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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 incubusfan5 on February 22, 2009, at 14:02:07
Currently, the only drug I'm taking is 4MG of Trilafon(anti-psychotic) at night.
It seems that sometimes during the day, or even most of the day, I'll feel great. Self-esteem up, more social, less anxious, not depressed, etc. Then, out of nowhere, my mood starts to just drop, I feel like I want to cry, and I don't understand it. There are no external changes that I can attribute this to.
Is this possibly a by product of being BPII? If not, how does one with BP II usually feel during there cycles?
Thanks,
- Mike
Posted by SLS on February 22, 2009, at 14:41:50
In reply to Is this a sign of being Bipolar?, posted by incubusfan5 on February 22, 2009, at 14:02:07
> It seems that sometimes during the day, or even most of the day, I'll feel great. Self-esteem up, more social, less anxious, not depressed, etc. Then, out of nowhere, my mood starts to just drop, I feel like I want to cry, and I don't understand it. There are no external changes that I can attribute this to.
Hi Mike.Is there a regular daily pattern to your mood shifts? If so, what is it?
- Scott
Posted by fayeroe on February 22, 2009, at 14:54:26
In reply to Is this a sign of being Bipolar?, posted by incubusfan5 on February 22, 2009, at 14:02:07
> Currently, the only drug I'm taking is 4MG of Trilafon(anti-psychotic) at night.
>
> It seems that sometimes during the day, or even most of the day, I'll feel great. Self-esteem up, more social, less anxious, not depressed, etc. Then, out of nowhere, my mood starts to just drop, I feel like I want to cry, and I don't understand it. There are no external changes that I can attribute this to.
>
> Is this possibly a by product of being BPII? If not, how does one with BP II usually feel during there cycles?
>
> Thanks,
>
> - MikeMike I've been DXed with Bipolar II and I have days just like you've described. I've learned to lean into it and make the best of the situation. Of course, I can't do that every time but it helps to know I have a plan.
I take Lamictal and Buspar and I actually can see a light at the end of the tunnel. I worked outside today and am watching an NBA game now. Six months ago I was worthless when it came to concentration.
I wish you luck...Keep us updated...Pat
>
>
Posted by polarbear206 on February 22, 2009, at 15:38:47
In reply to Re: Is this a sign of being Bipolar? » incubusfan5, posted by fayeroe on February 22, 2009, at 14:54:26
> > Currently, the only drug I'm taking is 4MG of Trilafon(anti-psychotic) at night.
> >
> > It seems that sometimes during the day, or even most of the day, I'll feel great. Self-esteem up, more social, less anxious, not depressed, etc. Then, out of nowhere, my mood starts to just drop, I feel like I want to cry, and I don't understand it. There are no external changes that I can attribute this to.
> >
> > Is this possibly a by product of being BPII? If not, how does one with BP II usually feel during there cycles?
> >
> > Thanks,
> >
> > - Mike
>
> Mike I've been DXed with Bipolar II and I have days just like you've described. I've learned to lean into it and make the best of the situation. Of course, I can't do that every time but it helps to know I have a plan.
> I take Lamictal and Buspar and I actually can see a light at the end of the tunnel. I worked outside today and am watching an NBA game now. Six months ago I was worthless when it came to concentration.
> I wish you luck...Keep us updated...Pat
> >
> >
>
> Hi,I also take Lamictal. Great drug for my mild bipolar. I also take effexor, but have been thinking about cutting back and possibly adding buspar due to sexual side effects. I've tried wellbutrin and didn't help. Effexor has worked very well for me. What has your experience been with buspar. Thanks...
Posted by fayeroe on February 22, 2009, at 16:01:37
In reply to Re: Is this a sign of being Bipolar? ))Fayeroe, posted by polarbear206 on February 22, 2009, at 15:38:47
Buspar is working well and has improved my sexual health. I really like Buspar as I feel that I've finally gotten over the hump of the "low grade depression".
