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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 27. Go back in thread:
Posted by avr on August 10, 2001, at 22:08:51
In reply to Recurrent unipolar vs bipolar...a way of life, posted by alexamum on August 10, 2001, at 18:54:59
I feel your pain because i've had very similar problems. I am also dysthymic and have had recurrent episodes of mania and have tried ssri's with too many side effects and immunity to the drugs. I guess it comes down to dealing with the disability with the best possible medications for your conditition and just hope for newer technology to help. You might not be a religious person and not believe in god but I've found help in asking god for help. I am very young, only 17 and am very sorry for you for having to live your whole life with these terrible problems since you were in junior high. Best of luck
Posted by Mitch on August 11, 2001, at 10:44:23
In reply to Recurrent depression vs bipolar, posted by alexamum on August 10, 2001, at 21:31:23
> Besides the highs, manias and mixed episodes, what is the difference between recurrent depression and bipolar? If antidepressants were the answer, why do I continue to slip back into the trough?
A.
Between your recurrent depressions (or during them) you lack any hypomania or manic symptomology. It is still a cyclical problem though. I have seasonal major depressions overlaid on top of my rapid cycling BPII. They are more predictable than the stock market! AD's help some, but there is a risk of aggravating mixed symptoms. You may have seasonal affective disorder and could benefit from "light therapy". You may have to try a different antidepressant or increase the dose when they happen. Are your recurring depressions *predictable*?
Mitch
Posted by sillygrrl on August 11, 2001, at 15:38:50
In reply to Recurrent unipolar vs bipolar...a way of life, posted by alexamum on August 10, 2001, at 18:54:59
wait a sec...the doc doesn't think you're bipolar but he put you on Risperadol (an atypical antipsychotic - often used on bipolar people) for rages??Mania can be dysphoric and irritable, rage being part of that.
Two books I'm reading that have been very helpful (and I've been able to argue with my docs when they say something that seems incorrect thanks to the information in them) are:
Am I Okay? : A Layman's Guide to the Psychiatrist's Bible by Michael B. First, MD and Allen Frances, MD.
Essential Psychopharmacology for Depression and Bipolar Disorder by Dr. Stephen Stahl, MD, Ph.D. This one is really technical, but you can basically get the gist of it just from looking at the diagrams and pictures.
You might want to try Effexor with Remeron rather than Serzone. Dr. Stahl refers to this as "California Rocketfuel" and explains why they are a good combo for recurrent depression and minimize each other's side-effects.
Best,
silly
Posted by Elizabeth on August 12, 2001, at 4:35:53
In reply to Recurrent unipolar vs bipolar...a way of life, posted by alexamum on August 10, 2001, at 18:54:59
Here's my take on the issue of "soft" bipolar disorders (a seemingly ever-expanding category)....
In addition to classic depression and manic-depression, there seems to be another category of mood disorder, the core symptom of which is what I will call "mood dysregulation" (a term sometimes used in the literature). This symptom is often attributed to anxiety and/or personality disorders. It may be identified as extreme interpersonal sensitivity (social phobia, atypical depression) or excessive mood reactivity (usually diagnosed as emotionally unstable [cluster B] personality disorder). The mood dysregulation syndrome also resemble posttraumatic stress, except that the reactions occur frequently and are far out of proportion to the "traumatic" events. Sometimes there is a personal history of severe childhood trauma, which probably contributes to the syndrome in many people, perhaps sensitising them to emotional pain later in life, contributing to the development of dissociative symptoms, etc. There also may be temperamental (congenital) aspects: some people seem to be sensitive, easily hurt, "thin-skinned," by nature.
The group of people who I'm attempting to identify are very susceptible to emotional pain and tend to have extreme reactions even to relatively minor hurts or losses. The mood dysregulation results in behavioural manifestations that can resemble symptoms of depression, mania, and/or anxiety disorders.
The course appears to be episodic; mood dysregulation episodes are much briefer than major depressive, manic, or hypomanic episodes, lasting hours or at most days rather than weeks, months, or years. Some examples of mood dysregulation episodes:
-extreme, but short-lived, depression following interpersonal rejection or loss (e.g., feeling suicidal after the breakup of a romantic relationship)
-anxiety attacks in response to fear or threat of loss, rejection, or abandonment
-emotional "crises" or "breakdowns," often involving self-injury or impulsive suicide attempts
-impulsive aggression and intense anger, often directed at selfMood dysregulation and emotional hypersensitivity also have profound effects on a person's outlook:
- a sense of desperation and chronic suicidality
- feelings of bleakness, emptiness or boredom when not in a state of "crisis"
- thrill seeking, risk taking, and/or self-destructive behaviour (perhaps in an effort to recreate emotional crises)
- extreme concern about how the person is viewed or judged by others, resulting in body dysmorphia, eating disorders, various types of social anxiety, etc.
- drug abuse (especially, alcoholism) in attempts to self-medicate; addiction may occur very rapidly perhaps due to impulsivity and frequent excess in the use of drugsMedications that seem to be helpful for people with this type of mood disorder include:
- Anticonvulsants: valproate (Depakote) and carbamazepine (Tegretol) are the best-studied ones, but lamotrigine (Lamictal), topiramate (Topamax), and gabapentin (Neurontin) may also be effective in smoothing out the mood swings.
