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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Anna Laura on April 4, 2002, at 1:41:40
First of all, i thank you for being here and for spending your precious time answering our questions.
I live in Europe (Northern Italy). I have a few questions for you most of pdoc i have been consulting here don't answer to. Sorry if this post it's gonna be a little long but i have to describe my depression history in order to have an accurate answer.
Here's my brief story: i developed major depression at age 21 after severe prolonged stress . Unfortunately I had been misdiagnosed , given benzos at high doses instead of AD's.
Needless to say i got worse as years went by. A few months after a traumatic experience i went psychotic: i felt horribly anxious and i was experiencing a state of permanent horror. The pdoc who finally made the right diagnosis thought i was schizophrenic at first: he eventually told me he believed i suffered from severe psychotic depression.
I was given imipramine (300 mg). I did Cognitive-Behavioural Therapy also.
I got better real slowly and i took two more years to make a substantial improvement.
Major Symptoms of depression had deseappeared within two years. I was feeling much better but still unmotivated/anhedonic, kind of low-functioning.
My pdoc made me quit imipramine: i finally managed to get along fine without it even though apathy and anhedonia subtly and slowly got worse over the years.
Three years after quitting imipramine i noticed an abrupt change: i became socially withdrawn, i lacked sexual desire and i experienced unexplainable personality changes: my character became strangely "feeble": never felt so weak in my entire life; lost every trace of self confidence, (it might sound weird but i was far more confident when i was psychotic, my self esteem was better also) i didn't have any drive whatsoever (again, felt better years before as i was far more active and involved in many activities during the day);
strangely, i didn't feel much depressed, just heavily numbed and anhedonic. My body perceptions got so worse i was experiencing a state of analgesia. Didn't feel anything, not even pain. I could barely feel my feet touching the ground.
Unfortunately i experienced a traumatic event during that period.
I went to my ex-pdoc seeking for advice : he told me i didn't need any meds and he just gave me psychological support which gave me no benefit whatsoever.
After four months of continous stress and pressure (i was taking care of a my fianceé in the hospital) i got suddenly sick. I experienced hot flushes, night sweats, rashes on my arms and chest, nausea, low grade fever, extreme weakness, mind diziness ,vertigos ,severe hypotension and worst of all, a strange "numbed" anxiety which brought about a state of horrible mental confusion. I felt like i was experiencing a benign version of Alzheimer Desease: it was very scary since i didn't have any control whatsoever.
I took Zoloft which improved the situation a little bit (enough to be able to stand on my own feet, more active, less apathetic even though i still had severe blood pressure shifts and neurological like symptoms). Still, i took a few years to recover. I'm currently taking Effexor (300 mg) and Reboxetine (8 mg.)
I was retrospectively diagnosed with a severe form of CFS with neurological symptoms. I've been searching for CFS Syndrome info since then. I found a site ran by Jay A. Goldstein, a doctor who's specialised in CFS syndrome, whic states that CFS could be triggered by a lack of synaptic plasticity; could i have aquired this deficiency through long term synaptic potentiation which possibly led to excitoxic damage? I'm asking you this 'cause i've read that chronic depression might induce brain shrinkage.
A year and half ago i experienced double depression (which was reversed by imipramine) and i noticed that depression was qualitatively different: it was a lethargic/anergic type whereas the depression type i had experienced years before was more like the agitated type. On my second depression, i'd get lost in familiar places and couldn't recognize people faces. It never happened to me before. Is that a sign of deterioration?
Could it be similar to involutional depression ? Is that possible that depression induced brain shrinkage would make the brain age prematurely? And if it was so, would be a nootropic drug like piracetam or memantine a valid augmenting option for me?Second question:
I'm wondering why i went fom extreme hypearousal/vigilance, "vivid" sense of reality down to hypoarousal/dream-like-mental state and mental confusion/numbed anxiety.
Is there a neurobiological mechanism underlying the above mental states?
Is there a reason why anhedonia got worse throghout the years? (May be dopamine deficency?).
Sorry, one more question: could the emotional/sensory numbing i suffer from
somehow related to PTDS? I'm asking you this 'cause when i was psychotic years ago i experienced a state of hyperarousal, constant terror, high blood pressure, and high heart rate which lasted for many months with virtually no breaks.
After that state subsided anhedonia took its place (it's like i experienced a reversed state). Could that endogenous shock be similar to PTDS, neurobiologically speaking? And if it was so, could be the endogenous opiate system play a role?
I've read that extreme, prolonged shock triggers anhedonia via the opiate system.O.K., enough with questions. Sorry if i've been so long. I thank you again for your patience and support.