Pat
Posted by Phillipa on February 22, 2009, at 17:38:20
In reply to Re: Is this a sign of being Bipolar? ))Fayeroe » polarbear206, posted by fayeroe on February 22, 2009, at 16:01:37
Seriously does it work if been on the long length of benzos I have as they now make me tired. Buspar was only 5mg long time ago. Phillipa
Posted by fayeroe on February 22, 2009, at 17:41:19
In reply to Re: Is this a sign of being Bipolar? ))Fayeroe » fayeroe, posted by Phillipa on February 22, 2009, at 17:38:20
> Seriously does it work if been on the long length of benzos I have as they now make me tired. Buspar was only 5mg long time ago. Phillipa
I do not understand your post, Phillipa
Posted by softheprairie on February 22, 2009, at 20:50:18
In reply to Is this a sign of being Bipolar?, posted by incubusfan5 on February 22, 2009, at 14:02:07
I'm sorry, I don't have bipolar, and I can't answer your question directly, but I do take perphenazine at night (used to take 8 mg, now 1 and a half 4-mg pills) _and PRN for crying spells during the day_. What keeps me from using it more abundantly PRN is that it's sedating, when I already have a lot of fatigue as it is. But the perphenazine usually really helps me calm down from being upset and crying.
I've been quite pleased with perphenazine helping my mood, the main reason I wanted to cut down on my dose is the T.D. and EPS risks, but now I have decided to stay put on my current dose for a while, and just live with the risks.> Currently, the only drug I'm taking is 4MG of Trilafon(anti-psychotic) at night.
>
> It seems that sometimes during the day, or even most of the day, I'll feel great. Self-esteem up, more social, less anxious, not depressed, etc. Then, out of nowhere, my mood starts to just drop, I feel like I want to cry, and I don't understand it. There are no external changes that I can attribute this to.
>
> Is this possibly a by product of being BPII? If not, how does one with BP II usually feel during there cycles?
>
> Thanks,
>
> - Mike
>
>
Posted by dcruik518 on February 22, 2009, at 20:51:21
In reply to Re: Is this a sign of being Bipolar? ))Fayeroe, posted by fayeroe on February 22, 2009, at 17:41:19
I'm not sure, but I think Phillipa was trying to say something like: Do you really think Buspar will work for someone who is accustomed to the much stronger anti-anxiety effects of benzos. My answer would be Probably Not. I'm sort of surprised to see Buspar come up again; I thought the stuff had sort of gone out of favor over the last few years.
As for having Bipolar, if you do, you'd be an awfully rapid cycler. I wonder if instead of that, what you're experiencing is a result of the AP wearing off during the day/evening. You might try taking a second smaller dose during the day to see if that eliminates the problem. You may be a fast metabolizer of the med.
Posted by dcruik518 on February 22, 2009, at 21:03:19
In reply to Re: Is this a sign of being Bipolar? ))Fayeroe, posted by dcruik518 on February 22, 2009, at 20:51:21
Mike,
I looked in my Prescriber's Guide by Stephen Stahl, which is considered the authoritative guide on psychiatric drugs. It says that the usual dosing for Trilafon is 4-8mg three times a day for a total of 12-24mg a day. I'm not sure it makes sense to take this drug only at night. Apparently it's short acting; therefore, it seems to me it's bound to have some withdrawal type effects when it wears off during the day. Btw, what are you taking it for?
Posted by Incubusfan on February 22, 2009, at 21:06:23
In reply to Re: Is this a sign of being Bipolar?, posted by SLS on February 22, 2009, at 14:41:50
> > It seems that sometimes during the day, or even most of the day, I'll feel great. Self-esteem up, more social, less anxious, not depressed, etc. Then, out of nowhere, my mood starts to just drop, I feel like I want to cry, and I don't understand it. There are no external changes that I can attribute this to.
>
>
> Hi Mike.
>
> Is there a regular daily pattern to your mood shifts? If so, what is it?
>
>
> - ScottLate afternoon/nights are the worst. I usually wake up feeling good, but there's always a couple of hours in the morning that turn bad after that.
