![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by ttime on March 14, 2005, at 10:31:02
Hello:
I have had anxiety for many years (approx. 20 - started with a major anxiety attack). The reason for this post is try to tap into some of the brilliant minds who post here on a regular basis to try and help with where I am at now.
The anxiety has been an up and down sort of thing for the last 20 years and has manifested into mild depression. Also, I have very little patience for anything. Sitting in traffic kills me, or standing in line for groceries, etc...This tends to lead to anger very quickly. I know my blood pressure rises each and every time and I am beginning to worry about the physical effects on my system.
For the past couple of years I have used Xanax .25 or .5, as needed for breakthrough times when my anger, anxiety, frustration seemed to get out of control. It helps..however I am wondering if Ativan, Klonopin or even Valium might be a better alternative?
The anxiety has gotten progressively worst in the past couple of weeks and I have a dentist appt. coming up that I am big time afraid of. The last time I went to the Dentist, my heart seemed to skip a beat every other beat for an hour and a half - no fun...Do you think I should take some Xanax or maybe just get some laughing gas?
I want to try and get in front of this before it gets any worst so I am going to list characteristics of my personality to see if they mirror anyone else's and maybe get enough info. to get pushed in a right direction.
- Have trouble sleeping - racing thoughts, can't seem to shut brain off
- Seem to focus on one thought (especially if it brings anxiety, like going to dentist)
- Beginning to have little patience with people (why can't that person drive faster/slower)?
- Snap at my wife and loved one's/friends over little things
- Tough to concentrate at times
- Lethargy - Brain can't seem to get going during day.
- Knot in my stomach - almost constantly for 2 weeks.
- Breathing seems labored - not natural
- I was driving home the other day and seemed dizzy/woozy
- Harder to focus - have to read things 2,3, 4 times and I still miss some things
- Feel better at home - when I am out I feel socially uncomfortable (although friends and family think I am life of party)
- I make less eye contact now then in the pastI guess the goal is to see if anyone else has similar symptoms to me and what they have done for their issues. I have little time and patience to be going to the p-doc for weeks, months, years and quite frankly think people on this board have alot more going for them (not that I would dismiss p-doc and listen to anyone on this forum, however it seems that people here genuinely care for other people).
So...thanks for reading and I am hoping to start a dialogue with other's who are going through similar sorts of things...
Good Luck to Everyone.
TTime
Posted by Ritch on March 14, 2005, at 12:09:15
In reply to Need help with Diagnosis..., posted by ttime on March 14, 2005, at 10:31:02
Sounds like generalized anxiety disorder (GAD). The worry wart anxiety disorder. You ruminate, but don't have OCD-like rituals. You said anxiety "attack".. was it a *panic* attack in the classic sense (brief and intense, sometimes recurrent, sometimes no apparent "reason"-out of the blue), or did you just feel overwhelmed and unable to cope (chronic day-long, hand-wringing stuff, pace the floor variety, about specific topics)? Are you on any meds? What do your doctors say? GAD is what it sounds like to me, anyhow. The distractability is also a symptom (can't focus because you either can't sleep well due to ruminating, or you can't keep your mind off the worries).
Posted by ttime on March 14, 2005, at 12:45:58
In reply to Re: Need help with Diagnosis... » ttime, posted by Ritch on March 14, 2005, at 12:09:15
> Sounds like generalized anxiety disorder (GAD). The worry wart anxiety disorder. You ruminate, but don't have OCD-like rituals. You said anxiety "attack".. was it a *panic* attack in the classic sense (brief and intense, sometimes recurrent, sometimes no apparent "reason"-out of the blue), or did you just feel overwhelmed and unable to cope (chronic day-long, hand-wringing stuff, pace the floor variety, about specific topics)? Are you on any meds? What do your doctors say? GAD is what it sounds like to me, anyhow. The distractability is also a symptom (can't focus because you either can't sleep well due to ruminating, or you can't keep your mind off the worries).
Hi Ritch:
Thanks very much for your input...When I had my first anxiety attack, around 18 years of age, it was a classic whopper. I was taking on way to many things, college, girlfriend, job, etc...and in one very vivid moment I broke out in a cold sweat and was scared of the world. I actually had to go into my parents room because I thought I was having a a heart attack. After that initial "attack" I had weird symptoms for approx. 1 year. I could not regulate my breathing and I could not feel food in my throat when I swallowed (very strange). I also was very scared of the dark and thought the devil was out to get me (again strange thoughts). Throughout this next year I actually fought off everything pretty well and never did see a P-Doc, nor did I take any medications.
Today, twenty years later, I have had similar times of anxiety, however never quite as intense as that first "attack". Lately, though, I feel a bit more out of control day by day. As for meds, again, I only take very small amounts of Xanax. I have tried, Concerta, Dexedrine Spansules, Zoloft and Wellbutrin but did not like the way any of them felt.
With regards to OCD...That brings up a very interesting course of thought. I do count in ny head sometimes and I do follow things with the same "thinking" that things will be good if I do this, so I would have to say that I do have a very mild form of OCD. The biggest question I have is how does this Anxiety/Mild Depression/Very Mild OCD/Anger/Lack of Patience/Social Inferiority at Times - How does this all tie together?
