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Dr. Bob is Robert Hsiung, MD,
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Posted by Janice on May 5, 2000, at 15:42:10
In reply to need help: unable to recognize manic state, posted by judy1 on May 5, 2000, at 13:20:51
hi judy,
I'm so happy to hear from you again. I was very concerned about you. I always found you to be very charming and informative, and other than your last posting, never that far out there.Just to let you know your not alone, it took me 5 years to tell my psychiatrist I can speak to spirits. It never even occured to me that this could have been a part of my manic depression. I mean if people believe their depression is real, my experience has been that my manias are about twice as believable as my depression. They sure can be dangerous too.
Lithium seems to work fairly well for my manias. But this is how I still monitor myself. Sleep. If I don't get 8 1/2 hours of sleep at night, I have someone watch me. I also closely monitor my eating patterns because for me when I become manic, my body seems to stop sending signals to my brain and I often don't eat much.
For me, if I notice any changes in both my sleep and eating patterns, I have someone keep an eye of me. Plus I have made a 'contract' with this person that I will agree to give up my rights to make decisions for myself-- until I am depressed again.
Hope I've helped you at all judy. I am happy to hear you're alive and out of the hospital.
Sometimes (many times) I'd like to give up all decision making for myself forever because I don't do much better when I am depressed.
Janice
Posted by Janet on May 5, 2000, at 17:54:01
In reply to Re: need help: unable to recognize manic state, posted by Janice on May 5, 2000, at 15:42:10
It may be helpful for you to use a mood chart everyday. Then you can see if there is any change at all. Even when you feel fine (if that exists for you). The Standley Foundation Bipolar Network has a free packet of information plus the chart for free. Call 1-800-518-7326.
Posted by judy1 on May 6, 2000, at 12:52:18
In reply to Re: need help: unable to recognize manic state, posted by Janet on May 5, 2000, at 17:54:01
JohnB: I appreciate your taking the time to post. I'm not really sure if the meds I've taken- depakote, tegretol, lamictal, neurontin, klonopin, ativan, effexor, wellbutrin, prozac, paxil, zyprexa, seroquel and risperdal- those are the ones I remember, worked or not. Mostly because I cycle rapidly, AD's are now prohibited, and I tend to go off drugs when I feel well. I wonder if I have some kind of personality disorder which prevents me from being compliant or if that is the nature of the disorder (in my case). I know I do really self-destructive things, maybe this is another manifestation of that.
Janet: I called the Stanley Foundation for a mood chart, although it's incredibly obvious when I swing. It is an extreme and sudden occurence, I will try to chart but I'm curious if there are actually warnings leading up to an episode- have you found that true for yourself?
Janice: I feel a certain link with you- your spirit talking during mania is similar to my conversations with God. Something in you must have recognized this as abnormal if you kept it from your pdoc, I was happy to share my delusions/hallucinations with anybody which tended to land me up in the hospital. I cannot take Lithium, but have been on all the current mood stabilizers which were effective in mania, but not in depression (with the exception of lamictal which made me hypomanic). My real difficulty may lay with not having a current relationship with a psychiatrist. After my "breakup" with the one I had for 2 years, I have been through seven in the last 6 months (which hardly creates a sense of trust on either side). I like my psychologist, but he isn't knowledgeable about meds, and while I find therapy really helpful it hasn't stopped the cycling. I read a story on some site about a professional (I think an engineer) who functioned well into his 30's- like me- and hasn't worked in 5 years and has basically given up. I'm feeling perilously close to that, but my child keeps me alive. I don't mean to bring you down, you sound well and I hope that is continuing.
Take care, everyone.
