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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 Kingfish on October 31, 2000, at 8:48:56
I have been seeing a psyc. for about a year. I really like him, but am having diffculty getting a specific diagnosis from him. Have been on Zyprexa, then Celexa and Neurontin, and now Celexa and Topomax. I have the symptoms of Bipolar Disorder, plus Dissociative Disorder, but they occur within a day or two, so I don't meet the criteria for the specified time-lapse. Depressions actually can last longer, though, up to several months. Also, when I'm in my "manic" state, I am irritable and self-destructive, rather than "elated".
Has anyone else had trouble getting a diagnosis? Is it possible to cycle between depression and mania within a day or two, or is that just too rapid?
Thanks!
Posted by KarenK on October 31, 2000, at 10:51:32
In reply to Am I bipolar - difficulty getting diagnosis, posted by Kingfish on October 31, 2000, at 8:48:56
That's called rapid cycling.
You're right, a manic state is pretty unpleasant for all concerned.
My son is bp and he has a great pdoc but every now and then it helps to get a fresh perspective and he gets a second opinion from another pdoc or neurologist.
If I were you, I would want a correct diagnosis too. I think the more important question is, are you being helped?
Posted by Greg on October 31, 2000, at 11:37:07
In reply to Am I bipolar - difficulty getting diagnosis, posted by Kingfish on October 31, 2000, at 8:48:56
It certainly sounds like it to me. Sounds like classic BP (agitated mania, depression). I am BP II and it took my current pdoc one visit to figure that out. It took my last one a bit longer, but nowhere near a year. I would certainly think that would be ample enough time to make the call, but I could be wrong. Have you asked why he/she is so hesitant to make a firm diagnosis? It sounds like you might be a little med resistant? Maybe that's the reason, just guessing here. Could be the extended bouts of depression too. If you're not satisfied with the care that you're getting from your current pdoc, get a second opinion. If your doc is a good one, he/she will respect your decision. Don't worry about hurting feelings or offending anyone, do what is right for you. I really liked the last guy I was with, but he couldn't figure out what meds to put me on, so I switched. Best decision I ever made.
The type of mania you describe is typical for BP. I don't think there is really any restraints on rapid-cycling. At one point I was cycling in 10-15 minute intervals, you never knew what to expect from me. I am currently taking Zyprexa (25 mgs daily) and Neurontin (900 mgs daily) and I was wondering if you've ever used that combo? It's been a lifesaver for me.
I hope this helps a little. I'm no expert on the subject, but I thought I'd send these random thoughts your way.
Peace,
Greg> I have been seeing a psyc. for about a year. I really like him, but am having diffculty getting a specific diagnosis from him. Have been on Zyprexa, then Celexa and Neurontin, and now Celexa and Topomax. I have the symptoms of Bipolar Disorder, plus Dissociative Disorder, but they occur within a day or two, so I don't meet the criteria for the specified time-lapse. Depressions actually can last longer, though, up to several months. Also, when I'm in my "manic" state, I am irritable and self-destructive, rather than "elated".
>
> Has anyone else had trouble getting a diagnosis? Is it possible to cycle between depression and mania within a day or two, or is that just too rapid?
>
> Thanks!
Posted by S. Howard on October 31, 2000, at 21:20:13
In reply to Am I bipolar - difficulty getting diagnosis, posted by Kingfish on October 31, 2000, at 8:48:56
Diagnostic Criteria for the Major Mood Disorders*
MAJOR DEPRESSIVE EPISODE-
Characterized by at least 5 of the following symptoms, present every day or nearly every day,
during the same 2-week period:
1)Depressed or irritable
2)Diminished interest or pleasure in all, or almost all, activities (apathy)
3)Significant weight loss or gain (not intentional), or decrease or increase in appetite
4)Insomnia or hypersomnia
5)Psychomotor agitation (restlessness) or lethargy
6)Fatigue or loss of energy
7)Feelings of worthlessness or excessive or inappropriate guilt
8)Diminished ability to think or concentrate, or indecisiveness
9)Recurrent thoughts of death or suicideMANIC EPISODE-
Characterized by at least 3 of the following symptoms present to a significant degree:
1)Abnormally and persistently elevated, expansive, or irritable mood
2)Inflated self-esteem or grandiosity
3)Decreased need for sleep
4)More talkative than usual
5)Feelings that "thoughts are racing"
6)Easily distracted
7)Increase in goal-directed activity, or agitation
8)Excessive involvement in pleasurable activities which may be harmful, i.e., buying sprees, sexual indiscretions, foolish business investmentsCYCLOTHYMIA
General-
1)Onset in teens or early adulthood
2)Clinical presentation as a personality disorder(patient often unaware of "moods")
3)Short cycles-usually days-recurrent in an irregular fashion, with infrequent euthymic periods
4)May not attain full depression or hypomania during one cycle, but all symptoms occur at various times
5)Endogenous mood changes, i.e., often wake up in a certain moodBiphasic Course-
1)Hypersomnia alternating with decreased need for sleep
2)Shaky self-esteem which alternates between lack of self-confidence and naive or grandiose overconfidence
3)Mental confusion and apathy, alternating with periods of sharpened and creative thinking
4)Marked unevenness in quantity and quality of productivity, often associated with unusual working hours
5)Uninhibited people-seeking (may lead to hypersexuality) alternating with introverted self-absorbtionBehavioral Manifestations-
1)Irritable-angry-explosive outbursts that alienate loved ones
2)Episodic promiscuity, repeated romantic failures
3)Frequent shift in line of work, study, interest, or future plans
4)Resort to alcohol and drug abuse as a means for self-treatment or augmenting excitement
5)Occasional financial extravagance***Copied in part from "Touched With Fire" by
Kay Redfield Jamison**My God, I just diagnosed myself!! -SGH
Posted by pullmarine on October 31, 2000, at 21:54:46
In reply to Am I bipolar - difficulty getting diagnosis, posted by Kingfish on October 31, 2000, at 8:48:56
Hi.