Sincerely,
Anna Laura
Posted by IsoM on April 4, 2002, at 13:25:10
In reply to A few questions for Dr. Kramer, posted by Anna Laura on April 4, 2002, at 1:41:40
Dr. Bob, even though Dr. Kramers's no longer taking questions, please do include Anna Laura's question as she's from Italy & services there aren't necessarily the same as in N.A. She doesn't post too often either....Please?
Posted by CtrlAlt n Del on April 4, 2002, at 13:33:57
In reply to DR. BOB !!!! please send above to Dr. Kramer, posted by IsoM on April 4, 2002, at 13:25:10
Posted by Zo on April 5, 2002, at 0:50:55
In reply to A few questions for Dr. Kramer, posted by Anna Laura on April 4, 2002, at 1:41:40
Anna Laura,
As a person with Bipolar II who lived most of her life unaware of this, going through AD after AD. . .reading your post, I get a strong sense of a Bipolar content. I imagine you've looked into this, and just wanted to offer, as an experienced patient, my impression.
Best wishes,
Zo
Posted by JohnX2 on April 5, 2002, at 2:20:27
In reply to A few questions for Dr. Kramer, posted by Anna Laura on April 4, 2002, at 1:41:40
> Second question:
>
> I'm wondering why i went fom extreme hypearousal/vigilance, "vivid" sense of reality down to hypoarousal/dream-like-mental state and mental confusion/numbed anxiety.
> Is there a neurobiological mechanism underlying the above mental states?
> Is there a reason why anhedonia got worse throghout the years? (May be dopamine deficency?).
>This is conjecture, take it with a grain of salt..
I believe that your assertion may be correct. I also feel that this may be related to a dysfunction in the hypothalamus-pituitary-adrenal (HPA) gland workings. Specifically a hypofunctional system. This may occur after prolonged trauma (which would hyperstimulate the
HPA) reaches an exhaustion phase. At this point your body's thermostat may get stuck on "low". Your adrenals are underproducing glucocorticoids and adrenaline, etc. This may cause you to feel very fatigued and anhedonia/detached. Prior to this your HPA may have been hyperactive, producing too much adrenaline, "fight-or-flight" chemicals and making you anxious, psyhotic feelings, heart racing, high blood pressure etc.>
> Sorry, one more question: could the emotional/sensory numbing i suffer from
> somehow related to PTDS? I'm asking you this 'cause when i was psychotic years ago i experienced a state of hyperarousal, constant terror, high blood pressure, and high heart rate which lasted for many months with virtually no breaks.Emotional/sensory numbing is a classic symptom of PTSD.
> After that state subsided anhedonia took its place (it's like i experienced a reversed state). Could that endogenous shock be similar to PTDS, neurobiologically speaking? And if it was so, could be the endogenous opiate system play a role?
> I've read that extreme, prolonged shock triggers anhedonia via the opiate system.
>There have been studies that indicate that the opiate system may be involved in the "emotional blunting" felt after trauma.
Zoloft is a primary medicine prescribed for PTSD related symptoms. Zyprexa is a useful adjunct for disassociative symptoms. Some people think that the opioid antagonist Naltrexone may help to relieve emotional numbing/depersonalization/derelialization. I believe that Lamictal has also been used successfully to treat these symptoms.
Many times PTSD and atypical depression symptoms that you are describing also seem to be indicators of bipolar symptoms. People with PTSD often times have "non-textbook" symptoms of other disorders.
Take care.
John> O.K., enough with questions. Sorry if i've been so long. I thank you again for your patience and support.
>
> Sincerely,
>
> Anna Laura
Posted by Anna Laura on April 5, 2002, at 20:06:27
In reply to Re: A few questions for Dr. Kramer » Anna Laura, posted by Zo on April 5, 2002, at 0:50:55
Hi Zo,
Just a question: could you be bipolar without hypomanic switches? I'm asking you this since i've been wondering if i could be bipolar.
The last pdoc i've seen told me mood-stabilizers could be an option for me since i could be bipolar; i'm still kind of skeptical though, 'cause i've never been hypomanic nor euthymic since i got depressed (eleven years).
Are you currently on mood-stabilizers? Are they effective for you?Thanks for listening
Posted by Anna Laura on April 5, 2002, at 20:10:46
In reply to Re: A few questions for Dr. Kramer, posted by JohnX2 on April 5, 2002, at 2:20:27
> Many times PTSD and atypical depression symptoms that you are describing also seem to be indicators of bipolar symptoms.
John, do you know how to find those studies? (about PTDS/bipolarity connections)?
Thanks in advance
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