If you can provide any additional help it would be greatly appreciated.
Thanks!
TTime
Posted by Phillipa on March 14, 2005, at 18:29:04
In reply to Re: Need help with Diagnosis..., posted by ttime on March 14, 2005, at 12:45:58
Oh no, you sound like my "twin". I have all the same symptoms, and about 30 yrs ago had my first panic attack. The only thing that helps me is benzos, and I prefer valium! AD's do nothing for me. Fondly, Phillipa
Posted by Wildman on March 14, 2005, at 19:26:25
In reply to Re: Need help with Diagnosis... » ttime, posted by Phillipa on March 14, 2005, at 18:29:04
I have about 80% overlap of the symptoms that you describe, and my pdoc thinks i'm a mild BPII.
Whatever the label, I get tremendous relief from Lexapro (20mg/day) and Seroquel (25mg/night). I've been on this combo for about a year and I'm doing really well. I am so much more able to control my patience and my anger threshold, my life has improved tremendously.
Hope this helps.
Wildman
Posted by Ritch on March 14, 2005, at 23:59:28
In reply to Re: Need help with Diagnosis..., posted by ttime on March 14, 2005, at 12:45:58
>..As for meds, again, I only take very small amounts of Xanax. I have tried, Concerta, Dexedrine Spansules, Zoloft and Wellbutrin but did not like the way any of them felt.
Sounds like panic disorder. I would suggest trying out a tricyclic like imipramine, clomipramine, or maybe amitriptyline or even an MAOI like Nardil along with your Xanax.
Posted by ttime on March 15, 2005, at 7:27:44
In reply to Re: Need help with Diagnosis... » ttime, posted by Phillipa on March 14, 2005, at 18:29:04
> Oh no, you sound like my "twin". I have all the same symptoms, and about 30 yrs ago had my first panic attack. The only thing that helps me is benzos, and I prefer valium! AD's do nothing for me. Fondly, Phillipa
Hi Phillipa:
Thanks for your response. Do you take the Valium everyday? If so, what dose? Have you tried any other drugs for your symptoms?
Thanks for any insight - I would love to speak with someone who is going through similar symptoms such as myself.
Regards,
T-Time
Posted by ttime on March 15, 2005, at 8:17:50
In reply to Re: Need help with Diagnosis..., posted by Wildman on March 14, 2005, at 19:26:25
> I have about 80% overlap of the symptoms that you describe, and my pdoc thinks i'm a mild BPII.
>
> Whatever the label, I get tremendous relief from Lexapro (20mg/day) and Seroquel (25mg/night). I've been on this combo for about a year and I'm doing really well. I am so much more able to control my patience and my anger threshold, my life has improved tremendously.
>
> Hope this helps.
>
> WildmanWildman:
Thanks for the input...Have you tried any other SSRI's with limited success? I tried Wellbutrin and Zoloft and they did nothing for me.
Take Care
T-Time
Posted by Wildman on March 15, 2005, at 13:03:52
In reply to Re: Need help with Diagnosis..., posted by ttime on March 15, 2005, at 8:17:50
ttime,
I am one of the lucky few whose pdoc got the meds right the first time (either that, or I could be much better but don't know what I am missing?).
I've only been on Lexapro/Seroquel for a year and it's gone really well. I've tried other things besides Seroquel, namely Risperdal, but it didn't help me to sleep nearly as well.
My sister is now on Lex/Seroquel also after having tried just about everything else (Paxil, Zoloft, Wellbutrin, Prozac), and feels that it's the best combo for her too.
I find that getting my sleep is KEY to feeling good. I've also cut way back on beer and wine, which has helped more that I thought it would.
Hope this helps.
Wildman
Posted by ttime on March 15, 2005, at 14:18:54
In reply to Re: Need help with Diagnosis..., posted by Wildman on March 15, 2005, at 13:03:52
> ttime,
>
> I am one of the lucky few whose pdoc got the meds right the first time (either that, or I could be much better but don't know what I am missing?).
>
> I've only been on Lexapro/Seroquel for a year and it's gone really well. I've tried other things besides Seroquel, namely Risperdal, but it didn't help me to sleep nearly as well.
>
> My sister is now on Lex/Seroquel also after having tried just about everything else (Paxil, Zoloft, Wellbutrin, Prozac), and feels that it's the best combo for her too.
>
> I find that getting my sleep is KEY to feeling good. I've also cut way back on beer and wine, which has helped more that I thought it would.
>
> Hope this helps.
>
> Wildman
Thanks - I will keep that combo in mind for future reference. Just one more question - have these drugs had any negative side effects such as loss of libido, tiredness, apathy, spaciness, weight gain, etc...Take Care,
T-Time
Posted by cache-monkey on March 15, 2005, at 23:23:12
In reply to Re: Need help with Diagnosis..., posted by Wildman on March 14, 2005, at 19:26:25
<< I have about 80% overlap of the symptoms that you describe, and my pdoc thinks i'm a mild BPII. >>
Ditto on that for me.
