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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Maxime on June 11, 2003, at 20:15:17
I feel like I have been on every med and combination of meds possible in the past 10 years.
When do you say enough is enough? When do you know that meds are never going to help?
Take cancer for instance. There comes a point where treatment isn't going to help anymore and impend on the person's quality of life.
What about people with mental illness. If I decided to say enough is enough do you think people would be mad with me? Or do you think they would understand how much I tried?
Because I am close to the point of saying enough is enough. I don't want to pump my body with this shit anymore.
So how will I know?
Max
Posted by pseudonym on June 12, 2003, at 0:58:29
In reply to Do you think meds will help, posted by Maxime on June 11, 2003, at 20:15:17
Hello Maxime,
I read many of your interesting posts and I got the impression that Parnate was doing well for you, getting you out of the "black hole", so to speak. Where are we with that, as it seemed to me you were doing relatively well a couple days ago and then Lamictal happened?
As for the meds questions, there are many meds on the horizon, and furthermore, an equally large number of brain imaging diagnostics to help us figure out whats chemically amiss. That's cause for hope.
Posted by Maxime on June 12, 2003, at 10:41:13
In reply to Re: Do you think meds will help, posted by pseudonym on June 12, 2003, at 0:58:29
The Parnate helps my depression big time - like nothing before it. But even when I was in the black hole of depression, I was never suicidal. I would become almost catatonic.
The mixed states however, I have been never lessened. It's during the mixed states that I am at my worse and most suicidal ... like right now.
The lamictal is making me dizzy and nauseous. I will try to continue with it (since I just started) but there have been other mood stabilisers that I have had to stop because of the dizziness. It makes me walk like a drunk.
I have already lost all my friends because they can't handle my mixed states and suicide attempts etc. In the end, I am all alone.
I already know that I am going to die at my own hands. It's really just a question of when and how. But it is something I have known since I was child - I am now 34. I have a strong feeling that it will be this year or next.
max
Posted by mmcasey on June 12, 2003, at 10:51:07
In reply to Do you think meds will help, posted by Maxime on June 11, 2003, at 20:15:17
>
> When do you say enough is enough? When do you know that meds are never going to help?
>
> Take cancer for instance. There comes a point where treatment isn't going to help anymore and impend on the person's quality of life.I have recently had the EXACT SAME thought of comparing mental illness treatment failure with cancer treatment failure. Honestly, I just don't know. Over this past weekend, I also was just thinking that I'm really sick of it. It gets so annoying to try more and more drugs and have them not work (at least, that's been my story). I've talked to my doctor about quitting, about giving up, and about the comparison with other illnesses. But, like the other poster said and my doctor said, there are always new advances and new drugs being developed. He also mentioned to me something that you don't hear much about, transcranial stimulation, which isn't really used in most places, but there is definite potential.
I don't think I'm in the same position as you really, because I've only actually tried about 7 different medications so far... but NONE of them have worked as of yet, so I'm really holding my breath for the Parnate right now. I've also been on Lamictal for 5 weeks and it doesn't seem to be doing *much*, but maybe it's helping a little and maybe I just need to - what else!! - wait longer!
I asked my doctor if there are people who truly nothing ever works for, and he said that he supposes there are... but that you will never know if something is going to work until you try, and you've basically got nothing to lose.
> What about people with mental illness. If I decided to say enough is enough do you think people would be mad with me? Or do you think they would understand how much I tried?
>I personally don't think people have the right to be mad at you. It's your decision, it's your life. But that isn't to say that they definitely won't be mad. I had a therapist once who basically said that if I didn't go on medication, she would really question if I was doing everything I could to help myself. That really pissed me off, because I feel like it's my decision and she shouldn't be imposing her will on me like that. Also, it's like she thought it would make her job easier.
Well, good luck with whatever you decide. I really hope that you find something.
