![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 28. This is the beginning of the thread.
Posted by Janice on April 16, 2000, at 22:25:15
The more I read about this disorder, the less hope I seem to have. With all my changes that I make, I feel like I just go from one state of bad to another state of bad.
I know this isn't the best place to look for happy, stable rapid cyclers, but if anyone has had any luck, please let me know.
I am especially curious as to whether anyone has ever had anyluck with ADs…ever!
Thank you for your time and effort, Janice
Posted by Chris A. on April 17, 2000, at 2:01:22
In reply to Any happy, stable rapid cyclers out there? , posted by Janice on April 16, 2000, at 22:25:15
Dear Janice,
I empathize with your dilemna, because it is mine. If it weren't for my relationship with God and a loving family that I don't want to hurt irreparably, suicide would be the logical answer to the pain that never goes away. It continues to be a constant temptation. It seems logical to give a depressed person antidepressants, but they seemed to complicate my depression. I wonder if the mixed/rapid cycling symptoms would have started if I had never taken them - especially our friend Prozac. In six hours is my fifteenth ECT treatment since the latter part of January. It would be nice not to have to go that route and they're not a magic fix, but they do help keep me out of the morgue. In trying to spread the treatments out I ended up inpatient for safety reasons a week ago. Omega three essential fatty acids (specifically 6.2 grams of DHA and 3.4 grams of EPA) are one treatment I am trying and I'm not sure how long it takes to kick in if it's going to. Life-style-hygiene is easier to believe in than to
acomplish - sleep, exercise, relationships, faith, light, healthy diet, etc. Just when I have a handle on one area, something happens. My sixteen year old and I had a great time walking together until I sprained my ankle recently. One of my treatment team has mentioned the vagal nerve stimulator a couple of times. Since we have waited this long, I would like to see what the results of more clinical trials are. There always seems to be a honey moon phase with new treatments. Frankly, I wish Lithium would have worked. Life would have been so much simpler. We've tried everything out there, and I am very weary of it all. Yes, that includes buprenorphine and nimodipine. Are you also hypothyroid? I take Cytomel and Synthroid. We're always having to mess with the doses. Currently I can tell that my TSH is higher than our target of 1-2. At times we have overly supressed my thyroid, and that doesn't work either. I had Hashimoto's thyroiditis some 14+ years ago. Sorry that I don't have any great encouragement. We can make it one minute at a time with a lot of help. Have you gone to see a consultant that works with refractory illnesses? If my consultant comes up with something that works, I'm nominating him/her for the Nobel prize. If some great answer comes my way I'll let you know.Blessings,
Chris A.
Posted by KarenB on April 17, 2000, at 11:23:27
In reply to Any happy, stable rapid cyclers out there? , posted by Janice on April 16, 2000, at 22:25:15
Hey Janice,
Does a happy, stable FORMER rapid cycler qualify?
The only AD that ever worked for me was Amineptine, a "mood brightening psychostimulant." Nothing else worked - ever. And, I have tried many SSRIs (worthless- made me feel sleepy or crazy) and Tricyclics (fine, if you don't mind constipation 24/7).
Turns out, I'm ADD. Whadayaknow? I was diagnosed prior to two years ago as "Major Depressive Disorder," then by the last three docs as Bipolar with rapid cycling and mixed states. Problem is, they couldn't find a single AD that worked and mood stabilizers made me too ill to function.
Then, I discovered the babble board and couldn't help but notice that all the ADD people sounded exactly like me. So, I went to the ADD sites, took some tests, did some research, re-evaluated my life and am thoroughly convinced that I have been ADD as long as I can remember. My first symptoms were evident at age 5. But, I didn't have the hyperactivity, was not disruptive so was never diagnosed.
Anyway, all that to update you: I have been on Ritalin ONLY for more than a week and have felt good EVERY DAY. Doc wanted me to stay on the Nortriptyline but convinced of the new diagnoses, I ditched it against his orders, got all medication out of my system, putting up with a little insomnia along the way and started "clean" on the Ritalin.
It works. I am stunned. I feel good and completely unmedicated. Ohhhhh, I hope it lasts.
My symptoms without it? Depression, suicidal ideology (almost constant), no energy, sleepiness, frustration, irritability, quick temper, migraine headaches, restlessness, feeling "out of control," procrastination, anhedonia, total lack of interest in life.
My point? If you feel like you are trying everything and getting nowhere, consider that the diagnoses may be wrong and the meds muddying the waters. That was certainly the case with me.