I'm still looking for a med combo, as the mild BPII is a recent revelation. I've started on Lithium plus Klonopin for anxiety (plus possibly Depakote). I don't like the Klonopin and will ask my pdoc to switch to Valium. (Based partially on Phillipa's recommendation -- thanks!) I'm going to try to get low-dose selegiline added later.
The rationale for the mood stabilizer(s) + benzo is that they should help with my racing thoughts and anxiety.
The selegiline I see as helping with concentration, lethargy, focus, and possibly social phobia. It also might help with the other big concern of mine: smoking. (I basically spiral into a depression or mixed state every time I try to quit.)
Anyway, from the other posts here, it sounds like there are number of possible avenues to try. Good luck, and keep us posted!
Best,
cache-monkey
Posted by ttime on March 16, 2005, at 20:17:56
In reply to Re: Need help with Diagnosis... ttime, posted by cache-monkey on March 15, 2005, at 23:23:12
> << I have about 80% overlap of the symptoms that you describe, and my pdoc thinks i'm a mild BPII. >>
>
> Ditto on that for me.
>
> I'm still looking for a med combo, as the mild BPII is a recent revelation. I've started on Lithium plus Klonopin for anxiety (plus possibly Depakote). I don't like the Klonopin and will ask my pdoc to switch to Valium. (Based partially on Phillipa's recommendation -- thanks!) I'm going to try to get low-dose selegiline added later.
>
> The rationale for the mood stabilizer(s) + benzo is that they should help with my racing thoughts and anxiety.
>
> The selegiline I see as helping with concentration, lethargy, focus, and possibly social phobia. It also might help with the other big concern of mine: smoking. (I basically spiral into a depression or mixed state every time I try to quit.)
>
> Anyway, from the other posts here, it sounds like there are number of possible avenues to try. Good luck, and keep us posted!
>
> Best,
> cache-monkey
Cache Monkey:Thanks for your feedback. A few questions, though. Why do you take Lithium for Mild BPII. Does it seem to help? I thought only BPI diagnosis would get the true benefit(s. Also, do you have to have alot of bloodwork to take Lithium? Again I thought this was a med for more intense Bi-Polar Symptoms. Have you ever tried Lamictal - I have read that this could be a decent place to start if one was BPII and showed less intense ups and downs.
With regards to the selegiline, I have seen that mentioned also on these boards. I thought this was for anxiety related symptoms as well as a decent med for sleeping. If it is helping you with concentration, lethargy and the like, I would love to have updates on how this is working for you. These are my main problems (lack of concentration, etc) which then leads to frustration, hostility, no patience, yelling, etc...
Thanks for letting me ask a few questions to someone who has been there. Looking forward to your responses.
Regards,
TTime
Posted by cache-monkey on March 17, 2005, at 1:09:35
In reply to Re: Need help with Diagnosis... ttime, posted by ttime on March 16, 2005, at 20:17:56
Hey TTime,
<< Thanks for your feedback. A few questions, though. Why do you take Lithium for Mild BPII. Does it seem to help? I thought only BPI diagnosis would get the true benefit(s. Also, do you have to have alot of bloodwork to take Lithium? Again I thought this was a med for more intense Bi-Polar Symptoms. >>I think Lithium works as a mood stabilizer regardless of the severity of one's symptoms. As far as the blood work, yeah I'm getting blood drawn about biweekly, since we're trying to get the level into the "therapeutic range". So far I'm not sure if it's working, especially since I'm not in the the therapeutic range yet. Time will tell, I guess. I haven't found the bloodwork cumbersome.
<< Have you ever tried Lamictal - I have read that this could be a decent place to start if one was BPII and showed less intense ups and downs. >>
You're right, Lamictal is gaining favor for BPII. It was actually what I tried first in terms of mood stabilizers. It ended up not working out so well for me. I found even the smallest dose increments to be tough to adjust to due to extreme agitation. It also was causing me pain/tightness in my lower back and groin muscles, and -- to a lesser extent -- some sexual dysfunction. (Sexual dysfunction is not common with Lamictal; many find it a little prosexual, so I guess I'm a freak in that regard.)
<< With regards to the selegiline, I have seen that mentioned also on these boards. I thought this was for anxiety related symptoms as well as a decent med for sleeping. If it is helping you with concentration, lethargy and the like, I would love to have updates on how this is working for you. These are my main problems (lack of concentration, etc) which then leads to frustration, hostility, no patience, yelling, etc... >>
So, selegiline _in low doses_ is a selective monamine oxidase B (MAO-B) inhibitor. [At higher doses, it also inhibits MAO-A, in a similar manner to traditional MAOIs like Parnate and Nardil. But since it is selective at the lower doses (<10mg/day), there isn't a need for dietary restrictions.]
MAO-B is the enzyme responsible primarily for cleaning up dopamine from the synapses. To a lesser extent selegiline can act as a dopamine reuptake inhibitor. So the end result is more dopamine in the system. More dopamine tends to be associated with more energy and well-being. It's also good for concentration, in theory. (There's a whole dopamine deficiency hypothesis of ADD/ADHD.) Additionally, selegiline is metabolized to some amphetamine-like compounds which are also directly useful for energy and concentration.