- Antipsychotics: can be helpful, as you've discovered, in relieving rage, obsessive suicidal ideation, and other intense and dysphoric feelings. Because of their better safety profile, the newer "atypical" antipsychotics are the ones usually used; these include risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), and ziprasidone (Geodon). They are usually used in smaller doses than would be prescribed for psychotic disorders. They can be used acutely/"as-needed," to help the person out of episodic emotional "crises," or on a fixed schedule, to prevent such episodes from occurring. Because these drugs can take a couple of hours to work, the latter may be more practical unless the episodes are infrequent or are mostly controlled by other medication.
- Psychostimulants: in some cases, mood dysregulation may arise from what is currently called "attention deficit disorder;" stimulant drugs can help them to focus and slow down (or perhaps, allow them to keep up with their racing thoughts and feelings) so that they can experience moderate emotions and not only extreme ones, and so that they are able to think fully before acting, rather than acting on impulse.
- Serotonin reuptake inhibitors: the selective SRIs (Prozac, etc.) and the nonselective ones (e.g., Effexor) can be helpful in smoothing out moods and alleviating hypersensitivity and decreasing mood-reactivity.
- Monoamine oxidase inhibitors: may combine the benefits of SSRIs and stimulants.
- Opioid antagonists (naltrexone (ReVia)): seems to be particularly helpful for people who experience dissociation. I'm not too clear about this, but my guess is that naltrexone eliminates the "rush" that some people experience from "dangerous" behaviours such as self-injury. It also decreases opioid and alcohol cravings.Because of the wide range of medications that can be helpful to people with this problem, I think that it would be interesting to study the relationship between clinical features and drug response (antidepressant, stimulant, mood stabiliser, antipsychotic) in individuals with this type of syndrome (which I think should be classified as a mood or anxiety disorder).
OK, so now that I've written a dissertation < g >, back to your question! I think you're on the right track toward achieving long-term stability. I'm pretty sure you will find that at least some of the stuff I've written about applies to you. If the Risperdal is working and you're tolerating it okay, stay with it -- "antipsychotic" drugs (dopamine antagonists) can be effective in nonpsychotic disorders and may even have antidepressant effects in some people (just as "antidepressants" can be used for panic disorder, social anxiety, and even nonpsychiatric disorders such as neuropathic pain and allergies). Has Risperdal helped with any other symptoms besides rages?
Some of the other medications I mentioned might be worth looking into as well. It might be a good idea to take a look at the anticonvulsants, since your response to antidepressants has been lukewarm; on the other hand, you might want to try some other antidepressants since Effexor did help for a while. See what your doctor says. Stimulants and naltrexone are more experimental, so those should probably be low on your list of things to try.
One thing worth noting is that tricyclic antidepressants rarely work for emotion dysregulation; MAOIs, SSRIs, and Effexor have good track records, and Remeron, BuSpar (in high doses and/or in combination with SSRIs or other ADs), and Wellbutrin might be worth looking at too.
I know a few people who would fit into the category I've described. One is a young woman diagnosed with bipolar II disorder, borderline personality disorder, and temporal lobe epilepsy who has an extensive history of self-injury and multiple suicide attempts (she has several large, prominent scars as well as many smaller ones). She now takes Tegretol, Zyprexa, and Zoloft. Another woman, who has been diagnosed with unipolar depression and borderline personality, was abused as a child, used to dissociate and cut herself, and has an extensive drug abuse history (mainly alcohol and methamphetamine), takes Wellbutrin, naltrexone, and lithium (lithium can also be used as a mood stabiliser, although I think the anticonvulsants have a better record for this type of mood swings). She was the person who first brought naltrexone to my attention as a potential treatment for this condition, actually. A third woman, diagnosed bipolar I and borderline personality, has a history of self-injury (cutting and burning) and has had a hard time achieving stability despite being very intelligent (IMO). She is now getting herself together. She takes Moban (an older antipsychotic), Topamax, Zyprexa (as-needed), Wellbutrin, and Prozac. These are just some examples -- there are a lot of people who are overcoming this very painful condition.
I think that psychosocial therapy is warranted, if you can afford it. Are you seeing a psychotherapist of some sort, and if so, what is his or her school of thought (psychoanalytic, cognitive-behavioural, etc.)? This isn't really the primary topic of this board, but I thought I should mention it because I think it's important for people who've been mentally ill for most of their lives. (I have too, BTW, although the emotion dysregulation syndrome I described is not among my problems.)
Be well. I hope this lengthy discourse has helped answer some of your questions.
-elizabeth
Posted by AKC on August 12, 2001, at 11:16:34
In reply to Re: Recurrent unipolar vs bipolar [long] » alexamum, posted by Elizabeth on August 12, 2001, at 4:35:53
Elizabeth,
Thanks for this. I'm printing it out to show to my doctor. While not directly on point, I think it hits many areas of my life and offers some explanation that she and I could find helpful.