Posted by mmcasey on June 12, 2003, at 11:32:41
In reply to Re: Do you think meds will help, posted by Maxime on June 12, 2003, at 10:41:13
I think that you are currently on the same regimen as me - Lamictal and Parnate. I'm surprised that you are having such severe side effects to the Lamictal. I don't really have any. But anyways, I know exactly how you feel about being alone. I have had the existential thoughts at times that everyone is really so completely alone and all that. And I have often felt like there just isn't anyone who can really help me, and that people can try but really nothing can help... or that people can try but in the end no one really cares because they all have their own lives to lead and can't be there for me 100%. This goes for psychiatrists, friends, family, therapists...
Although I do get quite agitated at times, I do not have what would be called mixed states. I am not bipolar, just plain depressed.
I also know exactly what you mean about dying by your own hand. I sort of think I will too, although I'm not totally sure. But even though I have never attempted suicide, I really think at times that I will sometime in the next year or two. I dont have exact plans, but I know that the suicidal thoughts/feelings/desire comes over me so much that it just seems so likely.
Well, I don't know if this is much help to you, but I do hope that things get at least slightly better for you soon. Hang in there, as obnoxious as that might sound.
Posted by Larry Hoover on June 12, 2003, at 11:47:08
In reply to Re: Do you think meds will help, posted by Maxime on June 12, 2003, at 10:41:13
> The Parnate helps my depression big time - like nothing before it. But even when I was in the black hole of depression, I was never suicidal. I would become almost catatonic.
>
> The mixed states however, I have been never lessened. It's during the mixed states that I am at my worse and most suicidal ... like right now.
>
> The lamictal is making me dizzy and nauseous. I will try to continue with it (since I just started) but there have been other mood stabilisers that I have had to stop because of the dizziness. It makes me walk like a drunk.
>
> I have already lost all my friends because they can't handle my mixed states and suicide attempts etc. In the end, I am all alone.
>
> I already know that I am going to die at my own hands. It's really just a question of when and how. But it is something I have known since I was child - I am now 34. I have a strong feeling that it will be this year or next.
>
> maxHave you been using fish oil, and/or B-vitamins? There are case reports of fish oil relieving suicidality. Niacinamide could have a calming effect. Have you considered your diet as a controllable factor in your well-being?
Lar
Fortschr Neurol Psychiatr. 2001 Oct;69(10):460-7.
[Cholesterol, omega-3 fatty acids, and suicide risk: empirical evidence and pathophysiological hypotheses][Article in German]
Brunner J, Parhofer KG, Schwandt P, Bronisch T.
Max-Planck-Institut fur Psychiatrie, Munchen. jbrunner@mpipsykl.mpg.de
Studies in psychiatric patients described an association between lower serum cholesterol concentrations, suicidality, depression, impulsivity, and aggression which is not entirely attributable to depression-related malnutrition and weight-loss. Several lines of evidence suggest that a serotonergic deficit in the prefrontal cortex may predispose vulnerable subjects to impulsive, autoaggressive, and suicidal behaviour in stressful life-events. In-vitro studies, animal experiments, and human in-vivo studies support the hypothesis that cholesterol reduction may contribute to the serotonergic abnormalities which have been postulated in suicidal subjects. Recently it was hypothesized that decreased consumption of polyunsaturated fatty acids, especially omega-3 fatty acids, may be a risk factor for depression and suicide. Data from human studies in healthy volunteers suggest that increasing the dietary intake of omega-3 fatty acids may increase central serotonergic activity and reduce impulsive and aggressive behaviours. Earlier epidemiological studies showed an association between low cholesterol concentrations and increased suicide risk. Recent epidemiological studies with greater samples and longer follow-up periods, however, even showed a positive correlation between cholesterol concentrations and suicide risk after controlling for potential confounding variables. Large trials of statins (simvastatin, lovastatin, pravastatin) did not show an increase of suicide mortality.
Posted by Maxime on June 12, 2003, at 14:18:51
In reply to Re: Do you think meds will help » Maxime, posted by Larry Hoover on June 12, 2003, at 11:47:08
Yes, I have been taking fish oil and B-vitamins for about 3 years now. I don't know if they help or not, but I figure my body needs them anyway because I am anorexic.
