![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 36 to 60 of 69. Go back in thread:
Posted by BarbaraCat on March 25, 2002, at 0:58:52
In reply to Re: Hurting all the time? » BarbaraCat, posted by shelliR on March 24, 2002, at 20:51:33
Shelli,
Regarding fms and no cure, I agree with you. I've spent alot of money on specialists who try one thing after the other and then finally admit that there's no cure at this time. I mainly control it by diet and stress reduction. I'm familiar with costocondritis, having had it myself about 5 years ago. It eventually went away. I remember it being very painful and not being able to raise my arms at all or take a deep breath.
Yes, low thyroid causes a deep muscular aching pain, muscle weakness and tingling. In fact there are some schools of thought that suggest improper functioning of the thyroid causes fms. I know that when I upped my dose (also taking natural brand) my fms pains diminished considerably. I'd urge you to get it checked since even a slightly low function can mean depression. AT the risk of repeating what you already know: Your TSH values should be around 1.0 - 1.5. Many doctors will let it go at 2 and above, but that is not good enough to get a good therapeutic antidepressant effect. Good luck to you. - Barbara
Posted by Elizabeth on March 25, 2002, at 14:43:45
In reply to Re: Anyone had success with ECT?, posted by OldSchool on March 23, 2002, at 15:04:53
> It might be true that atypical depression doesnt respond as well to ECT.
From what I've read, it's not totally clear to me whether there's solid evidence of this, or whether it's just a reputation. Interestingly, there doesn't seem to be any recent research on the subject at all. But anyway, these subtypes don't predict anything *absolutely*, so in some cases it's probably worthwhile to try ECT even if you seem to have "atypical" depression.
My pdoc and I did talk about ECT once (when I was in Boston), and he took the particular features of the illness (neurovegetative signs/symptoms, etc.) into consideration. This was when I'd tried a lot of things to augment Nardil (which had pooped out) and they didn't help. In the end we decided to keep trying with the medications. This ended up paying off, although it took a long time.
I think that doctors in a place like Boston, where there's a major medical center (three, in fact) and lots of research going on, would probably be more likely to take subtypes of depression into account than the average community doctor. Boston doctors also seem to be into trying experimental medication approaches, rather than just trying you on an SSRI, TCA, MAOI, and lithium and then referring you for ECT. :-)
> You might know more about this than the docs do in some cases because of your readings.
That's pretty scary, because I really don't know much about ECT. I definitely would not be willing to have ECT on the advice of a doctor who knew even less about it than I do.
> You know how it is in the real world, if you dont respond to meds you just get shocked, period.
Heh, my experience has that they just throw more meds at me!
> As far as bilateral, its definitely better to start off with if you have psychotic features with your mood disorder.
Hmm. It's been a long time since I seriously considered ECT, so I'm not sure that my information is up to date. My recollection is that it's a judgment call, though: you might want to start out using bilateral ECT for the most urgent cases, whereas if there isn't so much of a hurry you can afford to titrate so as to minimize the risk of cognitive side effects. Is there some other issue, or is that what you were thinking of?
> Bifrontal ECT is supposed to be the best of both worlds, having effectiveness comparable to bilateral, but without the severe memory loss side effects of bilateral.
I'm not very familiar with bifrontal ECT, but I'll keep this in mind (although I hope I never have to use the information myself!).
-elizabeth
Posted by Elizabeth on March 25, 2002, at 14:59:27
In reply to Re: Anyone had success with ECT? » Elizabeth, posted by Mags on March 23, 2002, at 13:31:37
> I am scheduled for ECT but have to first figure out how to get Lamictal out of my system and how long it should be out.
I'm not sure if there's any washout required beyond the time it takes to get the Lamictal out of your system, which is itself hard to predict because the elimination half-life is so variable. (Two weeks should probably cover it, I'd think. I'll be interested to hear what your doctor has to say.)
> I am BP11 and still in a DEEP atypical type depression. just got out of hospital after four weeks. Am very sensitive to drugs.
Is that one of the reasons you're trying ECT, because you have trouble with medication side effects? I hope that it works for you. Are you going to remain outpatient while having ECT?
It'd be great if you'd post here about the treatments; I think it's important for people here to get real stories from people about what ECT is like from people who've actually had it.
> Any info is greatly apprecited!