Thanks,
AKC
Posted by Emme on August 13, 2001, at 12:27:42
In reply to Recurrent unipolar vs bipolar...a way of life, posted by alexamum on August 10, 2001, at 18:54:59
Hi there. The cycling of your depression, failures of many antidepressants, and heightened irritability and impulsivity that you experienced on Serzone are awfully suggestive of bipolar disorder. Have your antidepressants ever been augmented with a mood stabilizer? See what your doctor thinks - couldn't hurt to try, right? And if it helps, that's all that matters. You deserve to get some relief. The medicine that works is the best treatment, regardless of the label you are diagnosed with. How is your current regimen working out?
I'm sorry you have been suffering for so long and have lost so much. I hope you can see yourself as someone with intelligence and that you are (as my therapist would say) a work in progress and you don't yet know what you will accomplish when you get control of your mood disorder.
Emme
> What is the difference between recurrent unipolar depressison and bipolar? I know, the highs! But seriously, I can't seem to see myself mirrored in psych literature. When you read about depression, there's barely a mention of recurrent types, particularly rapidly recurring depressions. When you read about bipolar, there's no mention of recurrent episodes without manias or mixed episodes. My doctor says I am not bipolar, but I have been shifting back and forth on the depressive scale for years now: primary dysthymia that has turned into recurrent depressions, modified by whatever medicine I'm on at the moment, and I've tried many antidepressants and antianxiety meds. Most recently: Effexor worked for awhile, but faded. Serzone was added, but brought out heightened irritability and impulsiveness and perpetual grogginess. Respirdal seems to have helped calm the rages. So now I am on small doses of all three.
>
> What can I do to stay stabilized? So that my world doesn't fall apart with stress? So that I can predict how I am going to be feeling/reacting to things in order to make a commitment to long-term goals? So that I don't lose my sense of self along with my sense of cause and effect in managing my own behavior and actions? What used to be just periodically frustratingly futile interruptions in my life has turned into a way of life itself. I first sensed I need help when I was in junior high school, but didn't get it until I was in my mid 20s...I'm now nearly 50. I see now that I will never have a career or lead a normal life. I have been dx'd with ptsd and depression. Is the problem medications, my attitude, my intelligence or lack of it, my psychiatrist, that I suffered too long before being treated and that has made it worse, bad karma, or....what?
>
> I write here because I don't know where else to turn for any scrap of new information or possibly...hope. I keep looking for the key to the puzzle and keep coming up empty handed. Can anyone relate?
Posted by alexamum on August 13, 2001, at 22:50:24
In reply to Re: Recurrent unipolar vs bipolar...a way of life » alexamum, posted by Emme on August 13, 2001, at 12:27:42
Thank you all who responded to my message. I read your responses with tears in my eyes, part hopeless, part hopeful. I'm going to see my doctor in a couple of days with your insights and information to see what she says.
Yes, I do have psychotherapy in addition to med checks, in answer to your questions...I've never been a cutter, etc., thin-skinned would be a good description I guess. Unfortunately, when I am stressed acutely, emotionally disregulated(?), which can happen very quickly, I lose control not only of my emotions, but my ability to think as well. Very difficult for me to learn new job tasks, for example. From the outside, what it probably looks like is that I cry easily, sometimes losing it and hyperventilating, and of course this embarrasses me tremendously. (My psychiatrist told me I lost consciousness in her office one day when this happened. But I have absolutely no recollection of that happening.) On top of that, I can't get my mind in gear to speak, to respond adequately. It can take me awhile to calm down. In any case, my irritability is easily aroused as well, at least recently. Sometimes the tears are an expression of inhibited anger. I don't "think well on my feet."
At the moment, my body is not doing well with the medications. Lots of aches and pains, headaches, a generally drugged and rundown feeling, elimination loose, sporadic. I don't sleep well. Sometimes I take naps and sleep long, at other times I can't fall asleep, can't stay asleep. Up at 3-4 in the morning, staying up all day, go to bed late. I'm not hyper or bouncing off the walls, pretty lethargic - my world has grown very small. I avoid doing anything I don't have to do, including talking to friends, housecleaning, even bathing some days. Yet I go to my part-time job and struggle through the days.
I don't remember what "normal" for me felt like. I think I was naturally "light" and with a restless energy, bright, curious, shy, imaginative, inventive, aloof, always quiet. Such a contrast to the fried brained, leaden-faced person with the poor memory (whole conversations drop out of my mind, for example). I'm having trouble tracking the writing of this message, and I have to keep going back and seeing what I wrote to remind myself what should come next because I can't remember what I already said. I think the medications over time have altered my body and brain, have made me stupid, sensitized my nervous system and changed my personality. If nothing else, the meds have probably prompted the 60 pounds I've gained as well.
