![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Vanillintabaktöne on April 25, 2004, at 13:08:02
SYMPTOMS ARE:
Mornings: Once out of bed, hard to get "awake". Sluggish, ocassionally grumpy. takes about 4 cups of coffee and 2 smokes to really wake up.
Between Morning and Noon: Relatively OK. Feels anxious, tense, sometimes can't really focus 100 percent, constantly on the go or else boredom sets in fast. Experiences hand tremor quite often especially in a one on one situation or at the centre of attention, in meetings etc. However, not in the supermarket or store,malls etc.
After Noon to approximately 4 pm or 5 pm: extreme mentall fuzziness, drowsiness, lethargy, sets in regardless of meal size or type [originally thought to be post prandial hypoglycemia, AND IT IS NOT! No thyroid trouble either. Its at its worse between 1 pm and 3 pm.
6 pm: Comes home and the tiredness sometimes wears off by 7 pm'ish. Between 7 and 8 pm, he COMES ALIVE so to speak. Not bouning off the walls or dancing on the roof tops, but concentration is 110%, motivation is up, work can be done. However, multitasking ensues and causes alot of frustration and agitation. E.g. Doing homework assignments, go into kitchen for a drink, end ups washing up the dishes, then making a snack, then watching T.v. then remembering about 1-2 hrs later that an assignment is has to be finsihed. Ends up in bed at about 1 am, thinking about what has to be done tomorrow, and finally falling asleep by 2 am if lucky.
Then the vicous cycle begins again at 7 am the next morning.
All in all, day to day fluctuations in intensity. Very high strung, anxious, tense, a few angry short lived out bursts, very feeling that "inner contentment" peace if you will, always worrying especially about events about 2 or 3 weeks down the road. Angry outbursts, although rare, are always followed by extreme drowsiness and totally mentall and physical drain. Been fairly good at profession and achieving in high school and college, but has a very very low tolerance for uninteresting subjects. No patience!
HELLLLLLLLLLLLLLLLLLP! Is this a personality thing or a latent disorder? 30+ years old, cant live like this any longer, its too stressfull!
Posted by Civ on April 25, 2004, at 18:24:59
In reply to Anyone Wanna Play P'doc??, posted by Vanillintabaktöne on April 25, 2004, at 13:08:02
These symptoms are very consistent with a mood disorder (BP II). I experience many of them myself. Are you currently seeing a pdoc?
Posted by holymama on April 25, 2004, at 19:20:55
In reply to Re: Anyone Wanna Play P'doc??, posted by Civ on April 25, 2004, at 18:24:59
I was going to say the same thing. You could be bipolar and be 'rapid cycling', as in one cycle every day. Inconsistent moods and energy levels are frustrating and sometimes seemingly unbearable. I started getting help myself for mood cycles at age 30. I'll be interested to see if anyone has any other ideas. Best of luck to you in your quest to feel better.
Posted by smokeymadison on April 25, 2004, at 20:43:03
In reply to Re: Anyone Wanna Play P'doc??, posted by holymama on April 25, 2004, at 19:20:55
depression can be worse in the morning and lessen at night and it may not be BPII. could be though. the only way i could really think of actually finding out would be to try a SSRI like Paxil (which really helps with anxiety) and see if you get hypomanic. then you are BPII for sure. of course, you would probably hate Paxil b/c it tends to kill the sex drive. assuming you are BPII the best thing for you would be a mood stabilizer AND an antidepressant. one to lift your mood and the other to stabilize it. trileptal is a good mood stabilizer. there are also gabitril and neurontin, but those made me feel dopey. Wellbutrin is a good antidepressant which doesn't kill the sex drive and is activating and won't make you cyle faster like other antidepressants. but i am not sure it really helps with anxiety very much. could just be me, of course. good luck.
Posted by Vanillintabaktöne on April 25, 2004, at 20:49:29
In reply to Re: Anyone Wanna Play P'doc??, posted by holymama on April 25, 2004, at 19:20:55
I could never sit still for too long. And I would always feel bored. And I have to be honest that I did have a friend who had Ritalin 20 LA [and this might have been a stupid move on my part] but since I failed on Divalproex, for the sole reason that it did help the mood swings ALOT, BUT I felt zombie-like, the motivation for everyday activities went way below zero. The SSRI's made me extremely irritable. And secondly, I always found a good couple of strong cups of coffee calmed me down while still being able to be stimulated enough to do "stuff". So I tried the Ritalin LA and MY GOODNESS, its was the best I have felt in all my life.