Oh, almost forgot: MAOB is also responsible for breaking down the "chocolate" amine phenylethylamine (PEA). So inhibiting, MAO-B could theoretically lead to increased feelings of well being due to higher PEA and dopamine, as well as improved energy and concentration.
Low-dose selegiline might be useful for social anxiety. But the only study that's been published had a very small sample, and the results weren't as strong as for, say, Nardil (one of the unselective MAOIs).
In terms of general levels of general anxiety, the trouble is that selegiline can actually have negative effects in many people. And it can also interfere with sleep.
So it's kind of a tricky drug. I haven't actually tried it yet, but I'll definitely post once I do. You also might want to consider searching through the archives on babble. There have been a number of threads on selegiline over the past couple of years.
Best,
cache-monkey
Posted by SLS on March 17, 2005, at 6:37:12
In reply to Need help with Diagnosis..., posted by ttime on March 14, 2005, at 10:31:02
Hi.
There are a whole bunch of things that might be responsible for your bouts of anxiety and anger. It would really take a good diagnostician to sit down with you and attempt to reconstruct some of your history to tease out the markers of specific conditions.
To me, it sounds like your illness might be somewhere along the bipolar spectrum. A mood stabilizer might be indicated. Tegretol or Trileptal are particularly good to treat anger. The anger and and racing thoughts might be an expression of a mixed state that is now drifting more towards depression.
I am not a professional diagnostician, and I would not be able to rule out an Axis II disorder. However, I think it makes sense to take a good look at the possibility that you suffer from bipolar disorder (BP) and generalized anxiety disorder (GAD) together.
- Scott
Posted by ttime on March 17, 2005, at 11:01:58
In reply to Re: Need help with Diagnosis... » ttime, posted by SLS on March 17, 2005, at 6:37:12
> Hi.
>
> There are a whole bunch of things that might be responsible for your bouts of anxiety and anger. It would really take a good diagnostician to sit down with you and attempt to reconstruct some of your history to tease out the markers of specific conditions.
>
> To me, it sounds like your illness might be somewhere along the bipolar spectrum. A mood stabilizer might be indicated. Tegretol or Trileptal are particularly good to treat anger. The anger and and racing thoughts might be an expression of a mixed state that is now drifting more towards depression.
>
> I am not a professional diagnostician, and I would not be able to rule out an Axis II disorder. However, I think it makes sense to take a good look at the possibility that you suffer from bipolar disorder (BP) and generalized anxiety disorder (GAD) together.
>
>
> - ScottHi Scott:
Thanks for the input! My biggest concern is that Iam Bi-Polar, however Cyclothymic Disorder seems to best describe me. No major ups and downs and some days just right. The reason I can come to this conclusion is that I am now in a space in my life where I do not know if the next day will be good, bad or indifferent, It's kinda like pot luck. I think the best thing I can do is myabe try Trileptal and see how I react. Since this is one of the more milder BP Drugs, I really have nothing to lose.
Also, I wish I could have someone explain to me what the difference between Cyclothymic BP and Overfocused ADD are. I know you are extremely well-versed in psychiatric conditions and would hope that you could give me your 2 cents. I am torn at this point between having either/or and how to go about treatment. And it seems to me both conditions can lead to lack of patience, frustration, touble sleeping at times, racing thoughts, anger and the like.
Anyway, thanks again!
All the Best,
T-Time
Posted by HappyGirl on March 17, 2005, at 23:22:02
In reply to Re: Need help with Diagnosis... » ttime, posted by SLS on March 17, 2005, at 6:37:12
Hi Scott:
>>> would not be able to rule out an Axis II disorder. <<<--- I wonder what does "Axis II' mean?
When I was dx'ed with Bp II years ago, my pdoc. wrote on the paper, ... I clearly recall even now, ... "Axis II," or 'Axis (something).' I wanted to know what 'Axis II' is or means, ... but at that time, I was pretty sick, then I just didn't ask my pdoc. on this regard. However, even to this day, the word, 'Axis II or Axis ...' still keeps bugging me.
If you have time to explan about this term, 'Axis II,' I would be GREATLY appreciated.
Thanks for your time in advance.
H.G.
Posted by SLS on March 17, 2005, at 23:38:38
In reply to Re: Axis II » SLS, posted by HappyGirl on March 17, 2005, at 23:22:02
> Hi Scott:
> >>> would not be able to rule out an Axis II disorder. <<<
>
> --- I wonder what does "Axis II' mean?
Axis II disorders are predominantly personality and behavioral disorders. Borderline personality disorder is Axis II.
- Scott
Posted by jasmineneroli on March 18, 2005, at 1:16:27
In reply to Re: Need help with Diagnosis..., posted by ttime on March 17, 2005, at 11:01:58
Hi Ttime:
Just came into this discussion a bit late.
However, wanted to let you know that you have extremely similar symptoms to me. Including the impatience/irritability etc..
My dx is severe GAD. So I would concur with those posters who suggest GAD.
