![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Abby on February 9, 2000, at 19:09:23
Noa's right. I never described my symptoms. Here's a brief history. I always struggled some and may have been dysthymic all my life, but I also had a terrible time as a child, because my mother is really crazy, paranoid etc., and I could not keep her chaos away from me.
When I was 19 and a sophomore in college (fall of 94) I slipped into a ‘moderate' depression. I was rotten company, but I felt a little bit safer when I read in the room of one of my old roommates. Friends were worried, and I sought help in late October. I got a couple of counseling sessions with a social worker, but I couldn't really get them to take me seriously. I was clear that I needed help (I don't think they really believed me) but couldn't afford outside help. I was clear about my mother and the fact that my Dad's mother was manic-depressive. I first went in in late October; it wasn't until mid to late December, just a day before Christmas break that they finally referred me for a 20 minute psychiatric consult. I was prescribed Zoloft, written out always as sertraline, starting at 25 mg and then up to 50 mg. For a while it was great, and then I felt ‘normal' though slightly better than I had been in the past.
I stayed at 50 mg for 4 years. I noticed that I felt worse in winter and tried some light therapy. The psychiatrist said I might try it out, but he never bothered to supervise the light therapy. I felt more comfortable sitting in front of the bright light while I did my work, but I still felt worn down by winter. In general, I feel off and awful during most of the winter---tired, slow, stupid and sleepy. October and November are somewhat worse than January, when I usually feel really good for about a week. I always tried to get things taken care of--summer plans and fellowships during good weather, but of course the applications were never ready. I also notice that my visual acuity is reduced in winter.
Early spring and summer is the most comfortable for me, but high heat and humidity really wipes me out.
In the summer of 1998, I weaned myself off of the Zoloft without medical advice. I had no objection to being on the drug; it's just that I didn't have a prescription. Following graduation in 1997 I was very aggressive about looking for jobs, but I never fit or I didn't have the right resume to work in business. Nor was my resume appropriately tailored etc. In desperation I had gone for some advice from a firm in Cambridge, MA called Interim. Their main business was helping high school students plan a year off. They waved all kinds off possibilities from various contacts, including an international business experience in Germany. In the end, they referred me to some people in England who said they could set up an internship and teach me finance. That was a disaster; they never did get me a proper internship; they had no connections, and the tutor they found was interested in marketing. On the life front, I'm applying to law school for next year, but I need a real job w/ benefits now. So, I need to get better fast and would prefer drugs which don't require expensive blood tests.
I had tapered the medication, figuring that I could hold out until I was in England where I could get National Health benefits. As it turned out, I wasn't really a student, and I hunted around for a private psychiatrist; there were only two in Oxford. The one who agreed to see me seemed to think that I just had the common cold of mental health--depression and upped the dose to 100mg of Zoloft. I was better. I tried to talk to him about cyclothymia, but he didn't believe me. (My mother had beeen briefly committed in January 98, and thought to be atypical bipolar rather than schizophrenic.)
One of the things I noticed was that in April and May in England when spring came, there was an exacerbation of certain unpleasant symptoms associated with spring. I think that this may have to do with the fact that England is further north than the U.S., and once the days got longer. Overall I feel better in spring, but I was starting to feel a bit antsy, couldn't sit still or had to be doing something---even if that was reading. Sometimes, though I felt so activated that I had to listen to very regular classical music; this usually helped after a few hours. Sometimes I had to lie down in a dark room for up to 45 minutes.
More recently, I've been experiencing these energized states along with periods when I break into tears after almost nothing. Twice in the past two weeks, but it only lasts one day; I think it would be too exhausting otherwise. After an awful time Friday, I was really productive for two days, then sort of normal, then I had an unpleasant ‘hypomanic state' again. Sometimes driving--more even than walking calms me a bit---but while I am actually driving. I also think that taking a long hot bath might help, but this really terrifies me, because my mother used to take endless baths.
I've also noticed a kind of depression where the weight of it is so oppressive that I have to walk. Exercise helps I know, but for me this is partial symptom relief if I pace in a room, not behavior most people appreciate.
Right now I'm taking 150mg Zoloft in the AM and 300mg of lithium at night; I've been on this regimen since mid-October. I'm wondering whether I ought to add an anti-convulsant mood stabilizer, one which might be more appropriate to ‘rapid-cycling'. I'm a little wary of Depakote, because we got my mother into treatment briefly, and depakote just zonked her out.
So I'm wondering about Lamictal and Neurontin. The predominant problem is depression, but there is considerable mood lability.
So, any advice is much appreciated.