I think I may be seeing a breakthrough with this medication. I've been seeing moments where the haze of depression and dread have disappeared for the first time in over a year and a half. I may need to up the dose and take it twice a day.
Tardive dyskinesia is a slight concern, but if I could feel normal, hell, I'd learn to embrace it :)
Thanks,
- Mike
Posted by Incubusfan on February 22, 2009, at 21:14:31
In reply to Re: Is this a sign of being Bipolar? )Mike, posted by dcruik518 on February 22, 2009, at 21:03:19
> Mike,
>
> I looked in my Prescriber's Guide by Stephen Stahl, which is considered the authoritative guide on psychiatric drugs. It says that the usual dosing for Trilafon is 4-8mg three times a day for a total of 12-24mg a day. I'm not sure it makes sense to take this drug only at night. Apparently it's short acting; therefore, it seems to me it's bound to have some withdrawal type effects when it wears off during the day. Btw, what are you taking it for?Wow, you didn't have to go through the trouble of looking that up! I greatly appreciate that though, and that is useful information.
My Pdoc prescribed Trilafon to go along with Clomipramine after I mentioned that I suffer from internal agitation with depression, along with the other co-morbidities(some OCD, BDD, Anxiety). I'm unable to tolerate a full-trial of Clomipramine right now, as it fatigues me to the point of uselessness. I need to finish my associates degree before I get kicked out of school.
My Pdoc told me to take it at night, as it's supposed to be sedating; I haven't found it to be sedating in the slightest to be honest though. I told him I'd call him again on Tuesday; I imagine we'll up my dose. I've had ZERO side effects from Trilafon, which is the first time I can ever say that.
I'd love to be able to take Lamictal, but it's far too expensive for someone uninsured. The generic is a joke, it'd cost me $150 a month for just 200MG.
Posted by Incubusfan on February 22, 2009, at 21:17:30
In reply to Re: Is this a sign of being Bipolar? » incubusfan5, posted by softheprairie on February 22, 2009, at 20:50:18
> I'm sorry, I don't have bipolar, and I can't answer your question directly, but I do take perphenazine at night (used to take 8 mg, now 1 and a half 4-mg pills) _and PRN for crying spells during the day_. What keeps me from using it more abundantly PRN is that it's sedating, when I already have a lot of fatigue as it is. But the perphenazine usually really helps me calm down from being upset and crying.
> I've been quite pleased with perphenazine helping my mood, the main reason I wanted to cut down on my dose is the T.D. and EPS risks, but now I have decided to stay put on my current dose for a while, and just live with the risks.I think I'm going to discuss with my doctor about upping my dose and taking it multiple times a day. I've experienced ZERO side effects from perphenazine, which I find to be incredible. No sedation, cognitive impairment, nothing. Hell, I wouldn't even mind Tardive dyskinesia if I could be happy again.
What's the non-PRN reason for you taking perphenazine? As a mood stabilizer?
Thanks,
- Mike
Posted by softheprairie on February 22, 2009, at 21:36:49
In reply to Re: Is this a sign of being Bipolar? » softheprairie, posted by Incubusfan on February 22, 2009, at 21:17:30
> > I'm sorry, I don't have bipolar, and I can't answer your question directly, but I do take perphenazine at night (used to take 8 mg, now 1 and a half 4-mg pills) _and PRN for crying spells during the day_. What keeps me from using it more abundantly PRN is that it's sedating, when I already have a lot of fatigue as it is. But the perphenazine usually really helps me calm down from being upset and crying.
> > I've been quite pleased with perphenazine helping my mood, the main reason I wanted to cut down on my dose is the T.D. and EPS risks, but now I have decided to stay put on my current dose for a while, and just live with the risks.
>
> I think I'm going to discuss with my doctor about upping my dose and taking it multiple times a day. I've experienced ZERO side effects from perphenazine, which I find to be incredible. No sedation, cognitive impairment, nothing. Hell, I wouldn't even mind Tardive dyskinesia if I could be happy again.