Posted by Chris A. on May 6, 2000, at 14:40:12
In reply to Thank you for your input-JohnB, Janet and Janice, posted by judy1 on May 6, 2000, at 12:52:18
Judy,
You sound like you have a lot of insight into what is going on. I am mixed bipolar, rapid cycling, and can empathize. Perhaps while you're at a more stable point would be a good time to set up some guidelines as preventive medicine. I am no poster child. My lifestyle hygiene has lately consisted of lying on the floor and crying. One doc that I liked flat out told me that there's never any reason I need to be up past midnight. He's right and I try to hold myself to it. If I can't sleep I load on the Klonopin and Ambien, as it's better than encouraging mania. Other guidelines include 1) never drive over the speed limit. If I can't drive under it or have to use cruise control to get through town, the hypomania needs to be treated more aggressively. 2) Have significant others that are my intervention team. They understand my illness and are aware that I might contact them anytime day or night for help or feedback. 3) Always stay on a mood stabilizing regimen - whether I like it or not or think it is necessary or working very well. Right now I'm doing a course of ECT, so can't take any anticonvulsants. I have chosen to try Omega 3's - 34 fish oil capsules a day (if it's good enough for Harvard it's good enough for me). My husband also has me adding Choline (found in lethicin, eggs and peanuts to my diet). It was mentioned in the "Bipolar 2000 Expert Guidelines." 4) Exercising moderately (for me it was walking with my teenage daughter until I sprained my ankle) has some benfits for the vast majority of us. My depression doesn't seem to be as severe when I am able to move a bit.
Please don't give up. Look back over the docs you've seen and pick out the one or two you liked the best and see if through letter writing, or whatever, you can get a regular doc. Sometimes I feel a tad paranoid or frustrated with mine and I find it's best to be as open about those feelings as possible. No doc is going to be perfect, but in our case a relationship with one is essential. I ask mine to be honest with me. Since I'm unstable he sends me to a bipolar expert at a university every once in a while for a consult. If nothing else that always offers hope, as he's on the cutting edge and my doc's a whole lot more willing to try new things when he has the list in writing from a well respected expert. The next thing they want me to try is the vagal nerve stimulator. We shall see. My faith in God and my family keep me going. Your child does deserve to have a Mom. It helps to have friends and support in places like this, too.God Bless,
Chris A.
Posted by Chris A. on May 6, 2000, at 14:46:25
In reply to Re: More input, posted by Chris A. on May 6, 2000, at 14:40:12
Judy,
The "rules" I've made for myself are so I can have more freedom, a higher quality of life and health in the long run.Life and Health,
Chris A.
Posted by Abby on May 7, 2000, at 11:54:13
In reply to need help: unable to recognize manic state, posted by judy1 on May 5, 2000, at 13:20:51
Judy,
Given Noa's experience thyroid was on my mind. Wqhybrow and others have found that hypermetabolic doses of thyroid hormones can help with the cycling in some patients. It's worth giving it a try.
Abby
Posted by Janet on May 7, 2000, at 17:20:42
In reply to Thank you for your input-JohnB, Janet and Janice, posted by judy1 on May 6, 2000, at 12:52:18
Judy, I definately have signs that I am going manic, but I ignore them because I like not being depressed and thinking everyone is avoiding me. But after a while, the high gets too high and it is not "fun" anymore. Plus I realize I'm embarrassing myself. Charting is great so I can see what I've been doing, mood -wise. I tend to forget how long the episodes last and how often. The doctors like to look for patterns and at what meds. you have taken.I tend to prelude mania with, being HAPPY, which everyone likes, I feel sexual, full of energy, like doing good for others, don't want to sleep, thoughts are fast-firing, I can't sit still, I drive fast,I can't read.
Then, it turns to laughing when I'm the only one laughing, can't get enough sex, too much energy for my physical body, far out thoughts that I can't stop, hearing bells, ringing, children, seeing people and creatures, driving recklessly, unable to focus, irritated and so on. Just like the literature reads. I see my chart spiraling up and I seek help.
I'm bipolar 1 with rapid cycling.
Janet
Posted by Janice on May 7, 2000, at 22:33:15
In reply to need help: unable to recognize manic state, posted by judy1 on May 5, 2000, at 13:20:51
Hello Judy and Chris A,
I can't bear the thought of you two sitting around with little hope. Here are some other things that I've done that seem to help my bipolar that are not (as far as I know) a common treatment method for rapid cycling depression. I hope I'm not telling you things you already know:
•Have either of you tried stimulants? Sometimes I think Dexedrine has helped my rapid cycling more than lithium. They never make me manic. On my depressed days, When I take them, they keep my energy on an even keel with manic days. They can even get me out of bed on a depressed day, and help with my mood (if I don't use them very often).