I know the anorexia contributes greatly to my mood etc. But I haven't been able to win the fight against the eating disorder. I've had inpatient treatment, outpatient treatment .... you name it.
It's gotten to the point where I feel that no one wants to help me anymore. I see therapists etc. and tell them my story and some have turned me away saying that they can't help me. Others get that look in their eyes that says "you are a lifer!". Others will come right out and say that I am never going to get better.
So when the medical community has no faith in me, how do you think that makes me feel? It has happened more than once or twice too.
Max
> Have you been using fish oil, and/or B-vitamins? There are case reports of fish oil relieving suicidality. Niacinamide could have a calming effect. Have you considered your diet as a controllable factor in your well-being?
>
> Lar
>
> Fortschr Neurol Psychiatr. 2001 Oct;69(10):460-7.
>
>
> [Cholesterol, omega-3 fatty acids, and suicide risk: empirical evidence and pathophysiological hypotheses]
>
> [Article in German]
>
> Brunner J, Parhofer KG, Schwandt P, Bronisch T.
>
> Max-Planck-Institut fur Psychiatrie, Munchen. jbrunner@mpipsykl.mpg.de
>
> Studies in psychiatric patients described an association between lower serum cholesterol concentrations, suicidality, depression, impulsivity, and aggression which is not entirely attributable to depression-related malnutrition and weight-loss. Several lines of evidence suggest that a serotonergic deficit in the prefrontal cortex may predispose vulnerable subjects to impulsive, autoaggressive, and suicidal behaviour in stressful life-events. In-vitro studies, animal experiments, and human in-vivo studies support the hypothesis that cholesterol reduction may contribute to the serotonergic abnormalities which have been postulated in suicidal subjects. Recently it was hypothesized that decreased consumption of polyunsaturated fatty acids, especially omega-3 fatty acids, may be a risk factor for depression and suicide. Data from human studies in healthy volunteers suggest that increasing the dietary intake of omega-3 fatty acids may increase central serotonergic activity and reduce impulsive and aggressive behaviours. Earlier epidemiological studies showed an association between low cholesterol concentrations and increased suicide risk. Recent epidemiological studies with greater samples and longer follow-up periods, however, even showed a positive correlation between cholesterol concentrations and suicide risk after controlling for potential confounding variables. Large trials of statins (simvastatin, lovastatin, pravastatin) did not show an increase of suicide mortality.
>
>
Posted by pseudonym on June 13, 2003, at 0:35:27
In reply to Re: Do you think meds will help, posted by Maxime on June 12, 2003, at 10:41:13
For the sake of education, could you tell me what a mixed state is, as opposed to a depressed one? You say that your mixed state is the one that has heretofore been untreatable, right?
Posted by Maxime on June 13, 2003, at 13:35:30
In reply to Re: Do you think meds will help, posted by pseudonym on June 13, 2003, at 0:35:27
For me a mixed state is hypomania, but it doesn't manifest itself as a "happy" moment.
http://www.psycheducation.org/depression/frameset.html
The following is from the above URL.Unfortunately, "hypomania" is quite a mis-naming. There are many patients whose "hypomanic" phases are an extreme and very negative experience. As noted above by Dr. Jamison, mania can be negative as often as it is positive. The "racing thoughts" can have a very negative focus, especially self-criticism. The high energy can be experienced as a severe agitation, to the point where people feel they must pace the floor for hours at a time. Sleep problems can show up as insomnia: an inability to sleep, rather than decreased need.
For now, imagine someone with manic symptoms of rapid thoughts and speech, who instead of feeling euphoric, feels terrible: depressed; with negative thoughts, especially about her/himself; full of negative energy, and possibly even delusional (e.g persecutory or paranoid delusions, or delusions of terrible guilt and responsibility). This combined state occurs very commonly in mania, unfortunately.
