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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by nolegirl323 on January 26, 2010, at 0:24:08
I am currently diagnosed with bipolar disorder II, ( I say currently because I've previously been diagnosed with clinical depression before my Dr. changed my dx.)
For four years, I've been in therapy, on meds, and have been hospitalized 3 times for psychiatric issues. None of this is working, I'm only getting worse. I'm 28, I live in beautiful SW Florida, 10 minutes from some of the most beautiful beaches in the nation, I have a great job (that I enjoy when my depression allows me to leave my bed), I have great friends, but none of it is enough, somedays, I just want to die. I can't leave my house unless i have to, and the other day, while grocery shopping, a panic attack caused me to leave my entire grocery cart, full of groceries, in the middle of the grocery store because I just HAD to get out of there - I was suffocating.
I currently take 400 mgs of Lamictal
50 mgs of Pristiq
4 mgs of Xanax XR
.5 mgs of xanax IRMy current diagnoses are Bipolar II, G.A.D., builmia nervosa, ocd, & I'm a cutter ( I don't know what the diagnosis for that is..)
Despite my compliance with my current medication regiment, my condition is getting worse, and I'm not sure what to do.
Has this happened to any of you? IF so, what did you do? Did it help?
Posted by Phillipa on January 26, 2010, at 12:28:18
In reply to depression is getting worse, posted by nolegirl323 on January 26, 2010, at 0:24:08
Noele so young I have a Daughter also in S fla. I also lived there once so understand when such beauty surrounds you that it's hard so hard to understand why you can't enjoy it. I truly do understand as I don't enjoy either. The cutting is of concern are you in any iminent danger? Would that be considered a personality disorder that might be helped in therphy borderline personality? How's your pdoc? Good? And the panic in stores seriously envy you for doing it all yourself. I'd just crash and burn. Do you cycle and got manic or stay mostly depressed? Love Phillipa
Posted by conundrum on January 26, 2010, at 12:51:08
In reply to depression is getting worse, posted by nolegirl323 on January 26, 2010, at 0:24:08
sounds like you might need to see a new doctor or ask for new meds. If what you are doing is not currently working try something new.
Posted by floatingbridge on January 26, 2010, at 16:49:34
In reply to depression is getting worse, posted by nolegirl323 on January 26, 2010, at 0:24:08
Hi Nole,
I do agree w/ conundrum that your meds are not working. I am a med inexperienced babbler. However, can you get another opinion from another psychiatrist? Are you being treated by one? I don't know if the lamictal (is that a high dose) is addressing your anxiety, which seems high. And for me, pristiq was not effective at 50mg. When increased to 100mg I had too many side effects. My next step is to try remeron. Supposedly it works synergistically with pristiq to reduce stress and increase AD effect. We'll see....
Hopefully, others will weigh in with their experience.
You're not alone. No cutting, but have left carts of groceries before. I've also hidden in bed, even from my best friends. Sometimes therapy can be a great adjunct....
Good luck to you, and welcome. Are you new here?
fb
Posted by inanimate peanut on January 26, 2010, at 17:30:33
In reply to Re: depression is getting worse » nolegirl323, posted by floatingbridge on January 26, 2010, at 16:49:34
You definitely don't have to live like you are living now. If you don't have a psychiatrist or don't like the one you have, find a good psychiatrist who can help you with your med combo and don't stop working on it until it actually works for you. You've got too much going for you in life to let bipolar mess it all up.
Posted by bleauberry on January 26, 2010, at 17:44:29
In reply to depression is getting worse, posted by nolegirl323 on January 26, 2010, at 0:24:08
This is such a sad story and I'm so sorry you are experiencing this. No one can offer the magic solution, but some ideas to consider...
Get another doctor ASAP. You don't have to do a direct switch, but a second opinion never hurts. When the drugs one office is giving you are failing you, it usually takes someone else's fresh look to change those drugs.
The diagnosis doesn't matter much. Trying various meds to see what helps is what matters. When doctors get too hung up on the diagnosis, they can accidentally rule out drugs that could have you feeling wonderful. A diagnosis is not fact. It is a subjective educated guess and will vary from doctor to doctor.
I suspect the very meds you are taking are making you worse. The most guilty is the 400mg of Lamictal. It is used in depression treatment, it is used in bipolar treatment, and it does work about as often as anything else. But...it is primarily for epilepsy and seizure control. Furthermore, a not uncommon side effect is worsened depression or causing depression. In clinical studies with the patients that it did work with, it didn't continue to work past 9 months. (speaking of depression, not epilepsy)
And on the topic of lamictal, it needs to be known that the noted difference between generic and brand is rather stunning. People right here who have tried both can attest to that. Someone doing well and stable on brand lamictal will often relapse when switched to brand, and higher doses of the generic do not help them. Generic fans of course will say they are the same active ingredient with no difference. Real-world users have quite different stories of what happened to them. Bioequivalence does not equal clinical equivalence. Unfortunately, generics are not tested for clinical equivalence. My doctor is big on the generic vs brand debate. Of the half dozen drugs where he sees a huge difference, lamictal is one of them.