My symptoms have varying degrees of impact upon me. It certainly changes often, sometimes day to day, sometimes every couple of weeks or months.
It's definitely related to 1) sleep 2) life stress and 3) hormone fluctuations (I'm female).I often feel I've got things pretty well under conrol and feel almost "great" for weeks or months, and then I "relapse" again...often quite gradually.
The only thing that helps the physical anxiety and generally calms me, is Klonopin, which I take everyday in low dose (.5mg). At the moment I also take (by prescription -in Canada) 1gr Tryptophan daily. This combo seems to work alright as long as my life is in order and I sleep OK. Sleep has long beeen an issue, and often the stress and lack of sleep go hand in hand.
I have tried the following drugs over the years: Paxil, Effexor, Remeron, Amitryptiline, Ativan, Moclobemide, Buspar and Celexa. I've had two separate trials of Celexa, first alone, and more recently with Klonopin. I've also tried several sleep medications added on to the SSRI's. (Like Zopiclone and one of the hypnotic benzo's- but the name escapes me right now!).
The most effective drug combo was Celexa + Klonopin, however, I couldn't tolerate the side effects of Celexa (sexual dysf., insomnia, jaw clenching, neck stiffness and headaches). I also found it to be very effective for anxiety with ruminations at first, then to wear off as it induced depression.At the moment, after a period of prolonged stress and poor sleeping, I've begun the a.m. lethargy, irritabilty sequence again. It's now lasting further into the day too. At my Pdoc's yesterday, he said I'm starting to get into a depression (which happens periodically, after the anxiety state). So he's upped my tryptophan dose to 1500mg. We'll see if it helps!!!
My Pdoc is adamant that I don't have any of the Bipolar forms. Even though my energy and mood "cycles" and I get "manic" phases where I just go-go-go and get loads done and talk fast etc.
He asked me if I feel euphoric or "unbeatable" and like I can handle anything/conquer the world, when I'm in those states. I told him I just feel "driven", I "must get things done" and that most of the time I'm not happy or giddy or enjoying it particularly. I basically feel like I've been switched on "max"!!!!
This, he said, is the reason why he doesn't consider me BP. It's not true mania, it's just peaking generalized anxiety adrenaline pushing me.You might want to consider that.
I also believe I have a bit of OCD thrown in.....more the "c" part of OCD. The compulsions, I believe, are part of mt atempts to control my anxiety and soothe myself. I'm not sure that it would be classed as true OCD or OCPD, or an occasional coping mechanism.
Sorry to be so long. I'm the world's worst poster...just go on and on......! I hope some of the rambling has helped though, ask any questions you like! I recommend you continue to research as much as poss, then go to your doc armed with info, opinions and people's experiences!
Take care
Jas
Posted by KaraS on March 18, 2005, at 2:26:49
In reply to Re: Need help with Diagnosis..., posted by jasmineneroli on March 18, 2005, at 1:16:27
> Hi Ttime:
> Just came into this discussion a bit late.
> However, wanted to let you know that you have extremely similar symptoms to me. Including the impatience/irritability etc..
> My dx is severe GAD. So I would concur with those posters who suggest GAD.
> My symptoms have varying degrees of impact upon me. It certainly changes often, sometimes day to day, sometimes every couple of weeks or months.
> It's definitely related to 1) sleep 2) life stress and 3) hormone fluctuations (I'm female).
>
> I often feel I've got things pretty well under conrol and feel almost "great" for weeks or months, and then I "relapse" again...often quite gradually.
>
> The only thing that helps the physical anxiety and generally calms me, is Klonopin, which I take everyday in low dose (.5mg). At the moment I also take (by prescription -in Canada) 1gr Tryptophan daily. This combo seems to work alright as long as my life is in order and I sleep OK. Sleep has long beeen an issue, and often the stress and lack of sleep go hand in hand.
>
> I have tried the following drugs over the years: Paxil, Effexor, Remeron, Amitryptiline, Ativan, Moclobemide, Buspar and Celexa. I've had two separate trials of Celexa, first alone, and more recently with Klonopin. I've also tried several sleep medications added on to the SSRI's. (Like Zopiclone and one of the hypnotic benzo's- but the name escapes me right now!).
> The most effective drug combo was Celexa + Klonopin, however, I couldn't tolerate the side effects of Celexa (sexual dysf., insomnia, jaw clenching, neck stiffness and headaches). I also found it to be very effective for anxiety with ruminations at first, then to wear off as it induced depression.
>
> At the moment, after a period of prolonged stress and poor sleeping, I've begun the a.m. lethargy, irritabilty sequence again. It's now lasting further into the day too. At my Pdoc's yesterday, he said I'm starting to get into a depression (which happens periodically, after the anxiety state). So he's upped my tryptophan dose to 1500mg. We'll see if it helps!!!
>
> My Pdoc is adamant that I don't have any of the Bipolar forms. Even though my energy and mood "cycles" and I get "manic" phases where I just go-go-go and get loads done and talk fast etc.
> He asked me if I feel euphoric or "unbeatable" and like I can handle anything/conquer the world, when I'm in those states. I told him I just feel "driven", I "must get things done" and that most of the time I'm not happy or giddy or enjoying it particularly. I basically feel like I've been switched on "max"!!!!
