![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 15 to 39 of 47. Go back in thread:
Posted by johnnystats on January 18, 2005, at 16:02:50
In reply to Re: Depakote works, but be wary of side effects » johnnystats, posted by catmint on January 15, 2005, at 14:27:59
> Thanks a lot for your post.
> I spent some time yesterday researching the Lamictal/Depakote combo and have decided against it.
> I was on just Depakote before the Lamictal and it is true what you said. I was tired all the time, my depression worsened and I had a huge apppetite.
> I am now considering going off all meds for a while. I've done it before and can't say it was that much better but I don't know what else to try at this point.
> What meds do you take now?
>I'm currently taking nardil, xanax xr, and switching from depakote to lamictal. It's the best combo i've tried so far for anxiety/depression.
Posted by catmint on January 18, 2005, at 16:32:17
In reply to Re: Amy, have you ever tried Trileptal? » catmint, posted by Ron Hill on January 18, 2005, at 14:32:56
Hi Ron,
Thank you so much for your post. It was good to see your name again.
I have stayed off recreational drugs since August. I had a close call a month ago. I smoked some cigarrettes for a couple days and had that euphoric recall thing. I have too much at stake to ever go down that road again. The depression that followed was too much. I don't want to want to die ever again.
I have cut back the Lamictal from 200 to 100 a day and am feeling a lot better. Of course, I am entering the better part of the month for me, so I don't know if the dose reduction is the answer.
Yes, Ron I have tried Trileptal for a brief period before I started Lamictal. I probably stopped taking it because I was really in need of an effective antidepressant other than an ssri, you know why.
Once on Lamictal, I never looked back until now.
Ron, sorry to hear you don't or can't post until February. Great to hear from you. Let's all keep in contact. Another person I'm interested in talking to is BarbaraCat. I haven't seen her in a while. I think she and I have a lot in common.
Hopefully Colin will chime in soon.
Bye Ron, take care, talk to you soon.
Amy
Posted by SLS on January 18, 2005, at 21:26:44
In reply to Re: Colin Wallace » Ritch, posted by Ron Hill on January 18, 2005, at 13:30:01
Hi Ron!
:-)
Glad to see you back.
- Scott
Posted by Ron Hill on January 18, 2005, at 22:50:42
In reply to Re: Colin Wallace » Ron Hill, posted by SLS on January 18, 2005, at 21:26:44
Posted by Ritch on January 19, 2005, at 0:08:33
In reply to Re: Colin Wallace » Ritch, posted by Ron Hill on January 18, 2005, at 13:30:01
> Mitch, did you really hear from Colin recently, or do you have me confused with my good buddy Colin? The most recent post I've seen from Colin was back in October:
> It's no big deal if you've got us mixed up; we can write off the name recall glitch to the Depakote.
YEP, got your post mixed up with Colin's!
>
> I feel bad that I didn't get back to thank you for your response to my former post regarding Adderall. I've had a very "interesting" response to the addition of 5 mg of Adderall. At some point I'll tell you all about it. My one-year protest is over sometime in February.
>
> Thank you Mitch!
You're welcome. Stims DO have good utility with bipolar for the ADD/depressive dimensions, but watch out for panic.. that was my case. If you don't have comorbid panic troubles and you can respond to low dosages for limited periods....
>
> Hey in reference to your posts in a thread above, have you ever tried ginger on a prn basis to treat Trileptal induced nausa? I buy crystallized ginger at the grocery store in the bulk food section. It's a little spendie (about $7 per lb) but it does the trick on my rare bouts of nausa. YMMV.
I've heard about the ginger "trick" for Depakote nausea. Thanks for reminding me about that. It just seems weird that 300mg Trileptal gives me such nausea and 500mg Depakote doesn't. The PDR numbers for nausea are actually worse for Depakote! You see, that makes me worried that Trileptal and its associates being not such a nice fit for my particular chemistry. I didn't get serum sodium checked.. and if it was seriously dipping serum sodium that led to the nausea symptoms--I don't want to take it--BUT if *Tegretol* WOULDN'T do that AND give me better or as good benefits as Trileptal for the manic-mixed symptoms I would rather take the Tegretol than the Depakote that I take now BECAUSE I think my sleep quality would be better and it would be *less* depressogenic than the Dep. Just a theory now.