Benzos of any kind can worsen depression. Xanax is the least likely, but at your doses I think pretty much anyone would feel depressed.
Pristiq seems like a reasonable choice, though I would much prefer a true SNRI approach (which Pristiq is not, though claimed to be) which would be a Zoloft+Nortriptyline combo.
A complicated situation is actually pretty clear when it is narrowed down to logic. That logic is...
You are getting worse on the meds you are on, which means either: 1)They are not working for your chemistry, 2)They are making you worse than you would be without them.Either way, it is clear...the meds have to be changed. If that requires a different doctor to get the job done, so be it.
Four years is a long time. Let someone else take the helm and see what they can do, because the ones in control right now don't seem to be doing a very good job at all. Disgusting job actually. If they won't switch your meds, get someone who will.
Sorry to be so blunt. I want to see you get well as fast as possible. I don't see that happening as long as your current meds are continued.
> I am currently diagnosed with bipolar disorder II, ( I say currently because I've previously been diagnosed with clinical depression before my Dr. changed my dx.)
> For four years, I've been in therapy, on meds, and have been hospitalized 3 times for psychiatric issues. None of this is working, I'm only getting worse. I'm 28, I live in beautiful SW Florida, 10 minutes from some of the most beautiful beaches in the nation, I have a great job (that I enjoy when my depression allows me to leave my bed), I have great friends, but none of it is enough, somedays, I just want to die. I can't leave my house unless i have to, and the other day, while grocery shopping, a panic attack caused me to leave my entire grocery cart, full of groceries, in the middle of the grocery store because I just HAD to get out of there - I was suffocating.
> I currently take 400 mgs of Lamictal
> 50 mgs of Pristiq
> 4 mgs of Xanax XR
> .5 mgs of xanax IR
>
> My current diagnoses are Bipolar II, G.A.D., builmia nervosa, ocd, & I'm a cutter ( I don't know what the diagnosis for that is..)
>
> Despite my compliance with my current medication regiment, my condition is getting worse, and I'm not sure what to do.
> Has this happened to any of you? IF so, what did you do? Did it help?
Posted by nolegirl323 on January 27, 2010, at 0:52:25
In reply to Re: depression is getting worse » nolegirl323, posted by Phillipa on January 26, 2010, at 12:28:18
> Noele so young I have a Daughter also in S fla. I also lived there once so understand when such beauty surrounds you that it's hard so hard to understand why you can't enjoy it. I truly do understand as I don't enjoy either. The cutting is of concern are you in any iminent danger? Would that be considered a personality disorder that might be helped in therphy borderline personality? How's your pdoc? Good? And the panic in stores seriously envy you for doing it all yourself. I'd just crash and burn. Do you cycle and got manic or stay mostly depressed? Love Phillipa
Hi Phillipa,
I think I remember you from a couple of years ago when I first posted here on psychobabble, thank you for your support :)
As opposed to most cutters, my cutting began in my mid-twenties; most cutters begin in adolescence. My cutting began in a treatment center a few years back. I was hospitalized for anorexia nervosa in 2005, and while in treatment, they took EVERYTHING from me; all of my coping mechanisms were stripped from me, and my roommate was a cutter. She swore that when she cut, it was as if the intolerable emotions that were killing her inside were being evacuated from her body as the blood poured out of her skin. I was 25 then, I tried it, and unfortunately, it worked. I'd never been a cutter before, so up until that point, my pdoc never looked into the possibility that I had a personality disorder. I've had the same pdoc since 2005, and it wasn't until I was admitted into another treatment center in 2009 that the pdoc at that facility educated me about Borderline Personality Disorder. I have a bachelor's degree in psychology, and have taken a few graduate level classes in psychology, and from everything that I've learned in school, being labeled as a "Borderline" is like a death card. From what I understand, therapists and psychiatrists alike are unwilling to take on Borderline patients because we are so "difficult & resistant to treatment." Based on the stigma attached to BPD, I've been extremely hesitant about exploring that area of my disease. I'm afraid that once I have a BPD diagnosis, that nobody will want to treat me, and that I'll be looked upon as a hopeless case. But, based on my symptoms & behaviors, I would say that there is a possibility that I may have some sort of personality disorder, probably BPD.
I'm just so afraid of being a "hopeless case," and I've heard so many times that BPD is extremely hard to treat, and oftentimes, individuals with BPD simply do not recover. I'm so scared that I'll never recover, so when BPD is brought up, I shut down. I dropped my last therapist when she suggested that I display numerous borderline traits... She herself even said that "personality disorders have no cure." I haven't been in therapy for about a month now, and I only see my pdoc once every three months for medication management. Whenever I see him, he seems overly eager to prescribe me whatever drug that the pharmaceudical sales rep who just left his office was peddling.. But at the same time, I'm afraid to switch doctors, I'm not quite sure why.