>
> What's the non-PRN reason for you taking perphenazine? As a mood stabilizer?
>
> Thanks,
>
> - MikePlain-old depression problems for many years. (I also have the hoarding type of OCD, which my dr. lists as my most prominent disorder, and inattentive ADD, but the perphenazine doesn't help those.) I take several other meds, too.
My mood has _finally_ gotten better most of the time such that I am rarely using it PRN, maybe once a month or so of late.After you get permission, I predict you'll be glad you tried upping the dose and/or frequency!
It's funny, but I do understand what you say about not minding the T.D. if perphenazine gives you your happiness again.
Posted by Incubusfan on February 22, 2009, at 21:53:59
In reply to Re: Is this a sign of being Bipolar? » Incubusfan, posted by softheprairie on February 22, 2009, at 21:36:49
> Plain-old depression problems for many years. (I also have the hoarding type of OCD, which my dr. lists as my most prominent disorder, and inattentive ADD, but the perphenazine doesn't help those.) I take several other meds, too.
> My mood has _finally_ gotten better most of the time such that I am rarely using it PRN, maybe once a month or so of late.
>
> After you get permission, I predict you'll be glad you tried upping the dose and/or frequency!
>
>
> It's funny, but I do understand what you say about not minding the T.D. if perphenazine gives you your happiness again.I do some hoarding as well, fortunately for me, it's of the digital nature(collecting thousands of old games I'll never play, or touch, but feel the need to archive them for myself). What have you found to help with your OCD? Something that works on serotonin? CBT/ERP?
I've found adderall to help tremendously with my inattentive ADD, but I use it as sparingly as possible, as I do not want to build a tolerance.
On a side note, I'm just awe of how many intelligent, wonderful people are on this board. I've never seen anything like it before.
Thanks,
- Mike
Posted by softheprairie on February 22, 2009, at 22:00:07
In reply to Re: Is this a sign of being Bipolar? )Mike » dcruik518, posted by Incubusfan on February 22, 2009, at 21:14:31
>
>
> I'd love to be able to take Lamictal, but it's far too expensive for someone uninsured. The generic is a joke, it'd cost me $150 a month for just 200MG.There's a good chance you'd qualify to get the name-brand Lamictal free from the company's patient assistance program.
Posted by softheprairie on February 22, 2009, at 22:45:29
In reply to Re: Is this a sign of being Bipolar? » softheprairie, posted by Incubusfan on February 22, 2009, at 21:53:59
>
> > Plain-old depression problems for many years. (I also have the hoarding type of OCD, which my dr. lists as my most prominent disorder, and inattentive ADD, but the perphenazine doesn't help those.) I take several other meds, too.
> > My mood has _finally_ gotten better most of the time such that I am rarely using it PRN, maybe once a month or so of late.> > After you get permission, I predict you'll be glad you tried upping the dose and/or frequency!
> >
> >
> > It's funny, but I do understand what you say about not minding the T.D. if perphenazine gives you your happiness again.
>
> I do some hoarding as well, fortunately for me, it's of the digital nature(collecting thousands of old games I'll never play, or touch, but feel the need to archive them for myself). What have you found to help with your OCD? Something that works on serotonin? CBT/ERP?The only help has been from a local woman experienced in dealing w/ hoarders at their homes. She dosen't have a graduate degree and is only licensed as a mental health technician, and now that she does this independently she can only claim to be a mental health case manager. But, I found her more useful than some licensed practitioners who do have advanced degrees (although, she's the only one who has come to my house). Anyways, my psychiatrist and she used to work at the same facility, and he gave me her card. I'm currently unemployed and on disability for mental problems. My mom paid her privately to come to my home and go through things with me and talk me into letting go of things and getting better organized. That was when I was using PRN perphenazine a lot, because I dreaded her coming over and dealing with the mess directly gave me a lot of anxiety and brought on sobbing (before or after she got here). But, it was expensive, and my mom couldn't afford to keep on with such an expense, so we had to taper off/ go with less frequent visits and then stop altogether. I'm
backsliding, I'm sorry to say. I don't think ERP would do any good for me -- I'm already exposed to my mess all day. Sometimes I try to convince myself of something w/ CBT, but it seldom works.