It was such a peaceful feeling. But on the downside, while it calmed my head [CNS] my heartrate went up moderately and my hand tremor got worse. I dunno what this means. I never tried teh ritalin again, but its made me wonder if I would benefit from a stimulant-moodstabilizer combo? I am not depressed, the symptoms I described in my first post does make me alittle down sometimes.
Posted by Keith Talent on April 25, 2004, at 21:01:43
In reply to Re: Anyone Wanna Play P'doc?? What About ADHD, posted by Vanillintabaktöne on April 25, 2004, at 20:49:29
Which SSRIs did you take, at what doses and for how long? Have you been prescribed any other antidepressants. Do mood disorders run in the family?
Posted by Vanillintabaktöne on April 25, 2004, at 21:06:23
In reply to Re: Anyone Wanna Play P'doc??, posted by smokeymadison on April 25, 2004, at 20:43:03
Meds I have tried:
Paxil: kills sex drive, agitation, eventually dysphoria, no motivation, anxiety worse, sleepiness....made me drink and smoke even more!!!!!!Zoloft doped me up....fuzziness worse. Prozac was numbing, agaition, insomnia. Celexa was a sugar pill at 20mg and a hypnotic @30 mg :-((
Manerix waz better for motivation, but insomnia, agitaion and anxiety worse. Added inderla, tight chest, SEVERE LETHARGY, dizziness on standing.AIH! Visken was better and monotherapy was ok for while for anxiety was pretty good. However, lack of concentration was still there, boredom, restlessnes, had a REAL SERIOUS PROBLEM actually sitting at a table and just engaging in conversation, I would drift off at the slightest disinterest of the topic, constant foot shaking esp when trying to concentrate on even a subject I really enjoyed. When faced with a project I would like procrastinate to start, and charged up with coffee like mad just to do so, and take frequent breaks to recharge before i actually get finish. Also had a tendency to look at a question on a paper and see one word in the question and then just answer, only to realize that I had it all wrong.....:-((((( Life on the whole is just one big stressor especially when faced with challenges and new moves, projects, job change, and I always had a very low self image..........aaaaaaarg!
Its total crazinness
Posted by Vanillintabaktöne on April 25, 2004, at 21:14:01
In reply to Re: Anyone Wanna Play P'doc?? What About ADHD, posted by Keith Talent on April 25, 2004, at 21:01:43
paroxetine 20 mg for 1 month, the 30 mg for 6 months. Zoloft 50 mg for 5 mothns. prozac 20 mg for 3 motnths. Celexa at 20mg for 3 weeks then 30 mg for 5 months. Wellbutrin 300 mg for about 3 months [better than SSRI's no sexual disturbances, somewhat claming into beginning then its like making me extremely tried ALL the time and has lately become a sugar pill. tegretol with it made my heartrate go through the rooof and dizziness extravaganza!!! YUKKKKKKK
Posted by Viridis on April 26, 2004, at 1:41:19
In reply to Re: Anyone Wanna Play P'doc?? SSR1'S, posted by Vanillintabaktöne on April 25, 2004, at 21:14:01
If you can, see a pdoc who's knowledgeable about ADD and anxiety. You sound similar to me, and a combination of Klonopin, Adderall, and Lamictal works quite well (for me). Like you, I can't tolerate SSRIs at all and simply refuse to take them any more, a position endorsed by my pdoc.
Posted by T_R_D on April 26, 2004, at 13:19:58
In reply to Anyone Wanna Play P'doc??, posted by Vanillintabaktöne on April 25, 2004, at 13:08:02
I couldn't wait to get in on this one! Of course I'm no pdoc but my opinion might help here as I suffer form some of what you are talking about.
A lot of people play a "one or the other" diagnosis game but disorders cna be comorbid and/or mask each other. You sound comorbid ADD/bipolar to me. I know when untreated I can get very ADD and also cycle (my formal diagnosis is BPII but I know enough about ADD and my own traits that it's easily there too.)