Best wishes for you. I pray that you'll get to the truth.
Karen
Posted by Terri on April 17, 2000, at 13:53:25
In reply to Re: Any happy, stable rapid cyclers out there? , posted by KarenB on April 17, 2000, at 11:23:27
Hi Janice,
Don't give up hope, I have been a Rapid Cycler for years, I have been hospitalized 4 times and I finally found out I am not able to take any of the meds for it. I stopped taking everything except my Xanax, and the rapid Cycling went away, I am now just a Manic-Depressant. It turns out, mine was medication induced. Since November 1999 I have been drug free except for the Xanax, and after 10 years I am now VERY happy, I can think clearly and I am working. Something I never thought I could do again. My Head was too messed up and I was cycling WAY to fast. never knowing what each day would bring.
I would of never known the Rapid Cycling part was drug induced, until one day I could not wake up at all, it lasted about a week and I was falling into things. Finally I called the doctor and was immediatly placed in the Mental Hospital and detoxed. They said my blood was highly toxic from trying so many different meds and all were allergic reactions and I thought it was normal, They said if I hadn't called when I did, I would not of woke up again.
Doing this drug free, I have my mind back and lost the weight from the other meds and I am very Happy.
Best of luck to you Sweetie.
Posted by Mark H. on April 17, 2000, at 19:42:43
In reply to Re: Any happy, stable rapid cyclers out there? , posted by KarenB on April 17, 2000, at 11:23:27
Right on, Karen!!
I have never read that point so well made. I think everyone with refractive depression should eventually TRY stimulants if indicated, whether as primary or adjunctive medication. Among those I've spoken with, people who DO NOT need stimulants know it within a day or two -- it just doesn't help. Likewise, those of us who do need them often seem like we're the most unlikely candidates, yet the stimulants have an immediate and profoundly positive effect on our condition.
Methylphenidate also potentiates some antidepressants. I've said this before, but the combination of ritalin and Effexor (at least with my body chemistry) allows me to get the same AD effect from 1/4 the amount of Effexor that I was taking 6 years ago (150mg/day vs 600 mg/day). That alone is a great blessing, since I avoid most of the side effects of Effexor by taking so little, and I don't have to keep increasing my dosage to get a good anti-depressant effect.
Posted by Scott L. Schofield on April 17, 2000, at 21:08:05
In reply to Re: Any happy, stable rapid cyclers out there? , posted by KarenB on April 17, 2000, at 11:23:27
> Hey Janice,
>
> Does a happy, stable FORMER rapid cycler qualify?
>
> The only AD that ever worked for me was Amineptine, a "mood brightening psychostimulant."This is fascinating. Why did you stop taking it?
Did any of the tricyclics help at all?
> Then, I discovered the babble board and couldn't help but notice that all the ADD people sounded exactly like me. So, I went to the ADD sites, took some tests, did some research, re-evaluated my life and am thoroughly convinced that I have been ADD as long as I can remember. My first symptoms were evident at age 5. But, I didn't have the hyperactivity, was not disruptive so was never diagnosed.
> Anyway, all that to update you: I have been on Ritalin ONLY for more than a week and have felt good EVERY DAY...
> It works. I am stunned. I feel good and completely unmedicated. Ohhhhh, I hope it lasts.Me too. God bless.
> My symptoms without it? Depression, suicidal ideology (almost constant), no energy, sleepiness, frustration, irritability, quick temper, migraine headaches, restlessness, feeling "out of control," procrastination, anhedonia, total lack of interest in life.
PLEASE keep posting updates.
> My point? If you feel like you are trying everything and getting nowhere, consider that the diagnoses may be wrong and the meds muddying the waters. That was certainly the case with me.
Thanks for offering this perspective.
Sincerely,
Scott
Posted by Jan on April 17, 2000, at 23:15:54
In reply to Re: Any happy, stable rapid cyclers out there? , posted by Scott L. Schofield on April 17, 2000, at 21:08:05
I am a rapid cycler "in remission" I guess you could call it. I never take antidepressants to lower the chance of an episode. I'm bipolar 1 on Tegretol and Lithium and Seroquel at present. I spent over 3 years on Depakote ending in 3 hospitalizations and 100 pounds of excess weight. I find that with each episode of rapid cycling, it gets worse. As in quicker changes and more severe. But I am getting wiser as to how to handle myself, to some extent. I go weeks sometimes without a problem that lasts typically a week.