If these medications are "working" then, I don't know what to say. Serzone, Effexor and Risperdal together or apart don't seem to be the answer. Other meds I've tried included TCAs, Prozac, Paxil, Zoloft, Wellbutrin, Bupropion, Anafranil, Flexeril, a couple of benzodiazepines, and a neuroleptic or 2 for brief periods. Unfortunately, the ADs can aggravate my anxiety, meds for anxiety tend to deenergize me. Prozac worked well the first year I was on it, especially at first, then I started getting irritable, wired and tired. Nonetheless, at its best, it became the standard against which I've judged all the other medications. TCAs didn't do much for me. Paxil caused me to involuntarily read unimportant data such as license plates and then read them again and again, and did nothing for my energy. Zoloft put me to sleep. Wellbutrin caused my body to be highly reactive to stimuli (a door slamming, a knock, an unexpected voice behind me) but no other discernible side effects, Bupropion gave me a headache for all the months I was on it. Weight gain is a problem with Anafranil. So there are still some classes of meds that haven't been tried.
Thanks again for your comments.
Posted by alexamum on August 14, 2001, at 23:12:03
In reply to Re: Recurrent depression vs bipolar » alexamum, posted by Mitch on August 11, 2001, at 10:44:23
The lows aren't seasonal or predictable as far as I can tell. I think you're right. A change of meds is in order.
Posted by Mitch on August 14, 2001, at 23:51:07
In reply to Re: Recurrent depression vs bipolar, posted by alexamum on August 14, 2001, at 23:12:03
> The lows aren't seasonal or predictable as far as I can tell. I think you're right. A change of meds is in order.
A.
You said a "change of meds" is in order. Did you see a doc about your depressions and he put you on a mood stabilizer that most bipolar people generally take, hence your question about what the difference is between unipolar and bipolar recurrent depression? Well you can still have bipolar depression and it not be "predictable". The bottom line is if you have had hypomanic or manic symptoms/episodes. If not then it would be an unpredictable nonseasonal recurrent unipolar depressive disorder. Sometimes certain mood stabilizers that bipolar people take can be helpful for unipolar depressives, such as lithium, i.e.
Mitch
Posted by alexamum on August 15, 2001, at 13:20:28
In reply to Re: Recurrent unipolar vs bipolar [long] » alexamum, posted by Elizabeth on August 12, 2001, at 4:35:53
Wow, Elizabeth,
Who are you and how do you know all this?It seems that all the examples of people with "mood dysregulation" you've described have borderline personality diagnoses, which I do not. The "thin-skinned" category may be more accurate. I've tried a number of medications (see my 8/13 message in this thread), and meds that improve my ability to compete in the everyday world seem most helpful, but it's always been a trade off between side-effects and positive effects. The risperdal may be helpful, but my body feels like **** and I unilaterally decided to quit the serzone and the risperdal and stay on the effexor till I see psydoc tomorrow.
Someone mentioned the combination of remeron and effexor as a possibility. What's your take on this combo?
Posted by alexamum on August 15, 2001, at 13:40:12
In reply to Re: Recurrent unipolar vs bipolar...a way of life, posted by susan C on August 10, 2001, at 22:06:02
Susan,
Since you have possibly similar problems, what meds have worked for you? And what caused in your opinion your transition from chronic depression to rapid cycler? Was it an antidepressant? Did you have any inkling that your chronic depression might become somethng else? Did you have rapid and active response to ADs that faded after awhile, for example?Do depressives run in your family? I believe depression (very irritable, volatile types) and anxiety run in my family, and possibly a grandmother with what might now be described as a borderline personality, and a grandfather with possible alcoholism.. No one else but me in my family, however, has been diagnosed for any mental illness nor received any treatment. I am the designated patient for the family, I guess.
Posted by Elizabeth on August 15, 2001, at 18:40:01
In reply to Re: Recurrent unipolar vs bipolar [long] » Elizabeth, posted by alexamum on August 15, 2001, at 13:20:28
> It seems that all the examples of people with "mood dysregulation" you've described have borderline personality diagnoses, which I do not.
Or they're *diagnosed* with borderline personality disorder (a diverse group). BPD is more than a little bit of a fad diagnosis.
> Someone mentioned the combination of remeron and effexor as a possibility. What's your take on this combo?
It could potentially be very effective for severe depression. Also, Remeron can negate some of the side effects of SSRIs and Effexor.
-elizabeth
Posted by akc on August 15, 2001, at 19:18:48
In reply to Re: Recurrent unipolar vs bipolar [long] » alexamum, posted by Elizabeth on August 12, 2001, at 4:35:53
I shared this with my pdoc today. She to wanted to know your training! One thing I like about my doctor is that she is willing to respect a layperson's ability to learn.
A lot of what you have shared here fits me. I experienced a lot of trauma as a child -- mainly physical and emotional. Starting at 11 until 3 years ago, I abused alcohol -- it definitely was a way I tried to self-medicate. Since giving up the alcohol, and hopefully up till this past February, I turned to cutting as a way to cope. I have also punched walls and done other self-injurous behavior.
Of course, it doesn't seem to me that it takes much to set me off, but my pdoc did seem to beg to differ. I have had some pretty major stressors these past two years. Two bar exams and two extreme difficulties getting admitted to the state bars (involved hearings, etc. due to my mental illness). Plus moving to a new city. But I also have been triggered by stuff in group therapy, by attending a one-week intensive therapy program, and by my therapist being out of town. So in some ways I am thin skinned. This latest bout seems to be purely med driven -- my pdoc thinks it is most likely related to having taken me off the lithium. She would diagnosis me as Bipolar II, PTSD, and chemically dependent, I think.