You really should not worry about psychiatric labels. they are very arbitrary (basically, the labels are a list of symptoms that are designated via consensus with little or no scientific validity.
If your doctor is not giving you a diagnosis. Then he's probably a very knowledgeable man. Patients usually seek and cling to labels and let them define their lives. Please avoid this trap. Refuse the labels, and accept taht the things that you go through are just normal variances in human temperament.
Personally, I have been on meds, and dealt with the labels for many years. I am currently off meds (except for dexadrine, but I'm working on that too). I have known people who were diagnosed with bi-polar, put on lithium and years later, are living med free and depression free (in no way am I suggesting that this is the right option for everyone.
In my experience, I have come to accept that everything has cycles, be it the economy, or the seasons of the year. I am no different, I have my seasons and my cycles, but overall, I am functional (but the journey has been long and hard and I'm not entirely through the woods yet).
Best of luck.
John
PS. if you want to know about some non med ways of dealing with depression, just ask.
Posted by JohnL on November 1, 2000, at 4:41:15
In reply to If i've said it once, I've said it 1000 times, posted by pullmarine on October 31, 2000, at 21:54:46
> Hi.
>
> You really should not worry about psychiatric labels. they are very arbitrary (basically, the labels are a list of symptoms that are designated via consensus with little or no scientific validity.
>
> If your doctor is not giving you a diagnosis. Then he's probably a very knowledgeable man. Patients usually seek and cling to labels and let them define their lives. Please avoid this trap. Refuse the labels, and accept taht the things that you go through are just normal variances in human temperament.
>
> Personally, I have been on meds, and dealt with the labels for many years. I am currently off meds (except for dexadrine, but I'm working on that too). I have known people who were diagnosed with bi-polar, put on lithium and years later, are living med free and depression free (in no way am I suggesting that this is the right option for everyone.
>
> In my experience, I have come to accept that everything has cycles, be it the economy, or the seasons of the year. I am no different, I have my seasons and my cycles, but overall, I am functional (but the journey has been long and hard and I'm not entirely through the woods yet).
>
> Best of luck.
>
> John
>
> PS. if you want to know about some non med ways of dealing with depression, just ask.
I am in favor of all the excellent points John made in his above responses. Making the link between diagnosis and medication is a pipedream in my opinion. I mean, sometimes it happens, sometimes it doesn't. If biplor is the diagnosis, then the drugs appropriate would be Lithium, Depakote, or Tegretol. So how do we explain that a bipolar person might not do well with any of these, but instead do extremely well with an antipsychotic instead? Or a stimulant? Or anything else with no clinical justification? The fact is, it happens. I know doctors are trained to make a diagnosis and then match drug treatment to that diagnosis. Sometimes that works. Sometimes it doesn't. Might as well flip a coin. The odds are about the same. Just my opinion based on what I've seen happen in the real world.In the book "Dysthymia, The Spectrum of Chronic Depression", by renowned world researcher/psychiatrist Hagop Akiskal, he states that mental illness is an evolving condition. In other words, it doesn't stay the same forever. It's constantly in motion as we age, and it doesn't breed true from one generation to the next. It presents itself in various forms over time, and in various forms from one generation to the next. In general, he basically feels that there is a good deal of overlap between all the various psychiatric conditions. In the real world, I personally have found it best to use a preliminary diagnosis as a starting point in treatment. It is guidance tool to get started, but in the end may have no relevence to which drug actually works or not for the particular person. Brain chemistries are too complex and too unique from one person to the next to neatly categorize them into a diagnosis. Someone either feels better on a drug or they don't. The diagnosis may have nothing to do with it.
I know when someone has recovered from alcoholism, years later they will still say, "Hi, I'm So&So, I'm a recovering alcoholic." I don't like using that same approach to bipolar or whatever. I think it's counterproductive to include a diagnosis as part of our identity.