•running really seems to help. (you probably know this). I hope your ankle is better Chris A.
•It's probably the illness itself that has made me search out this type of help. I have a really great psychic that can do long distance readings. She has probably helped me more than anyone (and everyone put together). She is one of the most wonderful people I have ever met. Let me know if you would like to know more about her.Thinking and hoping the best for the both of you, Janice
Posted by judy1 on May 8, 2000, at 13:33:17
In reply to Judy Chris A…, posted by Janice on May 7, 2000, at 22:33:15
One of my previous pdocs, I forget which one, strongly recommended I attend a bipolar group he ran for support. I remember saying I didn't want anyone to know I had bipolar disorder and he, totally confused, replied " but everyone there has it." This board is the perfect support group- knowledgeable, compassionate and above all for me anonymous.
Chris- Thank you for the wonderful suggestions, I'm so impressed with how supportive your husband is. I think I have alienated mine with my manic episodes, as I did my first husband. I'm grateful he stays around for our son, and pray that continues.
Abby- My thyroid tested right in the middle of normal range and I've always tended to be more manic than depressed- do you think it still would be worth investigating?
Janet- I don't think you could have given a better description of a manic episode and I agree I probably ignore the warning signs because it feels too good. Once I get into that part where I really am out of control, it's too late, the damage is done. I guess the key is to trust someone enough to intervene, and maybe the mood chart will help.
Janice- I worry dexedrine will just push me up further- I know you have ADHD and that is probably why it helps you. I abused cocaine for years trying to extend my mania, and it worked pretty well.
Again, thank you all. I'm in one of my sleep 20 hours/day mode- I'm sure you can all identify. Take care.
Posted by Noa on May 8, 2000, at 17:22:40
In reply to Many thanks- Chris, Abby, Janet and Janice, posted by judy1 on May 8, 2000, at 13:33:17
Which thyroid test did you have? What phase of your manic-depressive cycle were you in when the test was done?
It is possible that your thyroid fluctuates to reflect your manic vs. depressed moods. Also, being in the middle of the normal range may or may not be normal for you.
Posted by Janice on May 8, 2000, at 21:56:41
In reply to Many thanks- Chris, Abby, Janet and Janice, posted by judy1 on May 8, 2000, at 13:33:17
Hi Judy, I found this article while surfing the internet. I thought maybe you may like it.
Also check out what Peter J says in the thread, 'Drugs for creativity" below.
Take care, janice
How to Avoid a Manic Episode
------------------------------------------------------------------------Whether an episode occurs, when, for how long, and how severe it is depends to a large degree on factors that are within the control of patient and family. For an episode to occur, the following are necessary or sufficient:
1. Genetic vulnerability (necessary)
2. Cyclicity/anniversary (sufficient)
3. Major stressors (sufficient)
4. Lack of support (sufficient)
5. Lack of medication (necessary)
Factors Important for Triggering an EpisodePeriodicity
Many bipolar patients demonstrate a biological rhythm with impressive regularity with regard to mood swings. Cycles of hypomania and/or depression come with predictable occurrence. These tend to be seasonal; spring for hypomania and fall for depression, or summer for hypomania and winter for depression.Anniversary
A significant event, usually an "exit" event -- a loss, such as the death of a significant person, a divorce, a major move, change or disruptions, or a previous episode makes one more vulnerable. The appearance of the episode is one way of dealing or not dealing with the psychobiologically remembered trauma.Stressful Life Events
For some bipolar patients, positive events such as a marriage, graduation, promotion, and honors can be as stress-producing as negative events. For some patients, any major change or deviation from a well-ordered, stable routine may trigger biopsychological disequilibrium.Belief Systems
The way you think about yourself and the world around you has a great deal to do with how you behave. If you believe a hypomanic episode is inevitable and that you have no control over it, chances are the episode will occur in the fashion you have prophesied. Many bipolar patients become victims of self-fulfilling prophecies, assuming little responsibility for modifying behavior that might prevent episodes from occurring. Many patients believe if they continue to take medication regularly, the medication alone will automatically prevent episodes from happening.Recognizing Symptoms
If an episode is to be prevented, accurate knowledge of the symptoms of hypomania and depression are crucial for both bipolar patients and family members.A Support System
There is increasing evidence that individuals who live in an emotionally stable environment or who have significant others available for support during times of stress or crisis have an overall healthier outcome.