>
> I love two things about Trileptal; it reels in my hypomania within minutes of taking a dose and I sleep like a baby on it. As you are well aware, good sound sleep is an excellent bipolar "medication".Yes, there is something weird about Depakote that I don't like regards sleep. It seems to *aggravate* sleep maintenance troubles I have. If I take a dose at bedtime it seems that it activates me and wakes me up just a few hours later and then I can't go back to sleep.. and then I DO go back to sleep right before I need to wake up- really irritating! This leaves me all foggy headed and tired all next day. SOOO I have tried taking it earlier in the evening and it has helped some but not enough. It is like a triphasic response... first I get sedated and might nap or nod off.. then there is an *activation* that happens 4-6 hrs in (while I am trying to sleep), then several hours of somnolence after that (the next morning-midday). I liked Trileptal or lithium because I could take a dose at bedtime and it would put me out right.
>
> Unfortunately, Trileptal does not help my BPII atypical depression. In fact, it almost feels like it hinders me from cycling out of the depressive phase of my cycle. In other words, it kinda holds me in the depressive phase longer than I would have been without it. I notice this particularly at higher dosages. As a side note, I'm absolutely convinced that Depokote caused depression when I was on it years ago.
>
>----- RonI get clearly depressed on Depakote if I take it during a depressive episode in doses exceeding 250mg/day. You know, here's something I've been wondering about a little: Effective antimanics are associated with effective PKC inhibition, but I think brain norepinephrine levels are reduced as some downstream consequence of this...and if they aren't corrected during a BP depression an antimanic might actually worsen it.. SO I've found that a low dose of a stim or a little Strattera or nortript. whatever seems to be the right thing to counteract the antimanic's depressogenic tendencies.. just thinking out loud a little.... Mitch
Posted by Ron Hill on January 19, 2005, at 10:55:55
In reply to Re: Colin Wallace » Ron Hill, posted by Ritch on January 19, 2005, at 0:08:33
Mitch,
> You're welcome. Stims DO have good utility with bipolar for the ADD/depressive dimensions, but watch out for panic.. that was my case. If you don't have comorbid panic troubles and you can respond to low dosages for limited periods....
10 mg/day of Adderall completely resolved my atypical depression within hours of taking the first dose. I believe it is the dopamine reuptake inhibitor action, but the norapinphrine reuptake inhibitor action of Adderall might play a role as well.
Unfortunately, the Adderall caused severe insomnia (2 hr sleep per night)immediately, and within four days I was in a full-blown mania. The cause of the mania was two fold: 1) the Adderall induced insomnia and; 2) The amphetamine directly.
When the insomnia started I immediately knew that I was at great risk of going manic, but I felt sure that I could control it my increasing my Trileptal dosage. My pdoc has been ragging on me for "self-medicating" by adjusting the dosages of my meds on my own. So I called the good doc's office (which I never do) and left a v-mail on the nurse's phone to ask the doc for his permission to increase my dosage of Trileptal to reel in the Adderall induced hypomania and insomnia because I was at risk of becoming manic.
Based solely on the brief v-mail that I left for the nurse, he instructed the nurse to call me and tell me not to change the dosage of
my meds at least until the following Monday (four days later). He made this edict without even calling me to fully hear my rationale.Well sure enough, I went manic the next day (which was New Year's Eve) while the good doc was enjoying a well deserved long weekend. Initailly my wife encourged me to strictly follow the doctor's orders, but when I woke up, after my usual two hours of sleep, at 1 am on Sunday morning (1/2/05) in a full-blown manic state, my wife changed her tune and was pleading with me to take some extra Trileptal to reduce the severity of the mania. But I responded that I had told my pdoc in my last appointment that I would strictly adhere to his instructions and, by golly, I fully intend to keep my word.
Needless to say, I was on the phone Monday morning letting the nurse know my displeasure and instructing her to convey to the good doc the consequences of his poor decision. He responded by telling the nurse to call me back and grant my request to increase my Trileptal, and to grant my new added request to reduce the Adderall to 5 mg/day (which required a new script).
Don't get me wrong, I have a very good pdoc. He just made a couple bad calls. The other bad call was to start me out on 10 mg/day when we should have started with 5 mg/day. We all make mistakes, and I can forgive. I just wish that these pdoc's would listen to us patients a little better.
To bring you up to date with regard to my Adderall trial, two weeks into the trial the pstim caused burnout. My symptoms of burnout are physically drained, increasing amounts of sleep required to recover physically, aches and pains (flue-like without the runny nose and/or cough), etc.
These symptoms are distinctly different from the atypical depression symptoms of increased sleep, low energy, etc. I'm not able to articulate the symptoms of burnout very well, but trust me it's very different from the simillar words that I use to describe atypical depression.
