brought me back to sanity.
I still have alot of anxiety, which is my bane, but I can manage it with benzos and if I can get my butt in gear, exercise makes everything better.
I experiment on myself at times and tried to go without meds for 4 months and started going downhill. Lithium brought me out within 1 week. But not enough, so I started my trial with the different SJW until I hit upon the combo I'm on today. I'm on so many nutritional things but I attribute my physical health to getting my hormones balanced (including thyroid) and my mental health to lithium, SJW, inositol and fish oil.
I'm not working because I'm on disability from the fibromyalgia, so I don't have alot of the miserable stress I was under in my high-tech corporate job. That makes a huge difference in my stress level, but there's the financial stress, so stress doesn't go away. But I can handle it and I trust I'll be able to handle it. Before, I was overwhelmed by everything and was no longer able to multitask anything. I was a project manager at my job and the last few months before I had to stop working were spent sobbing in my cube. I became super-super sensitive, hearing the lobsters screaming in the tanks at the market, road-kill made me throw up, couldn't drive anymore, all was doom. Reading my journal from those years, I am amazed how far I've come in this journey, amazed I'm still alive. One tends to forget those horrible memories. Yes, I'm doing very much better these days.
My days now are primarily centered, hopeful (however, this last election sent me into despair), if I have a bad time, I know I'll be out of it soon. I don't feel like every nerve is raw and exposed. I don't have the constant 'electrical' feel, more like a soothed feel. I still get all the pissy emotions of everyday life, but as long as I don't drink too much and mix my alcohol with opiates, I don't burn myself out. As long as I keep a moderate life and look after my health, get enough sleep and exercise and all that Ben Franklin stuff, I'm one of the strongest and emotionally healthiest persons I know. I can't say I'm exactly 'happy', except for occasional times, but I look forward to living and have hope that it will become more and more fulfilling and interesting as I relearn how to do life. You have to realize, I've spent most of my life swinging wildly with normal times in-between, but I've been severely mixed states since 1997 which I was able to hide somewhat, but then not at all and ended up in a psychiatric unit.
Also, and this is huge, whatever my fibromyalgia was about is letting go. The pain and fatigue and sheer misery of fibro was a big deterrent to doing or planning anything. But I've been waking up without any pain, and feeling absolutely normal physically for the last 2 months. I feel like I can schedule and structure my life now. Before, I never knew if I was going to be laid low with pain and fatigue. I don't know what to attribute this to, but it coincides with when I started feeling consistently better all around, about 3 months ago. I'm doing something right, I wish I know exactly what.
So yes, even though I go through bad times, depression and anxiety, they come and go very quickly. It's much better now, started getting better with lithium and since finding the other meds and nutrients that are working, my life has been stable, at times lovely and good, and I have hope that it will continue this way. Oh, and a happy note, I still get mini hypomanias (might be due to I'm taking a non-therapeutic dose of lithium of only 750mg) and I'm able to 'come down' from them but still enjoy them while they last. The lithium prevents them from going too wild.
>
> 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 barbaracat on January 3, 2005, at 16:12:42
In reply to Re: Those are hypomanias, posted by banga on January 3, 2005, at 14:05:25
Let's not forget the new problems that these episodes bring with them. The unpaid bills, the lost jobs, the messy house, the damaged relationships, the unkept commitments, the nasty words, can't find the friggin' keys. It's bad enough how bad the disorder makes us feel, but then we have to face the fallout from our actions. We cause alot of damage at a time when we're least able to do anything about it. Or we just get dragged down farther and farther, can't catch up and miss out. Just when we need compassion and understanding the most, people respond to us like we're weird - cause we ARE acting weird. And that would be depressing even without a raging mood disorder.
Everytime I go out to my garage and see those shelves and shelves and aisles and aisles of expensive junk from my never to be finished grand projects, I feel dismayed. I'm amazed anyone could have that much energy to buy all that stuff, that many ideas for creative projects in one lifetime. Now I have to clean it up, I need to clean it up just to free up that trapped energy. But AT LEAST, now that I'm in a stable place, I no longer feel overwhelming shame and paralysis. AND I'm no longer adding more stuff to it. In fact, come Spring, I'm even looking forward to going on a 'stuff safari hunt' and seeing what I've got in there.