Serotonin meds haven't helped.
>
> I've found adderall to help tremendously with my inattentive ADD, but I use it as sparingly as possible, as I do not want to build a tolerance.
>I've tried several different stimulant medications in the past several years, and some may have helped my depression, but I don't know if I got an improvement in attention or not. I was most looking to first treat my depression, and when my desipramine didn't "play well" with the mixed amphetamine salts (generic Adderall) (they gave me scary heart episodes and exhaustion when gardening in the summer) I decided I had to pick one or the other, and decided on the desipramine that was so helpful to my depression.
> On a side note, I'm just awe of how many intelligent, wonderful people are on this board. I've never seen anything like it before.
>
> Thanks,
>
> - MikeAww, that's very nice.
Posted by Phillipa on February 23, 2009, at 0:03:26
In reply to Re: Is this a sign of being Bipolar? ))Fayeroe, posted by dcruik518 on February 22, 2009, at 20:51:21
Thanks for interpreting for me right on the spot and the second part was that when buspar came out low doses were prescribed only 5mg. Love and thanks Phillipa
Posted by SLS on February 23, 2009, at 7:18:09
In reply to Is this a sign of being Bipolar?, posted by incubusfan5 on February 22, 2009, at 14:02:07
I don't think you are an ultra-dian rapid cycler bipolar, simply because it is so rare. The majority of cases of atypical depression follow a similar course of mood shifts during the day as you do. Unless you can say that your mood shifts are actually paroxsysmal mood switches occuring over the course of 30 minutes or less, I would tend not think in terms of ultra-dian rapid cycling.
My guess is that you are just beginning to relapse into either atypical depression or bipolar disorder, which can look very much like an atypical depression. My daily mood shift looks like U curve. I feel best in morning and evening, and worst about 2:00pm. This is a circadian rhythm, but not an ultradian rapid cycling.
Besides your daily mood shifts, what other symptoms would you suspect are signs of bipolar disorder?
- Scott
Posted by fayeroe on February 23, 2009, at 8:01:23
In reply to Is this a sign of being Bipolar?, posted by incubusfan5 on February 22, 2009, at 14:02:07
I take Buspar three times a day and I think that is one reason that it keeps me from having a down/high time.
Posted by bleauberry on February 24, 2009, at 19:15:06
In reply to Is this a sign of being Bipolar?, posted by incubusfan5 on February 22, 2009, at 14:02:07
Bipolar or not, I don't know. Ask 10 different docs and you'll get 10 different opinions. No one even knows what bipolar is. It is just a name given to apparently unprovoked mood swings. Why those swings happen deserves a look before trying to blindly take a shot at treating it.
But what you describe sounds like something to me that should be investigated. The two things that stand out in my mind are:
Start a food/drink diary. Carry it with you at all times for 2 weeks and write down every single thing you put in your mouth and at what time you did it. Try to identify any particular mood pattern associated with something you consume. Wheat, coffee come-down, chocolate, nuts, whatever, anything and everything. You might be allergic to something and don't know it. Once you have identified something that might be involved, it is easy to test by not consuming it for a while, and then consuming it to see what happens. You might find that nothing you eat or drink has anything at all to do with your mood swings. That is good because you have ruled something out.
From an alternative MD, integrative MD, or naturopath doctor, request a 24 hour saliva cortisol test. It measures your cortisol at four points throughout a day. Cortisol is very much in control of many things including mood. An unexplained dip below the normal curve, on your lab results chart, that coincides with when you experience your mood drop, is clear as day. A dip like that is a general hint that your body and/or mind is under a bit more stress than your adrenal glands can deal with, and they are getting exhausted. Treatment would be to calm some things down in your life, eat more veggies, less sugar, less coffee, and respect that the body is not an iron tank that can take abuse forever.