Something needs to change; at times I'm flying so high and loving life so much that it makes me wonder what depression ever felt like, but for the majority of the time, I just want to crawl into a hole and die.. Thats when I cut, when the depression creeps in and takes over my body and starts to 'make choices for me.' Sometimes I feel like I'm just a host body where my extreme feelings make the choices for me. When the depression creeps under my skin, it starts to burn and boil until I feel I'll explode unless it can be released; and thats when the cutting helps. Its as if cutting my skin opens up a space for the depression and anxiety to escape from my insides..And I hate it, I hate that it actually helps. I so want to be 'normal,' if normal even exists. I just want to feel as if I'm not on the verge of absolute insanity every second of every day, and I don't know what to do.
As to whether or not I'm in any danger regarding the cutting, I'm pretty sure that, at least at this point, the cuts aren't deep enough to cause great danger. But, over the years, I have begun to cut deeper, longer, and in a much more frenzied manner than ever before. It baffles me; I'm on meds, I was in therapy, I've been in two treatment centers in 5 years, and nothing is getting better. I just don't know what to do, or even what to say to my pdoc.. Or if I should get a new one.
Thank you so much for your support, I feel better just knowing that there are others out there who can relate.
Posted by nolegirl323 on January 27, 2010, at 1:21:51
In reply to Re: depression is getting worse, posted by bleauberry on January 26, 2010, at 17:44:29
I just want to thank all of you for your input, it really helps to have additional information from others, so that when I do talk to my pdoc, I have your experiences to discuss with him.
I am especially intrigued by the brand name vs. generic discussion. I've always wondered whether or not there was actually a difference in the efficacy of a generic vs. a brand name. My pdoc actually did tell me that generic lamictal is *NOT* as effective as the brand name. AFter he told me this, I asked the pharmacist; the pharmacist said that "they are all the same, they have all the same chemicals in them, there is no difference." But, I've always had a hard time believing that. Different pharmaceudical companies manufacture pills in different ways, so there has to be some difference, somewhere.
Thank you all for your support, and I think that you have all helped me to muster the courage to confront my pdoc with the issues that I'm having with my current treatment.
Bless you all :)
Posted by floatingbridge on January 27, 2010, at 1:31:05
In reply to Re: depression is getting worse, posted by nolegirl323 on January 27, 2010, at 0:52:25
Nole,
So much more is understood about BPD, and there if still so much ignorance. My understanding is that borderline traits exist on a spectrum, and at their mildest are aligned with the 'normal' range of human experience, including lonliness, isolation, a sense of emptiness, and an unstable sense of self. I sense borderline
features about myself. Yes, many therapists avoid BPD- like patients--I feel the level of suffering is too intense for them. Some therapists avoid ptsd patients for the same reason--theu back away from the real sh*tty stuff. I think it's important to accept what one is dealing with and experiencing-- without
becoming the label. Who says there is no cure for a personality disorder? I Just don't buy that, and the woman who said there is no cure just flat out doesn't know you. (Besides being quite a narrow-minded, harmful thing to say.)
Your suffering is real and you want help. Trust that. Find the therapist you deserve who will go the miles w/ you and not worry about your dx. One of the best therapist's I ever had was an intuitive dbt based practictioner who didn't back away from hard work. Many here are
borderline or whatever. I'm. glad you wrote and hope you quickly find the treatment you deserve to get you feeling better.fb
Posted by emmanuel98 on January 27, 2010, at 19:14:17
In reply to Re: depression is getting worse, posted by nolegirl323 on January 27, 2010, at 0:52:25
According to Glen Gabbard, who wrote the psychiatry textbook that is widely used, borderline personality disorder is very treatable with psychodynamic therapy and dialectical behavioral therapy. Some T's (my p-doc, for example) actually enjoy work with borderline patients. Gabbard also writes that many borderline patients get better as they get older. So you're not a hopeless case. Marsha Linehan developed DBT specifically to work with borderline patients. Have you looked into DBT groups?
Posted by floatingbridge on January 27, 2010, at 19:29:17
In reply to Re: depression is getting worse, posted by emmanuel98 on January 27, 2010, at 19:14:17
Emmanuel, thank-you. Yes, said much better than my (strident) post.
Absolutely. The first key ingredient to recovery from anything is patient intent, desire, and effort. (Well, that's three: -D )
Posted by floatingbridge on January 27, 2010, at 19:30:23
In reply to Re: depression is getting worse, posted by emmanuel98 on January 27, 2010, at 19:14:17
Emmanuel, thank-you. Yes, said much better than my (strident) post.
Absolutely. The first key ingredient to recovery from anything is patient intent, desire, and effort. (Well, that's three: -D )
Posted by Phillipa on January 27, 2010, at 20:39:09
In reply to Re: depression is getting worse, posted by emmanuel98 on January 27, 2010, at 19:14:17
True and agree with the others that you will heal. It takes time but you will recover. Love Phillipa
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