> This, he said, is the reason why he doesn't consider me BP. It's not true mania, it's just peaking generalized anxiety adrenaline pushing me.
>
> You might want to consider that.
>
> I also believe I have a bit of OCD thrown in.....more the "c" part of OCD. The compulsions, I believe, are part of mt atempts to control my anxiety and soothe myself. I'm not sure that it would be classed as true OCD or OCPD, or an occasional coping mechanism.
>
> Sorry to be so long. I'm the world's worst poster...just go on and on......! I hope some of the rambling has helped though, ask any questions you like! I recommend you continue to research as much as poss, then go to your doc armed with info, opinions and people's experiences!
> Take care
> Jas
Jas,
Sounds like your pdoc is using the old guidelines for bioplar illness (BPI?) to judge your case by. It seems like a lot of doctors are now calling cycles with slight agitation a version of bipolar illness. I get some times where I'm more agitated and can't sleep. My doctor thinks I may have a soft bipolar condition because of this. I have no mania or eurphoria whatsoever. I don't even feel driven. I've read of many other posters who have had this same kind of diagnosis. Who knows whether this new line of thinking is correct. I'm assuming that if I have some luck with mood stabilizers that it will be some confirmation of the diagnosis. At any rate, I think it's good to be aware that different doctors can diagnose the same situation quite differently.K
Posted by SLS on March 18, 2005, at 5:58:40
In reply to Re: Need help with Diagnosis... » jasmineneroli, posted by KaraS on March 18, 2005, at 2:26:49
Hi.
I agree with Kara.
You might have a sort of bipolar disorder. What I would like to know is how often you "cycle"?
Although Neurontin has lost favor with psychiatrists, it might be interesting to give it a quick trial. It can help quite a bit with anxiety and might yet demonstrate some mood stabilizing properties in a select group of people.
- Scott
Posted by ttime on March 18, 2005, at 7:28:46
In reply to Re: Need help with Diagnosis..., posted by jasmineneroli on March 18, 2005, at 1:16:27
> Hi Ttime:
> Just came into this discussion a bit late.
> However, wanted to let you know that you have extremely similar symptoms to me. Including the impatience/irritability etc..
> My dx is severe GAD. So I would concur with those posters who suggest GAD.
> My symptoms have varying degrees of impact upon me. It certainly changes often, sometimes day to day, sometimes every couple of weeks or months.
> It's definitely related to 1) sleep 2) life stress and 3) hormone fluctuations (I'm female).
>
> I often feel I've got things pretty well under conrol and feel almost "great" for weeks or months, and then I "relapse" again...often quite gradually.
>
> The only thing that helps the physical anxiety and generally calms me, is Klonopin, which I take everyday in low dose (.5mg). At the moment I also take (by prescription -in Canada) 1gr Tryptophan daily. This combo seems to work alright as long as my life is in order and I sleep OK. Sleep has long beeen an issue, and often the stress and lack of sleep go hand in hand.
>
> I have tried the following drugs over the years: Paxil, Effexor, Remeron, Amitryptiline, Ativan, Moclobemide, Buspar and Celexa. I've had two separate trials of Celexa, first alone, and more recently with Klonopin. I've also tried several sleep medications added on to the SSRI's. (Like Zopiclone and one of the hypnotic benzo's- but the name escapes me right now!).
> The most effective drug combo was Celexa + Klonopin, however, I couldn't tolerate the side effects of Celexa (sexual dysf., insomnia, jaw clenching, neck stiffness and headaches). I also found it to be very effective for anxiety with ruminations at first, then to wear off as it induced depression.
>
> At the moment, after a period of prolonged stress and poor sleeping, I've begun the a.m. lethargy, irritabilty sequence again. It's now lasting further into the day too. At my Pdoc's yesterday, he said I'm starting to get into a depression (which happens periodically, after the anxiety state). So he's upped my tryptophan dose to 1500mg. We'll see if it helps!!!
>
> My Pdoc is adamant that I don't have any of the Bipolar forms. Even though my energy and mood "cycles" and I get "manic" phases where I just go-go-go and get loads done and talk fast etc.
> He asked me if I feel euphoric or "unbeatable" and like I can handle anything/conquer the world, when I'm in those states. I told him I just feel "driven", I "must get things done" and that most of the time I'm not happy or giddy or enjoying it particularly. I basically feel like I've been switched on "max"!!!!
> This, he said, is the reason why he doesn't consider me BP. It's not true mania, it's just peaking generalized anxiety adrenaline pushing me.
>
> You might want to consider that.
>
> I also believe I have a bit of OCD thrown in.....more the "c" part of OCD. The compulsions, I believe, are part of mt atempts to control my anxiety and soothe myself. I'm not sure that it would be classed as true OCD or OCPD, or an occasional coping mechanism.
>
> Sorry to be so long. I'm the world's worst poster...just go on and on......! I hope some of the rambling has helped though, ask any questions you like! I recommend you continue to research as much as poss, then go to your doc armed with info, opinions and people's experiences!