Posted by Janice on April 18, 2000, at 0:22:53
In reply to No! , posted by Chris A. on April 17, 2000, at 2:01:22
Hi Chris, Thank you for all your information on your disorder. I have never been as suicidal since I've increased my lithium. I am still cycling…now it seems like from low to very low.
Yes, it's pain that never goes away. Today I snapped and yelled at my family so much, they kept asking me if I am taking my medication? I feel evil inside.
I remember my rapid cycling from about 20…although I only remember it looking back at my life with the knowledge that I have rapid cycling bipolar.
Please let me know about your ECT sessions. (sounds like they must be helping a bit). If you try the vagus nerve stimulator, and how your Omega three essential fatty acids therapy goes.
A couple of questions for you Chris
•Does your thyroid medication help your mood?
•Do you experience alot of anger?
•Do you find your mood is worse first thing in the morning, and lifts in the late afternoon/early evening?Thank you for sharing all this with me. You've given me some hope, funny enough. Janice
Posted by Janice on April 18, 2000, at 0:30:41
In reply to Re: Any happy, stable rapid cyclers out there? , posted by KarenB on April 17, 2000, at 11:23:27
Hi KarenB,
Glad to hear you found out what your problem is.
Like Mark said, I'd look into an AD if I were you. Feeling suicidal is not, as far as I know, a symptom of ADD. Plus Stimulants can make you a little high the first week or two of taking them.
I believe I too could have ADD. As I was just on Dexedrine for a year, and it helped me alot. Other than the first couple of weeks, I'm uncertain it did much for my mood.
I'm still definately bipolar, unless people with ADD can talk to spirits and sleep solid for 3 days.
Thanks for your imput. It sounds like you are on the right track. I am happy for you, Janice
Posted by Janice on April 18, 2000, at 0:37:19
In reply to Re: Any happy, stable rapid cyclers out there? , posted by Terri on April 17, 2000, at 13:53:25
Terri,
Good god, what an experience! I am surprised you are not angry or feel like wanting to sue the crap out of someone.
I am half thinking of trying that drug-free route. The drugs don't seem to work for us, plus the side effects are sometimes worse than the disorder. Sometimes I think I was better off before medications.
I hope you have some people watching out for you in case you do go manic.
Thanks for your input, Janice
Good luck to you
Posted by Terri on April 18, 2000, at 6:31:43
In reply to Terri, thanks… , posted by Janice on April 18, 2000, at 0:37:19
Hi Janice,
Yes, I am fine, the manic episodes are not as hard to tolerate now. I wanted to find ME again, and that is what happened, and those meds they were giving me, took me from 110 pounds to 200. Now I am down to 153 as of yesterday, the weight seems to fall off, therefore, also getting rid of alot of the depression, the weight gain alone will also depress you. I have had 7 years of therapy and know how to handle the Manic episodes, and am doing fine,.
My family said they thought I was crazy when I was on all those meds, Now I am OK, I can actually have my 2 yr old Granddaughter spend the night. People trust me again and it is a wonderful feeling.
Posted by Scott L. Schofield on April 18, 2000, at 9:58:36
In reply to Re: Any happy, stable rapid cyclers out there? , posted by Jan on April 17, 2000, at 23:15:54
> I am a rapid cycler "in remission" I guess you could call it. I never take antidepressants to lower the chance of an episode. I'm bipolar 1 on Tegretol and Lithium and Seroquel at present. I spent over 3 years on Depakote ending in 3 hospitalizations and 100 pounds of excess weight. I find that with each episode of rapid cycling, it gets worse. As in quicker changes and more severe. But I am getting wiser as to how to handle myself, to some extent. I go weeks sometimes without a problem that lasts typically a week.
Hi Jan.How are you today?
Are you happy with the way things are going? If so, please disregard the rest of the following:
Are you still cycling?
Can you describe your cycle in detail:
1. How often does the cycle run its full course?
2. In what order do the different phases occur?
- Normal -> Mania -> Depression
- Normal -> Depression -> Mania
3. How long does each phase last?
4. For what reason were you hospitalized?
5. How would you describe your manic state?
- Euphoric?
- Psychotic?
- Mixed State?
- Hypomanic?
- What sorts of things do you do while in a manic state?
6. Do you feel that Tegretol is contributing to the improvement in you condition? Why?If you are still cycling, it is CRITICAL that you find a treatment to abolish or minimize it as much as possible. As you have already seen, things become worse if cycling is allowed to continue.