Sure. What would you like to know?
-e
Posted by Mags on March 25, 2002, at 18:06:03
In reply to Re: Anyone had success with ECT? » Mags, posted by Elizabeth on March 25, 2002, at 14:59:27
> > I am scheduled for ECT but have to first figure out how to get Lamictal out of my system and how long it should be out.
>
> I'm not sure if there's any washout required beyond the time it takes to get the Lamictal out of your system, which is itself hard to predict because the elimination half-life is so variable. (Two weeks should probably cover it, I'd think. I'll be interested to hear what your doctor has to say.)
>
> > I am BP11 and still in a DEEP atypical type depression. just got out of hospital after four weeks. Am very sensitive to drugs.
>
> Is that one of the reasons you're trying ECT, because you have trouble with medication side effects? I hope that it works for you. Are you going to remain outpatient while having ECT?
>
> It'd be great if you'd post here about the treatments; I think it's important for people here to get real stories from people about what ECT is like from people who've actually had it.
>
> > Any info is greatly apprecited!
>
> Sure. What would you like to know?
>
> -e
Thanks for response Elizabeth,
You have so much information to share. I am not so much looking for info now as I have researched it myself (I think) and have definately decided to go ahead with it.I am really hoping to hear from others who have had ECT.
Re meds: I am very sensitive as in headaches or GI symptoms, or unusual responses(couldn't stay awake on Wellbutrin!)
..if I survive S/E's then I haven't had anything work except as follows:
"four days of major on top of the world happiness" When Lithium was added to Effexor while in hospital due to suicidal ideation...then a MAJOR crash. Then I couldn't take Li anymore (dopey, staggering, shakes,throwing up)Then I got onto Lamictal...25 mg and I was on top of the world for about 6 weeks then an insidious backslide until my next hospital stay due to an OD. Increases in Lamictal didn't help. I am only at 100Mg now and it took four months to get there.
Also tried Prozac and felt very, very good for about a week, then crashed.
Other meds tried with either no response or couldn't take side effects:
Desipramine
Celexa
Zoloft
Remeron
WellbutrinThis has been in the last two years.
So now doc thinks ECT. He is a very young, progressive doc.His idol is Stephen M. Stahl.
He doesn't like labelling patients too soon but he thinks I MAY be BPll due to my responses to meds, my previous history of sexual promiscuity and spending WAY too much (bankruptcy)plus my Mom ,who committed suicide, was diagnosed as BPII. But none of my super happy times seemed manic and did not involve lack of sleep,but my sleep has always been affected by my depression
( can't get to sleep for hours then the 4:00 AM wakeup call)Other than times mentioned above I have been depressed (exhausted, no energy,sleep and eat too much, weepy, withdrawn, anti-social, apathetic, irritable.)But I can respond to events and/or people favourably for a short time and do smile, even laugh sometimes.
My doc is confering with a neurologist to make sure re washout of Lamictal. He will be doing Bilateral ECT twice a week in hospital at first and then as an outpatient.(He wants to keep his eye on me and space out the treatments as apart as we can and watch for memory loss, but doesn't want to "waste" a treatment by trying unilateral)...he calls me one of his challenges due to my S/E's and weird responses.I actually tried Speed as a teenager and slept for three days!I am very lucky to live in Canada where this will not cost me anything, plus I am on Disability through my employer. I am hoping I will respond more favourably to meds after treatments but if not I am prepared to get maintenance ECT.
Sheesh, I guess I really rambled , didn't I? Anyway, I welcome any words of wisdom you may have.
Thanks!
Mags
Posted by BarbaraCat on March 25, 2002, at 19:21:36
In reply to Re: Anyone had success with ECT? » Elizabeth, posted by Mags on March 25, 2002, at 18:06:03
Mags,
I'd also like to second that it would be a great favor to all of us here if you kept us informed of your ECT experiences. You probably won't be feeling too peppy during the treatments, but it might be good therapy and a contribution to your 'memoirs' to keep a record of your days during this time. Who knows, there may even be a book in it for you down the line!I'd also like to let you know how much your meds and 'wanton' history jibes with mine. I've gone through every single one of the newer ADs and some of the older ones. I'll get a honeymoon rush for a few weeks or months and then - splaaat!