> Take care
> Jas
Hi Jas:Thanks so much for your informative post! You and all the other's are the reason I come here, knowing full well I can talk to people going through the same thing I am.
After I read all the posts - and continue to read, my head starts to spin. I know, full well, that since my first major anxiety attack (and quite honestly the "worst" one I ever had), at 18, I have "something wrong with me". Has this stopped me from becoming what people would describe as successful in life (im in IT Sales), no. Has it stopped me from being the luckiest man in the world and marrying my unbelievably loving wife, no. Has it stopped me from having the most beattiful daughter in the world, no. What it has done, is this "something wrong with me" is robbing the joy out of everyday things. I wake up not knowing if I will be a tyrant or not.
I know I am lucky - I thank God everyday, however I would just like to be able to smooth things out a bit. I would like to go outside and have confidence again and feel that "inner" peace. I constantly worry about how people look at me. I am very jumpy lately, like I have a startle reflex. I guess it is because I am on "edge" most of the time. It seems that "stress" has become part of my life and it does not go away. It's not like I ask for it, it's just there (I am sure my chosen profession, and having a 15 month old doesn't help my "stress" level). Who knows.
My reason for continuing to post and seeing what other's who have similar symptoms, like myself, do to manage their life, is to see if there is anthing I can try to help me get to a "neutral" place again. I am not hoping for a miracle. I just want to be able to take a little something that has very few side affects, however allows me to be the guy that is kind, considerate, compassionate, loving, patient and well, you know.
Based on a few posts, I belive by Scott, I think I might call my very little used P-Doc and ask to try Trileptal and maybe a splash of Seroquel. There is a chance that I might have Cyclothymic traits (self diagnosed) as well as GAD. Maybe these 2 can help get me going in the right direction.
I look forward to continuing our dialogue...
Good Luck With Everything,
All the Best
T-Time
38 YO Male
Posted by jasmineneroli on March 19, 2005, at 19:37:02
In reply to Re: Need help with Diagnosis... » jasmineneroli, posted by KaraS on March 18, 2005, at 2:26:49
Hi Kara: How are you doing?
I agree that my Pdoc is most likely using older guidelines for Bipolar. And they definitely all have their particular biases, depending upon their experiences. I tried to talk to him about the (possibly) 6 different versions of BP, but he didn't seem interested (this was lasat year). He just sees me as classic GAD, that is exacerbated by hormonal changes (perimenopause etc).
I agree with those that say it doesn't really matter too much what the dx is, if a treatment works! As you can see from my list of meds tried, the only groups missing are mood stabilizers and MAOI's. I already refused the MAOI's, due to the dietary restrictions (I love cheese and red wine!).
So maybe that leaves a mood stabilizer?????I have to go back in 3 weeks to see if the upped tryptophan has helped. I'm thinking of asking all over again about bipolar.......and moood stabiizers.
Thanks for your input, as always.
It's funny, I repsonded to this thread to share experiences to help TTime, but it ended up giving me a few ideas too! That's why I love Babble!!!
regards,
Jas
Posted by jasmineneroli on March 19, 2005, at 20:24:45
In reply to Re: Need help with Diagnosis..., posted by SLS on March 18, 2005, at 5:58:40
> Hi.
>
> I agree with Kara.
>
> You might have a sort of bipolar disorder. What I would like to know is how often you "cycle"?Hello Scott, nice to talk to you again!
Well, it's kind of hard to say how often I cycle.
First, I would call it more of an "energy" cycle, than a mood cycle. I get progessively more cheerful and energetic throughout the day. Often in response to what is happening during that time.
I ALWAYS start the day physically slow and drowsy, OCD, grumpy and irritable which wears off mid-morning. Recently (past month), each of those symptoms have notched up to the VERY level! (ie: VERY slow, VERY OCD etc.). This is what my Pdoc, is calling early depression.
Also I get "driven" urges on a sporadic basis, but it does seem to be in response to stress. I don't think there's a pattern to it as far as timing is concerned. But it is several times per month at least.
However, there is also a seasonal aspect, which includes mood. EVERY March for the past 4 years, I get more depression, more insomnia, more rage attack type anxiety, more emotional lability, and do what might be considered "unusual" or "rash" things.This year my "rash" thing was to get my long mousy blonde hair chopped off short and dyed platinum blonde!!!! (Had long hair for several years). Just on a whim! Last year (exact same week, I now realize) I left my workplace in tears, without a word to anyone, because I was really anxious about an arrangement of keys hanging on a board. I decided it was a very "insecure" system, and once that was decided, I had to do something about it. I thought it would be better to move them some where else and put up pictures instead. I had an argument about it, drove off, drove to the town 30kms away, where my husbands' workplace is, walked in and demanded to know where the "old" calendars were, because I wanted to frame some of the pictures!! He was nonplussed! What was I doing there and not at work? Why didn't I just phone and ask him, instead of driving in? Obviously strange behaviour, but it seemed normal to me at the time. This is very out of character for me, otherwise. My pdoc blamed that on "hormonal" surges. That is definitely a factor. So it's very confusing.