I like to use a chart of statistics as a guide. Let's say for example I am depressed and may be bipolar. I go to my chart and I see that the highest percentage of depressed people responded to a serotonin drug over other drugs. OK. So I'll start there. If I get worse, or get manic, then I would go down the list to the next highest percentage which happens to be Lithium. Closely following are Depakote and Tegretol. If treatment is still going lousy with these, which it often is, what use was that diagnosis in the first place? I continue down the list. Antipsychotics. Stimulants. Thyroid.
Just one real life example is me. One psychiatrist said I had double depression. Another diagnosed me as bipolar. A third diagnosed me as depressed with possible psychosis. Really? Who was right? What good were these diagnosis in actual treatment? One thing for sure was the depression component. Paxil, Zoloft, Serzone, Effexor, Luvox, Nortriptyline, Moclobemide, and more....hey, one of these should have worked, yeah? But no. In the end, it was a stimulant+antipsychotic combination that worked. In a way, all three pdocs were partially correct. There may have been overlapping components of each different diagnosis, but not one exactly correct. And the fact is that the drugs that actually worked were far removed from what normally should have worked with any of the diagnosis that were made.
I don't know. Diagnosis is helpful to get started. But in the end it is often fruitless. Sometimes. Sometimes not. It's just a guide that may or may not prove helpful. I like to keep an open mind, and know that anything's possible, any drug might work. Don't rule any out just because they aren't clinically justified. Sometimes the magic we're looking for is hiding in a place we don't suspect. A diagnosis might prevent us from finding it.
Just opinions.
JohnL
Posted by Kingfish on November 1, 2000, at 11:01:51
In reply to Re: If i've said it once, I've said it 1000 times, posted by JohnL on November 1, 2000, at 4:41:15
I really appreciate the follow up's to my question, and realize I am groping here. I disagree, though with the two John's. They make it sound as if the desire for a definition, or "label" is really unnecessary. I know that it is one "expert's" opinion over another's but it does give a starting place as John L. pointed out and that can be invaluable in the road to recovery. I have no idea what the first John is suggesting re: no meds - this is supposedly a chemical imbalance and no meds seems dangerous to me. At the same time, though, I'm being placed on many different things, with no specific diagnosis and it's frustrating. Of course, it will be ideal when there are physical tests for mental illnesses but who knows when that that will be. I just wanted some Bipolars' opinions. Thanks.
Posted by shar on November 1, 2000, at 19:26:13
In reply to Re: If i've said it once, I've said it 1000 times, posted by Kingfish on November 1, 2000, at 11:01:51
We use labels to categorize things in the world around us, to make sense out of chaos, to provide information to others, to receive information in a meaningful format.
I don't have any research results or anything, but I don't really believe that people become their labels. Or, use them to define themselves. At least not to any greater extent than any other medical diagnosis. Ie, the person with asthma who "can't do x, y and z" when that may or may not be true.
Without a label as a starting point, how does any treatment occur--ie, if you don't use "depression" as a starting point, how do you know that you wouldn't necessarily go through all the hypnotic agents, then the antipsychotics, then some endocrine meds, before finally hitting some of the antidepressants.
Personally, in any medical situation I prefer to have some kind of label, or else how do I research it? If a doc says I'm bipolar, and I research it and none of the symptoms fit, or I don't experience any of the things that "bipolars" talk about experiencing, I'd have to get back to the doc (or get another doc) and straighten things out.
Recently, a doc in an ER referred me to an ENT because I had a quickly appearing growth or something on the roof of my mouth, and my sinuses were hurting like crazy (really, really hurting). It turned out to be a split in the root of a tooth that had a root canal previously, and it was not a good root canal, so it was infected, and since they put a little plug in, the abcess that might have formed along the gum line of a normal tooth went to the roof of my mouth. All of this was inflaming my sinuses (or putting pressure on them).
So, instead of an ENT I went to my dentist because I suspected something like that, and ended up with oral surgery.
Point being, no field has a corner on perfect diagnoses, psych included.
The important thing IMHO is that one doesn't get so entrenched in labels that they close off their minds to any other thing. There are often multiple things going on (like thyroid stuff) that can be checked when people are depressed.
BTW, other posters may rebut this if they want, but I'm just interested in putting in my 2 cents to the person who originally asked for input. I'm not interested in debating the perceieved merits (demerits?) of my response.
Posted by Kingfish on November 2, 2000, at 8:42:47
In reply to Why labels can help IMHO » Kingfish, posted by shar on November 1, 2000, at 19:26:13
====
Thank you, Shar. I'm tired of being considered "weak" because I want a starting point, as if I can't think for myself as well. I'm not concerned what the diagnosis turns out to be, just that there is one. I can then move on from there.
Posted by Noa on November 4, 2000, at 10:17:30
In reply to Re: Why labels can help IMHO » shar, posted by Kingfish on November 2, 2000, at 8:42:47
Yes, sometimes having a diagnosis to work from is very helpful. Sometimes it can help to narrow it down to the two diagnoses that match your symptoms closely, and then to compare the treatment options that would logically flow from each. Sometimes, the treatment options are very different, sometimes quite similar, but it can help you clarify your thinking about what you need. (with the caviat, of course, that a dx is one as useful as it is useful!)
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