My garage resembles a stuffed to the gills warehouse. I can easily open a Michael's Craft Store with all the fallout from my brilliant craft and project ideas that never came to fruition (you have no idea how serious I am about this!). Bankruptcy has not happened yet, but looms and leers around every corner every month of the year. Billpaying time is either a matter of intense overwhelm and stress or 'I'll think about it tomorrow' and tomorrow never comes.
I'm currently stabilized and relatively serene on a brew of Remeron, lithium, Klonopin and thyroid (plus handfulls of vitamins and amino acids). I'm counting the days until another splaaat.
I've recently been upgraded from unipolar to Bipolar II mainly because of my med history and the fact that members of my family fit into the BPII category.
So, I think we have much in common, and I'd like you to know that you're not alone by any means. Please keep in touch. - BCat
Posted by Mags on March 25, 2002, at 21:00:20
In reply to Re: Anyone had success with ECT? » Mags, posted by BarbaraCat on March 25, 2002, at 19:21:36
Hi BCat,
WOW...we DO sound alike....I just about fell off my chair when you mentioned crafts and Michael's!! I too have got all hepped up about something, flower arranging, ceramics, computer crafts, sewing etc. I buy all the stuff, do it for awhile, get bored and give it up or I just lose interest. I have often wondered if I could have ADD. Sometimes I can concentrate and sometimes I can't even read this board!I also SOOO relate to bill paying....I actually call myself Scarlett.....I find even when I have the money I put it off....sometimes the simplest chore seems so overwhelming..it took me an hour today just to convince myself I could do the dishes!
I will definately keep everyone informed about my ECT experience. I do sporadically keep a journal so I will try to make notes. The nurses on the Pyschiatric unit (where I have spent TOO much time) are very helpful and will remind me to do it. Someone else on this board said to keep notes BEFORE the ECT to jog my memory and I plan to do that also.
I am sure it won't be a Bestseller (I wish) but I will do my best!
Thanks for your well wishes. That's what makes this board so great...it is nice to know we are not alone....that is one thing I have really learned when in hospital...I have made some good friends from my incarcerations ;o)
Mags
Posted by OldSchool on March 25, 2002, at 22:12:17
In reply to Re: Anyone had success with ECT? » OldSchool, posted by Elizabeth on March 25, 2002, at 14:43:45
> > It might be true that atypical depression doesnt respond as well to ECT.
>
> From what I've read, it's not totally clear to me whether there's solid evidence of this, or whether it's just a reputation. Interestingly, there doesn't seem to be any recent research on the subject at all. But anyway, these subtypes don't predict anything *absolutely*, so in some cases it's probably worthwhile to try ECT even if you seem to have "atypical" depression.thats my plan. I dont know what type of depression I have at this stage anyway. I dont think any of my doctors do either. Its changed probably ten times thru the years. I personally think I have melancholic depression with some psychotic depression mixed in with it. So Im just gonna do the bilateral ECT thing. Ive also been told I have a retarded depression but with "mood reactivity" and a "rigid" personality. whatever that means.And Ive had atypical depression dx a few times. I also have the EPS symptoms now, mild parkinsons type symptoms, mild rigid right arm and stuff. Not noticeable to the naked eyeball unless I get examined though.
Frankly, I think the only thing anybody knows is Ihave some sortof mood disorder and thats about all. And some kind of mild movement disorder thats not severe.
>
> My pdoc and I did talk about ECT once (when I was in Boston), and he took the particular features of the illness (neurovegetative signs/symptoms, etc.) into consideration. This was when I'd tried a lot of things to augment Nardil (which had pooped out) and they didn't help. In the end we decided to keep trying with the medications. This ended up paying off, although it took a long time.
>
> I think that doctors in a place like Boston, where there's a major medical center (three, in fact) and lots of research going on, would probably be more likely to take subtypes of depression into account than the average community doctor. Boston doctors also seem to be into trying experimental medication approaches, rather than just trying you on an SSRI, TCA, MAOI, and lithium and then referring you for ECT. :-)
>Is it really that much different in Boston? I realize its an elite academic town and all. But when it comes to psychiatry, which is so primitive about wherever you go, I find it hard to believe the psychiatric services there would be much different than in Winston, or Charlotte...or NYC..or wherever. Are there really experimental drugs there available for the taking? I realize people up there are probably more open minded than down here. But are there really more treatments up there?