What do "bipolar variations" look like?Warning: The following represents my clinical experience taking referrals from primary care physicians. Most patients I see have been on 3 or more antidepressants before I see them. This selects very directly for "bipolar spectrum" patients. However, note that none of these descriptions are found in the DSM, nor are they widely spoken of by mood experts. This is my personal formulation based on 5 years of full-time selection for such patients.
Roller coaster depression
Many people have forms of depression in which their symptoms vary a lot with time: "crash" into depression, then up into doing fine for a while, then "crash" again — sometimes for a reason, but often for no clear reason at all. They feel like they are on some sort of mood "roller coaster". They wonder if they have "manic-depression". But, most people know someone or have heard of someone who had a "manic" episode: decreased need for sleep, high energy, risky behaviors, or even grandiose delusions (‘I can make millions with my ideas"; "I have a mission in space"; "I’m God"). So they think "well, I can’t have that — I’ve never had a manic episode".
However, the new view of bipolar disorder means it’s time to reconsider that conclusion. Hypomania doesn’t look or feel at all like full delusional mania in some patients. Sometimes there is just a clear sense of something cyclic going on. Some mood disorder experts consider recurrent depression to have a high likelihood of having a manic phase at some pointFawcett, especially if the first depression occurred before age twenty.Geller, Rao
Depression with profound anxiety
Many people live with anxiety so severe, their depression is not the main problem. They seem to handle the periods of low energy, as miserable as they are. Often they sleep for 10, 12, even 14 hours a day during those times. But the part they can’t handle is the anxiety: it isn’t "good energy". Many say they feel as though they just have too much energy pent up inside their bodies. They can’t sit still. They pace. And worst of all, their minds "race" with thoughts that go over and over the same thing to no purpose. Or they fly from one idea to the next so fast their thoughts become "unglued", and they can’t think their way from A to C let alone A to Z. When this is severe, people who enjoy books can find themselves completely unable to read: they just go over and over the same paragraph and it doesn’t "sink in". They will get some negative idea in their head and go around and around with it until it completely dominates their experience of the world. Usually these "high negative energy" phases come along with severely disturbed sleep (see Depression with Severe Insomnia, below). Thoughts about suicide are extremely common and the risk may be high.Fawcett(b)
Depressive episodes with irritable episodes
Many people with depression go through phases in which even they can recognize that their anger is completely out of proportion to the circumstance that started it. They "blow up" over something trivial. Those close to them are very well aware of the problem, of course. Many women can experience this as part of "PMS". As their mood problems become more severe, they find themselves having this kind of irritability during more and more of their cycle. Similarly, when they get better with treatment, often the premenstrual symptoms are the "last to go". Others can have this kind of cyclic irritability without any relationship to hormonal cycles. Many, perhaps most, men with bipolar variations say they have problems with anger or rage.
Depression that doesn’t respond to antidepressants (or gets worse, or "poops out")
Many people have repeated episodes of depression. Sometimes the first several episodes respond fairly well to antidepressant medication, but after a while the medications seem to "stop working". For others, no antidepressant ever seems to work. And others find that some antidepressants seem to make them feel terrible: not just mild side effects, but severe reactions, especially severe agitation. These people feel like they’re "going crazy". Usually at this time they also very poor sleep. Many people have the odd experience of feeling the depression actually improve with antidepressants, yet overall —perhaps even months later —they somehow feel worse overall. In most cases this "worse" is due to agitation, irritability, and insomnia.
In some cases, an antidepressant works extremely well at first, then "poops out". The benefits usually last several weeks, often months, and occasionally even years before this occurs. When this occurs repeatedly with different antidepressants, that may mark a "bipolar" disorder even when little else suggests the diagnosis.Sharma
Depression with periods of severe insomnia
Finally, there are people with depression whose most noticeable symptom is severe insomnia. These people can go for days with 2-3 hours of sleep per night. Usually they fall asleep without much delay, but wake up 2-4 hours later and the rest of the night, if they get any more sleep at all, is broken into 15-60 minute segments of very restless, almost "waking" sleep. Dreams can be vivid, almost real. They finally get up feeling completely unrested. Note that this is not "decreased need for sleep" (the Bipolar I pattern). These people want desperately to sleep better and are very frustrated.