My current meds are: Lithium 300 mg am, 600 mg pm
Effexor XR 75 mg am
Seroquel 200 mg, 2x a day
Topamax 75 mg, 2x a day
and Trazadone 50 to 150 mg as needed for sleep (currently taking 50 due to the latest episode).Anyway, I respect your knowledge -- I know it is a spotty history, but any thoughts or feedback you have on what I have shared would be appreciated.
Thanks,
AKC
Posted by sar on August 16, 2001, at 16:20:27
In reply to Re: Recurrent unipolar vs bipolar » alexamum, posted by Elizabeth on August 15, 2001, at 18:40:01
dear elizabeth,
what's your take on BPD other than it being a "fad" diagnosis? i've been dx'd "borderline" twice because i meet 5 or 6 of the criteria, but i'm not very angry or jealous like the typical borderline i've read about--but i am extremely thin-skinned and self-destructive (drinking, drugs, sex, shopping, stealing). other than that i am *ver* well-behaved! in fact, i am also socially anxious. what do you think of this comorbidity?
i know i am a weirdo.
thanks,
sar
Posted by Elizabeth on August 17, 2001, at 3:36:20
In reply to Re: Recurrent unipolar vs bipolar [long] » Elizabeth, posted by akc on August 15, 2001, at 19:18:48
> I shared this with my pdoc today. She to wanted to know your training! One thing I like about my doctor is that she is willing to respect a layperson's ability to learn.
That's very cool! Tell her that my training is in theoretical mathematics, please. (It's true. Topology and differential geometry.)
> A lot of what you have shared here fits me. I experienced a lot of trauma as a child -- mainly physical and emotional.
I'm sure that contributed to the syndrome.
> Starting at 11 until 3 years ago, I abused alcohol -- it definitely was a way I tried to self-medicate.
I think there are two kinds of addicts: self-medicators (usually alcohol or opiates) and thrill-seekers (usually cocaine or amphetamines). I'm sure there are some people who fit both descriptions. Also, self-medication can become thrill-seeking in the sense that once you discover there's a drug that not only alleviates your distress but also produces soaring euphoria, the euphoria can be quite compelling. At the same time, thrill-seekers can become self-medicators when they start needing their drug of choice to fend off withdrawal symptoms.
> Since giving up the alcohol, and hopefully up till this past February, I turned to cutting as a way to cope. I have also punched walls and done other self-injurous behavior.
So, what you need is ways to cope (probably including medication of some sort) that don't have harmful effects!
> Two bar exams and two extreme difficulties getting admitted to the state bars (involved hearings, etc. due to my mental illness).
I think that's a travesty. They shouldn't discriminate like that.
> She would diagnosis me as Bipolar II, PTSD, and chemically dependent, I think.
Seems like a reasonable DSM-IV description of the syndrome that I believe represents a different kind of mood disorder.
> My current meds are: Lithium 300 mg am, 600 mg pm
> Effexor XR 75 mg am
> Seroquel 200 mg, 2x a day
> Topamax 75 mg, 2x a day
> and Trazadone 50 to 150 mg as needed for sleep (currently taking 50 due to the latest episode).What do you feel that each of these medications is doing for you?
-elizabeth
Posted by Elizabeth on August 17, 2001, at 3:39:19
In reply to Re: Recurrent unipolar vs bipolar » Elizabeth, posted by sar on August 16, 2001, at 16:20:27
> what's your take on BPD other than it being a "fad" diagnosis?
I think it's real, and people suffering from it experience a lot of pain that shouldn't be trivialised. I also think it's a diagnosis that is so overused that it's hard to draw any conclusions from the information that someone was diagnosed with it.
> i've been dx'd "borderline" twice because i meet 5 or 6 of the criteria, but i'm not very angry or jealous like the typical borderline i've read about--but i am extremely thin-skinned and self-destructive (drinking, drugs, sex, shopping, stealing).
"Borderline" is a big umbrella -- it encompasses a variety of symptoms and symptom clusters.
> other than that i am *ver* well-behaved! in fact, i am also socially anxious. what do you think of this comorbidity?
It sounds like emotional sensitivity.
> i know i am a weirdo.
Naw.
-elizabeth
Posted by akc on August 17, 2001, at 8:13:26
In reply to Re: Recurrent unipolar vs bipolar » akc, posted by Elizabeth on August 17, 2001, at 3:36:20
> That's very cool! Tell her that my training is in theoretical mathematics, please. (It's true. Topology and differential geometry.)
>I have no problem believing this -- I at one point was working towards a phd in mathematics, but couldn't hack it, so stopped at a master's and went on to become a dreaded lawyer!