Treatment with a combination of mood-stabilizers is probably necessary. Lithium seems to be filling its role as well as can be expected in a rapid-cycling presentation. I would keep it. There is no reason why three mood-stabilizers cannot be used, and sometimes seems to be necessary when treating rapid-cyclicity.
Adding Tegretol was a good choice.Obviously, Depakote is not a good choice for you. I’m going to try to check out a paper recently written by the Department of Psychobiology of the NIMH division of the NIH. It was published in the Journal of Clinical Psychopharmocology. From what I understand, it is a summary of a decade’s worth of experience in treating difficult cases of depression and bipolar disorder. They always emphasize the utility of polypharmacy. I read some of their stuff a few years ago. They seemed to like the lithium-Tegretol combo, but commented that the addition of Neurontin or Lamictal may be a good idea if rapid-cycling continues.
If I manage to find the article, I’ll post something about it.
- Scott
Posted by Jan on April 18, 2000, at 11:49:18
In reply to Re: Any happy, stable rapid cyclers out there? , posted by Scott L. Schofield on April 18, 2000, at 9:58:36
I am not cycling today, but I can answer your questions if you are curious.
I rapid cycle for about a week at a time.It goes from manic->depressed->manic->depressed...
lasting from minutes to hours. I feel like Dr.Jekyll and Mr.Hyde. I can be sitting, enjoying a "hypomanic moment" and WHAM, depression hits me like a blanket of bad news and I've suddenly lost all interest in life, for no reason. I usually just try to sleep it off to avoid the crap that comes with it like contstant reoccuring thoughts.
I'm still fasinated by the oxymoron of "mixed state", but I seem to experience that also.
I was hospitalized for 1. full blown mania. 2.threatening to put myself into a coma by overdosing to avoid the rapid cycling. 3.being suicidal which comes at the drop of a hat with depression, no matter for what length of time. It is so weird, because today, suicide is furthest from my mind, I feel normal, like I'm not on drugs. But every time I stop them, I start going crazy immediately.
My manic state:
> - Euphoric? definately,I think I'm to help mankind totally, I'm sexually excited, I want to be outside in the cool temperature, wide-eyed, loud,energetic,I want to walk,talk, write in my journal, be reckless,daring,not tired,intense, my mind goes faster than my mouth or body,secretive from my husband, the typical bi-polar stuff.
> - Psychotic?
What is this, well, since you'll never know me, yes, I do tend to get that way at times, but I go to bed so I can keeep it under control.
> - Mixed State? yes
> - Hypomanic? been there, do that.
> - What sorts of things do you do while in a manic state?
In addition to what I've mentioned, I drive fast and listen to my favorite Micheal W Smith tape. I'm very restrospective.
> 6. Do you feel that Tegretol is contributing to the improvement in your condition?
I started it recently and had 3 bad rapid cycling days about 3 weeks into it, so it is too early to say.I've lost some weight already, just never hungry, nice change !Your expertise and concern surprises me. I've gone to lots of psychiatrists and they don't ask many questions and think they already know what I need, like I'm a generic patient. thanks
Posted by Scott L. Schofield on April 18, 2000, at 15:44:29
In reply to Re: Any happy, stable rapid cyclers out there? , posted by Jan on April 18, 2000, at 11:49:18
Hi Jan.
> I am not cycling today, but I can answer your questions if you are curious.I guess I am less curious than I am interested to help. It's really cool when people here help others and these others help them right back.
> I rapid cycle for about a week at a time.It goes from manic->depressed->manic->depressed...
The order in which these phases occur has importance:
1. Normal -> manic -> depressed is the usual presentation.
2. Normal -> depressed -> manic is infrequent, and may respond differently to treatment.
After a period of euthymia (normal mood), which is the first phase to appear? Which occurs more abruptly: mania -> depression or depression -> mania?
> It goes from manic->depressed->manic->depressed... lasting from minutes to hours. I feel like Dr.Jekyll and Mr.Hyde. I can be sitting, enjoying a "hypomanic moment" and WHAM, depression hits me like a blanket of bad news and I've suddenly lost all interest in life, for no reason.