But prior to feeling better, I was not able to face the sheer overwhelm of it all or the shame and beating myself up for being so 'irresponsible and stupid'. I don't know about you, but I think the worst part of being in a really bad place is how much I hate myself when I'm in it.
Posted by olysi79 on January 3, 2005, at 19:07:32
In reply to Re: Dysthymia versus Bipolar type 2 » Mr.Scott, posted by barbaracat on December 30, 2004, at 14:05:14
Hi barbaracat, it's chris (formerly cpallen79- new screenname now)
I agree with your post. I have those awful agitated depressions with intense racing thoughts, paranoia, panic, and despair. I've had two over the past 9 years that were incredibly intense. I've also had couch potato sleep 15 hours a day type depressions too. Like you, I'll take those ANYDAY. Ask me 6 months ago if I thought I was bipolar and I woulda said nope, that is until I started to rapid cycle and alternated between hypomania and depression and anxiety. It was quite a discovery that still presents problems but I'm working through it and faithfully taking my meds, and goign about my business. I need to take an SSRI for my ocd and will not give it up, which may or may not exhasberate the problem. Mood stabilizers have helped, but it's all a balancing act. For me, a combo of mood stabilizers and antidepressants have helped and when things start to get out of control, I pop Zyprexa, extra trileptal, ativan, and some bendryl.
I think that those with agitated depressions need to really consider adding mood stabilizers or anti-psychotics into their cocktail.----------------------
> 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 banga on January 3, 2005, at 20:08:39
In reply to Re: Those are hypomanias, posted by barbaracat on January 3, 2005, at 16:12:42
Yes, the fallout is so awful. For me its the depression--all the avoided phone calls, undone projects, broken deadlines and promises, and yes the messy house,...it must get so old for those who know me, to have me one day come into the room with sort of an "I'm back and on the ball!!" attitude, only to have me slip away from the radar screen yet again for weeks on end.
The self-loathing is agony. The amount of relief you get in saying to yourself--"you're not iresponsible, lazy and uncaring, you have a disease" is very minimal.
Posted by barbaracat on January 3, 2005, at 20:18:04
In reply to Re: Dysthymia versus Bipolar type 2 » barbaracat, posted by olysi79 on January 3, 2005, at 19:07:32
Nice to hear from ya, Chris! Been awhile! I remember we shared some enjoyable posts a while back. I'm not glad for you, but I'm glad that I'm not the only one with those hellacious things. Before I even remotely suspected I was bipolar, I called those things 'depressions', but I knew they weren't anything like depressions I'd heard of other people experiencing.
I'm pretty convinced at this point that I'm BP-I and not II, mainly because of those godawful mixed states things. Also, I've had some classic wacko manias too, and the DSM says you only need one. But what's in a name? You could call it agitated depression as well. I never could figure out what the difference was.
Glad that Zyprexa works for you. None of the APs did a thing for me and if anything made me feel more despairing. I always keep an arsenal of benzos around. Just knowing they're there... I can also snap myself out of a funky blue-type depression if I take an opiate - but it's just a temporary fix. I'm the lithium poster child at any rate. I'm so very grateful it works so well for me. I don't think I would be alive if it weren't for what I learned on this board and marching into my pdoc's office and saying 'I think I'm bipolar'. Duh. I'm so glad that I found the right brands of St. John's Wort to deal with the remaining depression. I'm glad fish oil is making a difference. These days I feel like I have so much to be grateful for.
I totally agree with you about mood stabilizers and agitated depression. My heart goes out to the many of us getting treated for depression with SSRIs alone. They worked for me for a while but man oh man, when they started turning against me it was not a pretty sight. I think it's a travesty that I was seeing one pdoc or another for over 20 years and not one of them ever made this leap of intellect, ever asked the right questions. It's so clear to me now how bipolar I've been most of my life, but not one of them ever questioned the 'major depression' dx and kept substituting one SSRI with another. I know 'mixed states' is rather arcane, but I did have some royal Patty Duke type zingers too, but never made the connection.