>
> I think there are two kinds of addicts: self-medicators (usually alcohol or opiates) and thrill-seekers (usually cocaine or amphetamines). I'm sure there are some people who fit both descriptions. Also, self-medication can become thrill-seeking in the sense that once you discover there's a drug that not only alleviates your distress but also produces soaring euphoria, the euphoria can be quite compelling. At the same time, thrill-seekers can become self-medicators when they start needing their drug of choice to fend off withdrawal symptoms.
>I can confidently say I was never a thrill-seeker. When I drank, I didn't want to feel at all. Oh, at first, it helped me feel more part of the crowd, but most of the time, I was drinking to get rid of the icky feelings more than to feel good. And at the end, it was just to get away from it all -- and it had quit working, which was very sad. That's when I had to admit I needed help.
>
> So, what you need is ways to cope (probably including medication of some sort) that don't have harmful effects!This is a point I have been trying to get across to my treatment "team" (my therapist, pdoc and then two therapist that lead my group therapy) this week. We have taken away all my bad tools -- but I have these episodes that are so painful and I just don't have the strength to get through them any more. And I am certain that I haven't seen the last of them. Now I am still at the tail-end of one, so my thinking is not the most rational, but the thought of just enduring another episode is just too much. Just talking to my therapist, or calling a friend and saying I'm having a rough time doesn't seem to be enough. I try to play with my dogs or do other things to get out of myself but I'm not to successful when I am in that black pit (you know, 10 out of 10 on that depression scale). I'm not sure of the answer, but I know that this is going to be the focus of my therapy for the next few weeks.
>
> > Two bar exams and two extreme difficulties getting admitted to the state bars (involved hearings, etc. due to my mental illness).
>
> I think that's a travesty. They shouldn't discriminate like that.
>Don't get me started. If I ever get my strength up, this is my mission in life, I believe.
> > My current meds are: Lithium 300 mg am, 600 mg pm
> > Effexor XR 75 mg am
> > Seroquel 200 mg, 2x a day
> > Topamax 75 mg, 2x a day
> > and Trazadone 50 to 150 mg as needed for sleep (currently taking 50 due to the latest episode).
>
> What do you feel that each of these medications is doing for you?
>Good question. In all honesty, I am not sure most days. I would say the effexor is helping my depression, but then I keep having these horrible depressive episodes. Same thing with the lithium, which is also suppose to be helping with my agitated states (what my pdoc would label my "manias" -- it has taken me a while to accept this bipolar diagnosis). I know the trazadone does help me with my sleep when I am having problems, though I fight what dose to take. I have to be careful of not taking too much and oversedating myself for the next day. The seroquel has helped with some of the distorted thinking. I had great success with zyprexa with that -- but at a high cost -- I gained 70 pounds in a matter of a few months. She switched me to seroquel. It has not worked as well -- it would work better if I could take a higher dose, but upping it to 300 mg, twice a day, sedates me horribly. To early to tell what the topamax is going to do. One other thing -- because I have had repeated crises since I have been with this doctor, we have never had me at a steady state for any length of time to really be able to tell what any med is really doing. I will get a few weeks where I am doing well, then crash and burn. So I have had repeated med adjustments, changes, etc. Sigh.
Thanks for your response. I smiled to see you are a math nerd (said with all lovingness). There are not many around!
AKC
Posted by Elizabeth on August 17, 2001, at 14:42:39
In reply to Re: Recurrent unipolar vs bipolar, posted by akc on August 17, 2001, at 8:13:26
> I have no problem believing this -- I at one point was working towards a phd in mathematics, but couldn't hack it, so stopped at a master's and went on to become a dreaded lawyer!
The "take the Master's and run" strategy. < g > I've known a few people who were math majors and then went on to law school.
> This is a point I have been trying to get across to my treatment "team" (my therapist, pdoc and then two therapist that lead my group therapy) this week.
Wow, you have quite an entourage there.
> We have taken away all my bad tools -- but I have these episodes that are so painful and I just don't have the strength to get through them any more.
But as long as your behaviour is "good," you can be suffering a great deal and it doesn't matter to treaters? (No, of course I'm not bitter. :-) )
> And I am certain that I haven't seen the last of them. Now I am still at the tail-end of one, so my thinking is not the most rational, but the thought of just enduring another episode is just too much.
I know what you mean.
> > I think that's a travesty. They shouldn't discriminate like that.
> >
>
> Don't get me started. If I ever get my strength up, this is my mission in life, I believe.A good cause to take on.
> > What do you feel that each of these medications is doing for you?
> >
>
> Good question. In all honesty, I am not sure most days. I would say the effexor is helping my depression, but then I keep having these horrible depressive episodes. Same thing with the lithium, which is also suppose to be helping with my agitated states (what my pdoc would label my "manias" -- it has taken me a while to accept this bipolar diagnosis).I'm not convinced that agitated depression constitutes mania for treatment purposes. I'm definitely unipolar, but I've had periods of depression when I was quite agitated (and various mood stabilisers didn't help, BTW). If you are having some kind of mixed state, I think the anticonvulsants are actually preferred over lithium.
> I know the trazadone does help me with my sleep when I am having problems, though I fight what dose to take. I have to be careful of not taking too much and oversedating myself for the next day.