Best Way to Avoid an EpisodeThe best way to avoid an episode is to learn well from the first one.
The hypomanic episode clinically presents a clearly recognized, well-defined syndrome. This consists of a cluster of symptoms that include pressured speech; increased, often purposeless activity; marked decrease in need for sleep and perhaps food; and a marked need for instant gratification, attention, and approval. Noticeable irritability and displeasure prevail.
Hostility and argumentativeness occur when the individual is thwarted. There is a need to expand and exaggerate all behaviors. Voices are louder, and the colors of clothing are brighter. There is more spending of money, letter writing, phone calling, travel, gift bestowing, and advice giving.
There is a marked lowering of inhibitions and a pronounced disregard for the rights and feelings of others. There is also increased risk-taking; for example, relationships with strangers are personalized at an inappropriate level and with little regard for social amenities.
How can an Episode be Prevented, Stopped, or Lessened Before Clinical Symptoms Occur?
When the patient is in a stable condition, it is MANDATORY to establish an oral contract that elicits his/her cooperation in permitting a trusted significant person to make an intervention. The patient grants the significant person PERMISSION to intervene to prevent an episode by:
1. Giving feedback regarding patient's thinking, mood and behavior.
2. Calling patient's doctor to arrange an appointment or to discuss treatment.
3. Modifying the living situation to reduce stimulation.
4. Providing consistent, structured, and support reassurance.
When You Notice Hypomanic Symptoms in Your Family Member or FriendPlease remember:
1. Remain calm; do not panic or criticize.
2. Make statements rather than ask questions such as, "Are you getting high again?" Instead, say something like, "You are wound up and seem preoccupied. Let's talk about it." If you meet resistance, don't push; remind patient of the contract.
3. Discuss with patient the fact that he has a choice and options. He can choose to avoid an episode or allow it to escalate and run its course with the probability of hospitalization and the loss of many present gains.
4. Make positive suggestions to:
a. Review activities and decrease schedule by one-third for at least 7-10 days.
b. Reduce stimulation (loud music, noise, light, talking, violent movies, etc.) Enforce a QUIET environment (no visitors or celebrations). Maintain planned, low-key days.
c. Regulate sleep--no naps--stay off the bed until at least 10:00 p.m. and don't get up until at least 6:00 a.m.
d. Monitor medication intake. Increase medication with doctor's approval. Get serum level if on lithium, and make appointment to see doctor.
e. Reassure patient that if he follows these steps, in 72 hours the episode may be aborted.
f. Be positive in attitude and actions. Use your sense of humor.5. Suggest to patient he has internal control to regulate his behavior and thereby alter his biochemistry.
When you have achieved success with this episode, congratulate yourself and the patient. Mark the date on the calendar and write down what you observed and what you did to modify it.
------------------------------------------------------------------------Taken from a paper by Dr. Julia Mayo, Chief, Clinical Studies, Department of Psychiatry, St. Vincent's Hospital
------------------------------------------------------------------------
Posted by Janice on May 9, 2000, at 15:11:02
In reply to Re: Many thanks- Chris, Abby, Janet and Janice, posted by Janice on May 8, 2000, at 21:56:41
I forgot to change the subject line.
>
Posted by Janet on May 9, 2000, at 18:13:02
In reply to How to Avoid a Manic Episode (above)--for Judy , posted by Janice on May 9, 2000, at 15:11:02
Janice, thank you so much for the article by Dr. Mayo. It is so nice to get that information in writing. I printed it out right away. I have a hard time knowing what triggers my episodes. They broadside me so often and I don't know why. I'll study this information more.
Thanks again. I think this is what this site is all about. I love ya man. Am I a little high ???
Posted by Abby on May 9, 2000, at 23:02:49
In reply to Many thanks- Chris, Abby, Janet and Janice, posted by judy1 on May 8, 2000, at 13:33:17
> Abby- My thyroid tested right in the middle of normal range and I've always tended to be more manic than depressed- do you think it still would be worth investigating?