> For the sake of education, could you tell me what a mixed state is, as opposed to a depressed one? You say that your mixed state is the one that has heretofore been untreatable, right?
Posted by avid abulia on June 13, 2003, at 13:57:56
In reply to Re: Do you think meds will help, posted by Maxime on June 13, 2003, at 13:35:30
mostly just from watching my friends (a lot of them are also nuts) a lot of the say, agh, these meds don`t work! and quit taking them, when in fact, what they find out later is, the meds just aren`t working well, not not working.
as regards dizziness and lamictal, i noticed that you mention you have an eating disorder (as do i). how is your sodium intake? when i started lamictal, i had very low sodium/potassium ratio in my diet (about 2:5) because of eating low-Cal vegetables and refusing to eat sodium-rich foods much at all... but extracellular sodium is critical for neuronal excitability, and from what you describe it sounds like your neurons are not all that excitable right now... i was having the same problem, but forced myself to get a bit more sodium and that seemed to help a bit. now, as my body has had a while to adjust, i`m eating my old diet and not having such problems anymore.
~AA
Posted by Maxime on June 13, 2003, at 14:54:45
In reply to Re: Do you think meds will help, posted by avid abulia on June 13, 2003, at 13:57:56
I tend to avoid sodium at all costs for fear of water retention. Sigh. OK, this is really hard for me to do but I will try and ad some to my daily diet and see if it helps.
Having an ED makes all food seem so damn scary!
Max
> mostly just from watching my friends (a lot of them are also nuts) a lot of the say, agh, these meds don`t work! and quit taking them, when in fact, what they find out later is, the meds just aren`t working well, not not working.
>
> as regards dizziness and lamictal, i noticed that you mention you have an eating disorder (as do i). how is your sodium intake? when i started lamictal, i had very low sodium/potassium ratio in my diet (about 2:5) because of eating low-Cal vegetables and refusing to eat sodium-rich foods much at all... but extracellular sodium is critical for neuronal excitability, and from what you describe it sounds like your neurons are not all that excitable right now... i was having the same problem, but forced myself to get a bit more sodium and that seemed to help a bit. now, as my body has had a while to adjust, i`m eating my old diet and not having such problems anymore.
>
> ~AA
Posted by avid abulia on June 14, 2003, at 18:17:20
In reply to Re: Do you think meds will help, posted by Maxime on June 13, 2003, at 14:54:45
>
> Having an ED makes all food seem so damn scary!
>
> Maxtell me about it... but i thought it was worth it in the end to get a little more sodium for a stretch.
Posted by Angel1 on June 14, 2003, at 22:51:06
In reply to Re: Do you think meds will help » Maxime, posted by avid abulia on June 14, 2003, at 18:17:20
Maxine,
You are currently taking Parnate, correct? I know being a former anorexic myself, you probably wouldn't stay on it, if weight gain was a problem?
Let me know. Curious to know if you suffered being tired all the time in the beginning and what dosage are you taking? I read a book called "Fat is a Feminist Issue" and it saved me from anorexia. Maybe you should check it out. There's also a good article discussing anorexia in "Health" magazine, May issue. Take care and don't ever give up. ANGEL1
Posted by Dr. Bob on June 15, 2003, at 0:32:11
In reply to Re: Do you think meds will help:MAXINE, posted by Angel1 on June 14, 2003, at 22:51:06
> I read a book called "Fat is a Feminist Issue" and it saved me from anorexia. Maybe you should check it out.
I'd just like to plug the double double quotes feature at this site:
http://www.dr-bob.org/babble/faq.html#amazon
The first time anyone refers to a book without using this option, I post this to try to make sure he or she at least knows about it. It's just an option, though, and doesn't *have* to be used. If people *choose* not to use it, I'd be interested why not, but I'd like that redirected to Psycho-Babble Administration:
http://www.dr-bob.org/babble/admin/20020918/msgs/7717.html
Thanks!
Bob
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