I recognized the burnout symptoms right away because I experienced a very simillar effect with Ritalin when in 1996 a bad pdoc (my first) misdiagnosed my bipolar hypomania as ADHD and fed me Ritalin without having a moodstabilizer on-board. But that's a whole 'nother pdoc from hell story, and I'll not bore you with it here (besides, you've probably already read some of my previous rants on this topic that I've posted on PB in years past).
So back to the story at hand. One week ago I discontinued the 5 mg/day of Adderall and I left a v-mail for the nurse asking her to tell (not ask) the pdoc that I had to discontinue the Adderall trial due to burnout. I didn't hear back from his office, but I'll talk to him at my next appointment next week.
I was deeply regreting that I had to discontinue the Adderall because it had helped me so much initially and because I expected a huge rebound depression from the discontinuation. But to my suprise, the antidepressive effects are continuing even still, one week later. No hint of depression. Some hypomania, but I can chase it down with extra Trileptal.
From a pyschopharmacological standpoint, it makes no sense at all to me that the antidepressant effect continues for me after discontinuation. The half-life of Adderall is 13 hours, so it's gone by now! So my plan at this point is to use Adderall on a prn basis and to take it as infrequently as possible and for short durations. Time will tell.
> Yes, there is something weird about Depakote that I don't like regards sleep. It seems to *aggravate* sleep maintenance troubles I have. If I take a dose at bedtime it seems that it activates me and wakes me up just a few hours later and then I can't go back to sleep.. and then I DO go back to sleep right before I need to wake up- really irritating! This leaves me all foggy headed and tired all next day. SOOO I have tried taking it earlier in the evening and it has helped some but not enough. It is like a triphasic response... first I get sedated and might nap or nod off.. then there is an *activation* that happens 4-6 hrs in (while I am trying to sleep), then several hours of somnolence after that (the next morning-midday). I liked Trileptal or lithium because I could take a dose at bedtime and it would put me out right.
Mitch, do you take magnesium at bedtime? I take 750 mg of magnesium malate every night at bedtime. It really helps my sleep (going to sleep, staying asleep, and sleeping sound. Along with it, I also take 10 mg of P-5-P (co-enzyme B6) to help the magnesium do its thing, and I take 1/2 tablet of a B-100 (B-complex) so that the Bee's don't get out of balance by taking the P-5-P. The Bee's can get angry if they get outta balance. :-)
> I get clearly depressed on Depakote if I take it during a depressive episode in doses exceeding 250mg/day. You know, here's something I've been wondering about a little: Effective antimanics are associated with effective PKC inhibition, but I think brain norepinephrine levels are reduced as some downstream consequence of this...and if they aren't corrected during a BP depression an antimanic might actually worsen it.. SO I've found that a low dose of a stim or a little Strattera or nortript. whatever seems to be the right thing to counteract the antimanic's depressogenic tendencies.. just thinking out loud a little.... Mitch
Exactly!! I don't know about the mechanism, but that's why I like to decrease my Lithobid and Trileptal dosages when I cycle into a depressed phase because I'm convinced that these moodstabilizers make the depression worse. Of course, when the depression abates, I have to increase these dosages to keep my hypomania in check. But this dosage adjustment is what my pdoc is complaining about. Go figure.
Posted by Ritch on January 19, 2005, at 13:44:51
In reply to Re: Adderall tx for Atypical Depression » Ritch, posted by Ron Hill on January 19, 2005, at 10:55:55
> Mitch,
...
> Unfortunately, the Adderall caused severe insomnia (2 hr sleep per night)immediately, and within four days I was in a full-blown mania. The cause of the mania was two fold: 1) the Adderall induced insomnia and; 2) The amphetamine directly.Wow! you really had a serious spinout there! Yeah, 10mg is too high too start off with a potentially serious risk of inducing mania from the getgo. It is tough to tell what that stuff will do (at least you can find out relatively quickly!).
I started at 5mg first thing in the AM and I was only taking some Neurontin with it.. that's it. No Depakote, lithium, anything that is supposed to be an "antimanic" med. I *was* beginning the usual seasonal depressive thing, so I wasn't taking it at a time where manic sx tend to predominate anyhow. I slept like a ROCK.
When I was taking Ritalin (10mg/day) or Dexedrine (5mg/day) I never had any sleep trouble. To me stims seemed to work out my brain and tire it and when bedtime came I SLEPT. When I took dexedrine I actaully felt somewhat tired and drowsy feeling and my forehead seemed as hot as an iron.