>Per Noa's suggestion I got a book on Living Well with Hypothyroidism by Mary Shomon. "Normal" goes up to 5.5 TSH, but some people think that there are a lot of hypothyroid people included in those samples. Maybe the numbers ought to be more like 1 or 2. Also, as Noa says each individual has a particular need.
It could be that you have enough T4 but not T3, the more active form. Dr. Bob's psychopharmacology tips has some info there. Peter Whybrow did some research on treating rapid cycling patients with hypermetabolic doses---above what endocrinologists would consider normal.Here's a link to his UCLA grand rounds presentation on the topic in 1997. Hope this helps.
Abby
Posted by Noa on May 10, 2000, at 10:11:56
In reply to Re: More thyroid thoughts judy, posted by Abby on May 9, 2000, at 23:02:49
Yep. Some people even have enough T4, which causes a "normal" TSH test, but might be protein associated with changing T4 to T3, for instance. There are other possibilities.
And, my endo has told me it is advisable for me to keep my TSH down below 1. When it was around 3 or 4, I felt lousy.
Posted by Abby on May 10, 2000, at 13:31:40
In reply to Re: More thyroid thoughts judy, posted by Abby on May 9, 2000, at 23:02:49
> > Abby- My thyroid tested right in the middle of normal range and I've always tended to be more manic than depressed- do you think it still would be worth investigating?
> >
>
> Per Noa's suggestion I got a book on Living Well with Hypothyroidism by Mary Shomon. "Normal" goes up to 5.5 TSH, but some people think that there are a lot of hypothyroid people included in those samples. Maybe the numbers ought to be more like 1 or 2. Also, as Noa says each individual has a particular need.
> It could be that you have enough T4 but not T3, the more active form. Dr. Bob's psychopharmacology tips has some info there. Peter Whybrow did some research on treating rapid cycling patients with hypermetabolic doses---above what endocrinologists would consider normal.
>
> Here's a link to his UCLA grand rounds presentation on the topic in 1997. Hope this helps.
>
> AbbySorry, I forgot to paste it in.--Abby
> http://www.MentalHealth.ucla.edu/webcasting/gr9697rv.html
>
Posted by hypolex on April 28, 2005, at 14:21:07
In reply to Re: More thyroid thoughts judy, posted by Abby on May 9, 2000, at 23:02:49
I have been on levothyroxine for about 7 - 8 weeks with no real relief. I am still exhausted and fatigued all the time. I have gained more weight despite working out and diet. I still have a low libido and basically don't feel good. Is there any hope? I had blook ran again yesterday and don't know results, but even if my TSH is normal, I still feel terrible. I am getting married in a week and going on a honeymoon and would like to feel halfway decent. Any tip?
Posted by Maxime on April 28, 2005, at 16:07:41
In reply to Thyroid Treatment, posted by hypolex on April 28, 2005, at 14:21:07
It takes 3 months for the medication to even everything out. Have you already had a new TSH test done in these 7-8 weeks?
Many people never feel the same after having a thyroid problem. And many people have trouble losing the weight or they continue to gain. People think that once they start the med and everything is "normal" that they will feel normal. Unfortunately from what I have read, it's not true.
Actually I am currently reading "The Thyroid Diet" and it basically says the same thing.In terms of how you feel, it takes more than 7-8 weeks to feel better. I still don't feel better and it has 10 years (sorry).
Maxime
> I have been on levothyroxine for about 7 - 8 weeks with no real relief. I am still exhausted and fatigued all the time. I have gained more weight despite working out and diet. I still have a low libido and basically don't feel good. Is there any hope? I had blook ran again yesterday and don't know results, but even if my TSH is normal, I still feel terrible. I am getting married in a week and going on a honeymoon and would like to feel halfway decent. Any tip?
Posted by hypolex on April 28, 2005, at 16:20:02
In reply to Re: Thyroid Treatment » hypolex, posted by Maxime on April 28, 2005, at 16:07:41
Thanks! That's not very encouraging. I thought 8 weeks was the magic number, but knew that I really didn't feel much better. How do you work, live and deal with this?