This is familiar to me. I can see how it would be difficult to discern a discreet period of euthymia that might occur between the depressed and manic/hypomanic states. My "up" periods never reached the point of mania or hypomania. They actually fell short of euthymia, as I learned in retrospect when I first responded to an antidepressant. However, the cycle was strikingly obvious - 8 days of severe depression followed by 3 days of near-euthymia. The switch from one state to the other occurred over the course of 30 - 60 minutes. This cycle never varied by more than half a day, and only skipped once. It skipped over my "up" period - figures. This presentation is considered to be ultra-rapid cycling.
Would you say that your cycle displays this sort of regularity?
> I'm still fasinated by the oxymoron of "mixed state", but I seem to experience that also.
Whether or not one experiences a mixed-state instead of a euphoric mania is another important criteria for guessing at a course of treatment. Nothing you have described here resembles this.
Perhaps this is a better question: Are you a happy manic, or are you an angry, irritable, impatient, or unhappy manic?
> I was hospitalized for
1. full blown mania.This is what I had guessed.
2.threatening to put myself into a coma by overdosing to avoid the rapid cycling.
Understandable.
3.being suicidal which comes at the drop of a hat with depression, no matter for what length of time.
The initial drop into depression is precipitous, and can be the time when it is most severe.
> It is so weird, because today, suicide is furthest from my mind, I feel normal, like I'm not on drugs. But every time I stop them, I start going crazy immediately.
Starting and stopping drugs is worse than taking no drugs at all.
> > Do you feel that Tegretol is contributing to the improvement in your condition?
> I started it recently and had 3 bad rapid cycling days about 3 weeks into it, so it is too early to say.I've lost some weight already, just never hungry, nice change !
You seem to display episodic ultra-dian (ultra-ultra) rapid-cyclicity. You experience several dramatic mood-switches during the course of a single day.
How long have these cycling periods generally lasted in the past as contrasted to the three-day period you describe above?
Are the periods of euthymia between these episodes variable in length?
Since adding lithium, have the euthymic periods between episodes become longer - have the cycling episodes become less frequent?
> Your expertise and concern surprises me. I've gone to lots of psychiatrists and they don't ask many questions and think they already know what I need, like I'm a generic patient. thanks
Doesn't that suck? There are people here with far more "expertise" than I can offer. I hope you see more replies.
Sincerely,
Scott
Posted by KarenB on April 18, 2000, at 16:24:56
In reply to Re: Any happy, stable rapid cyclers out there? , posted by Scott L. Schofield on April 17, 2000, at 21:08:05
Scott,
Your questions:
> The only AD that ever worked for me was Amineptine, a "mood brightening psychostimulant."
This is fascinating. Why did you stop taking it?
Did any of the tricyclics help at all?
Amineptine is a "modified" tricyclic, whatever that means. It was discontinued by the manufacturer, reportedly because of "potential for abuse," although it was used successfully in Europe for decades. Go figure. I never even had the desire to abuse it while I was taking it and that was almost two years. No other tricyclics worked but I only tried Pamelor and Vivactil. SSRIs ALL made me worse, in different, creepy ways. I tried Prozac, Paxil, Effexor, Serzone and Zoloft. Wellbutrin made me feel all tense and triggered my migraines. Depakote made me crazy, Lithium made me hurl.
Thanks so much for your interest. I will keep you updated. So far, the Ritalin alone does affect my mood positively. I have had NO symptoms of depression since I started it, over a week ago. This is nothing short of a miracle to me.
Best to you,
Karen
Posted by Chris A. on April 18, 2000, at 18:56:35
In reply to Chris A…thanks a couple of questions, posted by Janice on April 18, 2000, at 0:22:53
Dear Janice,
> Please let me know about your ECT sessions. (sounds like they must be helping a bit).
They are is helping a bit. I still have a lot of reservations about doing it. I do experience some short term memory difficulties and confusion. This series has all been unilateral with lower than average stimulus intensities. We do them on an outpatient basis and I am home by 8:00 a.m.
> A couple of questions for you Chris
> •Does your thyroid medication help your mood?
Can't answer definitively on that one. I've been taking the thyroid for fourteen years, but the Cytomel (T3) only for about six months. It clearly helps regulate my weight and energy.
> •Do you experience alot of anger?
Some. It's something that I definitely try to keep under control.
> •Do you find your mood is worse first thing in the morning, and lifts in the late afternoon/early evening?
That's true for periods, but there are also times when the opposite is true. My life is about 90% depression. Sometimes it just happens to be laced with racing thoughts, irritability, rapid speech, a heavy foot and forgetting to sleep. The rest of the time it is slower than molasses in January - not of much interest in anything and very little motivation. Most of the time I am fighting for the will to go on. All of my hospitalizations have been for being suicidal. My diagnois is officially "mixed," which fits.