> > You might know more about this than the docs do in some cases because of your readings.
>
> That's pretty scary, because I really don't know much about ECT. I definitely would not be willing to have ECT on the advice of a doctor who knew even less about it than I do.
>
> > You know how it is in the real world, if you dont respond to meds you just get shocked, period.
>
> Heh, my experience has that they just throw more meds at me!
>
> > As far as bilateral, its definitely better to start off with if you have psychotic features with your mood disorder.
>
> Hmm. It's been a long time since I seriously considered ECT, so I'm not sure that my information is up to date. My recollection is that it's a judgment call, though: you might want to start out using bilateral ECT for the most urgent cases, whereas if there isn't so much of a hurry you can afford to titrate so as to minimize the risk of cognitive side effects. Is there some other issue, or is that what you were thinking of?
Bilateral is just plain stronger and it doesnt require a titration procedure so the first treatment is not wasted like in unilateral. I figure I should just go for the gusto and go for bilateral and expect memory loss. At least Iknow it will be powerful.
>
> > Bifrontal ECT is supposed to be the best of both worlds, having effectiveness comparable to bilateral, but without the severe memory loss side effects of bilateral.
>
> I'm not very familiar with bifrontal ECT, but I'll keep this in mind (although I hope I never have to use the information myself!).Bifrontal is supposed to have the effectiveness of bilateral, but without the memory loss side effects. Its the best of both worlds. The electrodes are placed above the eyes, on the forehead instead of the temples. Its making a comeback from what Ive read.
later,
Old School
Posted by shelliR on March 25, 2002, at 22:43:19
In reply to Re: Anyone had success with ECT?, posted by OldSchool on March 25, 2002, at 22:12:17
>
> Bilateral is just plain stronger and it doesnt require a titration procedure so the first treatment is not wasted like in unilateral. I figure I should just go for the gusto and go for bilateral and expect memory loss. At least Iknow it will be powerful.> Bifrontal is supposed to have the effectiveness of bilateral, but without the memory loss side effects. Its the best of both worlds. The electrodes are placed above the eyes, on the forehead instead of the temples. Its making a comeback from what Ive read.
This past February I went through a series of bifrontal ECT treatments. The bad news is that the treatments didn't turn out to be helpful in treating my depression. (I don't know what specific kind I have--diagnosis is major depression.) The good news is that my memory loss was pretty minimal; there is a lot gone from the period that I was getting the treatments, and some minor memory blocks of things before the treatments, like directions, names of things, etc. Within about ten days of the last treatment, I was pretty much able to jump right back into life and work. I got eight all together: Mondays, Wednesdays, and Fridays. I think it made it easier for me to be in the hospital (it was a pretty nice hospital with a nice staff). I don't regret trying it
shelli
Posted by IsoM on March 25, 2002, at 22:43:40
In reply to Re: Anyone had success with ECT? » Elizabeth, posted by Mags on March 25, 2002, at 18:06:03
Excuse me for jumping in but I read in your post that "I actually tried Speed as a teenager and slept for three days!" That sort of reaction sounds very much like you've got ADD traits, no matter what else you may have. Have you been checked by a "QUALIFIED" psychologist who specialises in ADD for it? Most doctors & pdocs will brush it off & refuse to believe that adults really have it. Please post your answer back about this, Mags.
Posted by Mags on March 25, 2002, at 23:25:58
In reply to About Possible ADD » Mags, posted by IsoM on March 25, 2002, at 22:43:40
> Excuse me for jumping in but I read in your post that "I actually tried Speed as a teenager and slept for three days!" That sort of reaction sounds very much like you've got ADD traits, no matter what else you may have. Have you been checked by a "QUALIFIED" psychologist who specialises in ADD for it? Most doctors & pdocs will brush it off & refuse to believe that adults really have it. Please post your answer back about this, Mags.
Thanks for jumping in IsoM!
I have never been diagnosed for ADD...I just kinda wondered because of things I read here plus I took one of those self diagnostic tests on the web, and it said I could possibly be ADD.
Why would my weird reaction to speed be a clue?
Would this make a difference in how I would be treated?