The food diary for some kind of intolerance, sensitivity, or allergy is free. The cortisol test is about $100. A diagnosis of bipolar without testing for basic things is eventually about a $20,000 bill.
Posted by Incubusfan on February 25, 2009, at 10:05:34
In reply to Re: Is this a sign of being Bipolar? » incubusfan5, posted by SLS on February 23, 2009, at 7:18:09
> I don't think you are an ultra-dian rapid cycler bipolar, simply because it is so rare. The majority of cases of atypical depression follow a similar course of mood shifts during the day as you do. Unless you can say that your mood shifts are actually paroxsysmal mood switches occuring over the course of 30 minutes or less, I would tend not think in terms of ultra-dian rapid cycling.
>
> My guess is that you are just beginning to relapse into either atypical depression or bipolar disorder, which can look very much like an atypical depression. My daily mood shift looks like U curve. I feel best in morning and evening, and worst about 2:00pm. This is a circadian rhythm, but not an ultradian rapid cycling.
>
> Besides your daily mood shifts, what other symptoms would you suspect are signs of bipolar disorder?
>
>
> - ScottThe cycling has become far more frequent as of late. The only real difference has been the Trilafon.
I saw a new therapist last Friday, whom I liked very very much. She recommended a new psychiatrist that she believes is brilliant; it turns out this psychiatrist was the last one my brother saw in the area when he was dealing with drug addiction problems. My brother liked his attitude, but didn't see him for long as his drug addiction was out of control.
The only two drugs which consistently help me are Adderall and Valium.
I just don't know that I should switch psychiatrists until more avenues are explored I supposed. I called my Pdoc today, I'll see what he recommends. It will probably be Noritriptyline, but I'd rather not deal with another TCA trial until the summer. I'd like to at least achieve my goal of getting my associates degree before I'm older than 24 :)
Thanks,
- Mike
Posted by SLS on February 26, 2009, at 7:38:14
In reply to Re: Is this a sign of being Bipolar? » SLS, posted by Incubusfan on February 25, 2009, at 10:05:34
Maybe you are an ultra-dian rapid cycler - as rare as those are. If you have bipolar disorder, you are not doomed to remain a rapid cycler. This phenomenon can be more of a transient "season" in the course of bipolar illness rather than being a separate illness. It can change with age. Rapid cycling happens more frequently in the young and in females. Such rapid cycling presentations often call for 3 mood stabilizers, one of which would be Lamictal. You could then pick among lithium, Trileptal, Depakote, or Topamax. Keppra has shown some efficacy in a few cases. This does not mean that you cannot take antidepressants at the same time. They are sometimes necessary. Adding an atypical antpsychotic is often helpful.
- Scott
Posted by desolationrower on February 27, 2009, at 1:59:16
In reply to Re: Is this a sign of being Bipolar? » incubusfan5, posted by SLS on February 23, 2009, at 7:18:09
'ultradian' really sounds more like a relative of atypical or ADHD than bipolar. i think there is actual chang ein gene expression during switches and buildup of different secondary messangers and chang ein receptor sensitivity. there just isn't time over the course of an hour or two for that.
-d/r
Posted by SLS on February 27, 2009, at 7:39:59
In reply to Re: Is this a sign of being Bipolar?, posted by desolationrower on February 27, 2009, at 1:59:16
> 'ultradian' really sounds more like a relative of atypical or ADHD than bipolar. i think there is actual chang ein gene expression during switches and buildup of different secondary messangers and chang ein receptor sensitivity. there just isn't time over the course of an hour or two for that.
Still, epidemiologically, ultra-rapid cycling and ultradian cycling between antipodal mood states exist, one of which is mania I can tell you from experience that the switch from one extreme to the other can take as little as 30 minutes. It can be a paroxsymal event. I think we could come up with a few scenarios where whole systems are turned on and off by modulators beginning in the lower brain - where biological clocks reside. Ultra rapid cycling or the rare ultradian cycling are probably phenomena of great complexity including dysregulated feedback loops on several levels.
Don't know.
- Scott
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