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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Jimmyboy on August 14, 2006, at 21:08:42
Is there a difference between BP II and treatment resistant depression? If so are the approaches to treat them different? I need to know this b/c I have heard that taking anti-depressants when you are bipolar it can make the cycling faster/worse.. But I have suffered almost exclusively from severe depression that comes and goes for no reason, as far back as I can remember.
I have had 1 full blown manic episode. I was in a terrible depression 12 yrs ago and started taking zoloft ( as well as lots of drugs like acid) and ended up full blown-manic and in the psyc hospital. A period of cyclyical depressions started after that interspersed with times of feeling normal. Last year after a traumatic time ( mom committed suicide) I started taking SAM-e and had a hypomanic episode that lasted approx. 2 1/2 months and it has been back to cycling depression but much deeper this time. Along with depression there is definitely alot of anxiety, social avoidance, hypersomnia, cloudy thinking , etc.
So does that sound like BP II or atypical depression and the two manic episodes were induced by the medication I was taking?
Thanks much for any advice or thouhgts on the subject! I need it...
JB
Posted by silvercoin on August 15, 2006, at 8:46:34
In reply to Calling all amateur psychiatrists, posted by Jimmyboy on August 14, 2006, at 21:08:42
> Is there a difference between BP II and treatment resistant depression? If so are the approaches to treat them different? I need to know this b/c I have heard that taking anti-depressants when you are bipolar it can make the cycling faster/worse.. But I have suffered almost exclusively from severe depression that comes and goes for no reason, as far back as I can remember.
>
> I have had 1 full blown manic episode. I was in a terrible depression 12 yrs ago and started taking zoloft ( as well as lots of drugs like acid) and ended up full blown-manic and in the psyc hospital. A period of cyclyical depressions started after that interspersed with times of feeling normal. Last year after a traumatic time ( mom committed suicide) I started taking SAM-e and had a hypomanic episode that lasted approx. 2 1/2 months and it has been back to cycling depression but much deeper this time. Along with depression there is definitely alot of anxiety, social avoidance, hypersomnia, cloudy thinking , etc.
>
> So does that sound like BP II or atypical depression and the two manic episodes were induced by the medication I was taking?
>
> Thanks much for any advice or thouhgts on the subject! I need it...
>
> JB
It does sound rather like BP II to me, considering your manic episodes were induced by medications. The one might be excused for concomitant use of acid and the like, but the hypomanic episode from the SAM-e and your reports of long term cycling suggest you may be somewhere long the so-called bipolar spectrum. I have suffered from depression for many years but do not really "cycle"; my experience has been that I slowly fall back into depression when off ADs with little natural ability to go back the other way. It is like sliding down into a pit that can be nearly impossible to climb out of on one's own. I did suffer a manic/psychotic episode last year, but the combination of meds was extremely powerful and involved a high and unwise dose (0.5 mg/night) of Halcion, which has been associated with psychotic behavior.In your case, I would suggest considering moving into the world of mood stabilizers, perhaps combined with some sort of AD. I have tried Lamictal myself, and while it had no therapeutic benefit for me, this drug has very few side effects compared to most mood stabilizers. Geodon is an atypical antipsychotic that has very strong antidepressant properties in my experience; this might be also worth considering. However, many doctors have developed their own protocol for dealing with issues like yours; try to find someone with some experience in this area who can help you.
Todd
Posted by Jimmyboy on August 15, 2006, at 8:59:22
In reply to Re: Calling all amateur psychiatrists, posted by silvercoin on August 15, 2006, at 8:46:34
Thanks for the advice Todd, unfortunately I think you are right. I am currently taking Lithium and Lamictal w/ no side effeccts but it is taking a long time for the right dose. Hopefully it will work
JB
Posted by med_empowered on August 16, 2006, at 12:53:31
In reply to Re: Calling all amateur psychiatrists, posted by Jimmyboy on August 15, 2006, at 8:59:22
The line between BP II and complicated unipolar depression is blurry at best, and really not all that important. Mood stabilizers might help. Personally, I'd avoid antipsychotics b/c of the risks involved.
Trileptal helped me, and I had some similar problems. Lamictal helps a lot of people, but some people think it pushes people "up" too much, which can be a bad thing. Benzos can help with the anxiety...sometimes, its best to avoid antidepressants (kind of counter-intuitive if you're treating depression).
Posted by finelinebob on August 17, 2006, at 3:23:26
In reply to Calling all amateur psychiatrists, posted by Jimmyboy on August 14, 2006, at 21:08:42
My current PDoc says just about anyone can be described as being on the "Bipolar Spectrum", but there is one emerging category that's not inthe DSM-IV that my previous PDoc thought more appropriate than my dx at the time (MDD, GAD). When I looked it up on the web, it sure sounded like me.
Of course, I can't find any references I had before because discussing the "Bipolar Spectrum" seems to be the current rage. Things that stuck out in my mind were:
-- combination of major depression and anxiety, not mania
-- at least one manic epsiode trigger by an SSRI, most likely the first use of it
-- further treatment resistance to SSRIs after the manic episode.
-- good response to TCAs
-- good response to Atypical Antipsychotics as mood stabilizersI wish I could remember more. SSRIs are toxic to me, other than that manic episode my first trial on zoloft gave me. Nortriptylene (TCA) helps considerably better than any SSRI, with virtually no side effects for me. Adding Zyprexa (atypical antipsychotic) was the best response I've every had, other than have my triglycerides jump to 900+. Abilify didn't work as well. I've had to settle with lamictal, which is working well.
This is the end of the thread.
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