Thanks,
Mags
Posted by IsoM on March 25, 2002, at 23:51:19
In reply to Re: About Possible ADD » IsoM, posted by Mags on March 25, 2002, at 23:25:58
Depending on how I'm feeling Dexedrine will either wake me up & help me focus, or if I'm worn out, it'll calm me down & let me sleep. To a certain extent, it depends on the time of day for the reaction I get.
People with ADD will often have so many things going on in their mind at one time that don't necessarily lead anywhere except to another thought. I compare my thoughts to popcorn being popped & richocheting around in my head. Dexedrine will stop thoughts from bouncing about & calm my focus allowing me to slow my thoughts down to fall asleep. It seems to be fairly common in ADD people but it's not a reaction found in ordinary persons.
I know you're home for now from the hospital but I don't recall reading what your diagnoses is supposed to be. Could you explain first before I suggest anything? Have you taken various ADs before & what was your responses to them? A bit of background info would be helpful.
I have ADHD & narcolepsy. I think depression developed not as a separate issue but related to the ADHD, narcolepsy, & absolutely crappy, stress-filled marriage I had. The depression was secondary.
Posted by BarbaraCat on March 26, 2002, at 0:28:51
In reply to Re: Anyone had success with ECT? » BarbaraCat, posted by Mags on March 25, 2002, at 21:00:20
Mags,
You have no idea how relieved I am to know that I'm not the only one who has these 'irresponsible' habits. I can get so down on myself and frustrated because I know better. I'm beginning to see the light that these behaviors are a product of some weird syndrome we suffer from and not due to some horrible shortcoming. The thing is that I am very talented and could probably put these artsy crafty things to very good use - another Georgia O'Keefe - if only I could concentrate long enough. Or slog through the piles of boxes and stuff to find the darn items I need when I'm wildly inspired. I also wonder about ADD, but what's in a name? It's all just degrees of the same malfunction. Well good. Connect those circuits in our brains and watch out World!The reason I'm so interested in ECT is that I'm coming to believe that medication has the unfortunate effect of lag time. By the time the receptors are duly affected, our chemistry has moved on to new things. I think that resetting our brain's circuits via electric or magnetic means is the key and I hope they figure out how to do it right in our lifetimes. We're rooting for you - what an adventure. Also, if you could let us know when you'll be going in, there's a few of us here who wouldn't mind putting in a good word for you in our daily good thoughts. - Barbara
Posted by BarbaraCat on March 26, 2002, at 0:51:19
In reply to About Possible ADD » Mags, posted by IsoM on March 25, 2002, at 22:43:40
Anyone who has a clue,
My drug of choice when I was in my late teens and early twenties (back in the early '70's) was methadrine. It was the only substance I recall where I would feel sooooo mellow, focused and centered. It was a Zen-like no-thoughts space that I sought forever after. I know now that I was self-medicating via the street scene. Even so, speed in abusive amounts is a killer, no doubt about it. I also stayed up for days, crashed and burned, and fried my delicate system.
A question I'd like to put out there is: this suggests to me that I have ADD in addition to depression. However I also have a tendency towards severe anxiety and panic disorder. I'd hesitate at this stage to take a stim because I do not want to elicit a strung-out spin into hypomania or compromise my fledgling health and immune system. I have an appt with my pdoc this week. He's very wary of prescribing a stim because he knows I had a bit of a Jones in the past. The bottom line of my question is, how do speed-type drugs affect those with serious affective/anxiety disorders? - BCat
Posted by Zo on March 26, 2002, at 3:56:56
In reply to Re: About Possible ADD - Speed anyone?, posted by BarbaraCat on March 26, 2002, at 0:51:19
Hi BCat, I have a friend in same situation, and she survives on Adderall. . .got to THIRTY mgs a grain at a time. I've been on Dex for four years, and some Adderall, am BPII. .. and neither ever rocketed me to any kind of interesting high. Anyway, the Adderall has not triggered any old addiction in her, nor have I gotten manic. On other meds, yes, but not stims! You control the anxiety by ramping up sloooowly, and by using benzos PRN.
Zo
Posted by Mags on March 26, 2002, at 7:47:04
In reply to Re: About Possible ADD » Mags, posted by IsoM on March 25, 2002, at 23:51:19
Pls see this and let ne know what else I can add...