When I want to get "high" on something, all I have to do is take an extra pinch of an SSRI! That's the stuff that sets *me* off. Just like weed.
The negative effects that I got from pstims were: 1) sometimes overfocused and aloof, cold personality, 2) occasionally an exaggerated sense of interest in something... REALLY!, that's INTERESTING!, 3) A worsening anxiety scene over time (without a pinch of SSRI/Eff. +a little clon). I kinda think that I truly have a comorbid ADHD condition. I felt just a slight bit of euphoria a day or two starting up any stim, but very quickly there was zero euphoria from them. I could get "excitable" on them, but NOT euphoric... OK that's the distinction with me. It is difficult to explain, I was *interested* in stuff and worked one thing at a time, but wasn't HIGH. Very strange.
...
> Don't get me wrong, I have a very good pdoc. He just made a couple bad calls. The other bad call was to start me out on 10 mg/day when we should have started with 5 mg/day. We all make mistakes, and I can forgive. I just wish that these pdoc's would listen to us patients a little better.
>
> To bring you up to date with regard to my Adderall trial, two weeks into the trial the pstim caused burnout. My symptoms of burnout are physically drained, increasing amounts of sleep required to recover physically, aches and pains (flue-like without the runny nose and/or cough), etc.
IMO, I think you should have just just halved the Adderall on the second day and checked what happened. If you had trouble after a couple of days on the lower dosage I would have dx'ed it. I've been hounded for self-discontinuing as well. But, I can TELL when something is going seriously awry.. especially if it is immediately triggering hostile/mixed/manic symptoms.
>
> These symptoms are distinctly different from the atypical depression symptoms of increased sleep, low energy, etc. I'm not able to articulate the symptoms of burnout very well, but trust me it's very different from the simillar words that I use to describe atypical depression.I think it triggered a mixed state. Or what many folks would call an agitated depression. I have two different "flavors" of depression.. the 'atypical' one where I sleep and eat too much and the other where the anxiety is like an air-raid and I have sleep disruption and am agitated/angry as hell, no appetite.
> So back to the story at hand. One week ago I discontinued the 5 mg/day of Adderall and I left a v-mail for the nurse asking her to tell (not ask) the pdoc that I had to discontinue the Adderall trial due to burnout. I didn't hear back from his office, but I'll talk to him at my next appointment next week.
>
> I was deeply regreting that I had to discontinue the Adderall because it had helped me so much initially and because I expected a huge rebound depression from the discontinuation. But to my suprise, the antidepressive effects are continuing even still, one week later. No hint of depression. Some hypomania, but I can chase it down with extra Trileptal.If something is irritating or agitating you and you stop it you can get an antidepressive effect by stopping the offending substance. Your reaction to stopping Adderall is the reaction I've gotten (for a few days or so) after stopping Wellbutrin when it gets too agitating.
>
> From a pyschopharmacological standpoint, it makes no sense at all to me that the antidepressant effect continues for me after discontinuation. The half-life of Adderall is 13 hours, so it's gone by now! So my plan at this point is to use Adderall on a prn basis and to take it as infrequently as possible and for short durations. Time will tell.Yep, it's gone by now, but your receptors are re-regulating from stopping it.. I'm wondering whether ever using Adderall might be a good thing for you. I would suggest trying 5mg dexedrine (cut it in half take it twice a day) instead if you want to pursue stims again. That way you can get a definite crash after six hours or so.. you shouldn't be staying up on that one... if you do.. WARNING.
>
> > Yes, there is something weird about Depakote that I don't like regards sleep. It seems to *aggravate* sleep maintenance troubles I have. ... I liked Trileptal or lithium because I could take a dose at bedtime and it would put me out right.
> Mitch, do you take magnesium at bedtime? I take 750 mg of magnesium malate every night at bedtime. It really helps my sleep (going to sleep, staying asleep, and sleeping sound. Along with it, I also take 10 mg of P-5-P (co-enzyme B6) to help the magnesium do its thing, and I take 1/2 tablet of a B-100 (B-complex) so that the Bee's don't get out of balance by taking the P-5-P. The Bee's can get angry if they get outta balance. :-)Ron, I've been down the B'vits, etc. route and did try magnesium and it simply upset my stomach. It seems that MEDS are causing a circadian sleep disruption of some kind.. I'm trying to mitigate the source of the disruption instead of trying to treat it as much.. haven't found much that really helps to treat it. The only supps I've found to be helpful is folic acid (I stopped losing hair on Depakote!), a little fish oil (and I'm even a little doubtful on that one).