Posted by Janice on February 9, 2000, at 21:31:07
In reply to My symptoms and history (longish). Please help , posted by Abby on February 9, 2000, at 19:09:23
why not take more lithium before you try something else? Most people take about 900 mg to 1200 mg daily. Janice
Posted by Abby on February 9, 2000, at 23:35:44
In reply to Re: My symptoms and history (longish). Please help , posted by Janice on February 9, 2000, at 21:31:07
> why not take more lithium before you try something else? Most people take about 900 mg to 1200 mg daily. Janice
I know that 300mg of lithium is really low and I mentioned this to the psychiatrist. It's just that lithium is generally less succesful with rapid-cycling and mixed states. So, I wanted to find out about my other options.
Abby
Posted by Janice on February 10, 2000, at 22:05:54
In reply to Re: lithium Janice, posted by Abby on February 9, 2000, at 23:35:44
hello abby,
i am a rapid cycler (8 cycles a month), and use lithium.
it was the third mood stabilizer I tried, and the most successful.
i noticed you mentioned a seasonal component to your moods. i also cycle seasonally, in fact, this is the most powerful force in my cycle.
i would be high as a kite in spring and summer, and then many times couldn't haul myself out of bed in the winter. Janice
bonus - lithium also helps my depression
Posted by Janice on February 11, 2000, at 11:31:14
In reply to rapid cycling, posted by Janice on February 10, 2000, at 22:05:54
hi Abby
i was just rereading your original posting. you may want to look into ADHD also. Abby, I have both manic depression and ADHD, and they can resemble each other. Sometimes they are found together.
How i differentiate mine is by my feelings of self-esteem.
with manic depression, i would feel like i was a great person and could do absolutely anything - well maybe not fly. I felt magical and could sometimes communicate with spirits. I also began to notice it in my teens and it progressed fairly rapidly. I believe the earlier it starts the more likely the manic depression will progress rapidly.
the mixed states, however, were very similar to ADHD.
With ADHD, my feelings about myself are not usually good - but i am tightly coiled and intense. Simple things are difficult and many difficult things are easy. This disorder starts before 6. Often young girls are daydreamy and don't cause problems in school like the little boys do.
I was always rushing around trying to 'get things done', and felt everyone else was 'slow & stupid'. I felt I was living in a slow motion movie picture, and I was irritable as hell.
I would also pace and walk for hours, to help relieve my symptoms. i was not always hyper, sometimes it was hard to get out of bed.
how's your impulse control? do you say things you later regret? Is small talk difficult? any binge eating, or have sex you later regret? change your hair colour alot?
Let me know Abby. I am very curious now, Janice.
Posted by Janice on February 11, 2000, at 21:43:15
In reply to abby, posted by Janice on February 11, 2000, at 11:31:14
just ignore that nonsense I wrote above Abby. I forgot to take dexedrine today, and was a slave to every impulse I had (this includes thoughts that seem to come out of nowhere...and spending an hour on the internet while I had a report due at 4pm today!). I didn't even remember that I forgot the medication until I found myself yelling at my secretary. Now, I am embarrassed to face her on Monday.
If i were you, I'd look into the disorder your mother has (if you don't want to raise your lithium).
Janice.
Posted by S. Suggs on February 12, 2000, at 5:22:11
In reply to Abby needs help with her medications!, posted by Janice on February 11, 2000, at 21:43:15
Abby, for what it is worth, I am dysthymic and have add-h. I currently take parnate 80mg and lithium 900mg daily with great results. If you are still unhappy with your med mix, consider an maoi with your lithium (I agree w/ Janice, an increase now or "down the road" would be a good idea). Best wishes and blessings!
S. Suggs
Posted by Janice on February 16, 2000, at 23:29:26
In reply to Re: Abby needs help with her medications!, posted by S. Suggs on February 12, 2000, at 5:22:11
I haven't seen you posting lately. Glad to hear you are doing well, and the Parnate & Lithium are doing their jobs. It gives the rest of us inspiration when someone does so well!
take care, Janice
Posted by S. Suggs on February 17, 2000, at 6:28:16
In reply to hello S. Suggs!, posted by Janice on February 16, 2000, at 23:29:26
Janice, thanks for the note. I've been on the road / air for job interviews. Been unemployed since August. Whenever a "burst of interviews" comes along, I just have to focus on that first, plus there are some woodworking(hobby for several years) sites I am visiting as well. Take care, and of course, blessings,
S. Suggs
Posted by Noa on February 17, 2000, at 17:54:29
In reply to Re: hello S. Suggs!, posted by S. Suggs on February 17, 2000, at 6:28:16
Good luck with the job search, an activity I personally consider to be one of the most taxing there is.
This is the end of the 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.