If anyone has any great suggestions, I am open. In the meantime there is a salmon in the oven for dinner.Please forgive me if I was too much of a downer the first time around.
Chris A.
Posted by Janice on April 18, 2000, at 20:45:50
In reply to Re: Janice -answers to a couple of questions, posted by Chris A. on April 18, 2000, at 18:56:35
you a downer? on this board? please!
my depression lifted today…what a relief (for 3 days).
Thanks Chris A. I'll be thinking good thoughts for you--especially during my up cycle. I cannot think of a worse way to live--except maybe with constant physical pain.
You're eating the right thing for dinner. Janice
ps. I'm such a coward, I'd half to hire someone to do my suicide.
Posted by Jan on April 18, 2000, at 23:25:11
In reply to Re: Any happy, stable rapid cyclers out there? , posted by Scott L. Schofield on April 18, 2000, at 15:44:29
Say What ? You're a bit too anylytical for me today. All I know is that sometimes I feel like crap and sometimes I don't.
And by the way, I don't make a practice of going off my meds.PS How did you guess I'd been hospitalized for mania ? I feel paranoid like you're in my brain.
Jan
Posted by Chris A. on April 18, 2000, at 23:41:39
In reply to Chris A…, posted by Janice on April 18, 2000, at 20:45:50
Dear Janice,
I'm happy to hear your depression lifted. I pray that it stays that way for a while - like even forever.
Regarding suicide - I don't believe it is ever right regardless of how I feel or think (since I believe there is a Designer), so try to remember to seek help when I am over the edge. Different people have to battle with different foes in life-guess this is one of mine.I wish you well,
Chris A.
Posted by Scott L. Schofield on April 19, 2000, at 9:21:38
In reply to To Scott L. Schofield, posted by Jan on April 18, 2000, at 23:25:11
> Say What ? You're a bit too anylytical for me today. All I know is that sometimes I feel like crap and sometimes I don't.
O.K.
> And by the way, I don't make a practice of going off my meds.
Good.
> PS How did you guess I'd been hospitalized for mania ? I feel paranoid like you're in my brain.Don't worry, I'm not.
As far as how I guessed that you had been hospitalized for mania, let's just say that I've been there. Mania, for me, is more embarrassing than depression, and I tend to keep it a secret. You probably regret saying anything about it. I hope you come not to. If you read this board, you will see that quite a few other people have described their manic episodes. This includes me. Different types of mania respond to different drugs. This is why an accurate description is necessary to receive appropriate treatment. I was not trying to pry from you private information just for the hell of it.
You might as well forget everything I wrote in my previous posts. They probably don't apply to you. Perhaps you are not a rapid-cycler at all. If you have not been "officially" diagnosed as such, I would be careful using the term.
Most of the people here who think of themselves as being rapid-cyclers do not appear to be so from their descriptions. Frequent changes in mood or "mood lability" are not the same as "rapid-cyclicity". The term "bipolar" also seems to be used a bit loosely, in my estimation.
Anyway, if you are a true rapid-cycler, the addition of Neurontin, Lamictal, or perhaps Topomax is a strategy well worth consideration. You are definitely bipolar, though. If depression continues to be a significant obstacle in your life, using an antidepressant might be a good idea. Of course, doing so carries a risk of causing a switch into mania. However, the mood-stabilizers you are taking may prevent this from happening.
It sounds like you have a good doctor. All three of the drugs that he has chosen for you are appropriate and demonstrate that he possesses good clinical insight.
Good luck. I apologize for upsetting you. Listen to your doctor. He deserves more of your confidence than do I.
Sincerely,
Scott
Posted by Brenda on April 19, 2000, at 10:06:50
In reply to Re: To Jan - Don't listen to me., posted by Scott L. Schofield on April 19, 2000, at 9:21:38
> > Say What ? You're a bit too anylytical for me today. All I know is that sometimes I feel like crap and sometimes I don't.
>
> O.K.
>
> > And by the way, I don't make a practice of going off my meds.
>
> Good.
>
>
> > PS How did you guess I'd been hospitalized for mania ? I feel paranoid like you're in my brain.
>
> Don't worry, I'm not.