Mags
http://www.dr-bob.org/babble/20020322/msgs/100101.html
Posted by Mags on March 26, 2002, at 7:52:37
In reply to Re: About Possible ADD » IsoM, posted by Mags on March 26, 2002, at 7:47:04
Hi folks,
Heard from pdoc this morning. My first ECT is set for April 16. I will be admitted the day before. Depending on how I do they will start with 2 a week and then bump it to three.....I am actually getting excited about it...it has given me back hope which I haven;t had for a looong time.
Wish me luck and I will keep you all posted.IsoM, I will discuss Adderral if needed after ECT's. We had at one time discussed stims, but for some reason tried Wellbutrin and Remeron instead.....
Mags
Posted by BarbaraCat on March 26, 2002, at 11:10:02
In reply to ECT date is set » Mags, posted by Mags on March 26, 2002, at 7:52:37
Mags,
You're on my special 'prayer calendar'. I'm not particularly religious but I find it a powerful practice. - Barbara> Hi folks,
> Heard from pdoc this morning. My first ECT is set for April 16. I will be admitted the day before. Depending on how I do they will start with 2 a week and then bump it to three.....I am actually getting excited about it...it has given me back hope which I haven;t had for a looong time.
> Wish me luck and I will keep you all posted.
>
> IsoM, I will discuss Adderral if needed after ECT's. We had at one time discussed stims, but for some reason tried Wellbutrin and Remeron instead.....
>
> Mags
Posted by Zo on March 26, 2002, at 16:35:11
In reply to Re: About Possible ADD » IsoM, posted by Mags on March 25, 2002, at 23:25:58
Posted by Zo on March 26, 2002, at 16:39:38
In reply to Re: Anyone had success with ECT? » Mags, posted by BarbaraCat on March 26, 2002, at 0:28:51
Barbara, Where you at w/ meds? Any ADD demanding tasks get done solely related to how my meds are.
Have been on Dex since '97. .. Just added Provigil a few weeks ago, and lo and behold, suddenly-----I can sort and file papers and handle business matters. And when the day's Provigil wore off, the papers abruptly became "unreadable" again. It was striking. Provigil opens a whole new part of my brain.
Zo
Posted by BarbaraCat on March 26, 2002, at 16:58:02
In reply to Re: Anyone had success with ECT? » BarbaraCat, posted by Zo on March 26, 2002, at 16:39:38
Hi Zo,
I'm on Remeron, lithium, klonopin primarily (plus natural estrogen/progesterone and natural thyroid). The only 'pstim' I've tried recently was adrafinal which made me feel uneasy and restless. I have no idea what my real dx is. Non response to AD's hence the lithium, but maybe BPII because of some possible hypomania which could be stress related. I'm not always symptomatic, and have long clear stretches. But when I'm feeling overloaded, I'll start things and not finish, overspend, get totally flustered like a brain lock. You talk about filing. I could start with a pile of papers and end up with a bigger messier pile and end up crying from sheer frustration.Isn't ADD an all the time thing (without meds)? Also, coffee really affects me. If I have more than one cup I'm up all night. I sometimes get wired by benzos. My major experience with stims is when I abused meth in my wild days of youth, and I often wonder if I burnt out my dopamine system. But maybe a therapeutic pinch of a stim might really do something for me. Geez, I just hate to keep adding stuff to my poor body. Barbara
, > Barbara, Where you at w/ meds? Any ADD demanding tasks get done solely related to how my meds are.
>
> Have been on Dex since '97. .. Just added Provigil a few weeks ago, and lo and behold, suddenly-----I can sort and file papers and handle business matters. And when the day's Provigil wore off, the papers abruptly became "unreadable" again. It was striking. Provigil opens a whole new part of my brain.
>
> Zo
Posted by Zo on March 26, 2002, at 17:34:16
In reply to Re: Hurting all the time? » BarbaraCat, posted by shelliR on March 24, 2002, at 20:51:33
Posted by Zo on March 26, 2002, at 17:43:54
In reply to Re: Anyone had success with ECT? » Zo, posted by BarbaraCat on March 26, 2002, at 16:58:02
All I can say is, Remeron stupified me, lithium was difficult and crude compared to Lamictal. . .ADD varies a lot from hour to hour, day to day. True pstims--Dex, Ritalin, Adderall, and subjectively, Provigil, tho it is not chemically a pstim--even things out. I could handle papers and piles--but before Dex was as you described, and cried every day at the too-muchness. Provigil just opened up a whole new area of paper-clarity. You should see my file--you could eat off the floof!