Heh. I found that trazodone was of no use for chronic insomnia: I got up to about 400 mg (due to tolerance) before I gave up on it.
> The seroquel has helped with some of the distorted thinking. I had great success with zyprexa with that -- but at a high cost -- I gained 70 pounds in a matter of a few months.
(Oof.) What sort of distorted thinking do you mean? I found that neuroleptics just made me feel more tired and anergic.
If Seroquel doesn't work out, you might try Geodon. That seems to be giving some people good success.
> To early to tell what the topamax is going to do.
It might help with the weight thing, at least!
> One other thing -- because I have had repeated crises since I have been with this doctor, we have never had me at a steady state for any length of time to really be able to tell what any med is really doing. I will get a few weeks where I am doing well, then crash and burn. So I have had repeated med adjustments, changes, etc. Sigh.
That sounds awful. I can see where a pdoc would get the idea that you're bipolar: it sounds like you're cycling.
> Thanks for your response. I smiled to see you are a math nerd (said with all lovingness). There are not many around!
Nerd pride!
-elizabeth
Posted by akc on August 17, 2001, at 16:33:26
In reply to Re: Recurrent unipolar vs bipolar » akc, posted by Elizabeth on August 17, 2001, at 14:42:39
> > This is a point I have been trying to get across to my treatment "team" (my therapist, pdoc and then two therapist that lead my group therapy) this week.
>
> Wow, you have quite an entourage there.
>
I really only work with my pdoc and my therapist - the other two do handle a crisis from time to time, but even though they do group, are not really that involved in my primary treatment.>
> But as long as your behaviour is "good," you can be suffering a great deal and it doesn't matter to treaters? (No, of course I'm not bitter. :-) )
>It is easy to feel bitter. I had to get my therapist on the phone this week after our session just to make sure she understood the pain I am feeling -- I am convinced now she did, but on Monday, during our session, I sure felt that she was minimizing it with the "you are doing great" type talk.
> I'm not convinced that agitated depression constitutes mania for treatment purposes. I'm definitely unipolar, but I've had periods of depression when I was quite agitated (and various mood stabilisers didn't help, BTW). If you are having some kind of mixed state, I think the anticonvulsants are actually preferred over lithium.My pdoc seems to be giving my the lithium as much for the depression as for mood stabilization. When we started the topamax, I stopped taking the lithium, and then had this episode. She blames the stopping of the lithium for the depressive episode, more than the lowering of the effexor. I did have a period of high anxiety, that she blamed on the increasing dose of topamax. I try hard to know why exactly she has me on stuff, but obviously, I am not clear.
>
>
> Heh. I found that trazodone was of no use for chronic insomnia: I got up to about 400 mg (due to tolerance) before I gave up on it.
>I don't have sleep troubles all the time -- just when I am in an episode. So far it has helped some, so I am going to keep my fingers crossed -- I sure don't want to add any more meds to the mix.
> (Oof.) What sort of distorted thinking do you mean? I found that neuroleptics just made me feel more tired and anergic.
While I have had problems with cutting and such, my distorted thinking gets locked on images of self-harm. It is more than just wanting to cut. I get in a frame of mind that I can't shake the images at all. And it is more than just cutting. It is pretty disturbing, to say the least.
>
> If Seroquel doesn't work out, you might try Geodon. That seems to be giving some people good success.
>My pdoc has mentioned Geodon.
> > To early to tell what the topamax is going to do.
>
> It might help with the weight thing, at least!I so hope!
>
> Nerd pride!RULES
akc
Posted by Elizabeth on August 22, 2001, at 13:34:19
In reply to Re: Recurrent unipolar vs bipolar » Elizabeth, posted by akc on August 17, 2001, at 16:33:26
> It is easy to feel bitter. I had to get my therapist on the phone this week after our session just to make sure she understood the pain I am feeling -- I am convinced now she did, but on Monday, during our session, I sure felt that she was minimizing it with the "you are doing great" type talk.
I think that sometimes therapists are trying to help by being optimistic, but it ends up just feeling like they're ignoring your pain. OTOH, depressed people tend to interpret anything in the most negative possible way!
> My pdoc seems to be giving my the lithium as much for the depression as for mood stabilization.Yes, it has antidepressant (or at least, AD-augmenting) effects as well as being a mood stabiliser (antimanic).
> When we started the topamax, I stopped taking the lithium, and then had this episode. She blames the stopping of the lithium for the depressive episode, more than the lowering of the effexor.
Well, if you make too many changes simultaneously, it can be hard to tell what caused what.
> I did have a period of high anxiety, that she blamed on the increasing dose of topamax. I try hard to know why exactly she has me on stuff, but obviously, I am not clear.
Try and get her to explain it to you. I think it's very important that you be giving truly informed consent to all these medical interventions.
> I don't have sleep troubles all the time -- just when I am in an episode.
I've had sleep troubles all my life. My mother even has told me about some problems I had when I was less than 1 year old. My earliest memories of disturbed sleep are from when I was about 3 or 4.