>
> > I get clearly depressed on Depakote if I take it during a depressive episode in doses exceeding 250mg/day. You know, here's something I've been wondering about a little: Effective antimanics are associated with effective PKC inhibition, but I think brain norepinephrine levels are reduced as some downstream consequence of this...and if they aren't corrected during a BP depression an antimanic might actually worsen it.. SO I've found that a low dose of a stim or a little Strattera or nortript. whatever seems to be the right thing to counteract the antimanic's depressogenic tendencies.. just thinking out loud a little.... Mitch
>
> Exactly!! I don't know about the mechanism, but that's why I like to decrease my Lithobid and Trileptal dosages when I cycle into a depressed phase because I'm convinced that these moodstabilizers make the depression worse. Of course, when the depression abates, I have to increase these dosages to keep my hypomania in check. But this dosage adjustment is what my pdoc is complaining about. Go figure.
Yeah the conventional wisdom with antimanics is to maintain the dose all the time at the level that is effective for the worst manic sx and then just toss plenty of antidepressants onto the smoldering bonfire when the flames are about to go completely out :) I understand the reasoning, I just don't think all the truth is known just yet about how they effect the depressive phases.... Mitch
Posted by CareBear04 on January 19, 2005, at 19:27:45
In reply to Re: Adderall tx for Atypical Depression » Ron Hill, posted by Ritch on January 19, 2005, at 13:44:51
i've heard of this being done, but i've certainly never met a pdoc who would do this for me. then again, i tend not to have atypical depression nor purely melacholic depression, but rather, jittery and agitated depressions.
10mg of adderall doesn't seem like too much to me. i take 30mg of xr and 10mg of immediate release. but then again, when i started at about 20-30mg a day, i was on lithium for my mmood stabilizer, which is as strong as they come for me.
i have the tendency to self-medicate or adjust my doses myself, too. it doesn't help that my pdoc gives me scripts for a handful of prns that i can take at my discretion. at least she's pretty cool about taking more or less meds depending on how i feel, which is more than what it sounds like your pdoc is like.
i think if my pdoc put stringent restrictions on what i can and can't do, i'd be more apt to disobey. my last pdoc kinda joked that if i were any younger, he would diagnose me with oppositional defiant disorder. maybe knowing this, the drs would rather help me do things safely than take the chance that i could hurt myself by disobeying their orders.
i don't remember much anymore about what the last couple of posts were about, but i hope this relates at least minimally.
Posted by Ritch on January 20, 2005, at 0:05:14
In reply to do many drs prescribe stims for depression?, posted by CareBear04 on January 19, 2005, at 19:27:45
> i've heard of this being done, but i've certainly never met a pdoc who would do this for me. then again, i tend not to have atypical depression nor purely melacholic depression, but rather, jittery and agitated depressions.
>
> 10mg of adderall doesn't seem like too much to me. i take 30mg of xr and 10mg of immediate release. but then again, when i started at about 20-30mg a day, i was on lithium for my mmood stabilizer, which is as strong as they come for me.
>
> i have the tendency to self-medicate or adjust my doses myself, too. it doesn't help that my pdoc gives me scripts for a handful of prns that i can take at my discretion. at least she's pretty cool about taking more or less meds depending on how i feel, which is more than what it sounds like your pdoc is like.
>
> i think if my pdoc put stringent restrictions on what i can and can't do, i'd be more apt to disobey. my last pdoc kinda joked that if i were any younger, he would diagnose me with oppositional defiant disorder. maybe knowing this, the drs would rather help me do things safely than take the chance that i could hurt myself by disobeying their orders.
>
> i don't remember much anymore about what the last couple of posts were about, but i hope this relates at least minimally.
The real theme that Ron is talking about is self-discontinuation of a *new* medication (add or change) that is prescribed at one visit and then soon after the add or change, the patient experiences what they sincerely believe (with good evidence) of *worsening* of their condition (an immediate manic reaction). It is generally understood that it takes a classic unipolar depressive at least a two week trial (i.e) with an antidepressant to experience much positive benefit. So one might expect a doctor to poohpooh adverse effects of the AD and push the patient to comply and wait it out. With bipolar things get a lot more complicated... there are a lot of substances that can worsen the condition immediately (and potentially very dangerously) and not just fail to work and give "side effects". I just think Ron's pdoc was a little asleep at the wheel and didn't pay proper attention. I took a 4-day course of high dose prednisone once (for hives) and nearly flipped out so bad that I almost lost my job. It was kind of like putting salt on a slug. This is where pdocs have to watch things closely... When the communication loop isn't the best sometimes the patient needs to make the call.