I am BPII, ADD, TLE, CFS. Respond to coffee same as you.
Prescribed stims *are* a pinch of speed, in comparison to the amount one uses "recreationally"---and truly, have been nothing but helpful to my body. Better posture, muscle tone.Klonopin, while a great med, aggravated my ADD so much all the next day, it also got filed under Stupid-making drugs.
ADD and BP II are almost impossible to separate, and are both Kindling disorders of the brain. Your long clear stretches *strongly* suggest that BPII is your primary dx. Which the stims do not aggravate, they are very organizing, which always helps. My life didn't come together, however (15 years of trying meds) til I added Lamictal just last fall. I encourage you to consider it.
Zo
Posted by BarbaraCat on March 26, 2002, at 18:08:30
In reply to Re: Anyone had success with ECT?, posted by Zo on March 26, 2002, at 17:43:54
Thanks for the clarification. Lamactil, as I understand, is another mood stabilizer and would most likely replace the lithium. Concerning another thread we had going about fibro, would neurontin be added to it, or combined, or. . . duh! there is so much to keep together in this poor befuddled brain. Good thing I have an appointment with my shrink tommorrow. I'm going to definitely ask for the lamactil and a wee dram of a stim.
Zo, just what is TLE and what is your current med brew? Do you not take anything for anxiety? - BCat
Posted by Elizabeth on March 26, 2002, at 20:11:59
In reply to Re: Anyone had success with ECT?, posted by OldSchool on March 25, 2002, at 22:12:17
> I dont know what type of depression I have at this stage anyway. I dont think any of my doctors do either.
It might very well be like you said, that they just don't think in any terms that are more exact than "major depression." Anyway, "major depression" isn't at all exact; I think that, as you suggest, it's probably not "a" disease, but many different diseases.
> Its changed probably ten times thru the years.
That's possible; I've read that it isn't always consistent over the course of a person's illness. And of course, there really haven't been many different types that have been identified; the only ones I know of that predict treatment outcomes at all are psychotic, melancholic, and atypical features. I think the majority probably don't fit into any of these categories; this is called "simple mood-reactive depression," although it really doesn't tell us anything to say something this vague (that it doesn't fit into any known subtype, that is).
I think that you're right that it would help if we worked on the biological research, although I also think that we're limited by technology.
> I personally think I have melancholic depression with some psychotic depression mixed in with it.
Psychotic? What sort of delusions or hallucinations have you had? I can see the melancholic part (not sure if it's "technically" right, but it's probably at least close), but you never struck me as psychotic. I'd be careful about going on that assumption.
BTW, are you taking any medication now, and if so: 1) what? 2) how much is it helping? 3) what is it not helping with (or only partially helping with)?
> So Im just gonna do the bilateral ECT thing. Ive also been told I have a retarded depression but with "mood reactivity" and a "rigid" personality. whatever that means.
"Mood reactivity" means it's nonmelancholic: your mood changes, somewhat, in response to things that happen around you (i.e., environmental stuff). "Retarded" means you're slowed down rather than agitated. Anything a psychiatrist says about your personality probably tells you more about the psychiatrist than about you, but FWIW, "rigid" would mean "not amenable to change."
> And Ive had atypical depression dx a few times.
Huh. That is sometimes associated with irritability and moodiness, as well as psychomotor retardation and reactive mood, but that stuff alone isn't sufficient. I wonder why they thought that.
> I also have the EPS symptoms now, mild parkinsons type symptoms, mild rigid right arm and stuff.
Oh god, that sucks. How did that happen? Have you tried any antiparkinsonian drugs, like Cogentin, Benadryl, Artane, Symmetrel, etc.?
If you really think that psychosis is involved, and if you think you could deal with the regular tests required, Clozaril might be something to consider; it hardly ever causes EPS (like, very rarely even compared to other atypicals) and can even be used to treat them. Psychotic depression pretty much requires either a dopamine antagonist, or maintenance ECT (the latter being rather a PITA).
> Frankly, I think the only thing anybody knows is Ihave some sortof mood disorder and thats about all.
If it's any comfort, that's all they know about anybody, pretty much!
> Is it really that much different in Boston?