Posted by Maxime on April 28, 2005, at 22:34:26
In reply to Re: Thyroid Treatment » Maxime, posted by hypolex on April 28, 2005, at 16:20:02
> Thanks! That's not very encouraging. I thought 8 weeks was the magic number, but knew that I really didn't feel much better. How do you work, live and deal with this?
Well there are a lot of people, mainly women, on this board who have thyroid problems so I am hoping that someone will have something more encouraging to say. Actually Dr. Bob will probably move this thread to the Health board which is where it should be.
I have a lot of problems right now so I can't really answer your questions. But a really good place to read up about it and find stuff about diet, the types of tests you need etc.
is http://thyroid.about.comWhich med are you taking and how much? You have to take it on an empty stomach and not consume any iron pills (or vitamins with iron) for a couple of hours before and after taking the medication.
Maxime
Posted by SLS on April 29, 2005, at 8:27:29
In reply to Re: Thyroid Treatment » Maxime, posted by hypolex on April 28, 2005, at 16:20:02
> Thanks! That's not very encouraging. I thought 8 weeks was the magic number, but knew that I really didn't feel much better. How do you work, live and deal with this?
Have you recorded your body temperature over the course of the day? You might do better with T3 Cytomel.
- Scott
Posted by hypolex on April 29, 2005, at 14:56:50
In reply to Re: Thyroid Treatment » hypolex, posted by Maxime on April 28, 2005, at 22:34:26
I am on .88 synthroid for about 7 - 8 weeks now. I had labs done this week and found out they are normal T4 8.1 (5.53 - 11.), TSH .865 (.465 - 4.68), T-Uptake 26.4 (23.,5 - 40.6). I still feel terrible and am hoping that my symptoms will catch up to my labs. It is so frustrating as you know. I was reading some information about naturethroid and wondered if adding that to levothyroxine might help. It appears to help some people.
Posted by hypolex on April 29, 2005, at 15:02:55
In reply to Re: Thyroid Treatment » hypolex, posted by SLS on April 29, 2005, at 8:27:29
I haven't taken my temperature during the day. The strange thing is that I never get cold. I stay hot and have hot flashes all the time.
Posted by Maxime on April 29, 2005, at 19:58:41
In reply to Re: Thyroid Treatment » Maxime, posted by hypolex on April 29, 2005, at 14:56:50
I have begged my endocrinologist to add Cytomel to my Synthroid (well lower the Synthroid) and he refuses. Yesterday I took L-Tyrosine for the first time and I had energy. It was weird. A good weird.
I didn't take it today and I was lethargic.If you look in the Health section you will see other threads on thryoid problem. But the forums on thyroid.about.com are better (no offence Dr. Bob).
Maxime
> I am on .88 synthroid for about 7 - 8 weeks now. I had labs done this week and found out they are normal T4 8.1 (5.53 - 11.), TSH .865 (.465 - 4.68), T-Uptake 26.4 (23.,5 - 40.6). I still feel terrible and am hoping that my symptoms will catch up to my labs. It is so frustrating as you know. I was reading some information about naturethroid and wondered if adding that to levothyroxine might help. It appears to help some people.
Posted by Cecilia on April 30, 2005, at 5:16:24
In reply to Re: Thyroid Treatment, posted by Maxime on April 29, 2005, at 19:58:41
Several people have mentioned that people with depression should try to keep their TSH around 1, or even lower. How do you stand this if you`ve also got a lot of anxiety? After nearly a year of very gradually increasing my levothyroxine, because the side effects are so unpleasant, and trying to clue my doctor in to the new norms for TSH (she still thought 5.5 was fine), I`ve finally gotten my TSH down from 12 to 2.5 on 0.0625 mg/day of levothyroxine. I don`t know if I should try to increase my dose any more or not. It certainly hasn`t helped my depression. My doctor (GP) is so patronizing. When I mentioned reading about a TSH of 1 being reccommended for people with depression, she said oh, we don`t treat depression with thyroid, we use antidepressants. Like I was a total idiot. She knows perfectly well that I`ve tried virtually every antidepressant ever made, they don`t work for me. I hate doctors!!!!!! I know nothing is ever going to cure my depression, my pdoc has long since run out of ideas, I`m just wondering how low you should try to get the TSH when you`ve got big time anxiety problems as well. Cecilia
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