Posted by Ron Hill on January 22, 2005, at 16:25:07
In reply to do many drs prescribe stims for depression?, posted by CareBear04 on January 19, 2005, at 19:27:45
Posted by smith562 on January 23, 2005, at 7:59:04
In reply to Re: Thanks Care Bear. I'll talk to ya in February (nm), posted by Ron Hill on January 22, 2005, at 16:25:07
Hey Ron,
I have a feeling I am BPII ... father is BP II and I have this tough atypical depression with panic that low dose lithium helps. I keep playing with lamictal ... seem to work great for 3 days then nothing. How is lamictal working for you?
Thank a million ...
Smith
PS I had read Colin's troubles with lamictal in the past
Posted by smith562 on January 23, 2005, at 8:01:51
Hey Ron,
the post is above
http://www.dr-bob.org/babble/20050119/msgs/446121.html
Thanks
Smith
Posted by Ron Hill on January 24, 2005, at 23:13:18
In reply to Ron: Quick Question about Lamictal, Thank You » Ron Hill, posted by smith562 on January 23, 2005, at 7:59:04
Smith,
I'm not the best person to ask about Lamictal because my pdoc and I added it to my cocktail only two months ago. I tend to get rashes from any of the moodstabilizers (AED's and Lithobid) so it's no suprize that I get a rash from Lamictal. I've ramped up VERY slowly (I'm up to 50 mg/day after two months) and yet I have developed a pronounced rash problem from Lamictal. My pdoc wants to hold at 50 mg/day until we see if the rash will go away.
Therefore, as you can see, I'm not the best person to ask, because I'm not even up to a theraputic dose level. Others on this board are much better qualified to answer your questions. However, I have noticed that your experience of obtaining early but short-lived benefit from Lamictal seems to be a common complaint with this particular medication. Further, short-term benefit is often reported after each small increase.
I like Lamictal (except for the rash). I like the way it feels in my brain. But I'm not on a high enough dose to make any conclusions yet. I also tried Lamictal several years ago (1998) but I had to discontinue due to rash. I started at way too high of a dosage back then.
-- Ron
Bipolar II and Obsessive Compulsive Personality Traits
600 mg/day Lithobid
900 mg/day Trileptal
50 mg/day Lamictal
5 mg/day Adderall XR for just one day when needed to chase away the bipolar atypical depression demons. If I take Adderall XR for more than one day at a time, it induces "pstim burnout" symptoms.
-------------------------------------------------> Hey Ron,
>
> I have a feeling I am BPII ... father is BP II and I have this tough atypical depression with panic that low dose lithium helps. I keep playing with lamictal ... seem to work great for 3 days then nothing. How is lamictal working for you?
>
> Thank a million ...
>
> Smith
>
> PS I had read Colin's troubles with lamictal in the past
Posted by SLS on January 25, 2005, at 6:20:50
In reply to Re: Ron: Quick Question about Lamictal, Thank You » smith562, posted by Ron Hill on January 24, 2005, at 23:13:18
Hi Ron.
> Bipolar II and Obsessive Compulsive Personality Traits
My bipolar disorder is kind of a strange one that doesn't fit into either I or II. However, I have had to deal with perfectionism. Do you think your obsessiveness might be perfectionism?
- Scott
Posted by Ron Hill on January 25, 2005, at 21:19:13
In reply to Re: Ron: Quick Question about Lamictal, Thank You » Ron Hill, posted by SLS on January 25, 2005, at 6:20:50
> Hi Ron.
>
> > Bipolar II and Obsessive Compulsive Personality Traits
>
> My bipolar disorder is kind of a strange one that doesn't fit into either I or II. However, I have had to deal with perfectionism. Do you think your obsessiveness might be perfectionism?
>
>
> - Scott
>
>Scott,
Perfectionism is definitely part of it. Obsessive Compulsive Personality Traits is more commonly referred to as Obsessive Compulsive Personality Disorder (OCPD). But OCPD is not to be confused with OCD. For example, no frequent hand washing in OCPD.
I have a very mild case of OCPD and several of the criteria listed in DSM-IV are not applicable to my case. Sometimes I wonder if my OCPD symptoms are merely coping mechanisms that I have unconsciously implemented to compensate for my bipolar II brain chemistry problems. In other words, as a BP II, I desperately need order and structure in my life in order to function. And perhaps my OCPD traits are merely the outward signs of the mechanism that my brain has implemented so as to facilitate the needed structure and order. However, I'm sure it's not that simple. For example, I suspect there is also a genetic component to the OCPD.