Yes, very. I guess that I should really say it's different if you see a pdoc who's affiliated with Harvard, because those are the only ones I have experience with. I don't know if doctors at BU and Tufts, or non-academic psychiatrists, are similar.
> I realize its an elite academic town and all. But when it comes to psychiatry, which is so primitive about wherever you go, I find it hard to believe the psychiatric services there would be much different than in Winston, or Charlotte...or NYC..or wherever. Are there really experimental drugs there available for the taking?
There's an awful lot of research there. (New York is probably similar, I'd think.) I was thinking more of the willingness of the doctors there to try off-label stuff, though. Like, at some point I was told by a pdoc here that they were starting to use Neurontin for mood disorders. I said, "yeah, I tried that three years ago," and he seemed startled. I think that pdocs here are much less likely to suggest something like selegiline (or indeed, to be comfortable with MAOIs in general), pindolol, ketoconazole, that amoxapine-Parnate cocktail that I've heard such good things about, etc., and most of the ones I've spoken to have been downright hostile when I mentioned that I take buprenorphine. (I'm afraid that all the publicity about its use as a treatment for addiction has given it a bad name.) I've been having a problem getting my pdoc to let me take 20 mg of Ambien (10 mg is useless for me -- not tolerance, just the way my body works), or even to let me try more than 300 mg/day of Effexor XR. (Strangely, the labelling for immediate-release Effexor recommends a higher maximum dose than the labelling for Effexor XR -- 375 mg vs. 225. I guess they just didn't bother studying Effexor XR at > 225 mg.)
> I realize people up there are probably more open minded than down here. But are there really more treatments up there?
Not that so much, no (although there really is very little research down here) -- but practically speaking, it's a lot easier to get newer off-label treatments there than it is here.
> Bilateral is just plain stronger and it doesnt require a titration procedure so the first treatment is not wasted like in unilateral. I figure I should just go for the gusto and go for bilateral and expect memory loss. At least Iknow it will be powerful.
Running out of patience? I can understand it, although on the other hand I'd really think twice about rushing if it might mean that even recovery would be bitter. Wasting one session of ECT doesn't seem so bad from that perspective. On the other hand, I wouldn't mind forgetting what it was like when I was depressed (unfortunately I don't think you get to choose what you forget).
> Bifrontal is supposed to have the effectiveness of bilateral, but without the memory loss side effects. Its the best of both worlds. The electrodes are placed above the eyes, on the forehead instead of the temples. Its making a comeback from what Ive read.
I looked it up after reading your post. It sounds promising. Why do you want to have bilateral ECT when something like this is an option?
Whatever you decide, I hope it helps turn things around for you.
-e
Posted by Elizabeth on March 26, 2002, at 20:39:11
In reply to About Possible ADD » Mags, posted by IsoM on March 25, 2002, at 22:43:40
> Excuse me for jumping in but I read in your post that "I actually tried Speed as a teenager and slept for three days!" That sort of reaction sounds very much like you've got ADD traits, no matter what else you may have.
Some people just don't get activated on amphetamine -- it's just an unusual reaction, it doesn't necessarily mean that you have ADD. (If that were true, it'd be easy to test people for ADD.) It is interesting how some people have these so-called "paradoxical" reactions, though. (I'm the same way: I took several different stimulants at various times and they didn't make me at all tired -- and on the other hand, opioids act like stimulants for me.)
On a different subject: that's interesting what happened to you when you were taking lithium (I know it wasn't interesting to you at the time, of course!). The reaction you had to lithium after you had the crash sounds very much like lithium toxicity, but I don't know why that would happen all of a sudden. Did you have your lithium levels, kidney function, etc. checked when you were on it?
I think your pdoc has a good point, a lot of things about your history suggest bipolar II. I don't think that ECT has been researched in bipolar II people, though. It has been known to trigger mania on occasion, so keep your eyes open for that sort of thing. ECT isn't supposed to be very good for atypical unipolar depression, but that might not apply to bipolar II atypical depression.
Speaking of atypical depression, though, I don't recall you mentioning whether you'd tried any MAOIs. Have you? Intolerance of other ADs doesn't necessarily mean that you won't tolerate MAOIs -- they have different sorts of side effects than other ADs, and you might well find them less troublesome.
Anyway -- I hope the ECT helps you. Keep posting if you can.
best,
-elizabeth
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.