The difficult aspect of the whole thing is that bipolar and ADD can look so much like each other it's hard to tell.
One of the things that said ADD to me were the sudden tiredness after mental exertion. It can happen in reverse too (i.e. I have gotten tired before studying for exams.)
The late afternoon/evening pick me up is a phenomenon called "sundowning." It's most often reported with Alzheimer's patients but I am also a "sundowner" as my (hypo)manic cycles could/would tend to occur at that time of day. I have also been known to get sleepy around that time of afternoon too (just after lunch and it isn't always to do with a full tummy either!) The key to the whole thing--people suspect--is the whole circadian rhythm thing. It's a theory anyway. Serotonin is also linked with sleep etc...hence the problem with insomnia/somnolence with depression, yadda, yadda, yadda...
So what do you think?
Karen
Posted by Vanillintabaktöne on April 26, 2004, at 14:07:58
In reply to Re: Anyone Wanna Play P'doc??, posted by T_R_D on April 26, 2004, at 13:19:58
Thank very much TRD [kAREN]
I think you are right on target. I actually tried ritalin about 4 weeks ago. A friend had some and I asked for 2 10 mg tabklets. i took one 10 mg tab and in about 30 minutes [didnt really time it] I felt really really calm and could concentrate, the irritability dropped about 90%. I was shocked...howevr i soon felt very drowsy and fell asleep. i tried a 5 mg the next day and it worked super, no sleepiness. the funny thing is that although it clamed my mind alot, it increased the physical anxiety symptoms like palpitations and hand tremor. that was the only downside, and also it didnt last long, about 4.5 hrs. I was never really depressed, at least i dont think. its just living with the synptoms i described earlier and always feeling stressed made feel down somtimes and i worried about my future. Serotonergic drugs always made me feel worse very disphoric and very mentally restless and a intense feeling of unsatisfactoriness, for lack of a better word. Another thing I would notice was that although I frequently shook my feet, or twiddle or bite on a pen while attempting to concentrate, I didnt notice any other signs of "hyperactiveness". HOWEVER, my speech was often ramble-like and while reading I would tend to skip the middle parts of sentences and concentrate on the nouns, the subject of the sentence and sometimes end up missing important details while responding on the appropriate subject topic if you will.
I am no p'doc but, I have come to realize TWO MAJOR THINGS about myself:
1. I am very very very sensitive to meds of all kinds, even a tylenol.
2. My symptoms/illness are NOT serotonin related.
Finally I really feel I would benefit greatly from a Rx of
1. RITALIN 10 CR/ ER once day,
2. NADOLOL for somatic anxiety,or CLONIDINE,PINDOLOL.....not PROPRANOLOL I think because it is lipohilic and could slow me down mentally too much.
3. SODIUM VALPROATE @ low dose and extended or slow release, just to stabilize the bipolar tendency.
But who am I to say..........
Posted by greywolf on April 26, 2004, at 15:18:03
In reply to Anyone Wanna Play P'doc??, posted by Vanillintabaktöne on April 25, 2004, at 13:08:02
Let me be a devil's advocate here in the face of some uniformity of opinion on this being BP. Everyone's experience with BP is different, and for some it's remarkably different. Although some of what you describe certainly could fall within the recognized symptomology of BP, overall it doesn't strike me as diagnosable as such under prevailing criteria. I've been dealing with BP for several years, so I may be viewing it through the lens of what I've experienced.
It may be a lack of information on your history Vanillin that leads me to suggest it's not BP. But, does anyone else see some social anxiety disorder along with a sleep disorder in this?
Just throwing this out for what it's worth.
Posted by T_R_D on April 26, 2004, at 16:05:17
In reply to Re: Anyone Wanna Play P'doc?? In response To TRD, posted by Vanillintabaktöne on April 26, 2004, at 14:07:58
I think it sounds like you know yourself very well! A positive response to Ritalin like that generally indicated ADD. If it ramps you up (works as a stimulant) you're not "officially" ADD...but like I said, there are so many grey areas and so much overlap...
The most important thing is to find the right med(s)...it doesn't really matter what your diagnosis is.
Take care,
Karen
This is the end of the 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.