>
> As far as how I guessed that you had been hospitalized for mania, let's just say that I've been there. Mania, for me, is more embarrassing than depression, and I tend to keep it a secret. You probably regret saying anything about it. I hope you come not to. If you read this board, you will see that quite a few other people have described their manic episodes. This includes me. Different types of mania respond to different drugs. This is why an accurate description is necessary to receive appropriate treatment. I was not trying to pry from you private information just for the hell of it.
>
> You might as well forget everything I wrote in my previous posts. They probably don't apply to you. Perhaps you are not a rapid-cycler at all. If you have not been "officially" diagnosed as such, I would be careful using the term.
>
> Most of the people here who think of themselves as being rapid-cyclers do not appear to be so from their descriptions. Frequent changes in mood or "mood lability" are not the same as "rapid-cyclicity". The term "bipolar" also seems to be used a bit loosely, in my estimation.
>
> Anyway, if you are a true rapid-cycler, the addition of Neurontin, Lamictal, or perhaps Topomax is a strategy well worth consideration. You are definitely bipolar, though. If depression continues to be a significant obstacle in your life, using an antidepressant might be a good idea. Of course, doing so carries a risk of causing a switch into mania. However, the mood-stabilizers you are taking may prevent this from happening.
>
> It sounds like you have a good doctor. All three of the drugs that he has chosen for you are appropriate and demonstrate that he possesses good clinical insight.
>
> Good luck. I apologize for upsetting you. Listen to your doctor. He deserves more of your confidence than do I.
>
>
> Sincerely,
> ScottScott - I agree with your supposition that the "bipolar" designation is most likely overused. In my opinion, bipolar seems to be the current diagnosis for everything. The first pdoc I saw diagnosed me bipolar and put me on Topamax. I never believed I was bipolar - especially the bipolar II diagnosis. That one's getting to be very common. The symptoms closely match an anxiety disorder which is what I have, also depression. I was much improved when I changed pdoc's and told the second Doc I wasn't going to take it anymore. That I wasn't bipolar and I wanted the diagnosis changed. Thank god - this one listened to me. Mood lability is associated with depression as well as anxiety. My concern is that with all this bipolar I and II diagnosing going on, perhaps I'm not the only one who was misdiagnosed and put on meds that weren't necessary. Bipolar indicates the EXTREMES in poles, not mood lability. I've mentioned I work for a psychiatrist, and what I've seen is there is a lot of use of the term "manic" or manicy, when in fact it isn't mania at all, but anxiety, agitation or mood lability. Bipolar is a very serious diagnosis and the current trend to diagnosis as bipolar is rather alarming to me.
Thanks - that was my two cents. Brenda
Posted by Jan on April 19, 2000, at 11:03:32
In reply to Re: To Jan - Don't listen to me., posted by Scott L. Schofield on April 19, 2000, at 9:21:38
I have offended you and I should not have done that. (paranoia is my greatest weakness)
I like mania somewhat because it is near my natural temperament. But I'm not going to take antidepressents to risk inducing an upper.
I have found in my experiences with psychiatrists that it is best not to tell them what to prescribe. They are the "holder of the prescription pad".
I am "officially" a rapid cycler.
My dotor is a jerk, he put me on high doses of 3 mood stabilizers plus the Seroquel and made me toxic. When I called him, he asked why I was on so much medication. Also,he wanted me off the Seroquel and I about went crazy. I'm to see a new doc. soon.
I don't put much confidence in doctors. But I'm at their mercy for my life. AND THEY DON'T CARE.
Jan
Posted by Scott L. Schofield on April 19, 2000, at 23:40:56
In reply to To Scott, may I call you Scott? , posted by Jan on April 19, 2000, at 11:03:32
Dearest Jan,
You have not offended me. The "Don't listen to me" was not meant to be a retort nor a sarcastic remark. It was more like a "Never mind". I was upset that I may have done something to hurt you rather than help you.
> I like mania somewhat because it is near my natural temperament.
It can feel pretty damned good. The problem is, when the dragon gets loose, it can do quite a bit of damage.
> But I'm not going to take antidepressents to risk inducing an upper.
I'm kicking myself because I forgot to ask my doctor for his copy of the J. Clin. Psychopharmacology that I was telling you about. Damn. I do know that those NIMH researchers I mentioned had become less quick to use antidepressants in bipolar disorder, especially in rapid-cycling presentations. It is nice to be able to fix everything with mood-stabilizers. However, they still use antidepressants when necessary.