Chris, answer me this, can you make any distinction between 'agitated depression' as the subset of major depression it currently is defined as, and 'bipolar mixed states depressions'? And why do some bipolars never get these mixed states? Is it a separate category, a unique DSM they'll someday figure out? To me it seems more than just anxiety and depression, it's a personal little corner in Hell and the 'why' has never been adequately addressed by any of my many shrinks.
> Hi barbaracat, it's chris (formerly cpallen79- new screenname now)
>
> I agree with your post. I have those awful agitated depressions with intense racing thoughts, paranoia, panic, and despair. I've had two over the past 9 years that were incredibly intense. I've also had couch potato sleep 15 hours a day type depressions too. Like you, I'll take those ANYDAY. Ask me 6 months ago if I thought I was bipolar and I woulda said nope, that is until I started to rapid cycle and alternated between hypomania and depression and anxiety. It was quite a discovery that still presents problems but I'm working through it and faithfully taking my meds, and goign about my business. I need to take an SSRI for my ocd and will not give it up, which may or may not exhasberate the problem. Mood stabilizers have helped, but it's all a balancing act. For me, a combo of mood stabilizers and antidepressants have helped and when things start to get out of control, I pop Zyprexa, extra trileptal, ativan, and some bendryl.
> I think that those with agitated depressions need to really consider adding mood stabilizers or anti-psychotics into their cocktail.
>
Posted by banga on January 3, 2005, at 20:18:39
In reply to Re: Dysthymia versus Bipolar type 2 » barbaracat, posted by olysi79 on January 3, 2005, at 19:07:32
>>I think that those with agitated depressions need to really consider adding mood stabilizers or anti-psychotics into their cocktail.
Yes, after years of only partial relief on antidepressants I definitely find atypical antipsychotics and mood stabilizers have something to give me. Atypicals helped with the anxiety and obsessive parts; and being on a mood stabilizer for the first time ever (Lamictal) I feel it truly acts in stabilizing my mood--no deep despair interlaced with agitation and crippling anxiety. I wish I paid more attention to the whole piture, inluding multiple people with bipolar in my family, so I could have tried other drugs earlier.
I am hoping a combo of anticonvulsants and an antidepressant, and perhaps a stimulant, may be more helpful than an antidepressant alone. The atypicals I have tried had some side effects I didnt care for--REALLY spacey and foggy--but I know to turn to them if things get really out of control, especially the anxiety.
Posted by olysi79 on January 3, 2005, at 20:30:42
In reply to Re: Dysthymia versus Bipolar type 2 » olysi79, posted by barbaracat on January 3, 2005, at 20:18:04
Hi Barbaracat,
Good to hear back from ya! I took keep an arsenal of good old Benzos handy in case I plunge and am happy they are there if I need them. I find that an AP works for me if I take it as an emergency med. If I take it too long, I get yucky old akathisia. ick ick ick. I keep my SSRI dose low (thank good my PDOC actually recommends this rather than hiking my dose up to some hellish level).
As far as your question goes between the bipolar mixed states and agitated depressions, I believe they are one in the same, and for the DSM to even separate them as two separate diagnosis' is ridiculous. They are so awful and hideous. Anyone that has them needs to get on a mood stabilizer asap. It's good talking to you again!
Chris
> Nice to hear from ya, Chris! Been awhile! I remember we shared some enjoyable posts a while back. I'm not glad for you, but I'm glad that I'm not the only one with those hellacious things. Before I even remotely suspected I was bipolar, I called those things 'depressions', but I knew they weren't anything like depressions I'd heard of other people experiencing.
>
> I'm pretty convinced at this point that I'm BP-I and not II, mainly because of those godawful mixed states things. Also, I've had some classic wacko manias too, and the DSM says you only need one. But what's in a name? You could call it agitated depression as well. I never could figure out what the difference was.