Here are the DSM-IV diagnostic criteria for OCPD:
Diagnostic criteria for 301.4 Obsessive-Compulsive Personality Disorder
A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:(1) is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
(2) shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met)
(3) is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)
(4) is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)
(5) is unable to discard worn-out or worthless objects even when they have no sentimental value
(6) is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
(7) adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
(8) shows rigidity and stubbornness
Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Copyright 2000 American Psychiatric Association
Scott, just so you know, I'll be gone for a couple of weeks. So if you reply, it may be a while before I get back to you. Be well, my friend! :-)
Posted by jasmineneroli on January 27, 2005, at 13:26:31
In reply to Re: Obsessive Compulsive Personality Disorder » SLS, posted by Ron Hill on January 25, 2005, at 21:19:13
Hi:
Just jumping in here - from my work with "at risk" youth, it's pretty clear that a personality disorder IS just what you describe - a way of coping with certain life events, traumas, chronic illness, abuse or other situations. It's an adaptive behaviour.
There may well be brain chemistry involvement, due to physiological brain "adaptations" or responses, on a chemical level, to the above- described scenarios. There is also the psychological aspect, in terms of the behaviour a certain personality adopts, to cope and soothe.If the behaviour becomes such that it interferes with the quality of a person's life, or makes them appear "eccentric" or otherwise not "fit in" socially, then it's a "disorder".
Best of luck with it. OCPD can be very difficult to live with, for both the patient and others.
Regards,
Jas
Posted by CareBear04 on January 28, 2005, at 12:51:22
In reply to Re: Ron: Quick Question about Lamictal, Thank You » Ron Hill, posted by SLS on January 25, 2005, at 6:20:50
hey sls,
i think there's at least one big thing to keep in mind about OCPD. it's supposed to affect mostly men, but as a female, i meet nearly all the criteria. still, i've never been diagnosed because though i meet the letter of the diagnosis, i don't really fit the 'spirit' of it. i think OCPD is a diagnosis for those who are very controlling, who fail to trust others and delegate because they don't trust that the other people will do things as well and as thoroughly as they would. perfectionism is one part of it, but so is the tendency to control and subordinate others for the sake of doing it. that's my impression of the disorder and the reason i've never been diagnosed, though i meet the criteria. hope this helps!
Posted by lars1 on January 30, 2005, at 2:02:58
In reply to Re: Obsessive Compulsive Personality Disorder » Ron Hill, posted by jasmineneroli on January 27, 2005, at 13:26:31
Are any drugs effective for OCPD, or is the treatment exclusively psychosocial? Do drugs that work for OCD (SSRI's, Anafranil) work for OCPD?
Posted by CareBear04 on January 30, 2005, at 15:26:38
In reply to Re: Obsessive Compulsive Personality Disorder, posted by lars1 on January 30, 2005, at 2:02:58
i don't know of any meds that are specific for OCPD. supposedly, therapy is hard but most effective, and it's a long-term commitment. i think therapy is supposed to be so difficult because people with OCPD have a hard time trusting or trusting that the T is competent, so they are often wanting to terminate early. good luck!
Posted by medhed on January 31, 2005, at 2:23:16
In reply to Re: Obsessive Compulsive Personality Disorder » lars1, posted by CareBear04 on January 30, 2005, at 15:26:38
Luvox is an SSRI prescribed for this disorder.
Posted by Questionmark on January 31, 2005, at 5:49:31
In reply to Re: Obsessive Compulsive Personality Disorder, posted by lars1 on January 30, 2005, at 2:02:58
> Are any drugs effective for OCPD, or is the treatment exclusively psychosocial? Do drugs that work for OCD (SSRI's, Anafranil) work for OCPD?
i definitely have OCPD and i have not found any drugs to have any significant benefit-- including Paxil, which, as an SRI, should be one of the more promising or helpful, and Nardil, which has been extraordinary for my depression and anxiety but has done nothing really noticeable for my perfectionistic and obsessive-compulsive thoughts and behaviors.
i *have* noticed that when i miss enough Nardil doses (currently at 4 pills or 60mg per day) to cause a noticeable withdrawal-type feeling (which doesn't take much or long), i get much more obsessive-compulsively perfectionistic and what not-- as Paxil withdrawal also did. Despite what some naive researchers and psychiatrists might say, however, i do NOT believe that this is an indication that the Nardil is significantly benefitting my OCPD symptoms. It's simply that withdrawal makes them worse.