> I have found in my experiences with psychiatrists that it is best not to tell them what to prescribe. They are the "holder of the prescription pad".
This is sometimes a difficult line to walk. Keep reading PsychoBabble to see how others have become pro-active in there own therapy. Perhaps you can find a balance that suits you. I'm not sure it is to your advantage to remain passive. You do have some control. It is important to communicate with your doctor and let him know what's going on. Write stuff down, and be as detailed as possible. Ask questions.
> I am "officially" a rapid cycler.
Neurontin may help.
> My dotor is a jerk, he put me on high doses of 3 mood stabilizers plus the Seroquel and made me toxic. When I called him, he asked why I was on so much medication. Also,he wanted me off the Seroquel and I about went crazy. I'm to see a new doc. soon.
> I don't put much confidence in doctors. But I'm at their mercy for my life. AND THEY DON'T CARE.
Perhaps your first doctor didn't. I know that many do. Mine does. I am lucky. If you have lost confidence in this doctor or don't feel that you interact well with him, seeking someone new sounds like a good idea.
Speak to you soon.
Good luck.
- Scott
Posted by Jan on April 20, 2000, at 11:20:00
In reply to Re: To Scott, may I call you Scott? - Yes :-), posted by Scott L. Schofield on April 19, 2000, at 23:40:56
Scott, I had a totally trippy day yesterday. I was sailing fairly high and thought I was just in a good mood, then it turned weird and I think I was mixed. I started feeling that I did not like it anymore and I'd rather be depressed and I was a little scared. I wanted the magic emotion fairy to zap me into one feeling and pick it for me. This is how I felt and if you would, help me put a label on it. My handwriting went jerky,I had contained energy yet I felt exhausted. I went to take a nap but couldn't stay there. I was tired of "doing" and just wanted to escape from all responsibility. Yet felt like "doing". I know it seems impossible. But I just report 'em as I experience 'em. I felt like throwing things and screaming and having a fit. Which is so totally opposite of how I am. I've never thrown anything in my life. Anyway, I went to choir practice because Easter is coming up and I needed the practice and I thought it would take my mind off myself. Well, we have an hour of prayer first and I couldn't sit still and kept having to leave. Then in choir practice I "crashed" I guess they call it and fell apart and left crying UNCONTROLLABLY. I was anxious (as in bad) to be around people while a friend came to talk to me as I was leaving. She offered to take me home and I said I was "a big girl" and left. After about half an hour, I was playing a game with my family and doing ok. I did not sleep well. The last few days I've been sleeping less and less. I usually need 9 hrs. a night, last night it was 6. Today I see a social worker from the Co. Health Dept. I've had this appt. for weeks. Then I'll hook up with a psychiatrist. My favorite people:( I've seen about 7 different ones.
So was that mixed state or rapid cycling or manic ,disphoric ???????????
Looking forward to your reply. Jan
Posted by Scott L. Schofield on April 21, 2000, at 11:54:24
In reply to To Scott, posted by Jan on April 20, 2000, at 11:20:00
Hi Jan.
I am curious as to whether or not you have ever taken Neurontin.
If so, what dosages did you try? What other drugs were you taking at the time, and at what dosages?
I forget, have you made any recent changes in medication?
> So was that mixed state or rapid cycling or manic ,disphoric ???????????You described some very, very nasty stuff to have to experience. I empathize with you and wish that things were not so difficult. I am not sure if what you describe represents a mixed-state or an intermediate state that occurs during a transition from a normal (or manic) state into a state of depression.
At this point, I would suggest keeping a daily journal or diary and post mood-ratings and brief descriptions of what you experience. Use a numerical rating system. Let 0 represent rock-bottom, 10 represent normal, and use numbers of 11 and higher to represent mania. I think you should make three entries - one for morning, afternoon, and evening. If you feel the need, add no more than two entries. Too many entries might be confusing. Try to establish a regular schedule, rating yourself at the same times each day. Perhaps include a one-sentence description along with each rating. Leave more detailed information to be written at the end of each day's log. In addition, I recommend that you document your sleep each day. Include the time you go to bed, how long it takes to fall asleep, how many times you wake up during the night (just guess - don't get up and turn on the light to write an entry), and what time you awake. You may also want to describe your eating patterns. It may not be a bad idea to get some input from your husband. Keeping track of one's own manic states is often very difficult.
Keeping such a journal will provide important diagnostic information for your doctor, along with a way to chart how you respond to different treatments.
Let's see how things go.
- Scott
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