> While I have had problems with cutting and such, my distorted thinking gets locked on images of self-harm. It is more than just wanting to cut. I get in a frame of mind that I can't shake the images at all. And it is more than just cutting. It is pretty disturbing, to say the least.
That sort of obsessive/intrusive thought might be helped by antipsychotics, yes (at least, that's what my gut tells me). Good luck to you.
> My pdoc has mentioned Geodon.
Really? I don't know much about it except for certain pharmacological differences from the other atypicals. What did your pdoc say about it? (Anything interesting?)
> > Nerd pride!
>
> RULESCheers!
-elizabeth
Posted by akc on August 22, 2001, at 14:13:39
In reply to Re: Recurrent unipolar vs bipolar » akc, posted by Elizabeth on August 22, 2001, at 13:34:19
> I think that sometimes therapists are trying to help by being optimistic, but it ends up just feeling like they're ignoring your pain. OTOH, depressed people tend to interpret anything in the most negative possible way!
I definitely can fall in this category. You can say anything, and I'll "Yeah, but" you to death.
>
> Well, if you make too many changes simultaneously, it can be hard to tell what caused what.My pdoc and I had a good talk after this most recent episode. I was to blame for most of the changes, in that I came across so determined about the topamax. I have a way about me that appears unbending -- when really, I am just a push-over. She made some of the med changes to cope with what she saw as a possible manic phase being brought on by the topamax -- a med that she thought I was going to continue to increase regardless of how she felt. I think she understands me a lot better now, and definitely understands that I am going to trust her judgment -- I may ask a lot of questions, and may challenge her from time to time, but I am going to trust her. She wants me to continue to study and learn about my meds and bring the questions. I think I have a healthy relationship with this doctor -- I trust her -- and I think she knows her stuff. She stays up-to-date, she reads a lot, goes to a lot of conferances, seems to know about everything I bring in.
>
> Try and get her to explain it to you. I think it's very important that you be giving truly informed consent to all these medical interventions.See the above dissertation!
>
> I've had sleep troubles all my life. My mother even has told me about some problems I had when I was less than 1 year old. My earliest memories of disturbed sleep are from when I was about 3 or 4.What is funny to me, is that before I started meds, my one and only sleep problem was I could sleep all the time. Now, I can have problems getting asleep. But my biggest problem tends to be restless sleep -- just tossing and turning and never really getting that deep sleep. I hate it.
> > My pdoc has mentioned Geodon.
>
> Really? I don't know much about it except for certain pharmacological differences from the other atypicals. What did your pdoc say about it? (Anything interesting?)She did no more than mention it as another alternative to the seroquel. As I mentioned earlier, zyprexa worked at a high cost. The seroquel doesn't work as well at the current dose, and a higher dose sedates the heck out of me. So she just mentioned it as another alternative. I didn't ask. It was nothing more than a passing comment at this point.
akc
Posted by Zo on August 22, 2001, at 18:18:08
In reply to Re: Recurrent unipolar vs bipolar » Elizabeth, posted by akc on August 22, 2001, at 14:13:39
I just read something somewhere about not only RLS, which used to *plague& me (but comb of Dex andbenzot ook care of, after man years) but also like a Restless *Body* Syndrome. Whole body movements in sleep. , , ,
Zo
Posted by Elizabeth on August 23, 2001, at 10:48:15
In reply to Re: Recurrent unipolar vs bipolar » akc, posted by Zo on August 22, 2001, at 18:18:08
> I just read something somewhere about not only RLS, which used to *plague& me (but comb of Dex andbenzot ook care of, after man years) but also like a Restless *Body* Syndrome. Whole body movements in sleep. , , ,
(Wow, your typing got pretty mangled there :-) )
Can you tell me more about "RBS?" During what sleep stage(s) do the movements occur, in particular?
-elizabeth
Posted by Zo on August 24, 2001, at 15:56:07
In reply to Re: Recurrent unipolar vs bipolar » Zo, posted by Elizabeth on August 23, 2001, at 10:48:15
> (Wow, your typing got pretty mangled there :-) )
Um, can you say Effexor withdrawal? Actually just a dose reduction, dropped 75mg instead of just 37.5 at a time. . .wow.
> Can you tell me more about "RBS?" During what sleep stage(s) do the movements occur, in particular?
>Damn, I *knew* somebody was going to ask. Why are those always the links we don't keep? I'll look. . I remember I was looking for BPII. . .
Zo
Posted by phoeb on October 2, 2003, at 11:30:11
In reply to Re: Recurrent unipolar vs bipolar » akc, posted by Zo on August 22, 2001, at 18:18:08
Help. I just "recovered" from a horrible horrible month depression and now it comes back semi-regularly, but not tied to my cycle. On average, I get three weeks of feeling totally normal, then a week or two of wailing, suicidal, screaming from the agony, etc. My doctor doesn't know what it is, but my psychologist says she's seen it and these people eventually stabilize after "tweaking" their medicine. I'm on Nardil 105 mg, lamictal 200 mg, nortriptyline 50 mg, and lorazepam and zyprexa when needed (when I'm hysterical). Any one have this experience?? What did you try? Did anything seem to help?
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