*Although i have not found any substances to noticeably help my OCPD, there are many substances and factors that can easily/significantly aggravate it.* For example, stimulant use can make me much more obsessive-compulsive, especially in the "come-down" phase. Insufficient food intake (i.e., the hunger and mental effects that accompany this) can as well. Probably the worst factors for inducing and aggravating compulsive perfectionistic behaviors in me are stress and anxiety. They can make me a crazy obsessive-compulsive freak-- being perfectionistic to the point where i begin telling myself (in my head) that i need to stop doing what i'm doing and trying to improve every little minute insignificant detail.. yet STILL conTINue!! And it drives me freaking inSANE!!
But so, yeah, anyway, i haven't found any medications to be helpful in any noticeably significant way.
i seriously doubt it, but i do wonder whether a benzodiazepine might be at all helpful. i've taken Klonopin a number of times but i can't remember how it affected my OCPD. Also, i've never taken a benzo daily for that long and wonder whether that may be helpful at all. But again i doubt it.Oh, to all of you OCPD people: you must find a good therapist and get ongoing therapy. It (particularly CBT) is the only effective.. the only POSSible way that one can overcome OCPD to any significant extent. i have been seeing a great therapist for almost two years now and, in minor but very important ways, have been helped a great deal (espECIally in at least knowing what kind of things i have to do to get better). Ultimately, i still have hardly improved at all (sadly), but this is primarily if not solely because i haven't followed his instructions and advice very well at all (due to my horrendous procrastination problem and the inexplicable complexity of my mind and of my obsessive & perfectionistic ways & needs)... (and NOT because i distrust or doubt my psychologist [i don't distrust or doubt him]-- as i understand many OCPD patients are said to do-- among other problems that make therapy difficult for them).
But yeah, this sickness, this disease, has totally prevented me from bettering my life. It has exponentially increased my regrets, for which depression and anxiety had already made immense. If anyone knows of any miracle cures for this and lets me/us know, i will be in debt to you for life.
Hope this post is helpful.
Posted by gadman on January 31, 2005, at 12:20:34
In reply to Re: Obsessive Compulsive Personality Disorder, posted by lars1 on January 30, 2005, at 2:02:58
I have been diagnosed GAD with minor OCPD.
I have found that in some cases Effexor actually made my OCPD worse, where now I am on Cymbalta and it seems to have helped in that area quite a bit. (Although worse in other areas)
Watch, I will mispell a wourd. There... I did it, and I am not going to correct it. :-)
Gadman
Posted by Questionmark on January 31, 2005, at 17:37:21
In reply to Re: Obsessive Compulsive Personality Disorder » lars1, posted by gadman on January 31, 2005, at 12:20:34
Posted by lars1 on February 2, 2005, at 0:41:54
In reply to Re: Obsessive Compulsive Personality Disorder » lars1, posted by Questionmark on January 31, 2005, at 5:49:31
> Hope this post is helpful.
Thanks. It was. When I read the DSM description of OCPD in Ron Hill's post, it was as if he was describing me personally!
I too have tried cognitive-behavioral therapy. I found it very helpful for depressive symptoms, but only slightly helpful for obsessive/compulsive symptoms. With CBT, I could see that my perfectionism was unnecessary and counterproductive, and I could understand the cognitive distortions behind it, but somehow that wasn't enough to let me stop being perfectionistic. I was doing this on my own, using David Burns' books. Maybe I would have had more success with a therapist.
I'm currently taking stimulants (Adderall + Wellbutrin) and have been considering if they have any effect on obsessiveness/compulsiveness. When I am on them, I have a strong tendency to continue doing whatever I am currently doing. This could be interpreted as a kind of "obsessiveness." However, when I look at the OCPD symptoms from the DSM, I find that, if anything, stims help them. So, while stims (for me) may cause obsessiveness in the general sense, they don't cause it in the specific way that the DSM means it.
Lars
Posted by thinkfast on February 3, 2005, at 19:15:37
In reply to Re: Obsessive Compulsive Personality Disorder, posted by medhed on January 31, 2005, at 2:23:16
> Luvox is an SSRI prescribed for this disorder.
I've got a roomate with OCPD and BP that takes Luvox. Luvox is also my new med for OCD. I'm not dx'd BP but we are almost exactly the same and take the same meds, including seroquel. What does this mean? One of our therapists and their Dx is wrong. I'm dx'd OCD, but don't have the rituals and whatnot. Perhaps it is OCPD and not OCD?
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