4 years ago, I was feeling very suicidal, had stress leave, and decided I really needed " to get away from this place", so I booked a hotel in a city 400kms away, and told my husband that night that I was going away for 3 days, starting the next day. And I did. Whilst I was away, I dyed my hair in multi-colour streaks in my hotel room!! What's this hair thing all about???
> Although Neurontin has lost favor with psychiatrists, it might be interesting to give it a quick trial. It can help quite a bit with anxiety and might yet demonstrate some mood stabilizing properties in a select group of people.
My Dr. did consider Neurontin, about 20 months ago, but felt it wasn't a strong enough anxiolytic. He wasn't considering mood stabilization.Funny thing is Scott, about a year ago I had a dream (now you will really think I'm nuts!!). In it I went to this huge old building (like a Victorian era train station). Inside were many tables set up with men in spectacles sitting behind them, and people lining up at them. I went to one, and was given a little tin. On the tin was a word. Inside were tablets!!! The next morning I tried to visualize the word and it seemed to be "Trileptical".
I'd never heard of such a drug! So I did a web search and the nearest drug name was Trileptal! I had no idea what it was used for (at least consciously),
until I researched and found that it was an anti-seizure drug, often used as an anxiolytic.
Then I read all about Temporal Lobe Epilepsy. At my next appointment, I raised my dream and TLE, and Trileptal, but my doc said "no".Ha! Maybe I should try again????
>
>
> - ScottThanks a lot for your interest Scott. What do you think?
Best wishes, Jas>
Posted by SLS on March 19, 2005, at 22:04:32
In reply to Re: Need help with Diagnosis... » SLS, posted by jasmineneroli on March 19, 2005, at 20:24:45
Hi Jas
> > You might have a sort of bipolar disorder. What I would like to know is how often you "cycle"?
> Well, it's kind of hard to say how often I cycle.> First, I would call it more of an "energy" cycle, than a mood cycle.
It doesn't sound like this is a true mood cycle. It is what is known as a "diurnal variation".
> I get progessively more cheerful and energetic throughout the day.
It is common that someone with unipolar endogenous depression to feel worst in the morning.
> Often in response to what is happening during that time.
It is uncommon that someone with unipolar endogenous depression be mood-reactive.
> However, there is also a seasonal aspect, which includes mood. EVERY March for the past 4 years, I get more depression, more insomnia, more rage attack type anxiety, more emotional lability, and do what might be considered "unusual" or "rash" things.
I'm sure you are familiar enough with seasonal affective disorder to know that many sufferers experience mania in the spring. This might include mixed states. Although mood stabilizers aren't generally chosen to treat SAD, it might make sense to try if you are seasonally bipolar. I'm suprised the medical literature doesn't say more about this.
What does your doctor call "hormonal surges", and how did he suggest to treat them?
> Thanks a lot for your interest Scott. What do you think?I think that it will take quite a bit of work with a skilled psychiatrist to tease out the salient information from your descriptions to be used to make a diagnosis and choose treatments. There is just so much going on here. However, that doesn't mean that the answer couldn't be as simple as taking one medication.
I wish I could have been more help.
:-(
- Scott
-------------------------------------------------
Winter SADDepression
Loss of energy
Social withdrawal
Increased sleep and sleepiness
Loss of interest in sex
Overeating, especially foods high in carbohydrates
Weight gain
Difficulty concentrating and processing information, especially in the afternoonSummer SAD
Anxiety
Insomnia
Irritability
Weight loss
Decreased appetite
Posted by KaraS on March 19, 2005, at 23:07:12
In reply to Re: Need help with Diagnosis... » KaraS, posted by jasmineneroli on March 19, 2005, at 19:37:02
> Hi Kara: How are you doing?
> I agree that my Pdoc is most likely using older guidelines for Bipolar. And they definitely all have their particular biases, depending upon their experiences. I tried to talk to him about the (possibly) 6 different versions of BP, but he didn't seem interested (this was lasat year). He just sees me as classic GAD, that is exacerbated by hormonal changes (perimenopause etc).
> I agree with those that say it doesn't really matter too much what the dx is, if a treatment works! As you can see from my list of meds tried, the only groups missing are mood stabilizers and MAOI's. I already refused the MAOI's, due to the dietary restrictions (I love cheese and red wine!).
> So maybe that leaves a mood stabilizer?????
>
> I have to go back in 3 weeks to see if the upped tryptophan has helped. I'm thinking of asking all over again about bipolar.......and moood stabiizers.
> Thanks for your input, as always.
> It's funny, I repsonded to this thread to share experiences to help TTime, but it ended up giving me a few ideas too! That's why I love Babble!!!
> regards,
> Jas
Hi Jas,
I'm hanging in there (thanks for asking). I'm also dealing with hormonal issues so I know how hard it is to separate out what is doing what. Maybe your pdoc will let you try a mood stabilizer. I think they are useful in augmenting depressions that may not be bipolar as well (but Scott would know more about that than I do). That is a great thing about Babble - you never know when you're going to learn something helpful. Anyway, I hope you have good luck figuring everything out. Please keep us posted.Take care,
Kara
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