>
> Glad that Zyprexa works for you. None of the APs did a thing for me and if anything made me feel more despairing. I always keep an arsenal of benzos around. Just knowing they're there... I can also snap myself out of a funky blue-type depression if I take an opiate - but it's just a temporary fix. I'm the lithium poster child at any rate. I'm so very grateful it works so well for me. I don't think I would be alive if it weren't for what I learned on this board and marching into my pdoc's office and saying 'I think I'm bipolar'. Duh. I'm so glad that I found the right brands of St. John's Wort to deal with the remaining depression. I'm glad fish oil is making a difference. These days I feel like I have so much to be grateful for.
>
> I totally agree with you about mood stabilizers and agitated depression. My heart goes out to the many of us getting treated for depression with SSRIs alone. They worked for me for a while but man oh man, when they started turning against me it was not a pretty sight. I think it's a travesty that I was seeing one pdoc or another for over 20 years and not one of them ever made this leap of intellect, ever asked the right questions. It's so clear to me now how bipolar I've been most of my life, but not one of them ever questioned the 'major depression' dx and kept substituting one SSRI with another. I know 'mixed states' is rather arcane, but I did have some royal Patty Duke type zingers too, but never made the connection.
>
> Chris, answer me this, can you make any distinction between 'agitated depression' as the subset of major depression it currently is defined as, and 'bipolar mixed states depressions'? And why do some bipolars never get these mixed states? Is it a separate category, a unique DSM they'll someday figure out? To me it seems more than just anxiety and depression, it's a personal little corner in Hell and the 'why' has never been adequately addressed by any of my many shrinks.
>
>
> > Hi barbaracat, it's chris (formerly cpallen79- new screenname now)
> >
> > I agree with your post. I have those awful agitated depressions with intense racing thoughts, paranoia, panic, and despair. I've had two over the past 9 years that were incredibly intense. I've also had couch potato sleep 15 hours a day type depressions too. Like you, I'll take those ANYDAY. Ask me 6 months ago if I thought I was bipolar and I woulda said nope, that is until I started to rapid cycle and alternated between hypomania and depression and anxiety. It was quite a discovery that still presents problems but I'm working through it and faithfully taking my meds, and goign about my business. I need to take an SSRI for my ocd and will not give it up, which may or may not exhasberate the problem. Mood stabilizers have helped, but it's all a balancing act. For me, a combo of mood stabilizers and antidepressants have helped and when things start to get out of control, I pop Zyprexa, extra trileptal, ativan, and some bendryl.
> > I think that those with agitated depressions need to really consider adding mood stabilizers or anti-psychotics into their cocktail.
> >
>
Posted by barbaracat on January 3, 2005, at 20:35:02
In reply to Re: Those are hypomanias » barbaracat, posted by banga on January 3, 2005, at 20:08:39
Amen to that. Depression really derails life. It's bad enough when other people are blaming us for not coming through, but when we're beating on ourselves - yuck, very counterproductive and very sad. Gollum comes to mind. When you get down to it, though, I can't think of too many people who aren't very screwed up in one way or another. But, yeah, they might be sad and frustrated but the messy house thing and avoiding calls is indicative of how bad it really is.
The thing is, I love a clean orderly environment. Some people couldn't care less, but I do, very much so. I go into cleaning overdrive when I'm feeling well. It's just real tough to keep things in order when I'm putting the car keys in the refrigerator, the scissors in the hamper, etc. I've really done this and it's funny in retrospect, but when I can't find those those car keys it's not so funny. Thankfully, I've got a husband who just shakes his head and does his best to keep things sane.
> Yes, the fallout is so awful. For me its the depression--all the avoided phone calls, undone projects, broken deadlines and promises, and yes the messy house,...it must get so old for those who know me, to have me one day come into the room with sort of an "I'm back and on the ball!!" attitude, only to have me slip away from the radar screen yet again for weeks on end.
> The self-loathing is agony. The amount of relief you get in saying to yourself--"you're not iresponsible, lazy and uncaring, you have a disease" is very minimal.
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.